Elderly patients visiting our clinic have frequently encountered in recent years, because the aged have markedly increased according to improvement of the health management. Then we collected and analysed their kinds of diseases, complication fater admission and operative procedures. It must be kept in mind that the elderly patients should be considered on the general nursing care and rehabilitative mesures should be started immediately after admission due to the above investigation.
During the years from 1965 to March 1969, 1283 infants were born in the maternity department of Yamaguchi Prefectural Central Hospital, All were examined within the first week of life to laxity of the hip joint and restricted abduction. Ortolani clicking sign with restricted abduction were noted in 0.9 percent in the Newborn babies. In the examination of 1283 babies 14 cases (1.1 percent) of congenital dislocation of the Hip, 20 cases (1.6 percent) of subluxation and 23 cases (1.9 percent) of acetabular dysplasia were found. 3 cases of dislocated hips were treated with Riemenbügel band only at average 5 weeks of life and continued for average 4 months. In 3 cases of impossible reduction with Riemenbügel, “frog” plaster cast was applied for 3 months after over head traction for 1 month. All 6 cases had excellent results.
We observed four patients with congenital dislocation of the hip, performed the arthrodesis of the hip. Years of surgery were from eleven to fourteen years old, and postoperative periods were from seventeen to thirty-five months. We found the following complication: scoliosis, increase of lordosis, lumbago and knee disturbances. The change of the knee are recurvatum, varus and posterior dislocation of the tibia. The roentogenogram showed the inclination to posterointeriorly of the proximal tibial epiphyseal line and the joint surface of tibia, and the early closure of the tibial epiphyseal line. We considered the factor of the these changes, the following things: the destruction of proximal femoral epiphyseal line, the alteration of weight bearing, the question of arthrodesis and the imbalance of muscle.
Activities and some behaeviors of the serum alkaline phosphatase (AP) and of the bone and liver extract AP, which were prepared from experimental rachitic rats, 3′-Me-DAB rats and normal rats, were examined in this paper. Results were as followes: 1. In the rachitic rats sera AP activities, the maximum intensity was attained at sixth week of life prior to the radiological appearances of the rachitic changes. 2. In the inhibitory reaction of the 0.05mM EDTA, the bone AP was inhibited about 50% but the rachitic sera was not inhibited so much at the same concentration EDTA, and then, at the 5mM EDTA, the behaeviors of the rachitic sera AP were different from those of the 3′-Me-DAB sera AP. 3. At the high concentration Urea, the AP of the rachitic sera were more inhibited than those of the 3′-Me-DAB sera. 4. In the findings of the starch-gel electrophoresis, the zymograms of the rachitic sera were different from those of the 3′-Me-DAB sera. The zymograms of the rachitic sera, staining by α-Naphthylphosphate, β-Glycerophosphate, p-Nitrophenylphosphate and Phenylphosphate, were fairly showed the same pattern, but the zymograms of the bone AP, staining by the same substrates, were not stained by β-Glycerophosphate. 5. Significant difference was found out at the 55°C heat inactivation ratio of the AP in the sera from rachitic sera and 3′-Me-DAB sera. The ratio of the AP inactivation in the bone extracts were fairly similler to those of the rachitic sera.
The inorganic Pyrophosphatase activities of sera from human and rat were assayed as substrate 3.0mM sodium pyrophosphatase in 50mM Tris-HCl-1mM MgCl2, pH 8.5. The result of this work was reported in the 42nd Congress of the Japanese Orthopedic Association in April, 1969. In the present paper, the inhibitions of pyrophosphatase activity by heat, urea and EDTA-2Na were examined with reference to alkalne phosphatase activity, employing the homogenates of human tissue extracts as the crude enzyme solution. Heat inactivation: the enzyme solution with MgCl2 and H2O was incubated for 5, 10, 15min. at 56°C. After 3min. cooling in ice bath, the remaining activity was assayed. Effects of urea and EDTA: the enzyme solution was preincubated with urea or EDTA-2Na of various concentration for 15min. at 37°C, and then activity was assayed. The results; The pyrophosphatase activities in both patient serum and tissue extracts were parallel with those of alkaline phosphatase. The alkaline phosphatase/pyrophosphatase ratios of itssue extracts were 7 to 9 except for intestine extract. In heat inactivation and effect of urea, pyrophosphatase activities of placental extract and serum of pregnant woman were most stable, whereas those of bone extract and serum of skeletal disease were extremely inactivated. As compared with alkaline phosphatase, pyrophosphatase activity was more stable by heating and more inhibited by EDTA treatment. The result shows that the increased activity of inorganic pyrophosphatase in serum of bone diseases acts as a marker of bone metabolism.
