The case reported here was a ten-year-old boy who developed a painful subcutaneus lump in the upper part of his right leg. Pathological diagnosis was nodular fasciitis. Nodular fasciitis is a benign tumor found in the subcutaneus fascia, usually of the upper extremity or trunk. It frequently develops as a rapidly growing mass, which is alarming because its behavior suggests a malignant neoplasm.
A 51-year-old woman with myxoma in the vastus medialis muscle is reported. She became aware of swelling in the right thigh in June, 1984 and admitted to the hospital two weeks later. On admission, a tumor was palpable in the right thigh and seemed to be in the deep portion of soft part tissue. We diagnosed this tumor to be a benign soft part tumor and carried out the resection of the tumor. The tumor was found in the vastus medialis muscle and separated from the tissue around the tumor completely. Pathological examination revealed intramuscular myxoma and no evidence of malignancy. At four months postoperatively the patient has no complaint.
Four cases with giant cell tumor of tendon sheath arising from the finger were reported. The ages of patients ranged from thirty-one to fifty-four years. The sites of the tumor were the middle finger in three cases, and the little finger in one case respectively. In all cases, the tumor was found at radial side of the finger. Radiographs showed pressure atrophy of the cortex of the phalanx in one case. Histological findings revealed the proliferation of giant cells and xanthoma-like cells in the typical cases. No malignancy was to be seen.
We have experienced 6 patients of the upper cervical cord tumor (histological diagnoses were 3 meningiomas, 2 neurinomas, one metastasis of chorioepthelioma). The age of the patients ranged from 32 to 66 years, the median being 48 years. The considerable difficulty in early diagnosis is emphasized. When biceps tendon reflex and pronator reflex were hyperactive on asymmetry and Babinski reflex was positive, the upper cervical cord tumor should be also considered. And then, CT scan, CT myelography vertebral angiography are also indispensable to eefine the tumor size and the distribution of nutrient artery to the tumor.
A case of the alveolar soft part sarcoma is reported. The primary site was the right calf. She visited a doctor because of back pain. Compression fractures of the thoracic spine and pulmonary metastases were discovered. Spinal palsy was advanced. Bone metastases developed in the skull, ribs, and the breast bone. Chemotherapy was performed, but tumors developed gradually. She died one year and five months after the onset of symptoms.
A case of twenty-four year-old male patient with an epithelioid sarcoma is presented. The patient died of pulmonary metastases eight years and six months after the initial surgery. During the course, the lesion recurred as many as fifteen times instead of aggressive surgical management, combination chemotherapy, and radiotherapy. Epithelioid sarcoma is a tumor first described by Enzinger in 1970, who reported clinicopathologically on a series of 62 cases. Young adults are most affected and the volar surface of the fingers, the palm, and the extensor surface of the forearm are the most favored locations. Once the lesion recurred, persistent recurrences are unavoidable, therefore the exact diagnosis and adequate surgical choice is necessary at initial stage of the lesion.
The low grade malignant soft tissue tumor tends to be resected easily but some histological types are easy to develop a local recurrence even after a wide resection. We have treated 53 cases of the malignant soft tissue tumor and 8 cases developed local recurrences without metastasis in our series. These histological types include myxoid type, ordinary type of MFH and the myxoid type of liposarcoma. The ordinary type of MFH consists of low-pleomorphic cells and low anaplastic neuclei and shows the storiform and herring bone pattern. The results of the treatment are wretched because 4 cases needed to undergo the amputation. All patients had been operated at the other institutes and tumors had invaded to the layers of other structures, especially the deep subcutaneous layer and we colud not eliminate the marginal invading tumor with surgery. We need to resect the tumor more widely and in case of the multiple surgeries, even prompt radical surgery is indicated.
