Since 1973, we have studied lumbo-sacral myelograms using methylglucamine incarmate (Dimer X) on 57 patients with low back pain (in our Hospital). They were divided into two grours: thirty cases examined by using 5cc of methylglucamin iocarmate only, and twenty-seven cases by mixture of 3cc of methylgrucamine iocarmate and 2cc of liquor. The former has much better results in ability of radiographic contrast (sharply demarcated) and side effects than the latter. We consider that water soluble contrast myelography is valuable for diagnosis and indication of treatment for the low-back condition.
Forty patients with cervico-omo-brachial syndrome, twenty with cervical spondylotic myelopathy, twenty cervical spondylotic radicuolpathy and 20 normal controls were selected for this study. After catheter for cevrical epidural anesthesia had been placed in the cervlcai epidural space of these cases, circulation of the epidural space by R. I. and cervical peridurography were examined. From the results of our study, we suggest that one of the causes of cervico-omo-brachial syndrome is the lesion of the root area or unstable circulatory dynamics of the cervical epidural space.
The myelopathy in cervical osteochondrosis was classified into the three types, that is the central type (type I), the posterolateral type (tye II) and the posteroanterolateral type (type III), due to the range and the severity of the cord damage. It was discussed the relation between these types and clinical findings. The posteroanterolateral type shows most sevese type in the subjective and objective symptom. Generally, the first subjective and objective symptom appears on the upper extremities. The type is transitive (type I→type II→type III). Compared the disturbed region of the spinal cord by the clinical view with by myelogram, the former extend to some upper cord.
Isolated horizontal fracture of the anterior arch of the atlas is very rare. Few references to this fracture are in the literature: Boni and Kuroda mentioned a case respectively. We report the mechanism, clinical symptoms, roentgenometry, and differential diagnosis of this fracturs.
Case 1. A 43 years old man. The neurological signs were as follows; 1) sensory disturbance below bilateral T10 dermatome level, 2) bowel and bladder disturbance 3) spastic gait. Myelogram revealed complete block at the level of T9-10. Laminectomy was done from T9 to T11 inclusive. At the level of T9-10 disc on the right side, a protruded mass was removed. The recovery was excellent. Case 2. A 18 years old boy. The neurological signs as follows; 1) sensory disturbance below L1 dermatome level, 2) hyperreflexia, 3) right femoral and bilateral sciatic nerve stretch test positive. Myelogram revealed the contrast medium defect at the level of L1-2 intervertebral disc. Laminectomy was performed from L1 to L2. At the level of L1-2 disc on the right side, a protruded mass was removed. The recovery was poor. The microscopic findings of these were degenerated discs.
Thoracic myelopathy is very rare condition. We experienced 6 cases of this condition, namely a case of ossification of the posterior longitudinal ligament of thoracic spine, a case of 8th thoracic intervertebral disc herniation, a case of ankylosing spondylitis, and a case of ossification of the yellow ligament from eighth to eleventh thoracic vertebra. According to myelographic block laminectomy was carried out in all cases, including nucleotomy for disc herniation and extirpation of ossified ligament. The operative results are satisfactory in 3 cases, the other 3 cases are fair. The operative results showed that extent of laminectomy is most responsible for relieve the symptoms.
A female, aged 27 years, was admitted to our hospital complaining of a radiating pain in the left leg. X-ray findigs showed the localized ossification situated at the posterior margin of the L4-5 vertebral body. On myelography posterior protrusion at L4-5 and L5-S1 intervertebral space were found. Her clinical signs seem to arisen from L5 nerve root compression due to the bony fragment at L4-5. Laminectomy has been carried out. Bony fragment compressed L5 nerve root and dura mater posteriorly at the posterior site of the L4 vertebral body, and large protruded disc was found at L5-S1. Histologically, the excised bony fragment showed metaplastic ossification of the posterior longitudinal ligament.
