Four patients with four involved shoulders underwent a second attempt at repair of an initial rotator-cuff repair that had failed. Factors associated with the failure of the initial repair included inadequate measure of the cuff repair, massive ossification in the subdeltoid subacromial space and possibly inadequate post-operative rehabilitation program. We concluded that a secoud attempt at repair of an initial rotator-cuff repar was so pessimistic that we have to try the least treatment at an initial repair.

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We studied about the 26 babies with 27 birth fractures who had visited our hospital between 1980 and 1988.
These fractures consisted of 22 clavicular fractures (21 babies), 3 humeral shaft fractures (3 babies), and 2 femoral shaft fractures (2 babies).
The study of these fractures revealed that: (1) the prognoses were very good in all cases due to the correction of the deformity by growth, (2) the main cause of birth fractures seemed to be the difficult labor, and (3) to treat the clavicular fracture, only the rest of the local lesion is needed, and to treat the humeral and the femoral shaft fracture the traction is effective in minimizing the displacement.

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Fracture of the clavicle is a common injury. Fifty-four cases were treated in our hospital during 3 years and 7 months from January, 1985 to July, 1988. In these, 2 caces were thought to be rare: the bilateral fracture and the double fracture of outer and inner third of the same side.
A 41-year-old man met with a traffic accident when he rided on the motorcycle. He was diagnosed roentgenologically as the bilateral fracture of the clavicle. We thought that it might be produced by a direct force applied to each side.
A 74-year-old man fell down the stairs. He was diagnosed roentgenologically as the double fracture of the clavicle. We thought that it might be produced by an indirect force traveled along the shaft of the humerus.

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There are various procedures for the treatment of the Acromio-Clavicular separation. Complete dislocation when occurred in sportsmen should be usually treated surgically.
Since 1976, we have treated 10 cases by the modified Dewar's procedure in a mean of 8.5 days after injury. The mean length of follow-up was 4 years and 1 month. One year after the operation, prognosis was favourable and the patients had no complaints in playing all sports and military hard training. We believe that this operative method is the best procedure for the fresh complete A-C dislocation.

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We operated 5 cases of complete dislocation of the acromioclavicular joint (Tossy's grade III) by the modified Weaver's procedure. The time of follow-up ranged from 6 months to 18 months with an average of 13 months. Cases were all male, age ranged from 21 years to 62 years with the mean of 42.6 years. Four cases were right side and one was left side.
Roentgenologically, the acromioclavicular joint was completely reduced in 2 cases and subluxation in 3 cases.
Postoperative results were evaluated by means of Kawabe's scores and according to the shoulder evaluation form of Jpn. Orthop. Assoc.. Four cases were excellent and one fair by means of Kawabe's scores. The average of total point was 86.4 according to the shoulder evaluation form of Jpn. Orthop. Assoc:.

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A ten-year-old male with supracondylar fracture of the humerus (Smith classification, complete displacement.) was treated by manual reduction and percutaneous pinning. Although the case was complicated by brachial artery injury, compartment syndrome was not observed. Serum CPK, GOT and LDH levels were elevated. After reperfusion by arterial anastomosis, the serum CPK was rapidly normalized. These date suggest that serum CPK measurements are useful for the diagnosis of brachial artery injury.

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Displacement of fractured medial epicondyle of the humerus into the elbow joint is an unusual condition. Recently we have treated one case.
The patient was a 14-year-old man who had injured in volleyball. Initially, there was palsy of the ulnar nerve and range of motion of the elbow was restricted. Five months after the injury, clinical result was favourable and the patient returned to the volleyball club.

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Out of the patients with fractures of the radial head and neck in children treated in Minamata City Hospital during 7-year period from 1981 to 1988, nine were available for follow-up assessment. One was radial head fracture and eight, radial neck. The average age was 10.7 years, with a range from four to thirteen years. One patient with radial neck fracture was treated by open reduction and internal fixation, and eight by closed reduction. The rusults were rated clinically, and all were with good results. We think that most fractures can be treated by closed means which should be tried even in those cases with complete displacement.

