We reported Four cases of lumbar canal stenosis associated with the swallow-tail shape of the inferior articular process which was seen on the P-A view of a roentgenography. We described three mechanisms in the development of the lumban canal stenosis associated with the swallow-tail shape of the lamina. We also referred the method of the operation.
We had experienced three cases of double lesion at both lower thoracic spine and upper lumbar spine. In such cases the clinical signs were various and we could not decide the main lesion easily. All our three cases had characteristically remarkable muscle atrophy of quadriceps and abnormal reflex and sensory disturbance. Were neurological signs available for the diagnosis of the main lesion in such cases? We had investigated neuroglogical signs of thoracic lesion and lumbar lesion respecively and concluded that neurological signs were reliable to decide the level of the main lesion.
We operated on 21 cases in old age (above 65 years) with low back pain and leg pain. The results of surgical treatment were almost good, but 5 cases of them showed fair results. We discussed about 5 cases of them. They had scoliosis or instability in lumbar spine before operation. We think it better to add spinal fusion for them.
Instant centers of 51 patients of pseudospondylolisthesis, 58 patients of lumbar instability and 55 patients of lumbago were compared. In pseudospondylolishesis, instant centers were placed lower than these of other two groups and the vertebral motion was considered rotatinal movement. Degenerative changes of fecet joint and anterior inclinations of articular processes were related to the low position of instant center. Posterior portinos of motion segment were more important than the disc degeneration as a factor of the vertebral slip in pseudospondylishtesis.
Follow-up study was done for periods of one to eight years on 97 cases of lumbar disc prolapse. Of these 25 cases were operated on by the posterior route without fusion and 72 cases by the anterior route with fusion. Two groups of patients were compared from the standpoint of clinical results. The results of surgery in the former group were: excellent in 40%, good in 40%, fair in 16%, and poor in 4%, whereas those in the latter were: excellent in 44.4%, good in 33.3%, fair in 18.1% and poor in 4.2% of the patients. Between these two groups there were few significant statistical differences.
During the period from 1977 to 1983 we operated on 8 cases of high lumbar disc herniation-that is the intervertebral disc at L1-2 and L2-3. In the period 215 patients were operated on for lumbar disc herniations, including 8 cases (3.2%) located at L1-2 and L2-3. Mean age (53 years) of patients operated for high lumbar disc herniations is higher than that of the other patients (36 years) operated for lower lumbar disc herniations. All patients complained first of back or lower extremity pain, or both. The pain in the lower extremity followed a pattern of radiation over the lateral side of the thigh and frequently over the anterior surface of the thigh. The diagnosis was difficult for few characteristic signs and features. Postoperative results were excellent. Myelography was the most helpful method of Iacalizing herniated upper lumbar disc. The lumbar root block and the discographic exploration were helpful methods.
Four (3.7%) patients under 15 years of age —a total of 110 patients of all ages— underwent surgery for lumber disc herniation at the Misasa Onsen Hospital from 1977 to 1983. One of them was a lumbar disc herniation with the fracture of the lumbar vertebral ring epiphysis. Most patients had complained of pain in the low back and the leg (two patients offered the complaint after doing sports) and there were marked limitation of straight leg raising and forward bending of the body. Plain radiographs displayed disc degeneration at the level of herniation. Myelography confirmed the diagnosis and the level of the disc herniation. The results of the surgery were excellent or good.
Three cases with the burst fracture of lower lumbar spine who were injured in a falling accident of the air plane, were reported in this paper. It is well known that the most frequent fracture of the spine in a falling accident is the compression fractures of Th-11 to L-2 and the Jower lumbar spine is rarely involved. The mechanism of fracture was discussed. We thought that the longitudinal axial pressure through the vertebral disc and/or the hyper-flexion of lumbar spine caused that type of fracture.
Of fifty-nine consecutive cases with fractures of fracture-dislocations of the thoraco-lumbar spin e who were operated on within a month after the injuries, there were five cases (six per cent) with injuries of lower lumbar region from 1979 to 1983. These cases were consisted of one flexion-distraction fracture-dislocation, three burst fractures and one traumatic spondylolisthesis. They were operated by the method of one staged anterior-posterior reduction, decompression and fusion except one case. Another one old traumatics pondylolisthesis was operated by the same manner. All cases received anterior decompression and fusion showed good neurological recovery. No cases complained of pain in the back or legs. We stressed that the disc of lumbosacral junction should not 4e fused by bone graft except for cases with injuries in that region.
