Serum lipid peroxidation was measured in 17 patients with rheumatoid arthritis, and the titers of lipid peroxidation were much elevated in classical RA patients compared with definite or probable RA. Serum hemolytic complement was measured in 18 RA patients, our studies indicate that activity of RA is reflected by a little elevated serum hemolytic complement rather than a depressed titer, and complement activation in sero positive RA is depressed compared with sero negative RA. The change of content of serum lipid peroxidation in 6 RA patients and hemolytic complement titer in 7 were pursued during 6 months, but they were not always parallel with the clinical course.
44 rheumatoid patients treated by D-Penicillanine during the peroid of 4 to 28 months were estimated clinically and by serological examination. The changes in ESR, CRP, LFT, RAHA, Hb, A/G ratio were measured monthly as the parameters. 34 patients (77.3%) improved, within whom 25 patients (73.5%) showed the effect until 3 months. Adverse reactions appeared on 79 % of the patients with the withdraw of 7 patients (15.9%); 22 cases in dermatologic reaction such as itching and eruption, 8 patients in gastrointestinal upset, 6 patients in proteinuria and 4 patients in loss of taste.
Recently we experienced the gout develping in the family. One of them suffered from the typical gout including the multiple gouty deposits with disintegration and his renal function was impaired. We didn't recognize the effectiveness of the treatment gout with probenecid and bicarbonate of soda. Therefore, we used allopurinol and bicarbonate of soda, and we got the normal control of serum uric acid in this combination. Moreover, as gouty deposits were too eminent and they didn't tend to contract and vanish, we selected surgical treatment too. Conseqnently, we took the good result.
A stady was made on 13 cases, 14 joints—11 knees, 2 elbows and one ankle—, of purulent arthritis of the corticosteroid hormones. There was no x-ray changes in 5 joints and obvious bone and cartilage destruction in 9 joints. Under the administration of large dosis of antibiotics, the synovectomy and debridement were performed. All 5 joints which showed no postoperative improvement of local signs and E. S. R. were diagnosed as the tuberculous arthritis by histological investigotion. All 13 joints out of 14 regained fairly good joint motion and clinical cure. One tuberculous joint undewent secondary arthrodesis.
59 cases, average age 64, were examined by arthrography. Degenerative changes of components of the knee were observed. The relationship between the changes and FTA was recognized. The indication for the treatment was reffered.
We have experienced 5 cases of painful bipaltite patellae. The age of patients ranged from 13 years old to 30, 2 cases were females and 3 cases were males. The type of partite patellae were all Saupe's III. Characteristic clinicalflndings were tenderness on the patella anterior superior and knee pain on the physical exercise such as running. All cases were treated surgically remove of fragment and the result is quite satisfactly.
The cause of persistent symptoms after menisectomy has been assessed clinically, radiologically, arthrographically, and arthroscopically in 10 cases. The commonest findings was the retained fragment of posterier sggment in meniscus. In the largest patient group of our material, the symptoms were caused by a remnant of the operated meniscus. A remnant greater than a half of the length of the original meniscus segment often causes recurrent symptoms, which have been relieved by a second complete menisectomy in our experience.
To know some problem after meniscectomy, we undertake long-term study. There were 13 male and 6 female, age range at operation was from 10 to 49 years. The range of post-operative follow-up was from 10 to 15 years and average was 12.7 years. 1) Thirteen patients had excellent or good results. Five patients undergone discoid meniscectomy in their youth had all good results. 2) Roentogenographic changes noted in all cases, but no related with clinical results. 3) Severe OA changes was seen in 10 patients. (53%) 4) Degree of ligamentous instability was related with OA changes. 5) Two patients of poor result was seen retained posterior horn.
Since 1975, we carried out reconstruction to 4 cases of the injured anterior crutiate ligament by the Kenneth-Jones method which utilizes 1/3 of the patellar ligament. Cases were 4 males aged from 27 to 47 years, all physical laborers. The period before operation ranged from 3 months to 2 years. Three cases showed associated injury such as of the collateral ligament. Reconstruction of the anterior crutiate ligament was performed in these cases. Postoperative results were examined based on the estimation criteria by Solonen and comparatively favorable results were obtained except muscle atrophy of the thigh.
