Specimens were the 5th rib from 18 adult cases died in uremia. After dehydration they were embedded in methylmetacrylate and sectioned to the thickness of 60 micra. The microradiographic images and tetrachrome stained sections were both examined. Two main features of this disease have hitherto been reported to be osteomalacia and hyperparathyroidism. The widening of osteoid seam, however, was observed in only one case, while the hyperparathyroidism were the common findings. Besides these findings we found frequently the internal demineralization (inside of bone) which were stained deeply with fuchsin. These areas are neither osteomalacic nor osteocytic osteolysis which is frequently found in primary hyperparathyroidism. The hydroxyapatite density in these undermineralized areas were ranged approximately 0.6-1.2 gram per cubic centimeter. We consider these suppression of mineralization may be due to the dysfunetion of osteoblasts and osteocytes.
The syndrome, usually termed the “male Turner syndrome”, is characterized by short stature, webbing of the neck, hypogonadism and cubitus valgus and occurs in males with a normal karyotype. A similar syndrome, but with normal gonadal development, occurs in girls. To avoid confusion with the 45XO Turner syndrome, it has been suggested that the syndrome be called the Noonan syndrome. Recent reports have confirmed the occurrence of the syndrome in families. We also have studied a case of two brothers aged fifteen and twelve years which illustrates some of the familial characteristics of the syndrome. They were not mentally retarded, but the elder had mental depression. So we were obliged to stop trying to correct his thoracic scoliosis because of his refusal.
Polyostotic fibrous dysplasia (Albrights Syndrome) is a rare disease of bone. We reported three cases of this disease. Case 1. 10 years-old girl had walked with a limp. She sustained a pathological fracture of her left femur and had a cutaneus pigmentation on her neck and waist. Laboratory examination not remarkable endcrine dysfunction, but serum alkaline phospatase were 24.1 B. U. Case 2. 12 years old boy complained of pain on his left knee joint. He had cutaneus pigmentation on his upper arm, left leg and right foot. Secondary sex characteristics not appeard. Laboratory examination showed a slightly hyperthyroidism. Case 3. 7 years-old girl had walked with limp. Her menstruation started at four years-old. Endcrine dysfunction not remarkable, but serum alkaline phosphatase 41.5 B. U.
Alkaptonuria is very rare disease characterised by the presence of homogentisic acid in the urine, associated with an inborn error of metabolism of certain amino acids, namely tyrosine and phenylalanine. The disease is inherited. We experienced a 48 years old woman who complained of low back pack pain and, feeling of numbness and pain of the lateral aspect of right leg, and who was supposed to be an alkaptouria from her clinical histories. First clinical manifestations were ochronosis both in the auricles and sclerae, slight kyphosis and stiffness of the thoracolumbar spine. Radiological examination showed degenerative changes of thracolumbar spine and right knee joint, and demonstrated narrowing of the intervertebral spaces and diffuse calicification of intervertebral discs. Except for anemia, CRP positive and decrease of potassium in the serum, there is no clinical significance in the blood examination. On standing, the urine turned brown and finally black in color. Treatments, such as traction, hydrotherapy, medication, were done without appreciable therapeutic effects.
This paper reports a case of osteochondromatosis of the knee joint, we recently experienced, which had as many as 1677 loose bodies in the knee joint. The patient is twenty-eight year old office lady. She has suffered from the swelling and the pain of her left knee for three years without any exciting cause. Her pain increased at walking. In spite of the various treatment by the practicians, her condition did not improved and at last she visited our hospital. The diffused swelling, oppressive pain, inflammation and fluctuation were recognized at the suprapateller region of the left knee. The flexion was slightly limited. X-ray findings; On arthrography, the innumerable dotted shadows were seen at the super pateller lesions of the left knee. Operative findings; The suprapateller lesions of the left knee and the articular cavity were filled with the loose bodies of the size of the dried boiled rice and the knotted swelling and the congestion were recognized on the surface of the synovial membrane. The extraction of the loose bodies and the curetting of the synovial membrane were performed. All of the 1677 extracted loose bodies were the small pieces of the white opaque cartilage which were about the size of the dried boiled rice, whose surface was smooth and as hard as the cartilage. Pathological and histological findings; All of the loose bodies consist of the mature cartilage cells. The ossification within the cartilage and the formation of the medullary cavity could not be recognized.
