We investigated the functional results of the fracture of lower end of the radius on 82 patients (39 males and 43 females). Their age distribution was from 5 years to 79 years old. All of them were treated non-operatively with reduction of the fracture and plaster cast immobilization. The overall results which included the subjective symptom such as pain and stiffness of the wrist joint, and X-ray findings such as dorsal tilt angle at the fracture site were as follows; excellent 31 patients (40%), good 42 (50%), fair 8 (10%), and poor 1 (1%).
The Monteggia fracture is described as a fracture of the ulna (usually the proximal third) associated with a dislocation of the radial head. If, in the early stages, the dislocation of the radial head is overlooked, as is often the cases, the treatment becomes difficult. In the sixteen years and four months between 1964 and April, 1980, we experienced eighteen cases. Of these, we reexamined nine cases. Four cases were treated conservatively. The results were excellent. Of the five cases treated by open reduction, two cases came out excellent, one case fair and two cases poor.
Five cases of Osteochondritis Dissecans and one case of Osteochondritis of the capitulum humeri (Panners' disease) were presented. In one case of the Osteochondritis Dissecans bilateral knee joints were affected, others were the right elbow joints. They were all boys, aged eleven to fourteen at onset and thirteen to seventeen at visit to our clinic. Three of them had been operated, the results were excellent on the knee joints but good on the elbow joints. Another two conservative cases of the elbow joints had good results. The case of the Osteochondritis of the capitulum humeri has been treated conservatively, has no symptoms nor functional disabilities.
Twenty-four supracondylar fractures of the humerus in children were treated with cast, traction (Dunlop, vertical, skeletal), and/or open reduction for this fifteen years. Ten of those case were examined personally at follow-up and six were observed clinically and roentgenographicaly by hospital chart. Six out of ten cases complicated cubitus varus deformity. The deformity appeared to result from faulty reduction with medial angulation of the distal fragment and not to a growth disturbance.
Papineau's procedure is an open method of a bone grafting with autogenous cancellous bone chips. It is popular in France but the report of this operation is rare in Japan. Our patient, a thirty-six-year old woman, developed osteomyelitis of the left tibia after open fracture, which ended up with a wide ranged defect-pseudarthrosis two years after the injury. A bone grafting was necessary for osteosynthesis, but the scar was such a wide, deep and hard one, so that a common blocky subcutaneous bone grafting was hesitated. Therefore the Papineau's procedure was used and good result was obtained. Four months after the operation weight-bearing was allowed with Hoffmann's external fixation device and bone union was completed within nine months.
Although traumatic aneurysms in the extremities are common, it is rare at the anterior tibial artery. Recently we have experienced a case of the traumatic aneurysm of the anterior tibial artery with the fracture of fibular head. And because of enlargement of the aneurysm under the soleus muscle, entrapment neuropathy of the tibial nerve was occurred at its entrance of the muscle. We report such a case because of its rarity, the difficulty of early diagnosis and problems of management.
In our clinic we have treated thirty-five patients over the age of sixty-five for trochanteric fracture of the femur since 1975. Eight of them were males and twenty-seven females with the average age of seventy-five and seventy-eight, respectively. Fracture was classified into stable and unstable as described by Evans. Except for one stable fracture thirty-four of them were treated operatively. Of the twenty-four fractures, treated by three cancellous screw fixation, fifteen were of the stable type and nine of the unstable type. Sixty percents of them were able to walk using crutches postoperatively, however coxa vara developed in five cases. Non-union did not occur in any of them. The remaining ten cases, most of which were unstable fractures, were treated by compression hip screw, plate and Ender nail techniques. Eighty percents of these showed good results.
A case of fatigue fracture of femoral shaft was reported. A 13 year-old boy was sent to our hospital for treatment of rt. femoral fracture. Roentgenograms revealed periosteal reaction along the fracture site. 2 weeks before the fracture accident, the boy complained pain above rt. knee, and was taken a roentgenogram at some clinic. The roentgenogram had already shown periosteal reaction at the fracture site. Doubting the pathological fracture, we did angiography, and chemical study, but no abnormal finding was given. Then we did biopsy and osteosynthesis and got the good result. Accordingly we diagnosed it fatigue fracture of femoral shaft.
