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相良 正志, 二田水 節, 井上 博, 柿添 光生, 中尾 祥史
1988 年 37 巻 2 号 p.
772-776
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty-nine cases of unstable trochanteric fracture were treated in our hospital. Out of these 29 cases, 24 cases were treated using ordinary fixation materials like dynamic hip screw, Ender pinning and others (group A), while other 5 cases were treated by our new fixation method using or additional buttress plate (group B).
In group A, telescoping of the screw and medial displacement of the distal fragment occurred in 50 percent. In group B, anatomical reduction and stable fixation were accomplished. As to the after-treatment, all the patients could walk at 3 weeks on the average.
Our new method of operation is considered to increase the capability of early release from bed rest.
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松永 保英, 林 茂, 城間 公博
1988 年 37 巻 2 号 p.
777-779
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
In intertrochanteric fracture of the femur, the operation by the Ender pin is wide spread. But this method has some complications.
Pain around the knee is the most significant problem and damages postoperative rehabilitation. The main cause of pain around the knee is distal slipping of the Ender pin. We report the study of distal slipping of the Ender pin.
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宮城 成圭, 川崎 正章, 築山 達人, 日吉 澄之, 山田 収, 高木 久雄, 百田 耕, 百武 靖之
1988 年 37 巻 2 号 p.
780-785
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Eleven cases of old fractures and non-union of the intracapsular femoral neck were operated with MK-pins (hook pins). The average age of the patients was 80.1 years, and the shortest elapsed time after fracture was 25 days and the longest 8 months. The fractures united in all cases but one, and the results were satisfactory. The authors emphasized that the MK-multiple pinning should be considered as the first choice of treatment for old fracture and non-union of the intracapsular femoral neck.
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益川 眞一, 忽那 龍雄, 笠原 貴紀, 松下 和徳, 上田 淳, 坂野 裕昭
1988 年 37 巻 2 号 p.
786-790
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
A group of 36 patients (7 males and 29 females) with femoral neck fracture, who were treated by Austin-Moore's prosthesis during 1981-1986, were studied. These cases were 52 to 89 years old (means, 72.4 years), and followed for 1.5 to 5.9 years (mean, 3.1 years). Postoperative OA hip score (J. O. A.) was 83.4 points on an average. End results were decided by age, period from injury to operation, osteoporosis, laterality of the length of femoral necks and central migration. Austin-Moore's prosthesis seems to be valuable in the treatment of the femoral neck fracture.
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野呂 純敬, 内藤 正俊, 中家 一寿
1988 年 37 巻 2 号 p.
791-793
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty-four intertrochanteric fractures had been fixed with the titanium captured hip screw and five with a conventional stainless steel sliding device. The mean operating time using the former was four-minute shorter than that using the latter.
Titanium is less stiff and stronger than stainless steel. Because of that, the titanium casptured hip screw can have keyless system. That has given simpler and quicker operation using the titanium device than using the stainless steel one. Titanium also produced less soft-tissue reaction than stainless steel.
It is concluded that the titanium captured hip screw is a promising device for intertrochanteric fractures that often occur in the elderly people.
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福岡 真二, 桑野 正, 加茂 洋志, 野村 茂治
1988 年 37 巻 2 号 p.
794-800
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
A series of 105 patellar fractures were evaluated for the range of mobility of the knee-joint, pain, limping and the force of the extensors of the knee. Concomitant jnjuries and the step-off of articular surface after the treatment entailed a great risk of a poor result. The best results were obtained by the tension-band wiring with K-wire and the combination treatment of tension-band wiring and circumferential wiring.
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原口 和史, 吉田 光男, 橘 寛, 安藤 俊行
1988 年 37 巻 2 号 p.
801-804
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
The results of the 13 fractures of the distal end of the femur were examined. Two cases of epiphysiolysis and one monocondylar fracture obtained good results by the cancellous screw fixation. In ten supracondylar and intercondylar fractures, six were treated by AO condylar plate and four by the other methods. All cases treated by the other method and intercondylar fractures treated by AO condylar plate showed unsatisfactory results. Surgical treatment of the distal end of the femur should be treated under technical familiarity and full equipment.
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竹川 克一, 遠藤 寿男, 辺見 達彦, 西岡 隆夫, 金沢 慶治, 藤井 幸治
1988 年 37 巻 2 号 p.
805-808
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
In this therapy, there are always such problems as the maintenance of reduction of complexed displaced fragments and recovery of full motion of the knee joint after bone union.
