Arthroscopic surgeries for 16 meniscal and 10 shelf lesions were performed from Aug. '82 to Sep. '83. Meniscal lesions were diagnosed in 14 patients (9 males, 5 females: average age was 26 years; range, 14 to 49 years), of which 5 were medial lesions and 11 lateral meniscal lesions, of which 9 were discoid type. Shelf lesions were revealed in 10 patients (5 males, 5 females; average age was 25 years; range, 13 to 38 years). Partial removals of unstable parts of the injured menisci were performed and uninjured stable periphery of the menisci were preserved. Degenerated and tightened shelfs were resected widely. Postoperatively, full weight bearing was allowed on the second or third day in the patients, who were operated on partial meniscectomy or resection of the shelf. Patients who were operated on total meniscectomy, were allowed full weight bearing on the second week after the surgery. Postoperative evaluation was performed by Kurosawa's scoring procedure. Preoperative score which was 3 points (range, 1 to 5 scores) was improved to 8.1 points (range 6 to 10 points) after meniscetomy. The clinical symptoms on shelf injured patients were all improved postoperatively. In conclusions, arthroscopic surgery is actively indicated for meniscal or shelf lesions.
The are some problems with the treatment of discoid lesion in the childrens knees. First, operative indication should be set. Even if operation is selected, it is often difficult to decide which procedure should be employed between total and partial meniscectimes. Recently, we have treated two children who complained of flexion contracture of the knee without pain or tenderness. The first case was treated by total meniscectomy and the other by partial. We think that partial meniscectomy should be pursued as far as meniscal is cleavage missed or minimum.
We reported a case of injury to the medial meniscus which was associated with lunula in the left knee joint. The patient was a 24-year-old boy who complained of left knee pain. Roentgenograms showed a loose body in the left knee joint. Arthroscopic findings were rupture of the medial meniscus and no loose body was found. Operative findings showed that the medial meniscus had been ruptured and associated with lunula.
Using a positive single-contrast arthrography under fluoroscopy with magnification, the knee joint of 299 patients, i. e. 313 knees were examined. Seventy-three knees were diagnosed with meniscal injuries in which meniscal cysts in eleven cases were on arthrogram. The frequency of meniscal cysts in meniscal injuries was 15.1% or 11/73. Ten cases were associated with horzontal tears. The importance of the use of arthrography to observe the relationship between meniscal cysts to horizontal tears is discussed.
It is recently reported that arthroscopic operation can bring about a satisfactory result in meniscus lesion of the knee joint, but this operation is not widely done. Our recent experiences of this procedure is presented. Twenty-seven knee joints were operated through this procedure in twenty-three patients with meniscus lesion. Medial meniscus was removed in thirteen cases, lateral meniscus in seven, lateral and medial meniscus simultaneously in three and lateral meniscus on both sides in one. Five patients showed discoid meniscus. The average time of operation was about a half hour in partial meniscotomy and seventy minutes in total meniscotomy. The patients were discharged from the hospital on the 10th postoperative day in average. Postoperative results were satisfactory in most of the patients. The conventional surgical procedure can be replaced by the arthroscopic surgery in meniscus lesion.
Optimal positioning where the entire longitudinal axis of the cruciate ligaments could be demonstrated on computed tomography was discovered by using an amputated knee and was applied clinically. To demonstrate the anterior cruciate ligament, the patient was positioned on the table with the hip flexed, abducted, externally rotated and knee flexed at a 110-140 degrees angle. For the posterior cruciate ligament, the patient was placed in a prone position on the table with the knee flexed at a 50 degrees angle. These positions, especially the one for the anterior cruciate ligament, were difficult for some patients with gonalgia or limited range of motion. Reconstruction in the oblique planes was studied for those patients by using an amputated knee and quasi-ligament made of gum. Clinically, an axial image was obtained by the simple position of the patient lying prone on the table with knee extended. Oblique reconstruction was made from the axial images and this reconstructed image also demonstrated the entire longitudinal axis of the ligament. The rupture of the cruciate ligaments could be assessed by the reconstructed image in the oblique plane.
Fifteen cases of fresh injuries to the ligaments of the knee were treated in our hospital from January, 1980 to May, 1983. Most of them were satisfied with the results. But, in the case of severe injury, we may obtain a good result by primary reconstruction in addition to primary repair.