From 1971 to 1980, cast brace method was applied to 64 fractures of the lower extremities. The age of patients ranged from 4 to 83 years. Thirteen cases were under the 12 years of age. 31 fractures were applied the cast braces on an average of 4 to 5 weeks after skeletal traction. The cast braces for 33 fractures were combined with osteosynthesis using intramedurally nailing or plating. The fracture healing was favourable in all all cases were over the 90 degrees of ROM except seven cases. No severe stiffness of the knee joint less than 30 degrees of ROM was encountered.
Since 1975 eight patients with upper cervical spine injury (fracture of the posterior arch of the atlas in one, fracture of the dens in three, pure anterior atlant-axial dislocation in one, Os odontoideum in one, hangman's fracture in two) were treated. Two patients (fracture of the dens, pure anterior atlant-axial dislocation) were not definitely diagnosed during six months after injury. These two cases and one case of Os odontoideum were treated with posterior C. 1 to C. 2 fusion, others conservatively. The case of pure anterior atlant-axial dislocation was operated only two weeks before. A follow-up study for five months to 5.6 years revealed rather good results in the other seven cases.
The purpose of this paper is to discuss the relationship between discogram and the pattern of neck motion or clinical pictures in patients who has suffered sprain of the cervical spine. The results are as follows. 1) Although there is no abnormal finding in X-ray pictures, in twenty-three of sixty seven patients, ruptures of the posterior area in one or two disc levels were seen in the discograms. 2) It was not found any correlation between the type of discogram and the pattern of neck motion or clinical pictures. 3) The patients who showed normal pattern of neck motion had the incidence of the injury of upper cervical disc, but lower cervical discs were frequently affected in those ones who showed abnormal pattern. 4) Many patients who had abnormal pattern of neck motion showed clinical pictures of sprain and Barre-Lieou type.
Two cases of the discitis following removal of lumbar intervertebral disc and three cases due to hematogenous spread were recently experienced. 1. Increased erythrocyte sedimentation rate and positive C-reactive protein were most consistent abnormal observations 2. Roentgenographic changes are not detectable for at least three weeks after onset of symptoms 3. In four cases of them operative procedures were carried out and one case was conservative treatment. Causative organisms were not isolated from the affected discs
Since 1970, forty-four patients with cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) have been performed the anterior decompression surgery in our clinic. Thirty out of them were followed up after surgery, and fifteen of the thirty patients were radiologically recognized reossification of OPLL in the ossification-removed levels. They were examined by CT scanning. The CT findings of reossification are classified into four types by the manner of reossification. The type II, ossification grows medially from the unremoved remnant of ossification on the lateral site of the canal is the most common type. The etiology of reossification is unknown.
In the orthopedic field, intermittent claudication is almost caused by spinal canal stenosis. But we experienced a rare case with intermittent claudication due to the entrapment neuropathy of the posterolateral branch of L3 spinal nerve. At operation the nerve was identified to be entrapped between the fascia of the latissimus dorsi and the obliqus internus abdominis, and resected at the same point with fascia. Five months later, the clinical assessment is satisfactory without any disturbances of ADL.
From April, 1975 to September 1980, 90 cases had been operated on for lumbardisc hernia. Follow up study was done in 30 out of 90 cases. Duration of follow-up was from 6 months to 5 years and 5 months. The results were as followed; Of 30 cases, 17 were excellent, 9 good, and 1 poor. 3 cases were operated again. The factor that had worsed results were patient's age and the duration from the onset to the operation. Prolaps type had better result than protrusion type. Narrowing of the intervertebral space was observed in 11 of 30 cases.
15 patients were surgically treated for the lumbar spinal canal stenosis with lumbar scoliosis. They were classified into two groups. The one group had single curve (A group). The other group had double curve (B group). The causes of these scoliosis were mainly attributed to disk degeneration. The cases of B group were accompanied with congenital scoliosis, anterior and lateral displacement. The degrees of curves were more severe in B group than in A group. Clinical symptoms in A group were more prominent in concave side than convex side. On the other hand in B group they tended to be seen on both sides. Decompressive wide laminectomy was usually an adequate procedure, but in cases with instability postero-lateral or anterior spinal fusion was performed. Clinical symptoms were much improved but physical signs were not satisfactory as a result of operative treatment.
