Recently we have experienced two cases of chondrosarcoma and one of chondroma. The smears from chondrosarcoma show giant cells containing large nuculei, several nuculei or a number of chromatin chumps. Histochemically tumor cells of chondrosarcoma exhibit alkaline phosphatase activity, on the contrary tumor cells of chondroma do not exhibit alkaline phosphatase activity. The cells of chondrosarcoma electromicroscopically have the characteristics of the malignant tumors with irregularity and invagination of the nuculear membrane, so called inclusion body in the nuclei, agglomeration of the chromatin, and increase of the free-ribosome and the atypical mitochondria. Smear, Histochemical findings of alkaline phosphatase, electromicroscopical findings are useful in diagnosis of chondrosarcoma.
The giant cell tumor of short tubular bone is very rare. We have recently experienced the gaint cell tumor which occurred in the fifth metacarpal bone. A man, aged sixty-two years, had been suffering from pain and swelling in the right fifth metacarpal portion for about last five months. Roentgenograms revealed the significant osteolytic lesion. After the disarticulation of the carpo-metacarpal joint, this tumor was diagnosed as gaint cell tumor on microscopic examination. Postoperative course was very satisfactory.
9 cases of giant cell tumor of the lower end of the radius were treated in our clinic past 20 years. Follow up data were obtained by 7 cases of these patients. The procedures for removal of the tumors were curettage and bone-grafting or resection and bone-grafting. 4 cases were treated by primary curettage and bone-grafting. 3 of these cases required resection of the recurrent lesion and bone-grafting. 3 cases weres treated by primary resection and bone-grafting. There was no recurrence in these 3 cases. The roentgenographic findings and histological features were not of prognostic value for recurrence. According to these results, we emphasized that the distal portion of the radius could be supplanted successfully by the proximal end of the fibula.
36 cases of the entrapment neuropathy of the saphenous nerve were reviewed. 10 cases were treated as other diseases. Complaint of the most patients was marked pain at the medial aspect of the knee when they step up and down. In most cases were found various degrees of the sensory disturbances in the area of the distribution of the infra patellar branch but was not involved the descending branch. Tenderness was marked at the opening of the Hunter's canal. All cases were treated by infiltration at the entrapment point with dexamethazone and procainehydrochloride.
Thirty three patients with lesions of the brachial plexus were investigated about the prognosis and operative treatments. The following surgical procedures were performed. 1. Neurolysis of the injured brachial plexus-10 cases. 2. Nerve sutures and nerve grafting-2 cases. 3. Transfer of the intercostal nerves into the musculocutaneous nerve-2 cases. 4. Reconstructive operations-8 cases. The authors discussed the diagnostic value of neurolysis of the injured brachial plexus, and the therapeutic value of the intercostal nerves transfer into the musculocutaneous nerve in complete irrecoverable paralysis of the arm caused by a traction injury of the brachial plexus, or of reconstructive operations in partial irrecoverable paralysis.
This paper is based upon 23 bone graftings in 22 cases. Ages of 22 cases are 10 cases of 1st decade, 7 of 2nd decade, 2 of 3rd decade, 2 of 4th decade and a case of 5th decade. Freeze-dried bone graft was performed for the following conditions: Bone cyst (9cases), Fibrous dysplasia (5 cases), Giant cell tumor (2 cases) and others. The evaluation of the result was made by recognition of remodelling namely, resorption and new bone formation on roentgenogram. All cases were found to be remodelled to some degree respectively, but saying to remodelling rate, cancellous bone graft was superior to cortical and massive bone graft. However, even the segmental, cortical and massive bone grafts were moderately remodelled within one year. Loss of bone tissue was occurred in 4 cases in the site where graft was united to bed. It may be due to incomplete inmobilization.
The patients were both 16 years old males. After making an every-day-jumping-exercise from double knee bend for four days, they complained of pain at the lateral upper third of the legs. By X-ray examination after two weeks they were diagnosed as stress fracture of the upper third of the fibula. Making conservative treatments for two weeks, the fractures united completely.
Von den Fällen, wobei die Osteosynthese zum Tibiaschaftbruch in meiner klinik vorgenommen wurden, wurde das Behandlungsergebnis von 32 Fällen mit Osteosynthese Ohne Kompression (nach gebräuchlichen Platten nach AMAKO) erforscht. Und zugleich, die Stärke der Platten und Form des Schraubenloches, die der wichtige Unterschied zwischen Kompressionsplatte und Non-Kompressionsplatte ist, betrachte ich beifügend mit dem einfache Exaeriment nach einem Modell. Die Ergebnisse der klinische Fälle ist zufriedend. Insofern entsprechende postoperative Behandlung durchgefühlt wirt, können weicherere Platte im Vergleich mit der Kompressionsplatte und länglich runde Schraubenloch der Non-Kompressionsplatte einige Vorteil haben.