Thirty-five cases of malignant soft part tumors which were treated at our clinic from 1971 to 1984, and were 24 males and 15 females, were reviewed clinically and histopathologically. They were composed of 8 liposarcomas, 6 leiomyosarcomas, 6 neurogenic sarcomas, 3 rhabdomyosarcomas, 2 malignant fibrous histiocytomas, 2 alveolar soft part sarcomas, one synovial sarcoma, one extra abdominal desmoid, one hemangiopericytoma and 5 undifferentiated sarcomas. The survival rate (of each malignant soft part tumor) was influenced by each histopathological type, that is, liposarcoma, malignant fibrous histiocytoma, synovial sarcoma, extra abdominal desmoid and hemangiopericytoma showed the higher survival rate (5/8, 2/2, 1/1, 1/1, 1/1, respectively), whereas leiomyosarcoma and undifferentiated sarcoma had the lower survival rate (1/6, 1/5 respectively). The radical operations, including wide local resection, amputation and disarticulation, resulted in the higher survival rate. On the other hand, the extirpation resulted in the lower survival rate. Concerning with time of operations, the less than twice radical operation led to the higher survival rate, the more than third led to the lower survival rate. Grading the tumors by GTNM (UICC calssification), stages I and II showed the better survival rate, but stages III and IV showed the poor survival rate. These facts indicated that the radical operation should be primarily done for malignant soft part tumors.
Many reports have been made of benign chondroblastoma, which was first termed by Jaffe and Lichtenstein in 1942, however, reports are rare of its onset in carpal bone, and no Japanese report is found in the literature over which we have ranged so far. This time we happened to experience a case of benign chondroblastoma which occurred in the right capitate bone of a 20-year-old man. He remains uneventful thanks focal curettage and bone transplantation, so we should like to make its report together with some literature consideration.
An 11-year-old girl who had numerous exostosis was reported. Range of motion of her right knee joint was restricted in flexion by the multiple exostosis of the distal portion of the femur and the proximal portions of the tibia and fibula. Surgical resection of the tumor around the knee was performed and histological findings of the tumor showed benign osteochondroma. Her father and sister were also involved in the same disease and the family history was investigated in the hereditary aspects.
A sixty four years old woman was admitted to our hospital on stretcher. She complained of right thigh pain and swelling. Ten days before admission she had slight pain there. At the day of admission she fell down to floor. Radiological examination revealed fracture of the right femoral diaphysis. Two weeks after open reduction by Kuntscher nail, abnormal radiolucent defect appeared around the fracture site. We suspected pathological fracture. General survey by scintigraphy or other laboratory data did not present other lesions. Bone biopsy was made and pathological diagnosis was malignant mesenchymal tumor. Because she did not wish to have operation done, she had disarticulation surgery five months later, followed by chemotherapy. At present she is healthy and has no local recurrent sign and symptom, nor lung metastasis.
Osteoid osteoma has been known to occur in practically every bone of appedicular and axial skelton. However the intraarticular localization close to articular surface is considered to be rare. This paper presented an 18-year-old boy with osteoid osteoma in the hip joint. Initial symptom and sign were pain and limitation of movement. Nidus formation was not clear on serial X-ray films. Final diagnosis was made by histological examination of biopsy specimen at fifteen months after the initial symptom.
101 cases of bone and soft tissue tumors in the upper limb were found in a recent review of the clinical and pathologic records treated at the Hiroshima Municipal Hospital since 1974. The literature is reviewed and occurring site of tumors, recurrence and functional prognosis of these cases are discussed in this paper.
We have experienced 2 cases of primary malignant fibrous histiocytoma of bone in the period 1979 through 1984. The first case, an 86 years old man, had primary lesion in the right femoral shaft. We have followed up him for 5 years after operation and he is still well. The second case, a 46 years old man, had the lesion in the left tibia, but we could not perform amputation due to lack of the patient's consent. He died 3 years later. If operation had been done in the early recurrence stage, he might have been saved.