Seven cases of Histiocytosis-X in spine were discussed concerning to clinical appearances and radiological examination. On follow-up studies, all of our patients had become asymptomatic within about one month from the onset and have had no discomfort since. On radiological examination, three cases have shown the regeneration of vertebral body by the time of follow-up study. The degrees of which were one half compared with normrl height. The conclusions, obtained from our clinical and radiological studies, suggest that so-called Calvé's vertebral plana is due to the involvement of Histocytosis-X.
The patient, a 61-year-old male, noticed he had dysphagea in October 1975. He visited a radiologist and his illness was diagnosed as an esophageal cancer. Irradiation therapy was given; a dose of 6000 rad to the region of Th3-Th12, another 1000 rad to Th6-Th9. The patient progressed well until he noticed a sensory disturbance on the right toe. He entered our clinic in July 1979. He had Brown-Sequard syndrome at left thoracic level. His condition grew worse and resulted in complete paraplegia. He died in 1980. Autopsy revealed neither reccurrence nor metastasis. Spinal cord was atrophied from Th5 to Th10.
Three cases of the cervical syringomyelia that we have experienced recently, were reported and discussed. Case 1. A female, aged 34 years was drain aged by syringotomy. 7ml syrinx fluid with 5g/dl protein was punctured. Case 2. A male, aged 29 years of quadriplegia with diaphragma-respiration was drainaged by syringotomy. 3ml syrinx fluid with 380mg/dl protein and 43/3 cells was punctured. Case 3. A female, aged 42 years of hemiplegia complicated with internal hydrocephalus, moderate odontoid invagination and scoliosis was shunted by ventriculoperitoneal approach. Case 1 was diagnosed cystic glioma by characteristics of syrinx contents, case 2 idiopathic syringomyelia by nothing with trigger and genetic disease and case 3 syringohydromyelia by complications and atrophied cord. Myelopathy score was improved from 10/17 to 15/17 in case 1, but in case 2 and case 3 was unchanged. Early diagnosis and early operation was desired.
We clinically used the evoked spinal action potentials in the spinal cord injuries. Results were following. 1) In all Frankel's A type and B type injuries, we could obtain no potential that conducted through the injured level of the cord. 2) Below the injured level action potentials were seen within 24 hours. 3) The evoked spinal potentials were available in case of determination of the injured spinal cord level.
An experimental study was carried out to obtain the adequate CT picture by using a cadaver vertebra. EMI, CT 5005 scanner was used. Best condition to observe the thoracic canal by CT was nearly 400 EMI units in window width and 150 in level. Scanning angle was permited within about 10° in configulation and dimention. Configulation of 10 normal thoracic canals at each vertebral level was assessed and the dimentions of the canal at these levels were measured. In the cases of developmental cervical canal stenosis, the thoracic canal showed narrow especially in sagittal diameter. On the other hand it did not show marked difference in transverse diameter. In 4 cases of ossification of the yellow ligament treated surgically, 3 cases showed narrow thoracic canal on CT scan and narrow cervical canal in conventional radiographs.
A 82-year-old man consulted our clinic, suffering a fist-sized subcutaneous tumor on his left upper back for 10 years or more. Excision of this tumor was performed. It was a yellow, soft, encapsulated tumor weighed 100g. Microscopically it consisted of mature lipocytes and nests of fibroblastic spindle cells. Among these spindle cells, pleomorphic cells and bizarre mononuclear or multinuclear giant cells were observed. Pleomorphic lipoma is a rare and special type of lipoma, sometimes misdiagnosed as a liposarcoma. This patient had another soft part tumor at his right elbow. It was also extirpated and diagnosed as an angiomyoma.
A 23-year-old male was seen by authors with pain on his left wrist. Roentgenograms of the left wrist showed a round, radiolucent lesion about 5mm diameters in the scaphoid bone. At operation, the cystic cavity was found to be unicompartmental and devoid of fluid. In addition, there were no connective tissues on the surface of the inner wall of the cavity. Histological section of excised wall revealed only bone trabeculae showing a death of osteocytes in some areas. No recurrence have been noted 4 months after surgery.