Supprative arthritis in adult represents a diagnostic and therapeutic problem. The purpose of this study is to describe the method of treatment and the results. Seven patients with supprative arthritis of the knee joint were treated. The patients ranged in age from fourty seven to eighty four years with an average age of sixty-four years. Five patients were male and two were female. The mean interval between various predisposing factors and onset of symptoms was 4.4 days. Pain, swelling, fever and impossible to walk were most prevalent complaints. The erythrocyte sedimentation rate was accelerated in five patients and the leucocyte count was elevated in four patients. The organisms cultured from the joint fluid were staphyrococcus aureus and streptococcus pneumoniae. The possible predisposing factors are intraarticular injection of corticosteroids, postoperative infection and systemic administration of corticosteroids. All cases were treated with tubal irrigation with the antibiotic saline. The Trocar Catheter was used and it was soft and flexible and did not destroy the articular cartilage. The joint that contained pus and nectotic debris was washed out with much saline till washings were clear. All patients made an eventful recovery from their infection. Adequate treatment of supprative arthritis is dependent of early suspiction, diagnosis, identification of the organism, prompt institution of adequate antibiotical regimen and tubal irrigation with antibiotic saline.
Three patients with unicompartmental osteoarthritis were treated by single compartment arthroolasty with Marmor's modular knee. Chief complaints were severe pain and the gait disturbance associated with slight varus angulation and the lateral thrust and medial joint-space narrowed showing 184-192° of FTA on the standing X-ray picture. The most significant improvement was noted in pain relief. In this method, no immobilization and long time after treatment are necessary, and this is the most favourable procedure in the elderly patient with single compartment lesion.
We have carried out selective spinal angiography to the disorders of the thoracic and lumber spinal cord in which myelopathy signs are seen, and to the lesions of the vertebral body of the thoracic and lumber spine and the lesion of the intervertebral disc since 1975. The instances consist of 19 cases of spinal cord injuries, 11 cases of spine injuries, 5 cases of spinal cord tumors or probable, 9 cases of tumors of the spine, 7 cases of tuberculosis of the spine, 10 cases of O. P. L. L. and O. Y. L., 3 cases of spinal canal stenosis, 3 cases of disc herniation and other 10 cases. Although the purpose of examinations differ in each disorder, mainly we intend to know spinal cord circulation and to suggest a treatment. We got useful information in each case by performing S. S. A. G. and other examination as myelography at the same time.
Cervical Discography has been performed on 5 cases of traumatic myelopathy. These cases have no fracture, dislocation and disc degeneration in X-P. All of them have negative myelogram. In discography contrast medium leaked into the spinal canal and all patients complained of nape pain, arm pain, when disc was injected. In two patients the pain spread downward into abdomen and extremities. All of them were performed anterior body fusion of cervical spine, neurological recovery were excellent.
Mechanism of arm pain syndrome at handwork is as follows. Overwork at handwork (ultimate cause) brings on overstrain of M. levator scapula. Overstrain of M. levator scapula (working cause) brings on subluxation of cervical spine. Subluxation of cervical spine (local cause) brings on overstrain of M. scalenus medius, M. scalenus anterior and etc. For example, overstrain of M. scalenus medius brings on pain and numbness of arm in radial nerve area. Overstrain of M. scalenus (local cause) brings on pain and numbness of arm (result). Analysis on disorder of neck, shoulder and arm was carried out in 103 cases. Enforcement of adjustment of cervical spine was carried out in 68%, including that relation subjunctive symptom and spinal column was obvious. These facts of subluxation of cervical spine were proved by computer tomography. Mechanism of arm pain syndrome in accidental disorder of neck is explained by external force without overstrain of M. levator scapula.
The aim of this study is to evaluate the spinal canal configuration by comparison of direct measurements of dried specimens of the vertebrae with the measurements on those x-ray films (62 vertebrae of 20 individuals). We measured the superior vertebral notch distance (A), the distance between medial cross points of articular facets (B), and interpedicular distance (C). As result of these measurements, three configuration of spinal canal were classified as follows. 1) Those vertebrae with less than 4.5mm in A and 67% in B/C×100 had trefoil canal. 2) Those vertebrae with less than 4mm in A and over than 80% in B/C×100 had triangular canal. 3) Those vertebrae with over than 6.5mm in A had deltoid or oval canal.