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As a treatment of radial head fracture, we devised a continuous traction method by adding a metacarpal pin traction immediately after operative reduction, and the method was applied to 16 cases. Thereafter, satisfactory results were obtained in most of the cases.

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Twenty Monteggia fractures were treated during a twenty-year period. Fifteen out of them were of acute type and five were old type. The average age of the patient was ten years (range, three to forty-nine). Eight of the injuries could be classified as Type I of Bado and eleven as Type III of Bado. Eleven cases had closed reduction of the dislocated radial head and fractured ulna, followed by immobilization in a plaster cast. Eight cases had open reduction and one case was kept under observation without treatment. Early treatment with completely perfect reduction of the dislocated radial head is the most important part for the prognosis in these fractures. Nine cases had radial nerve palsy as a complication. In eight cases of them, their nerve function recovered spontaneously within three months after treatment. In one case, the radial nerve was explored and examined. The nerve was entrapped at the arcade of Frohse. In the absence of electromyographic and clinical evidence of return of nerve function within three months, exploration and neurolysis appear to be the treatment of choice.

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Five cases of free vascularized bone graft applied to upper limb reconstruction were studied. Three cases of pseudarthrosis of the humerus and a case of pyogenic arthritis of the elbow were treated with free vascularized fibula grafts. A case of giant cell tumor of the distal end of the radius was treated by wide resection and a free vascularized fibula head graft. Their results were satisfactory, and the bone unions were achieved within 3.5 months postoperatively in most of them. However, bone defects and recipient bone in the upper limb are often too small to use free vascularized fibula or iliac bone graft. In such a case, free vascularized metatarsal bone graft or free vascularized periosteal graft may be useful.

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For the past three years, five stiff elbows were treated with operative method in our hospital. Their ages ranged from 23 to 58 years (average, 46.2), and four cases were male and one case female. The causes of stiff elbow were: old trauma in two, osteoarthritis in three, and those with severe joint destruction.
The mean range of motion before operation was 68 degrees (from 45° to 75°). An average postoperative improvement in the range of motion was 22 degrees resulting in a postopertive mean of 90 degrees (from 85° to 100°). Most gain was in flexion.
Their elbows give no difficulty in normal activity.

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Between 1980 and 1988, lengthening of the pronator teres and flexor carpi radialis was performed in 56 pronation deformities of the forearm in 55 patients with cerebral palsy. Twenty of these were monitored and the mean age at the time of surgery was 17 years and 7 months. The mean period of follow-up was 1 year and 5 months. Before surgery, the mean active supination was 1.7 degrees. At the end of the follow-up, it was improved to 39 degrees. According to Sakellarides' evaluation system, there were 8 excellent, 3 good, 4 fair, and 6 poor results. We found that this method was effective to correct a pronation deformity excluding fixed Contracture cases. There were 6 poor results in the fixed contracture cases. The causes of these results were discussed.

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Closed ruptures of the extensor pollicis longus tendon usually appear as a consequence of fractures of the wrist joint or ensue from polyarthritic changes or result from a process of degeneration. Mechanical injury of the tendon is quite rare but can be observed after direct trauma or rotational injury.
The patient in the case described was a 19-year-old woman who had not been injured. A slight pain in her right wrist persisted for two weeks and then she was unable to extend her thumb interphalangeal joint. Clinically distinct signs of a rupture of the extensor pollicis longus could be seen.
During the operation a tear of the muscular portion of the extensor pollicis longus was found. The muscle was severely degenerated. It was enclosed in the muscular sheath which was also degenerated. The sheath originated from the same as the extensor pollicis longus and inserted into the dorsal transverse carpal ligament.
The function of extension was restored by transfer of the extensor indicis proprius tendon.