To these problems, various instruments for fixation of reduced fragments such as plates and pins have been developed, whereas, there are still some problems. The one is coronal fracture which can be hardly given the keep-reduction. Also, complicatedly crushed fragments may be given the closed treatment by traction for a long term.
The practice and results of the closed and open treatment are reported for the supracondylar fracture of various types as mentioned above.
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臼井 正明, 伊野部 淳吉, 浮田 泰孝, 栗田 英明, 吉田 和久
1988 年 37 巻 2 号 p.
809-811
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
We studied the end results of condylar fractures of the knee, which had displacement and were treated by open reduction and internal fixation. 51 patients (male: 29, female: 22, average age: 46 years old) were surveyed. The period of follow up ranged from 13 to 114 months (average: 46 months). 76 per cent of them had acceptable knee function. The result of mono condylar fracture of the femur were better, but those of medial condylar fracture of the tibia and bicondylar fracture of the femur were worse.
Osteoarthritic changes on X-ray examination were found in 59 per cent. They had no significant relation to the functional results.
Residual instability of the knee was found in 45 per cent and it was the principal factor that led to bad results. It was very important to repair torn ligaments and displaced fragments that might cause instability.
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佐々木 誠人, 川嶌 眞人, 田村 裕昭, 多田 勝弘
1988 年 37 巻 2 号 p.
812-816
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
We have treated eleven cases of tibial condylar fractures between 1981 and 1987. Nine of them were fresh fractures and treated surgically. The others were treated conservatively, because they were old fractures passed about 6months after the injuries.
Judging from the study of these cases, we found the followings important. (1) It may be difficult to find out its fracture conditions or lines, so the fracture may be missed. (2) Meniscus should not be removed but sutured if possible. (3) As it is difficult to treat the suffering after the malunion of them, the fracture may be required proper cares and treatments as early as possible.
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西崎 博巳, 上崎 典雄, 松永 大助, 村上 陽太郎, 西田 民夫, 上妻 隆秀, 山本 裕之, 下永吉 耕一, 南島 広治, 山口 宏治
1988 年 37 巻 2 号 p.
817-822
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
A study was made of 20 cases of fracture involving the tibial condyles in the last 10 years. Open reduction was used in 19 patients. Non-surgical treatment was employed in only one patient with severe comminuted fracture. There were five medial, one lateral collateral, one anterior, and two posterior cruciate ligaments injured, and all ligaments were repaired. Results were judged using Hohl score.
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黒木 一弥
1988 年 37 巻 2 号 p.
823-826
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Arthroscopic management for the tibial plateau fractures has the advantages of accurate reduction and rigid fixation without extensive operative exposure. In addition, it allows accurate diagnosis of associated intraarticular pathology. We have applied the arthroscopic management on 8 cases of tibial plateau fractures in 19 cases and obtained the good results. We usually implanted the iliac bone for the defect after the reposition. This time we have used “Apaceram granules
®” (2, 000-4, 000μm) as the bone implants for the defect after the arthroscopic reposition. It shortened the operative time and allowed the early motion excercise without the iliac pain.
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大槻 伸吾, 金井 成行, 夫 猛, 森下 常一
1988 年 37 巻 2 号 p.
827-829
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Ender nailing was used in two comminuted femoral shaft fractures. The fractures were classified according to Aoyagi's classification. The first case was a 77 year-old female with a comminuted fracture of Aoyagi's type III. Five months after surgery, the fracture was healed with external rotatory deformity. The second case was 23-year-old female with a comminuted fracture of Aoyagi's type V.
Three months after surgery, the fracture was healed with 1.3cm shortening. The patients were allowed early weight-bearing and early mobilization. Therefore Ender nailing is a suitable treatment for these fractures.
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内藤 正俊, 野呂 純敬, 中家 一寿
1988 年 37 巻 2 号 p.
830-832
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Seven comminuted fractures of the femoral shaft in seven patients were followed after treatment with the Brooker-Wills distal locking intramedullary nail. Three of the fractures were open and four were closed. All fractures united in a mean time of 59 days. Shortening of more than 2 centimeters occurred in one patient. No patient required postoperative traction or external stabilization, and all patients regained normal range of motion of the ipsilateral knee. There were postoperative complications in two patients with heterotopic bone at the site of the insertion of the nail. No problems were encountered with removal of the nail.
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滝口 明, 松元 司, 粟国 順二, 小酒井 治, 郡谷 正夫, 高田 裕康, 小川 和彦, 橋本 卓, 鶴野 寿一
1988 年 37 巻 2 号 p.