Only a few cases of extraskeletal chondrosarcoma affecting the hand have been reported to date. In this paper, we present the case of a 51-year-old-male, whose right thumb was affected by the tumor and amputated at the right metacarpal neck. This kind of tumor is difficult to diagnose by clinical examination and may result in inadequate excision or biopsy. Therfore, the possibility of this kind of tumor should always be kept in mind.
This paper is to present a report on clinical application of ceramic custom knee prosthesis for malignant bone tumor. Two patients have been treated by radical wide resection; one with osteogenic sarcoma of the distal femur and another with malignant fibrous histiocytoma of the proximal tibia. We also performed intra-arterial high-dose adriamycin for preoperative treatment, so that the clinical responses were obtained. Both patients now walk with the knee braces, and are free of disease for 10 to 12 months.
Twenty-one cases of osteosarcoma in the knee region were summarized in this series and the relation between clinicopathological findings and prognosis was studied. Treatment of those cases were divided into 3 groups as follows; group I (amputation, 3 cases), group II (adjuvant chemotherapy and amputation, 10 cases) and group III (high-dose radiotherapy with combination chemotherapy and surgical treatment, 8 cases) respectively. Ten cases of survival more than 4 years consisted of 5 of 10 cases in group II and 5 of 8 cases in group III. No significant differences of prognosis between groups II and III were recognized. According to radiological findings, 21 cases were classified into 3 types; osteolytic type (5 cases), sclerotic type (6 cases) and mixed type (10 cases), On the relation between radiological classification and prognosis, 5 cases of sclerotic type died. It suggests that sclerotic change in the roentgenogram is one of the poor prognostic findings. Histological classification of the cases in this series consisted of fibroblastic type (MFH-like, 5 cases), osteoblastic type (11 cases) and chondroblastic type (4 cases). The survival rate of fibroblastic type with severe cellular atypism is higher than that of osteoblastic type with mild atypism.
A case of intraosseous ganglion of the scaphoid is reported. A twenty-six years old lady had suffered from mild, and localized pain associated with a dorsiflexion of the wrist since five years ago. The radiographs of her wrist showed a round radiolucent defect in the middle portion of the scaphoid with a sclerotic border. Curettage was performed, removing typical ganglionic fluid and the cyst was packed with the iliac bone graft. There was no direct communication with the joint cavity. The histological diagnosis was intraosseous ganglion and her symptoms resolved two months after operation.
A series of 12 patients who had post-traumatic dystrophy of the foot, were treated with intravenous injections of a solution of 1% xylocaine and solu-medrol followed by standard physical therapy. The results were satisfactory or better in 10 extremities and poor in 2. We reported results of skin temperature and digital plethysmography.
In 26 patients clinical studies of femoral head blood flow were made using electrochemically generated hydrogen gas. Our results showed that in eight patients with undisplaced femoral neck fractures (Garden types I and II), the mean blood flow rate was 226.5ml/104gm/min. On the other hand, in five patients with degenerative arthritis of the hip, the mean blood flow rate was 143.4ml/100gm/min. The mean rate of diffusion in six dead femoral heads was 40.4ml/100gm/min. It was concluded that measurement of blood flow by electrochemically generated hydrogen gas was very useful for such as this type of clinical study.
A case (73-year-old female) of chondrocalcinosis with destructive coxarthrosis was reported. The case had complained of slight pain in her left knee and severe pain in her hip for several months. X-ray findings of the left hip showed severe destructive changes of the femoral head and of the acetabulum with subluxation, and those of the left knee showed calcification of the meniscus. Laboratory data of the blood and urine were normal, but microscopic study on the joint fluid of the hip and of the knee revealed CPPD crystals through the compensated polarized light. Total hip replacement was carried out for the hip. Histological findings of the femoral head were almost the same as those of ordinary coxarthrosis. However, histological findings of the synovium showed many CPPD crystal depositions on the surface.