The patient, two month-old girl, was admitted to our clinic with a soft part tumor in the distal one-third part of the right thigh. She had no history of injury or inflammation after birth. The biopsy specimen was diagnosed as lipoma and the en block resection was attempted, which was failed because of marked infiltration of the tumor mass into the surrounding tissues. Histologically, the majority of tumor was consisted of the mature fat cells and partially the infiltrating connective cells. The tumor was diagnosed as infantile fibrolipoma. Six months after the operation there is no evidence of local recurrence.
The association of enchondromatosis with hemangiomata is a rare condition first described by Maffucci in 1881. Of the two components of the syndrome, the enchondromaatosis is identical with Ollier's dyschondroplasia and the vascular abnormalities consist of cavernous hemangioma, phlebectasia and phleboliths. Recently a female aged nineteen years, was admitted to our hospital with complaints of the deformity of right toes and several soft tumors on the right foot. Roentgenogram showed remarkable changes in right tibia, metatarsals and phalanges with irregular rarefactions of the structure. Histological examination of the bony tumors revealed a typical enchondroma, but also in a part, cytologic evidence of changs in the direction of malignity. The problem of malignant transformation of an enchondroma is most important, so we will argue about histologic findings in this paper.
The benign osteoblastoma is uncommon, solitary, benign, vascular, bone and osteoid-producing tumor and is the term used by Jaffe and Lichtenstein in 1956. We have experienced a case of this tumor involved in the fifth cervical vertebra. The patient, 28-year old female, was first seen on April 18, 1968. The chief complain was dull pain in her neck and shoulder. The roentgenolgic pictue showed distinct expansion of the right superior articular process. After her admission, the lesion was partly curetted and followed by irradiation of 60Co. The histologic finding consists of an osteoblastic connective tissue stroma which is highly vascular. Within this cellular and vascular tissue, osteoid and primitive bone is deposited. She was last seen on October 10, 1972 at which time there was no evidence of recurrence and was in good health.
The authors experienced a case of benign chondroblastoma involving the patella. To our knowledge this is the third recorded benign chondroblastoma in this site. The patient, a seventeen-year-old boy, was admitted with complaint of pain in the patella. Roentgenograms revealed a multiloculated radiolucent area in the patella without cortical destruction. Microscopically, there were polygonal or rounded stromal cells and small giant cells. There were also several areas of chondroid matrix which appeared to be derived from young chondroblasts. Curettage and bone grafting was carried out and no evidence of recurrence ocurred clinically six months after operation.
We had oppotunity to study so called a giant cell tumor variant recently. A 12-year-old girl was first visited to our clinic in June, 1971. Pain and swelling had developed in upper part of right tibia. Roentgenogram showed a round, limited area and a vague, fuzzy mottled appearance. Microscopic examination revealed a composed findings of giant cells, variable size cells (round, oval or polyhedral), osteoid matrix and chondroid matrix in this material. It was beleaved that it was a benign chondro-blastoma rather than a genuine giant cell tumor.
In 1965, Enzinger proposed to classify a certain type of malignant tumor arising in tendons and aponeuroses as an additional tumor entity. The tumor, which was provisionally named clear-cell sarcoma of tendons and aponeuroses, has a uniform and distinctive clinical and morphological pattern, which distinguishes it from other groups of tenosynovial tumors. This brief paper presents a 40-year-old Japanese male with the clear-cell sarcoma. This tumor arose in the tendon of the right vastus lateralis, and appeared as a firm circumscribed lump of grayish white tissue. Microscopically, it was composed of polygonal and spindle cells in lobules separated by fibrous trabeculae of varying thickness. The cells characteris-tically had clear cytoplasm and distinctive nuclei of large basophilic nucleoli and prominent nuclear membrane.