Gargoylism or Hurler disease, first described by Hunter, is a generalized congenital disease of the connective tissue. Recently, we observed a eight-years-old boy who suffered from a limitation in articular movement and delayed growth, and established the diagnosis of Gargoylism by; 1. Dwarfism, Gargoyle appearance and mental retardation 2. Typical roentgenographic findings, especially in the vertebral bodies 3. Very high mucopolysacharide content in the urine 4. Abnormal cytoplasmic inclusions in a proportion of lymphocytes 5. The same deformities being found in his sister
In 1937, W. P. Blount called attention to a disease which he called osteochondrosis deformans tibiae or tibia vara. This disease is characterized by a disturbance of growth localized to the medial part of the proximal end of the tibia. The condition was grouped by Blount into an infantile type which occurred in the first year or so of life, and an adolecent type which appeared between six and thirteen. We experienced three patients of tibia vara. In all three patients there was the same abrupt angulation in the upper end of the tibia. Case I. male, aged sixteen. The deformity closely followed a trauma of football at twelve years of age. The left leg was two centimeter shorter than the right. He walked with a considerable limp on the left. Case II. female, aged one and one-half years. Both legs were bowed a eleven months when she started to walk. After three months the bowing had become much exaggerated on the right. The family history was negative. Case III. male, forty years, had belateral involvement. This deformity had been noted when the patient was seven years of age, and had gradually exaggerated. There had been pain the knee for one year. There was the same deformity in the family tree.
In a previous report ten years ago, Kumagai and Ohta presented a case of myositis ossificans progressiva of nine-year-old boy. The authors re-examined this case as the more progressed stage. Clinical and radiographical features were as follows; 1) The spine, which showed stiff scoliosis, was ankylosing and showed no mobility, 2) Left shoulder joint and bilateral hip joints were completely ankylosed, 3) Conditions of the other joints were less progressive, 4) The vital capacity diminished remarkably, 5) The parts having tendency not to ossify were not involved even in the later stage.
There have been established no final treatments for heterotopic ossification which has been found not infrequently. We have tested continuous irrigation therapy with EDTA (ethylen-diamine tetraacetic acid) and predonisolon solution for one months following surgical removal of ossified lesion on two cases of heterotopic ossification. Four to six months follow-up study revealed satisfactory result on both radiological and clinical findings. Case 1, was a 23-year-old male who developed heterotopic ossification at the right femoral joint and both knee joints 5 months after spinal injury due to dislocation and fracture of the first lumbar vertebra. Five months later the lesions were removed and irrigation was initiated. Case 2, was a 20-year-old female who noticed pain and motor disturbance at the right femoral joint followed by heterotopic ossification. Operation was performed 10 months later followed by irrigation therapy.
Many orthopedic surgeons agree that the most important problem on the treatment of supracondylar fracture of the humerus is to prevent varus deformity of the elbow. As a closed treatment, veritcal traction and Dunlop's traction are widely used. We had experienced that the vertical traction showed some difficulties to correct rotation or angulation deformity and to maintain correct position of the fragments, and that the Dunlop's traction resulted some degree of circulatory disturbance and also has a possibility of causing the radial, ulnar, or median nerve palsy. To prevent these disadvantages we established the new vertical traction method with slightly flexed position of the elbow. Eleven patients with fresh supracondylar fracture of the humerus were treated with this method after manipulative reduction, and the excellent anatomical and functional results were obtained in all cases.
