Samatosensory evoked potentials (SEPs) were recorded from the scalp in 30 patients with incomplete cervical cord injury, 29 patients with cervical myelopathy and 23 normal adults using median nerve stimulation. The latencies of SEPs were corrected with a multiple linear regression analysis for age and arm length of normal adults. The latencies of the early components of SEPs more increased in patients with cervical cord injury than those with cervical myelopathy, but these latencies hardly reflected the degree of sensory impairment.
To study the relation between cervical corculation and function, vertebral angiography was performed in 17 cases with cervical cord injuries after operation. We classified anterior spinal artery into continued, partial disappear and disappear. And we assessed cervical cord function with Frankel classification. We did not find clear relation between anterior spinal artery and cervical cord function.
Between June, 1979, and March, 1981, 54 patients with acute cervical spinal trauma were treated in the Spinal Injuries Center. Fiftythree of 54 patients were treated with early spinal operation. Neurological impairment using Frankel classification system was compared at admission to follow-up examination. Nineteen of 54 patients with neurological defecit were unchanged at follow-up. The other patients were improved at follow-up examination but comparison between the non-operated cases reported by Frankel and our reported cases revealed no significant difference within neurological recovery. Early spinal operation within 24 hours did not influence outcome of neurological function except recovery of injured cervical segment. If neurological recovery of cervical spinal cord injuries expect, spinal operation must perform within a few hours after injury.
A four-year-old girl with an old, pure anterior atlanto-axial dislocation was treated by posterior arthrodesis of the atlanto-axial joint, in which the posterior acrh of atlas and spinous process of axis was fixed by silk threads followed by iliac bone grafts. The neck had been immobilized for six months. About four months after the operation, roentgenograms with the neck in flexion and extension showed a solid bone union between atlas and axis. Seven months after the operation, there was a marked neurological improvement, which however was associated with slight limitaion of cervical mobility.
Two cases of foramen magnum tumor on whom long period should be took for the final diagnosis from initial adission were reported The cases were a thirty-three year old woman and a fourty-eight year old man. On both cases, final diagnosis could not be made on their first admission because of the previous history of trauma in the first case. And, in second case, demyelinating disease had been suspected. The diagnosis of formen magnum tumor was established on second admission by thorough examination including serial CT scanning and myelography. Total resection of the tumor was done both cases. The results were favorable. Histological examination showed Schwannoma.
A head holder is neccessary for cervical myelography. Morris have described Duncan head rest for cervical myelography. We improved on Duncan head rest, our head rest has the desired degree of tiling. A simple device maintains a patient's head position while performing cervical myelography. This holder permits patients to assume a comfortable position and is especially ideal when using lateral puncture at C1-C2. The patient is placed in the prone position with head rest. A lateral cervical film is made with a net marker taped to the skin over the mastoid tip, the marker is removed, under local anesthesia 20G or 21G spinal needle is introduced between the laminal arches of C-1 and C-2. This device may also be used when examining the cervical region using trans-lumbar technique, the patient is a prone. 15°-20° head-down position with a pillow beneath the hips.
There are some cases with multiple lesions in the spine. But it is difficult that the responsibility for clinical symptoms and signs is diagnosed. We have operated two lesions at one stage with good results in five cases which have cervical myelopathies with another spinal lesion that is thought responsible for clinical symptoms and signs. From these exeperience, we think that in some cases, one stage operation for each lesion in the spine is reasonable for shortening of treatment periods.
We have classified cervical spondylotic myelopathy (CSM) into 3 types. The cases with type II and type III comprise wide variety of degree of myelopathy. The purpose of this study is in special reference to subdivision in type II and type III. 179 cases which had treated by surgery were chosen for study, and were analyzed statistically with a microcomputer. The best standard for the subdivision is to evaluate the motor function of the lower limb, which is divided into two groups according to point system of standards for judgement of CSM created by Japanese Orthopedic Association. In group A (cases with mild dysfunction) of type II and III, the symptoms are dominant in the upper limbs. In group B (with severe dysfunction) of type II and III, the symptoms are more severely involved in the upper and lower limbs. Using our classification, the area of spinal cord lesion and the prognosis in CSM can be presumed and, therefor, we think our classification is useful in clinical understanding of CSM.