833-837
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
A review is given of 38 patients with open fractures who are operatively treated in our hospital from 1973 to 1987. Treatment principles consisted in primary wound cleansing, primary definitive internal fixation of fracture, and primary or delayed primary closure of wound. It is acceptable to do primary closure when wound is clean and without extensive soft tissue damage. But when a operator is unsure of wound status, it is recommended to do delayed primary closure. Our “Delayed Primary Method” is to dress the wound with packed gauge with a tube for injecting antibiotics. For about a week antibiotics is injected 3 or 4 times a day, and then wound is closed by suture or skin graft. As a result, 11 patients required secondary operation for delayed-union but no patient became infected. Generaly speaking, “primary internal fixation” has many advantages, but it increases the risk of infection. But using “Delayed Primary Method”, we can do “primary internal fixation” without increasing the risk of infection.
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神里 晋, 粟屋 梧老, 岡田 温, 二見 徹, 柏木 直也, 多田 弘史
1988 年 37 巻 2 号 p.
838-840
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
A patient with combined intraarticular and extraarticular synovial chondromatosis is reported. A 14 year-old girl visited our hospital with the complaint of swelling and pain at the anteromedial side of the left talus. Spotty calcification and invasion to the talar neck was seen on the plain radiogram.
99mTc and Ga-citrate scintigraphy were positive at the same location. Digital subtraction angiography revealed hypervascularity and tumor stain. Considering the possibility of malignant lesion, we performed operation for biopsy and exploration. Chondromatous free bodies were resected, three from the ankle joint and one from extraarticular synovium. Histological findings were typical synovial chondromatosis.
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佐久間 克彦, 高良 健, 有村 一盛, 香田 英俊, 須古 修二, 米村 憲輔
1988 年 37 巻 2 号 p.
841-844
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Lipofibroma of the peripheral nerve or its branches is a rare benign tumor and its pre-operative diagnosis is difficult. We reported one patient with lipofibroma of the median nerve. The patient was a nineteen-year-old boy who noticed a soft mass in his left hand thirteen years ago. The mass increased in size slowly. He was asymptomatic, the tumor mass was palpable, and there was no loss of function. An exploratory operation revealed a fusiform enlargement of the median nerve extending from the distal palmar crease to the middle finger. Epineurotomy was performed. The pathological diagnosis was Lipofibroma.
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上田 久司, 吉岡 薫, 藤本 吉範, 立川 勝司, 大作 浩一, 渡 捷一, 生田 義和, 久保田 政臣, 山本 進
1988 年 37 巻 2 号 p.
845-848
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Three patients with multiple neurilemmoma are presented. None of them have affected family with von Recklinghausen's disease. Two of them had multiple tumors in one peripheral nerve without café au lait spots. On the basis of this finding, we propose that the pathogenesis of these two cases is partial mutation of cell line of Schwann cell and that they are closely related to von Recklinghausen's desease. The other case is diagnosed as von Recklinghausen's desease (a central form) because of bilateral acoustic tumors.
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小橋 芳浩, 太田 正紀, 橋口 重明, 柴田 直之
1988 年 37 巻 2 号 p.
849-852
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Although knowledge of soft tissue tumors has increased greatly in recent years, there is still much confusion concerning their incidence and behaviour and the best mode of therapy. We studied 320 cases that had histological diagnosis.
Soft tissue tumors included mainly ganglion, lipoma, fibroma, neuroma, and teratoma.
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前田 公, 平野 徹, 貞松 俊弘, 吉良 秀秋, 山田 正幸, 岡崎 威
1988 年 37 巻 2 号 p.
853-857
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Two cases of intraosseous lipoma in the humerus and the ilium were reported with the review of literature. Intraosseous lipoma was extremely rare and its incidence was 0.12 per cent of the whole primary bone tumor. The diagnosis of this tumor was not easy by conventional radiographic findings. The CT values of intraosseous lipoma in previously reported 16 cases ranged from -40 to -132 and those in our cases from -102 and -50. A negative CT value shows that the contents of cystic tumor is composed of fatty tissue. Therefore, CT will be a most reliable method to differentiate intraosseous lipoma from other bone tumors with cystic appearances.
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栗林 善昭, 伊地知 正光, 小林 靖幸, 井原 成男, 三島 真一, 瀬戸嶋 政勝
1988 年 37 巻 2 号 p.