Coracoid process fracture is very rare injury. This injury is produced mainly by the direct violence and rerely by the muscle contraction. Recently I had two cases of the coracoid fracture. Case I: A male, aged 14 years, fell down and was beaten on his left shoulder when he played the baseball. Radiograph showed a fracture on the base of the coracoid process. Case 2: A male, aged 24 years, rugby player, noticed suddenly the sever pain and the limitation of the motion on his right shoulder in the scimmage. Radiograph showed the sprain fracture of the coracoid process.
We treated fifty-five fractures of the femoral neck during the last 6 years. The rate of male and female is about 1 to 5. Transcervical fracture were 34 cases and trochanteric fractures were 15 cases. Falling is the main causes of these cases. Patients had many complications, which often dominated their treatments or prognoses. Twenty-six cases were followed up and average follow-up interval is about three years 1 month. Of the twelve transcervical fractures, seven cases were satisfactry and five were unsatisfactry; two cases due to technical errors, one case due to severe complication and one case got no treatment because of her advanced age. Most cases of the trochanteric fractures had satisfactry results in both operatively and conservatively treated groups. Seven cases of the old transcervical fractures were treated surgically and had bad results. Avascular necrosis occured in five cases; two were old fractures treated surgically, two were fresh fractures treated surgically and were allowed early weight-bearing, and one case was not-treated old woman.
Nowadays, medullary fixation of fracture of femoral neck by use of Smith-Petersen nail, Küntscher nail, screw, peg or pins has been an ordinary procedure. A new method of internal fixation of this fracture by K-U compression blade plate has been devised in our clinic. The K-U blade plate consists of two parts; one is the part of plate with pre-bent curve to conform to neck-shaft angle of the femur and the other is the part of blade with 2 blades that are proximal to the part of plate and flexed posteriorly at angle of 150°. The technique of internal fixation by K-U compression blade plate: At first, set the blade plate on the anterior surface of femur and then insert the blades into proximal fragment of femoral neck. In subcapital fracture, the blades must be inserted into the marginal part of articular cartilage of femoral head. Secondly, insert a cancellous screw into distal fragment through a “sliding groove” which is holed at the curved part of the plate and make compression force, so that both fragments may be compressed and fixed each other. Then, insert another cancellous screw into a inclined hole which is near the base of two blades and directed toward the centre of femoral head. Finally, insert screws into the femoral shaft through the round holes on the longitudinal part of the plate and satisfactory fixation will be obtained.
A case of a male, 18 aged student, whose left hip joint acutely reduced to atrophic condition in about one month after suffering from cleftlike fracture of the same side pubis and ischium was reported. Characteristic roentgenological findings of the hip joint altered with the advancement of this disease. Atrophy of the femoral head was gradually repaired in about 19 months in spite of appearance of partial necrosis in it, but changes of the acetabulum have developed to “protrusio” with a few functional disturbances. Cause of this disease was considered to be some vascular disorders occurred in succession of the trauma as well as cases of Sudeck's atrophy of the hands or the foot.
In our hospital, 375 cases of the legfracture were treated during 1964 to 1968. The legfractures almost were caused by the traffic accident. In the situation of the fractures of tibia, 1/3 distal of tibia was found the greater number. The operation were performed 66% in the fractures of tibia. Pseudarthrosis found 15% in the fractures of tibia.
Recently we have experienced six operations for reconstructing the old rupture of the cruciate ligament. We tried Augustine's method for three cases, Hey-Groves for two and Lee for one. After operation we are satisfactory for the function of kee joint of these cases.
The calcaneum is so shaped and related to the wedge-shaped inferior surface of the talus that it's fracture is difficult in treatment. Osteoarthritis develops in a damage and distored subtalar joint and this complication is the main cause of late and prolonged disabilitty. Six patients with fractures of the calcaneum have been treated in subtalar arthrodesis, three in subtalar and Chopart joint fusion, and three in reposition with Westhues pin. We consider if there is significant distoration of the subtalar joint, operative fusion of the joint should be undertaken as a primary treatment. We assume that, in this way, average periode of time until returen to work is able to shorten.
