From short experience of surgical treatment of the fracture and dislocation about the shoulder in our series, recommendations are: 1. Treatment of the clavicle fractures in certain cases, especially in adult, open reduction and internal fixation when indicated will provide excellent results. A retrograde intramedullary Steinmann pin fixation is a best choice of treatment. 2. Surgery is indicated in acute complete acromioclavicular dislocation in active patients and to those patients with pain, disability, and arthritis, for whom conservative measures or previous operative procedures failed. Elderly and very inactive patients may be treated with skillful neglect. Simple transfieation of the acromioclavicular joint using one or two Kirschner pin without repair of the coracoclavicular ligament is the choice of treatment. 3. Fracture-dislocation of the proximal humerus must be treated by open reduction and internal fixation. Surgical skill, special treatment and judgement are mandatory for effective treatment.
A case of uncommon rupture of the infrapatellar ligament was reported. An adult male, aged 26 years, a first classed vollyball player was suddenly struck a shock on his right knee when jumping up. He was unable to stand up and to stretch the knee. Several days after injury he visited the clinic. Marked swelling and pain were observed at the lateral infrapatellar portion and a x-ray film showed abnormally high patella. First, marked swelling concealed the definite diagnostic signs of rupture of the infrapatellar ligament. Delayed repair was done five weeks after injury. A scar tissue between the ruptured ends was resected end-to-end anastomosis of the ligament was performed. Medial part of the ligament was reinforced with a semitendiosus tendon. Result was satisfactory.
It is well-known that the scoliotic spine has three deformities on each of its three orthogonal planes. A scoliosis with abnormality on the sagittal plane is called lordoscoliosis or kyphoscoliosis. But it is not well-known whether scoliosis is more often complicated with lordosis or kyphosis. We studied one hundred and two scoliotic spines with mild curvature of less than fifty degrees, and seventeen normal spines as controls. The scoliotic spines with thoracic curvature had less degree of thoracic kyphosis and more degree of lumbar lordosis than normal spines. We also estimated the sagittal curvature limited in the three apical vertebrae of the scoliotic spines. In the cases of thoracic curvatures these values were significantly correlated with the degree of curvature on the coronal plane.
Spinal cord monitoring during surgery by using SCEP has been shown to be superior to the wake-up test, because it enables the practitioner to determine the induced ischemia of the spinal cord more precisely and promptly before neural deficit develops into permanent. Surgical procedures have to be stopped when peak amplitude of N1 has decreased up to 50% of the control potentials. We have already successfully operated on 72 patients with spine deformity under it. The purpose of this paper is to introduce animal experiments which have given conclusion described above. The study was conducted in three parts. In the first part, injury experiment by distraction force was done. The spinal cord was impaired by longitudinal distraction using a special designed instrument. There was a certain degree of distraction which produced transient augumentation of the N2 amplitude without neural deficit. The N1 deflection always decreased more than 50% with paralysis immediately after continueing 4mm distraction. In the second part, intraspinal potentials were recorded using glass pipet electrodes in order to identify precise location of N1 and N2 in conductive SCEP. The N2 conducted in the dorsal column. N1, however, was compound potentials from the whole spinal cord. In the third part, ascending and descending pathways of N1 and N2 was determined by the collision test. It was strongly suspected that the N1 and N2 of ascending and descending conductive SCEP had common pathways.
Blood flow in the lateral funiculus of the rabbit thoracic spinal cord was studied after mild experimental spinal cord injury, using the hydrogen clearance technique. The mild Injury was produced with the compressing the cord with a force of 50gm for 30 seconds. Spinal cord blood flow was significantly decreased at 6 hours after injury. (30% reduced P<0.05). With pathological specimen, it has been confirmed in the model that cord compressing injury produced posttraumatic ischemia in the white matter at 6 hours after injury.