Recently, ossification of posterior longitudinal ligament (O. P. L. L.) has been known as one cause of myelopathy, but epidemiological examinations are still limited. Authors examined X-ray films of the cervical spine in 352 Koreans. Two typical and six doubtful cases with O. P. L. L. are found. Spondylotic changes of the cervical spine are almost similar to those in Japanese. The incidence of O. P. L. L. is no difference between Japanese and Korean by statistical analysis, although Yamanouchi has reported that incidence of O. P. L. L. in the Caucasian is low than Japanese.
As it is said that ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is specific to Japanese population and very few in foreign countries we want to check the incidence in Korea. X-ray films of 748 patients consulted EWHA University, School of Medicine, National Medical Center and Ulchi Hospital in Seoul, due to cervical disorder, were examined on March 1978. 13 OPLL and 17 possible cases were found. The frequency of this lesion is almost the same as in Japan. Ossification of the anterior longitudinal ligament, Barsony's disease, narrowed disc space and osteophyte formation were showed no much difference in incidence either.
This paper reports two cases of spinal arachnoid diverticula with neurological impairment in the lower limbs. Case 1. 50 years-old female had weakness of right lower limb and gait disturbance for 20 years. She was hospitalized in our clinic because of gradually progressive neurological impairment in the lower limbs. At admission she had spastic paresis and hyperactive tendon reflex of the lower limbs, gait disturbance, sensory disturbance below the level of T4 and muscle atrophy of the right lower limb. On myelography with the patient prone, there was no evidence of obstruction but in the supine position, five ovoid stractures filled with myodil at the level of T6-T11 were seen. These were defined sharply in the upright position. Laminectomy from the 6th to 11th thoracic vertebraes was carried out. The arachnoid looked thin, muddy and mesh formed, and was filled with colorless fluid and myodil. The abnormal arachnoid were resected as extensive as possible. Gait disturbance and paresthesia improved gradually in 6 months after operation. Case 2. 55 years-old female has complained of back pain and weakness of both lower limbs for 10 years. The only neurological finding was hyperactive knee jerk on both sides and hyperactive ankle jerk on the right side. On myelography with the patient supine, two ovoid structures filled with myodil at the level of T3-4 and T4-5. Because of poor neurological sign, she was treated conservatively and the neurological signs have been observed.
Seventy-three patients with cervical myelopathy were able to be followed directly more than 3 years up to 16 years and 9 months (mean 6 years and 8 months). There were 57 patients with cervical spondylotic myelopathy (CSM) and 16 with myelopathy due to ossified posterior longitudinal ligament (OPLL). Better results were, generally, obtained at the time of follow-up (excellent+good: 77% in CSM, 69% in OPLL), compared with discharge time (69% in CSM, 62% in OPLL). However, 13 patients had worse results at the time of follow-up. Sensory disturbance increased or appeared in the upper limbs (10 cases) and in the lower limbs (9 cases). Gait disturbance increased or appeared (4 cases). The patients who had late regression showed a tendency of old age, previous history of trauma, appearance or increase of degenerative changes adjacent to the operated level and increased ossification of the posterior longitudinal ligament.
We presented a case, 60-year-old male, with thoracic myelopathy that had been caused by severe spondylosis from T5 to T11 associated with ossification of the yellow ligament at T9 and T10 on the radiological examination. Decompressive laminectomy was made on at those levels, and he showed a good recovery from myelopathy a year after surgery. In addition, he has spondylotic canal stenotic changes in the cervical and lumbar regions, and so this may cause another re-worsening of his symptoms again. A careful follow-up will be also needed for postolaminectomy instability and kyphosis.
Since 1972 anterior decompression surgery has been performed on 14 cases of cervical myelopathy. Anterior decompression was carried out by way of subtotal vertebrectomy and the fusion with the bone-graft. For only one case among 14 cases, decompression laminectomy was furthermore needed. Those operation results indicated the more effective improvement of ADL. We conclude that this procedure is more advisable for patients whose lesions are localized in the cervical spine.
