The tuberculous tenosynovitis of the hand is an uncommon condition. Early diagnosis is important because this condition has a slow and progressively destructive process. In this report we describe two cases and review the available literature.
Authors described three cases of spondylotic myelopathy at the upper thoracic spine. They were male with the age of 46, 47 & 48 years. The affected level was Th2-3 in two cases, and Th3-4 in one. Initial symptoms were numbness and/or powerloss of the lower limb and cough, and myelopathy developed gradually. It was hard to recognize the lesion from clinical signs and radiological findings, pre-operatively. Posterior decompression was performed in all cases, although post-operative recovery was not satisfactory.
Case 1; A sixty-year-old woman complained dullness of left lower limb at walking, five days before admission. Physical examination showed an analgesia at the hip and both legs. She couldn't walk at all and bladder and bowel involvement was associatted. Myelogram showed a central shadow defect at Th12-L1, In operation, there was a capsulized intra-dural hematoma on the dorsal side of the conus medullaris. Hematoma was removed, and a bleeding from the posterior spinal vein was coagulatted by a bipoler hemostat. After operation, she could walk and bladder and bowel involvement also improved. Case 2; A twenty-year-old woman complained low back pain and fever after playing balletball, two days before her initial admission. Physical examination showed percussion pain at L3-L5. Straight leg raising tests were positive at eighty degrees in right, thirty degrees in left leg. Laboratory examination showed leucocytosis. Myelogram showed a shadow defect at L3. In operation, a white tumor was seen among the cauda equina. The tumor was so soft and thin that the capsule was ruptured. We removed the tumor and after operation she was free from symptomes.
1. The authores examined the frequency of ossification of the yellow ligament (O. Y. L.) in the lower thoracic and upper lumbar spine from the lateral roentgenograms focused at Th10. The number of the cases were 149, who had consulted for complaint of lumbago at our clinic and related hospitals. 2. About 20% of these cases had O. Y. L. 3. All the patients operated on in our clinic for myelopathy due to O. Y. L. had clear sensory disturbance. The most disturbed sensation was vibration. 4. Clear difference in the anteroposterior canal diameter of the thoracic spine was existed between operated myelopathy cases and 149 cases. Myelopathy cases showed narrow canal. 5. Operated myelopathy cases due to O. Y. L. showed the narrow cervical canal coincidently.
Injuries to the thoracic and lumbar spine may result in severe instability with progressive neurologic defecit. Attention must be directed not only to restoring or improving neurologic function where possible, but also to promoting bony stability. We have carried out one stage decompression-stabilization procedure consisted of Harrington and anterior spinal fusion with anterior decompression in a total of 6 patients. All 6 of these with thoraco-lumbar spinal injuries had a neurogic defecit. The results have shown to be beneficial in restoring spinal alignment, allowing early mobilization of the patients, shortening rehabilitation, preventing the late complications of increasing deformity in all patients and recovering neurologic function in 4 cases with incomplete neurologic defecit.
130 cases of whiplash injury were followed up directly or by mail from 4 years up to 13 years (average 8. 2 years). These cases were divided into 2 groups, which is, 75 cases with mild symptoms (improved less than 6 months after injury) and 55 cases with persistent symptoms (more than 6 months). Comparative study of 2 groups regarding age, sex, occupation, clinical pictures, x-ray findings and other factors were described. Of them, ten cases (7.7%) have being treated for 6.2 years in average. The factors which kept their symptoms remained for such a long time were discussed.
Since 1974 six patients with atlanto-axial instability (non-union of an odontoid fracture in three, secondary to os odontoideum in one, and rheumatoid arthritis in two) were treated by posterior arthrodesis of the atlanto-axial joint, in which Gallie's modification methods and McGraw methods were used. One of the rheumatoid cases died at our hospital four months after fusion due to pneumonia. A follow-up study for one to five years revealed that the fusion of the atlanto-axial joint was complete in the remaining five cases. Flexion and rotation of the neck movement were limited to about a half of the normal range of motion but extention remained almost normal. From the above experience it is thought that the Brooks procedure modified by Griswold is the most satisfactory method.
Five cases of Arnold-Chiari malformation have been treated surgically in our clinic. Cerebellar and vestibular disturbance, pyramidal signs and cervical root signs were the most frequent clinical pictures, and lower cranial nerve signs were seen in some cases. An open C-shaped filling defect was shown in the upper cervical myelograms, which should be taken through lumbar puncture. Vertebral arteriography showed downward displacement of the posterior inferior cerebellar artery into the upper part of the spinal canal. Suboccipital craniectomy, including laminectomy of C1 and C2, was done in all cases. Satisfactory results were obtained in all cases after surgery.