Two cases of non-specific arthritis of the hip joint were reported in this paper. Each patient had a severe hip joint pain and a high fever. Radiological findings showed the widening of the joint space and the lateralization of the femoral head, as if they had supprative arthritis. One of the cases was complicated with mucocutaneous lymph node syndrome. Histological examination of synovial tissue revealed the findings of non-specific synovitis and no angitis was seen.
We reported a case of a 34-year-old man who showed painful transient osteoporosis of both hips and left ankle. The clinical symptoms resolved spontaneously with subsequent remineralization of the osteoporotic areas.
A case of 42-year-old male with Idiopathic Transient Osteoporosis of the Hip (T. O. H.) was reported. T. O. H. is relatively rare disease and previously only 18 cases have been reported in Japan. In this study, T. O. H. was roentgenographically classified in three types. Type 1: femoral head type; Type 2: hip joint type; Type 3: multiple joint type. Our case belongs to type 1. T. O. H. is thought to be self-limited disease with full recovery. So, non-weight bearing with crutches and analgesics will be enough to treat it. Our case was healed in one year with such treatment.
Synovial osteochondromatosis, which results from cartilaginous metaplasia of the synovial membrane, occurs commonly in the knee and elbow joints. Synovial osteochondromatosis of the hip joint is uncommon, but awareness of the lesion is essential for prompt diagnosis. One case was a 16-year-old girl, and another was a 19-year-old girl. They had complained of pain in their hip joints for two and four years respectively. After synovectomy, the hip joint pain disappeared and the full range of motion was regained. There was no radiological sign of secondary osteonecrosis of the femoral head at the time of follow-up.
A case of 67 years old woman who had pain and paresthesia over the anterior aspect of the right thigh as well as the motor disturbance of the same side of the knee was admitted to our hospital. She had had an episode of the traffic accident sustaining a forced hyper-extension of her right hip joint eleven months prior to the admission. The rentogenographic examination revealed a large bony mass arising from the lessor trochanter of the femur to the lower one third of the iliopsoas muscle. Probable diagnosis was a traumatic femoral nerve palsy associated with a myositis ossificans of the iliopsoas muscle. A surgical excision of the mass including a neurolysis of the thickend femoral nerve was performed. However, the recovery of the motor function of the quadriceps muscles as well as the sensation was not so prominent at six months post-operatively. The poor recovery of the femoral nerve palsy might be due to the prolonged compression of the nerve by the localized myositis ossificans.
Four cases of resistant piriformis syndrome and a new maneuver in diagnosing this syndrome were reported. All cases were operated successfully and were free from symptoms. Anatomical variant between piriformis muscle and sciatic nerve was found in all cases. The maneuver which evokes radiating pain along sciatic nerve is as follows; the patient stands on his affected leg and rotates his trunk externally.
Hip arthrodesis has been performed on a total of 46 cases at this hospital during the last 10 years. Of this number, 32 in whom more than 1 year has elapsed since operation were directly examined. Distribution of the ages at the time of surgery showed that those in their forties were most predominant includiug 12 cases, and that the youngest was 15 while the oldest was 55, with a mean of 38 years. The period of follow-up ranged from the minimum of 1 year and 6 months to maximum of 10 years with a mean of 4 years and 2 months. All of them have obtained bony union and relief from pain. Majority of patients could do their daily activities without gross troubles, except for squatting, going up and down stairs, Japanese sitting and cutting their toe nails. Low back pain and the knee joint flexion contraction after surgery greatly hinder the daily activities. It was concluded that in cases with bilateral involvement, consideration must be given to age of the patient and range of both hip joints and knee joints, and prudence should be exercised in determining the indication.
Opening wedge osteotomy was performed at the proximal tibia in 4 cases of the degenerative knee and at the intertrochanteric area in one case of the degenerative hip. The bone defect developed by the osteotomy was filled with autogenous bone graft alone or combinated with ceramic implant. As the implant did not interfere the bony healing of the osteotomy, it was thought to be a useful supplement to bone graft.