We analyzed the post-operative radiographic findings in 112 cases with cervical spondylotic myelopathy who were operated by anterior or posterior approach and the following results were obtained. 1) Solid fusion of the intervertebral space occurred in most patients within 4 months and pseudarthrosis developed in 12% of 83 cases. 2) The changes of the fused intervertebral height were classified into five groups, B group (the height increased at the time of operation, but decreased gradually after-ward) was founded more frequently than other groups. 3) The posterior spurs which had not been removed were resorbed gradually within 1 year to 3 years after the operation. 4) At the adjacent intervertebral discs, disc narrowing (22%), posterior spur formation (28%), instability (22%) developed. However, these changes at the adjacent discs or pseudarthrosis at the fused levels did less frequently correlate with the clinical results. 5) 5 cases (28%) of enlargement of the cervical canal without laminectomy, and 4 cases (36%) of laminectomy showed abnormal alignment at the time of study, but the degree was generally slight.
A follow-up study of 50 cases with the partial vertebrectomy and fusion of cervical spine was carried out radiographically and clinically. And the following results dbtained. 1) It took longer time in multilevel fusion than in single level fusion to get solid union between the grafted bone and the vertebral bodies. 2) Pseudoarthrosis was observed in 4 cases and delayed union in 4 cases. 3) Local kyphotic change which occurred in fused level developed in 9 cases. 4) The fused intervertebral height was decreased in 75% of 36 cases. 5) The posterior spurs which had been left were found in 4 cases, but the spurs were not so large and tended to become smaller and be absorbed. 6) At the adjacent intervertebral discs, disc narrowing, posterior spur formation, instability developed. However, these changes at the adjacent intervertebral discs had less influence on the postoperative results.
Thoracic myelopathy due to developmental canal stenosis has not been reported so far. This is to report one case of this disorder. A sailor, 39 years old male, had numbness and weakness of legs 4 months before admission, and gait disturbance was followed. Neurologically tendon reflex of lower limbs were hyperactive and sensory disturbance was observed at the feet. Spinal fluid examination showed 106mg/dl of protein and 103/3 of cell cont. Segmental SEP at cervical and lumbar enlargement levels of the spinal cord was normal, but conductive disturbance was observed between C6 and T11 spinal levels. Plain radiogram showed developmental canal stenosis with mild spondylotic changes at T9-10. A-p diameter of thoracic spine was small in x-ray film by the measurement of our method and C-T scanning revealed by small compared with the normal cases. Cervical and lumber spine also had the small canal. Laminectomy at T8 through T11 brought excellent result.
Adhesive arachnoiditis in thoracic spine is rare. We experience two cases of adhesive arachnoiditis in thoracic spine. The first case, a 28 years old female, was operated on within 1 month since the appearance of palsy. After operation, palsy disappeared well. The second case, a 39 years old male, was operated on with microsurgical technique, ten years after the appearance of palsy. After operation palsy improved slightly. We think that in this condition we had better operate under microscope as soon as the sympton appears.
A case of epidural abscess was reported in this paper. The patient was a male and 28 years old. He had developed parplegia suddenly with severe low back pain but no fever, and was admitted to our clinic five days after the onset of the symptoms. Radiological examination revealed no abnormal findings, while myelography showed complete block of the contrast medium at the level of T-6. This showed extra-dural tumorlike appearance. Decompressive laminectomy was performed twelve days after his admission making no definite diagnosis. It was proved to be epidural abscess with staphylococcus epidermidis. The patient still remains paraplegic with no remarkable improvement. The early diagnosis and early decompressive laminectomy are important in this disease for a good prognosis. We should have been more careful for the diagnosis preoperatively.