We have experienced unusual case of bone cyst after the pathological fracture. Bone cysts are usually found during the first two decades of life. The cavity is filled with cystic fluid and the wall is lined by a thin layer of connective tissue. But our case was twenty-eight years old. In the cavity of the bone, we couldn't obtain not only the cystic fluid but also the fibrous connective wall of the cyst.
A 31-year-old male complaining of trembling and numbness of the right hand for 5 years was admitted due to aggravation of symptoms. Physical examination revealed a mild cervical myelopathy. Cervical spine film showed radiolucency and expansion of C6 spinous process and other deformities of C6 and C7 vertebrae. Cervical myelogram showed almost complete block at this level. Blood chemistry studies were normal. Laminectomy from C5 to C7 was performed and multiloculated cyst formation was observed beneath the cortex of C6 and C7 posterior elements. Microscopy also revealed bone cyst and the symptoms were improved postoperatively.
Patient was a 56-year-old man with a soft tissue tumor of left thigh. Since 1969 to 1979, patient was operated eight times because of local recidivum without metastasis. Pathological diagnosis was Liposarcoma primarily, but it was changed three times as malignant mesenchymal tumor, malignant schwannoma and malignant fibrous histiocytoma. In October 1979, he admitted for recidivum of tumor. In roentgenogram, bony invasion from soft tissue tumor was seen but there was no metastasis in other organs. Radical en bloc resection was performed to avoid amputation. Bone cement, autograft of fibula and intermedular nail were used to fill the defect of tumor. The final pathological diagnosis was malignant fibrous histiocytoma of soft tissue. Patient showed good functional recover but five months after operation the inter medurally nail was broken by stress. Because reconstructive surgery seemed to be impossible, we had to amputate his lower limb from hip joint.
Four cases of MFH were reported. These tumors were histologically diagnosed as MFH, being differenciated from such a rhabdomyosarcoma, a liposarcoma or a hemangiopericytoma. As treatment for MFH, after being removed, VACA chemotherapy with local radiation has been done in our clinic.
Four patients with synovial sarcoma were reviewed from the diagnostic, therapeutic and prognostic point of view. The first case, 27 years old female, had the primary lesion on her right calf, the second, 50 years old female, on her right thigh, the third, 29 years old male, onhid right thigh and the fourth case, 47 years old female, on her left thigh. The follow up periods were ten, sixteen, eleven and three years respectively after the initial treatment. The first case was treated by means of several local excision followed by amputation. The other patients were treated almost same method as the first case. But the fourth case was treated by a partial pelvectomy instead of amputation. Three of the patients are alive without evidence of any disease, but the third case developed metastases to the lymphnode and the lung.
We studied the bone remodeling process in the handtubular bones with enchondroma treated by bone grafting. X-ray films were analized by microdensitometer and bone mineral content was measused. The results were as follows; 1) The bone remodeling was almost completed after one year postoperatively and the microdensitometric pattern showed substantially the same as the control. 2) But, the same mineral content could not be obtained between the affected bone and the control a few years after operation; in one case the content was lower than the control and in other cases higher than the control. 3) It is valuable to analyze the bone remodeling process using the microdensitometer and the bone mineral analyzer.
Histochemical staining methods were applied to the study of congenital clubfoot. Muscles were obtained from 51 patients, mostly under the age of five years. Altogether 62 biopsies were examined. The site of muscle biopsies were gastrocnemius (38) and abductor hallucis (24). Histochemical anomalies were revealed in 42 specimens (68%); fiber type grouping (4), fiber type predominance (17), type I fiber hypotrophy (25) and type II fiber hypotrophy (6). These anomalies considered to be neurologically determined, so the evidence sugested the neurogenic factor as the causation of congenital clubfoot.
This paper reports the movement of the hind foot in operated club foot. Over 2.5-year period, a total of 46 feet in 34 patients were used for this investigation. The movement of the hind foot was measured by the lateral radiographs in the maximal plantal and dorsal fiexion of the ankle. TC index (Beatson) was measured before and after the operation to determine the varus condition of the club foot. Preoperatively, tibio-calcaneal angle of the lateral radiograph in the maximal dorsal flexion was measured to determine the equinus condition. The movement of hind foot, to the plantal fiexion, was found to be closely related with TC index in both before and after the operation. The equinus condition was related to TC index. As a consequence, limited plantal flexion was augmented in severe equinus foot.