Three patients with the lumbar spinal problems were studied. The diagnosis were two unstable burst fractures and one multiply operated back. As they seemed to be intolerable to recumbency for a long time, they were treated with Luque instrumentation with double L-rod and segmental wiring (L-SSI). There were no neurologic complications associated with sublaminar wiring in this series. As the lumbar region cammonly has a wide sublaminar space, L-SSI is a safe and effective method for lumbar spinal disorders. An external support should be continued until bone union becomes rigid, because L-SSI may not be able to fix firmly the both ends of fixation in a sagittal plane.
We presented one case of aneurys mal bone cyst (a relatively rare condition) in the fifth lumbar vertebra, The patient was a 16 years old girl. Her chief complaint was low back pain. Destructive changes were proved radiologically in the fifth lumbar vertebral body showing soap bubble pattern or ballooned-out appearance. After curettage of the lesion and bone grafting in the involved area of the vertebral body through the posterior approach, reconstructive surgery of the lumbar spine was done by a posteroJateral fusion and spinal instrumentation in the lumboscral region. Seven months postoperatively, she was almost free of complaints showing a solid bony fusion in the fusion area of the lumbosacral region on the X-ray film.
Primary malignant lymphoma in spinal epidural space is a rare case. We have experienced one patient with primary malignant lymphoma in lumbar epidural space. The patient is a 57 years old male who has bladder and rectal paralysis, left foot numbness and left sciatica. Myelogram demonstrated an epidural compression mass at the left side of L5-S1 vertebrae. A wide laminectomy of L4 and L5 spine was performed and the ossification of ligamentum flavum at the L4-5 level, compressing the cauda equina from left side, was removed. The neurological symptoms improved remarkably soon after operation, but the plantar numbness remained. About six months after the laminectomy, he complained of left gluteal and foot pain. Seven months after the operation, he was unable to pass urine on his own. Myelogram revealed an epidural tumor at the level of L5-S1 spine, compressing from the left posterolateral side. Dura and left L5 nerve root were decompressed completely by the operation. The tumor was diagnosed at the malignant lymphoma (non-Hodgkin's type), diffuse and large cell type by histological examination. Three months after the resection of the tumor, scintigram discovered the bone bone metastasis at the sacrum and the right temporal bone. He was given radiotherapy and chemotherapy with a combination of VEMP.
A case reported here was a 56-year-old female with lower thoracic pain and muscle weakness of both legs. The patient was given cholecystectomy for cholecystolithiasis in November 1982 with a 2 months history of fever, abdominal pain and general fatigue. The culture of the bile obtained at surgery showed Salmonella tyhi. Afer the operation her symptoms became free. However She began to suffer from lower thoracic pain and muscle weakness of both legs since December. Her lower thoracic pain and muscle weakness became disabling to walk. She was admitted to our hospital in February 1983. On examination, she had hyperreflexia of both legs with bialteral patella and ankle clonus. All muscle groups in both legs had grade 2 power. There was no sensory loss and no urinary disturbance. The plain roentgenogram indicated destruction of the T10 and T11 vertebrae and the disc between them. The myelography showed a complete bolck at the level of the disc between T10 and T11. On the third of March, anteior body fusion between T10 and T11 was performed. At the operation a small abscess containing pus was found. The culture of the pus showed Salmonella typhi. She was given Chloramphenicol and after 3 weeks the Chloramphenicol was replaced by Ampicillin. The patient was rested on the plaster shell for 2 months and then began a exercise to walk with a body cast. The power in both legs increased gradually to grade 3-5 and she could walk well with a cane in September 1983.
One case was a 58-year-old female complained of the nape pain and weakness of the right upper limb. Although X-ray findings showed the disc space narrowing at C4/5, 5/6 and 6/7 with spur formation, no significant lesion was observed by laminectomy and dural incision. A month after the operation, destruction of vertebral body appeared on X-ray view. So, the replacement of C5 vertebral body was performed and culture revealed Staphylococcus aureus. Another case was a 68-year-old male who complained of low back pain and paresis in both legs. X-ray showed the destruction of the 10th and 11th thoracic spine, and so anterior fusion was performed. Culture at surgical operation yielded Staphylococcus aureus. In both cases, recovery of paresis and bone union were obtained after operation.
