The effect of the immunosuppressive agent FK-506 (FK) on collagen arthritis in Sprague-Dawley rats is investigated. A 14-d course of FK treatment at a dose of 1.0mg/kg per day, begun on the same day as type 11 collagen immunization, suppressed completely the development of a arthritis as well as humoral and delayed-type hyper-sensitivity (DTH) skin test response to type 11 collagen. To study whether the immunologic unresponsiveness can be produced by FK, we rechallenged the FK-protected rats with type 11 collagen after discontinuation of FK treatment. Type 11 collagenimmunized, FK-protected rats did not develop arthritis in response to reimmunized with type 11 collagen. Furthermore, to study whether FK-mediated unresponsiveness can be transeferred passively with serum, we immunized with type 11 collagen the naive recipient rats, which were transferred with the serum from FK-treated, type 11 collagen tolerant donor rats on the same day of immunization. Serum-transferred recipient rats showed a suppressed arthritogenic reaction in response to immunization with type 11 collagen. These results indicate that immunologic unresponsiveness can be induced by FK in the experimental model of polyarthritis, collagen arthritis, and that its unresponsiveness can be transferred passively with serum. The results further indicate that humoral properties may, at rest in part, participate in the immunosuppressive mechanism of FK nad the regulation of the clinical course in the experimental model of polyarthritis in rats.
Passive arthritis induced by anticollagen antibody was a mild, transient disease from which the animals normally recovered and the rats that had recovered from passive arthritis were resistant to develop a second phase of arthritis following the subsequent challenge with type II collagen. Treatment with FK shortly before serum transfer suppressed passive arthritis completely. Furthermore, these FK-treated, serum transferred rats failed to develop arthritis even following a subsequent challenge with type II collagen. These results suggest that FK suppresses not only the activation or proliferation of T-cell but the other process of arthritis, without preventing the induction of immunologic unresponsiveness to type II collagen.
The effect of FK506 (FK), a potent immunosuppressive agent, on collagen arthritis in Sprague-Dawley rats was investigated. A single subcutaneous injection of FK at a dose of 10mg/kg on the same day as type II collagen immunization, suppressed the development of arthritis as well as humoral and delayed-type hypersensitivity (DTH) skin test responses to type II collagen, possibly by interfering with IL-2 or IL-2 receptor. Additional studies demonstrated that FK treatment after the disease onset, a significant suppression of the disease was obtained with single injection at the same dose. These results appear to be attributable at least in part to a suppressive effect of FK on a later phase than IL-2 phase.
The effects of short and long term treatment with FK506 (FK), a new immunosuppressive macrolide, on rat limb-allograft were investigated across the BN-to-F344 histocompatibility barrier. This vascularized composite tissue allograft model represents a strong and major transplantation barrier. In this combination, median limb-allograft survival time (MST) measured by the first visual signs of skin rejection was 11±0.7 (mean±SD) days when recipient rats received no immunosuppressive treatments. In the first set of experiments, dose-response studies of FK were carried out in a 14-day course of treatment in which a total of 15 rats received daily intramuscular administration of FK at a dose of 0.2, 1.0, or 5mg/kg/day for 14 days, begun on the day of transplantation. By daily treatment with FK at a dose of 1.0mg/kg or more, limb-allograft survival times dramatically prolonged; i. e., MST was 15±2.6 days in the 0.2mg/kg group, 129±50 days in the 1.0mg/kg group and 101±9 in the 5mg/kg group. In the next set of experiments, we wished to see if a single treatment with FK would have similar effects on graft survival. In other words, groups of rats received single administration of FK at a dose of 2, 10 or 50mg/kg only on the day of operation. Surprisingly, this regimen of FK-treatment also prolonged limb survival time in a dose-dependent manner. MST was 16±3 days in the 2mg/kg group, 51±7 days in the 10mg/kg group and 104±17 days in the 50mg/kg group. These results show the effectiveness of FK-treatment on this animal model of limb-allograft and suggest the possibility of composite tissue allograft in humans.