Recently, we have experienced a case of spinal Extradural Cyst. The patient, 42 years old male, was admitted to our hospital with chief compliant of pain and numbness in the left lower extremity. Roentgenogram showed a mild scoliosis with convexity to the left. The spinal canal was widened and the pedicles narrowed from the 11th thoracis to the 2st lumbar vertebrae. In the lateral view there was slight concavity of the posterior surface of these vertebrae. Myelogram revealed an extradural lession in the above area. Laminectomy was performed at 11th, 12th thoracis, 1st and 2nd lumbar vertebrae. A large extradural cyst was encounted, then completely removed. The cyst had a communication with the dural membrane on left 12th thoracis nerve root. Histologir section of the cyst wall revealed collagenous tissue with partially hyalinigation and calcification Now two months postoperative course, and was markedly relieved of his symptoms.
We experienced two cases of spinal cord tumor. Both of them are intradural extramedullary tumors, histologically neurinoma. Case 1, a 62 year-old female, was treated initally as cervical spondylosis and one month later shoulder-hand syndrome was associated. After two months deep tendon reflexes of the lower extremities were hyperactive and sensory disturbance was noticed below the level of C5 and then cervical spinal cord tumor was suspected. Case 2, a 6o year-old male, felt the left upper abdominal pain at onset and was treated as pancreatitis by a medical doctor, but he visited our clinic because of walking disturbance. X-ray, tomogram and CT revealed thoracolumbar OYL. Myelograms demonstrated a filling defect of contrast medium around the level of Th7 and proved the thoracic spinal cord tumor.
The report about cerebrospinal fluid (C. S. F.) fistula as a sequela of spinal operative intervention is very few. We are reporting our clinical experiences in four cases of fistula or pooling of C. S. F. that we tried to repair surgically. As primary disorders two cases were of cervical cord tumor, one of syringomyelia and one of lumbar disc herniation. After exposure of the appropriate spinal levels, we could see a cavity covered with thin and white fibrous membrane inside and a pin hole defect or tiny tear in the dura. The dural defects were closed by direct suture in one case and by the use of tissue adhaesiva (alon alpha), cadaver dura and fascia lata. The postoperative results were satisfactory in three cases except for one of syringomyelia, in whom pooling of C. S. F. is still reconized on CT scan examination.
Twenty-nine patients, ten to seventy-six years old, were followed up for seven to thirty-six years after laminectomy for spinal cord trmor. Post laminectomy kyphosis occurred in eight patients (27.6%) and instability in Seven patients (24.1%). Facet joints appears to be most important in the development of kyphosis and instability.
We experienced a case of spondyloepiphyseal dysplasia (S. E. D.) with a colapsed high lumbar disc herniation. His diagnosis was the autosomal dominant S. E. D. that had the severe osteoarthritis of several joints and deformities of the vertebral bodies. He complained of the gait disturbance with an acute severe low back pain. On X-ray film, his spine showed a significant developmental canal stenosis and lumbar kyphosis which might be due to the vertebral deformities. At first those might be supposed the causes of his symptoms. But finally his myelogram and peridurogram comfirmed the diagnosis of H. N. P, of the second lumbar disc.
“Posterior Kantenabtrennung” is a rare disorder. Recently, we have experience an operation of the disorder. The chief complaint of the patient was low back pain radiating to the leg. On phsical examination, straight leg raising test was positive at 30 degrees on the right. MMT of the right anterior tibialis was graded as poor. Sesation and reflex were intact. Radiographic examination demonstrated a scleosis at the inferior border of L4 as well a bony fragment projecting posteriorly into the spinal canal. Myelography revealed complete blockage just the L4-L5 interspace. Discography showed Schmorl's nodes of L4 and L5 vertevral bodies. Computed Tomography disclosed equally divided two bony fragments, associated with the postero-inferior angle defect of L4 vertevral body. These two bony fragments detached from L4 vertevral body were partially removed by performing laminectomy.