Atlanto-Axial Rotatory fixation is rather an uncommon condition. We experienced 6 such cases in children recently. We terated 4 cases conservatively and one chronic case and one case associated with Os odontoideum surgically. All clinical results were satisfactory. We duscussed about the diagnosis and the treatment of atlanto-axial rotatory fixation in this report.
A case of atlanto-axial rotatory fixation with fracture of the right clavicle, in which traction therapy had failed, was treated satisfactorily with manipulation under general anesthesia. This patient was a 5-year-old boy without evidence of rheumatic disease or fracture of the dens.
In recent years we treated 17 cases of upper cervical spine disorder consisting of 5 cases of traumatic type and 12 cases of non-traumatic type. Traumatic type included 2 cases of odontoid fracture, 1 case of Hangman's fracture and 2 cases of atlanto-axial rotatory fixation. Non-traumatic type included 4 cases of cervical fusion, 4 cases of atlanto-axial subluxation due to R. A, 1 case of atlanto-axial subluxation due to unknown cause, 2 cases of OPLL and 1 case of atlanto-axial rotatory fixation. Some interesting cases were reported herein.
Abnormality of atlanto-axial joint in Down's syndrome has been recognized gradually. We operated upon two cases of os odontoideum with spinal cord compression. A fifteen-year-old girl with significant neurologic compromise was treated by posterior fusion of C1 to C2. But she died of pneumoria five months after surgery. Another case was a two-year-old girl with progressive neurologic deterioration. Posterior fusion of C1 to C2 was performed but fusion was not achieved. We operated again and solid fusion was obtained. On the basis of our experience, we emphasize that a routine X-ray check up and early diagnosis are important and rigid internal fixation and firm external fixation are also necessary.
We reported a case of spondyloepiphyseal dysplasia (SED) whoes associated atlanto-axial instability with recurrent faint attacks (type II by Rowland) was treated by the Brooks' posterior wiring and fusion secured by halo-brace application, odontoid hypoplasia is thought to be a common complication in SED, but the case treated by operation is rarely reported. Excessive atlanto-axial instability merely with minimal neurological symptoms should be fused promptly to prevent further neurological deficit that makes the coexisted limitations of daily life by polyarticular lesion worse in SED.
We reported 7 cases of cervical spondylosis with clear muscle atrophy and severe weakness. These cases were thought to be the dissociated motor loss syndrome in cerivical spondylosis reported by Keegan. Muscle atrophy was almost localized at C5, 6 myotomes and corresponded to findings of plain X-ray and myelogram. Sensory disturbance was seen is 3 cases but its degree did not corresponded to that of muscle weakness. CT and CT myelogram were effective in finding the causes of these cases. We think that the cause in the lesion of motor root at the preforaminal part and the lesion of anterior horn.
The basic treatment of cervical spondylotic radiculopathy and myelopathy is conservative including bed rest, cervical traction, epidural block and nerve root block. The cases of cervical spondylotic radiculopathy well responded to these methods of treatment. So there are very few cases which need operative treatment. According to Hirabayashi, we have determined the indication of operative treatment as foolows: 1. Severe radiating pain in the arm which doesn't improve in spite of 3 or 4 weeks of conservative treatment, 2. Recurrence of symptom, and 3. severe muscle atrophy and fatigability in the arm. We have been experienced four cases which showed above symptoms and were operated upon.
Two cases of cervical soft disk herniation were reported. Herniations were found at the levels of C 4/5 and C 6-7 respectively. Their clinical pictures resembled closely Hirayama's disease. They were treated with discectomy and anterior cervical fusion and satisfactory results were obtained.
Thoracic disc herniation is very rare and the diagnosis is difficult for its variety of the clinical symptoms. Recently, me experienced three cases of the lower thoracic disc herniation that were treated by transthoracic anterior approach. They all were involved at the lower thracic level and developed low back pain and myelopathy. The dianosis was not established for a relatively long period ranging from seven months to three years after the onset of disease before reforring to our clinic. All of them were operated upon with transthoracic anterior decompression and fusion resulting in a satisfactory relief of myelopathy and pain.
