A case of parathyroid carcinoma with primary hyperparathyroidism was reported. Man aged twenty-four years complained of increasing pain in the right thigh in the walking. This symptom had been present for past eleven months, recently complained of disturbance of gait. On examination, there was tenderness in the ritht thigh. The radiograph of all bones showed demineralization and subperiosteal resorption. In the long bones the cortex was thinned, while the medullary cavity was correspondingly widened. The serum calcium varied from 7.7 to 9.1 miliequivalent per liter, the serum phosphorus was within normal limits, and the serum alkaline phosphatase varied from 38.1 to 73.6 Bodansky unit. Urinary calcium and phosphorus excretion increased. A diagnosis of primary hyperparathyroidism was made, and parathyroidectomy was performed. A encapsulated tumor was found at the left supraclavicular region. It weighed 5.8 grammes and histologically showed appearances of a parathyroid carcinoma. Four months after operation, biochemistrical examination was within normal limits. The radiograph of all bones showed calcification.
Peripheral injection of 3 per cent phenol solutions for the relief of sasticity in the lower extremities that had resulted from cerebral palsied over three years. The mentally retarded child is usually unable to ambulate with braces and crutches until he had attained a mental age of three years. The patients had good function of upper extremities and had a little mentally retarded. Spasticity presents a major problem in the rehabilitation of many patients with neuromuscular disability. After the phenol block of obturator or sciatic nerve, bracing of spastic child is necessary at an earlier age, as the spastic child is more prone to develop contractures. Cerebral palsy children should have bilateral long leg brace with a pelvic band before ambulating. Those children who do not have good control of the trunk should have, in addition, a Knight spinal attachment. Nearly all cerebral palsy children will learn to ambulate in some manner without braces or treatment. The purposes of bracing and treatment after the block of dilute phenol solution is todevelop the correct pattern of walking so that in pater life they will, as nearly as possible, have the appearance of being normal.
Before applying Long Leg Brace to the severe paralytic leg, having flexor deformity of the knee, supra-condylar osteotomy is often chosen for correcting the alignment of the leg. In these cases we tried osteoclasis manually after drilling of the femur at supracondylus circulatory through skins. Merits 1) Operative field is small. 2) Operative time is short. 3) No need of nailing, only casting. 4) Bone fusion is relatively good. Fault 1) Indication is limited.
We usually prescribed a long leg brace for the knee extensors weakness as seen in poliomyelitis. The SKA orthosis (New York University) and Saltiel brace (Israel) were invented in order to substitute a short leg brace for a long leg brace. We made a plastic short leg brace (K. U. Short Leg Brace) which has fixed ankle joint, the STP shaped pre-tibial shell, and thin heel lift plates. The proper heel lift plates may be attached to the outer heel base in case the brace needs more dorsi-flexion as walk without shoes. In the Japanese way of life, there are frequent opportunities to walk without shoes. In such case, you can get reasonable knee tability with this Short Leg Brace because of the brace can accomodate to the heel height variations. The features of K. U. Short Leg Brace are as follow: 1. light weight 2. excellent cosmesis 3. fit any shoes 4. can sit in knee maximal flexed position 5. easy donning and easy to take off 6. easy to clean the brace 7. noiseless 8. cheap 9. decrease energy consumption due to movable knee joint
Dr, Burgess has presented the new operation technic on the immediate postsurgecal prosthetic fitting which have developed by Dr, Weiss. The principle of this new technic on Below Knee Amputation is as follow. 1. The stump should be covered with a long posterior skin flap and muscle of the calf for keeping good distal circulation. 2. The fibula is left somewhat longer than conventional amputation techniques because the modern tolal-contactt socket depends upon the more cylindical, broad stump for rotation stability. This new technic can apply as one of the routine of immediate fitting methods and is effective to the patient with distal circulatary disturbance. We reported the details of this operation technic on 6 cases
In a series of 241 soft tissue tumors at our clinic, 228 benign and 13 malignant tumors were found. The benign tumors were classified into 118 ganglia, 12 lipomatoses, 9 angiomatoses, 8 fibromatoses, 2 pigmented villonodural synovitis and one myositis ossificans generalisata. 163 of the tumors were in females but they were encountered at any age. The malignant tumors were composed of 6 fibrosarcomata, 2 synovial sarcomata, 2 sarcomata of undetermined histogenesis, one hemangiosarcoma, one rhabdomyosarcoma and one liposarcoma. They occurred in patients from sixteen to seventy-two years of age. The sex incidence was about equal. Reccurrence in six patients with a recurrence rate of 46 per cent was observed and the average time for development of recurrence was ca. one year. Four patients with the tumors, three of whom were administered by intraarterial infusion, have survived. Metastatic rate was 68 per cent and the average time for occurrence of the metastasis after the operation was ca. one year. The five-year cumulative survival rate was 34.8 per cent.