So-called Klippel-Weber's disease, congenital arteriovenous fistulae and congenital phlebectasia, etc., seem to be rare, although cases which manifest asymmetrical hypertrophy of the extremities are not so uncommon. We already reported two cases of so-called Klippel-Weber's disease at the 27th Meeting of the Central Japan Orthopaedic and Traumatic Surgical Society. This time we would like to present one more case of so-called Klippel-Weber's disease and one case of congenital arteriovenous fistula. Case 1: so-called Klippel-Weber's disease with arteriovenous fistulae (Parker-Weber syndrome), 15 years old girl, complained about hypertrophy of her left lower extremity. Case 2: congenital arteriovenous fistula, 14 years old girl, complained aboout hypertrophy of her left upper extremity.
M. T., female, aged 19 Hypertrophy of the left lower extremity was noticed at age 12, since then it was gradually increased with fatigue. Her right leg showed obvious muscular atrophy and drop foot (resulted from polimyelitis at age 3). No other symptoms. On the examination of heart, functional murmurs was listened. C. T. R. was 51.2% and blood pressure 136-148/80mmHg preoperatively. No pulmonary congestion. On regional findings, whole left leg showed obvious hypertrophy with increase of skin temperature and normal skin color, but with the dilatation of superficial veins. Over the popliteal space, left inguinal region, and the anterior upper side of the left calf were felt the characteristic thrills and bruits of arteriovenous fistulae. O2-saturation and pH of the left femoral and dorsal veins showed respective 97%, pH 7.410 and 79%, pH 7.372. X-ray showed discrepancy of 6.7cm in length of whole extremity. Angiogram demonstrated dilation of A. and V. femoralis and defect of dye in the peripheral artery suggested arteriovenous shunts at the level of the popliteal space. Under epidural anesthesia, an incision was made over the popliteal space. The greatly dilated popliteal vein was exposed, in which was observed “whirlpool phenomenon”. Longitudinal suture of the defect in the wall of the vessel was performed and distal popliteal vein was ligated.
The symptom complex, consisting varicosity, hemangioma and hypertrophy confined to one side of the extremity is generally called “Klippel-Weber Syndrome” The clinical features, however, are full of varieties. An unusual case of Klippel-weber Syndrome in 9-year-old boy is reported. He has had hypertrophies in his right fingers and both lower extremities, hemangioma in trunk and legs, and naevus verrucosus in right side of the body since his birth. The association of hemangioma and naevus verrucosus is corresponded to Adamson-Best type in Phacomatosis Pigmentovascularis (Ota-Kawamura), and very rare in occurence. Angiographic examination in extremities showed venous varicosities, dilatation of veins and probably arteriovenous fistulae. Histologically naevus verrucosus, hemangioma simplex and lymphangioma were seen in right leg. This case, which had hypertrophies of both extremities is thought to be corresponded to “form alterne S. double” by Klippel & Trenaunay.
(1) Material: Sciatic nerves of rabbit. (2) Apparatus: It used transducers with two SPD (SPD-500). (3) Contrast Medium: Popiodol+Sudan black B. (4) Results: The velocity of the neurography was about 8-10mm/sec. Contrast medium flowed to proximal direction, regardless the direction of the injection needle.
Case 1; 45 years old, female, had numbness in the sole of the left foot. Physical examination revealed hypesthesia in the foot sole, positive Tinel's sign over the posterior tibial nerve. At operation, ganglion was found compressing the posterior tibial nerve in the tunnel. Case 2; 74 years old, male, developed numbness in the lateral aspect of the right thigh. Entrapment neuropathy of the lateral femoral cutaneus nerve was found at operation which was probably caused by adduction of the hip joint after pseudoarthrosis in the same side. Case 3; 73 years old, male, developed pain in the right infrapatellar area. The operation disclosed entrapment neuropathy of the infrapatellar branch of the saphenous nerve due to the scar tissue after contusion.
We had experienced three cases with the deformities of their feet, who had be not given the comfortable treatment. Case 1, 9 years old girl, have serious deformities of her bilateral feet, which was burnt in a period of her childhood, have inexperienced in walking. Case 2, 14 years old girl, had put on a unfit prosthesis, who get her bilateral feet burnt serious deformities. Casee 3, 14 years old girl, have congenital deformity of the left lower leg and foot, and is lame in her leg with awkward short leg brace. The PTB or PTS prosthesis are indicated to three cases and have be put to a good use in their daily life.