Nous avons ostéosynthèsé 23 fractures de l'extrémité supérieur et inférieur du fémur par vis-plaque de Judet. Elle est la plus solide et la meilleur adaptable au niveau de fracture. Les délais de consolidation est en moyenne 4, 5mois au côté supérieur et 4, 0mois à l'inférieur. Globalement notre résultat a été très satifaisant.
We first used the closed irrigation-suction treatment in 1970. From 1970 until June 1973, 55 patients have been treated by this technic, 46 of 55 were followed for more than five months. Of 46, 41 were successful in that wound healed and no further evidence of drainage or intection occured. We pointed out many problems of this technic and improved the method. To improve the effect of the irrigation, we made a 4 channel method utilizing the double silicon tube, and succeeded in preventing the obstruction of the tube.
In recent 5 years, 44 cases of hematogenous osteomyelitis were experienced in our clinic. The femurs were involved in 16 cases. Next, in order of frequency were 14 tibiae, 8 arms, 3 iliac bones and others. No pyogenic organisms could be cultured in 15 cases, and among the remaining 29 cases staphylococcus were cultured in 23 (79.3%). According to the clinical courses, physical signs, laboratory tests and X-ray findings, 7 cases were suspected bone tumors, and the diagnosis could be confirmed after surgery.
Mrs. T. M., a nurse, twenty-nine years old, had a eleven-year history of rheumatoid arthritis. In October 1972, she noticed a spontaneous inability to extend the fourth and fifth fingers of the right hand. Clinical examination revealed dorsal prominence of the distal end of the ulna and typical findings of rheumatoid arthritis in the hands. At operation, the tendon of the extensor digiti quinti proprius was found to have been ruptured. The extensor digitorum communis tendons to the fourth and fifth fingers were separated completely.
The basic objectives of surgery for Rheumatoid hip are to preserve articular surfaces, to relieve pain, to correct deformity, and to improve motion and function. We believe that arthroplasty of the hip is the most successful operation. We have experienced Cup-arthroplasty, prosthetic replacement and total hip replacement. We discussed the indication and problem of the surgical treatment for Rheumatoid hip.
Since the first report of Lande who, in 1927, reported benefit from the use of gold thioglucose in 14 patients, gold salts have been used for the treatment of rheumatoid arthritis for approximately fifty years. Nevertheless, the definite method of maintenance therapy has not been constituted. So we selected 47 cases and discussed the way of maintenance therapy.
The relationship between clinical response and serum gold levels in chrysotherapy was studied in 61 cases of the patients with rheumatoid arthritis. Thec ases were divided into group A and B. The group A includes 31 cases with chrysotherapy in every one week. The group B includes 30 cases with chrysotherapy in every two., three and four weeks. The improvements of morning stiffness, ESR, CRP test and the score of joint activity by Lansbury were admitted remarkably in group A. The side effects such as the exanthema and stomatitis were noted in 56% of group A and in 17% of group B.
Today, total hip replacement for hip joint has already been accepted as a common treatment. But total knee replacement seems to be now under study because it contains many problems in its prosthesis, complication and results. We performed the synovectomies and the arthroplasties with the MacIntosh prosthesis for the two patients who could not walk due to the flexion contractures of the knee from the rheumatoid arthritis. And they gained the relief of pain and restoration of function and attained to be able to walk with a crutch.
The intradural spinal lipoma was not frequently seen at spinal surgery. We have recently experienced a case of it. M. A., male aged 44. complaining admitted to our clinic on October 25, 1972. was dysuria. His physical findings revealed the saddle anesthesia and the neurogenic bladder. A cysternal myelogram showed the contrast medium defect like tumor at the level of between L3 and L5. Laminectomy of L3-L5 was performed. The yellowish intradural tumor about 10cm in length was found and strongly fused adhesive to the cauda equina. Microscopic section of the specimen showed well differentiated adiposed tissue.