We studied radiologically the natural history and the results of muscle surgery of the cerebral palsy children, We measured a Migration Percentage, a Sharp angle, a CE angle, and a Joint Space Ratio. We defined the Joint Space Ratio as the ratio of the vertical joint space to the horizontal joint space multiplied by 100. This study suggested that the muscular hypertonicity leads the lateralization and the elevation of the femoral head stresses the acetabular roof, and then the subluxation worsens.
Hip dislocation in cerebral palsy occurrs with muscle imbalance about the hip. Selective muscle releases of hypertonic muscles were performed for prophylaxis of hip dislocation. The procedure included proximal elongation of the hamstrings and resection of adductor longus and gracilis. The psoas tendon and rectus femoris were elongated and the origin of the sartorius muscle was transferred to the anterior inferior iliac spine. If acetabular dysplasia or coxa valga were distinguished, we added pelvic osteotomy or femoral detorsion varus osteotomy.
A rare case of slipping of the upper femoral epiphysis accompanied by pan-hypopitutarism due to pituitary tumor was reported. In Japanese literature, five these cases have been reported. A 14-year-old girl was admitted in our department complaining of hip pain and limping. Drehmann's sign was positive. Roentgenogram showed posterior slip of the upper femoral epiphysis at an angle of 30 degrees. On the further examination, ballooning of the pituitary fossa was observed on cranial x-ray, and pituitary tumor was pointed out on C-T scanning. On endocrine examination, pituitary, thyroid, adrenocortical and sex hormones were all decreased. The tumor was removed neurosurgically, and diagnosed histlogically as ectopic pinealoma. Now the patient is 17 years old taking supplementary hormone therapy, and is asymptomatic is her left hip. Roentgenographically, slipping of the epiphysis was not increased, because spontaneous epiphyseal closure has occurred after the theraphy. In conclusion, it is said that secondary insufficiencies of the target organs due to pan-hypopituitarism were the major causes of the slipped femoral epiphysis.
It was reported by Salter, R. B. that the extent of the subchondral fracture in the early stage in Perthes' disease correlated precisely with the subsequent extent of maximum resorption in the femoral head. In this study, we examined wheather the sign of subchondral fracture on the X ray films can be reliable for the decision of the prognosis and the choice of the treatment in the early stage of this disease. Total number of the patient we studied was 240 cases of 265 hips. The signs of subchondral fracture was seen in 65 hips. The degree of subchondral fracture was proportional well to the grade by Catterall's classification.
The validity of the early prognostic significance of the subchondral fracture of the epiphysis in Perthes' disease was discussed by using the serial radiographs of 118 patients (123 hips). The extent of the subchondral fracture correlated with the extent of maximum resorption, according to the Catterall classification. However, there are some problems on detecting the visualization of the subchondral fracture and the extent of the fracture line. If these problems can be solved by introducing some new radiological techniques, the subchondral fracture may have early prognostic significance in Perthes' disease.
Despite of the alteration of the tibial plateau inclination, reports of the high tibial osteotomy rarely has mentioned about it. The purpose of this investigation was to evaluate the relationship of clinical effect and the tibial plateau tilting angle after the corrective osteotomy for osteoarthrosis of the knee with valgus deformity. Tibial plateau tilting angle to tibial axis (T. P. A-A) and to floor (T. P. A-F) were measured on standing antero-posterior roentgeno-grams pre-operatively and post-operatively. 1) In the virus type, T. P. A-A was closely related with the femoro-tibial angle (F. T. A.), but T. P. A-F was not almost. 2) In the valugus type, T. P. A-A was almost within normal range. 3) In good cases of clinical results, T. P. A-A was +3.5±0.95 degrees. In the fair and poor cases T. P. A-A was -3.15±2.95 degrees. These results indicate that when the determination of the amount of angular correction for osteotomy is made, an adequate T. P. A-A is about +3 degrees.