Twelve patients of spasmodic torticollis were followed up for an average of 10 years. There were 7 males and 5 females, ranging in age from 20 to 58 at the time of onset. Conservative treatment was chosen in all cases initially, however, surgical treatment was taken in 3 cases who had no improvement by conservative treatment. Anterior rhizotomy of C1/C3 combined with dissection of the spinal accessory root according to the method of Olivecrona was performed in two cases and dissection of the accessory nerve in one case. At the time of follow-up torticollis had improved in all operated cases. Nealy half of the cases who had had conservative treatment had improvement in some degree.
This paper is a report on a case of tuberculous tenosynovitis on the dorsal side of the left hand of a 33-year-old patient. This condition is very rare, and as preoperative diagnosis is extremely difficult, early excision of the lesion is important, as operative findings are essential for the complete diagnosis. In this case, the patient came to our hospital complaining of a pailnless swelling on the dorsal side of his left hand. Preoperatively we diagnosed it as a ganglion and performed excision, but during the operation we recognized a hypertrophied tendon sheath of brown color, containing a lot of “rice bodies”, and histological examination clearly indicated tuberculosis. After the operation an additional chest X-ray was taken (apical lordotic view), and a small tuberculous lesion was discovered in the superior lobe of the right lung; though tuberculous bacilli could not be found in cultures from sputum, urine, or gastric juice. For six months after the operation, antituberculous drugs have been employed, and there has been no recurrence of symptoms. Functional prognosis is also extremely good. We suggest therefore that the earlier such an operation is performed, the better the function of the hand can be preserved.
A 51-year-old female patient with snapping fingers of the bilateral thumbs and de Quervain disease was reported. She was suffered from restriction of the motion of bilateral thumbs and pain at the radial side of bilateral wrists. And she was treated surgically. After operation, all complaints disappeared.
Between 1977 and 1983, twenty-five patients with extensor pollicis longus tendon injury were treated in our hospital. And the results of ninteen cases were investigated. Eight thumbs were repaired with primary suture or delayed primary suture. Eleven tendon transfers were performed in old cases. Their over-all results were graded using our criteria (Table 4), and showed excellent in 11, good in 4 and fair in 2 patients. Old cases associated with other injuries had unsatisfactory results. In this paper, we discussed about the method of tendon transfer.
The authors reported twenty-four cases with spontaneous tendon ruptures in the hand, which were treated with surgical procedures between 1969 and 1983. Seventeen of the 24 cases were female and seven were male. The average age was 50 years with a range from 16 to 86 years. Right hands were involved in 15 cases, and left hands in 9. Twenty-three cases were extensor tendon ruptures and one was flexor tendon rupture. Nine cases of tendon ruptures were associated with rhematoid arthritis, 5 followed fracture of the radius or the first metacarpus, 4 resulted from osteoarthritis caused by Kienböck's disease or mal-union of the ulna, 3 followed contusion or sprain of the wrist, 2 resulted from overuse during the work and in one case the cause was not obvious. As a rule the ruptures were repaired by means of tendon transfer or graft. If necessary, resection or reconstruction of the distal ulna, synovectomy or excision of the lunate bone were combined with tendon repair.
Nine patients of tennis elbow (lateral epicondylitis) had operative trentment. Surgical technique was described by Robert P. Nirschl in 1979. It consisted of exposure of extensor carpi radialis brevis and excision of identified lesion. The results were rated as excellent in four elbows, good in four and fair in one.
Ganglion is not uncommon in the region of the hand. The authors experienced a case of carpal tunnel syndrome caused by a tripartite ganglion of the wrist joint, which occupied the hypothenar eminence, anatomical snuff box and ulnar side of the carpal tunnel. The median nerve palsy recovered favourably after extirpation of the ganglion and release of the transverse carpal ligament. While the ganglion resembled to a synovial cyst in rheumatoid arthritis, no evidence of rheumatoid arthritis was revealed by clinical and histopathological examinations. The carpal tunnel syndrome due to ganglion is well recognized, but it was scarcely documented, and a huge ganglion has not yet been reported in the literature.
Many reports of the fractures of the hooks of hamate have provided a sharp focus on causes, dignosis, treatment and associated anomalies such as ulnar neuropathy, bipartition and accessory ossicles. But there is no report about bipartite hamulus with carpal tunnel syndrome. This case report, presenting carpal tunnel syndrome with bipartite hamulus, illustrates the relation between carpal tunnel syndrome and this anomaly. A case of bipartite hamulus associated with carpal tunnel syndrome was reported. A 51-year-old man, who had had the fracture of the distal end of the radius and treated by cast fixation, found the sensory disturbance of the median nerve area in hand and muscle weakness of the thumb after one month of the injury. Radiological, computer tomographic and operative findings revealed that he had had the narrowed carpal tunnel caused from the radially deviated hook of the hamate. After 3 months of dissection of the transverse carpal ligament and removal of the hamulus, his median nerve palsy disappeared completely. It was concluded that carpal tunnel syndrome occurred due to trauma of the wrist in the situation of the narrowing of carpal tunnel which was based on the bipartite hamulus.