An experimental study on vascularized bone allograft transplantation using immunosuppressors was reported. The purpose of this paper is to discuss outbreak of the side effects of immunosuppressors and graft versus host reactions in vascularized bone allograft transplantation using immunosuppressors. And we also purposed studying correlation of spontaneous leukocyte blastogenesis with vascularized bone allograft rejection as a clinical marker to detect the rejection. Adult mongrel dogs were used in this study. Cyclosporin A (20mg/kg/day) or FK506 (1 or 0.32mg/kg/day) was used as an immunosuppression of allograft during the first three postoperative months. Evaluation of side effects of immunosuppressors, graft versus host reaction and rejection were obtained mainly with hematologically and clinically. Cyclosporin A successfully suppressed graft rejection in vascularized bone allograft transplantation. And it had no bad effect on general condition, kidney function, hematopoietic function although high blood lebel of cyclosporin A. But poor results were got with high dose of FK506 because of its side effect. There was no findings of graft versus host reaction under cyclosporin-A and FK506. Spontaneous leucocyte blastgenesis might be a useful clinical marker to detect the rejection.
Among major histocompatibility complex (MHC) mismatched dogs, bone allografts of the vascularized tibia with short-term immunosuppression drugs were done. This preliminary study was divided into three groups using twelve dogs as follows: 1. Allograft with Cyclosporin (CyA) in three pairs. 2. Allograft with FK506 (FK) in three. 3. Autograft without immunosuppression in one dog served as a control. Radiological evaluations after operation were analyzed by plane X-ray, angiogram and bone scintigram. Allograft with CyA had union at about three months as early as autograft, but allograft with FK did not have nonunion yet. Because two of three dogs given high dose of FK506 (1.0mg/kg/day) died approximately three weeks after transplantation and another dog under low dose of FK506 (0.32mg/kg/day) showed rejection by Tc-P bone scintigram. The graft rejected showed no callus formation in the plane radiogram. Bone scintigram indirected the definit process of rejection, differentiating between vascular thrombosis of the anastomosed vessel and rejection.
The uptake of carboxyfluorescein diacetate (CFDA) into live cells was used as the basis for a simple, rapid and fully automated micromethod for determination of cell growth. The aim of the investigation was to adapt the CFDA method for assessing the cytotoxicity of materials for use in medical devices. Thus, the cytotoxicity of biomaterials could be detected and quantitated at the same level of sensitivity as with the conventional [3H] thymidine incorporation. The CFDA method can prove to be rapid, reliable and well suited for several applications involving limiting numbers of cells and biological reagents.
The healing process of repaired tendon insertion of rotator cuff was studied biomechanically up to 24 weeks after operation. The right supraspinatus tendons of twenty-one adult mongrel dogs were repaired by tendon suturing to bone. The left shoulder of each animal was designated as sham operated control. Other 5 dogs without having surgical procedures were designated as normal controls. Tensile testing to failure was performed with supraspinatus tendon-bone units under low strainrate conditions. The major mode of failure changed from avulsion failure at 6-12 weeks to tendon disruption at 24 weeks. With the lapse of time, tendon-bone units showed higher maximum load to failure, higher stiffness, higher load failure energy, though mean values of these three parameters reached only 70%-85% of those of controls at 24 weeks.
Applying the horseradish perioxidase technique, we studied the effect of the phenol on the peripheral nerve in 39 rats. One side of the sciatic nerve was blocked by 5% or 10% phenol for ten minutes, and irrigated with saline. At intervals of 1, 2, 4, 8 weeks, the spinal cord was removed, and the serial transverse sections were cut at 50μm and stained with diaminobenzidine. The horseradish peroxidase was injected into bilateral tibialis anterior muscles before sacrifice. The number and soma area histogram of the labelled motor neuron were compared with the unblocked side. Following results were obtained: 1) The labelled motor neuron number that was mostly decreased in two weeks after the phenol block was increased in four weeks (p<0.01), 2) The histological study of the sciatic nerve supported the change of labelled motor neuron number, 3) There was a low correlation between the amplitudes of evoked nerve potential and the labelled motor neuron number, and 4) The selectivity of the damage by the phenol to the peripheral nerve was not clear from the some area histogram.
