Fourty trochanteric fractures treated with a compression hip screw are here reviewed. The average age of these is 74.6 years, with a range of fourty-four to eighty-seven years. Thirty-three patients were women and seven were men. All of them were classified according to the method of Jensen. The early results of thirty-two cases in this series were analyzed. Twenty-five (78.1%) of thirty-two patients were ambulatory at the time follow-up. There was no non-union and malunion. No screw protruded into the joint except in a case of postoperative avascular necrosis of the femoral head. Nineteen (90.5%) of twenty-one unstable fractures showed telescoping of the device and medial disclacement of the distal fragment.
It is purpose of this paper to follow up the results on 41 cases of a cemented endoprosthesis during past seven years. X-ray follow up date showed that troubles of the femoral component was present in 16 of 41 cases (40%) and of the acetabulum in 6 of 41 cases (15%). Clinical good results of the treatment was obtain 80% of the patients. But, it is difficult to evaluate the consequences of a cemented endoprosthesis. So far, a cemented endoprosthesis is approximately the same as the without cemented prosthesis as far as clinical results were concerned.
Total hip arthroplasty (T. H. A.) for complete dislocation has many problems. In order to perform the operation safer we attempted to do T. H. A. in two-stage, which consists of resection of the femoral head and skeletal traction of the femur before T. H. A., so as to obtain sufficient information of nerve palsy and of the site to place the socket. Case 1 A 53-year-old house-wife with 5cm dislocation of right hip. Eleven weeks later, the socket dislocated from the pelvis and grafted bone and screws were broken. Satisfactory result was obtained by re-operation with good function of the joint and muscles. Case 2 A 51-year-old male laborer with 8cm dislocation. Reposition was technically quite difficult. Leg discrepancy reduced to 2.5cm, but the abductor weakness remained.
Nous avons fait 175 prothèses totales de hanche chez 148 malades du 1971 jusqu' à présent. Hous avons étudie les resultats des 113 prothèses (88cas) ayant un récul minimum de 12 mois et récul maximum de 116 mois, la première ayant été posée en mai 1971. Nous utilisons chaque prothèse tptale cimentée de Müller, de Lagrange-Letournel et sans ciment de R. Judet selon ses vices architecturaux et son age chez malade. Nous avons analysé de ces trois prothèses sur la cotation pour coxarthrose de la Société Japonaise de Chirurgie Orthopédique minutieusement. CONCLUSION: 1) Il nous semble qu'il n'y a pas de différence significative entre P. T. de Müller et de Lagrange-Letournel radio-cliniquement. 2) Mais, la P. T. sans ciment est assez meilleure que les cimentées. 3) En ce qui concerne i'apparition de la zone claire sur radio, clle n'est pas beaucoup moms fréquente dans P. T. sans ciment que les deux autres.
Revision was necessary in two cases out of fifty-four Total Hip Replacement in our clinic. The first case was 46-year-old man with bilateral secondary osteoarthritis after congenital dislocation of the hip. The loosening of the femoral prosthesis was observed 28 months after surgery, probably due to malselection of the femoral prosthesis. The second case was 64-year-old woman, affected deep infection with fever and pain of the thigh 24 months after operation. The cause of infection was unknown, whether direct infection at surgery or hematogenous infection after surgery. The use of long stem prostesis resulted in success by both cases.
The purpose of this paper is to investigate cardiovascular effects of bone cement and to discuss about anesthetic management for total hip replacement. 54 patients were statistically studied. A fall in B. P. was greater on cementing into the femur than into the acetabulum. Oneset time of the maximum fall was within one minute and the hypotension did not last longer than five minutes. Arterial oxygen tension also fell after cement insertion but none of untowards reactions were encountered. As far as anesthetic method concerns, epidural anesthesia seemed to be favourable because blood loss was considerably less and the degree of hypotensive response to cementing was also slight.
