Total 430 cases of anesthesia from 1961, January 1 to 1973, September 10, at the Adachi Gakuen Hospital were investigated. The most important thing to be paid attenion to the Anesthesia for C. P. is limited only to two matters as follows. 1) To controle the psychological reaction with keeping tight contact with children befor the operation and prescribing heavy after the Anesthesia. 2) To select premedications and anesthetics for reducing salivations and complications through the treatment. Now we use usualy comparatively large dosis of tranqilizer with Atropine sulf. as premedication and Diazepam as relaxant for after treatment.
Equinus deformity of the foot in cerebral palsy is observed most frequently as the factor of impeading the gait and the standing. Although numerous operative methods were contrived for it since old times, the problem of recurrences of the deformity, the weaknes of muscle and etc. were observed frequently. In our educational institution, we have corrected the deformities of 146 patients since 35th of Showa. We could recently trace 51 feet of 33 patients. We have corrected these patients chiefly by gastrocnemius recession contrived by Vulpius, Strayer and so on or lengthening of the tendo calcaneus. In the results, we observed quite numerous recurrences in the gastrocnemius recession group. However gastrocnemius recession has given relatively good results to paraplegia but bad to monoplegia. There were few patients who have weakness of plantar flexor. As there were few patients operated by lengthening of the tendo calcaneus, we could not compare it with gastrocnemius recession.
Results and problems of 12 feet in 6 cases operated on by Batchelor's procedure were investigated. At the same time those of 14 feet in 10 cases were compared. The results of Batchelor's procedure by our criteria were as follows; 4 excellent, 3 good and 5 poor. 4n the othr hand those of Grice & Green's procedure were 4 excellent, 7 good and 3 poor. X-ray diagnosis is useful to judge the degree of the correction. This procedure has several advantages such as easy technique, firm fixation and the least influence on the bone growth, and must be indicated for those of reduced ones. It is necessary for us to observe the postoperative course to prevent the fracture of the graft and muscle unbalance.
In the review of 370 cases of flat feet, pronated feet, and painful accessory scaphoids seen in our clinic during these ten years, seven cases of peroneal spastic flat foot with some congeital tarsal coalition were found out. These congenital tarsal coalitions included 2 cases of medial talocalcaneal coaliotin, a case of posterior talocalcaneal coalition, a case of total (anterior, medial and posterior) talocalcaneal coalition, 2 cases of calcaneonavicular coalition, and a case of talonavicular coalition. In the case of total talocalcaneal coalition, skoliosis and a fusion between carpal navicular and trapezium were found coexisted. Follow-up study of these cases clarified the following: incomplete talocalcaneal coalition were more resistant to conservative treatment than complete type, and remained still symptomatic. On the contrary, 2 Cases of incomplete calcaneonavicular coalition and a case of complete talonavicular coalition became asymptomatic with only a few month's conservative treatment.
Six cases of the Syndactylia of the left Hand are reported. They are in one family and for three generations. In all instances, the middle finger and ring fingar are fused, not osseous. Only in one case, right hand is also involved. Male are 2, female 4.
A case of spondylometaphyseal dysostosis was reported. The subject in this case was a boy who was 8 years of age. The onset was at the time when he was 2 years of age. Clinical features reveal dwarfing, knock-knee deformity and slight impairment of joints movement, especialy hips, knees, shoulders and elbows. Roentgenographic manifestations are as follows. The metaphyseal changes are present in long bones and the epiphyses almost normal. Kyphoscoliosis is present at dorsolumbar region and the vertebral bodies are hypoplastic.
Three patients with Sprengel's Deformity have been treated by Woodward's operation in our clinic for these ten years. In this operation, lowering of the scapula is accomplished by release of the muscles attached to the upper and medial border of the scapula, removal of the omovertebral bone and other limitting structures followed by downward transfer of spinal attachment of the trapezius and rhomboides muscles. Follow-up of our cases were encouraging; There has been no complication. The lowering of the scapula revealed not always enough compared with normal side, but obtained good function of the shoulder.