The patient is a girl of four years old. She had been sufferred from common cold eighteen months ago. Then antipyretics had been injected mutually in both upper arms ten times. After two months of injections a tumor was found at her right upper arm; probably in triceps muscles. Thereafter other two fresh tumors were recognized near the first tumor. These tumors had developed and occupied right uper arm. The movements of elbow were disturbed. She was admitted to our clinics. Histologically the samples were diagnosed as fibromatosis.
In Japan, we can rarely find chloroma which is a kind of acute leukemia and which is characterized by the forming of green tumor and the greening of general tissue. This paper reports an autopsy case of chloroma complicated by spinal transverse lesion which we recently experienced. A fisherman of 69 years old was admitted to our clinic with complaints of paresthesia of the both lower extremities and the hindrance of motility. After admission, his condition became worse and he developed complete anesthesia of the lower part of the body and inability of walking due to spinal transverse lesion. With a diagnosis of spinal transverse lesion, we performed the extirpation of the tumor. The green tumors were seen in the epidural space. He was getting better after operation but three months after the operation, he again became serious and leukemia cell appeared. With a diagnosis of chloroma, we performed the treatment of leukemia but he died six months after onset. At autopsy, green infiltration of leukemia was observed in general tissue. The marrows of thoracic vertebra, collor bone, rib, ilium and etc. were filled with green pussy tissues and proliferation overran outside the bone substance.
We are reporting two cases of Aneurysmal bone cyst in talus. Case 1, twenty-one years old, a female. She has been suffering from the pain at her left ankle joint for the past two months. Roentogenograms revealed cystic lession in the trochlea of talus. At operation, cyst was found to contain fluid blood, and few spicules of bone. The lession was curreted and packed with graft taken from the patient's ilium. Microscopic examination showed large vascular channel lined with bone tissue composed of fibroblast and numerous multinuclear giant cells. Case 2, twenty-seven years old, a female, complaind in March 1971 of pain in the ankle. She was taken to a doctor who examined her. Jadging by the results of biopsy the doctor diagnosed the patient was suffering from malignant bone tumor. She went to our clinic. A roentgenogram of talus showed cystic lesion with irregular sclerosed area. At operation, cyst was found to contain blood fluid and bone spicules. Microscopic examination was the same as case 1.
From 1963 to 1969, intra-arterial infusion of chemotherapeutic agents combined with radical surgery against sixty-four malignant tumors of extremities had beed carried out at the Orthopedic Dept. of Kyushu University. The chemotherapeutic agents used in the infusion were Endoxan, M. M. C., Methotrexate, 5-F-U, Chromomycin A3 and Chromomycin S. In all of them, thirty-one cases of osteosarcoma were evaluated. The survival rate by life table method as follows; one year survival rate was 67.7 per cent, two years 40.6 per cent, three years 36.1 per cent, four years 36.1, five years 36.1 per cent. In thirty-seven cases which performed operation alone, survival rate as follows; one year survival rate was 51.4 per cent, two years 33.1 per cent, three years 19.3 per cent, four years 19.3 and five years 12.0 per cent.
This case report include possible metastatic lung cancer and associatec H. P. O. A. after above knee amputation due to osteosarcoma. The case is a 34 years old male. Chief complaint: clubbed fingers Present history: The patient noticed swelling of the left knee and limp since November 1969 and was visited our clinic on January 5 1970. The diagnosis of osteosarcoma of left femur was made, and above knee amputation was performed. On July 8, 1970 chest X-ray showed questionable lung metastasis and was admitted to the department of first internal medicine. X-ray survery of whole body was done. New periosteal bone thickening of 0.5mm to 2.0mm was found in diaphysis of tibia, radius, ulna, metacarpal, metatarsal and phalanx. Examination of blood chemistry showed no abnormality in liver function. However there were decreased albumin level in serum and slight depression of pulmonary functions. In the measurement of clubbed fingers, there was apparent hypertrophy of distal phalanx as compared to healthy person.