An advance of supping in spondylolytic spondylolisthesis was studied on 58 patients who didn't undergo an operative treatment and were checked by X-ray more than one year with an average of 6 years. At the first examination, an average rate of the slipping was 15% by Marique-Taillard's method. Advancement of the slipping more than 5% was found in 26% of all patients, the maximum slipping rate being 12%. The slipping was advanced in the third and fourth decade, and was associated frequently with a narrowing of the intervertebral space. Sixty per cent of the patients were released from their complaints, and the patients with some complaints in the lower extremities were found more frequently in the advanced patients than in the stationary.
The early results of treatment of idiopathic scoliosis with the Kyushu University Underarm Brace (K. U. U. B.) were studied in 70 patients, whose ages ranged from 2 to 19 years (average, 13.5 years) at the beginning of treatment. These 70 patients had 102 separate curves, and followed for six months or more after the beginning of brace treatment (average, 16.8 months; range, 6 to 45 months). The mean initial curvature was 26.9 degrees. The average percent correction at follow-up was 38.7% in 44 thoracic curves with the apex below T7. The mean T1-tilt in degrees was 0.06° before treatment and —0.99° in brace at follow-up. The K. U. U. B. was effective for thoracic curves that apices located below T7 without out of balance.
The effect on synovectomy and débridement with resection of distal end of the ulna is generally accepted. The one problem is the osseous ankylosis of the radiocarpal joint. The ankylosis of the radiocarpal joint often develops after the operation, when erosion of the articular cartilage in the radiocarpal joint exsists at the operation. But unfortunately, this finding has been neglected, presumably because the restoration of stability far overweighed any minor functional impairment brought about by lack of motion after the operation. We believe, if possible, the existence of pain free motion of the wrist is the more beneficial and functional in the rheumatoid patient. A technique of partial arthroplasty without ulnar head resection in the rheumatoid wrist was recommented. A flap of the extensor retinaculum was used as interposition material in the radiocarpal joint for covering the eroded articular surface of the radius and ulna. It must be stressed that this procedure is so useful as to stabilize the ulnar head, prevent volar subluxation of the carpus on the radius and prevent the postopera tive osseous ankyosis of radiocarpal joint. In the severely destructed wrist with collapse on the ulnar and volar side of the radius, radial head prosthesis or total wrist replacement was rather recommended as implant arthroplasty. The indication of the arthroplasty was also discussed in connection with that of the arthrodesis in the rheumatoid wrist.
For the past 18 years, forty-five stiff elbows mainly following trauma were treated with our operative method, in which postero-lateral skin incision is used. The feature of our method at exposure of the elbow joint is to maintain the continuity of the triceps tendon by wide subperiosteal stripping, so that early commencement of motion is possible postoperatively and also good exploration of the elbow joint can be obtained. Out of 45 cases, 41 were followed up with a mean of 6 years and 7 months. Average range of motion was 102 degrees, and 90 per cent of these 41 patients were excellent or good according to Kita's criteria. From this result, our operative method is thought very useful for the arthroplasty of elbow.
We had experiences of 10 cases of the elbow joint arthroplasty using the J. K. Membrane or the O. M. S. Membrane as an interposition, in which the J. K. Membrane for 3 cases and the O. M. S. Membrane for 7 cases. Our series consisted of the patients with traumatic arthritis (4 cases), rheumatoid arthritis (4 cases) and osteo-arthritis (2 cases). As for the operative technique, the modified Hass's procedure with radial head resection was indicated to most of the cases. The end-results were evaluated according to our own criteria taking account of the degree of pain, the range of motion, the disability on daily activities and the patient'-satisfaction for the operation. With this criteria, three cases were evaluated as excellent, two cases as good, three cases as fair and two cases as poor. The several factors which influenced the end-results were also discussed in this paper.