1) Neurography of the brachial plexus. For a diagnosis of thoracic outlet syndrome, we use neurography of the brachial plexus. We believe that it is a useful diagnostic method from experiences of about 100 cases. The situation of normal neurogram may be understood from our anatomical study by cadavers. Coloring material which was injected in the brachial plexus of fresh cadaver, was extended along the plexus, and filled in the loose connective tissues around the plexus. 2) Nerve Block of the brachial plexus. We use block of the brachial plexus as a conservative treatment for thoracic outlet syndrome. The effectiveness of block is greatest in patients who have severe symptom and sign, and have not so abnormal neurogram. It seems that the significance of block is as same as a role of epidural block for lumber disc herniation, etc.
Thrombosis of the ulnar artery in the hand was first reported by von Rosen in 1934. Although many similar case reports followed, thrombosis of the radial artery has not been reported. A twenty-year-old volleyball player felt coldness and pain in his right hand while he was playing volleyball two months before admission. His pain became severe gradually. Physical examination revealed discoloration of his right hand and pulselessness of both radial and ulnar arteries. Allen test was positive in the radial and ulnar arteries. There was no evidence of peripheral vascular disease or collagen disease. The arteriogram confirmed the occlusion of the radial artery and the ulnar artery. Surgical exploration revealed the complete occlusion of the radial artery in the distal forearm for about 8cm long and also of the ulnar artery in the palm. The thrombosed segments were resected. The great saphenous vein was taken from the thigh andgrafted in both arteries under the microscope. The patient was completely asymptomatic soon after the operation. On the 19th day after the operation arteriography was performed, which revealed that the radial artery was patent whereas the ulnar artery was not. Three months later, the patient was asymptomatic. It is assumed that repetitive impact to the forearm or the hand in volleyball players may cause vascular changes in these areas. Because the radial artery runs superficially at the distal forearm, it may be vulnerable to repetitive impact force in this area.
Replantation of amputated fingers has been a definitely established surgical technique and only problem for those severely crushed still remain unsettled. In the author's hospital amputated fingers and limbs were replanted in 46 cases between 1980 and 1982. Arterial transfer from other finger performed on 8 cases failed. The donor fingers for artereal transfer had slightly mild scar in digital space but showed good recovery. The value of arterial transfer for replantated finger was extremely hight, which was an essential surgical technique for the replantation of crushed type amputation.
In 1974, Grüntzig reported successful percutaneous transluminal angioplasty (PTA) for chronic arterial stenosis using the balloon catheter that was newly designed by himself. Many papers concerning about PTA using Grüntzig balloon catheter were presented Europe and U. S. A. Recently, the catheter has been used widely in Japan, also. PTA with Grüntzig balloon catheter is a very simple and useful procedure and can be accomplished under only local anesthesia, and then we can use it even for patients with poor risk. Three patients, who had been suffered from intermittent claudication caused by the stenosis or the obstruction of iliac or femoral arteies affected with arterio-sclerotic changes, were treated by PTA using Grüntzig balloon catheter in our hospital. The affected arteries were dilated successfully, and the patients were relieved from their complaints.
Involvement of the spinal cord from a vertebral osteochondroma is indeed rare. We have reported the clinical, roentgenographic, and operative findings of an osteochondroma arising from the lamina of the 5th cervical vertebra. Severe neurological deficits were largely relieved by excision of the osteochondroma.
Osteochondroma is the most frequent benign tumor of the bone. Its migration is well-known but its spontaneous disappearance is rarely reported. A three years and nine months follow-up study of an osteochondroma occurring in the left humerus of a one-year-old boy is reported. The broad-based lump was located on the anteromedial aspect of the left humerus at the proximal diaphysis. The diagnosis of solitary osteochondroma was made roentgenographycally. The lesion was followed with roentgenograms without treatment. Roentgenograms made three months later showed no apparent change in the lesion, but subsequent roentgenograms made fourteen and twenty-four months after the initial roentgenograms showed the gradual regression of the lesion. The final roentgenograms made three years and nine months after the initial roentgenograms showed the lesion to have completely disappeared without surgical intervention. Spontaneous resolution or regression of osteochondromas is rarely recorded, but it is suggested that it may be more frequent.