We have been wing a method of enlargement of the cervical spinal canal for cervical posterior decompression and satisfactory results have been obtained so far. In this study we have conducted an experimental observation on rabbits to clarify the transition of post-operative scar tissue and other influences around the dura mater after enlargement of the spinal canal, comparing with that after laminectomy. We divided the animals into three groups; for 1st group laminectomy was done, for 2nd group one-third partial laminectomy was done and for 3rd group enlargement of the canal was done. The animals were killed at the interval of 1, 2, 3, 6, 9, 12 weeks after operation and histological examinations were performed. Scar formation was observed far less in 2nd and 3rd groups than in 1st group. And also less influence of the scar to the dura was observed in 2nd and 3rd groups. In 3rd group, new bone formation was seen mainly at the dorsal site of the laminae remained. It can be concluded from this study that enlargement of the spinal canal has less scar formation and can obtain satisfactory decompression, therefore, this method is useful in clinic.
A series of 155 cases, who received various amounts of metrizamide for the purpose of cervical, thoracic and lumber myelography and metrizamide CT scan, has been studied. 79 cases (51%) were found to have various adverse reactions. The adverse reactions were seen in 66.7% of thoracic, 53.8% of cervical, 42.9% of lumbar myelography and in 26.7% of metrizamide CT. Most remarkable complications were mental disorders, which were seen in five cases of cervical myelography. We also found increased paralysis in thoracic myelography and urinary dysfunction in lumbar myelography. The rate of adverse reactions was less by C1-C2 lateral puncture than by lumbar puncture. It is suggested from our series that the maximum dose of total iodine is 2160mgI/ml in cervical, 2700mgI/ml in thoracic and 2250mgI/ml in lumbar myelography.
We investigated X-ray findings and the clinical features of the middle and lower cervical spine in 231 patients with rheumatoid arthritis. The resutls were as follows. 1. 121 (52%) of 231 patients with RA had radiographic abnormalities in the middle and lower cervical spine. There were abnormalities of the apophyseal joint in 111 cases (48%), disc narrowing in 63 3ases (28%), end-plate erosion in 37 cases (16%) and subluxation in 21 cases (9%). 2. 4 (19%) of 21 cases with subaxial subluxation had myelopathy. 3. 16 cases became worse radiographically including 3 cases with subaxial subluxation, in 23 cases with long term study (for average 8 years). 4. Surgical treatment was performed in 2 cases with myelopathy due to subaxial subluxation, and the results were good.
10 cases with separation of the lumbar vertebral rims, 5 of the anterior separation and 5 of the posterior one, were radiologically and therapeutically discussed. Furthermore, the mechanism of the separation was dynamically presumed. All patients except one showed no response to conservative treatment. 5 patients of the anterior separation and one of the posterior separation had anterior fusion. 4 patients of the posterior separation had extensive laminectomy plus excision of bony fragment. Consequently, fusion cases oftained complete relief of pain whereas laminectomy cases remained persisting low back pain due to intervertebral instability. Computed tomogram clearly revealed common characteristics in both anterior and posterior separation. Anterior separation may be produced in the anteriorsuperior rim of L5. On the other hand, posterior separation in the posterior-inferior rim of L4. Concerning the mechaism of the separation, in flexion, shearing stress acts so as to split obliquely the posterior rim. On the other hand, in extension, the stress acts so as to split the anterior rim. Tensile stress acting on the rims may pull out the anterior or posterior rim. Compressive stress acts so as to push the nucleus pulposus into the split.
Authors described four cases of the ossification of the yellow ligament of the thoracic spine, and wide extensive laminectomy was performed in all cases. We examined these clinical results, and reported one case. Satisfactory results were obtained in all cases, but increasing of the kyphosis of the thoracic spine was found in one case.
Four cases of pyogenic spondylitis were reported. It is important to discriminate this disease from tuberculous spondylitis. In early period, the collective judgment by past history, family history, clinical sign, erythrocyte-sedimentation-rate, Mantoux reaction and X-ray films are necessary.
We experienced a case of capillary hemangioblastoma forming the dumbbell shape. This tumor is rare and interesting form of the spinal cord tumors. A 51 year old male has been suffering from lumbar pain. About 9 months ago he developed so-called SHIBIRE-feeling in his feet and weakness of the extrimities. X-ray showed the enlargement of the right intervertebral formen of L1-2. The Th12-L2 laminectomy was performed and the dural canal was opened. The tumor was situated within the vertebral canal and was partially intradural, partially extradural, as if it was constricted by the dura. Histologically, the tumor was a capillary hemangioblastoma.