A retrospective study was carried out on sixteen patients undergoing intra- and extraarticular reconstruction using iliotibial tract for anterior cruciate ligament insufficiency. The results of thirteen cases with more than one year follow up were rated as excellent in seven cases, good in four cases, fair in two cases and poor in none. This procedure can be recommended as a beneficial method where intensive rehabilitation is available.
Ninety-four osteoarthritic knees with a varus deformity were treated by high tibial osteotomy at our clinic from 1975. Seventy-nine knees of them were followed for more than 6 months. (1) The clinical result was good in 67 (84.8%), fair in 8 (10.1%) and poor in 4 (5.1%) knees. (2) Sixteen out of 17 knees with recurring tendency of varus deformity (more than 176 FTA) were found within 6 months after operation. (3) Average FTA with obvious improvement of the knee joint by X-P findings was 169.9.
Between 1981 and 1983, ten patients were treated surgically and conservatively for depression fracture of the tibial condyles. Six patients had acquired almost maximal recovery of knee function. In one patient with open comminuted fracture, bony union has been still delayed. The result suggests that combination with bone grafting and rigid internal fixation, and surgical management of the associated soft tissue injuries are essential to recovery of knee function.
Curtiss et al. reported three cases of transient osteoporosis of the hip in 1959. This syndrome is very rare and consists of pain in the hip in an adult, lasting for a few months, and then remitting completely, without exacerbation or residual impariment. A 25-year-old woman was admitted to our hospital becanse of limp and pain of the left hip joint. Roentgenograms revealed marked demineralization of the involved temoral head with preservation of the joint space. The clinical course of this patient was benign with complete recovery in about 6 months. The mechanism of demineralization renains uncertain.
Three hundred and seventy-five cases have been diagnosed as idiopatic necrosis of the femoral head (INFH) in our hospital since 1965. They were categorized by a history of steroid hormone usage and non usage. 120 cases, that is approximately one third of the total, gave a history of having taken steroid hormones for diseases such as Systemic Lupus Erythematosus (SLE) and nephotic syndrome. INFH is commonly seen in men, but steroid induced INFH occurs equally in men and women. The incidence of bilateral INFH in adult in our study are about 50% in comparison to 71% among steroid induced cases. Within 2 years, it can be said whether unilateral INFH becomes bilateral. It is also well known that multiple osteonecrosis can occur in cases of INFH, but the incidence of multiple osteonecrosis has been shown to be very much higher in steroid induced than in non usage of steroids. The sites where osteonecrosis apt to occur are distal femoral ends and proximal Numeral heads. We believe that the results stated adove are due to the general influence of steroid hormones adding to an anatomical minor locus in the circulation of the femoral head.
In Japan there are many cases of secondary osteoarthritis of the hip caused by LCC or displasia of the acetabular roof. We performed rotational acetabular osteotomy on ten cases of precoxarthrosis or in the early stage of osteoarthritis of the hip caused by acetabular dysplasia. All patients, one male and nine females. had suffered from coxalgia while walking or after standing for a long time. The symptoms such as coxalgia, easy fatigability of the hip and limping, disappeared in 8 months after the operation. The mean operation time was 4 hours and one minute, and mean blood loss was 1173ml. Two cases are presented here. We believe that rotational acetabular osteotomy not only relieves pain but also prevents the development of osteoarthritis of the hip.
During 7.5 years from Jan. 1976 to Jun. 1983, 23 patients of medial fractures of the femoral neck and necrosis of the femoral head were operated by the femoral neck prosthetic replacement, 12 patients were fracture type and the others were necrosis type. Dual bearing type Bateman (Bateman type) and Bi-centric endoprosthesis system (Bi-centric type) were used and post-operative R. O. M. and cup varus degrees were studied. An average mark of post operative score of coxarthrosis by Japanese Orthopaedic Association were determined. Cases using Bateman type showed cup varus 45.6° in the average, in Bi-centric type was larger than the Bateman type, 63.0° in the average. But R. O. M. of Bi-centric type was not so bad. Difference of varus angle of cup between these two types might present some minor problems in future. From our experience, cases over 45 varus degree gained better R. O. M. of hip joint comparing with cases below 45°.