Spinal intradural neurentric cyst is rare. The authors report one case who is 10 year-old boy. The Pt. complained of the neck pain which radiated to the bilateral arms on moving. Myelography demonstrated anterior filling defect at the level of C7. After removal of the cyst, the Pt. restored in good health. Pathological examination showed the cyst wall was made up of connective tissue with cuboidal or columnal epitherium and mucicarmine stain demonstrated mucin deposits. In Japan 12 cases has been reported. The authors summerise the as follows. 1) Sex: male 9, female 3 cases 2) Age: 3-38 year-old (average 17.8) 3) Level: frequently in cervical and upperthoracic 4) Site with respect to cross section: all in ventral to the spinal cord 5) Onset: localized pain developed rapidly to walk and bladder disturbance 6) Therapy: resection of the cyst wall 7) Prognosis: good
Few reports have been seen on the autopsy study of intramedullar tumor, glioblastoma. In this paper postmortem examination was presented concerning glioblastoma in the cervical cord. The patient was a 31-year-old woman, who began to complain of muscle weakness and atrophy in the left upper extremity on December, 1977 and admitted to our clinic. Decompressive laminectomy was performed at C3 through C6 inclusive because intramedullary tumor was suspected from myelographyic findings. In surgery the cervical cord dilated remarkably between C3 and C6 segments, but no myelotomy was tried. Postoperatively in a year and three months, he developed a severe tetraplegia and died with respiratory palsy. In the postmortem study, section showed the histological findings of glioblastoma, and tumor mass infiltrated diffusely in the left part of the cervical cord substance between C1 and T1 levels with the existence of a small size of tumor mass in the medulla oblongata.
Congenital dermal sinus communicated with the spinal canal is rare and fourteen cases have been reported in Japan. We would like to report one case of this disorder. Our case is a five-year-old girl. She has a congenital dermal sinus (associated with dimple, pigmentation and hair.) in the sacral region. Roentgenogram showed spina bifida occulta in the second sacral vertebra. Myelography showed complete obstruction below the level of the third lumbar vertebra. Laminectomy and removing of cyst were carried out. Symptomes are improving of ter surgery.
The authors reported a case of intraspinal ossified meningioma which associated with ossification of the ligamentum flavum at the same level. She was 58 years old female, and consulted our clinic with complaint of intermittent claudication and numbness of both feet, at first. Degenerative spondylolisthesis of the 4th lumbar vertebra was found, and myelogrom showed complete block at this level. Then, laminectomy and P-L fusion was performed. After operation, intermittent claudication was removed, but numbness was persisting. And, about 8 months after operation, she began to complain of gait disturbance. On the roentgenogram, OPLL at C2-3, Th5-6 and OYL from Th7-8 to Th10-11 were found. Myelogram showed complete block at the level of Th10-11. So, we considered OYL was the cause of myelopathy, but operation revealed meningioma containing mature bone tissue was the cause of myelopathy. Generally, meningioma which contains bone tissue is called osteoblastic meningioma, but this condition is very rare.
Nine patients of spinal tumor were treated surgically from 1970 to 1980. Three cases of them originated in the intramedulla and six cases in the intradura-extramedulla. For all cases, laminectomy and total or partial resection of the tumor was carried out, except in one case (hemangioblastoma-suspect), in which the tumor could not be resected because of a large risk of bleeding. Histological diagnosis was made as follows except for one case: Schwannoma: 6 cases Ganglioneuroma: 2 cases The site of tumor was in cervical spine: 3 cases thoracic spine: 4 cases lumbar spine: 2 cases Postoperative symptoms, such as gait and sensory disturbance, improved in all cases and the histological type and the site of tumor could not explain such good results.
Experimental cervical spondylotic myelopathy was presented to examine the role of the small canal and its pathogenesis. Method: Three nails were inserted in C4, C5, C6 spine of 40 rabbits through the anterior approach to a depth of 0.25mm at intervals of 3 weeks. Result: Based on observation of the gait, 10 rabbits developed “delayed paralysis”, when sagittal canal diameter of 45% was kept on an average of 8 months after the operation. Microangiography showed reduced filling of the vessels in the cord. Central artery and its branches were deformed, with elongation of the arteries in the lateral columns. The main pathological change was the demyelination around the gray matter to lateral column. These changes extended about two segments proximal or distal to the compressed region.