A 17-year-old female had intracortical fibrous dysplasia of her right tibia. She complained of right leg pain and visited our hospital in July, 1982. Roentgenographic findings showed the ground glass appearance with the radiolucent area in the antero-lateral side at proximal one third portion of the tibia. The involved cortex expanded to its outer and inner side with sclerosis. En bloc resection of the lesion was performed, followed by bone grafting, on August 26, 1982. In the pathological studies, the central area in the tumor was consisted of numerous woven bone trabeculae without the lining of osteoblasts among spindle shaped cells ranged with storiform pattern, and the peripheral area was consisted of woven bone trabeculae with the lining of osteoblasts. At 57 weeks after the operation, she walked by herself. The grafting bone was unclear and no evidence of recurrence was found roentgenographically.
Benign chondroblastoma of the patella is relatively rare. A case of cystic type is presented here, which was managed by curettage and bone graft. A twenty-five-year-old man was admitted to the hospital on July 4, 1983, with the complaint of the left knee pain. The patient stated that he first noticed the symptom after a contusion of the left knee in December 1982. On examination, tenderness and local heat were evident over the left patella with muscle atrophy in the left lower extremity. The remainder of the skeletal survey was normal. Roentgenograms and CT-scans revealed a cystic lesion of two centimeters in diameter in the proximal third of the left patella. Bone scintigrams showed no increased uptake and laboratory findings were normal. Curettage and bone graft were performed on July 14, 1983, and a diagnosis of benign chondroblastoma was made.
Since 1978, 30 patients with osteogenic sarcoma were admitted to our hospital and treated by surgery and adjuvant chemotheraphy. Patients received high dose methotrexate with citrovorum factor rescue, adriamycin, bleomycin-cyclophosphamide-actionmycin-D theraphy and cisplatium. Most disturbed side effects were myelodepression and alimentary tract complaint of nausea, vomiting and appetite loss. Myelodepression was prevented by considering the interval between administration of HD-MTX-CF rescue and adriamycin, dosage of ADM, BCD and good rescue of MTX. Usage of many effective antiemetic drugs reduced the alimentary side effects. These experiences of chemotherapy were the reasons that prolonged the survival of patients with osteogenic sarcoma.
Three cases with bone soft tissue sarcoma, treated by limb-salvage operation are reported. Case 1: A thirty-five years old man had the recurrent mass at the left thigh, considered histologically as malignant fibrous histiocytoma and multiple metastatic pulmonary nodules when he was admitted. The local mass was evaluated as Stage III (extracompartmental lesion, high grade and pulmonary metastasis) by surgical grading system by Enneking (1981). After preoperative chemotherapy, marginal excision was performed. No local recurrence is observed one year and two months after surgery. Case 2: An eighteen years old boy had osteosarcoma of the left fibula. As the osteosarcoma was evaluated as Stage IIB (Extracompartmental lesion and high grade), wide local resection was performed after adjuvant chemotherapy consisting of vincristine and high dose methotrexate with citrovoruin factor rescue. He is the disease free survivor at one year after adjuvant chemotherapy. Case 3: A forty-seven years old woman had chondrosarcoma (grade 1 on Evans' classification) of the left femoral neck, diagnosed by aspiration biopsy. The chondrosarcoma was evaluated as Stage IA (intracompartmental lesion and low grade). The chondrosarcoma was removed by wide local resection and the bony defect was replaced by cermic femoral prosthesis. She can walk on one cratch at three months after surgery.
We described a case of chondrosarcoma involving the proximal end of the humerus— which was treated by the total shoulder joint replacement (Michael Reese type) after the wide resection. The case was a 43 years old man who was admitted to our hospital with pathologic fracture of the right proximal humerus in April 1983. This case was treated with intra-arterial high-dose driamycin pre- and post-operatively and total shoulder joint replacement after wide resection of the primary tumor. Histological finding of the tumor showed chodrosarcoma of Grade III (Evans). Satisfactory result was obtained at one year after the operation.
