Ten patients in whom fracture of the talus with or without dislocation was recently treated in our clinic and related hospitals have been followed up (average 2 years and 6 months). Avascular necrosis of the body of the talus occurred in 5 patients (50%). They had often associated with the subtalar luxation and/or the fracture of the malleolus, but had no close relation to initial treatment. Sufficient riduction, stable fixation and non weight bearing are the principle of treatment to prevent avascular necrosis and osteoarthritis of the ankle joint. If avascular necrosis is recognized, non weight bearing extending a long period of time will be necessary in anticipation to replace necrosis mass by new bone.
The treatment of 7 cases of tendon dislocation that we have experienced in these 3 years was reported in this paper. They were 3 cases of peroneus tendon and 4 cases of tibialis posterior tendon. The cases with tendon dislocatin were found in 3.2 per cent of the patients treated for ankle injury, and the ratio was higher than the prior other reports. But taking notice of this kind of injury, more cases will be found. The mean age of the patients was 24 years old, these injury used to be caused by sport in young men. Enforced varus cause the peroneus tendon to dislocate and enforced valgus cause the dislocation of tibialis posterior tendon. Chief complaint were local pain and abnormal elevation. The dislocation was diagnosed easily and surely with tendovaginography. Du Vries' operation was a easy and reliable treatment but bone block should be slided within ten mm not to remain post operative local pain.
Serum electrophoresis was carried out on cellulose acetate strips (1.5×7cm), Serum, 0.001ml, was applied with a thin capillary from the end of the strip. A veronal buffer was used (pH 8.6 μ 0.06), and with a current of 2mA per cm. width of strip, the duration of the run was 30 minutes. Each strip was removed after the run, stained for protein with Ponso 3R and alkaline phosphatase with Fast blue BB. With this method alkaline phosphatase was well separated easily.
A 48-years-old man was admited on June 4, 1975 with the complaint of swelling and pain of right side clavicle. He had been taken pustulosis palmaris et plantaris 15 years ago. Finding of the clavicle was that of the osteomyelitis by the X-ray examination and pathohistology. We consider that the osteomyelitis is associated with the pustulosis palmaris et plantaris.
We have often experienced Coxitis Simplex in childhood. The purpose of this paper was to investigate the etiology from the serological methods. The results obtained were follows; 1) Clinical examinations were carried out on 28 cases which were initially diagnosed as Coxitis Simplex at Shin Nittetsu Yahata Hospital during a 5-year period from 1971 to 1975. 2) The etiology of Coxitis Simplex may not be only one. It may be trauma, allergy and so on. It was suggested that many cases of Coxitis Simplex was concerned with the infection of Streptococcus hemolyticus in this study.
We observed several kinds of bone and soft tissue tumor under the scanning electron microscope using the frozen resin cracking method and the ion etching technique. The details of finding were as follows. 1. Giant cell tumor of bone Many spherical mitochondria (0.3-0.4μ in diameter) and bizarre nuclei were observed in the giant cell. Nuclear pores were seen at the surface of the nucleus of the endothelial cell. 2. Osteosarcoma The osteosarcoma cell was surrounded by collagen fibers, and occasionally contained solid and spherical structures about 1.0μ in diameter (possibly fat globules). 3. Malignant fibrous histiocytoma of bone Collagen fibers surrounded the spindle-shaped fibroblastic cell. The nucleus shape was irregular. 4. Liposarcoma Spherical fat globules about 0.8μ in diameter were observed in the cytoplasma of the lipdsarcoma cell.
This case was a five-year-old girl with the disorder of numerous bones that is more severe on one side of her body. Roentgenographically, the foci present more or less radiolucent areas interspersed by one or several septa running approximately in the long axes of the bones. Such striped radiolucent areas expanded in the epiphysial regions in severely affected bones as well. The focus at the distal metaphysis of right femur treated by curettage was occupied by glassy, gray-white, discrete or confluent cartilage masses separated by bony septa. Microscopic findings showed the proliferation of the hyaline cartilage tumor cells with triangular nuclei.
A 34 year old woman of eosinophlic granuloma was reported. The tumor was located in the soft tissue of the right upper arm, and confirmed finally its nature histopathologically. In this case, there were neither leukocytosis, eosinophlia nor elevated erythrocyte sedimentation rate, which were characteristic to eosinophilic granuloma. It is interesting that after the resection of the tumor transient eosinophilia appeared.
Bony lesion by a rhabdomyosarcoma in a 54-year-old male was reported. The patient sustained of open fractures of right femur, tibia and fibula complicating with hemothorax resulting from a traffic accident was admitted in our hospital. He had been recuperating after osteosynthesis untill osteomyelitis took place later. Ten months after the surgery he complained of progressive swelling and pain on the fractured region of the right lower leg. X-ray examination revealed suspecious signs of pathologic fracture. The diagnosis of rhabdomyosarcoma was established with pathohistological examination of biopsied specimens. He died of disseminated metastasis in spite of an amputation at the thigh.