858-861
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
We report a rare case of renal cell carcinoma with metastases in the ilium, the femur and the ulna. The initial sign was a painful metastatic tumor at the olecranon. It was pulsative. Tumors of the ilium, the femur and the ulna were resected, and then fixations of the elbow (humero-ulnar) and the femur were performed.
In case of metastatic tumors, the fixation of the humeroulnar joint by the Kirschner wire, combined with methylmethacrylate and a metal mesh, was not sufficient to obtain the stability of the elbow, because the position of the fixed elbow gradually changed. Ever with this gradual change, however, was there no loss of supportability from the fixation. To reconstitute the femur, the ceramics for the spine were used combined with methylmethacrylate and the intramedullary nail, but the ceramics might not afford immediate stability for the patient to resume walking.
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田中 裕三, 嘉村 親芳, 田中 宏明, 古川 英樹, 尾島 浩, 中野 盛夫
1988 年 37 巻 2 号 p.
862-865
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Exostoses occur in bones that have developed from cartilage, most often in the long tubular bones. Exostoses are rarely on the proximal phalanx. The patient reported here is a 44-year-old female who had a solitary exostosis. She noticed it's swelling but felt no pain and no sensory disturbance, so she neglected having it attended to for a long time. We resected the exostosis on the right ring proximal phalanx. As we could not pathologically find the cartilage cap, we thought it was an old exostosis.
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石原 秀一, 鈴木 勝己, 井原 成男, 三浦 直彦, 山上 繁雄, 進 英文
1988 年 37 巻 2 号 p.
866-868
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Between 1972 and 1985, 127 patients with non-Hodgkin lymphoma of bone and soft tissue were evaluated and registered by National Cancer Center. In Japan, lymphomas of upper extremities are very uncommon. We reported a rare case of malignant lymphoma of the left 5th metacarpal bone. A 78-year-old male was admitted complaining of severe swelling over the left hand. The preoperative examination demonstrated only the diffuse, swelled, painful dorsal site of the left 5th metacarpal bone. No lymph nodes were palpated. Routine laboratory data were within normal values except ESR and IgA. The plain roentgenogram revealed osteolytic change in the whole 5th metacarpal bone. High uptake was observed on the lesion by
99mTc. scintigram. At operation, soft tissues were edematous and the lesion was found to have a lytic change. Frozen section suspected malignancy, and we immediately proceeded a wide resection. The curetted material showed diffuse pattern consisting of small, rounded lymphocytes and it was diagnosed as malignant lymphoma. Postoperatively chemotherapy was started to prevent local reccurence and distant metastasis. Lymphangiograpy of retroperitoneum, Ga. scintigram, and
99mTc. scintigram showed no abnormal changes.
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泉 伸治, 米村 憲輔, 東 一成, 下村 義文, 相良 孝昭, 石川 浩一郎, 高木 克公, 北川 敏夫
1988 年 37 巻 2 号 p.
869-872
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty-seven cases of bone tumors of the hand and one case of tumor-like lesion consulted our clinic between 1976 and 1986. Classification of cases by tumor types is as follows; benign tumors: enchondroma in 18 cases (multiple, 5 cases), osteochondroma in 4 cases (multiple, 2 cases), ecchondroma in 1 case, schwannoma in 1 case, malignant tumors: chondrosarcoma in 1 case, muloma in 1 case, tumor-like lesion: bone cyst in 1 case. Bone cyst was localized on the scaphoid bone, and the others were on the metacarpal or phalangeal bones. There were 18 men and 9 women whose ages ranged from 3 to 94 years (average, 26.9 years). In benign cases, therapies were curettages of the tumors and substitution with cancellous bones taken from the iliac bones. In malignant cases, we chose a disarticulation at the wrist joint for the case of chondrosarcoma. For the case of multiple myeloma, we excised the metacarpal bone, replaced with iliac bone graft and inserted a finger implant. Two cases (enchondroma and ecchondroma) recurred and required additional operation.
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立川 勝司, 吉岡 薫, 藤本 吉範, 上田 久司, 月坂 和宏, 生田 義和, 原田 雅弘, 中村 修司, 原田 英男
1988 年 37 巻 2 号 p.
873-876
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
A case of osteoid osteoma of the skull is presented, with characteristic clinical, radiological and pathological features except for the site of the lesion. A review of the literature reveals three cases of osteoid osteoma of the skull, but osteoid osteoma of the occipital bone has not previously been reported.
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大里 裕治, 楊 水木, 長戸 文明, 平野 徹, 松尾 武, 木下 真吾
1988 年 37 巻 2 号 p.