A case of epiphyseal separation of the proximal humerus was reported. The lesion occurred by a birth trauma at pelvic presentation. As the proximal humerus did not appear on X-ray, the diagnosis was established by clinical findings. The new-born was treated by skin traction at abduction of 70 degrees in an incubator, aligning the humeral shaft to the scapular glenoid with difficulties. On the 12th day, callus developed on the lateral aspect of the proximal humerus, and the skin traction was discontinued on the 15th day. The patient was discharged from the hospital without fixation of his arm on the 19th day. Remodelling of the callus was recognized in 2 months, and the humerus showed its normal shape on X-ray and no restriction of ROM of the shoulder was noticed in 6 months.
The managements of fractures in severely handicapped children are difficult because of their variable complications and thin bone cortex. So there are many discussions for their management. We think that there is an indication of intramedullary fixation for the fracture of femoral shaft; and for the supracondylar fracture of femur, the cylinder cast made of linear polyester polymer may be indicated. There is no indication of traction for the fracture in severely handicapped children because it is very difficult to prevent their decubitus, hypostatic pneumonia and joint contracture which are caused by resting them in a same posture for a long time. There is no indication of plate fixation for the fracture in the patient who has thin bone cortex, very severe involuntary movement and severe muscle hypertonus.
From January 1978 to July 1983, we treated 95 cases of intracapsular and extracapsular femoral neck fracfures. Seventy-seven cases were followed. Of these, 34 cases were intracapsular femoral neck fractures, and 43 cases were extracapsular. The types of intracapsular and extracapsular femoral neck fractures were classified by Graden's and Evans' criteria. Conservative treatment, large pin fixation, and Ender's nail were adopted for extracapsular fractures. Large pin fixation, multiple pinning, and femoral head prosthesis were used for intracapsular fractures. Good results were obtained in the stable types of Evans, and Garden's types I and II by the previous methods. But, the prognosis was not good in the unstable type of Evans and Garden's types III and IV fractures because of occurrences of deformity and non-union or late segmental collapse.
We performed prognostic study of fracture of the neck of the femur, including of the trochanteric region, on 53 fractures in 51 patients with an average of 4.5 years follow-up. It was revealed that the prognosis was unfavorable if patients were 70 years or older, or osteoporosis was severe. Other factors including types of fractures, methods of treatment, or pre-and/or postoperative complications, were not significant for prognosis.
Recently we have experienced a case of traumatic posterior dislocation of the left hip associated with fractures of the femoral head and acetabulum, with incomplete sciatic nerve injury and fracture of the proximal end of the tibia. The patient, a 29-year-old man, was injured in a motorcycle accident. As a closed reduction was unsuccessful, an open reduction was performed at thirty six hours after the accident. The lesser fragment was located in the anteromedial portion of the head and showed about a third of the femoral head in size. The fragment of the head was fixed with two screws and acetabular fragment was reattached with silk. After the operation, he was managed with traction for eleven weeks. Nine months later, he had no complaints of the hip and knee joints and x-ray films revealed no progressive changes.
Out of 13 cases sustained a fracture dislocation of the hip for the past 3 years, 8 cases were examined by a computerized tomography (CT). Seven cases suffered from posterior dislocation and one case central dislocation; the fractures located at the femoral head in 3 cases and at the acetabulum in 5. Surgical treatment was carried out on 6 cases of posterior dislocation of the hip. CT presented exactly the fracture of the femoral head and acetabular rim, an intra-articular fragment and a congruity of the joint surfaces. CT was thought to be essentially useful for indicating a treatment of fracture dislocation of the hip.
Rwenty-three cases of traumatic dislocation and fracture of the hip were treated during past seven years in our hospital. We reported the treatment and results of nineteen cases which were followed for more than one year. The results were clasified by Epstein's criteria. Thirteen of nineteen cases had excellent or good results. Two factors were noted which contributed to the results. The first factor was the type of dislocation and fracture, and the second factor was the avascular necrosis.
Forty-one cases of traumatic dislocation of the hip were studied for prognosis. Their follow-up period ranged from one year to eleven years and ten months. In the cases of type IV (Rowe's classification) of central dislocation of the hip and types III and IV (Epstein's classification) of posterior fracutre-dislocation of the hip, incidence of poor result was higher than other types. The main factor which caused poor results was incongruity resulted from incomplete reduction of acetabular fracture. It is important to perform the anatomical reduction in traumatic fracture-dislocation of the hip.