A study of the long-term results of arthroplasty of the elbow and the knee using J-K membrane has been made. 37 cases of arthroplasty of the elbow were evaluated clinically and roentgenographically an average of 14 years after operation. These cases had an average range of motion of 61 degrees with good stability and without pain. An average range of motion is 76 degrees in the group following rheumatoid arthritis, 65 degrees in the group following trauma and 37 degrees in the group following infectious arthritis. 50 cases of arthroplasty of the knee were evaluated an average of 16 years after operation. An range of motion is 72 degrees in the group following rheumatoid arthritis, 70 degrees in the group following trauma and 47 degrees in the group following infectious arthritis. It can be concluded that arthroplasty of the elbow and the knee using J-K membrane, properly performed in selected cases, offers on useful range of motion with good stability and strength.
Follow-up results of arthroplasty without implant performed for the 27 elbows and 29 knees were reported. An average age of the patients was 26 years. J-K. membrane (chromatized fascia lata) was interposed for 19 cases of the elbow, in which deterioration of the articular cartilage was marked, and the remaining 7 cases underwent arthroplasty without interposition, the former being 12 cases and the latter 17 cases of the knee joint. The results could be evaluated on the 20 elbows and 21 knees with an average follow-up period of 6 years. 5 months and 5 years. 9 months, respectivery. While a recovery of muscle power of the extensor was inferior to that of the flexor, no case of instability was found and the painless joints were obtained in 85% of the elbow cases and in 69% of the knee cases. Seventy five percent of the elbow cases and 71% of the knee cases satisfied with the results of operation.
Follow up study of quadricepsplasty was done on 28 cases with the knee contracture due to femoral fracture. These cases were followed for an average of 92 months. Mean range of motion, being 39.2 before operation, changed to that of 105.8. At the follow up, the mean angle of extension lag was 5.5, and this caused no patients' complains. It may be important for good final results to get more than 110 flexion angle at operation and to do proper rehabilitation.
Follow-up study was made on results of artroplasty using interposing membranes performed on 4 hip and 6 knee joints (tuberculosis 6, pyogenic infection 3 and trauma 1) during 1957 to 1971. Age at surgery was 19 to 39, and an average of 20 years have elapsed since. Although X-ray showed sclerosis and absorption of articular surface, relief from pain, good stability, mobility and muscular power were restored in 7 out of 10. Pyogenic infection cases showed results inferior to those of other causes. Despite progress in artificial material, this procedure cannot be neglected from the biological viewpoint.
Subcutaneous rupture of flexor tendons of the fingers is a relatively uncommon occurrence. Von Zander's report in 1891 of a rupture involving the flexor pollicis longus tendon was the first reported flexor tendon rupture in the forearm and hand. Three patients have been treated recently for flexor digitorum profundus tendon ruptures of the little finger. In two cases early surgical treatment gave excellent result. In one case conservative treatment by plaster cast fixation gave excellent result.
Subcutaneous rupture of the tendon of flexor pollicis longus occurs infrequently. In this paper we report our experience with a patient who had the rupture secondary to past electrical injury. Case 36-year-old man He was sustained from an electrical injury (66, 000V) on this right palmar wrist about 20 years ago. He suddenly had a pain and could not bend his right thumb at the IP joint, while holding up a heavy thing on 19 April, 1980. Operation of tendon suture with modified advanced method was performed, and the range of motion of IP joint got the state of 0°-80°, 2 months later. It was considered that the past electrical injury was a cause of subcutaneous rupture in this case.
Fracture-dislocations of the proximal interphalangeal (PIP) joint may not be recognised as a severe injury and, as a consequence, treatment may be inadequate. We have treated twelve chronic fracture-dislocations of the PIP joint within the past fifteen years. Four cases were treated by open reduction, and three by closed reduction and five by arthrodesis. Many methods for the treatment of fracture-dislocation of she PIP joint have been reported. There are so many types of the fractures and shapes of the anticular surfaces in the fracture-dislocations of the PIP joint that most suitable treatments for the individual cases should be chosen.