The incidence of herniated lumbar discs at the first, second, and third lumbar interspaces in our clinic was 6.6% of 226 lumbar disc herniation treated surgically from 1969 through 1978. There were three herniation at the second lumbar interspace, and thirteen at the third lumbar interspace. 1) The majority of patients complained of back or lower extremity pain, frequently over the anterior surface of the thigh. 2) The youngest patient was thirteen years of age and the oldest seventy-two. 3) The psoas-stretch test was positive in four patients with herniation of the third lumbar disc, in one patient with herniation of the second lumbar disc. There was limitation of straight-leg raising in only each one. 4) The knee jerk was reduced in 55.5% and ankle jerk was reduced in 33.3% of the patients with herniation of the third lumbar disc. But, one patient with herniation of the second lumbar disc had accelerated. 5) In roentgenographic examination, two patients with herniation of the second lumbar disc and six patients with herniation of the third lumbar disc had narrowing of the lumbar intervertebral space. 6) Follow-up studies were available from three months to seven years after operation. Eleven of thirteen cases with herniation of the third lumbar disc had excellent results. But, no excellent cases with herniation of the second lumbar disc were found.
33 patients who had undergone lumbar disc surgery previously and had required two or more operative procedure have been evaluated. The indications for reoperation were as follows; 1. Recurrent disc protrusion 9 a) same level as previous surgery 1 b) different level from previous surgery 1 2. Segmental Instability 17 3. Post-operative lumbar canal stenosis with arachnoiditis 2 without arachnoiditis 2 4. Nerve root scarring 2 Twenty five (recurrent disc protrusion: 8, segmental instability: 17) of the 33 patients underwent anterior discotomy and interbody fusion. One with nerve root scarring and four with post-operative lumbar canal stenosis underwent laminectomy and facetectomy. One with nerve root scarring, one with post-operative stenosis and segmental instability at the same level, underwent procedure both anterior and posterior approach respectively. Reoperative results of the 30 patients which had lumbar disc surgery 6 or more months previously were Exellent 6 (20%), Good 20 (60%) and Fair 4 (13%).
A mass survey of scoliosis was carried out on 4, 847 school children in Nagasaki city in 1972. 53 (1.10%) of 4, 847 children were found to be structual or transitional scoliosis by the roentrenological examination; 3 (0.06%) were congenital scoliosis and 50 (1.03%) were idiopathic scoliosis. Among them, thoracic type occupied 54%, and right convex type was 51%, left convex type was 30%. Most cases were found to be scoliosis less than 20 degrees.
Ten cases of 34 adult patients, who came to see for the deformity of the spine, had the back pain. All of them complained the local pain. Sixteen cases among people who complained the neck and back pain were pointed the scoliosis. These patients were divided three types; the local pain, the osteo-arthritis and the disc herniation type. The first type (17 cases) had nothing particular in the degree of curve and age. In osteo-arthritis type (5 cases), all patients were more than 50 years old. In last type, all 4 patients had disc herniation at the concave side of L 4-5.
A female achondroplastic dwarf was referred because of intermittent claudication, complained for 4 months, with numbness and dull sensation in her legs. She had slight bowel and rectum disturbance. This 45 year-old female was 112cm in tall, weighed 40kg, and had short arms and legs, hyperlordosis of the lumbar spine, and moderate kyphosis at the thoraco-lumbar level. Sensation was diminished over the L1 to L5 and S1 dermatomes. Lumbar puncture was unsuccessful and myelogram by cisternal puncture was done which revealed total block between the L1 and L2 level. Operation: Total laminectomy at L1 through L5 was carried out. The laminae were thick and pedicles were all short and thick. The dura and nerveroots were compressed extremely. After the laminectomy the widening of the canal was done including foraminotomy. There was no evidence of a ruptured disc. The dura was not opened. Post operative course was very good and four months later she can walk well without complaints in her legs.