Hoffer has reported good results using the split anterior tibial tendon transfer for spastic pes equino-varus. His good results encouraged us to perform this procedure on five feet in three cases of spastic pes equino-varus. Recently we applied this split transfer to replapsed congenital club foot with attenuated peroneus muscles (8 cases, 11 feet), and also paralytic equino-varus foot caused by Polio with preserved anterior tibial muscle. We devised a method to suture the split tendon to Peroneus brevis near its insertion instead of Hoffer's procedure which anchored the tendon to the bored os cuboides. We believe this is easier and less destructive. All cases with club foot obtained remarkable improvements of X-Ray findings, appearance and gait. Three were rated as excellent; four, good; and three, fair. To obtain better results in club foot, complete correction of the three main deforming elements is mandatory before or at the time of split transfer. Improvement was obtained in spastic equino-varus and Polio cases, however, it is difficult to determine the proper balance of split tendon against the flexors.
No therapeutic program for Cerebral Palsy patient can succeed without the restoration of muscle power, proper joint aligment, and correcting posture. Treatment of leg deformity in Cerebral Palsy patient is important in ADL. Therefore, we have done surgical treatment to obtain the restoration of proper alignment of joints and muscle balance in the leg. Planovalgus deformity of the foot is an unneglectable factor for correcting posture in the gravity. We have done “Lateral Release, ” which is elongated peroneus brevis muscle tendon and flexor hallucis longus muscle tendon in order to attain a plantigrade foot and muscle balance. We have already reported about “Lateral Release, ” this time we will report the difference of the pattern in Force Plate between a normal child and a Cerebral Palsy patient. We will present some cases, which have improved to almost normal.
A seventeen year-old boy complained of pain in the left elbow without any cause. Two days later he noticed disability of extension of the left fingers and thumb. The pain was improved in two weeks but there was no change in the motor disturbance. On examination six weeks after the onset there was paralysis of the extension of the all fingers of the left hand and paralysis of abduction and extension of the left thumb. There was tenderness on pressure over the course of the posterior interosseous nerve, just below the elbow joint. Eight weeks after the onset the posterior interosseous nerve was explored. The nerve was covered by a thin membranous band just proximal to the Frohse's arcade and under the band two narrow constrictions of the nerve was found. Proximal to the band the nerve was found to be oedematous and there was one more sausage-like constriction about 1cm below the elbow joint. The cause of the constrictions could not be found macroscopically and microscopically. Tendontransfer was carried out. During the postoperative fixation paralysis of the anterior interosseous nerve has occured. The cause of this paralysis remained unknown. Fortunately, recovery of the paralysis is occurring.
The author reported two rare cases of spontaneous rupture of the extensor tendon caused by Kienböck's disease, which were also complicated with carpal tunnel syndrome. The middle finger was involved in a 60-year-old female patient, and the index finger in a 64-year-old female patient. X-rays revealed that the lunate bone was separated into two fragments protruded dorsally and volarly, being thought to be a cause of the symptoms. Surgical decompression of the median nerve, excision of the lunate bone and reconstructive tendon transfer were performed with satisfactory result.
Traumatic dislocation of the extensor tendon at the metacarpophalangeal joint in the hand is uncommon, but when it occurs, it is usually in the long finger. We had experiences of 4 cases of this lesion, in which 3 cases in the long finger and 1 case in the index finger. Three cases of them were treated operatively with good results, whereas 1 case which occurred in the index finger was treated non-operatively with still complaining some residual symptoms. At operation, obvious injuries of radial intertendinous fascia at the MP joint were observed in all cases. The experimental results of our biomechanical studies show that the extensor tendon of the long finger have a tendency to dislocate more easily than that of index finger or ring finger.
Recently we experienced four cases with electrical hand injuries. Although electrical burns are generally classified as special thermal burns, they present extra problems with progressive necrosis. Burns from electricity more often have a prolonged healing time and results in more crippling deformities than do other thermal burns. Our series of electrical hand injuries were covered with abdominal pedicle flap. Some of them required reconstructive procedures upon nerves, tendons and joints. To achieve a good functional result, early pedicle closure and prevention of stiffness are important.