Case 1. 59, year-old man noticed a lump in rt, calf for 2 years. 5 months after wide resection, amputation through the thigh was done. Tumor was not contact with bone, Microscopic findings were considered to be a chondrosarcoma with co-existing neurinoma. Case 2. 22-year-old woman noted a tumor at lt. leg for 10 years. X-p findings and microscopic exams were ossifying lipoma.
A 39-year old female, who lactated, was admitted to our clinic on March 22th, 1972, complaining of progressively increasing pain and swelling of the wrist joint since three months. A roentgentgenogram revealed lytic destruction of carpal bones and the second metacarpal bone. While, a small hard tumor was found on her right breast. Carpal bone biopsy showed adenocarcinoma, and then left upper arm amputation and resection of right breast tumor were performed on March 28th, 1972. The pathological diagnosis of breast tumor was scirrhous carcinoma. The patient became icteric eight days after operation and died on May 17th, 1972. There was no autopsy.
155 patients of diver's disease has been admitted to our hospital since the construction of hyperbaric chamber in 1966. Among them, 30 patients had spinal cord lesions. 7 of them had complete transverse injuries, others were incomplete or dissociated type. Prognosis of our patients was good especially when recompression therapy had been undertaken in 6 hours after the onset of symtoms. Etiology was discussed here.
The first report of a suited diver with bone necrosis was made by Grutzmacher in 1941. Since 1966, when our hyperbaric chamber was constructed 155 divers were treated and 135 divers were examined radiologically. Of the 135, 72 had aseptic bone necrosis. We clasified these bone lesions according to Ota-Matsunaga's criteria. The juxta articular lesions (Atype) were found more than 20% among the divers whose experiences were more than 4 years. The lesions of aseptic necrosis in diverers are offen multiple and bilateral. We found bone lesions at upper Humerus (61), upper femur (58), lower femur and upper tibia (31), lower Humerus (7), and Pelvis (4). In our survey 75% of the dirers who had bone lesions had experience of Type I decompression sickness (bends). The juxta articular lesions were found who had dived more than 11m deeper. Problems in further study in this field were pointed out.
Avascular necrosis of the talus is known to occur after severe trauma. But there are few reports about idiopathic-aseptic necrosis of the talus. We wish to report one case of idiopathic-aseptic necrosis of fhe caput tali. Case report. A 22-years-old female, complaining of pain in the region of the right foot, came to our hospital on Feb. 7, 1972. Roentgenogram taken in Feb. 7, 1972, showed bone absorption of the caput tali. Biopsy was done on May 30, 1972. Histological examinatition revealed aseptic bone necrosis, necrosis of subchondral bone tissue and no evidence of neoplastic growth.
Prolonged systemic therapy or repeated intraarticular injection with steroid hormones has been reported to accelerate joint destruction in rhematoid arthritis. This paper contains a brief review of the literature dealing with steroid induced arthropathy and adds two cases which had sustained unusually rapid and severe joint destruction. The mechanism of the production of avascualr necrosis after high doses of steroids is not definitely known, but the possible causes are also discussed.
During from April 1971 to Augast 1972, 2507 infants were born in the Obstetric Unit of Nagasaki University and two other matanity hospitals. All newborn babies have been routinely examined by Ortolani technique within the first week of life. Ortolani click sign with restricted abduction were noted in 13 cases (0.52%) in the newborn babies. In the exaimnation of 632 babies, 20 cases (3.2%) were noticed the limitation of abduction at examination about one and three month after birth. One case of subluxation, 9 cases of acetabular dysplasia and one case of cerebral paralyssis were found. 8 cases of click positive babies were treated with Pavlik's band modified for newborn baby and 10 cases of subluxartion and acetabular dysplasia were treated with Pavlik's band only. All treated cases had excellent results. We consider that radiography is of very limited value in early diagnosis.