Eight cases of Spinal cord tumors (four cases of Schwannomas, two of plasmacytomas, one of psammomatous osteogenic meningeoma and ganglioneuroma) were treated in our clinic for these four years. In this paper, two of them are reported. Case 1; 41 year-old male of plasmacytoma, he had fallen into paraplegia following acute back pain. On the myelogram, extradural tumor was suggested at the 6th thoracic level. At operation, the tumor adhered to the surface of dura and was seemed originated from it. Serum immunological study revealed abnormally high Ig. D value, 320mg/dl, but he had no hyperproteinemia nor M-protein. Case 2; 49 year-old female of psamonomatous osteogenic meningioma, she had worried about paraplegia and lower limbs' pain for five years. She had been treated as lumber disc hernia but was not ftee from her symptoms. By Myelography, contrast medium stopped at 8th thoracic level. At operation, an ossicle (7×12×3mm in size) and tumorous soft tissue around it were found in the intradural space. The bone chip had tight adhesion to dura. Histologically, the ossicle was made of mature bone tissue. After the operations, these two cases recovered but incompletely, the former can walk without a cruch but the latter with a cruch.
The authors reported a case of the spinal tumor which was considered to be a primary intraspinal medulloblastoma. 27 year-old male was admitted with the complaints of paraplesia and myelographic examination showed the space occupying lesion at the 4th & 5th thoracic vertebrae. Twice operations were carried out due to the recurrence in the same location. Histologically the tumor was revealed medulloblastoma. 11 months after the onset, the symptoms is completely relieved and there is no evidence of the intracranial involvement.
Thirty five cases of non-union, delayed union and postoperative refracture have been treated in our clinic since 1973. Judet's decortication was performed on 13 cases of long bones, five aseptic non-unions of humerus, femur and tibia, seven delayed unions of femur and tibia, one refractured femur. Out of 13 patients, 10 were males and 3 females, average age 42.3 years. On performing decortication, bone grafting was added in five cases because of bone defects. Average healing time of non-union was 95.6 days, delayed union 77.4 days, refractured case 75 days.
Since 1974, a continuous direct current have been applied to the total 53 patients of fracture. We reported 17 non-unions treated by electrical stimulation only without any additinal surgery such as internal fixation and bone graft. Of the total number of 17 patients treated with electrical stimulation, 15 achieved solid bony union. In recently, we used the new powes source such that a constance current of 10 microamperes, the anode of the aluminum foil in size to measure 10 by 20cm and multipule electrodes. In addition, the functional cast or the functional Orthoplast brace were applied.
During 1975 and 1977, 40 patients have been treated with Hoffman's external anchorage. These 40 cases comprise 24 fractures, 11 arthrodesis, 2 osteomyelitis and 3 cross leg skin graft. There was some advantages in the surgical and clinical properties of Hoffmann's external fixation. The conclusion from our clinical inverstigations is that stabilization by using Hoffmann's external anchorage in these problematic cases is the method to be chosen.
The Y-shaped plate designed by us was used for Barton's fracture initially, to compress the fragmented volar edge of the radius by two limbs of the plate, which was fixed to the shaft by one or two screws. The plate was also applied to Smith's, comminuted Colles, tibial plateau and ankle fractures. Four week's immobilization was performed for the fractures of upper extremities, six week's immobilization for the fractures of the lower extremities. We could obtain good results in most cases except for open fracture of the wrist which caused adhesion of the tendon.
Forty cases of fracture of extremity and trunk combined with maxillary and mandibular fracture were treated from 1970 to 1979. 1) 85% of the cases were caused by traffic accidents. 2) The fractures of upper extremity numbered 24 (47%), lower extremity 18 (35.2%), trunk and others 9, in total being 51 fractures. 3) Details of the cases were presented and the methods of treatment were discussed.
Sound transmission of the femur was recorded by holding a microphone on the pubic symphysis and tapping the patella with a autohammer. The sound transmissions in fractures and pseudarthroses of the femur were low in pitch and long in duration, and they returned to the normal one, delaying a few week after X-ray findings of facture healing.