Many recent articles in the orthopaedic literature have dealt with various causes of atlantoaxial instability, but we have not seen an unusual case of a separate odontoid with the remnant fused to the anterior ring of the atlas since Clark's report in 1979. Here we report a case of this type followed posterior spinal fusion due to atlantoaxial fusion.
Asymptomatic spontaneous subluxation of C1 on C2 is common in Down's syndrome and can result in compression of the upper cervical cord. Symptomatic atlantoaxial dislocations developed in two such patients. The causes of the atlantoaxial dislocations were possibly due to the ligament laxity in one case and due to the osseous malformation in the other. Conditions in both patients were relieved by surgical stabilization of the first and second cervical vertebrae.
The ponticulus posticus is a bony bridge connecting between the massa lateralis and the arcus posterior of atlas, under which the vertebral artery and suboccipital nerve pass. It is said that its essence is the ossification in the atlanto-occipital ligament. We studied roentgenograms of the cervical spine of 394 patients consulted at Fukuoka University Hospital during last one year. The ponticulus posticus was found in 36 cases (9.2%). Sexual ratio is 1.5 to 1 (males and females). In age, it is more frequently seen in persons of adolescent and middle age comparatively.
A male, seventeen years old, whose neck began to bend forward two years ago and disability of his extremities was increased gradually from severe kyphotic change of his cervical spine. This type of spasmodic torticollis is very rare because the neck bended forward. After his neurological symptoms were remissioned by correcting the cervical deformity by the Halo-pelvic traction with the release of anterior longitudinal ligament of the cervical spine, anterior fusion of C3-7 was performed on this patient.
A 70-year-old woman complaining of gait disturbance was admitted to our hospital in May, 1976. She was diagnosed as cervical spondylotic myelopathy and had C5-6 interbody fusion. The symptoms were improved thereafter but were aggravated rapidly without any cause in July, 1979, and she was re-admitted to ours. X-ray examinations showed one pair of radiopaque nodules adjacent to C4 and C5 laminae in the spinal canal, and her myelogram showed a block at the same level. The nodules were removed surgically and were confirmed to be calcifications of the ligamenta flava.
On treatment of interlocking facets in cervical spine, skull traction is now the more widespread method. But, in some cases, this method fail to obtain reduction. Two patients with interlocking facets of cervical spine were treated through an anterior approach. One case was unilateral interlocking facet, another was bilateral. In two cases, reduction was safely achieved and solid fusion was obtained.
In this paper clinical and radiological findings and the managements of the herniation in the cervical intervertebral disc are discussed. In 214 cases which were treated surgically as a disorder of the cervical intervertebral disc, 16 cases (19 intervertebral discs) were diagnosed as a soft disc herniation. The age of the onset ranged from 28 years to 62 years, average 43 years. There was marked predominance of the male in this series. The involved disc level was C5/6 in 16 cases, C4/5 in 2 cases and C6/7 in 1 case. The common complaints of patients were numbness of the extremities, walking disturbance and pain in the neck and an arm. As clinical findings, hyperactivity of the reflex and sensory disturbance of the extremities were mainly observed. Radiologically, narrowing of the intervertebral space at the affected level was seen in 12 cases (75%), but the most valuable information to confirm this disorder was obtained by a myelogram and a discogram. In this series 12 cases were effectively treated by anterior spinal fusion.
Rehabilitation of the patient with cerebral palsy depends on the restoration of muscle balance. And no therapeutic program for cerebral palsy can succeed without restoration of muscle power. Planovalgus deformity of the foot would be not merely the deformity of the foot but also the cause of the scissors position. In our series, lengthenings of Achilles tendon show definite tendency to causes eversion of foot. This finding would mean that triceps surae has function of plantar flexor with inversion of the foot and if be weakened, the power of inversion is also weakened. Muscle balance is then destructed and eversion foot appears. In order to restore this muscle balance, such as weakness of inversion power, we lengthen evertors of the foot, such as peroneus brevis. And we can attain plantigrade foot and establishment of correct posture.
It is not sufficient to correct the deformity only by osteotomy or muscle transplantation. To gain the satisfactory release of the contracture, we need expansive release of soft tissues. For residual deformity osteotomy or muscle trans-plantation is required. We report our cases.