Three hundred and sixty four congenital dislocation of the hip in 291 infancies were treated with Pavlik's bandage during the last 5 years, dislocation being 208 and subluxation 156 hips. While the reduction was all succeeded for the cases of subluxation, it was failed in 28 hips (13, 5%) out of 208 dislocated hips. Twenty two unreduced hips were treated by Lorenz's method or combination of Lorenz's method and Pavlik's bandage, and the remaining 2 cases were treated by open reduction. The follow-up results of 20 hips after 6 to 39 months showed the anatomical healing in 17 hips (85%).
Recently we have few chance to see the older child with untreated CDH owing to the progress of management for CDH in new-born baby or in infant. However incidence of the secondary O A. that occurs following dislocation or subluxation seems to be relatively increasing. In our clinic we performed the Chiari's transverse pelvic osteotomy for 14 cases of subluxation with acetabular hypoplasia in these 3 years. Now we report the result of the operation with some discussions, though period of follow-up study is short.
1. A review was made of twenty nine cases of congenital dislocation of hip in patients treated by Colonna's arthroplasty. One of these patients was bilateral. Ages at the surgery ranged from four yearr to fourteen years. 2. The clinical results are superior to that of the roentgenogram. 3. The clinical results were favorable —twenty-seven hips were excellent or good and three hips were fair or poor. 4. In twelve hips, roentgenograms were shown deformities of femoral head or acetabular dysplasias. The roentgenographic results of eighteen hips were excellent or good. 5. Causes of these are due to the following factors: (1) lack of traction before surgery, (2) technique of surgeon, (3) lateralization of femoral head after surgery, (4) structural problem of femoral head itsself.
We are treating club foot making the special clinic. We often meet the resistant club foot, but known what reason. So, we are not only treating but also doing the investigation of the progosis. For the investigation of prognosis, we are doing two methods. They are quite specific method which utilize the Bio-Mechanics. The first is using the potention meter. and E. M. G. The second method is quite the Uuique which was developed by us. It is, kinetic motion and E. M. G. are pictured on the same photograph, more over kinetic motion and E. M. G. is parfecfly correlated. We show the three examples, used first method and three examples the second. Especially the second method was investigated in relation to “walking cycle.” In these results, we found the next; In the first method, remaining calcaneovarus or pes adductus, M. Peroneus longs was not used fully. In the second method, Toe-in-gait type was not used the muscle of M, Peroneus longs. Excellent corrected type is similar to the normal pattern in walking cycle and E. M. G.
In our clinic, 56 feet of congenital clubfoot on 36 patients have been treated during 1962-1972. The operative method are classified to 3 classes with the lapse of time. 1) Lengthening or tenotomy of Achilles tendon. 27 feet (19 cases) 2) Lengthening of Achilles tendon and posterior capsulotomy. 16 feet (9 cases) 3) 2) procedure + lengthening of M. tibialis posterior, M flexor hallucis longus and M. flexor digitorum longus. 13 feet (8 cases) After investigation of these cases some problems in operative treatment are clarified. As a main factor of recurrence in congenital clubfoot, inverting muscle like M. tibialis posterior, M. flexor hallucis longus and M. flexor digitorum longus are very important.
Growth disturbance of distal epiphysis of the lower leg may affect the carring angle of the ankle joint, causing varus and valgus deformity. The authors experienced 4 cases of varus deformity after fracture and a case of valgus deformity resulted from defect of the fibula caused by orteomyelitis. The ages ranged from 6 to 14 years. In 2 patients, one of which was operated on by supramalleolar osteotomy and the other by the same osteotomy with short term Blount's stapling of the distal fibular epiphysis, the deformities recurred within 2 yeare. The other 3 patients were treated by supramalleolar osteotomy combined with epiphyseal arrest by means of 8-figure wiring, which are thought to be encouraging Discussions were made on shortening of the leg, cosmetic aspects, changes of weight-bearing axis and ages necessitating epiphyseal arrest.