This presentation describes the visual and mental changes in one episode of transient cortical blindness following Myodil myelography. Blindness was first detected from 6 hours after the myelography (absent light perception, but active papillary light responses). Even though unable to see, the patient seemed unconcerned about his blindness. There were numerous globules of Myodil scattered throughout the base of posterior fossa. By CT-scan, the infarction of left posterior lobe was suggested. Subsequently only quadrant hemianopia remains.
A 28-year-old man with hemophilia B, after falling down and striking his right thigh, was admitted to our hospital complaining chiefly of an inability to walk. On the physical examination, the mid-portion of his right thigh was spindle-shaped, tense, and swollen. The X-ray film revealed a pseudotumor and a fracture of the right femur. The patient didn't wish to have an operation and was therefore placed in skin traction for about 10 months under adequate replacement therapy for Factor IX using less than the standard minimam dose. Disarticulation of the right hip using Boyd's method was performed on February 17, 1978. The wound healed faster than expected under replacemtnt therapy of PTC during and after surgery PTC activity was frequently measured and no serious complications developed. The patient is now undergoing gait training, using a Canadian Hip. This case would indicate that any operation on hemophiliacs can be performed using adequate replacement therapy.
Alkaptonuria is a rare disease characterised by the homogentisic acid in the urine, waferlike calcification of the intervertebral discs and ochronosis. We have had opportunity recently to observe three patients with alkaptonuria from one family tree. They have complained low back pain and stiffness for many years ago, and have noticed their urine change to dark, but on the inspection, they have not any ochronosis. Radiographically, their spines have typical changes of alkaptonuria. We have confirmed the homogentisic acid in their urines with paper chromatography.
A three-year-old boy with vitamin D-dependent rickets had not been well controlled until administration of 1α-OH-D3 instead of ergocalciferol (VD2). 1α-OH-D3 was more effective and more safely used than VD2, because of less accumulation into the body than VD2. By three cases of vitamin D-resistant rickets, administration of 1α-OH-D3 improved radiological findings preceding the changes of calcium and inorganic phosphorous levels in blood serum. High dose of 1α-OH-D3 (6-16μg/day) has been used to improve the chemical data in blood serum, especially the regulation of low serum inorganic phosphorous was difficult, because vitamin D-resistant rickets have disorder of phosphate metabolism independent to vitamin D.
Five cases of familial brachydactyly in two pedigrees are reported which include rare two cases with shortening of all metatarsals except the second bilaterally. In these instances was there painful callosity at both heads of the second metatarsals of normal length. Satisfactory results were obtained in both instances after operations. The deformities may result from the early epiphyseal closure since it was found only in affected metatarsals of a 11-year-old case.
Thanatophoric dwarfism is a distinctive, lethal form of bone dysplasia delineated and named by Maroteaux, Lamy and Robert in 1967. They described four cases of their own and reviewed 17 others from the literature and personal communications. This disorder, which has often been confused with achondroplasia, is characterized by sever micromelia and narrowing of the thorax. Since the publication of Maroteaux and asociates a number of cases has been reported in the literature and it appeares that the condition is not extremely uncommon. This report presents the clinical, radiographic and histological findings in two cases of thanatophoric dwarfism based on our personal experience.
We reviewed all patients with skeletal dysplasias who has been admitted to Saga Crippled Children's Hospital now. There are nine cases skeletal dysplasias, i. e., three cases of Osteogenesis imperfecta, each one of Turner's syndrome, Marfan's syndrome, Hunter's syndrome, Spondyloepiphyseal dysplasia congenita, Multiple epiphyseal dysplasia congenita and Ehlers-Danlons' syndrome.
To study the bone metabolism in tumorous condition, bone mineral analyzer was applied in several cases with bone and soft tissue tumors, such as osteosarcoma, enchondroma and calcifying aponeurotic fibroma. Bone mineral content (BMC) was measured using Norland-Cameron Bone Mineral Analyzer Model 178, and which was compared with radiodensity of bone on X-ray films and with radioactivity of 99mTc-scintigrams. According this comparative study, BMC was parallel with radiodensity of X-ray film, but no correlation with radioactivity of scintigram.