In recent five years from 1977 to 1982, nine patients of spinal cord tumor were treated surgically. One case of them was intramedullar tumor and eight cases were intradural-extramedullar tumors. The site of tumor in cervical spine was one case, in thoracic spine was seven cases and in lumbar spine was one case. Histological diagnosis was made as follows. Neurinoma was 4 cases, meningioma was 1 case, angioblastic meningioma was 1 case, hemangioendothelioma was 1 case, Ependymoma was 1 case, and dermoid cyst was 1 case. The result of the operation was good in 4 cases, fair in 4 cases and poor in one case.
From May 1977 to March 1982, 81 cases of lumbar disc herniation were operated with Love's method in Isahaya General Hospital. In these operations it was intended to resect the degenerated disc as much as posible. This paper reports the radiological changes resulted from resection of the lumbar disc, especially paying attention to the narrowing of the intervertebral space and decrease of the mobility in lumber spine in relation to the weight of resected disc. As the weight of resected disc increased the intervertebral space narrowed, however the mobility of lumbar spine operated was independent on the weight of resected disc. In conclusion, it is not always necessary for Love's operation to combine with postero-lateral fusion, as the narrowing of the intervertebral space centributed to the stability of the spine.
Disc prolapse causing compression of the cauda equina is rare but it needs urgent surgical treatment. We have experienced one patient with cauda equina compression signs. The patient was 48 years old male who had gait disturbance, bladder and rectal paralysis, low back pain and bilateral sciatica. Myelogram revealed a total block at the midline level of fourth lumbar vertebra. Surgery was done after eleven days of the onset of symptomes. A wide bilateral laminectomy of L4 and L5 was performed and massive disc prolapse at the L4-5 level, compressing the cauda equina from right side, was removed. The size of the removed mass was 4.0×2.5×1, 0cm and the weight was 3.4gr. The sciatic pain was disappeared after operation. On the nineteenth day after operation he was able to pass urine on his own and rectal function returned to normal after four weeks. The motor weakness in the lower extremities recovered gradually and he could walk independently after seven weeks.
144 cases of cervical myelopathy (123 spondylotic, 21 traumatic) and 23 cases of incomplete cervical spinal cord injury without vertebral fracture and/or dislocation were surgically treated and followed for more than one year. 137 cases were treated by anterior interbody fusion and the remaining cases by laminectomy. The indications for these procedures were outlined. Successful operative results were obtained in 86 per cent of cervical myelopathy cases and 52 per cent of spinal cord injury cases. In contrast with the former cases the rate of recovery in the latter was markedly lowered as the duration of the disease became prolonged. These facts suggest that the rate of postoperative recovery in the spinal cord injury refflects the natural course of recovery rather than the effect of surgery, and that the existence of trauma history to the cervical spine does not have so much influence on the rate of recovery in cervical myelopathy as in spinal cord injury.
Six cases of the traumatic quadriplegia with the osscification of the posterior longitudinal ligament were operated. Five cases were treated with laminectomy and one case was fused anterior approach. One of them was incompletely paralysed and the other were complete. Two of 6 cases recovered moderately and one was slightly. The others were unchanged. A review of these series resulted in the needs of surgical treatment that was adapted on the quadriplegia due to minimal trauma, and adapted on the incomplate one.
Thirty-one patients of ossificaiton of the posterior longitudinal ligament in the cervical spine who had been treated conservatively more than five years are followed up clinically and radiologically. The classification of the ossification type is as follows, segmental in thirteen, mixed in eight, continuous in eight and other in two. At the time of the examination, the progression of the ossification in the longitudinal direction was seen in eithteen of them (58%) and the thichening of the ossification was seen radiologically to happen in seven of them (23%). Myelopathy remained static in the most of the patients. Clinical symptoms were mostly neck pain and numbness in the upper extremity. Some of the patients were associated with lumbar canals stenosis and ossification of the yellow ligament in the lumbo thoracic spine.