The symptoms of Lumbar Canal Stenosis are cauda equina claudication, unremitting back pain and sciatica. Cauda equina claudication is chiefly chracterized by weakness and numbness in the leg. In evaluating its synptoms, we used Thermography for 24 cases of Lumbar Canal Stenosis. In 2/3 cases, thermogram showed the area of the numbness of the leg nearly. On cooling and venous occluding test, the temperature of the leg became smoothly low down. After removing the load, the surface temperature recovered according to the severity of the symptoms.
Clinical investigation of lumbar disc herniation has been made about 395 cases which were operated on. The results were as follows; 1) Disc herniation was mostly found in second and third decade male heavy workers in L4-5 intervertebral disc with chief complain of left leg pain. 2) Provocating causes were found in 52.1%. 3) As to the physical sign, restriction of movement, sensory disturbance and Lasegue sign were found in high percentage (about 80%). 4) Muscle weakness and decrease of tendon reflex were found in low percentage (about 40%).
More than two hundred fifty cases of the aged of more than 60 year old were studied about relationship between degree of spinal curvature of thoracic kyphosis and lumbar as well as cervical lordosis and tilting of the sacrum. Significant co-efficient of co-relations were demonstrated in balanced type of the spinal posture between degree of tilting of superior surface of the sacrum and lumbar lordosis, thoracic kyphosis and lumbar lordosis, as well as thoracic kyphosis and cervical lordosis. It would be admitted that the curvatures of every part of the spinal column have an influence to each other in balanced type of the posture. In many of severe kyphosis, there have been observed an extension contracture of the cervical and lumbar spine, which showed a limitation of flexion. Electromyography by surface electrode revealed high action potential from lumbar and/or cervical extensors during standing in case of imbalanced, especially in lumbar and dorsolumbar kyphosis, and gives better informations for treatment.
From April 1971 to July 1974, 5, 745 newborn babies were routinely examined by the Ortolani technique within the first week of life. Ortolani's click sign with restricted abduction were noticed in 19 cases (0.33%) in the newborn babies. On the other hand, in the examination of 3, 403 babies, 8 cases of Ortolani's click positive were found and 20 cases were noticed the limitation of abduction with the acetabular dysplasia at examination about one and three months after birth. It is our opinion that all newborn infants should be examined by the Ortolani's technique, at least, within the first week of life and checked about one and three months and a year after birth.
Roentgenograms of 22 cases of congenital dislocation with interposition of soft tissues in the hip joint which had been treated with over head traction method or careful manual reduction were examined. The interposition of soft tissues had no bearing on the outcome in these cases. Thus in itself, it does not indicate open reduction. Open reduction should be reserved for the very few cases in which closed reduction is unsuccessful. Closed reduction is the method of choice in congenital dislocation of the hip joint.
Owing to the new settled neutral zero-starting position method, it became inconvenient to measure the range of the joint motion with the conventional goniometers, we have succeeded in inventing five new flat goniometers, a pendulum type goniometer and a caliper. With these devices, you can read the degrees of the scale directly in measuring the motions of all the joint ranges. The goniometers are constructed of transparent plastic and have lots of advantages.
Robichon (1974) reported a method of measuring the ratio between the length and width of the femoral neck in Perthes' disease. On 34 patients with unilateral Perthes' disease which had been treated by abduction plaster cast method, this measurement were made at the intervals of several monthes during the whole course of the disease. Consequently it was found that the degree of shortening and widening of the neck corresponded to the degree of malfomation of the head, but it was difficult to predict the prognosis of the disease within six monthes from onset.
Twelve cases of Perthes's disease operated on by intertrochanteric varus osteotomy with epiphyseodesis of the greater trochanter were followed on an average of 7 years and 5 months after the operation. 1) Satisfactory results were obtained in the cases operated on before 6 years of age. 2) The operation could be indicated for the late and regeneration stage of the disease, as for the early stage. 3) Development of high position of the greater trochanter appeared to be prevented by epiphyseodesis. 4) There were no significant differences in the anatomical results between the cases operated conservatively, but the periods of treatment were markedly reduced in the cases operated on.