Eighty cases with tumor of the soft tissue during the past twenty two years were presented. Fifty one casses were benign and twenty nine cases were malignant, respectively. The majority of the patients with malignant tumor died within two years, thus indicating a high grade of malignancy, whereas the relationship of the prognosis of the patient to the histological typing of the soft tissue tumor remained to be elucidated. Rare cases of the tumor, including synovial sarcoma, extramedullary plasmacytoma and eosinophilic granuloma were also reported.
A female, aged 76 years came to our hospital complainnig of sudden pain in the low back for three days. X-ray photograms showed neither fracture nor metastatic tumor. But as pain increased day by day, X-ray photograms were taken again one week after the initial time revealing a vertical fracture of the fourth lumbar vertebra. According to the experiment done by Roaf (1960) on the basic spinal unit taken from cadaver, vertical fracture occurs only when the intervertebral disc has its normal turgor. She had gemeral osteoporosis due to aging and to renal insufficiency. This is considered to play an important role in the occurrence of this type of fracture because her discs cannot anticipated to be normal.
This study is a preliminary report of the transverse axial tomography of the lumbar spines to evaluate them in the transverse plane. The cross section views were obtained in intraosseous and articular segments of the lumbar spinal canal at L4-S1 level in 10 normal men. We measured the transverse diameter, the sagital one and the area of the 4th and the 5th intraosseous segmats of the bony vertebral canal as follows; L4 transverse diameter 22.0mm sagital diameter 18.7mm area 256.4mm2 L5 transverse diameter 26.8mm sagital diameter 20.2mm area 367.0 mm2 ratio of L4 to L5 transverse diameter 82.5% sagital diameter 93.0% area 74.4% The shape of the bony lumbar vertebral canal was like a chestnut.
Twenty patients out of 315 with herniated lumbar discs showed a total block of myelogram were operated on in our clinic for the past 10 years, the incidence being 6.3%. The total blocks located at the L4-L5 in 15 patients and L5-S1 in 5, and the most significant clinical sign was a positive Lasègue's test. Sixteen herniated discs were removed by Love's operation and 6 by laminectomy. The follow-up results of 16 patients after 1 to 6 years revealed to be satisfactory in 14 patients.
During the period 1974-1975 we have experienced 15 cases of pelvic-ring-instability. All were females, 6 of them had no connection with pregnancy and parturition and 5 cases began to suffer several years after delivery. They had lumbago, dull pain from buttock to thigh, tenderness of ilio-sacral part, ilio-sacral pain by extension of the hip joint and these eymptoms had relieved temporally by local anaesthesis to ligaments behined the sacro-iliac joint. Beside these symptoms, we frequently noticed tenderness on pubic symphysis and radiating pain toward sacro-iliac joint, hip pain in walking, deformity of pubic symphysis, overmobility of pubic symphysis and osteitis-condensans-ilei like change. All of them had neither connection with T. B., rheumatic disease nor any changes in the lumbar spine. We can easily understand these series of findings, I think, when we recognize pelvic ring as a mechanical unit. The lesion will be occured by the over-stress to the sacro-iliac joint in the bases of sexual and individual differences of pelvis and sacro-iliac joint.
The nerve block of the articular branch of the tibial nerve was carried out with 1ml of 1% Lidocaine in 68 knee joints with severe pain mostly in the distal antero-medial portion. Although the pain was disappeared in 23 and was reduced markedly in 37 after blockage, the effect was continued for only one hour in a majority of the cases. The neurectomy or the nerve block with 1ml of absolute alcohol or 10% phenol solution was carried out in 8 and 9 respectively to get a continuous reduction of pain. The result was satisfactory in the neurectomy but less effective in the nerve block.
26 Patients of the entrapment neuropathy of the plantar nerve were examined. The complaints of them were pain and sensory disturbance in the sole of the foot. Clinical examination revealed that they had sensory disturbance and tenderness on the entrapment point. The point was one half fingerbreadth below and one fingerbreadth anterior to the medial malleolus. All patients but one were treated by local infiltration of dexamethazone. One patient was operated because the local infiltration could not relief the condition. The plantar nerve was pressed by abnormal tendinous portion of the abductor hallucis muscle. The differential diagnosis and its relation to the tarsal tunnel syndrome were discussed.
The etiologies of cerebral palsy are varied and very complicated. Retrospective clinical examination of cerebral palsy of prematurely born children were performed. During the years 1971 to 1975, low birth weight infants were found in 73 cases (41.5%) of the 176 cases of cerebral palsy. The incidence of cerebral palsy was increased, as birth weight decreased. 28 cases in 73 cases gave a history of neonatal asphyxia. 25 cases gave a history of severe neonatal jaundice, which was complicated further by premature birth. Perinatal and postnatal cares are needed in order to prevent low birth weight infants with cerebral palsy.
On the twenty patients with seve head injury, their disabilities (movemet, ambulation, speech and psycological factors etc.) were observed. The patients, who having left hemiplegia and a few coma period at the injury time, were haved usually a little disability.
The human toxicosis that was caused about ingestion of PCB through mouth, is only one in the world that is an occurrence of Kanemi Yushô in 1968 year, The sufferer is a person above 14000. This report is that the examination on sensibility of temperature is held about 71 patients and exhibits the paralysis of temperature in half that is 34 patients.