A follow-up study of open wedge high tibial osteotomy was reported. 23 knees in 18 patients were evaluated clinically and radiologically with an average period of 5 years and 4 months after the operation. More than 60% of them were good in result. Factors contributing to the poor result were analysed and advantages and disadvantages were discussed. Highly progressed arthrosis and patello-femoral arthrosis were the two factors producing the poor results. Under-correction of varus deformity also caused poor results. In this method, delayed union and postoperative recurrence of varus deformity were the main complications which were considered to occur after inadequate bone graft.
Many reports about knee rehabilitation have focused mainly on muscle exercise and range of motion. However, little attention has heed given to neuromuscular coordination. Neuromuscular system provides functional stability of the knee joint. Proprioceptive exercise (neuromuscular coordination) has been given to patients with knee ligament injuries as conservative treatment or postoperative exercise. KINCOM isokinetic exercise apparatus has been used to evaluate the effect of the proprioceptive exercise. The patient was positioned on the table with the knee flexed at a 90 degree angle and instructed to move the upper portion of the lower thigh of affected side backward as quickly as possible when the arm of the apparatus moves suddenly slightly forward which is felt on the lower part of the leg. Three patients were evaluated by this method and it was observed that their reactive speed increased as the exercise progressed. Proprioceptive exercise provides protection to the knee from reinjury and stabilization to the knee more dynamically.
The roentgenographic techniques to measure relative femoral-tibial displacement of the cruciate ligament insufficiency have been devised by several authors. Since those techniques are too complicated to perform at the outpatient clinic, we devised a new roentgenographic technique which has been useful for its simplicity, accuracy and reproducibility. We performed anterior/posterior drawer tests with the knee in 30 degrees of flexion in addition to 90 degrees of flexion. And our stress machine using a bicycle was useful for giving quantitative stress upon a knee joint and assessing the roentgenographic data more objectively. The statistical data were inclined to be as follows. In normal knees, the amount of displacement was greater at 90 degrees of flexion when anterior drawer test was performed, and was greater at 30 degrees of flexion when posterior drawer test was performed. The tibia rotated externally when both drawer tests were performed. In insufficient knees, on the contrary, the amount of displacement was greater at 30 degrees of flexion when anterior drawer test was performed in anterior cruciate insufficient knees, and was greater at 90 degrees of flexion when posterior drawer test was performed in posterior cruciate insufficient knees.
we experienced twenty-seven cases of discoid meniscus between 1980 and 1984. These discoid menisci were diagnosed by both arthroscopic and arthrographic examinations. According to the Watanabe's classification they were classified into two types; complete type in 7 cases and incomplete type in 20 cases. Ten cases were treated conservatively and 17 cases were operated by either asthroscopic or open surgery. Arthroscopic partial menisectomy was performed on 5 cases. The results of these 5 cases were excellent. Total menisectomy of 4 complete discoid menisci were necessary to use open method combined with arthroscopic release of the posterior horn. Eight incomplete discoid menisci were operated by open method. Based on our experience, we discussed the indication of meniscectomy for discoid meniscus.
Spontaneous hemarthrosis of bilateral knees is more rare than that of unilateral in the elderly patients. And it is specific that all these reports complicate with osteoarthritis of the knee without exception. We have experienced a bilateral case who is a sixty-nine years old woman. Spontaneous hemarthrosis of the right knee firstly appeared, and that of left knee appeared two years later. Synovectomy was done for both knees in order to stop the bleeding. Synovium was slightly villous, and its color was brown. But bleeding sites in the synovium was not seen. Histologically, a nonspecific inflammatory reaction is often present with hemosiderin in the synovial lining cells. We consider that this entity is a rare clinical sign of chronic synovitis with osteoarthritis and hemorrhage is induced by mechanical injury of villous synovium.