Simultaneous avulsion fracture of the anterior superior and anterior inferior iliac spine is extremly rare and only one case has been reported in Japanese literature. We have experienced a case with this type of the fracture. A 15-year-old school boy has felt a sudden sharp pain at the right groin while he was Bushing and he could not continue to run. An X-ray finding revealed a simultaneous avulsion fracture of the anterior superior and anterior inferior iliac spine and open redupction was successfully done with a method of tension band wiring 4 days after the injury. Two years and 4 months after the operation he has no pain and functional disturbance of the hip and leg. Discussion was made on the mechanism of the fracture.
Roentgenographic examinations were carried out on 20 patients with stiff and painful shoulders. Ages ranged from 40 to 61 years. In resting position, two roentgenograms were taken at distance of one meter and two meters between the X-Ray film and the source. Following that, only one roentgenogram was taken at two positions respectively, 45° and maximum elevation, which was elevated in a plane of 40 aganst the frontal plane. The patients were classified into 2 groups according to the results of this examination. The patients were categorized as follows; Gropu 1: Eleven patients who was suffering for less than 2 months from onset. Group 2: Nine patients who was suffering for more than 2 months from onset. The angle of the scapula was as follows; The medially tilting angle was nearly equal between the affected side and unaffected side. The downward tilting angle of the affected side was larger than that of the unaffected side in group 1. The downward tilting angle of the affected side was smaller than that of the unaffected side in group 2. The upward rotation angle of the affected side was larger than that of the unaffected side in all cases.
Arthrography of the shoulder is a valuable diagnostic method in the investigation of the glenohumeral joint. But there are few reports of the findings of the normal shoulder arthography. In this paper, we performed single contrast shoulder arthrography in fifteen shoulders of ten normal healthy volunteers to compare the findings of scapular view with those of anteroposterior view and those of west Point view with those of axillary view. Scapular view is helpful in outlining the glenohumeral articular surfaces and evaluating arthrographic changes in any shoulder positions because the scapula is always fixed and the glenoid is tangentially visualized. In single contrast artrography, west Point view is not superior to axillary view to outline the anterior labrum.
The intra-articular pressure-volume relationship was examined in two groups of patients. The first group consisted of 10 patients with painful shoulder. The second group consisted of 6 patients with a primary anterior dislocation of the shoulder. Under fluoroscopic control a 23-gauge needle was introduced into the antero-inferior part of the glenohumeral joint. The injection of contrast material containing lidocaine was made at a rate of 4ml/min by a infusion pump. The contrast material was infused with the transducer open to the needle via the three-way stopcock and continuous recording was obtained on the pen recorder during the injection phase. In 9 patients with painful shoulder the intraarticular pressure increased gradually at low volumes, reaching a pressure of 15 to 60 millimetres of mercury at a volume of 5 cubic centimetres. The pressure then rose more steeply, approaching 64 to 232 millimetres of mercury at a volume of 15 cubic centimetres. In one case who had a greater limitation of motion with painful shoulder, the intra-articular pressure rose steeply at low volumes, approaching 112 millimetres of mercury at a volume of 5 cubic centimetres. The mean pressure-volume relationship for all 10 patients with painful shoulder showed a curve of sigmoid form. Closed reduction was performed in all 6 shoulders of the second group. Two patients used an immobilization device for 3 weeks, while four patients began to use the shoulder as early and freely as possible. In every patient the same joint was studied on two separate occasions 3 weeks apart after the closed reduction and two pressure-volume curves obtained in each patient were similar regardless of treatment. No correlation was found between joint elastances and types of treatment. There was no complication associated with the recordings.
We have examined X-P and arthrograms of 32 cases, or 35 joints of the painful shoulder patients over forty years old. They did not have any history of injury, tumor, infection or systemic diseases. X-P findings appeared much more in the 2nd shoulder joint than in the 1st shoulder joint. If AHI is less than 7mm, we have to suspect the rupture of rotator cuff. We found any arthrographic findings in all cases, 89% in inferior pouch and subscapular bursa, 40% in rotator cuff, and 70% in biceps groove. The reduction of inferior pouch and subscapular bursa increases with aging and suffering period, and it makes the limitation of ROM. The rupture of rotator cuff increases with aging, and especially it exists in 64% of the patients over 60 years old. We could not find any relation between the clinical findings and the arthrographic findings of bicipital groove.