The transfer of tibialis posterior tendon to correct leprous drop foot was done mostly by circumtibial route to bring the tendon to dorsum of the foot and insert it into the 2nd-3rd cuneiform bone. A series of forty cases with tibialis posterior tendon transfer was subjected to follow-up study regarding active motion of foot. The time of assessment ranged from one to six years, averaged three years and three months. It is clinicaly observed that 32 cases had normal gait, 5 cases mild high stepping and 3 cases high stepping. The transfered tendon must be fixed with the foot in rest position of 110, so that the range of active motion of foot may be restored 90° of dorsiflexion to 130° of plantar flexion.
It is rare to find spondylolysis or spondlylolithesis in the cervical region. In the literature only 18 cases of spondylolysis have been reported. Another 2 cases are here presented. Case 1. N. U. a male, 19 years old had slight pain in the neck after a car accident. Physical examination revealed only slight disturbance of motion of the neck. Roentgenograms showed spondylolysis and spina bifida of the 4th cervical vertebra with hypoplastic articular pillars. The 4th cervical vertebra slightly displaced forward on the 5th cervical vertebra. Superior articular processes of the 5th cervical vertebra also doformed. Conservative treatment was done with success. Case 2. K. W. a male, 28 years old, consulted our clinic for the headache and slight pain in the neck after a struck on his head. Roentgenograms showed unilatleral spondylolysis of the 4th cervical vertebra with slight spondylolisthesis, and congenital fusion of the 4th and 5th cervical arch and spinous processes. Successful treatment was the halter traction for about one month. Follow up of the above 2 cases is 8 months and 17 months, respectively, and no symptoms are recognized during these periods.
Reported here is the result or a study on all spondylolysis patients who were found at the Orthopedic Clinic, Goto Hospital. in the four year period since its opening in May 1965 till April 1968. There were 516 lumbago patients including 294 male and 222 female patients. Among them 123 patients (23.8%) had spondylolysis including 83 male (28.2%) and 40 female (18.2%) patients. Redicular sign was present in 25 per cent of spondylolysis patients. As to the location of lesions, 74 per cent of the patients had spondylolysis in the 5th lumbar vertebra. When the lesion is more than one, it is usually in the 4th and 5th vertebrae. There was one case in which lesions were both in the 2nd, 4th and 5th vertebrae. This higher incidence of spondylolysis may be attributable to the unique closed environment of the Goto Islands, an interesting fact to suggest another etiological factor of spondylolysis.
1) A simple apparatus is deviced for hanging up both knees perpendicularly as one of the pelvic traction. By the method, a) lumbar lordosis is removed and posterior part of the disc is extended, b) by enlargement of the intervertebral foramina nerve root and posterior facet joints are decompressed. c) lumbar muscle spasm is released. 2) Some advantages of the flexion management for lumbosacral disc and ioint diseases are discussed. By step bed treatment with or without pelvic traction the pain is easily relieved as comparing with other conservative treatment.
Pigmented villonodular synovitis is unusual disease and the etiology is unknown. Jaffe and Lichtenstein concluded that the lesion is an inflammatory response to some unknown agent and that the disease is not a true tumor or neoplasm. In the previous literatures, the disease is manifested that the most common age of incidence is young adult life with a range from the second to the fifth decades. Recently we experienced a case of this disease in eighty four year old man, In our case the microscopic findings was demonstrated chronic inflammation of the synovial membrane and no tumorous condition.
In leukemic children, 50 to 60% can be expected to show bone change of some kind radiologically. It is reported that there are four types of lesions: transverse band, osteolysis, osteosclerosis and subperiosteal new bone formation. Among them, transverse band and osteolysis are most frequently seen (over 50%). And, it's reported that the demonstration of the narrow transverse band at the shaft ends of the long bones which is the earliest change provides valuable information for the detection of leukemia in children. Recently, we have encountered a case of leukemic child with marked osteoarticular symptoms and radiological signs. The patient was a girl 7 years of age whose upper back pain was 2 months' standing at the time of admission to the hospital and her clinical course suggested rheumatic fever and subsequently, compressional collaps of 7th & 12th thoracic spinal body was discovered. At that time, blood smears and marrow aspiration revealed no pathological findings. However, 5 months later, marked transverse zone of the proximal metalpysis of the left tibia and osteolytic lesions of the distal metaphysis of both femur appeared and inmature cells appeared in the peripheral circulation, too. So, under the diagonsis of leukemia, anti-cancerous chemotherapy was done successfully.