A seventeen years old boy was admitted to our clinic on March, 7. 1973, complaining gait disturbance with a relapsing history for the past seven years. He had clinical manifestations of spastic paraplesia, decrease in sensation below D-9 level, areflexia in the lower abdomen, bilateral clonus and bladder dysfunction. Myelographic examination revealed the complete block of the subarachinoid space at the level of 7th dorsal vertebra. Laminectomy and myelotomy for simple drainage of cyst were performed at the mid-dorsal region. Biopsy revealed no evidence of neoplastic cells. Postoperatively he showed gradual improvement in the paresis.
Three cases of the spinal cord tumor of special interest, that we have recently experienced, were reported. Case 1. a male, aged 45 years, was removed neurinoma located in the extradural space of C2-3 with bulky deposits of Calcium in the center of the tumor. Case 2. a female, aged 43 years, was operated for neurinoma located in the extradural space of Th2-3 continued to the large tumor of the right extravertebral, extrapleural space, which compressed the lung. Case 3. a female, aged 23 years, was removed epidermoid cyst located in the intradural space of L3-4. Those tumors were almost completely removed with successful results. The second case needed simultaneous thoracotomy.
A 61 year-old man. His early complaint was clumsiness in the legs. This complaint increased gradually, being accompanied by sensory disturbances of the lower extremities. He gradually became incapable of walking and standing. On X-ray findings, ossification of the posterior longitudinal ligament were observed in the 6th and 7th thoracic spine. Laminectomy was pursued and the disturbance of walking and sensibility have satisfactorily diminished at post-ope. 12 weeks.
A thirty-four year-old male was admitted with the chief complaint of his left shoulder pain. No positive physical and neurological findings were seen around the shoulder, but at that time markedly limited movement, especially rotation and anteflexion, of the neck was noticed out. Antero-posterior roentgenogram of the atlas revealed increased height of the massa lateralis or distance between the fovea articularis superior and the facies articularis inferior, and lateral roentgenogram revealed deep saddle form conture of the atlantoccipital joint. Extension and flexion of the neck measured by roentgenograms showed normal range of motion at the atlantooccipital joint and rigid articulatio atlantoaxialis lateralis.
The localisation of neurological findings in the spinal cord of the upper cervix is often unprecise and compression of the cord, especially due to congenital anomaly of the cervical spine, is often not recognised at first. A woman, twenty-one years old, suffered from disturbance of gait and skilled movement in the hands. At first she was diagnosed as cerebral palsy. There were no abnormal findings at birth and early infancy. She began to walk at eleven months, but tended to fall often. Cranial nerves are not affected but spasticity in the limbs exists. The lateral Roentgenogram of the neck showed a separated odontoid process which in flexion and extension demonstrated an abnormal range of motion. Congenital anomaly is often asymptomatic, but narrowing of the cervical canal with cord compression may occur. The investigation of any case of spasticity in all four limbs must therefore include a detailed Roentgenological assessment of the cervical spine. Congenital anomaly of the upper cervical spine is often recognised only because of symptoms which follow various types of traumas to the head or neck; otherwise this anomaly would go unnoticed. A man, twenty-four years old, started to have neck pain, headache, tinnitis and dizziness after a whiplash injury. No neurological signs were present at the time. Roentgenograms of the neck however showed developmental failure of the posterior arch of the atlas.
We experienced congenital anomalies of the cervical spine among 4961 patients in our clinic. These anomalies were analyzed 77 cases of congenital cervical vertebral fusion (C2-C3: 28, C5-C6: 13, C3-4: 12, Occ-C1: 9 and others), 14 cases of spina bifida occulta, 125 cases of posterior ponticle of atlas, and one case of os odontoideum. Among congenital cervical vertebral fusion 14 cases of myelopathy were observed, of which 4 cases were operated. Congenital fusion of lower cervical vertebrae affected commonly degeneration of adjacent vertebral disc. Congenital fusion of the occiput and the first vertebra is more frequently complicated with basilar impression and atlantoaxial subluxation.
The interesting cases of bony anomalies with various neurological symptoms in the upper cervical region were presented to discuss the relationship between the degree of bony anomalies and the severity of neurological symptoms. Case 1: acute complete quadriplegia due to atlantoaxial dislocation with os odontoideum. Case 2: Klippel-Feil syndrome with spondylotic myelopathy. Case 3: atlantooccipital assimilation with the severe symptoms of the brain stem and the upper cervical cord. Case 4: Arnold-Chiari malformation with remarkable cerebellar symptoms. Craniometry concerning the diagnosis of basilar impression was done on the x-ray films. All of the cases were accompanied with the various degree of basilar impression. In conclusion, the severity of neurological symptoms was in proportion to the degree of the narrowing of the foramen magnum and the cervical canal.