The purpose of this paper is to describe comparison of the human and rabbits spinal nerve roots. Rabbits have been selected in several spine studies as they are easier to obtain and keep. However, an appreciation of difference in structurel is essential for the correct extrapolation of results in the human stuation. Six rabbits weighing 3.0-3.5kg. were used. Microangiography was done, and vascularity of their spinal cord and nerve roots were examined macroscopically, histologically and radiographycally. The main results found in this study were as follows: 1) Segmental artery supplies 3 main spinal branches, i. e. radicular artery, spinal dorsal rami artery and spinal ventral rami artery. There are one anterior spinal artery and two posterior spinal arteries in spinal cord. Ventral radicular artery anasomoses to anterior spinal artery and dorsal radicular artery anastomoses to posterior spinal artery. These are essentially same in the human and rabbits. 2) The difference is the number of artery in spinal nerve roots. Rabbits have few arteries in their nerve roots. This suggests that nutrition of spinal nerve roots in rabbits depends on cerebrospinal fluid more than blood supply compared with the human.
The purpose of this study is to evaluate the results of surgery for the patients with rotator cuff tear. Fifty-four shoulders were treated in our hospital from 1980 to 1987. The surgical procedure was composed of cuff repair (McLaughlin's method), with partial lateral acromionectomy and resection of coraco-acromial ligament. On the first postoperative day, all of the shoulder joints were fixed with plaster cast at Zero Position. Then the cast was removed when the muscle power for shoulder abduction increased. Of total 54 shoulders, twenty-five were completely relieved from shoulder pain, and the abduction in 53 shoulders was improved more than 150°. The assessment using the criteria from Japanese Orthopaedic Association showed the average score of 91.1, and the good results were not related to the age of the patients and the size of cuff tear.
We studied suprascapular nerve block therapy for severely contractured shoulders. Suprascapular nerve block therapy was done at first. And after that, passive exercise of range of motion was continued. This is repeated one or two times per week. The total number of the therapy times was 10 as a rule. From December 1986 to February 1988, 21 patients (23 shoulders) were treated in this method. They were all outpatients and there were 9 males and 12 females. Their mean age was 58.8 years with a range from 44 to 86. 16 patients of these were adhesive capsulitis, 4 were rotator cuff tear and one was contracture after trauma. Prior to this therapy 12 patients were treated by local injection therapy (intra-articular injection etc.), but it was not effective. In this method 18 patients of this study obtained good results. It is considered that suprascapular nerve block is one of the valuable treatments for adhesive capsulitis of the shoulder.
Acromioclavicular injuries in children are very rare, and comfused with the fractures of the distal end of the clavicle. Rockwood reported that the clavicle was displaced superiorly out of the periosteal tube and coracoclavicular ligaments remain intact to the periosteal tube. The first case was an 11-year-old boy with the type III acromioclavicular injury. Conservative treatment was done. Seven weeks after injury, he had no symptoms and there was new bone formation under the original clavicle. The second case was a 15-year-old boy with the type III injury. Open reduction and transarticular K-wire fixation was carried out. K-wire was removed 4months after operation with successful clinical and roentgenographic results. The third case was a 12-year-old boy with the type II injury. Non-operative treatment was carried out successfully.
The purpose of this paper is to discuss the treatment of pseudoarthrosis of the humerus. The results of 5 cases operated on from 1982 to 1988 were presented and analyzed. Of all the cases, 3 cases had the nonunion in the middle third of the humerus and 2 in the proximal third. For the initial treatment, 3 cases were treated conservatively and 2 operatively. Of the former cases, one case had the good result at the first operation but the other cases were reoperated. The one case underwent a second procedure and the other case underwent a third procedure before healing. Of the latter cases, one case healed with one operation and the other case required a second procedure. Finally, all cases had the good results.
During the period from 1982 to 1987 sixty cases with supracondylar fracture of the humerus in children were treated by closed reduction and percutaneous pinning. Forty-eight cases out of them were examined with special reference to correlation between Baumann's angle, carrying angle and varus deformity. The cubitus varus deformity appeared in 10 cases in which Baumann's angle calculated less than 12 degree. The causes of the deformity were resulted from the mal-reduction and -pinning. However, there were two cases with varus deformity without rotation and medial tilting of the distal fragment.
Ninety-seven patients with supracondylar fractures of the humerus in children were treated during 11-year period from 1977 to 1987; 47 were available for follow-up assessment. Out of ten patients with poor results, nine were from ulnar displacement type fracture, and one from medial crush type fracture. To have satisfactory results, it is important to obtain good reduction, especially in coronal tilting, as soon as possible and to keep it until the enough callus formation occurs.