It is generally accepted that the prognosis of osteogenic sarcoma depends on whether lung metastasis has developed or not prior to the removal of its primary lesion. We have experienced a case of osteogenic sarcoma in the pelvic region. However, the patient and his family refused to undergo its surgical resection (hemipelvectomy) despite of our frequent suggestions. The following conservative treatments were therefore conducted; high-dose methotrexate (HD-MTX) with citrovorum factor rescue, vincristine (VCR) and adriamycin (ADM). Interferon was also additionally administered. However, pulmonary metastasis developed in this case within a short period and the patient died six months later despite of our vigorous medical treatments.
Mesenchymal chondrosarcoma is a rather unusual chondroid tumor that was first described in 1959 by Lichitenstein and Bernstein. A case of mesenchymal chondrosarcoma is presented in this paper. The patient was a twenty-year-old man and referred to our clinic with chief compliants of pain in the gluteal region and uro-rectal incontinence. Radiological and histological examinations with needle biopsy revealed a feature of chondrosarcoma occurring in the sarcrum, that occupied almost whole pelvic cavity. High amputation of sacrum and resection of the tumor was performed. Fourmon the after surgery, neither evidence of reccurrence nor of metastasis was seen radiologically and clinically. Japanese cases of this rare tumor were reviewed and 21 cases, including the present case, were accepted. Clinical characteristics were similar to those of a series reported by Salvador et al.
A 46-year-old man who had been diagnosed as hereditary multiple exostosis was admitted for treatment of large tumor of the left gluteal region. X-ray revealed characteristic findings of chondrosarcoma and embolization of the superior gluteal artery was carried out before the operation. Extra-pelvic tumor was excised completely but intra-pelvic tumor was partially resected. Microscopic pathological diagnosis was well differentiated chondrosarcoma.
A rare case of Ewing's sarcoma originating in the cervical spine was reported. The patient was a 16-year-old boy complaining of neck pain, weakness and sensory disturbance in the extremities. The radiograph showed a sclerotic change in the fifth cervical body where the bone scintigram showed abnormal concentration. As the pralysis progressed in a short time, subtotal resection and anterior spinal fusion was performed. Histological findings of the specimen showed the Ewing's sarcoma. Four days after the operation, however, apnea developed and he required respiratory support. Although radiotherapy was performed, he died a year and seven months later.
The influence of partial excision at the proximal epiphysis of the tibia to metaphysis in young growing rats were investigated from 2 days to 8 weeks after excision by roentgenological and histological methods. The results were as follows; 1) The longitudinal bone growth of experimental tibia was slightly inhibited while the transverse diameter of metaphysis was remarkably increased compared with normal controls. 2) At 2 and 4 days after operation the calcified cartilagenous septa were not seen in the primary spongiosa and many osteoblastic cells were transversely oriented along the growth plate metaphyseal junction. Then at 1 week after operation the calcified cartilagenous septa newly projected into the primary spongiosa, which were shorter in length and thicker in width than normals. Until 4 weeks they gradully increased in length and became same as normals. The peripheral trabeculae of the metaphyseal primary spongiosa which were located under excited epiphysis were arranged obliquely from 2 to 4 weeks. Since 1 week the cells of the deep proliferative zone of cartilagenous epiphysis and the marginal germinative zone of epiphyseal plate were remarkably increased in size and number.
The effects of long-term low-dose EHDP on experimental osteoporosis induced by ovariectomy and low calcium diet in rats have been investigated. EHDP was given at a dose of 0.5mg/kg daily for six months. Low calcium diet containing 0.1-0.2% Ca, 0.65-0.80% P and 2000 IU vitamin D3/kg was used. 1) Osteoporosis induced by low calcium diet was more marked than that of ovariectomized rats. 2) Both osteoporosis were clearly prevented by EHDP, judging from increased trabecular bone mineral content, cortical thickness, bone ash content and bending strength. 3) These findings suggest that long-term low-dose EHDP can prevent the osteoporosis induced by ovariectomy and low calcium diet as well as the denervation osteoprosis.
The effects of EHDP on the healing process of bone graft in rats tibia were observed roentgenographically and histologically. In the control and the treatment group with EHDP of 0.5mg/kg/day, remodelling of the callus was found, wheas it was not found in the group with EHDP of 1.0mg/day. In the groups with EHDP of 5mg/kg/day and 30mg/kg/day, the mineraliztion and calcification of the callus were strongly inhibited.