24 upper cervical spine injuries consist of 3 bursting atlantal fractures, 4 posterior arch fractures of atlas, 5 fractures of dens, 3 fractures of axis body, 2 hangman fractures, one vertebral arch fracture of dens and 6 atlanto-axial rotatory fixations. All bursting atlantal fractures were treated with skull traction and resulted in nonunion, but showed no instability and unremarkable symptomes. All atlanto-axial rotatory fixations belonged to type I in Fielding's classification and were successfully manipulated with or without anesthesia. Anterior dislocations of atlas associated with non union of dens fracture were possibly reduced with skull traction and were immobilized with posterior fusion from occiput to third cervical vertebra.
From 1974 through 1981, Ninety-nine patients were treated with anterior cervical decompression and fusion at our hospital. Fifty-nine cases, which include fifty-one with cervical spondylostic myelopathy and eight with cervical disc herniation, could be followed suitable for this analysis. There was no significant difference between the improvement of paralysis in patients with stenotic spinal canal and with non-stenotic one. The anterior decompression and fusion was effective even in patients with cervical spinal canal stenosis. Postoperative kyphoxic deformity of the cervical spinie was found mainly in cases with delayed union, and seems to be created by the sinking of the grafted bone at anterosuperior portion. This final-alignment of cervical spine should be followed carefully.
Posterior spinal fusion was done on the patients with Atlanto-Axial instability. Total sixteen cases included six cases of fracture of the Dens, seven cases of Atlanto-Axial subluxation and three cases of Atlanto-Axial subluxation with Os odontoideum. Surgery was done with modified Brooks method on eleven cases and with McGraw method on five cases. Results are as followes. 1) Good solid fusion was achieved in all cases who underwent modified Brooks' method surgery and the synptom improved in all cases except for one case who claimed residual occipital neuralgia. 2) Recurrent anterior slip with residual synptom after removing the Halo-Brace was experienced in one case who underwent McGraw' method surgery. 3) Modified Brooks method is not indicated in the case with severe instability and high risk of intraoperative posterior slip. 4) Halo-Brace seemed to be necessary for Atlant-Axial fixation before, during and after the surgery.
The results of treatment of six patients, five males and one female, with unstable thoracolumber fracture and dislocaion are reported. The sites of injury were thoracolumbar spine in four patients and lumbar spine in two paients. Five of six patients showed neurological deficit after injury. Two patients underwent open reduction and Harrington instrumentation within twelve hours of injury; two, after twenty four hours of injury; one, after six days; and one, after 82 days with pediculectomy for lateral decompression, after this procedure anterior spinal fusion was achieved. Three of five patients with nourological change showed neurological recovery, including one patient with lateral fracture and dislocation of low lumbar spine, who was operated on after 82 days of injury. Other two patients with complete damage on low thoracic spinal cord remained almost unchanged. One stage operation with Harrington instrumentation and anterior spinal fusion was performed in one patient who showed no neurological deficit. In conclusion, neurological improvement was obtained after the first surgery with open reduction and Harrington instrumentation in incomplete paraplegic patients, and anterior spinal fusion was necessary for further good stability of the spine.
Harrington instrumentations were performed 31 times on 28 scoliosis patients and the following results were obtained. The 28 scoliosis patients consisted of 9 idiopathic cases, 7 congenital, 7 neuropathic, 5 neurofibroma and 1 kyphosis by karies. Results Postoperative correction rate and loss of correction were respectively 53% and 5° in idiopathic deformity, 18% and 3° in congenital deformity, 44% and 9° in neuropathic deformity, 35% and 4° in neurofibroma deformity, and 41% and 6° in total. Thus, the results were similar to those of the others' reports. Complications during and after the operation were destruction of lamina portion in 5 cases, mis-insertion of hook in 2, hook dislocation in 3 and bursitis of hook-inserted portion in 2. There was no serious complication in particular.
Forty-five patients with fracture-dislocations of the spine were treated with Harrington instrumentation within ninety days of injury. Immediate reduction and stabilization could be accomplished with instrumentation and fusion without a substantial number of cmplications, and the patients could then be mobilized within a short time after the fracture-dislocation. However, there were six patients with kyphotic deformities related to the operation: four hook dislodgments; two pseudoarthrosis. In these six patients, the posterior bony fusion did not extend across all instrumented vertebrae. Alignment of the spinal column were examined by the roentgenograms on a sitting or standing position. In the patients with inferior distraction hooks placed on the inferior lamina of the third or fourth lumbar spine, the lumbar lordosis were reduced.