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Dorsal dislocation of the MP joint of the finger is a relatively rare injury. The most common digit involved is the index finger. We presented a case with complex dislocation of the MP joint of the little finger which was thought to be quite rare. This case involved a 52-year-old man who injured his little finger by hyperextension. Closed reduction failed and open reduction was carried out with the dorsal approach. Operative findings revealed that the structures obstacled closed reduction were volar plate and bilateral collateral ligaments which tightened the volar plate bilaterally. From our previous experiences and this case, we concluded that the main structure blocking the closed reduction in the complex dorsal dislocation of the MP joint is not a special structure described by Kaplan (FDC, lumbrical muscle, natatory ligament and superficial transverse metacarpal ligament), but volar plate connecting with deep transverse metacarpal ligament and collateral ligament which tightened the volar plate.
From these cases, the dorsal approach is recommended because it is easier to confirm the blocking structures and to reduce the dislocation. Also the neurovascular bundle is not as likely to be damaged.
This mechanism reduces the surgical exposure. It is difficult to confirm the mechanism using the volar approach and the neurovascular bundle is more easily damaged during this exposure.
The dorsal approach is recommended because it gives full exposure of the volar plate, it is easier to use for open reduction and there is no risk of damaging the neurovascular bundle.

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From 1981 to 1988, sixty-seven cases (eighty-two thumbs) of pollux rigidus were treated with the splint, and were followed at Fukuoka Children's Hospital and Medical Center. An average follow-up period was 24 months.
The results were as follows.
1. Flexion contracture of the interphalangeal joint of the thumb had diminished within three months in sixty-nine (71%) of them.
2. Seventy-one thumbs (93%) were free from flexion contracture at the time of follow-up.
We concluded that the splinting in extension is very effective for pollux rigidus in children.

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We observed macerated carpal bones and studied the correlation between arthritis of the first CM joint and Heberden's Nodes for the purpose of detecting the risk factor for arthritis of the first CM joint.
Fifty cadavers (thirty-eight male and twelve female, average age 62.0 years) were studied. Degeneration of the Trapezium and distal phalanx were obsered macroscopically and classified by the size of the oseteophytes.
Coefficient of corellation between arthritis of the first CM joint and Heberden's Nodes was 0.35 in males and 0.69 in females. These results indicated a close correlation of the two types of degeneration in female. It seemed to imply that the cause of artritis of the first CM joint was not only due to morphology but also the general constitution of the patients as in the case of Heberden's Nodes.

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Nineteen patients have been treated by operative and conservative methods since 1978. Sixteen of these patients were reviewed directly in the follow-up period from 8 months to 10 years and 5 months. Functional and radiological assesments were performed respectively. The former included pain, tenderness, range of motion, hand grasping power, and pinch strength. The latter included the evaluation of the size of the fragment of the volar lip in preoperative radiographs, the distance between both fragments and the remains of dislocation of the base of the first metacarpal in postoperative radiographs, and osteoarthritis in follow-up radiographs. Five of sixteen patients showed slight osteoarthritis, but functional results were good in all. It was suspected that the occurrence of osteoarthritis was associated with the remains of dislocation.

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Since May, 1986, we have used a continuous passive motion unit HI-100 (Trout Medical) for post-operative care of the hand. In November, 1987, we tried to use this CPM-unit to cases of MP joint contracture for a conservative treatment and found two problems in this CPM-unit. Since this CPM-unit moves just along a simple linear line distal to proximal and proximal to distal, when we use it for a sigle joint contracted finger, this movement was used up in great percentage with normal joints. In other words, at the begining normal joints were fully flexed or extended, then a contracted joint starts to move. So, a patient cannot obtain enough motion to the contracted joint with this unit only. Another problem is lack of traction which keeps joint space and/or relieves contracture of the collateral ligaments.
To overcome these problems we made a splint combined with this CPM-unit to get maximum movement to affected joint with the unit and give a traction also. Early results were encouraging and with some ideas, we believe that the CPM-device has an indication not only for post-operative care but also for pre-operative and conservative treatment of contracted joints.