Post-traumatic false aneurysm of the forearm is uncommon. We encountered these two cases, which were excised without any vascular reconstruction. Case 1. S. Y. (8013835-7) 42 Yrs, male, who visited our hospital 3 months after a traffic accident. Case 2. N. H. (7904143-0) 60 Yrs, male, who was operated 17 months after an incision. These clinical and pathological findings were reported, and their classification of the peripheral post-traumatic aneurysm, and their follow up data were also discussed in this paper.
The patient was a twelve-years-old body, who was injured by having a fall on rid-ding bicycle. By X-ray examination, forward dislocation of the elbow with fractures of radial and ulnal condyle of the humerus were observed. But fracture of the olecranon was not seen. Under general anaesthesia this dislocation was redused manually. Ten days after that, fracture of the ulnar condyle wad fixed with a screw. The active motion of the elbow was begun after the plaster cast fixation for three weeks. Seven months later of trauma, the motion was limited clinically and periarticular calcification was seen radiologically. In this case, it is thought that the olecranon which was displaced towards ulnar side at first broked the ulnar condyle and dislocated forward with it.
Ninety-seven children with supracondylar fracture of the humerus were treated dur-ing three years from 1977. Main complication of fracture was nerve palsies which were recorded in 20 patients (20.6%), but they were transitory. Methods of treatment were manual reduction, skin or skeletal traction and surgery. Results of treatment were evaluated from the motion of the elbow and varus or valgus deformity. Seventy-eight per cent of the patients showed satisfactory healing. Manual reduction followed continuous overhead skeletal traction was recommended to prevent varus deformity. Residual deformities were observed in 10 patients (10.3%); valgus in 3 and varus in 7. They were essentially caused by imperfect reduction and re-dislocation during immobilization. Authors also emphasized to pay attention to anterior angulation and rotatory deformity which resulted in restriction of motion of the elbow.
Ninty eight cases of supracondylar fracture of the humerus in children were followed-up from 8 months to 10 years with an average of 4 years and 3 months. The results obtained were as follows: 1. It was revealed that the cubitus varus was caused primarily by medial tilting of the distal fragment and accelated by rotational displacement. 2. The results showed that modified Dunlop's traction was a quite effective method of treatment. 3. So-called “medial impaction” was seen in 4 cases, which showed marked varus deformity at the follow-up. Such type of fracture should be treated carefully to prevent varus deformity.
We experienced 68 supracondylar fractures of the humerus of the children from January 1955 to December 1980. The patients comprised of 54 fresh ones who consulted our clinic within 10 days and 14 old ones after 24 days. 39 fresh supracondylar fractures were classified according to the initial roentgenographic data and were analyzed clinically. The correlations with the initial displacement of the distal fragment, the initial therapy, the following therapy and the complications were discussed.
Twenty-one elbows (20 patients) with varus and valgus deformities were treated with corrective osteotomy from 1966 to 1981. Eighteen cases of varus deformities were resulted from supracondylar fractures (7 cases) and diacondyle fractures (11 cases), and three cases of valgus deformities from radial condyle fractures. The age of the patients operated upon for the deformities were ranged from 4 to 23 years. At the follow-up survey, the deformities resulted from supracondylar fractures were corrected satisfactorily, and the deformities from diacondyle and radial condyle fractures were not always corrected satisfactorily. This results gave that the cases with growth disturbance of the distal humeral end due to the epiphyseal separation, should not be operated before about 10 years. Concerning to the operative method, French and Zuggurtung methods gave good results, that is to say, the stability at the osteotomy must be kept until the bony callus appears.