Some operations for paralytic lesion of the hip and knee joints due to spinal cord injury have been reported. A hip with loss of internal rotation because of incomplete thoracic lesion was treated with Mustard's operation or Sharrard's anterolateral iliopsoas transplantation. Another case suffering from partial cervical lesion was dealt with posterior capsulotomy of the hip and Sharrard's medial hamstring release for remarkable limitted flexion of the joint. Satisfactory effects were attained in these cases. Restorative operations for range of motion were attempted by excisions of periarticular heterotopic bones around the hip and the knee joints and by Thompson's quadricepsplasty to the stiff knee. Consequent greater flexion of the hip and knee joints made the wheel chair shorter, which means that the handling of the chair became easier and that moving about on unpaved roads became possible. And the patients have expressed their pleasure in being able to get on a car more easily.
Three cases of contracture of the deltoid muscle. Its diagnosis is relatively easy according to the following criteria. (1) Deformity of the shoulder. (2) Past history of injection to the deltoid muscle. (3) Palpation of the cord mass at the deltoid muscle. We treated as follows. (1) Release operation. (2) Immobilization by applying a sling for two weeks. (3) Apparatus for immobilization of the scapula.
Three cases of contracture of the gluteal muscles were reported. The cases had past hastoryies of repeated intramuscular injections into both buttocks at infancy. Their mothers noticed an abnormal gait with the abducted hips at three years of age. Two of the cases sat in a frog leg position, and they were unable to flex the hips in a sagittal plane, but in an abducted plane. Their trouble and handicaps in daily life could be improved by release operation of the contracted fascia and muscles.
Gluteal fibrosis is a rare condition, which Toyota first noticed in 1970. One of its characteristic findings is the disturbance of combined flexion and adduction of the hip joint. Three patients were diagnosed as bilateral gluteal fibrosis and operated upon in good results.
A follow up study and a clinical analysis of 11 patients of old achillis tendon rupture treated by surgical repair has been made. Because of the inadequate diagnosis and treatment by the first doctor, all of these patients, except one, was led to be neglected. The diagnosis of a partial rupture of the achillis tendon was made by he first doctor in 4 patients, but at the operation, all ruptures were found to be complete. This should give cause to reconsider the easy diagnosis of the partial rupture of it. More than a year after the operation, all of the patients, except one re-ruptured case, recoverd satisfactory and returned to heavy work and active sports.
We treated 220 cases of open wound in the last four years and three months, which cases were difficult to close the wound by only approximation and suture of wound margin. We chose two cases among these cases which were difficult to treat by only skin grafting, and described our method to treat such case. Such cases usually have deep dead space, necrosis extend to the surface of bone, and the wound are associated with infection, so we can not find out good recipient bed for skin graft. What is essential to treat such wound are followings; 1 removal of necrosed tissue 2 to fill dead space 3 coverage by skin If necrosed tissue is not removed completely, wound can never heal. It is essential to use well-vascularized tissue for filling dead space, so that we often used muscle for that. For coverage, we firstly choose free skin grafting wherever it is indicated, and secondly choose flap for the rest area where free skin grafting is not indicated.
Pretibial area has poor subcutaneous tissue, therefore, it is difficult to cover pretibial skin defects by STSG. Dr. Hartwell presented two bipedicle flaps in 1970 and Dr. Satomi reported a good result in 1972. We have been using this method since 1974 successfully. We had two cases each of pretibial open fracture, skin necrosis after open fracture and chronic suppurating osteomyelitis. We adopted the same design as Dr. Hartwell's. As Dr. Satomi reported, the advantages of this method are 1. Less risk of flap necrosis, 2. Less pain to the patient because it does not require the cross-leg position, 3. Shorter treatment period. Besides it does not require a special skill as free flap. We present two typical cases as follows: I. The first is pretibial chronic suppurating osteomyelitis. We took out the scar including the fistula in 3×12cm, scraped marrow, cleaned it and transplanted a piece of iliac bone to the dead space, then closed it by two bipedicle flaps. We noticed the redness in the suture but it cured completely. 2. The second is fresh pretibial open fracture. The skin was perforated by a piece of bone approximately 4cm wide. We fixed inside with 12cm KU plate, incised out the crushed skin, then closed it by two bipedicle flaps. Both bone fusion and suture were excellent.
