Der Verfasser berichtet 2 Psychoneurosen begleitende Unfallfälle. Der 1. Fall, 32jähriger Kohlenbergarbeiter, bei dem rechten Vorderarme unter einer grossen Kohlensteinxnasse 5 Minuten lang gedrückt war, bekommt, nach 7 monatlicher Behandlung, noch hartnäckig schlaffe Lähmung. Dieser Zustand ist nur durch eine einfache suggestive Faradisation, innerhalb 3 Monaten, fast voll geheilt. Verfasser nimmt diesen Fall als einfache Psychoneurose an, die durch ungenügendes Ratgeben des behandelnden Arztes entwickelt ist. Der 2. Fall, 40jähriger Kohlenbergarbeiter, bekommt eine kontraktive vollständige Unbeweglichkeit ganzes rechten Armes nach Verschütterung, die nach der 6 Monate langen Behandlung keine Besserung zeigte. Der rechte Arm ist gestreckt, mit halbgebeugter Finger, an den Körper entlang herabgehalten und wird nicht gebeugt und ausser Tätigkeit gesetzt. Nachher wurde aber die Tatsache beständigt, dass der Krankearm nach der Entschädigung, nur in einiger Wochen, ihre freie Bweglichkeit bis etwa 1/2 normal wiederhergestellt wurde. Verfasser nimmt bei dem gerade als eine sog. Entschädigungsneurose KAUFMANNS an. Verfasser hat die folgende Schlüsse gezogen: 1). Bei der Verletzungen dieser Art, führt die frühzeitige Begutachten leicht zu der Fehldiagnose, welche ganz Symptome als organisch bedingt, oder im Gegenteil, als psychoneurotisch beurteilt. 2). Bei der Behandlung solcher Fällen, ist einerseits die medizinisch-psychologische Therapie von früher Zeit an, um die Entwicklung der Unfallneurose zu verhüten, und andererseits über 1 Jahr dauernde energische orthopädische Nachbehandlung, das organisch bedingte Bewegungshindernis mögligst zu beseitigen, unentbehrlich. 3). Die einfache Psychoneurose, wie bei dem 1. Falle, ist durch eine Suggestionstherapie leicht zu beseitigen, während gegen die eigentliche sog. Entschädigungsneurose, wie bei dem, 2. Falle, ist das Entschädigungsverfahren das beste Heilmittel.
I designed in 1937 a hyperextension table for the compression fracture of the spine after Böhler's method. This table was widely used in Japan, but has some disadvantages. In this year I have improved some disadvantages. This table is a type of hammock, which streched between two rectangular frames and the hammock, which streched between two rectangular frames and the hammock can be tightend or loosend at will. Foot are suspended by the gear and pulley. Details are showed in Figures 1-4.
During 4 years, 1947 to 1950, in this department meniscotomy for the internal derangement of knee joint was carried out for 32 of patients and 37 cases which are classified into 7 cases of the internal semilunar cartilage and 30 cases of the lateral. All cases, treated conservatively but failed, still complained of pain and discomfort of the knee, and 93% of them “snapping” or “crackling” detected. Before operation, the conditions were examined by the pneumoarthrography after the method of Amako, and the menisci were in 33 cases totally, in 4 cases partially resected. 21 menisci were discoid, 4 menisci thickend, and 7 menisci teared. Patients were allowed to walk 2 weeks after operation. All of 18 patients (20 joints), elapsed over a year after the operation, improved, except for 4 cases showed the slight pain after long walking or hardward, and went back to their job. The crackling on the operated joints were recognized in 10 cases (50%), trivial and not caused the disability and pain of the joint. After all, 80% of the operations showed a satisfactory result. Accordingly, it is the author's opinion that the immediate surgical excision of the cartilage after the pneumoarthrography, is done to internal derangement of the knee, “snapping” and so prolonged disorders. In about 1/3 cases of them after operation, the regeneration seemed to be appeared in X-ray photograph (pneumoarthrography), but I will be discussed in the future the regeneration of excised cartilage.
We investigated to 195 Cases of labourers who had low back pain after estimation of their obstruction in accidental insurance and especially to grad of recovery about their capability of labour. About 69 cases of them, we could see their capability of labour after estimation. Many of 69 Cases could been at normal labour in the short time after estimation.
In a series of 50 patients of spondylolysis with low back pain, the results of conservative treatments were investigated. Fifty percent of the series were relieved from pain, and the other remained unimproved. The abnormal mobility of separated vertebra was detected in 29 patients, but not in remaining 21 patients. The effectiveness of the conservative treatment was established in those who were not engaged in labour and belonged to the latter group; not only any improvement was obtained in labourers belonged to the former group, but also increased the pain gradually.