877-879
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
A very rare case diagnosed as an adamantinoma of the tibia in an one year and 10 months old girl is reported.
She had gait disturbance and the ro-entogenograms showed a well circums-cribed multilocular cystic lesion and defect of anterior cortex of the left tibia. Marginal excision and bone grafting were performed. The light microscopic findings and immunohistochemical studies suggested that the meoplastic cells had epithelial nature. Thus, we finally diagnosed this tumor as adamantinoma of the tibia. Sixteen months postoperatively there was no relapse and the bone union was almost completed.
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伊藤 博史, 森本 典夫, 梅津 龍哉, 田中 信次, 上原 裕史
1988 年 37 巻 2 号 p.
880-883
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
As the operative indication of pelvic bone tumors is widely spread recently, the surgeon encounters many new problems. These include the problems of surgical exposure route, preservation of major nerves and vessels and pelvic organs, prevention of bleeding and infection, and reconstruction of the pelvic ring after tumor resection.
We present four cases of pelvic bone tumors, none of which was high grade malignant one. In these cases, we had one case of recurrence and another case of post-operative infection. We should remember the possibility of recurrence and try thorough resection of the tumor, even if the postoperative function is expected to get worse, especially in the case of low grade malignant tumors.
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平野 徹, 岩崎 勝郎, 鈴木 良平, 浅田 和英, 門前 芳夫
1988 年 37 巻 2 号 p.
884-887
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
The results of marginal excision and irradiation (3, 000-5, 000cGy) in 9 patients with liposarcoma of soft tissue were analyzed to determine the effectiveness of radiation therapy. Only one out of 9 patients, who received 3000cGy, developed a local recurrence at 3 years and 3 months after surgery. The 5-year actuarial local control rate was 84.7%, which was similar to that by radical and/or curative wide resection in soft tissue sarcomas. In addition, histological examination disclosed that a liposarcoma with preoperative radiation fell into almost necrosis.
It suggests that the combination of conservative surgery and radiation therapy in the treatment of liposarcomas is of use to maintain a functional limb.
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杉田 孝, 天野 幹三, 大作 浩一, 生田 義和
1988 年 37 巻 2 号 p.
888-890
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
MFH is the most frequent sarcoma in soft tissue. We treated three cases of MFH in the last three years.
Case 1: Immediately after simple excision of the tumor at the left thigh by a doctor, curative wide resection was carried out.
Case 2: As the tumor had contact with the right femur, the tumor was resected widely but not curatively. After the operation, radiation therapy was indicated.
Case 3: The tumor at the right axillar region had simple excision four times. But unfortunately, the patient died of the huge tumor.
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折戸 隆, 古瀬 清夫, 森本 兼人, 伊達 伸也, 高浜 顕弘, 山本 吉蔵
1988 年 37 巻 2 号 p.
891-893
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
Between January 1, 1971 and October 31, 1987, 18 cases with limb-salvage operations for malignant soft tissue sarcomas were entered into this study. The male/female ratio was 2: 1 and median age was 47.9 (range 16-75). The sites were thigh (14 cases), upper arm (2 cases), forearm (1 case) and lower leg (1 case). In the histological study, there were 6 cases of liposarcoma, 4 MFH, 2 alveolar soft part sarcomas, 2 malignant lymphomas, one neurogenic sarcoma, one synovial sarcoma, one lymph node metastasis of skin cancer and one unknown. The distribution of the histological grade (UICC) was: To (we could find no tumor on our secondly operation after soonly primary surgery at the other clinic.) -1 case, stage I-2 cases (Ia-1, Ib-1), II-7 cases (IIb-7 cases), III-1 case (IIIc) and VI-7 cases (VIa-4, VIb-3). Five-year cumulative survival rate was 72.0%. One case had 3 times of local recurrences, because she had been done by the intralesional resection on the first operation. Four cases had distant metastases. Scince they were elder patients, they had had no adjuvant chemotherapy. Two patients were dead. Sixteen patient were alive. Two cases had been done succesfully limb-salvage operations with vascular reconstractions by their large saphenous veins. And 2 cases underwent en-bloc resections with their sciatic nerves. They had little trouble in their daily living with a short-leg brace for their drop feet.
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1988 年 37 巻 2 号 p.
894-908
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
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1988 年 37 巻 2 号 p.
909-914
発行日: 1988/10/25
公開日: 2010/02/25
ジャーナル
フリー