Among 844 out-patients visiting the Saga prefectural Hospital for the past six months (from Oct. 16th, 1968 to Apr. 15th, 1969), 25 cases of bone tumors were diagnosed radiologically and cyto-histologically. 25 cases of bone tumors consists of 11 cases of carcinoma metastatic to bone, 2 cases of reticulosarcoma metastatic to bone, 7 cases of cartilaginous exostosis including 1 case of secondary chondrosarcoma, 2 cases of multiple myeloma, 1 case of chondroblastic osteogenic sarcoma, 1 case of monostotic fibrous dysplasia and 1 case of leukemia?, and so on. Chiefly, our observations centered around the diagnostic study of those bone tumors. It is suggested that the cytological examination through the bone marrow aspiration is very valuable for the early diagnosis of the malignant bone tumors.
Case I. A female, aged 10 years, was admitted with the chief complaint of nuchal pain. X-ray examination showed destruction of the vertebral body and right lamina of the 4th cervical vertebra. Under the diagnosis of bone tumor, needle biopsy was performed. Histological examination revealed eosinophilic granuloma. We operated this patient by the method of replacement of vertebral body. Case II. A female, aged 4 years, was admitted with the chief complaint of swelling and pain in the right lower leg. X-ray examinatisn showed clear part of the right tibia and curettment and bone graft was perfomed. Saying about these cases prognosis is very good.
Our classical and unusual chondroid tumors of bone were reviewed as follows: 31 cases of solitary osteochondroma, 13 cases of chondrosarcoma, 6 cases of multiple osteochondroma, each 5 cases of solitary and multiple enchondroma, each 2 cases of benign chondroblastoma and mesenchymal chondrosarcoma, and one case of chondromyxoid fibroma. The clinical, roentgenologic, and pathologic aspects of these tumors have been discussed. We classified four histological patterns for tumorous chondroid tissue: mesenchymal, myxomatous, chondroblastic, and cartilaginous. It is true that one or more manifestations of these histological patterns may be found in each individual variation of chondroid tumors. It should be emphasized, that over five year survival rate of malignant chondroid tumors proved to be more excellent than of osteosarcomas and, as for the treatment, some more conservative and effective orthopedic procedures except amputation of the limb may be more expectedly in future.
The three cases of multiple myeloma were discussed in the present paper. Their clinical examination findings were as follow; Bence-Jones protein in the urine revealed negative in all cases. These patients were admitted to the hospital due to the progressive pain of back and chest, of the weakness of lower limbs, that occured 8 to 10 months prior to admission. The first patient had suddenly an attack of paraplegia 7 weeks after hospitalization, then laminectomy of the 10-th dorsal vertebra was carried out and removed tumorous mass in this part. The mass examined micropathologically and found myeloma. He died of complication of paraplegia 14 months after onset of symptoms. It was important that, in case 2 and 3, bone marrow smear afforded diagnosis as myeloma. The second patient died 12 months after onset of symptoms. In case 3, bone pain was relieved because of medicating steroid hormone and endoxan; however destructive findings of x-ray examination was progressively increased. The third patient now living for 48 months after her troubles without complaints. When bone pain presents in eldery patients associated with some general weakness and progressive weight loss of anaemia, we emphasize, bone marrow aspiration is directed as a search for myeloma.