A thirty-six-year old male who had tendon Kanthomas on his extremities was reported. He was associated with type-IIb hyperlipoproteinemia characterized by elevated serum cholesterol and triglyceride. Subtotal resection of the tumors was carried out, and he was satisfied with the result. The early recognition and evaluation of the patients with hyperlipoproteinemia, especially type-II, is important, because it has a tendency to develop atherosclerosis at an early age.
The case was previously reported on this journal as a case report of a recurrent pigmented villonodular synovitis of the knee joint. It has been observed for four years after the second operation. There were clinical evidences of malignancy after the second local recurrence, i. e., metastasis to the adjacent lymphnodes and right thoracic cage and retroperitoneal invasion. Pathologically this case was diagnosed as malignant giant cell tumor of tendon sheath.
The patient, a 59-year-old woman, with a clear cell sarcoma of tendons and aponeuroses arising in the planta pedis was reported, She was given a chemotherapy including bleomycin, vincristine, and picibanil for the metastatic lesion in the right fifth rib and the lung which had rapidly increased in size after the operation. The tumor was responsive to it. Melanin pigment granules were identified in the tumor cells, which suggested a neural-crest origin for this tumor.
There are two types of angiolipoma, namely noninfiltrating and infiltrating. Noninfiltrating angiolipoma is seen in young individuals and presents as painful, soft, and cutaneous nodules. Occasional compression of nerve fibers that accompany the vascular channels could be demonstrated. Treatment is a mere enucleation. Infiltrating angiolipoma is rather rare. Only 34 cases have been reported in the English literature. Though histologically benign, the tumor can infiltrate bony, muscular, neural, and fibrocollagenous tissues to cause unusual symptoms and signs and can clinically simulate malignant neoplasms. Wide excision including the normal tissue surrounding the tumor is mandatory. We reported our cases with review of literatures and discussed the clinical and pathologiocal features of this entity.
Tumoral calcinosis is a rare disease characterized by periarticular calcification, hyperphosphatemia and normocalcemia Two cases of tumoral calcinosis have been followed up and examined. The masses occur in highest frequency about the hips, elbows and shoulders, but the involvement of the hands and knee is uncommon. However, our cases had calcific tumors of the knees. Radiographically it has been defined by the presence of periarticular calcific deposits varying in size. One of the patients was found to have unusual diffuse soft tissue calcification of the lower extremities. This may suggest an underlying defect in phosphate metabolism.
We performed clinicopathological study of peripheral nervous tumors with limbs and trunks at our clinic. Of twenty-three patients, 14 patients were men and nine woman. The sex ratio was slightly skewed toward man with 14:9. In regared to the location, the tumors were found predominantly in the lower extremity. Tumors occurred as either a solitary lesion (12 cases) or multiple lesions (11 cases). Twelve solitary lesions showed histological diagnosis such as a solitary schwannoma (8 cases), neurofibroma (1 case) and malignant schwannoma (3 cases) respectively. On the other hand, 11 cases with the multiple lesions were diagnosed histologically as neurofibromatosis in association with von Recklinghausen's disease. In the solitary lesions, eight schwannomas and one neurofibroma were easily extirpated, and have been followed with no recurrence. In three malignant schwannomas, one case died of the disease. In the multiple lesions, surgical extirpation was performed for benign each tumor, and no recurrence has been found in three cases. Of 11 of von Recklinghausen's disease, three cases (27%), of which two died of the disease, showed malignant transformation. Therefore, they were considered as poor in prognosis.
An electroencephalographic study was carried out on 54 children with idiopathic scoliosis, aged from 3 to 17 years and 20 normal development children aged from 7 to 16 years as controls. The results were as follows. 1) Abnormal EEG was found in 25.9per cent of the scoliotic patients. 2) The main EEG abnormalities were high voltage slow wave burst, asymmetry and and spike potentials. 3) Abnormality of EEG of juvenile group (below 9 years) was 1.7 times higher than that of adoslecent group. 4) EEG abnormalities were correlated with the severity of the scoliosis.
Moiré topography is a very common method for the screening of spinal scoliosis. However, there is the problem of the false positive ratio. We tried the Hanging Moiré topography to decrease the false positive ratio. Fourty-seven patients with the idiopathic and other scoliosis were examined. They swang by both arms from the hanging bar of the article on the market and they were photographed by using FUZINON. FM-90. At the same time roentgenograms were taken and measured for the Cobb angle, which is the Hanging Cobb angle. The results were as follows; 1) The Hanging Moiré topography was useful for check of the spinal flexibility. 2) The laterality above 10mm on the Hanging Moiré topography suggested the possibility of the rigid scoliosis. 3) Further investigation must be done for the scoliosis screening, since there are many factors concerning the Hanging Moiré topography.