Ten cases with gas gangrene were treated during past eight years in our hospitals. The clostridium was detected in four cases among them and other gas forming microbes, E. coli, Streptococci, Klebsiella, and Serratia, were cultured in other cases. Hyperbaric oxygen therapy were applied for two patients and oxygen therapy using the tent were performed for the others. Both the adequate surgical debridement and the treatment of massive antibiotics, particularly dosing the penicillin G, were performed. All patients with gas gangren were saved their life due to our therapy but seven were amputated their thighs because of the progressive necrosis.
A pathological study of a non-selected autopsy material was performed on fat embolism. Pulmonary fat embolism was found in 53 out of 102 consecutive autopsies. Fat embolism seemed as closely associated with bone fracture and bone marrow embolism. Main source of the embolic fat should be the traumatized tissue, especially the marrow cavity of the fractured bone. The incidence of the case numbers of pulmonary thrombosis had an intimate relationship with severity of pulmonary fat embolism. Intravascular fat droplets were sometimes trapped in fibrin clots. It should be very reasonable to consider that fat embolism contributes to the formation of intravascular thrombi.
Recently, we have exper enced two cases of “Necrotizing fasciitis” which is very rare. Case 1 is 62y woman and Case 2 is 68y man. Case 1 was contused the Knee region and Case 2 contused the elbow. Gradually local swelling, redness, pain were occured, and spead proximally and distally, and blister began to form. Two cases were very prostrated. Case 1 was performed amputation through the hip joint, and Case 2 local surgical debridement. Case 2 obtained group A β-hemolytic streptococcus in the necrosis mass. After the operation, general condition was very improved.
The leggs of 166 students who belong to various sports-clubs were examined radiologically. Among the legs examined both tibia of one of the students showed a hard thickened prominence of the posterior cortex at the junction of the middle and lowermost thirds. The student had mentioned that he had felt pain in both the front and the lower part of both legs while he had been running during a period of three months about one and half years ago. It was suspected that his condition was the result of the healing of a particular type of stress fracture of the tibia in athletes involving only posterior corticalis of the bone but this condition was not checked by a doctor at that time. Hypertrophic change of the lateral corticalis of the tibia was found in about 80% of the cases. The cause-effect relationship between sports and this change was discussed.
A thirty-two year old man, first noted pain in his left leg while pitching a soft-ball game on July 30, 1978. Because pain increased, he was admitted to our hospital on August 4. The physical findings were similar to those of acute anterior tibial compartment syndrome, that is, swelling, local heat, tenderness, muscle weakness and sensory disturbance of the lower leg, and pulselessness of the dorsal pedis artery were observed. Fasciotomy was performed eight days after onset. The muscles of the anterior and peroneal compartment were noted to be pale pink and bulging. There was no recovery of function of the paralyzed anterior compartment muscles.
A 5 year old girl with a congenital disorder of the skin, epidermolysis bullosa of the hypoplastic-dystrophic type had developed a deformity of the hands, being ensheathed in a mitten of epidermis. Bilateral thumbs were freed surgically and most of the surface could regenerate epithelium spontaneously, but defects in the dermis on the volar aspects of the thumbs had to be covered with full thickness grafts which took well in spite of the skin disorder. The observation is discussed.
In these 3 years, we experienced 103 cases (125 joints) who visited to our clinic with complaint of temporomandibular joint pain. We classified these cases to: (1) Traumatic (Contusion, Fracture, Dislocation) (2) Inflammatory (Suppurative, Traumatic, R. A.) (3) No-Inflammatory (O. A., Discopathy, Internal derangement) and reviewed them. A majority of cases were classified to non-inflammatory group, and younger girls were dominant. Results of them were good or excellent in O. A. and Internal derangement, while poor in Discopathy. In our treatment intraarticular steroid injection was most effective. We have a excellent case of operation (Discectomy), whose pain was not relieved by any conservative treatment.
Two cases of entrapment neuropathies at the buttock, one is sciatica due to an abnormal condition of the pyriformis muscle and another adhesive neuritis of the ischiadic nerve adjacent to tuber ischiadicum are reported. Simple operations such as tenotomy of the pyriformis muscle or neurolysis of the involved nerves have given relief to each of them. The pyriformis syndrome, which is usually traumatic in origin, should be differentiated from other pathological condition of the lumbar, sacral and hip joint areas. Through the review of some literatures, the diagnostic points of this syndrome are presented.
A case of the Saldino-Noonan type of short rib-polydactyly syndrome is reported. Although multiple internal malformations have been described in this syndrome, no significant visceral abnormalities were detected in this case except for the hypoplastic lungs. A similar case has been reported by Spranger et al. in 1974.