Fracture of the atlas is seldom recognized, because of anatomical characteristics. 3 patients of fracture of the Atlas (one case was isolated and two cases were associated fractures) recently were treated in our clinic. In all cases clinical symptoms, being relatively mild, improved under conservative treatment. Case 1. 47 years old, male, downfall, associated with fractures of 2nd spinous process and 7th vertebral body. Case 2. 21 years old, male, traffic accident, associated with fracture of the odontoid process. Case 3. 22 years old, male, traffic accident, isolated fracture of the atlas.
Histopathological and histochemical studies were performed on forty intervertebral discs which were taken by anterior discotomy and investigated the correlation between degenerative changes of discs and discogram. Staining methods were as follows, 1. H. E. 2. Azan Mallory 3. Alcian Blue 4. Metachromasia R 5. Ca S (von Kossa) 6. PAS R 7. Phosphorylase R Results 1. The degenerative changes of the discs which were taken from disc lesion were higher than the degenerative process with aging. 2. The degenerative order of the parts of the intervertebral disc is cartilagious plate, annular fiber and nucleus pulposus. 3. The rate of coincidence between histopathological changes and discogram was 90%.
The various suggestions have been made as to the etiology of the lumbar disc lesions. Of these suggestions the correlation between disc lesion and trauma, developmental anomaly were investigated about 109 cases which were diagnosed by neurological sign and special contrast studies. The results were as follows, 1) The corerelation between 1. disc lesion and trauma was 25.3% 2. disc lesion and developmental anomaly was not clear. 2) Disc lesions with transitional vertebra were often localized in L4-5 discs. 3) The frequency with spina bifida occulta in spondylolysis is high.
Two kind of water soluble contrast media “Mgl. iothalamate” and “Mgl. iocarmate” were used for standing functional myelography of the lumbar spine. Twenty-seven patients, aged from 19 to 64, complained of low back pain and of radiating pain to the leg, were diagnosed lumbar disc protrusion in 18 cases, thickening of the lig. flava in 5 cases, spinal canal stenosis in 2 cases, and others. Almost all of the three diseases revealed distinct change of myelographic findings. As narrowing of the column of the contrast medium was observed at the level of disc and facet, significant informations were obtained by comparison of sagital diameter at this level to those of adjacent vertebral body in position of standing flexion and extension of the spine.
Peridurography is a X-ray diagnostic technique for the lumbar disc lesion. The special studies were performed in 150 cases (Conservative treatment 100 cases, operative treatment 50 cases.) and discussed on the pain responses. Coincidence between pain response and patient's daily complaint was investigated in every level of lumbar disc lesion. Intervertebral disc in L5-S revealed the highest rate of it, and especially radiating pain coincided with the patient's daily complaints. Therefore, the pain response is seemed to be a very important factor in the final diagnosis of lumbar disc lesions.
The main diagnosis of cervical disease may be due to neurological signs, but special contrast studies are often necessary. Of these special studies, myelography is the most valuable X-ray diagnostic technique, however this technique has several dangers. Therefore, peridurography was adopted in order to reduce them. The results were as follows. 1. The X-ray findings in myelopathy reveal posterior protrusion of anterior contrast medium, stenosis, diffuse defect and decrease of A-P diameter. 2. In radiculopathy, oblique and A-P X-ray findings reveal unclear nerve root and partial defect. 3. The rate of coincidence between symptomes and their pain responses is 90.6%.
A 11-year-old girl was admitted in our clinic complaining of increased spinal lordosis. This deformity was found as early as two years of age and difficult to flex her trunk forward. The development of the extremities were normal without any complications. The deformity increased with years and became fixed. No congenital anomalies and systemic diseases were checked on X-ray. Not any neurogenic disturbances were found. Muscle release of low back and iliopsoas were operated on. Histological examination of back muscles showed an excess of adipose and fibrous tissues with small bundle of decreased muscle fibers.
Hormonal metabolic function in idiopathic scoliosis was examined, obtaining the following summaries: 1) Rhorer index pattern in the cases with scolisosis indicated that the cases in idiopathic group showed a tendency of emaciation. 2) The results of the tests for endocrine function (B. M. R., Growth Hormone, Pituitary Gonadotropin, 17-OHCS level, Metopriron test, ACTH test, Blood sugar controll test) suggested that in the cases with idiopathic scoliosis there exists a hypofunction in the hypothalamo-hypophyseal system.