We studied the frequency of the contracture of the quadriceps and the hamstrings muscles in 822 healthy male. The angle of the buttock elevation phenomen (BEP) and the straight leg raising test (SLR) were utilized for detection of above conditions. The contracture of the quadriceps which BEP showed below 100 degrees was found in 16.1%. The mean value of the angle of BEP was 124.0±16.71 on the right leg and 122.2±19.75 on the left. The contracture of the hamstrings which SLR test showed below 70 degrees was found in 31.3% with mean value of 79.3±9.56 on the right and 79.9±9.84 on the left.
Although many reports has been made in the field of measuring the center of gravity of the body, quantitative analysis could not be obtained by conventional techniques. Recent advance in electrical technology made it possible to measure and analyse quantitatively the center of gravity of the body. This is to introduce our method of measuring and analysing the center of gravity of the body quanitatively in normal persons by means of microcomputer system. Displacement of the center of gravity is found to be very few in normal persons at each age groups (20′s-60′s) in both eye opened and eye closed. Next step will be to measure it in patients group.
The studies of standing ability in hemiplegic patients were made by use of electrogravitiogram and surface EMG from trunk and lower extremities. Thirteen controls were used. The results were as follows; 1. The shifting of the center of gravity to the unaffected side was observed on standing with both feet in hemiplegic patients. 2. The fluctuation of the center of gravity was far greater in patients on closing eyes. 3. The surface EMG showed predominant activities in unaffected side where reciprocal EMG activities were also seen during swaying the body. 4. These findings seem to suggest the effectiveness of standing and gait exercises on hemiplegic patients.
Socioeconomical and psychological influences to the operated patients with low back pain were studied from 1976 to 1977 by means of questionnaires. Operated patients had been heavily suffered from economical loss for average six to eight months of work-off time which was statistically correlated with the duration from admission to returning to work and the operated method. However, the loss was not related to the postoperative medical evaluation and the patient's satisfaction to the operation as of psychological reaction. The fear of the recurrence was statistically forced their jobs into lighter work. Posterior appooach for aged female was revealed to be made carefully for psychological problem.
Patients with painful lesion of apparent laterality usually complain of joint stiffness of ipsilateral extremities. Eighty-four patients with painful lesion, such as radiculopathy or osteoarthritis, were examined to find out the relation between joint stiffness and painful lesion. The results are as follows: 1. A high incidence of joint stiffness was found in the ipsilateral extremities. 2. Joint stiffness would improve after treating the painful lesion. 3. In the case of joint stiffness in the opposed lateral extremities, treatment in situ would relieve the pain of the lesion.
It is necessary for orthopedists to get accurate informations about anatomical appearance of a femur. Now, it is common to calculate the angle of anteversion and neckshaft angle of a femur from two directional X-ray films, anterior-posterior view and lateral view. But it is often difficult to get the correct lateral view when the involved hip has severe limited range of motion or the patient is a crying baby. So to resolve these problems, we devised a new method. We can get anterior-posterior and oblique view by changing the position of X-ray beam like figure 1-a. From these films, we could know the anatomy of the femur.
Eighty-six cases of osteoarthrosis of hip using the faces method were reported on the pre- and postoperative evaluation. Scores of “Pain”, “Gait”, “ADL” and “ROM” of “Functional Evaluation of the Hip” were each other correlated to eyes, eyeblows, mouth and nose, which were designed into five grades. Then the multivariate observation was visualized graphically as a computer-drawn face. This representation made it easy for human mind to grasp the characteristics in the data of the functional evaluation of the hip.
Cystic change in iliac acetabulum is commonly recognized as the one of the findings of degenerative arthritis. There were some cases who appeared to us that their cysts were in part responsible for their discomfort on hip. Curettage and bone grafting was performed for the treatment on 5 cases who had acetabular cyst without arthritic changes or with minimal arthritic changes. These cysts include intraosseous ganglion, solitary bone cyst, subchondral bone cyst and osteoarthritic cysts. The results were variable.