It has been generally accepted that prostatic cancers as well as breast cancers are characterized by their marked hormone-dependency. Conventionally, the therapy of these carcinomatous diseases has been achieved by radical resection, endocrinological management, etc. Recently, a new surgical treatment, called surgical endocrine therapy, has been developed as one method to inhibit the growth of carcinomata by chang a hormonal environment within the living organism. We performed a set of the combined operation of anastomosis between left adrenal vein and colic vein, bilateral castration, and right adrenalectomy in 22 patients with prostatic cancer who had unfavorably lost the chance of radical operation or had metastasis, for the purpose of changing endocrine milieu within the body. Ten of our cases were associated with metastasis of prostatic cancer to the bone. This report deals especially with roentgenologic examinations of the effects of surgical endocrine therapy on the patients with late prostatic cancer additionally followed with osseous metastasis. The results are follows: In the measurement of urinary 17 KS showed a decrease postoperatively. The decrease of the amount of urinary aldosterone was also postoperatively observed but all the values obtained were within the physiological limits. All of cases almost complete improvement of symptome was observed and 5 out of 10 cases with metastasis to bone were demonstrated marked improvement of roentgenological findings.
Growth rates of pulmonary metastases (doubling time, duration of metastases) were studied according to the methods of Collins, V. P. et al.. Examined cases were as follows; 9 of osteosarcoma, 3 of chondrosarcoma, 3 of fibrosarcoma and 2 of liposarcoma. Following results were obtained. 1. “Doubling times” of osteosarcoma were 3 to 235 days, those of chondrosarcoma were 9 to 90 days, those of fibrosarcoma were 12 to 90 days and those of liposarcoma were 17 days. 2. In 13 cases the time of inception of metastasis followed prior to the earliest sign or syptom of the primary disease. 3. Shrinkage of metastases were found in one of chondrosarcomas and liposarcomas with radiotherapy. According to these results, the relation between growth rates and treatments were discussed.
Shoulder-hand syndrome is a disease accompanied by symptoms such as motor disturbance of the upper limbs, swelling, pain, blood circulation disturbance or neurotic disturbance the direct or contributory cause of which cannot be attributed to any known disease. In 1958 Steinbrocker made a detailed report of his findings based on a study of 146 cases. In the 10-year period from 1961 through 1970 we studied the cases of 30 patients diagnosed as shoulder-hand syndrome by the Plastic Surgery Department of Hiroshima Red Cross Hospital with interest in sex, age, affected limbs and contributory cause or complication. Further a prognostic investigation of 23 treated cases was made by means of questionnaire. Of the 23, questionnaires on 12 cases were completed and returned. A report including our review of the 12-returned questionnaires is made as follows:
Two cases of ishaemic contracture, local in the hand were reported. Case 1-A woman, twenty year old, had the press-injury on the right wrist. The initial treatment was performed by wound closure and application of a plaster. After application of the plaster the hand was enormously swollen but was neglected to have proper care. After four weeks the plaster was removed and she noticed that the thumb could not be opend for grasping and its metacarpophalangeal joint could not be opend from its slightly flexed position. At operation fibrous degenerated adductus pollicis muscle and flexor pollicis muscle were removed and Z-plasty on the thumb cleft was carried out. Histological changes were the same as in the muscles found in Volkmann's ishaemic contracture. Case 11-A boy of five sustained a supracondylar fracture of the light humerus and was treated with overhead sponge traction. During the treatment swelling of the hand in the too tight elastic bandage was found and formed decubitus on the radial side of the thenar eminence. When the fracture was healed it was noticed that the thumb could not be opend for grasping. On the examination it was confirmed that the adductor pollicis muscle was contracted. It was stressed that prophylactically great care should be used to avoid swelling of the hand or arm in the tight encasement.
At the time of neurolysis in Volkmann's contracture the following attempt was done: After neurolysis the nerve was wrapped with fat pedicle flap from the volar subcutaneous fat tissue to prevent the adhesion of the nerve from the surrounding damaged tissue. One of our cases reconstructive operation was carried out nine months after the first operation and it was confirmed that necrosis of fat pedicle flap was not occured and adhesion of the nerve was appeared slightly in the fat tissue but markedly in the other part.