The sagittal diameter of the cervical spinal canal was measured at the fifth cervical vertebra as the ratio of the diameter of the cervical spinal canal to the diameter of the cervical vertebral body on the x-ray film of lateral view. And also, the sagittal diameter of the cervical spinal canal narrowed by the posterior spurs or the posterior sliding of the cervical vertebra was measured at the involved cervical vertebra. The measurements obtained in this series of 110 myelopathic cases and of 260 asymptomatic cases indicated that the sagittal diameter of the cervical spinal canal of the former was definitely narrower than that of the latter. The correlation between the degree of defect of the shadow in myelogram and the degree of compression of the cervical spinal cord of myelopathy in cervical spondylosis was discussed. It is concluded that the narrowing of the cervical spinal canal may be form the base of the pathogenesis of myelopathy in cervical spondylosis.
30 years old male, who had felt nuchal pain for 10 days as prodrome, had sudden onset of weakness and numbness on the right upper and both lower limbs within 30 minutes. Neurological examination revealed right hemiparesis and hypesthesia (pain and temperature) on the right upper and the left lower extremities. Reflexes of four limbs were all hyperactive. X-ray film of the cervical spine, C. S. F. and C. B. C, were all negative. The symptoms gradually progressed in right hemiparesis, sensory disocciation and recto-vesical disfunction in 5 days, and then followed by rapid recovery. Five months after the onset of the symptoms, patient returned to normal life. Mild degree of presthesia remained on the left thigh. This case was considered to be caused by localized occulusion of the anterior spinal artery in right side of the upper thoracic level of the spinal cord.
Evoked electromyographic studies were carried out in two patients with cervical spinal cord tumor and in four patients with cervical myelopathy. Following repeating stimuli, these patients were divided into two groups, that one had high plateau level and another revealed fluctuations in the amplitude of the H waves. The authors could not found the difference between the cervical spinal cord tumor and the cervical myelopathy. On the other hand there were no definite relation between the evoked electromyograms and the macroscopic views of the spinal cord following laminectomy. The authors concluded that evoked electromyographic examinations will specific information concerning the prognosis of the spinal cord disorders.
The terms rigidity and spasticity are considered to denote different states in clinical neurology. Rigospastic muscle consisted of tonic and phasic component, was demonstrated in the hemiplegia, SMON disease and spinal lesion. Also on every case, each muscle was different in the distribution of rigid and spastic element and strength of the hypertonicity. The effect of phenol block and tenotomy was observed by stretch reflex.
Recurrent posterior dislocation of the shoulder joint is rare lesion and its operated cased of Japan are 12 cases in the literature. Our patient is a 20 years old male. He complained that his right shoulder dislocates each time he abducts and slightly internally rotates his arm. But he could easily reduce the dislocation himself by rubbing his shoulder. The initial dislocation occured in 1964, and in the following 2 years he had not experienced dislocation. But 2 years after initial dislocation, he became aware of recurrent dislocation by weight carrying or rotation of his arm. On September 11, 1968, plication of the posterior capsule was carried out under local anaesthesia. When the capsule opened by a vertical incision, no defect in the humeral head and glenoidal labrium was found. Repair was performed by suturing the lateral flap of the incised capsule to the posterior glenoidal rim and overlapping the lateral edge of the capsule flap over the posterior glenoidal rim. After operation the shoulder was abducted and fixed in a plaster bandage. The plaster bandage was removed after 5 weeks. 8 months after operation, he has no complaint. The right shoulder is symptomless and its function is normal.
We had treated 72 inpatients of rheumatoid arthritis during the past 10 years. Three cases of them, who died of generalized infcetion which appeared to be responsible for continued steroid hormone treatment, were described. Case 1. Female. Rheumatoid arthritis occurred at the age of 27. She died tuberculosis 3 years later from the onset. Case 2. Male. His onset age of rheumatism was 50 years old. Eight years after onset of the disease, he died of sepsis and paralytic ileus. Case 3. Female. She contracted the disease at the 8 years old. At the age of 13, she died of sepsis. And polyarteritis nodosa were found with sepsis. We should pay special care for prevention of infection, during steroid administration against rheumatism.
While the intertrochanteric displacement osteotomy is a encouraging method for osteoarthritic hip diseases, delayed union occurred in 4 out of 46 cases fixed with usual fixation nail. In order to get rigid fixation, compression devices and nail were originated, and the operative procedure with them was presented with case reports.