The short brace has been used for treatment of idiopathic scoliosis in 30 patients with 32 major curves measuring 25.7 degrees on an average. There was a mean per cent correction of 47.9. There was a mean per cent correction of 67.2 in 14 patients with a thoraco-lumbar scoliosis and 54.4 in 13 patients with a lumbar scoliosis. We could not find out relationship between the initial correction and the apex, vertebral rotation and skeletal maturity. In 9 thoraco-lumbar and 8 lumbar scoliotic patients who were wearing the short braces over 6 months, the mean best corrections were 75.9per cent and 60.8per cent respectively.
Scoliosis treatment should be considered not only in a frontal plane but in a saggital. Herein the authors reported four scoliotic patients with loss of thoracic kyphosis successfully treated by Harrington rod Segmental Spinal Instrumentation (H-SSI). H-SSI provides a lot of advantages and usefullness for rigid fixation and correction of scoliotic deformities compared with the conventional Harrington Instrumentation, though it has technical difficulties with a high risk of complication.
Three stage operation was done on an adult case with severe kyphotic deformity of the spine. The methods used were; 1) posterior release and osteotomy, 2) anterior release and bone graft, and 3) posterior Harrington instrumentation and spinal fusion. T10-L2 was corrected from 98° to 38°.
Diastematomyelia is an uncommon congenital malformation in which a septum of, bony, cartilagenous or fibrous tissue extends dorsoventrally through the spinal canal and between portions of either a partially duplicated or split spinal cord. We are presenting here a case of diastematomyelia in children. To prevent the irreversible and progressive neurological damage of diastematomyelia, prophylactic operation was performed.
“Spinal dysraphism” is a development abnormality of the neuro-axis. The symptoms usually occur in the childhood, but rarely develop in the adulthood. We reported an adultcase. The patient, a sixty-three years old male, complained of gaid disturbance that had begun at the age of twenty-five years and had developed very slowly. On admission, he could scarecely walk with two canes. The lege were analgesic, and paraplegic below the knee. The ankle jerks were absent. The feet showed severe “cave-varus” deformities. Subcutaneous lipoma was observed on the sacrum. Metrizamide myelography revealed saddle-shaped defect at the L3-4 level. Although laminectomy from L3 to L5 wasperformed and subarachonid lipoma was removed, good reasults were not obtained. The neural deficits of spinal dysraphism commonly occur at the age of four to six years, thereafter develop during the growth. Onsets or developments of neural deficits in an adult were rarely reported. The mechanisms of neural deficits in such lately developed cases were still unknown. Degenerative spinal stenosis accompanied with aging, relatively insidious traumas to the tethered cord, arterial sclerosis and ischemia may be concerned.
Two cases of spinal cord tumor were reported herein. Case 1, a 65-year old woman, consulted us complaining of pain in legs and disturbance of gait. Myelogram showed a complete block from C7 to Th1. Operation was performed and intradural extramedullary type tumor with ossification tissues was removed. Histologically the tumor was diagnosed as psommamatous meningioma. After operation the symptoms disappeared quickly. Case 2 was a 34-year-old man whose complaint was motor palsy of four extremities and hypesthesia below C3 level. Myelogram showed a complete block from C2 to Th4. Operation was done and the intramedullary type tumor was removed. Histologically the tumor was diagnosed as ependymoma.
The dumb-bell tumors are classified into several groups in accordance with constricting structures and their localization. We have experienced a case of thoracic spinal cord tumor that had developed into the vertebral body and the thoracic space through the intervertebral foramen. This case may be a mixed type of the foramen constriction group and the vertebral body eroding group.