Acromial fracture are rare and can usually be treated by conservative methods. We report two cases with acromial fracture which required operative treatment because of delayed (or non) union and persistent pain at motion. The case 1 had acromial fracture by motor car accident who was treated conseratively with immobilization for the first four weeks. Then, an active and passive exercise therapy had been begun, but pain at motion and the contracture of the shoulder persisted. Therefore, the osteosynthesis was carried out twelfth weeks after the injury by the method of Zuggurtung. For four weeks after surgery, the shoulder was kept in immobilization in the zero position which was followed by active and passive exercise. The case 2 was treated by immobilization for six weeks after acromial fracture caused by motor car accident. However, because of non-union and pain at motion, osteosynthesis was carried out by the Zuggurtung method with bone graft. After immobilization for eight weeks, exercise had been begun. An excellent bone union was accomplished in both cases. The patients have been pain-free and the shoulder function has recovered almost normal after six months following surgery.
Two cases of old traumatic dislocation of the shoulder joint were treated operatively. One case, a 56-year-old female, underwent total shoulder replacement (Stanmore shoulder) one and a half years after injury. Postoperatively, pains in the shoulder disappeared completely, while improvement of the shoulder motion could not be obtained more than preoperatively. Another case was a 28-year-old male who had suffered traumatic shoulder dislocation 40 days before. Operative reduction was performed, in which the anterior part of the joint capsule was simultaneously enforced by transferring the brachioradial muscle and tendon of long head of biceps to the anterior part of the capsule. Through these procedures a stable good reduction of the humeral head was achieved with a good postoperative result.
We invented X-ray camera applying polaroid film and its use in the orthopedic surgery affords us great facilities. This camera is the simple structure that the image which X-raying system irradiated on the screen is reflected by mirror and projected onto the polaroid film in the camera. The merits of this apparatus are as follows. 1. It takes us about 30 seconds to get the image after X-raying 2. Operating the apparatus is easy and repeating X-raying is possible. 3. We have only to prepare for a portable X-ray apparatus. 4. We don't need a development system in roentgen film. etc... But there are a few demerits. 1. The image is not so clear as one by roentgen film. 2. The height of the dark box is as long as 23 cm. etc... We must correct those faults, but many merits have done more than offset those faults.
As we reported previously, with high dose of EHDP (60mg/kg per day for 7 days), the thickness of the epiphyseal growth plate was increased and osteoid tissue was accummulated in tibias of young female rats. In this paper, influences of this inhibited bone mineralization on bone growth were assessed roentogenologically, histologically and microangiographically. Our results were as follows. Until one week after treatment, inhibited bone mineralization was still continued. Calcification in increased epiphyseal growth plate was seen from two weeks after treatment and normal trabecullar pattern was identified from six weeks after treatment. Judging by growth curve of tibia and femur, half-time of growth suppression by EHDP in this system was about two weeks.
Considerable interest has developed in the role of the autonomic nervous system and its effect on bone blood flow. In this paper, the effect of denervation on bone blood flow was studied using the hydrogen washout technique which allows repeated determinations of blood flow rates in the tissues. Six New Zealand white rabbits were anesthetized and platinum electrodes were inserted into the distal metaphysis of the both tibiae. Blood flow rates were measured before and after sectioning the proximal portions of the left sciatic nerves. Results showed that the average blood flow rate of the distal tibiae was 0.18ml/min/ml tissue. The blood flow of the denervated limb (left) was found to be increased by 24% in 5 minutes and by 17% in 30 minutes after the sciatic nerve section. On the other hand, the bone blood flow of the contralateral limb (right) showed 22% to 28% decrease after the left sciatic nerve section.
By the Hydrogen clearance method, focal blood flow has been measured under spontaneous breathing in the Rabbit. Blood flow in the spinal cord at Th-8 segment ranged from 30.7ml/100g/min to 6.5ml/100g/min. The overall mean was 18.55ml/100g/min± 1.57 S. E. (n=19). There had been no correlation between the variations of mean arterial blood pressure and spinal cord blood flow. Arterial blood Oxygen pressure had been significantly correlated with spinal cord blood flow. Under controlled P-CO2 and P-O2 condition, this technique appeared to be well suited to the spinal cord blood flow measurement, yielding reproducible results.