The authors devised five different kinds of balance board which varied progressively in design, and performed various kinds of balance test with them on 195 normal infants aged from two to six. The tests showed that “standing on one foot” was most difficult for them to do, and it appeared that the balance reaction would emerge gradually at two years of age, grows rapidly with ages of three and above, and become perfect with children six years of age. Based on these findings, the balance tests were performed on children with cerebral palsy, and the test results were studied for determination of characteristics according to types.
31 children with Down's Syndrome were tested for their motor development. 16 children were from special school, aged between 6 years and 16 years, another 15 children were those who recieved therapy from early childhood aged between 2 years and 5 years. Test items included fine motor, gross motor and balance reaction responsibility. For fine motor, we used Ushijimas' social ADL test, for gross motor, we checked exercise required anti-gravitational extensor postural tone, and for balance reaction, we used N-type balance board. The results were as followings. 1) children with Down's Syndrome developed poorly anti-gravitational extensor postural tone. 2) One-foot standing on 3.0cm height balance board, untreated pupils were 50per cent possible, even treated children were all unable. They have an immature equilibrium response. 3) Both groups had 50per cent passed 5 years level of Ushijimas' social ADL test, but the passage were decreased sharply on 6 years level.
In 9 patients undergoing routine orthopaedic operations under lumbar analgesia, intracompartmental pressure in the leg was measured continuously following release of a tourniquet applied for 30-71 minutes using a catheter-tip pressure transducer with a needle tip, which was built by Millar Instruments. A maximum increase in intracompantmental pressure was observed 45 to 315 minutes after release of a tourniquet. Intracompartmental pressure rose above 60 millimeters of mercury in 3 patients. These findings suggest that one must recognize the possibility of the occurrence of closed compartmental syndrome after temporary ischemia from tourniquet use.
The authors have been tried to study aging changes on X-ray films which were collected randomly from some clinics except for the orthopaedic clinic in our university hospital. Four items, that is, spur formation, narrowing, subchondral sclerosis and osteoporosis, in each bone were checked always by two doctors of the authors and numerical expression, which was classified as follows, no changes; O, some changes; 1, and prominent changes; 2, of each item was summed up in each bone. In each decade, these summed-up numbers were divided by numbers of patients in each bone. Of these data, correlations between these numerical data and ages in lumbar spines were reported and discussed in this paper. Of total 1274 films on the acromio-clavicular joints, the sacro-iliac joints, the lumbar spines and the hip joints, 226 films of lumber spines were studied and analyzed. Prominent aging changes were detected in lower lumbar spines of both sexes after the fifth decade. On the other hand, osteoporotic changes were remarkable after the sixth decade of female. These methods studying for aging are concluded as useful maneuvers.
We examined 56 cases by CT scanner during past three years. The cases are constituted of OPLL 10, Bone tumor 11, Soft tissue tumor 9, Spinal tumor 3, tuberculous spondilitis 1, Cryptoccosis 1, and the others. We can get many informations from CT Scan. For example, the relation between the lesion and normal tissue, about the size of the lesion, the nature of the lesion. If CT Scan reveal anatomical abnormality remakably, operative indication will become more definite one. CT Scan is useful especially at emergency diagnosis in spinal canal lesion. We can follow up these cases effectively after operation or chemo-therapy. Still more we made the lymphangiography or enhancement at the same time with CT scan.