Prosthetic replacement for the post-traumatic contracted wrist joint utilizing radial end prosthesis are reported in this paper. Two cases have been experienced in Nobuhara Hospital. One is a 38 year-old man to whom we followed-up for six years and a half after surgery, and the other is a 36 year-old man followed-up for two years and a half. The results were excellent releasing of pain, acquiring the useful range of motion and no loosening of the prosthesis. We believe that the reconstructive surgery applied with radial end prosthesis is one of the useful method in treatment of post-traumatic Contracture of the wrist joint.
Etiology of ossification or calcification of spinal ligaments is not clear. This is to report scanning electron microscopic observation of the ossification of the spinal ligaments, especially on the ligamenta flava. On the surface of the non-ossification there are large collagen fibers, measured 1.8-5μ in diameter and little fibrillar connection is seen between them. In the peripheral part of the ossification there was found an irregular network composed of the fine microfibrils which are 400Å-900Å in diameter. Between or on the surface of the microfibrils, a number of granular particles measured 1μ-5μ in diameter were seen. Crystal deposition in the ligamenta flava was observed at the accumulation of the layer where a clear line of demarcation was seen between the clllagen framework and crystals. The crystals were rod and granular with a length of 0.6μ-4.0μ in diameter. The crystals deposited in the tissue were examined by X-ray microdiffractmeter. The X-ray diffraction pattern of the crystal coincided well to that of CPPD (Ca2P2O7·2H2O).
The immediate effects of periosteal stripping on bone marrow blood flow were studied in adult rabbits using the hydrogen washout technique, a system which allows repeated determinations of blood flow rate. Periosteal stripping of the diaphysis did not severely slow the blood flow in the bone marrow. The bone marrow blood flow was markedly reduced by stripping the metaphyseal periosteum. These findings suggest that the bone marrow does not receive its blood principally from the centripetally oriented periosteal vessels in the diaphysis, and the metaphysis is a major region for blood flow to the bone marrow.
We tried to make an experimental arthritis by means of intra-articular injection of type II collagen derived from human, bovine and pig cartilage. Fourty-eight rabbits with a weight of 2.5-3.0kg, immunized with human, bovine or pig type II collagen, received 1 intra-articular injection of the same antigen in the right knee and PBS or 0.1M acetic acid in the left knee. The grading of the inflammation was examined by clinical and histological investigations. Histological investigations of synovial membrane of joints showed distinct signs of chronic synovitis, such as hypertrophy and hyperplasia of synovial lining cells infiltration of mononuclear cells. In another experiment, a group of rabbits was immunized with bovine type II collagen and had a subsequent intraarticular injection of pig type II collagen in the left knee. These animals showed mild inflammatory reactions, in the left knees. It was suggested that there was a cross reactivity between pig and bovine type II collagen.
Young female rats (70-80g) were treated for 7 days with several doses of ethane-1-hydroxy-1, 1-diphosphonate (EHDP) or dichloromethylene diphosphonate (Cl2MDP). Effects of treatment on the changes in the thickness, growth, and mineralization of proximal epiphyseal plate and metaphysis of the tibia were assessed roentogenologically and histologically. Our results were as follows. 1) With low doses (5-30mg/kg/day) of EHDP, resorption at the periosteal surface in the metaphysis was inhibited, so that the club-shaped appearance in the metaphysis was induced. It was similar to that seen in human osteopetrosis. 2) With high doses (40-150mg/kg/day) of EHDP, the thickness of the epiphyseal plate was increased as three fold as control, and accumulation of osteoid tissue was observed. 3) With every doses (5-70mg/kg/day) of Cl2MDP, the club-shaped appearance in the metaphysis occurred such as EHDP (low dose), but no change was found in the thickness of the epiphyseal plate.
Osteopoikilosis is a sclerosing osteopathy which was first described by Stieda in 1905. In this paper, we report one case of osteopoikilosis who is a man 25 years old. In roentgenological picture, bone sclerosing condition was recognized at the edges of all long bones and pelvis except cranium, claviculas, ribs and vertebras. Genetically, osteopoikilosis appears to be caused by a dominantly inherited autosomal gene. This condition was usually discovered accidintally when searching for some other condition.