A case of pycnodysostosis in a 6 year old boy was reported. The patient had all the skeletal and oral changes which were described in previously reported cases. It was discovered that he also had left parieto-occipital epidural haematoma and conegnital absence of the 2nd premolar. The epidural haematoma was operated on and it was suggested that the heamatoma had occurred previously but had gone undetected and that new bleeding was occurring in the old haematoma as the result of a recent injury. Examination of the respiratory function showed a high level of PCO2, though the PO2 was normal. It was suspected that there was some disturbance of the regulation of the CO2 elimination process in the lung.
A 27-year-old man visited our clinic, complaining of congenital absence of bilateral thumbnails. Roentgenological findings showed iliac horns, hypoplasia and lateral tilting of both patellae and spur-like deformity of cuneiforms. He had congenital dislocation of left hip as a past history. Family history were as follows. His first son had deformed thin thumbnails, iliac horns and asymmetrical hypoplatic patellae and congenital club feet as a past history. The patient's father had deformed thumbnails and hypoplastic patellae but no obvious iliac horns. Their elbow joints were not affected. Other musculoskeletal abnormalities were not found. Laboratory findings were within normal limits. Their ABO group blood type were all A.
The growth plate cartilages obtained from two patients with metaphyseal chondrodysplasia were investigated by light and electron microscopy. Histologically, the linear columns were irregular and occasionally round ball like clusters were seen in the hypertrophic zone. Electron microscopically, a large number of chondrocytes had dilated cisternae of rough-surfaced endoplasmic reticulum. Furthermore, the degenerating chondrocytes with enlarged mitochondria, dense nucleus, large lipid granules and numerous vacuoles were frequently observed even in the resting and proliferating zone. The cartilagenous matrix represented an unusual fibrillar appearance. The present study reveals that the involvement of the metaphysis in this disorder may be a result of degenerative changes due to the abnormal mechanism of protein biosynthesis or protein transport in resting and proliferating chondrocytes.
In spite of administration of Vitamin D and/or inorganic phosphate, satisfactory result has not been obtained for treatment of famillial hypophosphatemia. Two cases were treated with 1α-OH-D3 and inorganic phosphate in our clinic, but hypophosphatemia were residual after the improvement of the metaphyseal roentgenographic findings. In the first case, the administration of 1α-OH-D3 9, μg/day and phosphate 4.2g/day raised the serum inorganic phosphorus level to 4.6mg/dl. In the second, 6μg/day and 2.8g/day did it to normal range. Administration of 1α-OH-D3 was considered to activate the intestinal absorption of phosphate.
Patient: 2 years old female. Chief complaint is limping. Family History: Not contributely. Past History: She recieved an operation for buphthalmia. Present History: She was borne on Mar. 13 1975. She was diagnosed and therapied for 6M with congenital dislocation of the hip. In Dec. 1977 she was appointed out the limping and hospitalised in Jan. 1978. On X-Ray examination, all the joints showed fraying, flairing and cupping. She was suspected as Vitamin D resistent ricket. But on laboratory and physical findings revealed the renal tubular acidosis. Finally she was diagnosed as Fanconi Syndrome.
The commonest deformities seen in hemiplegic foot are equinovarus and claw toe which often respond to simple operative procedures. However, repeated preoperative assesment as an inpatient is essential because paralysis of central nervous system is different from peripheral nerve injury. From 1973 to 1979 ninety-one patients have undergone operation at our Center. The operation carried out, either singly or in combination, Vulpius's procedure, transfer of tibialis anterior, release of long toe flexors and elongation of the tibialis posterior. Correction once achieved is stable and the deformity does not recur. These operation benefited the patients in so far as more can walk afterwards, there is less deformity and there is less spasticity.
Congenital metatarsus varus is different from congenital club foot in many respects, but thy have been often confused. We experienced eight cases of this deformity during the years 1970 through 1979 which is sufficiently severe to require treatment in corrective casts. Two were unilateral and six were bilateral. Here we discuss the diagnosis and results of treatment in our clinic.
The following experiment was conducted in order to investigate pathological anatomy of the talus in the club foot. Surgical procedures were carried out on the left feet of young rabbits. The procedures consisted of the three methods; tenodesis of the achilles tendon in the position of plantar flexion, transection of the peroneal muscles and lateral capsulotomy of the calcaneocuboid joint. In addition, the dynamic adduction was forced by connecting with the thread between the skin of buttock and forefoot. The deformities of the foot and the talus were studied radiographically and microscopically during 12 weeks after this operation. The results obtained were as follows; 1. By this means, rigid club foot deformities were accomplished at 4 weeks after the operation. 2. The talar neck deviated medially and downward. The long, wide and high ratios of the talus in the club foot were smaller than those in the control. 3. On the medial side of the talar head where the navicular bone was deviated, hyperplasia or metaplasia was seen, on the other hand dysplasia occured on the lateral side.