For the purpose of makiug clear factor the ftacor of the toeing-in gait in congenital club foot, we make a trial of the objective measure the radiograph. (1) As the result of measure with the horisontal cross rotatory radiograph, there is denying of the adduction of the talus at the ankle mortice. (2) Antero-Posterior radiograph of the foot is gain at 30 plantal flexion. In this radiograph, the adduction of the talus neck, inner movement of the scaphoid, the adduction of the metatarsal bone, were observed. (3) The important factor of the toeing-in gait is the adduction of the foot axis. And inner movement of the scaphoid causes this adduction.
Though the human standing posture is disturbed constantly by various external and internal factors, antigravity muscles and their antagonists, etc. work at every moments to prevent from falling but causing minute sway, in which control mechanism of posture holding would be hidden. It was verified the postural sways in each of lateral and antero-posterior axes respectively show normal Gaussian stochastic processes. In addition, the amount of the sway at an arbitrary time would be related more or less to those in the past, the postural sway, therefore, can be considered as an autoressive process. Autoregressive power spectra of postural sways in the both axes showed a considerable nonperiodic power around 0Hz and less prominent periodic ones around 4Hz and 8-9Hz respectively. The periodic sways in the antero-posterior axis were more eminent than those in the lateral axis.
In recent years considerable experimental evidence has led to the consideration of Cathepsin D as the chief agent in the degradation of cartilage matrix. However a report has appeared that neutral proteolytic activities are present in the cartilage and that these activities are involved in the degradation of proteoglycans. We tested the enzymatic properties of proteases with the use of autolysis of human articular cartilage. The pH optimum for the Alitolysis of articular cartilage are pH 5 and pH 7-8. The addition of pepstatin at pH 5 inhibited 50% of autolygic degradation of cartilage. On the other hand pepstatin had no inhibition at neutral pH. These experimental evidence has led to the conclusion that there are two or more distinct proteases in articular cartilage.
Osteoarthritic conditions of the knee joints of the rabbits were produced by instability with surgical procedure. Degenerative changes was studied utilizing the cryoscanning EM and TEM. Results were as follows: 1. Surface of degenerative articular cartilage was mainly repaired by the juxta-articular fibrous tissue, synovial origin from peripheral rims. 2. Cell-cluster was concidered as an origin being intraarticular recovery sign in view of the ultrastructure and Aleian Blue staining. 3. Acid Mucopolysaccharide in chodrophyte was demonstrated by the Ruthenium Red staining.
With the increasing use of penicillin many side effects have beee reported. One of them is the inhibitaton of osteogenesis. From Kato's experimental studies to prevent the inhibiting effect of penicillin on osteogenesis, it was found that Vitamin K was the most effective agent for this purpose. Fifty six rats were used in our experiments. We made the closed fractofure tibia of the rats by manual method. Then the animals were divided inio the following groups. 1, Control group. 2, Group with daily injection of PC-G 15000units/kg. 3, Group with daily injection of AB-PC 50mg/kg. 4, Group with daily injection of SB-PC 50mg/kg. 5, Group with daily injection of TP-G 50mg/kg. 6, Group with daily injection of PC-G 15000units/kg and VK2 5mg/kg. 7, Group with daily injection of AB-PC 50mg/kg and VK2 5mg/kg. 8, Group with daily injection of SB-PC 50mg/kg and VK2 5mg/kg. 9, Group with daily injections of TP-G 50mg/kg and VK2 5mg/kg. These antibiotics inhibits especially ossification in its early stage, while Vitamin K2 promotes ossification and negates the inhibitation of ossification by antibiotics.
One hundred and sixty-two cases of Tibial Fractures were treated from 1969 to 1973. We investigated the statistic observations, bone union in each conditions, and follow-up studies of Tibial Fracture. 1. We had thirty five cases of open fractures. 2. Most cases were caused by industrial accidents and next by games and traffic accidents. 3. Average time to bone union in Tibial Fracture differed from fracture level, open or not, operative or not. 4. Immediate osteosythesis for the open fracture gave a poor result in this series. 5. In our follow-up studies, many complaints were left on the cases of open fractures.