We shall describe the points in differentiating hypochondroplasia from achondroplasia. Recently we saw a female patient with hypochondroplasia which, according to Ravenna's report, is a different entity than achondroplasia. The patient was brought to us at the age of three years and seven months for evaluation of short stature and for genetic consultation. The following may be the important clinical points in differentiating hypochondroplasia from achondroplasia: 1 No facial and cranial deformity peculiar to achondroplasia such as nasal depression, frontal bossing or hydrocephalic skull 2 No trident deformity seen between the long and ring fingers Then, roentgenographically, the following findings are not so remarkably expressed as those of achondroplasia in its own grade. 3 Protrusion of the greater and lesser trochanter 4 Champagne glass like deformity of the pelvic cavity 5 Ball-in-socket changes between the epiphysis and the metaphysis of the long and short tubular bones 6 Deep sciatic notches in anteroposterior view
A case of pycnodysostosis in a 36 year old female was reported. The patient was always shorter than the other classmate and frequently troubled with the skeletal fracture from her childhood. The other her family were so quite healthy that the immediate heredity was not proved. She had the bone abnormality that was characterized by dwarfism, hypoplasia of the mandible, dysplasia of skull bones and partial aplasia of the terminal phalanges. Recently her femoral-shaft fracture was treated with the fixing of metal plate in our hospital.
A case of cleido-cranial dysostosis was reported. A boy was brought at the age of three with deformity of the both clavicles and feet. Radiographs showed abnormalities in the skull, clavicles, shoulder joints, symphysis, hip joints and feet. Arteriograph revealed both subclavian arteries situated at a higher level. Consequently, it is possible that clavicular defect in cleido-cranial dysostosis as well as congenital pseudoarthrosis of the clavicle is due to abnormal elevation of the first ribs and subclavian arteries.
A case of “Membranous Lipodystrophy” with serious bone lesions was presented. The patient, a 39-year-old man, visited our clinic complaining of marked swelling and/or deformities of almost all joints in the extremities. He had the past history of numerous pathological fractures and the family history of consanguineous marriage. Roentgenograms showed expansion of the bone marrow spaces in the epiphyseometaphyseal areas. The C. T. scan. was found useful for diagnosis of the lesion. The E. E. G. and the C. T. scan. of the skull revealed an organic change in the brain. On histological examination, so-called membranocystic lesion was also observed in the subcutaneous tissue.
A twelve-years-old girl was seen initially with hypoplasia of the right lower leg and deformity of the right foot. She was noted at birth to have hypoplasia of the right leg with polysyndachtyly of the foot. The foot had eight toes and at the age of seventy days polysyndachtyly had been treated by amputation of the accesory structures. Growth was normal but she had been limping after her initial gait. The range of motion in the right hip was full but the right knee and the right foot were limited. Roentogenograms revealed absence of the patella of the knee, hypoplasia of the tibia, new-formation of the tibia-like bone tissue and duplicated tarsal bones. A skeletal survay revealed no other osseous abnormality. The child was fitted with a compensatory lift of the right foot with an inside splint.
In seventy cases of senile osteoporosis, serial plasma levels of Gc as well as PTH, Ca, P, vitamin A-binding protein and prealbumin were followed by simultaneous assays to investigate changing interrelations. The patients showed lowered plasma Gc levels though the decrease was not as marked as in patients with cirrhosis of the liver. The plasma Gc changes did not parallel changes in RBP or PA. There was no plasma Gc changes that could be corrected with any of such parameters as PTH, Ca and P. The data indicate that the lowered plasma Gc concentration provides a common background to all cases of senile osteoporosis and suggests that PTH, Ca and P do not control the plasma Gc levels, which may be mediated through an independent regulatory mechanism.
This paper describes a new hump meter for the measurement of height and angle of rib or lumbar hump in initial screening for the early detection of scoliosis. A total of 67 children were examined for measurement of height and angle of rib or lumbar hump, and compared with degree in curvature (by Cobb Method). The results emphasize the much more correlation between the degree (of Cobb Method) and, height or angle of rib than lumbar hump in age over 11 years. And also, there are many cases of higher correlation with height of hump and curvature of degree (by Cobb Method) than angle of hump and curvature in age under 10 years.