A 19 year old man came to our clinic in June 1977, complaining of a lmup in the left back. At the time of operation it was noted that the growth involved the M. longissimus. The tumor was excised wildely and proved to be a desmoid on pathologic examination. No recurrence was found 1 year after surgery.
A ten years old boy had complained of swelling of the lateral aspect of the left knee for about one month. Roentgenograms revealed an enlarged cystic lesion in the proximal metaphysis of the left fibula. At surgery, the cortex of the cystic legion was egg-shell thin and the cyst contained bloody fluid and a scanty amount of lining tissue around the inner wall. The lining substance of the cyst was curetted out without bone grafting. Clinically and pathologically, it was diagnosed as aneurysmal bone cyst.
A 29-year-old man visited our hospital complaining of multiple xanthomas occurred bilaterally at the achilles tendon, the lateral dorsal aspect of the foot, the tibial tuberosity, the lateral aspect of the elbow, and the dorsal aspect of the 2nd and the 3rd right metacarpal joint. Tumors were found to be elastic hard with comparatively clear edge. There were neither spontaneous pain nor tenderness, without limitation of joints movement. Blood examinations revealed 372mg/dl of cholesterol level and 3.8mm of β-lipoprotein. He was diagnosed as hyperlipemia of II a type with xanthomas. Tumors were resected, and the histological study made sure of the diagnosis. His father was also found to have IIa type xanthomas.
Fibrous Xanthoma- a rare primary bone tumor developed in the femoral metaphysis of a twenty-six years old male is described. Histologically, stromal storiform pattern, spindle shaped cells, foamy cells and giant cells are found. This feature is similar to fibrous xanthoma classified to soft tissue tumor, but it is not clear whether fibrous xanthoma of bone is different from non-ossifying fibroma or not. And it is difficut to distinguish histologically this case from malignancy, too.
Eosinophilic granuloma of the soft tissue is mostly found in the parotid region and in the face and neck. Histologically this disease shows formation of lymphoid follicle and infiltration with eosinophiles. Recently we experienced a case of eosinophilic glanuloma of the soft tissue, at bilateral elbows. The blood examination showed slight increase of leucocytes and remarkable increase of eosinophiles (64%) in the peripheral blood. Serum IgE level was very high values. The histological finding of this case showed typical findings. Etiology of this disease is still unknown. But recently it has supposed that allergic predisposition participates the cause by high serum IgE level and eosinophilia.
We treated three cases of eosinophilic granuloma of bone in eight years. Case 1; male, 32ys., left clavicle. Case 2; male, 12ys., fifth lumbar vertebra. Case 3; male, 12ys., left third rib. Treatment of three cases as follows. Case 1 and 3 were treated by operation. Case 2 was treated conservatively. Process of all cases is satisfactory.
The occurrence of bone metastasis of the giant cell tumor is rarely reported. On the other hand, the concept of multicentric leison should be considered, although it is difficult to distinguish a multicentric giant cell tumor from a secondary giant cell tumor of metastatic spread, each at a different time. This paper reports an unusual case of 29 year old woman who had been well for seven years after the amputation of primary lesion, the right humerus, until December 1977, when examination and roentogenogram revealed destructively expansile lesion of the body of the sacrum.
A female, aged forty two, visited us complaing of headach, vomiting and vertigo. The diagnosis of osteochondroma of the fifth cervical spine made based on the histological examination, roentogenogram, myelogram and angiogram. Histological examination of the specimen showed osteochondroma.
It is well-known that neurilemoma is benign nerve tumor originated from Schwann cell. We reported four cases of this tumor. Case 1 female, aged 56. The tumor of 6×5cm in size involved right sciatic nerve. Case 2 male, aged 42. The tumor of 6.5×5cm developed from left femoral nerve in the pelvic cavity. The cross section showed the secondary changes as multi-cystic structure filled with light yellowish serous fluid and deposit of haemosiderin. Case 3 male, aged 44. The tumor located in left common peroneal nerve. Case 4 female, aged 47. The tumor developed from the cutaneous nerve of the skull. Microscopically, those cases were distinguished as neurilemoma. Case 1 and 3 were composed of both of Antoni type A and B tissues. Case 2 had the microscopic findings of Antoni type A and B and also of massive secondary changes as hyalinization of the vessels, cysts and deposit of haemosiderin. Case 4 was mostly composed of Antoni type B tissue.