The authors experienced 52 fractures of extremity in 25 cases complicated with the serious head injuries for the past 5 years, Thirty eight fractures were closed and 14 open, and the average duration of disturbances of consciousness was 16 days. Nineteen fractures healed conservatively and 33 had to be treated by surgery, being the mean period from injury to surgery 22 weeks, While massive callus formations were noted in 5 fractures, they differed from heterotopic callus formation due to brain damage. They emphasized the necessity of co-operation between neuro-surgeons and orthopedic doctors from the time of first aid.
Von den 29 Fallen der lateralen Schenkelhalsbrüche, die in meiner Klinik blutig behandelt wurden, wurde die Oprerationstechinik, die ein wichtigste Problem bei der Schenkelhals-bruchbehandlung ist und zugleich Krümmung oder Bruch des Nagels im Laufe nach der Operation, die meistens ungünstige Resultat gebracht hat hauptsächlich darstellt und betrachtet.
Thirty three cases of posterior dislocations and posterior fracture-dislocations of the hip were followed-up one to five years. The satiefactory results were obtained in seventeen cases. The clinical results of seventeen cases out of hirty three were analysed as regard the intervals between dislocation and reduction by closed or open method, roentgenographic findings, age of patients, and complications such as a sciatic nerve palsy. It was concluded that in simple dislocations, early closed reduction was acceptable, but in fracture-dislocations early primary open reduction with removal of lose fragment or internal fixation of the fragment was better.
The purpose of the present paper is to describe the effect of our vetrical laminar air flow unit for aseptic operation. Our unit has the ability to remove approximately 99.97% of all particles larger than 0.3 microns in diameter from air. The degree of cleanness in the room can be achieved the class 100 classfication within few minutes after settinig the unit. Air contamination was tested by exposing three brain-heart infusion agar culture plates on the operating table during the course of the operation. The result has been estimated as averaging zero to two colonies per plate during 15 minutes on each stage of the procedure.
Total hip replacement has become a widely accepted procedure in severely affected hip joints. However, it is unknown how long an artificial joint will hold its function and there is no guarantee of absence of complications for a longer period of time. From the standpoint of these problems, we performed the total replacement of the hip in young adult patients and middle aged patients which consisted of an acetabular socket and a cup of concentric type. Nineteen hips were treated with the replacement. Eighteen hips which have been completed over 6 months were evaluated in relation to pain, range of motion and overall assessment. In the assessment of pain, 15 of 18 hips were graded as no pain or slight pain. Most patients gained adequate range of motion but the improvement was not quite as remarkable as relief of pain. The replacement with the combined use of an acetabular socket and a metal cup can be performed on younger patients and middle aged patients and has advantages in comparison with the exceptional use of conventional replacement at such age. The better preservation of bone allows for further reconstruction procedures on the hip. The avoidance of cementing excludes unknown long term effects which might occur.
This paper reports the results of total hip replacement with Weber-Huggler type prosthesis (made in Japan) in 25 hip joints with a follow up of 3 weeks to 17 months. The series consist of 7 primary osteoarthritis, 10 secondary osteoarthritis and 8 fractured necks of femurs. As regards relief of pain, the results were excellent. As regards ability to walk, always daily living and range of movement, the results were not spectacular in early cases after operation, but they were improved in almost all cases. Early post-operative dislocation in two cases was treated with plaster spica and late one in one case was reduced by revision operation.
Twenty-nine total hip replacement arthroplasties in twenty-four patients with osteoarthritis or rheumatoid arthritis of the hip were performed in our clinic. Total hip replacement arthroplasty utilizing the Mckee-Farrar prosthesis or Sbarbaro prosthesis relieved pain in eighteen of twenty-three diseased hips and improved the ability to walk, mobility and A. D. L. for periods of follow-up ranging from six months to three years. In this series eight complications occurred after twenty-nine replacement procedures. These complications included three loosenings of the socket, two non-unions of the greater trochanter, two periarticular ossifications and one dislocation.