The patients with hemiplegia were investigated if they have some trouble in their knees or not. Of twenty-eight hemiplegic in-patients, ten (35%) had painful knee, nineteen (67%) had osteoarthritic changes at involed side. Osteoporotic changes were seen in most patients. OA changes were seen with greater frequency in patients with duration of seven months or more than those of six months or less. And those changes were seen more frequently in wheelchair group than in ambulatory one. OA changes were not related with spasticity or sensory disturbance. (p>0.05). Discussion was made about these findings.
This study arose from a curiosity to see whether the menisci and the components of the knee joint could be visualized on CT scans. We wish to report the potential contributions and limitation of CT of the knee on this experience. CT scans of the knee were done on 63 patients with an Ohio Nuclear Delta 50 FS-2 total body tomographic scanner. The thickness of each scan is 8mm and each scan is displayed on 256×256 matrix. Contrast agent was not administrated. CT was very usefull method of investigation of osteosclerosis in osteoarthritis, a shape of patella and femoral condyle, and a relationship of their situation, comprehension of destructive area of bone in steroid arthropathy. However, CT couldn't display the detail of menisci, so we couldn't diagnose the lesions of menisci with CT at present.
We reported 2 cases of the traumatic recurrent dislocation of the patella treated surgically. One patient was a 14 year old girl affected bilaterally, another was a 13 year old girl unilaterally. These knee joints had predisposing factors which were joint laxity, hypoplasia of the femoral lateral condyle, trachleal groove and quadriceps weakness. These patelle were dislocated laterally at the flexion of the knee joint. All dislocated patellae were treated by combined Campbell's and Roux-Goldthwait method. After 6 months, all knee joints had good mobility and no dislocation of the patella. But one patient complained of slight standing disturbance. Roentgenograms showed no findings of osteoarthrotic changes.
Since 1977, the operative procedures were used variously in ten cases of the unstable patellae. According to Ficat, they were classified as follows, 1) recurrent dislocation: 5 cases 2) recurrent subluxation: 4 cases 3) permanent dislocation: 1 case. Their ages ranged from 15 to 43 years (average 20 years). There were 2 males and 8 females. The interaval between onset and operation averaged 64 months (1 month to 312 months). The diagnosis was determined by the clinical findings the hypermobility of the patella-Q angle, and the findings of the tangencial views of the patella, arthrography and arthroscopy. The operative procedures were used as follows, a): a) release of the lateral retinaculum and a tightening of the medial retinaculum and capsule; 1 case. b): a) and the procedure of Elmslie-Trillat; 7 cases. c): b) and semitendinosus transfer; 1 case. d): b) and McCarroll; 1 case. The follow up period ranged from 7 to 21 months and averaged 13 months. The results were rated according to the Ficat's criteria, consequently, 2 cases were exellent, 7 good, and 1 fair.
Recently we have experienced of contracture of the bilateral gluteal muscle due to frequent injections in early childhood. This patient was a girl aged 6 years old and could not sit properly. The hips could not be flexed fully in the neutral position, with further flexion the hips were abducted and externally rotated. The surgical treatment involved resection of the scar tissues in the gluteus maximus and release of contracted muscles and tendons was performed. Postoperative course was good.
Thirty Chiari osteotomies in 27 patiens, ranged 11 to 49 years, have been performed in our clinic since 1966. The radiografhic measurements were as follows: 1) the CE angle; 2) the supporting index; 3) the roof angle; 4) the level of osteotomy; 5) the displacement of the femoral head. The results of them have been examined 1 to 6.8 years after the operation in 15 patients. The caces, with the CE angle between 20 to 40 degrees and the roof angle between 10 degrees below and 20 degrees above the horizontal, were satisfactory results.
Idiopathic transient osteoporosis of the hip is very rare in female. 13 cases of female have been reported in the literature and pregnancy almost has been associated. Our patient suffered from severe hip pain during the last trimester. Roentgenogram showed marked demineralization of both femoral heads and necks. Complete recovery resulted within a few months after delivery. The cause of our case is unknown.