We have recently experienced a case of Benign Chondroblastoma which is clinicaly suspected as a Malignant bone tumor. This Patient is 12-year-old boy suffered from the left knee pain. Physical signs are motion pain of the knee and local heatness, swelling, severe tenderness, venous dilatation in the left knee joint. Roentagenograms reveal lucent lesion in the medial proxymal part of the left tibia. After the curattage and bone grafting of this tumor, it is histologically diagnosed as a Benign Chondrobrastoma. This boy have no recurrence and metastasis 10 months after the operation.
The patient was 19-year old male who noticed pain of the right knee in May, 1975. He was examined by three doctors before visiting our hospital. No one could point out abnormal findings radiographically. On May 2nd, 1977 radiographic findings revealed a large radiolucent area strongly suggesting giant cell tumor. We convinced our clinical diagnosis by hypervascularity on angiogram and moderate activity on scintigram. But in fact, it was found to be typical chondroblastoma on macroscopical and histological findings. Because of signs of biological activity follow-up study will be necessary.
Benign chondroblastoma involving the patella is a rare condition, being reported only 10 cases in Japanese literature. Benign chondroblastoma associated with cystic change is called as cystic chondroblastoma (Schajowicz) and one of the extremely rare conditions, which is sometimes difficult to be distinguished from aneurysmal bone cyst. In Japanese literature, to our knowledge, only 2 cases of cystic chondroblstoma in the patella have been reported so far. In the present paper one case of cystic chondroblastoma involving the patella was reported with special reference to its pathological aspects. The comparison with the cases presented in world literature was also included.
A 28-year-old male entered the hospital because of pain in the right hip of ten months' duration. The hip range of motion was full. The laboratory data were completely normal. Roentogenogram of the right hip showed a well defined lytic lesion involving the medial posterior aspect of the femoral head, which extended just below the articular cartilage of the head. On the 8th hospital day, a needle-biopsy was performed and we experienced “spurt of blood” from the needle. Two weeks later, the head of the femur was excised and a Moore prosthesis was inserted. At one year later. the patient had no evidence of recurrence and excellent hip function. Histology was the presence of focal areas of carcification, polyhedral cells, chondroid tissue and hemorrhagic cysts. It seemed that this case was chondroblastoma with aneurysmal bone cyst.
Benign osteoblastoma is uncommon, benign, vascular, primary bone tumor. It may present diagnostic and therapeutic problems. We experienced a case of this tumor involved in the lumbar spine and misdiagnosed it as lumbar disc herniation, because of its similarity of the clinical findings. 14-year old boy visited our clinic with complaints of lumbar dull pain and left leg pain. The X-ray films showed no paticular findings except scoliosis. But 6 months after the onset, we found the abnormal calcification in the left side between the transverse processes of L1 and L2. The lesion was curetted. Its histological diagnosis is benign osteoblastoma.
The radiographical appearance in osteosarcoma, shown neovascularity, blood pool, tumor stain and arteriovenous shunt at angiogram and high, diffuse up-take at bone scintigram, was characterizized by periosteal bone formations. It was difficult to differentiate osteosarcoma from Ewing's sarcoma and malignant fibrous histiocytoma, seen often the faint spicule-like “flare up” appearance, without histological examination. It was often difficult to differentiate radiographically sclerosing osteosarcoma without periosteal bone formations from sclerosing osteomyelitis and stress fracture without angiogram and bone scintigram, because the latter revealed angiographically slightly neovascularity and stain, and scintigraphically low, localized up-take.
An adult man, fifty-five years old, was admitted to our clinic on January 11th. 1978, with a history of chronic osteomyelitis of the left tibia since 1928. Intermittent drainage had been present through the three decades Two months prior to admission, the biopsy revealed the squamous-cell carcinoma developing into the bone. And then, an above-the-knee amputation was performed, and the patient was recieved the Bleomycin injection and applied the immediate prosthetic fitting.