Chondrolysis of the cartilage of the hip joint has been described frequently in patients with slipped capital femoral epiphysis. We observed chondrolysis of the hip joint in two adolescent male without slipped capital femoral epiphysis, infection, rheumatoid disease and ankylosing spondylitis. Idiopathic chondrolysis of the hip joint is characterized by pain and limp in adolescence, with progressive loss of articular cartilage space and stiffness of the hip joint. Our two patients were satisfactorily treated with R. O. M. exercise, non-weight bearing and leg traction on pain.
Children of Spina Bifida have many deformities in lower extremity correlate to their spinal cord damage. The purpose of this paper is to discuss about the treatment of paralytic hip dislocation. From 1972 to 1979, 9 unstable hips have been surgically treated. Sharrard procedure have been done on 8 hips and modified Sharrard procedure on 1hip. Subrequently, 8hips were reduced and remain so for several years.
Attempt to evaluate and to classify the degree of congruity of reduction at the time of manipulative reduction was made by arthrogram. From these arthrographic findings before and after traction, factors influencing the degree of congruity of reduction were investigated. And from the observations of intraarticular changes after reduction, pathogenesis of intraarticular interposition as a hindrance of congruity after reduction were discussed. Main factors influencing the degree of reduction are not only the structures within the joint but also tightness of the capsule and the structures around the joint. Incongruity of reduction at the time of manipulative reduction seems to have a significant influence on the formation of persistent intraarticular interposition after reduction.
The purpose of this study is to find out the factors that influence the occurrence of the deformity of the bony nucleus. Materials consist of 116 patients, 152hips, which were treated by Lorenz's method. These cases were followed up for fourteen years or more. Consequently, the age of treatment is the most important factor on the occurrence of the deformity of the bony nucleus. Namely, the frequency of the deformity of the bony nucleus was higher in the cases of less than two year olds than those over it. In the cases in which the treatment was begun in the early stage and had severe involvement of the bony nucleus, a deformity of the proxymal end of the femur was detected in X-ray pictures in the adult age. On the other hand, X-ray pictures of the cases in which the time of treatment was later, showed considereable dysplasia of the acetabulum in the adult age.
In our clinic, we have performed Chiari's medial displacement osteotomy for 32 cases of pre and early osteoarthrosis with dysplastic acetabulum since 1977. After the osteotomy, CE angle improved to 31.6 degrees and Sharp angle to 12.1 degrees in average with the achievement of a good coverage of the femoral head. We observed the medialization of the femoral in all cases and the decrease of the loading forces to the femoral head in almost cases.
A case with congenital bilateral total defect of the tibia, was reported. Case: A 2-year-3-month-old boy with bilateral clubfoot at birth, associated with the flexion contracture of the bilateral knee joint and the luxation of the ankle joints, and with bilateral toe deficiencies (right: first and second toe deficiency, left: first toe deficiency and second toe hypoplasia), and bilateral patella deficiencies. These findings with bilateral total tibia defects were demonstrated roentgenologically. Firstly, the bilateral knee arthroplasty according to Brown's method was performed, then followed by bilateral ankle joint arthrodesis. By post-operative X-ray film, it was demonstrated that alignment of lower extremity was improved, and the tibialisation of fibula was appearing. Nowadays, after 6th months from the last operation, he can walk using walker with long-leg brace.
This investigation was measured the movement of the hind part and fore part of the operated club foot and flatness of the body of talus with use the lateral radiographs. Radiographic studies were made of sixty eight club feet in fourty two patients and thirty six feet were used as controls. In all of the patients, ankle motion toword the plantal flexion was limited, and the flatness of the body of talus were observed. In some groups, instead of limitation of the hind foot movement, the range of motion of the fore foot was increased than in the normal limbs.