Between March 1983 and April 1984, 15 patients had lateral retinacular release of the patella performed for subluxation syndrome of the patella. The youngest patient was aged 10 at the time of operation, the oldest 26; the average age was 18. Of the 15 patients, 6 had unilateral and 9 had bilateral involvement, making a total of 24 operations. All knees didn't have the synovium opened and the joint inspected. The follow-up period varied from 1 year 8 months to 7 months, with an average of 11 months. There was no complication after the operation, the results of which were graded according to the Ficat's criteria. The overall results were excellent or good in 96% of the cases. A very small scar, early mobilisation and early return to work and sports make this surgical procedure very attractive to patients who are prepared to have a second-stage operation if necessary.
Habitual dislocation of the patella is relatively rare. This is to report our two cases with this disorder, in which successful results were obtained by surgical treatment. Case 1; a 10-year-old girl six months ago she got a sudden bruise on her left knee and she became impossible to extend the knee. After that she had such an episode two more times. Then she was referred to our clinic. Subjectively, apprehension sign was positive on her left patella and qadriceps muscle was atrophic. X-ray findings showed hypoplasia of the lateral condyle of the femur and others. Surgical treatment (lateral release and the Campbell's method) was taken. Case 2; a 13 year-old girl two years ago she got a bruise on the left knee joint, and have had a gonalgia. In admission, her left patella dislocated laterally when she flexed her knee. Surgical treatment (lateral release, the Campbell's method and the Galleazzi's method) was taken. At the present time (6 and 9 manths post-operatively), both cases have no dislocation of the patella and nearey normal ROM of the knee joint.
We have treated most cases with Osgood-Schlatter disease conservatively by avoiding strenuous activity or by a specially made knee supporter. However, once a mobile and tender ossicle has formed at the tibial tubercle, we do not believe that the lesion will respond well to conservative measures and do believe that early surgical treatment is indicated rather than subjecting the patient to prolonged limitation of activity. From October 1981 to August 1984, six patients were treated surgically by resection of a separate ossicle from the proximal aspect of the tibial tubercle. The duration of the symptoms of these patients at the time of operation ranged from 5 months to 5 years, with a mean of 2.7 years. Their mean age at operation was 14 years, with a range of 12 to 16 years. Within 3 months postoperatively, all patients had complete relief of symptoms and returned to full activity including their various sports activities. Histologically the excised specimens were composed of thickened trabeculae with fatty marrow, cartilage and fibrous tissue. Some specimens showed a bursa and granulation tissue between the ossicle and the tibial tubercle which suggested pseudarthroses.
There are many patients with rheumatoid arthritis (RA) who complain of painful shoulder joint. Sixty shoulders of 35 patients with RA were examined about clinical findings, function and plain roentgenograms of their shoulders. The results which were based on the third test plan of shoulder scoreing according to the Japan Shoulder Society were following. 1) Most tender points were in bicipital groove or insersion of deltoid muscle. 2) Relationship between pain and roentgenographic findings showed that the degree of pain increased correlating to abnormal findings, which seems to progress from narrowing of the gleno-humeral joint space, to cyst formation, to elevation of the humeral head and finally, to destruction of the shoulder joint. 3) Limitation of R. O. M. was correlated with abnormal X-P findings. 4) X-P changes of carpal bone were clearly correlated with abnormalities of the shoulder roentgenogram.
The present experiments were aimed to investigate the pathogenesis of collagen arthritis more fully using the passive transfer system. In this work, we intended to dissect some of the immunopathologic reactions by producing collagen arthritis by passive transfer of a serum concentrate from immurized donors to the rats in that antigen-specific suppression was achieved by pharmacologic manipulation. We provide evidence that collagen arthritis can be passively transferred with a serum concentrate to immunologically naive recipients as well as Cyclosporin-treated, type II collagen tolerant rats. In addition, significant enhancement and a longer duration of the passively tmansferred arthritis are induced if cyclosporin is being given continuously. The results of the present experiments indicate that collagen arthritis can be inducible by humoral immunity alone. The results also suggest that a cellular suppressor system, sensitive to cyclosporin, might participate in the regulation of arthritis, once initiated.