Results and problems in 14 cases of tibial lengthening were investigated. Patients such as poliomyelitis, congenital dislocation of the hip and osteomyelitis from 10 to 15 years old were operated on by Z or horizontal osteotomy. All but one were lengthened gradually using distraction apparatus (Katayama-Hirakawa). The average gain was 12.2 per cent of the initial length of the tibia. The results were classified as follows; 9 excellent, 2 good and 3 poor, we regarded genu valgum and axial displacement as severe complications. Genu valgum seems to occur by 1) descent of the fibular head. 2) muscular imbalance. 3) adduction contracture of the hip joint. 4) medial protrusion of the axis. The prevention of genu valgum is difficult but it'll be possible to avoid the axial displacement by inserting the pins correctly and by device of the pin itself.
Recently we have experienced twenty three cases of the thoracic outlet symdrome, among these thirteen operated. As a result of clinical investigation of these cases, we come to a conclusion about the causes of this syndrome that costoclavicular comrression is frequently more important factor than anticipated, although scalene muscles or anomalous fibrous tissues play a role in some degree. But, as yet we can not differentiate accurately causes of each cases preoperatively, by any methods even the angiography. Angiography is useful in determination of location of neurovascular compression. We thik as proper that criteria for diagnosis as follows are adopted. 1. The presence of symptoms or signs, continuously or recurrently, suggesting some neurovascular disturbance of the upper extremity. 2. Positive vascular sings such as Adson's test, Eden's test or Abduction-external rotation test with reapperance or aggravation of neurovascular symptoms. 3. Exception of cervical spondylosis, other peripheral neuritis or vascular disease, etc. As preoperative determination of causes of each cases is difficult, full exploration is necessary in search of the real cause in the time of operation. For this purpose Roos' transaxillary approach is adequate.
Four cases of neuralgic amyotrophy were seen in our clinic during past years. Their outline is as follows; The youngest patient was a man of 20 years and the oldest was a woman of 69 years. Three of 4 were male. In two cases, Herpes-zoster developed simultaneous with or following to the appearance of muscle weakness. Weakened muscles was localised in the shoulder girdle in two cases but distributed to the forearm too in other two cases. Sensory disturbance was observed in two cases alone, in which cases Herpes-zoster developed. In 3 cases, prognosis was good or fair in 2-3 months but the other case showed no improvement in 3.5 months.
There are two possible causes that developed the restriction of joint range of motion after intramuscular injection. The first category is peripheral nerve injury after injection which fregently occurred in the radial nerve and the sciatic nerve. The others is degeneration or scar of the muscle tissue which encounter often in rectus femoris muscle in children. The contracture of shoulder joint due to deltoid muscle shortening secondary to the injection is very rare. This 34 year-old-female patient came to our clinic with pain and stiffness feeling on her right shoulder joint. We could get the history that she received repeated intramuscular injections to her right deltoid muscle for two years. She was operated and was found a whitish cord like scarred band, 1cm wide, in the posterior part of the deltoid which was removed subsequently. The histology showed marked atrophy, degeneration, and hyalinization of the muscle tissue. She got fairly good range of motion in the horizontal adduction at the shoulder joint after the surgery. Generally it is difficult to diagnosed this kind of disease on its early stage. This adult case was not dropery diagnosed for about two years.
A female aged thhirty-eight years has been noticed spontaneously numbness and shoot down pain from left shoulder to hand in Jnne, 1972. She has treated with analgesic, intravenous injection and physical cure. Therefore she had slightly improved by these conservative methods. However, after four weeks, she had complained the left drop hand and disturbance of movement of left fingers. She admitted to our clinic in August, 1972. At the time on admission, we found the thumb's head tumor on flexion and radial region of left elbow joint. Then she suffered from tenderness to pressure and shoot down pain, but developed no sensory disturbance on the same region. On August 22, 1972 the operation carried out. There were ganglion in the capsule between N. radialis superficialis and N. radialis profund. Three months after the operative treatment, her complaint has lighteneed gradually and we have had satisfatory result. Here we report this case with some referential observations
The microangiographic study was undertaken to clarify the pathogenesis of circulatory disturbance in the cervical spinal cord when it was compressed anteriorly or posteriorly. Rabbit was chosen as experimental materials. The experimental procedures were as follows. 1) The intervertebral disc was drilled anteriorly and a small hole of 5mm in diameter was perforated carefully to avoid damage to the spinal cord. A piece of dried laminaria was inserted onto the dura mater. 2) The weight of 100gm was given to the dura anteriorly through the perforated hole by the designed simple instrument. 3) Laminectomy was peformed and the weight of 100gm was given to the dura posteriorly by the instrument. After injuires, perfusion with a 1.5% Berline blue solution was accomplished through a canula in the thoracic aorta. The microangiograms showed the following characteristic findings. In anterior compression by laminaria and a weight of 100gm, the spinal cord was flattend antero-posteriorly at the compressed level and non-filling area was found in the gray matter and anterior or lateral columns. The anterior spinal artery was well filled, although the central artery was showed circulatory disturbance. The vascular changes in the posterior compression were different from those of the anterior compression, and were showed the disruption of tissue and vessel in the central and dorsal part.