A series of surgical treatments for contracture of the deltoid muscles have been performed since 1972. In this paper, we examined postoperative clinical status of the 22 cases. The sort of operation performed to the disease was partial resection of fibrotic portion of the deltoid muscle. The result of the operation was excellent in 19 cases, but recurred in 3 cases.
A 4-month-old girl with restriction of the bilateral hip, which was suspected congenital, was reported. A string-like contructure of the ilio-tibial tract was noticed at the trochanteric region. Abduction of the hip joints in extended position was restricted up to 30 degrees. Manipulative treatment was done for 3 months, and no surgical intervention was undertaken. After about one year of follow-up, the limitation of hip joint motion was disappeared and a posture was normal on walking.
Two cases of psychogenic tight hamstrings were presented. Case 1: A boy, fifteen years old, visited our clinic complaining lumbar pain and disturbance of foreward flexion of the spine. Physical examination revealed decreased foreward tilt of the pelvis with elimination of the normal lumbar lordosis and exaggerated lordosis of the lower thoracic spine. Foreward flexion of the lumbar spine was markedly limited. There was marked hamstrings spasmus and straight leg raising was almost impossible on the left and limited 30 degree on the right. Neurogenic examination was otherwise normal. Roentgenographic and laboratory studies were negative. Case 2: A boy, sixteen years old, visited our clinic complaining disturbance of foreward flexion of the spine. Physical examination disclosed decreased foreward tilt of the pelvis. Foreward bending was limited so that he could reach no lower with his finger tip than 43 centimeters from the floor. All neurological and laboratory studies were negative. The disorder of the both cases were considered psychic and consulted by two of the authors (Psychiatrist). The first case was diagnosed depressed state and the second case conversion hysteria. It was suspected that they had some problems of the family background. The disorder was improved by the psychotherapy. Some problems of the psychosomatic medicine in orthopaedic clinic were discussed.
Hyperostomy syndrome have been first described by Pratesi in 1957 as an arteriovenular disease that simulates an ischemic arterial disease, but without evident signs of occlusive arterial disease. Malan, Mayall and other authors have also presented this syndrome. Two clinical pattern has been described; •Primary: of unknown origin •Secondary: appearing together with the some organic disease of arteries, veins and lymphatic vessels A fourty-four years old man was examined at our clinic with the complaint of swelling of his right leg. Circumferences of his legs were 38. 5 centimeters on the right and 35.0 centimeters on the left. The arteriogram of his right leg revealed as follows; •Delayed filling of contrast medium to the posterial tibial artery, anterior tibial artery and fibular artery. •Many abnormal branches derived from main arteries of his right leg. He was diagnosed as primary hyperostomy syndrome. He have been treated with wearing elastic stocking. Difference of the circumferences between his both legs decreased to 1.5 centimeters and he has no complaint on his right leg.
Three cases of pycnodysostosis were reported. All of those cases presented characteristic findings of pycnodysostosis such as proportionate dwarfism, fragility of bone, open fontanelle, obtuse mandibular angle, acro-osteolysis and dense skeleton. There were no consanguinity in their parents and no chromosome anomaly was found in case 1. Case 2 was delivered by cesarean section producing two normal healthy babies. Oral findings of the case 1 were described in detail.
Asymmetry of facial movements in a newborn infant suggests seventh nerve palsy due to birth trauma or congenital malformation. An infant whose face appears asymmetrical at rest yet whose mouth is pulled downward to one side when crying is said to have an “Asymmetric crying facies”. In a 5-months-old baby boy. We noted the total absence of the right radius, the radial deviation of the wrist combined with curvature of the ulna, the shortness of the forearm, hypoplastic thumb, asymmetry of the auricles and when he cried, the left corner of the mouth drew left and downward. We have performed corrective surgery of the wrist deformity.