The purpose of this study is to discuss the advantage of the abduction weight bearing treatment. Thirty-one patients with Perthes' disease treated by this method were evaluated at an average follow-up of ten years after onset. They were classified into four groups according to Catterall's method in the order of increasing severity of involvement of the femoral epiphysis. In each group the results were evaluated ragiologically. As the degree of epiphyseal involvement became severe, the result became worse. On the other hand, for less than six years old the results were good except for the cases of group 4. Although this method could not obtain good results in the case of group 3 and 4 because of the coxa magna, short neck and overgrowth of the greater trochanter, the articular surface of the femoral head was kept smooth and spherical. We believe this fact is an advantage of the abduction weight bearing treatment.
The results of femoral varus osteotomy carried out in 12 patients affected with Perthes' disease were estimated. There were 9 (75per cent) good, 1 (8per cent) fair, and 2 (17per cent) poor results. Recently, to shorten treatment period we perform varus osteotomy in the early phase and we allow patients free to bear weight in early postpoerative days.
In Kitasato University Hospital, the renal transplantations over one hundred cases have been carried out since 1972. In this series, fifteen cases of avascular necrosis of bone were complicated with or without surgical treatments. Five cases of them have been managed conservatively. Following up the progress of the femoral head deformity, two types of collapse were observed. One is the progressively collapsed head which has inisially severe pain but less severe later. Another is the non-collapsed or minimal deformed head which has also clinically good course.
Recently, experiences of vascular-bundle transposition into avascularized bones, are reported, in expectation of early remodeling. We transposed lateral femoral circumflex artery and veins into avascularized femoral heads, which were ideopathic or, secondary to non-united femoral neck fracture. Also, transposed dorsalis pedis artery and veins, into avascularized body of the talus secondary to talusfracture. Either case revealed remarkable remodeling of avascularized bone by X-ray, in 4-5 months, and obtained excellent result free from pre-operative pain. Post operative angio-graphy, in avascular necrosis of talus, revealed revascularization of transposed vascular bundles, but in cases of avasclar necrosis of femoral head, revealed no revascularization.
The influence of vitamin E on platelets changes of rats associated with decompression was studied. In the first study, rats stayed at 6 ATA for 2 hours and were decompressed in 15 minutes, and platelet count fell from 56.13±4.14×104/mm3 to 39.06±12.98×104/mm3 after decompression. In the second study, rats were devided into 3 groups: group A rats were fed vitamin E-deficient diets (tocopherol 3mg/kg), group B rats were fed control diets (tocopherol 18mg/kg), and group C rats were fed vitamin E diets (tocopherol 18mg/kg). These groups were fed for 3 months. Platelet count fell from 64.84±3.70×104/mm3 to 56.66±5.03×104/mm3 after decompression in group A. Platelet count fell from 56.28±3.12×104/mm3 to 45.62±13.84×104/mm3 in group B. But there was no significant changes of platelet in group C. In the third study, survival rate after decompression was studied. Highest survival rate was group C (50.0%) and lowest survival rate was group A (16.7%). These results suggest that platelets changes after decompression can be inhibited by vitamin E. Vitamin E seemed to inhibit platelet adhesiveness and aggregation after decompression.
Eighty-three specimens were obtained from 44 cases with rheumatoid arthritis, osteoarthritis, septic arthritis and Charcot's arthritis. The sample was aspirated from the knee. After irrigation and centrifugation, the remnants were sectioned and stained with H-E. The findings of rheumatoid arthritis showed predominantly neutrophils and the debris of fibrinoid degenerate synovia. The histology of osteoarthritis revealed many degenerate cartilage fragments and few neutrophils. The epidermis was found in the fluid introduced by puncture. It is suggested that before articular injection or operation, the synovial fluid should be examined cytologically and histologically to discover latent infection.
Clinical data of 180 cases (794 examinations) of definite or classical rheumatoid arthritis were analysed statistically and discussed on the correlation with between immunoglobulin (IgG, IgA and IgM) and joint symptoms. IgG has increased in cases with heavy joint symptoms, and decreased according to anti-inflammatory effect by treatment. IgA has also increased in cases with heavy joint symptoms, but not allways decreased by treatment. It is noteworthy that many of the cases showing constantly high titer of IgA are often suffering from contructures of multiple joints. In cases which IgM showed more than 300mg/dl joint symptoms were heavy.