A school boy aged seventeen years sustained a open fracture of right tibial and fibular shaft in a motorcycle accident. He had marked swelling of the injured leg and loss of sensation in right foot. When the plaster was removed a month later, he noticed equino-varus deformity of right ankle and clawed deformity of right toes. We repaired the clawed deformities of the hallux and other toes by the lengthening of the flexor hallucis longus tendon. The slip between the flexor hallucis longus and flexor digitorum longus tendon was confirmed anatomically. We think the lengthening of the flexor hallucis longus tendon is a excellent treatment for the claw toe deformity which was not caused by paralysis of the intrinsic muscles.
Hemophilia is an hereditary disorder of the blood transmitted as a sex linked mendelian recessive from the male through an unaffected daughter to a grandson and may occur bleeding tendency after most trivial injury. Hemoarthrosis is one of complication resulting from hemorrhage in hemophilia. The knees, the elbows and the ankles are most frequently affected. Hemoarthrosis may be repeated, the joints consequently incur contracture and permanent deformity. We give a report of two cases of hemoarthrosis which we experienced recently. Case 1; twenty six years of age. He shows severe contracture and deformity of the left knee joint. The other joints show middle contracture. There are demonstrable roentgen changes. Case 2; twenty years of age. He shows especially contracture of the both knee joints and elbows, not finding deformity. There are slight roentgen changes.
Thirty-five patients with classical rheumatoid arthritis have been followed for more than five years. The average duration of disease of the series was 13.5 years and the average age was 50.0 years. The series was collected between 1960 and 1964. In 1966 and 1971, the follow up assessments were carried out on laboratory finding, disease activity, functional capacity and X-ray findings. On the whole their level of disease activity tended to subside. However, there was a gradual but progressive worsening in the functional capacity. With regard to X-ray findings, the development of the radiological changes varied with the joints involved. Intercarpal joints and radio-carpal joints were most frequently involved and the X-ray changes of those jojnts progressed rapidly. In spite of beeing frequently affected, the X-ray changes of knee joints and ankle joints were less advanced in comparison with intercarpal joints and radio-carpal joints.
Recently we have experienced a Vitallium hinge arthroplasty of the rheumatoid knee, using the Shiers prosthesis. Patient was 68 years old Japanese female, suffering from rheumatoid arthritis for 15 years. She was disabled by the right knee which was markedly destructed. Her right knee had a 20-degree valgus deformity, poor lateral and antero-posterior stability, crepitus and flexion to 145 degrees. Roentgenograms of the right knee showed marked destruction looks like Charcot joint and flexion-valgus deformity. After operation she was well satisfied with good results. Her right knee was stable, painless and had 90 degrees of motion (from 180 to 90 degrees).
The Arthritic knee presents unique problems in each case. The surgical approach should be individualized with careful consideration of the factors of stability, deformity, and motion. We have used MacIntosh type tibial plateau prosthesis for the rheumatic arthritis and osteoarthritis since May in 1970. We discussed the adaptation and problem of the tibial pleateau prosthesis.
One case of congenital dislocation of the right knee was reported. It was a female new born complicating congenital dislocation of the bilateral hips. The patient was successfully treated by metal splint and plaster of paris bed.
We have treated some eariy cases of the congenital clubfoot in our clubfoot clinic during one and helf years, since biginning of 1970. In this paper we will report some problems observed in 8 feet. At first, in every feet, adduction and varus deformities were corrected by cast-correction. After the correction of these deformities, in 6 cases, equinus deformities were corrected by posterior release operation. In two foot, equinus deformities were corrected by cast only, after Kite-method. The night splints were used for the post operative treatment, and timely corrective casts were applied. In every cases, three kind of deformities were corrected satisfactorily but we had two problems during our treatments. One is the adduction and varus deformity in midtarsal and subtalar joints. The cause of these deformities is abnormal relation between tarsal and metatarsal bones. We think the correction of abnormal relation will be possible by cast only but correction should be done completely, or, relapse of adduction and varus deformities will occur. The other is the equinus deformty in ankle. Cause of this deformity is the shortening in posterior talo-fibular ligament at ankle as well as Achilles tendon. So, we think posterior release operation should be performed at every cases.