Ninety-nine cases of supracondylar fracture of the humerus in children were followed-up from 1 to 13 years with an average length of 4 years and 2 months. Supracondylar fractures were classified by Holmberg's classification. They were treated by fixation with plaster cast, plaster cast after manipulation, percutaneous pinning or open reduction. We studied about the range of motion (R. O. M.) and varus or valgus deformity of the elbow after the treatment. Baumann's angle at reduction correlated well with carring angle at the last follow-up (correlation coeficient r=0.79). There were no relationship between the R. O. M. and deformity of the elbow and the degree of displacement of distal fragment after the treatment. The deformity and abnormal R. O. M. of the elbow were essentially caused by incomplete reduction. decrease of the tilting angle led to the limitation of flexion of the elbow. If the conservative treatment is not acceptable to get the good aligment, open reduction must be considered.
Four patients with 6 congenitally dislocated radial heads were reported, which were associated with no anomalies in other parts of the body. The dislocation was anterior in 4 elbows, and lateral in 2. Radiological features revealed small and dome-shaped radial head, longer radius compared with the ulna and dysplasia of the capitulum humeri. In three elbows, radial head was excised because of restricted motion and elbow joint pain. Dome-shaped radial head and articular cartilage erosion were observed. Thick fibrous tissue existed between dislocated radial head and capitulum. Three-year follow-up results were satisfactory in relieving pain and increasing motion.
Twenty-five dislocations of the elbow associated with or without fracture that occurred at our hospital from 1975 through 1986 were studied. Of these patients, twenty-two were followed-up clinically for an average of 6.2 years. The patients could be classified into three groups, which were Type A (there are no concomitant fractures except for small periarticular avulsions), Type B (there are fractures of medial epicondyle or lateral condyle of the humerus) and Type C (there are fractures of radial head or olecranon). There were 14 Type A, 5 Type B and 3 Type C dislocations. Twenty were treated by closed reduction and two by open reduction. Results in Type A were excellent in 8 and good in 6, in Type B were excellent in 2, good in 2 and fair in one, and in Type C were good in one and poor in 2. At follow-up none had complaints by instability or osteoarthritis of the elbow, except for two patients of Type C associated with comminuted articular fractures.
Our new free vascularized periosteal graft with thin cortical bone is introduced in this paper. It is harvested from the medial condyle and supracondyle of the femur including the thin cortical bone leaving the cambium layer of the periosteum intact, and the vascular pedicle consists of the descending genicular artery and veins. Four cases of pseudarthrosis with small bone defects in the upper limb were treated with this procedure. They were all those where several conventional bone grafts had failed. But, except for one very recent case, bone union was achieved within 2.5 months postoperatively. And complications have not been seen at all. In addition, our procedure is very easy to perform. In conclusion, our vascularized periosteal graft with thin cortical bone is thought to be a more reliable method to achieve early bone union even for a difficult pseudarthrosis with a poor vascularized or infectious recipient bed.
Kapandji's intra-focal pinning for fractures of the lower end of the radius is now widely used in the french-speaking countries. The main advantage of this method is the possibility of starting immediately rehabilitation and normal use of the hand. Following closed reduction, the epiphysis is fixed steady with two or three Kirschner wires, sliding along its radial and its dorsal aspects, entrering the radius at the fracture site and transfixing the bone cortex above. Postoperative immobilisation such as plaster splint is unnecessary, and wrist re-education can be begun on the first day post-op. From February 1987 to May 1988, we treated eight fractures of the lower end of the radius by Kapandji's method, and reviewed six cases over three months after their treatment. There were five females and one male. Five out of six were intra-articular fractures. The mean age was 70.8 years with a range from 57 to 77 years. According to Gartland's demerit point system, three were rated as excellent and three good. Present findings indicate that functional recovery is rapid and socio-economically gratifying when compared with conventional treatments.
We reported arthrography of the wrist joint in nine cases of Kienböck's disease and six cases of scaphoid non-union. All these patients were under fifty years old. We injected the contrast medium (60% Urographin) into the radio-carpal joint from dorsal aspect of the wrist. We revealed infiltration of the contrast medium through the inter-carpal joint into the carpometacarpal joint in seven of nine cases of Kienböck's disease and five of six cases of scaphoid non-union. These findings are characteristic in comparison with normal variation of the arthrography of the wrist joint.