The patient, a 30 years old male, visited our clinic in June 1973, complained of gait disturbance and hoped to reduce his hypertrophied buttocks and lower limbs which gradually increased its volume during last 5 years. The pigmentations were presented on his face, trunk and all extremities. Roentgenograms revealed scoliosis, bone cysts, cortical defects and anterior angulation of tibia etc. Then angiograms of lower extremities were taken. As treatment, the extirpation of subcutaneous soft tissue including neurofibromatosis and the excision of its skin were done in antero-medial and in posterior parts of left leg in August and October, 1973. In operation, the bleeding from parenchyma was not so little to discomfort. The tumors were various in size and connected one another partly with nerve fibers. The appearance of tumors cut down was grayish and elastic. The tumors of Ca. 4kg. were extirpated. Microscopic examinations of these tumors showed schwannoma composed of numerous grown nerve fibers.
Patient was a man of 15 years, who, when 9 years was diagnosed as so-called Klippel-Weber's disease and some dilated superficial veins and hemangioma were removed. On August 1973, an operation for right hamstring muscle and plaster bandage were performed. After surgery the patient was complaining of pain at his knee joint and foot. Five days after surgery, necrosis and infection were noticed. The wound healed badly and anemia increased. His general condition gradually got worse and he was referrd to our clinic. The thigh was amputated at junction of middle and upper third.
A 5-year-old girl had been treated with local injections of the steroid hormone as stenosing tendovaginitis of the right thumb since Feb. 19, 1972. In May, 1973, swelling at the metacarpophalangeal joint of the right thumb was noted. In June, 23, 1973, the tumor was excised without postoperative recurrence, and diagnosed as so-called juvenile aponeurotic fibroma histologically.
Case 1. 71 years old man noticed a lump in rt. distal thigh for two years. The Tumor involved rt. common peroneal nerve. Macroscopic and microscopic examination suggested a severe degenerated neurilemoma. The large part of the tumor showed increased and enlarged blood vessels dotting, and large degeneration cysts. Case 2. Neurilemoma of R. superficiails ni. radialis dextra in a man aged 50 years. Microscopic features showed a typical neurilemoma with Antoni type A tissue showing palisaded nuclei and type B tissue showing microcystic degeneration.
Solitary bone cysts with surgical treatment were reviewed by clinical, roentgenographic findings, microscopic study and the result of treatment. Of eighteen cases with eleven males and seven females, twelve cases were less than 20 years old. The distribution of the cysts were six cases on femoral proximal end, six Numeral proximal end, three calcaneus, one fibula, one ulna, one pelvis. In nine cases the pathological fracture were first seen. Our follow-up period was from eight months to sixteen years. The result were excellent in eleven, residual defect in four and recurrence in three.
11 patients with histiocytosis-X were reviewed roentogenographically to evaluate the effectiveness of treatment. The cases of solitary lesion of eosinophylic granuloma were successfully treated by curettage alone or curettage alone or curettage with bone graft, but the cases of multiple or spinal lesions were irradiated with doses ranging from 1000 to 2000 rads. A cases of Letterer-Siwe disease has progressed satisfactirily for a few months by a combination of curettage, radiotherapy and chemotherapy.
In 1900, Reichel reported a case of chondromatosis of the knee joint-capsule and described the formation of osteocartilaginous bodies by the synovial membrane. There are three problems on synovial chondromatosis as follows: 1) Is synovial chondromatosis a true neoplasm or a chondrometaplasia? 2) Is the term “synovial chondromatosis” suitable for this condition? 3) Is there evidence of malignant transformation of an originally synovial chondromatosis? Synovial chondromatosis is not so uncommon, but the case presented here is unique in that this osteocartilaginous body is single and huge, which is occupying the medial suprapatellar pouch of left knee joint.
Twenty-five cases of pathological fracture associated with benign bone tumors and tumorous conditions were treated with curettage and chip bone graft for the past 21 years. Thirteen cases including 8 solitary bone cysts, 3 fibrous dysplasias, one chondromyxoid fibroma and one enchondroma could be followed from 4 months to 8 years after the operation, being on an average of three years and eleven months. The fractures had completely healed in all 13 cases, but recurrences were detected in 5 cases of solitary bone cyst. Owing to the results mentioned, grafting of large block combined with chips of bone followed by regional resection are being attempted for preventing recurrence of the cyst.