It is clear, as many authors say, that the results of early treatment of congenitally dislocated hip with Pavlik's bandage are superior to those with classical methods. Resultant lateral displacement or subluxation of femoral head after this treatment, however, is seen considerably. We assume the main causative factor of the lateral displacement must be passive stretch of tight iliopsoas muscle resulting from relaxinng the band in the course of the treatment. We think that the best way for the prevention of this complication is to lengthen the tight iliopsoas muscle gradually by slacking the band. After 2 to 3 weeks from spontenuous reduction the band is begun to slack gradually from so-called ‘frog’ position to 45 degrees' flexion and 25 degrees' abduction position, and the latter position is kept until satisfactory growing of acetabulum is aquired. Although we get relatively good results, further observation will be required for the conclusion in our methode because of shortness of observation time.
A new technique (intertrochanteric curved osteotomy) has been designed as varus osteotomy to prevent the elevation of the greater trochanter (Trendelenburg limp), shortening the leg and lateral displacement of the femoral shaft which was induced by the usual technique. Through a lateral longitudinal approach the proximal femurr is exposed from a point just inferior to the level of the lesser trochanter proximally to the top of the greater trochanter. Then curved osteotomy is performed through the medial portion of the attachment of the gluteus medius and minimus muscle on the greater trochanter to the lesser trochanter in the lateral part of crista intertrochanterica making a slight detachment of the vastus lateralis, medialis and gluteus minimus muscle origin from the frontal osteotomy line. The center of the circumferential osteotomy line should be the center of the rotation of the joint. Next pull the proximal fragment proximally into abduction under the extension of distal fragment distally until the desired varus position is reached. The fragments are fixed by several screws of the appropriate length. This technique is able to make torsional correction, to displace to proximal fragment to anterior or posterior direction on the transverse plane or insert a small bone piece in the anterior or posterior gap of osteotomy line. This procedure has been performed successfully on 16 patients. Follow up study and discussion has shown that this new technique is by far more successful than the usual technique.
To study the spondylosis deformans, the nucleus pulposus was escaped to incise the anulus fibrosus at the fourth and/or fifth intervertebral discs. After this procedure, macroscopical, roentgenographical and histological examination was made periodically. In one month, there was nothing particular findings except incision wound macroscopically. Two months later, osteophytic bulging was found at the ventral margin of the intervertebral disc. The spine mobility was severe restricted. Roentgenogram showed the narrowing of the intervertebral space in one month, but osteophyte and calcification which was usually found in the spondylosis deformans was revealed at the anterior part of the disc on three months after the procedure. The superficial part of the wound in the anulus repaired in three weeks. The deeper one was persisted unhealed in three months. In control rabbits, a faint fluorescens was observed at the epiphyseal plate, on the other hand, an apparent light green fluorescens was observed at the epiphyseal plate, trabeculae of the epiphysis and ossification part in disc incised rabbits.
From the population study of osteoporsis 586 skeletal X-rays were examined in Fukuoka City and in rural district of Saga prefecture. There was no significant differences between two groups. The metacarpal index (MI) of 50 year old group were in average 0.521±0.065 male, 0.533±0.046 female, 70 year old 0.496±0.069 male, 0.424±0.072 female, and 80 year old 0.483±0.074 male, 0.376±0.081 female respectively. These values presented considerably lower than those of Garn's and Nordin's results esp. in female of all age groups. The MI. and cortical area declined more slowly as age increases than those of Garn's but almost same as Nordin's population group in England.
Since March 1970 gas myelography has been used in our department on 26 patients with cervical myelopathy or radiculopathy. By the lumbar route we encountered sometimes unsatisfactory filling of gas into the cervical region, and many patients complained discomfort during and after the procedure. We used, therefore, two needle oxygen method on several patients recently. In this method, almost satisfactory results were obtained because of beeing free from heavy discomfort, and of better filling of the gas through the cervical subarachnoid space.
We describe a new method of cervical air myelography which has been made with 20-40ml of air using the catheter. This method has been performed on 21 patients with various cervical abnormalities since summer of last year. It can be performed simply and safely. Advantages and disadvntages of this method were discussed in comparison with conventional oil myelography or other method of cervical air myelography.
In 66 cases of low back pain with or without sciatica, peridurography using 60% Urographin had been made by upright position since July in 1970, in National Fukuoka Central Hospital. An advancement of this method was to be able to prove more exactly the existence of the disk herniation owing to recognition of the fine picture in lumbar peridural space than by prone position. The findings of these peridurographs were on the whole same as those of the operations. In case of the so-called central herniation, because of the symptomless of the sciatica; the herniation is found out only by this peridurography. We reported the results of six typical cases.