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We evaluated effects of acute compression on peripheral nerve of rats by injection of horseradish peroxidase to the anterior tibial muscle. Sciatic nerve was clipped with the hemoclip for five, ten and twenty minutes and observed at intervals of the second days, one week, two weeks, four weeks and eight weeks. Ratio of the number of the labelled cells of the affected side to the non-affected side decreased significantly at the first week. Over sixtyfive percent of the above mentioned ratio did not lead to the drop foot. Histograms of the area of the cell bodies of the neurons showed one peak and that of the affected side not any paticular pattern.

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A case of a 26-year-old woman who had peroneal nerve palsy caused by the fabella is reported. She had complained of weakness of the right ankle and pain of the right knee. After examination we suspected that her peroneal nerve palsy was caused by the fabella. Therefore we performed surgical exploration of the peroneal nerve and removal of the fabella. Postoperative result was good at first, but the peroneal nerve palsy relapsed about six months after operation.

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Eighteen patients (20 sides) with thoracic outlet syndrome were examined with both neurography of the brachial plexus and angiography of the subclavian artery and treated by surgical procedure (trans-axillary aproach). We compared two methods with operative findings. Angiography was examined in resting position, and it's positive findings were seen in 80%. Neurography was examined in resting and standing position, and it's positive rate was 100%. We think that neurography is more useful for evaluating the compression in costoclavicular lesion and interscalenus lesion than angiography. But angiography is more beneficial for assessing the hyperabduction syndrome and Power's syndrome.

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SSEPs have recently applied to 15 cases suspected of having thoracic outlet syndrome and to 21 normal cases depending on the absence of neurological sign. SSEPs have been recorded while stimulating the median and ulnar nerves at the wrist.
On stimulating the ulnar nerve, the SSEPs of the N9 at the Erb's point in the groups with thoracic outlet syndrome recorded an increase in N9 conduction time and a low amplitude of N9 potential. In the analysis of the N9 at the Erb's point, N91 is located in the peak of the first positive wave and N92 is located in the peak of the first negative wave. N9 (1-2) conduction time was 1.59±0.22 msec in the group of the thoracic outlet syndrome and was 1.40±0.17 msec in the normal group.
N9 (1-2) amplitude was 3.54±1.62μV in the normal group of the thoracic outlet syndrome and was 4.96±2.42μV in the normal group. These studies suggest that N9 (1-2) conduction time and N9 (1-2) amplitude provide useful information of the diagnosis in thoracic outlet syndrome.

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Resection of the first rib through axillary approach for thoracic outlet syndrome had been performed on 19 cases (22 arms) for 10 years recently. In this report we evaluated the postoperative results of the 15 cases (17 arms) who were able to be followed up. Synthetic evaluation was classified as excellent in 2 cases (11.8%), good in 10 (58.8%), fair in 4 (23.5%) and poor in 1 (5.9%). Subjective symptoms of upper limbs seem to improve more than those of scapular regions. The cases in which the 3 minute test (Roos) became negative or improved after the first rib resection had gained good relief of symptoms.

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A case of posterior interosseous nerve paralysis resulting from a constricting band is repored. A 35-year-old man complained of weakness in his left hand. Extension of the thumb and fingers was weak, and a so-called finger drop deformity was present. A constriction of the posterior interosseous nerve was found proximal to the supinator muscle. No other compressive force was noted along the course of the nerve. The constriction seemed to be caused by local torsioning of the nerve itself. When the forearm was pronated, the torsion became severe. The torsion point was released by gentle neurolysis around the constricting site. Four months later, full function returned to the left hand.

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Eight patients with posterior interosseous nerve palsy were treated surgically and postoperative results were evaluated. Five of them were found to have spaceoccupying lesions (ganglion in three, lipoma and chondroma in one respectively), two entrapment at the so-called arcade of Frohse, and two no compressing factor. In one of these was found a well-localized hourglass constriction proximally to the arcade of Frohse, that had been reported in a few cases. Surgical exploration was performed three to six months after the onset of symptoms and neurological recovery was obtained postoperatively in all cases.