The author described 8 cases of covering of skin and subcutaneous defects on the hand using reverse flow forearm island flap. In some cases, we use this flap as the compound flap, including the palmaris longus tendon or a part of the radial bone, nourished by the radial artery. In all cases, flaps survived completely and good results were obtained. So, we feel that this method is very useful for hand reconstruction.
We reported a modified Littler's procedure for the treatment of swan neck deformities. In this procedure the ulnar side of the lateral band which was rerouted to the radial side between flexor sheath and neurovascular bundle, was sutured to the proximal part of the radial side of the lateral band to obtain dynamic tenodesis effect. The tension of the rerouted lateral band was determined by the maximum tension positioning PIP joint in 20 degrees of flexion and DIP joint in 0 degree extension. By our modified procedure, dynamic block of hyperextension in PIP joint and dynamic increase of extension in DIP joint were obtained more functionally than original Littler's procedure.
Interim results of thirty-one cases including thirty-two operations reconstructed for their loss of opposition of the thumb after median nerve palsy were reported and discussed their indications individually. Among several procedures, i. e. 1. FDS transfer (modified Bunnell's method), 2. ABD, D. M. transfer (Littler), 3. proprius tendon transfer, and 4. palmaris longus transfer (Camitz), a proprius tendon transfer opponensplasty, either the extensor digiti minimi or the extensor indicis proprius is our first choice in a low median nerve permanent paralysis without or with associated flexor tendon injury. Camitz's method is applicable in a carpal tunnel syndrome with complete loss of ABD, P. B. muscle even if the muscle paralysis may be transient.
Ulnar nerve palsy due to an aneurysm in the Guyon canal is rarely described. Two cases of ulnar nerve compression caused by false aneurysm of the ulnar artery following trauma were treated in our clinic. Although the cases revealed a typical symptom and sign of entrapment neuropathy, there was an aneurysm without our suspicion at the first examination in a case. In preoperative examination including careful palpation of pulsating tumor, Allen's test, Doppler scanning and angiography, the aneurysm in the Guyon canal was diagnosed. The operative finding of both cases demonstrated a compression at bifurcation of the ulnar nerve due to false aneurysm from the ulnar artery within the canal. After removal of the aneurysm, their clinical symptoms were almost completely recovered. In diagnosing such cases, especially, a careful palpation of pulsating tumor and Allen's test are important.
In the past six years, we carried out surgery for carpal tunnel syndrome of twenty-two cases. Nine cases had the release of the volar carpal ligament alone, and thirteen cases had internal neurolysis adjunct to that. The latter was carried out when there was a pseudoneuroma, a marked narrowing or atrophy of the nerve. And, preoperatively, sixty-four per cent of the patients had loss of sensory nerve action potential (SAP). We examined the result of the operation, that is the improvement of symptom, the duration of the recovery, and the nerve-conduction studies. At any rate, all cases had improvement in the result of the operation, sixty-seven per cent in the former, seventy-seven per cent in the latter were remarkable. And within a month, fifty-six per cent in the former, fifty-four per cent in the latter appeared to have a tendency to recovery. In the nerveconduction studies, SAP came to appear in seventy-one per cent of the preoperative loss of that. Internal neurolysis appeared to have a more favorable result to carpal tunnel syndrome with marked degeneration of the median nerve.
Two concepts on the ligamentous stability of the first CM joint have been discussed. One of these is that emphasized on the anterior oblique carpometacarpal ligament by Eaton, in 1969. Another is the concept insisted by Pagalidis, in 1981 on the intermetacarpal ligaments. We attached great importance to the idea of Pagalidis. We tried to reconstruct the intermetacarpal ligaments with the ECRL tendon, rather than the FCR tendon because of it's ease to use. For past 12 years, we have performed this ligamentous reconstruction using the ECRL tendon on 6 patients. Except for one case whose instability of the CM joint resulted from trauma, causes of other cases were established by osteoarthritic changes. Four out of 6 cases, had Ashworth's surface replacement with ligamentous reconstructions, while two cases had only ligamentous reconstruction. After operation, all cases (except for one that was too early postoperatively to evaluate) achieved good results in stability and relief of pain.
Since 1982, eight patients who underwent a new ligament reconstruction procedure or suture of capsular ligament procedure for painful and unstable thumb carpometacarpal joints were studied. The condition was principally of posttraumatic and idiopathic origin. These procedures were indicated only when conservative treatment had failed. This study reviews six cases with an average follow-up of 4 years. Evaluation included freedom from pain, restoration of pinch strength and instability. Results were classified as excellent, good, fair or failure. Four cases had excellent results, one case had good result and one case had fair result.