We have studied the role of cellular immunity in collagen arthritis using athymic nude rats and their littermates. Immunization with type II collagen induced polyarthritis and definite immunity to type II collagen in normal rats, whereas nude rats did not develop arthritis nor immunity to collagen. An additional study demonstrated that collagen arthritis could be passively transferred with a serum concentrate from Sprague-Dawley rats to naive nude rats as well as their littermates. Despite no difference in clearance of anti-type II collagen antibody after transfer between nude rats and normal rats, the passively transferred arthritis in nude rats was significantly enhanced and prolonged as compared with that in normal rats. These results indicate that arthritis can be inducible by humoral immunity in the absence of functional T cells, and also suggest that anti-type II collagen antibody is not the sole regulatory factor and that suppressor cell system might play a role in regulation of the clinical course of the disease.
In the present experiment, we studied the effects of Cytimun on collagen arthritis in Sprague-Dawley rats and compared its effects with those of Cyclophosphamide. A 15-day course of Cytimun administration at a dose of 10mg/kg per day, begun on the day before type II collagen immunization, suppressed the development of arthritis as well as humoral response to type II collagen but not delayed-type hypersensitivity (DTH) skin reaction. When Cytimun was administered at a dose of 20mg/kg per day, not only humoral response to type II collagen but also DTH skin test response were suppressed. Administration of Cyclophosphamide showed similar effects but required less doses than those of Cytimun. The mechanism by which Cytimun exerts its effects on the immune system is not clearly understood, but the results of the present study support the observations of Brock et al. that the suppressive effect of Cytimun on antibody formation may be a result of its selective suppression of B lymphocytes. The results of this study further support the concept that humoral immune response to type II collagen might be more intimately associated with the development of collagen arthritis.
Articular and ligamentous tissues in 20 patients with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease were studied by using histological, electron probe analysis and X-ray diffraction techniques. Peculiar chondrocytes or metaplastic chondrocytes that seem to accumulate proteoglycans and inorganic pyrophosphate were seen constantly in the area of incipient formation of CPPD crystals. These cells appear to contribute formation of CPPD crystals by releasing inorganic pyrophosphate mostly from the portion showing destruction of cell membrane. The histological and histochemical findings in this study also indicate that proteoglycans play an important role in crystal growth by carrying high concentration of inorganic pyrophosphate on the crystal surfaces.
Treatment of chronic osteomyelitis by antibiotic-Polymethylmethacrylate beads has following advantages; (1) very high local cencentration of antibiotics is achieved without systemic toxic side effect; (2) the patient is not restricted to bed and thus comfortable; (3) there is less responsbility for the physician and nursing staff because the patient does not require continuous control; (4) there is no effects on bone mechanism. Our procedure is as follows. Following complete necrectomy, we implant self-made antibiotic-polymethylmethacrylate beads containing two or three species of antibiotics which are chosen among aminoglycosides, cephems and penicillins. As there is an extensive bone defect, a reoperation is performed several weeks after surgery to remove beads and to fill the cavity with cancellous bone graft. When bone itself is unstable, internal fixation is added. Six cases of chronic Osteomyelitis were treated by this method. Follow-up from five to twenty months arter bone graft, revealed that five stayed free of relapse after initial course of treatment. The remaining patient was not completely free of infection.
Very rare cases of spondylolisthesis in fraternal twins who were five and a quarter years old boy and girl were reported. One of twins visited our hospital on February, 1984 with complaint of low back pain. Roentgenograms showed a defect of the gars interarticularis of the fifth lumbar vertebra with minimum slipping. In contrast, another one had no symptom though her roentgenograms revealed similar spondylolisthesis. 99mTc-MDP scintigrams did not demonstrate any abnormal concentration. His complaint has been relieved after fitting of pelvicbelt, though there has been no roentgenographic change.