Since Charcot reported “Whiplash injnry” a cause of cervical syndrome have been discussed by many clinicians. In 1925 Barré et al explained that the Syndrome were due to the lesion in the inferior cervical sympathic system. This assumption has widely been accepted among orthopedists. We reported 9-Cases of typical whiplash injury with traumatic damage in the inferior cervical spine, otorhinological, ophthalmological and neurological central nervous system, wishing to present several facts that are some what conflicting with the theory in the past. Conclusion. We considerd the syndrome of whiplash injury may be divided into two categories in the following. A) Symptoms due to cervical injuries. B) Symptoms due to cerebral contusion (injuries in the cerebellum, occipital lobe and the base of the brain)
In 128 patients diagnosed cervical spondylosis except myelopathy tyep during 1971. All patients were given the treatment of cervical traction. 61 patients were investigated, male 24 patients, female 37 patients. The results were obtained as followed. 1) 18 patients were excellent results, 22 patients were good. 2) In 17 patients out of excellent and good results, we found that the symptoms relieved in two weeks after cervical traction. 3) In excellent patients, there were effective for shoulder pain, neck pain and sensory disterbance of fingers. 4) On the other hand, 21 patients were noted for no effect of cervical traction, and out of these 21 patients, 12 patients were no change on the symptoms, in 2 patients the symptoms had progressive worse. 5) It was noted that there was no relationships on the effection and cervical X-ray findings. 6) Out of excellent and good results, 93% of the cases were improved during three months by the treatment of cervical traction.
A case of leptomeningeal intradural cysts was reported, which had the length about two thirds of the total spine. Case: A 12 years old female was admitted on July 24, 1972 to our clinic, complaining of progressively increasing gait disturbance with sensory loss on bilateral lower extremities since about 2 years ago. The most important findindings at admission were spastic paraplegia with sensory level at Th7, hyperactive knee and ankle jerks on both sides, bilateral positive Babinski and no vesical and anal sphincter disturbance. The plain X-ray films of the thoracic and lumbar spine: There were increasing in the width of the interpediculate space and thinning of pedicles from Th6 to L2, abnormal enlargement of the dural sac below L3 and especially both poles of the cyst with one way valve mechanism. Operation: Laminectomy of Th4 and Th5, L2 and L3 was performed. Thin walled, long condom-like cysts extending from T5 to L2 and L3 to S3 were found inside the dura on the posterior aspect of the cord. The poles of cysts removed partially. After surgery, sensory loss disappeared and she became to ambulate in parallel bar.
In the thirteen-year period from October 1959 through September 1972, there were eleven patients with tumor of cauda epuina operated upon in our clinic. It is very important to discuss the clinical features in this disease, which is greatly similiar to disc lesions. In this paper our eleven cases are reported and for the purpose of the further discussion about this clinical pictures, fifty cases of Japanese literatures which had been recently reported in detail are gathered and investigated. The most common symptome is low back pain and/or radiating pain on the thigh and leg, which continues for a long time. Sensory disburbance and muscle weakness are not always recognised. The myelogram is the most significant and valuable aid in the differential diagnosis. In our cases there are eight neurilemmoma, two dermoid cyste and one meningioma.