Sixy-eight patients with tuberculous spondylitis or arthritis were observed. According to analysis of these cases, there were forty-three in the spine, eight in the hip, four in the knee and thirteen in others. Surgical procedures were required in twenty out of sixty-eight. There were tendency of increasing incidence in old age. Occasionary it was difficult to differentiate spinal tumor from spondylitis tuberculosa in old age.
Since 1963 seventy-one cases of tuberculous spondylitis were operated by radical removal of the diseased area, in which except 3 cases anterior spinal fusions were applied. Average age of the patients was 43 years (3-75). The local incidence were as follows; one in cervical, 18 in thoracic, 9 in dorsolumbar, 37 lumbar, and 6 in lumbosacral. Two patients died; one after 8 days by kidney and circulatory complication, and another after 14 days by hypoproteinaemia and general emaciation. Excellent or good results were obtained in all other cases. Recovery of Pott paraplegia was excellent. Average duration of bed rest after surgery was 4 months. No relaps has been produced.
133Xe clearance in about 100 cases with knee joint diseases was determined and thebiological half life (T1/2) was calculated. The results were as follows. 1. The greater the degree of pain, the shorter was T1/2 in all knee joint diseases. 2. No relationship could be demonstrated between T1/2 and Xray evidence of osteoarthritis. 3. Shortning of T1/2 was noted in many cases with articular effusion of large volume, but no relationship was noted between T1/2 value and those with mild or no articular effusions.
Serum and synovial fluid were collected from 80 patients with osteoarthritis and 10 patients with rheumatoid arthritis and the protein fractions of them were estimated electrophoretically. The following results were obtained: 1) Synovial fluid was found to contain 5 welldefined components. 2) The electrophoretic patterns of the total serum and synovial fluid proteins were almost similar in each cases. 3) Serum and synovial fluid proteins of osteoarthritis showed higher albumin, but lower gamma globulin levels than that of rheumatoid arthritis. 4) The total protein in the synovial fluid of osteoarthritis was approximately 3.05/dl in old age.
Femoro-tibial angles (FTA) of the 218 osteoarthritic knees in 141 patients were measured by x-rays at non-weight-bearing and weight-bearing. In 98% out of 137 moderate cases, FTA were between 171 to 180 degrees at non-weight-bearing, being in 96% at weight-bearing. Although at non-weight-bearing in 81 severe cases, FTA were measured over 180 degrees showing varus in 4 cases (5%) and under 171 degrees showing valgus in 6 cases (7%), they were measured in 17 cases (21%) and in 8 cases (10%) at weight-bearing, respectively.
The surgical treatment of osteoarthritic knee has been advanced greatly in recent years. It has been due mainly to successful application of new method of arthroplasty and of osteotomy. Since 1970, hemiarthroplasty was carried out in fifteen patients. Five of them were affected with osteoarthritis of the knee. The results were discussed. We stressed that high tibial osteotomy was a more successful method of treatment in the uni-compartmental type of osteoarthritis. Osteotomy seems to be the first choice in most cases of this type. Hemiarthroplasty should be reserved for certain selected cases.
The cases with osteoarthritis of the knee with persistent effusion were evaluated by X-ray at weight-bearing. Unilateral narrowing of the knee joint at weight bearing was assumed to cause instability and thrust of the knee joint at walking. Six of these cases were treated by hemiarthroplasty with the modified McKeever tibial plateau prosthesis. At average 10.3 months of following-up period, clinical results were revealed two cases as excellent, three as good and one as fair, assessed by Weinfeld's method of evaluation of arthroplasty of the knee joint. As early complication, occaisional hemoarthrosis was noted in one case, but late complications, such as sinking of the prosthesis, have not yet known.
In two years, the knee operations numbered twenty-four, most of which comprised the success of the procedure. High tibial osteotomy was indicated in fifteen joints and relief of pain, an adequate functional range of motion and no recurrence of effusion were obtained. A new arthrosis in the proximal tibio-fibular joint was hazardous provided that the joint was left. Lateral instability, however, sustained invariably after the procedure. Little loss of motions postoperatively in synovectomized joint usually was observed and was not associated either with pain or local recurrence. Implants of various designs to replace the tibial and/or femoral surfaces have recently enjoyed considerably popularity. Hemi-arthroplasty by prosthesis of MacIntosh was done twice, Shiers once, and a new type of Geomedic once. We have not been able to formulate any general rule as to arthroplasty.