We observed macerated carpal bones for the purpose of detecting the morphological risk factor for arthritis of the carpometacarpal joint of the thumb. Material and Method Fifty cadavers (thirty-eight male and twelve female, average age 62.0 years) were studied. Degeneration of the Trapezium were observed macroscopically and by soft X-rays and classified by North's classification. Results 1. There were no differences between the right and left hand in regard to the risk point. 2. Degeneration of the CMJ occurred almost bilaterally. 3. The risk point increased according to age. 4. There were no close relationships between degeneration of the CMJ and osteoporosis. Results. 1 and 2. implied that the heredity of an individual was the most important factor in arthritis of the CMJ, but we could not detect the morphological risk factor in the macerated carpal bones.
We examined prognoses of metacarpal neck fractures. Thirty-three cases (thirty-eight digits) were followed from two months to eight years with an average length of two years and three months. From eleven-year-old to fifty-five-year-old patients (average age, 26.5 years old) were investigated in this study. In conservative group, fifty cases (79%) showed excellent results and four cases (21%) good results. In operative group, eleven cases (78%) showed excellent results and three cases (22%) good results. We could not find either fair or poor results in both groups. Excellent results were recognized in the cases with lateral angulation of less than 10° and volar angulation of less than 20°.
Forty-nine replantations of amputated digits and limbs on 39 patients were performed during past 4.5 years from November, 1982. The success rate was 63%. A retrospective study was done to clarify the factors which had influence on the success rate. Age, ischemic time and number of platelet had no effect on it. Cause of injury and amputation type (complete or incomplete) seemed to be the factors for the successful replantation. The success rate in clean cut amputation was superior to that of blunt cut or crush amputation. The success rate in incomplete amputation excels that of complete one. The initial failure sign occurred by 72 hours postoperatively and was venous failure in most cases. Fish mouth and milking treatment were not successful when the failure sign occurred. Not a few amputated digits in unfavorable condition for replantation were carried to our hospital.
We reported the experience of continuous passive motion in postoperative rehabilitation of hand injury. The Mobilimb Hand unit, manufactured by the Toronto Medical Corporation, is attached to a volar splint and operated by two penlight batteries. We have been impressed with their relative freedom from pain and wound swelling during the time that the involved joint has been moved continuously and passively. But range of motion was not gained effectively in some cases. We thought that joint motion was concerned with the possition of CPM unit and joint stiffness. So we studied the use of CPM unit roentgenographically.
The relationship between clinical symptom and blood flow at fingers in chronic hemodialysis patients was investigated. The study was carried out on 64 hands from 32 hemodialysis patients. In hemodialysis group, the data of both venous distensibility and thermogram were lower than those in control group with statistical significant difference. In the group with clinical symptom in hemodialysis patients, the data of arterial inflow volume, venous distensibility and thermogram were lower than those without clinical symptom. It was suggested that the disturbance of finger blood flow contributes to the appearance of the clinical symptom such as coldness, numbness and difficulty to warm.
The trigger finger in children is frequently seen in hand clinic. It is often treated by operation, but it is well-known that some trigger fingers resolve spontaneously. We attempt to clear how to manage these children. Forty-six children with trigger finger had visited to Nagasaki University Hospital from 1976 to 1987. Twenty-three patients (thirty-one fingers) could be followed up by personal interview. Nineteen fingers were treated by operation, and twelve fingers were treated non-operatively. The mean interval between their first visit and this review was five years and eleven months. In non-operative cases, ten of twelve fingers recovered spontaneously and the mean interval between the onset and the recovery was three years and six months. Seventy-five per cent and of non-operative cases recovered in less than five years from onset, and one child showed disturbance of development of fingers.
A case report of a 12-year-old male with heterotopic ossification of the patellar tendon is presented. He was a baseball player and came to our clinic with the complaint of bilateral gonalgia after exercise. We diagnosed the case as Osgood-Schlatter disease. Inspite of the conservative treatment, a fragment was separated from the tibial tuburcle. The ossicle moved to the central portion of the patellar tendon, increasing its size.