To determine the mode of transfer of antibiotics to focus, 2g of sulbenicillin was intravenously injected into patients and changes in its concentration that took place during its transfer to tissues adjoining the lumbar spine were measured. 15 patients, aged from 19 to 59, suffering from the lumbarspine disorder were each given intravenous injection of 2g of sulbeniciliin, and then spinous process laminae, ligament flavum, nucleus pulposus, and blood were sampled from each patient during surgery. The tissue and blood samples thus collected were analyzed five times, with progressive delays of 15 minutes, 30 minutes, 60 minutes, 90 minutes, and 135 minutes, for comparative studies of sulbenicillin contents. The maximum reading in ligament flavum was 9.1μg/g given with the delay of 30 minutes, whereas it was 7.0μg/g in spinous process laminae and 4.9μg/g in nucleus pulposus measured with the delay of 60 minutes in either instance. Although the ratio of transfer was highest in ligament flavum, the tendency to remain in its tissue was not pronounced. Low in concentration commonly in the three tissues of spinous process laminae, ligament flavum, and nucleus pulposus, sulbenicillin should be said almost ineffective against Gram-negative bacteria there. Also, it was found that sulbenicillin, though effective against Gram-positive bacteria, especially staphylococcus aureus, in ligament flavum and spinous process laminae, is less effective in nucleus pulposus.
We reported a case of acute pyogenic osteomyelitis with granulocytopenia, treated by the elemental blood transfusion of leukocytes. A 4-year-old boy had complained of left coxalgia with high fever, and had been treated for common cold by a pediatrician. In spite of this therapy, he still had a high fever and coxalgia. After admission to our clinic, the diagnosis of acute pyogenic osteomyelitis of left femur was made and closed irrigation-suction was performed. His body temperature tended to decline gradually. However he had a high fever again after two weeks during the period of closed irrigation-suction, and his blood analysis data indicated a condition of severe granulocytopenia; the numbers of leukocytes and neutrocytes were 3400/mm3 and 272/mm3 respectively. We changed the antibiotics and administered the immunoglobulin, but his body temperature was not declined. Finally the elemental blood transfusion of leukocytes was applied, and so his body temperature declined to normal, and general condition was improved remarkably. Blood analysis data indicated a normal condition; the numbers of leukocytes and neutrocytes were 6600/mm3 and 2500/mm3 resectively.
A 36 years old man, whose hips had been treated with prosthetic repracements under the diagnosis of the avascular necrosis of the both femoral head 10 years age, visited our clinic with right shoulder pain and both ankle pain. X-ray pictures showed subchondral lucent area and collapse of the head of humerus, and sclerotic change and collapse in the head of talus. Neer's prosthetic replacement for the right shoulder and total ankle replacement for the right ankle were performed. 6 months after operations, he was completely relieved from pain. On histological examinations of these resected bone, the diagnosis of the avascular necrosis were made.
Extensibility of the rectus femoris and hamstrings muscles in 1788 healthy adult (946 males and 842 females) was measured and the results were statistically analysed. Extensibility of the rectus femoris (the average angle of the buttock elevation phenomen) in males was 123.9°±17.01° on the right leg and 122.2°±19.77° on the left leg. In females was 135.9°±9.42° on the right leg and 135.5°±11.01° on the left leg. Extensibility of the hamstrings muscle (the average angle of the straight leg raising test) in males was 78.7°±9.70° on the right leg and 79.0°±9.94° on the left leg. In females was 85.7°±8.48° on the right leg and 87.3°±8.38° on the left leg. Both muscle extensibility in females was higher than in males. Also, there was a high correlation between the right leg and the left leg.
We have used tissue culture techniques chiefly on malignant tumor of bone or soft tissue for these three years. Recently, several interesting findings have been obtained using the methods of tissue culture with electron microscopy and histochemical techniques. This report deals with some of them. Cultured cells revealed the morphological similarity to those of original tumor tissues. Cultured cells of synovial cell sarcoma disclosed the biphasic pattern of spindle cells and epithelial-like elements. In the case of malignant giant cell tumor of soft part, histiocyte like cells and fibroblast like cells were identified by electron microscopy. However the results that this tumor showed the positivity for α-naphthyl acetate esterase suggest the possibility of its histiocytic origin.
It is delicate and requires much experience to interprete the scintigrams of bone tumors. The scintigraphic patterns and densities of the lesion areas were tried to analyse by color data system (model 1200 B Nac K. K.) in 67 patients with bone tumor. Comparing with the opposite side, malignant tumors revealed clearly high density and abnormal pattern of wide range in 21 out of 25 patients, and was able to differentiate from benign tumors. In giant cell tumors, however, it was difficult to distinguish in reference to the histo-pathological grades on analysing of the scintigrams using this system.