Ganglioneuroma is a benign tumor of the autonomic nervous system and only rarely, if at all, occurs in the spinal ganglia. When a neurofibroma involves the ganglion, it resembles a ganglioneuroma microscopically and is occasionally erroneously diagnosed. In this paper we present a case of such a misleading tumor. The patient was a 42-year-old man, who complained of dysesthesia and weakness of both lower limbs. After a physical and roentgenological examination, we diagnosed an extradural spinal cord tumor and performed an operation. The tumor was discovered in the left eighth thoracic nerve root. It was compressing the dura and spinal cord, and had not extended beyond the intervertevral foramen. It was resected with the nerve root. At first, the histopathological diagnosis was “ganglioneuroma”. On a second examination, however, ganglion cells in the tumor were found to be not neoplastic but autochthonous. The corrected diagnosis was neurofibroma involving the spinal ganglion. In ganglioneuroma, ganglion cells are abundant, distributed diffusely throughout the tumor and often bi-or multi-nucleated. Degenerative changes such as pyknosis, cytoplasmic eosinophilia and ballooning degeneration are common in the neoplastic cells, whereas satellite cells are often absent in ganglioneuroma, lymphoid aggregates, which are prominent in ganglioneuroma, are notably lacking in neurofibroma. One must be careful not to confuse ganglioneuroma with neurofibroma which traps the pre-existing ganglion.
We reported a case of lumbar spinal stenosis associated with meningioma in thoracic spinal region. A 65-year-old man was admitted to our hospital with a chief complaint of muscle weakness of the left lower limb. He was diagnosed as lumbar spinal canal stenosis and underwent laminectomy of lumbar spine. After the laminectomy, his symptoms diminished a little for a short term. But his sumptoms of muscle weakness and sensory disturbance took a turn for the worse gradually. At about 6 months after operation, we performed myelography again and found out thoracic intradural and extramedullary tumor. We excised it and then he was recovered from his symptoms immediately. Histological diagnosis of this tumor was meningioma At present, he lives an active daily life without especial difficulties.
A six-year-old boy was first seen at our hospital in August of 1982. After he first fractured his left leg bones at the age of four years, twe operations were performed without success at the ages of four years and five years. Our choice of operative method was dual tibiofibular intramedullary rodding and slab bone grafting, which was done on September 17th 1982. Postoperatively the extremity was immobilized in a hip spica cast for four months and in above-knee cast for two months. Union of the tibia was achieved six months after operation, and then ambulation with above-knee brace was instituted. Shortning of both the leg bones and femur was demonstrated and was supposed to be caused by non-weight-Bering. Early weight bearing was recommended in order to promote and enhance normal longitudinal growth.
From January, 1973 to December, 1982, 139 cases of congenital dislocation of the hip were treated by Pavlik Harness. One hundred and sixteen hips were followed. Of these, 17 hips which failed in reduction by Pavlik Harness were reviewed.
A modified new method for funnel chest correction using Zimmer osteosynthetic plates is reported. This operative method has great advantages in the treatment of asymmetric funnel chest in adolescents and adults. This techique offers the righd and cosmetic normal chest wall.
A 79-year-old woman had gait disturbance and gradually developed numbness of the extremities. Radiographs showed round shape calcification in the spinal canal between C5 and C6. Laminectomy including C4, C5 and C6 was performed. There was a nodular mass in the flavum between the laminas of C5 and C6. Histologically, there were degenerated elastic fibers with necrotic subject and calcareous deposition. There was no evidence of ossification.
A case of ossification of anterior longitudinal ligament of cervical spine causing dysphagia is reported because of the rarity of the condition. A house-wife aged 52 years was first seen on April, 1, 1983 with the chief complaint of dyshagia of about 9 months' duration. Roentgenograms showed the excessive development of anterior longitudinal ligament of cervical spine at the level of C-3 to C-7. The disturbance of passage of contrast medium was also observed at the level of C-3 to C-4 in esophgogram. On April 26, 1983, anterior surgery was performed, in which the anterior bony mass was removed. Complete relief was obtained immediately after surgery and she has been asymptomatic 6 months postoperatively.
Five cases of luxution of lower cervical vertebrae with interlocking of unilateral facet were surgically trated with AO-H plates for stabilization. In the initial case, recurrence of luxation occured after reduction and immobilization with skull traction for more than one month. So, all cases were reduced and immobilized with AO-H plate after excision of the intervertebral disc and insertion of anterior bone graft under general anesthesia. Rigid stability and bone fusion of well aligned cervical vertebrae were gained on all cases after short period; after bed rest for one week and immobilization with neck collar for three weeks on the latter case. It is concluded that AO-H plates are very useful for their rigid stability, small mass and ease for use.