We have used a helium neon laser on twenty-five athletic patients who complained of pain during sport without actual injuries. Twenty-five subjects received an average of 5.3 trials of laser irradjation with a helium neon laser (632.8nm, 8.5mW) on the tender point for 5 minutes on each site. Before irradiation, they could not play sport due to pain. We observed a change in the degree of tenderness and motion pain prior to and after irradiation. After irradiation, all patients returned to their original sports. Twenty-two of 25 patients experienced a relief of motion pain without the use of drugs.
To examine the relationship between body control ability and player position in college basketball, ability to balance and reaction time of the hamstrings were measured in 12 female basketball players aged 18 to 23 years, who were four gaurds, one forward, four centers, one centerforward and two guardforwards. As ability to balance, postural sway data were collected for 20s while the subjects stood barefoot, looking straight ahead. A Postural Sway Measurement System provided the date. Subjects performed in following balance activities: 1) balancing on two legs in which one foot was directly in front of the other (first with the eyes open and then with the eyes closed), 2) balancing on each leg (first with the eyes open and then with the eyes closed), 3) balancing on each leg on an unstable board with the eyes open keeping not moving, 4) balancing on each leg on an unstable board with the eyes open trying maximal sway. As reaction time of the hamstrings, premotor time of medial and lateral hamstrings were measured by electromyography when the subjects were instructed to react to the sudden passive forward movement of the input arm of the Cybex II. Cluster analysis of the results above showed the relationship between ability to balance and player position, especially, the same kind of ability was demonstrated among the guards. For off-season conditioning program, ability to balance as body control ability must be considered according to player position.
Recently, as the popularity of soccer in children is tend to be grown, we need to evaluate the aspect of those injuries. This article is one of the series of medical check studies for young athletes. We report now the results of foot and lower leg injuries of the football players in seven elementary schools and analyze the risk factors.
Three thousand four hundred and twenty-seven patients who had orthopedic injuries related to sports activity were treated in our hospital between May 1981 and December 1986. There were 2335 men and 1092 women, and the ages ranged from 5 to 73. Sixty percent of the patients were in their teens and twenties. There was a tendancy of increase of the sports injuries. Of all injuries, 815 (23.8%) were in the knee, 603 (17.6%) were in the foot and toes, and 452 (13.2%) were in the lower back. Each sport had a concentration of injury in a specific lesion of the body. To prevent sport injury, it is necessary that doctors have good communication with coachers particularly those who teach young people.
Twenty-one cases of cervical disorders (CSM, 9 cases; CSR, 3 Cases; OPLL, 9 cases) were analysed for their neck muscles on CT. The neck muscles were devided into three groups at C5 level; sternocleidomastoideus (Scm), superficial dorsal group (SDG) and deep dorsal group (DDG). Cross-sectional area and mean CT value of each muscle group were measured. The results obtained were as follows; 1) Male patients have larger size of the neck and higher ratio of muscle transectional area to whole area than female patients. 2) CT view at an average of 8 weeks postoperatively showed enlarged intermuscular low density areas of superficial dorsal muscles and decreased mean density of deep dorsal muscles in the group of posterior approach, which suggested the state of edema in the former and the degenerative changes in the latter.
A clinical study of computed tomographic myelography with metrizamide was performed in 41 patients operated for cervical spondylotic myelopathy. Anteroposterior (AP) diameter and area of the spinal cord were measured at intervertebral levels. The correlation between these factors and clinical symptoms and surgical results were examined. Results were as follows: 1) AP diameter and area of the spinal cord at the most severely affected level were less than 5mm and 55mm2 deformity and the severity of symptoms; and 3) There was no good correlation between the degree of cord deformity and recovery of symptoms after surgery.
We studied about compression ratio of spinal cord on computed tomographic spondylotic myelopathy. We found that some cases with compression of below 40% ratio did not well. Some factors influencing on the postoperative results exist: for example, period until operation, canal diameter and heavy neurological sign. By compression ratio and those factors, we may be able to presuppose the prognosis of patients with cervical spondylotic myelopathy.