Four cases of subungal exostosis were reported. Of the four cases, two were male and two female, with an average age of 13.5 years at the time of diagnosis. All the patients had the exostosis on the great toe, and three of them had any history of the preceding trauma. Radiographically, one of the lesion, without the preceding trauma, arose from the area adjacent to the epiphyseal growth plate of the distal phalanx, and three of them, with the preceding trauma, the distal area of the distal phalanx. Histologically, in one case without the preceding trauma, the cap was composed of the hyaline cartilage, and in the others with the preceding trauma, the cap was covered by dense fibrous tissue, and a partial enchondral ossification was seen in the deep layer. The causative factors in the development of subungal exostosis have been unknown. However, it seems that in our three cases with the preceding trauma, the superficial dense fibrous tissue of the cap was affected by chronic mechanical stress. Four cases were successfully treated by local excision.
Benign osteoblastoma is rare tumor of bone. In this study we report one case of benign osteoblastoma of the ilium. Case: A 26-year-old man was first seen in March 1981 with a six months history of pain and swelling in the buttock. Radiographs showed an osteolytic lesion of the right ilium which was well limited. The cortex was preserved and there was marginally bone sclerosis. Curretage and bone cement graft was performed. One year after the operation, there is no evidence of metastasis. On microscopically there was an active osteoblastic tissue with alternating formation of osteoid. The stroma was vascular. In the periphery of areas of mineralized matrix, there were numerous giant cell osteoclasts.
Periosteal chondroma is an uncommon benign tumor, arising from the periosteal or parosteal tissue. A case of periosteal chondroma is presented in this paper. The patient was fifteen-year-old boy and was reffered to our clinic with chief complaint of tumor formation and pain in the middle part of his left upper arm. Radiological examination revealed a cortical indentation with juxtacortical soft-tissue mass, that was overlying on the shallow cortical indentation. En-block excision of the tumor was performed with bone grafting into the bone defect. Recurrence was suspected at the time of radiological check about nine months after surgery.
A case of Chondromyxoid fibroma was reported. The patient was a 4-year-old boy, and the proximal metaphysis of the right femur was affected. Curretage and Kiel bone graft was performed in the lesion, but 4 months after the first operation, he had a local recurrence. In 1948 Jaffe and Lichtenstein reported a series of bone tumors as chondromyxoid fibroma, emphasizing that this newly recognized entity was likely to be mistaken for chondrosarcoma but was a benign growth. Chondromyxoid fibroma of bone was a rare and benign tumor. Especially, there had been few reports of the tumor under 4 years old. We should carefully follow up this case, because several cases of malignant change from this tumor were reported.
Intramuscular myxoma had been confused with other malignant soft part sarcoma, that is, liposarcoma, myxoid variant of malignant fibrous histiocytoma and chondrosarcoma because of clinical and pathological resemblances to those of malignant tumors. Then entity and existance of intramuscular myxoma are disputed in the clinicians and pathologists. We reported our cases with review of literatures and discussed the clinical and pathological features of this entity.
An alveolar soft part sarcoma is one of the rare malignant neoplasms. A 14 yearold female who had a tumor of her right thigh was admitted to our clinic. Histological examination of the tumor obtained by needle biopsy revealed an alveolar soft part sarcama. Wide local excision was performed and the anti-cancer agents such as VCR, ADM, ACD and EX were administered. Though she is desease free now, careful observation will be necessary for long periods, since metastases occured long time later after excision has been reported.
The development of postirradiation osteosarcoma is a rare complication of radiation therapy. We are reporting a case of postirradiation osteosacoma. A sixty-seven-year-old female, with a 2 month history of incontinence, sensory disturbance of the pubic region, numbness of right foot, and pain in the gluteal region, sustained metastatic tumor in the sacrum and the sacroiliac joint before she was referred to a senior author. She sustained carcinoma of the uterus 9 years before and underwent a course of external radiation therapy. Dosage was calculated to be 5, 000 rads. In addition, she recieved 2, 400mCi. hr. radium therapy. She underwent an open biopsy in admission and sustained oseosarcoma. Chest roentgenogram revealed diffuse metastatic lesions in bilateral lungs. She gradually became painful and paraplegic after temporal pain relief by radiation therapy.