Muscular working ability of the labourers, who had been resected the laminae of the one or two vertebrae in lumbar region for root pain, was investigated in regard to number of absunces after operation, energy metabolic rate, attendance rate and strength of back. They have all returned to the former post in 2-3 monthes after the operation and then in more 1-2 monthes later been able to carry out their heavy works in full (E. M. R. is above 4.0).
According to author's experiences of 11 cases with nail- and blade-plate fixation is the method of choice in the treatment of fracture and osteotomy in the region of bone end. The cases are classified as following table:
I investigated the ankle stabilizing operations which had been done for forty-seven cases, forty-nine paralytic ankles in these three years in my clinic. In conclusion, I prefere bone block operation for paralytic ankle with more or less function of plantar- or dorsi-flexors by poliomyelitis. In view of stabilization, arthrodesis is more satisfactory than bone block. Incongruenz of talocrular joint were noted in nine cases of forty bone blocks. It seems that backward displacement of foot by excision of talus or removal of scaphoid obtains more excellent results.
On investigation of 19131 schoolchildren in Ube city, it was revealed that the crippled children were eighty-three, 0.43per cent.; nineteen of them, cerebral paralysis; fifteen, poliomyelitis; seven, congenital dislocation of hip joint.
We experienced a case of osteogenic sarcoma judged presumably secondary to the occupational injury. The patient, a workman 21 years old, had got a severe bruise on the medialanterior aspect of the lower left femur, on Nov. 1, 1951, when working, and pain, swelling and dysfunction had occussed subsequently. The pain had been so much increasing in severity that he came to receive our medical examination on Feb. 1, 1952, Examination showed the pain and the limitation of motion in the left knee joint. There was a palpable swelling of bony-hardness adherent to the bone in the deep of the part concerned. The roentgenogram revealed a translecent periosteal shadow above internal condyle of the femur. In the follow-up x-ray study was seen a enlarged tumor with more definite contour. On Mar. 6, the lesion proved, on open biopsy, to be osteogenic sarcoma, histopathologically. Therefore, deep roentgen therapy was first administered in amount of 150r. each, the total being 750r. Subsequent to this therapy, “Nitromin” (Nitrogen Mustard-N-oxide) was given intravenously in 50mg doses every other day, with the total of 500mg. Then, amputation was performed through the middle of the left femur. No appreciable reaction to the drug in blood picture, but marked loss of appetite and lassitude were complained of. Following the administration of “Nitromin”, there occurred much variation in the histopathologic appearance, compared with the biopsy specimen taken before the therapy. In the majority of tumor cells, degenerations were striking, both in the nuclei and in the cytoplasms. The karyolysis and cytolysis were also common finding. The tumor cells were seen dispersed in a more disorderly fashion, and remarkably decreased in number, presenting the appearance of homogeneous hyaline substance among these cells. Thus, Nitrogen Mustard is in efficacy and decreased in toxicity, in its N-oxide form. In the review of this case, being agreeable to the criteria described by Thiem or Segond after careful evaluation, the evidence for trauma as a pathogenic factor seems to be convincing. In our opinion, Workmens' compensation may be awarded for this case. It is thought advisable to make the unbaseded provision how it is handled, based on the sound clinical and statistical evaluation. The problems presented are difficult, but we trust these thought may be of some assistance.
I have experienced two cases of myeloma in young adult. 1. Male, aged 24 years, was invaded only his fourth lumbar vertebral body. His general condition was good; Bence-Jones's protein in urine was positive. At laminectomy for treatment of compression myelitis, tumor originated from the fourth lumbar vertebral body was found, which was determined histologically as plasma-cytoma. The clinical course was benign. 2) Male, aged 19 years, was invaded his ribbs, sternum and spine. No anemia and Bence-Jones's protein were proved and the clinical course showed malignant nature. The sort of cells consisting tumor could'nt exactly determine by autopsy, however, it can be said to originate from marrow tissue.
We have treated the patients with the congenital dislocation of the hip by the Lorenz's method, but we find the dissatisfied result such as; In anatomical, Caput femoris inclines towards more outside than in normal through the therapy. So we have observed what percentage of patients with the congenital dis location of the hip became in such situation in our cases through the treating by the Lorenz's method and we find in that case the result are imperfect in thirteen of eig thy five cases. So it may be argued that it is imperfect to be treated by Lorenz's method only, further it is very useful that we try the bloodless curing as aid of the Lorenz's method, and bloody operation in the propriate stadium.