Two cases which needed revision surgery after replacement of femoral head prosthesis were reported. This report showed macrosopic and histological findings of two cases. One of the case which suffered necrosis of both heads of femur were carried out total hip replacements using prosthesis of trunnion type. After surgery, the patient complained pain of both hip joints and was pointed out a pathologic fracture of right femur and wide necrosis of both trochanteric parts on X-ray photographs. Another case was a patient who could not tolerate of his weight bearing on his right hip joinit after the femoral head replacement using acrylic prosthesis, causing pain on walking. Two patients were carried out the revision surgery in our clinic.
Eighteen total hip replacements with Charlney and Charnley-Müller prosthesis for sixteen patients have been carried out since 1971. Preoperative diagnoses are osteoarthritis, aseptic necrosis, failed endoprosthesis, nonunion of the fracture of the femoral neck, ankylosis and Charcot joint. The time of observation after surgery is not long enongh as 5 months to 3.5 years. The results were assessed for pain relief, function and mobility according to the plan adopted and decided by the Japanese Orthopedic Association.
Forty-seven tumors of bone and soft tissues were investigated histochemically, among which 11 osteogenic sarcomas and 13 giant cell tumors of bone were contained. Specimens from frozen section and touch smears were prepared for 4 special stains of PAS, Sudan III, alkaline and acid phosphatase. For the detection of alkaline and acid phosphatase, simultaneous azocoupling method of Tomonaga et al., was employed because of its excellent stainability. Interesting results observed were as follows. 1) In case of giant cell tumor of bone, high activity of acid phosphatase was observed both in stromal cells and in tumor giant cells. 2) Moderate activity of alkaline phosphatase was seen in both cells in 5 cases. 3) One case of Ewing sarcoma showed the reaction of alkaline phosphatase, which was ordinary reported to be abscent. 4) The enzymatic reaction was low in many tumor of soft tissues.
The immunologicai status of patient with primary bone and soft part sarcoma were evaluated by means of measurements of CH50, immunoglobulin G, A, M, absolute lymphocyte counts, subpopulation of lymphocyte, blastformation of lymphocyte by PHA stimmulation and delayed cutaneus hypersensitivity by PPD skin test antigen and DNCB sentization. The observations of these immunological measurments showed wide variation in response in each cases which suggest they do not fully assess the status of cell mediated and humoral immunity in patient with bone and soft part sarcoma.
The five cases of pigmented villonodular synovitis are presented. These cases were two males and three females. The age range in these cases was 19 to 56 years. The knee was involved in three, the ankle one and toe one. In this paper, the histopathological findings and the clinical course were discussed. The histologic pattern is basically consist of masses foam cells, multinucleated giant cells, hemosiderin, fibroblasts with capillary proliferation. Especially, the foam cells and multinucleated giant cells were characteristic. It is suggested that these cells were originated from the mesenchymal tissue. In these cases of pigmented villonodular synovitis extirpation of the lesions is indicated as the favorable therapeutic procedure. In the course of the lesions, there is no evidence of recurrence for one to six years after extirpation in the writer's own experience. The true nature and genesis of pigmented villonodular synovitis is unclear. The idea of the tumorous condition secondary to the inflammatory response rather than neoplasia is suggested from the clinical and histopathological findings.
Cystic intraneural tumors filled with gelatinous material and referred to as “ganglions” are rare and may not be diagnosed without exploration. The patient, a healthy 49-year-old male, injured his right ankle in August, 1973, after which pain in the right calf and knee was developed. Shortly thereafter, the patient developed right footdrop. In March, 1973, the patient was admitted to our hospital. An EMG showed extensive denervation of the tibialis anterior. The peroneal nerve was normal on palpation preopeatively. When explored at surgery, the nerve was found to have a fusiform swelling with a nodular appearance. On incision of the nerve, clear gelatinous viscid material was identified and evacuated. Microscopic examination of portion of the cyst wall revealed no neoplasia. The patient has been doing well at 6 months postoperating, showing moderate return of function.