With the broadening of its diagnostic criteria of recent years, cases of MFH (malignant fibrous histiocytoma) have been on the increase, and its clinical feature also has come to greatly diversify. Nothing truly convincing has, however, been reported as regard the therapy effective against this particular disease. Eight cases have so far been diagnosed as MFH by this Department since 1978, and the patients so diagnosed were aged from 19to 72, or 44 years old on the average. Of the eight cases, three were located at the proximal portion of thigh, two at the distal portion of thigh, one near the knee, one at the proximal portion of upper arm, and one at the retroperitoneum, of which two were regarded as being of bone origin. For the purpose of reducing the local focus activity as well as of preventing the recurrence of the disease, the radiation therapy with about 4000 to 6000 Rad. has been administered on the patients by this Department before and after the surgery. Comparative studies made, principally, of observations which were obtained before and after the radiation therapy performed on the patients show that this radiation method of treatment can be expected to offer a considerable local effectiveness in some particular instances.
48 years old man of hepatocellular carcinoma with bone metastasis to the right clavicle was presented in this paper. There was chronic hepatitis in his history three years ago. Roentgenograms, bone scintigrams, tumor scintigrams, and angiograms showed clavicle metastasis from hepatocellular carcinoma. Removal of the right clavicle was carried out. Histological report was “bone metastasis from hepatocellular carcinoma”. Four months later, he died.
The effect of EHDP on alkaline phosphatase activity was studied by the use of enzyme-histochemical technique. Our result showed that the alkaline phosphatase activity in bone production and fracture repair under the influence of EHDP was unchanged. Thus EHDP can inhibit calcification without inhibiting the activity of alkaline phosphatase.
We have previously reported on the effects of high doses of EHDP on proximal rat tibia. Here reported the influences on proximal region of rat femur. Our results were as follows. 1) The anteversion angle and neck-shaft angle of proximal femur in the EHDP treated rats was not significantly different from that in the controls. 2) From 4-5 weeks after administration, remarkable increase in the breadth of femoral neck and shaft was observed.
The effects of long-term, low-dose EHDP administration on experimatal osteoporosis in female Wistar rats were studied. The experimental osteoporosis was induced by sciatic nerve dissection at major trochanter level, and EHDP was given at a dose of 0, 0.1, 1, 5mg/kg daily for six months. In the control group, denervated limb became osteopenic and the cortical thickness decreased markedly. Histological examination revealed thin and coarse bone trabeculae, similar to that seen in human osteoporosis. This osteoporosis was clearly prevented by EHDP given at a dose of 1 and 5mg/kg/day. However in the rats given 5mg/kg/day, the thickness of the epiphyseal growth plate was increased and the accumulation of nonmineralized osteoid tissue was demonstrated. So, if a proper dose is chosen, we think that EHDP is a valuable drug for the treatment of osteoporosis.
Twenty cases with osteoporosis were obserbed the effect of 1, 24R(OH)2D3. Various symptoms, low back pain and another disterbunces, of patients were changed allerviatory. As for the effect on bone mass determined by the microdensitoric method, 1, 24R-(OH)2D3 would seen superior to none treatmet. In this study, I have found 1, 24R-(OH)2D3 succesfull in the drug of osteoporosis.
A case of MPS I-H/S with bilateral carpal tunnel syndrome was presented. The patient, a 27-year-old female visited our clinic, complaining of flexion contracture and numbness of fingers. The clinical findings were short stature, coarse face, corneal clouding, flexion contracture of joints (hips, shoulders, elbows and fingers), hepatomegaly, umbilical hernia, carpal tunnel syndrome and no mental disturbance. These findings were the feature of MPS I-H/S. In biochemical findings, marked mucopolysaccariduria was shown and dermatan sulfate was the major component of mucopolysaccarides excreted in urine. The activity of α-L-iduronidase in peripheral leukocytes of this patient was very low.