Seven patients treated surgically with spinal cord tumor were examined by Magnetic Resonance Imaging (MRI). Of the seven patients, four turned out to be neurinomas, one meningioma, one ependymoma and one lipoma. We tried to compare the MRI findings with the operative findings. The involved level of the tumors in spine, their expanse and the size were similar to the operative findings. The extradural tumor had a low intensity band between the tumor and the spinal cord. In the extradural tumor the direction the tapering of the cerebro-spinal fluid at the level of the tumor in the spine tended to be medial. These two findings were useful to discriminate between the extradural and intradural tumors. We could not discriminate between the intramedullary tumor and extramedullary tumor, because the present MRI apparatus had low resolution and thick slice. The examination by MRI is non-invasive and can be done as an outpatient. The examination by MRI is useful not only for close examination, but also as a screening examination.
Magnetic resonance imaging (MRI) is becoming an indispensable examination in diagnosing spinal tumors. But some tumors can not be imaged clearly however the condition of MRI is changed. For this reason, to obtain clear image, enhanced-MRI with Gadolinium-DTPA was developed. The findings on enhanced-MRI of seven spinal tumors (6 neurinomas and one meningioma) is reported. Three cases, in which clear image could not be obtained by MRI, were imaged clearly by enhanced-MRI. In the remaining 4 cases, enhanced-MRI imaged the margin of tumors more clearly. In all cases, enhanced-MRI was more useful than unenhanced-MRI in diagnosing and defining the extent of tumors.
In order to evaluate diagnostic value of MRI of cervical spine, 439 patients who were examined by MRI were reviewed. In cases such as disease of the craniocervical junction, intraspinal neoplasm, tumor of the spine, syringomyelia, herniation of cervical disk, and spinal sepsis, MRI was superior or equal to other imaging methods such as plane X-P, tomography, myelography and CT scan. On the other hand, MRI was inferior to other imaging methods in case of cervical spondylosis and O. P. L. L.
Lumbar myelography was performed in 110 patients with low back pain. The aim of this investigation was to introduce the methods of lumbar myelography of our hospital and to show relatively high incidence of upper lumbar lesion. Patients are usually lying on a table in lumbar myelography. Sometimes preoperative examination is performed only to find out lower lumbar lesion because of its high incidence. This study, however, has revealed that myelographic findings in standing position is different from that in supine position and the former seemed to explain symptoms more correctly than the latter. The incidence of upper lumbar lesion was higher than that in previous reports. In conclusion, the myelography in standing position is more diagnostic and more careful attention should be given to look for upper lumbar lesion based on neurological findings.
Recently non-invasive imaging study of spinal canal had been well developed, but as for lumbar disease, examination with radio-opaque media is still needed in many cases. Lumbar peridurography is one of them which can be done in out-patient clinic easily. Sodium iothalamate has so far been used in many cases, but it sometimes causes severe pain during and after procedure. We have been using iohexol for lumbar peridurography since October 1987. 81.4% of patients in the group using iohexol (group 1) showed excellent or good contrast, and 68.4% of those using iothalamate (Group 2). Concerning about pain during and after procedure, only 10.9% of group 1 patients complained moderate or severe pain, whereas the rate was 35.8% in group 2. We concluded that iohexol gives more benefit than iothalamate in lumbar peridurography. We also discuss about Computed Tomography after lumbar peridurography, regarding to its diagnostic usefullness. It proved to be useful in making diagnoses in a few cases.
Roentgenological investigations have been performed on 135 cases with redundant nerve roots (RNR) of 652 cases myelography had been done. In these cases, 271 lumbar canal stenosis (LCS), 13 spondylolisthesis, 337 lumbar disc lesion (LDL), 1 abnormal caudal sac (ACS) and 23 normal (N) patients were included. These studies consisted of (1) incidence of RNR from classifications of diseases, types (undulant type, sepentine type, loop type), age group (LCS) and level (LCS) and (2) correlation between RNR and lumbar motion, RNR and lumbar total disc index (TDI). Results were as follows: 1) RNR was encountered in 21%. (LCS: 119/271, LDL: 14/337, ACS: 1/1, N: 1/23). In LCS, it was found in 44%. 2) Incidence from types was undulant type (54%), serpentine type (31%), loop type (15%). In degenerative spondylolisthesis, loop type accounted for 38%. 3) RNR tended to increase with aging and 70% was encountered from 50 to 64 yrs of age. Besides, redundant nerve tended to be more severe with aging. 4) The main location of redundant nerve was 2nd lumbar vertebra, but in 24%, they were found from 4th lumbar vertebra to L5/S segment. 5) In the cases with LCS or instability due to disc degeneration, correlation with RNR was encountered with high frequency.