A 26y-ear-old man developed a sarcoma in his left adductor magnus with inquinal metastasis which classified as was a clear cell sarcoma of tendons and aponeuroses. Conforming to the original description of clear cell sarcoma in many clinical and pathological points, electron microscopic examination from the excised material revealed ultrastructure of melanin. Evidence for a cutaneous melanoma was, however, lacking. This kind of tumor, therefore, must be considered as provisionally named “malignant melanoma of soft parts”.
A house-wife, aged 39, with leiomyosarcoma involving the bone was reported. The patient had complained of rapidly progressive swelling and pain on the left foot for about three months, followed by the formation of two tumors at the medial aspect of the left foot. Radiologically extensive osteolytic lesion of the tarsal bone was demonstrated. Chest radiograph showed no detectable tumorous shadow. Amputation was performed 8 days after admission. The diagnosis of leiomyosarcoma was histologically established. The tumor is presumed to have arisen from the deep soft tissue attached to the tarsal bone, but the possibility of the tumor originated in bone cannot be ruled out. She died of disseminated pulmonary metastases 7 months after her first admission.
1. For the past seventeen years, thirteen cases of fibrous dysplasia of bone which have done the surgical treatment were reviewed. 2. In our thirteen cases, eight was monostotic type, five was polyostotic type, and four cases among the latter were Albright's syndrome. 3. Our follow-up period was from one year to six years. 4. Recurrence of the lesions was seen four cases in monostotic type and three cases in polyostotic type.
A case of Juxtacortical Chondroma was reported. A nineteen-year-old man had a mass on the left leg for 4 months prior to admission. On the medial side of the proxmal half of the left tibia, an elastic-hard extraosseous cartilaginous mass (6×4×1.5cm.) was detected. Roentgenogram showed a calcified soft-tissue and a shallow depression in the cortex of the tibia. A block rescetion of the tumor was performed. Histpathologically the specimens were composed of lobulated, focally calcified lying within a fibrous capsule. Nuclear variation and atypism were not prominent. One month after the first surgery the mass recurred and eight months later a block resection of the tumor was perfermed again.
Osteochondromatosis of the hip joint is uncommon. A man aged twenty-nine years was complaining of pain in the right hip joint, especially at the flexion position. Radiographs showed large extraosseous mass of opacities in the joint cavity. A tentative diagnosis of osteochondromatosis was made by arthrography. At operation about ten loose bodies were removed.
The patient is 25 year old, female. From childfood she had hereditary multiple exostosis. 3 years ago the right thigh started to enlarge gradually and recently she has pain in the same region. From the clinical and X-ray points of view, the diagnosis was made as secondary chondrosarcoma in the upper part of the femur arising in cartilagenous exostosis. The mass was completly removed en-bloc and metal prosthesis was inserted. The tumor weighed 1250g. The histological diagnosis was osteochondroma. 8 months after the operation, there is no evidence of reccurence or metastasis.
The infantile cortical hyperostosis is not frequently seen in Japan. We have recently experienced a case of it. A girl, 3 months of age came to our clinic on May, 1974, with pain in motion. There was no history of previous trauma, specific intectious disease, or any allergy. Family history was unremarkable. Physical examination was negative except for the presence of diffuse swelling and tenderness over her both lower extremities. Laboratory findings were slight anemia and moderate elevation of W. B. C. and B. S. R. Serum calcium, phosphorus, alkaline phatase, protein spectrum, uric acid, urinalysis were considered within normal limits. The Wassrmann reaction was negative. Roentgenograms revealed cortical hyperostotic lesions in the mandible, the humeri (bilateral), the radiuses (bilateral), the ulnas (bilateral), the femurs (bilateral), the tibias (bilateral), and the fibulas (bilateral). No other bone were found to be affected. Cortical hyperostoses were most prominent in the lateral side of the both femurs. Their lesions cleared completely after 6 months.