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We treated surgically 54 wrists in 48 patients with carpal tunnel syndrome (CTS) between April, 1976 and October, 1988: idiopathic CTS, 34 wrists in 29 patients; traumatic CTS 10 wrists; specific inflammatory CTS, 5 wrists; familial CTS, 4 wrists in 3 patients; and other 1 wrist.
This reported family consists of 7 members of one generation. Within 7 siblings, 5 patients (two brothers and three sisters) were found to have the carpal tunnel syndrome and 4 wrists in 3 patients were operatively treated at our hospital. Operative and pathological findings were considerable thickening and degeneration of the transverse carpal ligaments in 4 wrists in 3 patients of familial CTS.
We think that this thickness of transverse carpal ligament was the most common cause of the familial CTS, but on the other hand, thickness of flexor synovialis was the most common cause of idiopathic CTS.

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Ulnar tunnel syndrome in the entrapment neuropathy is rare. We reported a case of this syndrome caused by ganglion. A 30-year-old woman complained of paresthesia at the left little finger and a mass in the left palm. The extirpation of the tumor was performed. Both the superficial and deep branches of the ulnar nerve were found to be entrapped by the ganglion. Ulnar nerve palsy was improved remarkably at months after operation.

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Twenty-four cases of cubital tunnel syndrome were operated on with our new technique from May, 1983 to April, 1987. A new neuro-groove was made at the anterior side of the medial epicondyle by cutting off the origin of pronator teres and flexor muscles. Then free fatty tissue was seated on the bottom of the new groove. The ulnar nerve was transposed to the new groove with its extrinsic vessels (A. collateralis ulnaris superior and A. recurrens ulnaris posterior). Results showed that 19 cases (79.2%) were estimated to be excellent or good. It is as good as results of a modified King's procedure. We had no “poor” case and no re-operated case.
Considering some merits for occupations and activities of daily living by preserving the medial epicondyle, not only a modified King's procedure but also our procedure of vascularized anterior transposition can be selected.

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Thyroid hormone has some effects on bone and cartilage tissue, but their details have not been explained clearly. Previous studies indicate that the renal tubular reabsorption of phosphate and bone metabolic cycles are enhanced in hyperthyroid states. Recently in Japan, Shimazaki and others reported the ameliorating effect of triiodothyronine on rickets' rats induced by Sttenbock diet and their new rachitogenic diet.
In this study, we examined the effect of triiodothyronine (T₃) on rickets' rats induced by HEBP. The 14 days administration of T₃ promoted the calcification of the growth-plate cartilage where there had been an increase in thickness due to the inhibition of calcification by the first 7 days administration of HEBP. And that action of T₃ almost appeared by the last 7 days administration of T₃. As our studies about the effect of vitamin D metabolites on HEBP induced rickets' rats, the action of T₃ was similar to that of cholecalciferol and 1, 25 (OH) ₂D₃. But the action of T₃ is thought to be direct to bone and cartilage tissue by our investigation of serum values of their rats.

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Human bone cells were cultured and transformed by SV40 virus. The trabecular bone samples of the femur obtained from surgery of a total hip replacement were prepared for cultures. Heterogenic bone cells were coexisted in early cultures. Cells with alkaline phosphatase activity were transformed by SV40 virus treatment. The cells contained abundant rough endoplasmic reticulum, mitochondria, free ribosomes, and irregularly shaped nucleus with heterochromatin. Mitotic figures were prominent. In extracellular space, collagen fibrils and electron dense materials, probably calcified substance, were noted. The cells were considered to be osteoblasts or osteocytes.

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In order to develop an ‘in vivo model’ to examine the direct effect of drugs to bone tissue, we conducted the following experiment in Japanese white rabbits. Under anesthesia we drilled a hole, 4mm in diameter, in the distal epiphyseal segment of the bilateral femurs. After 4, 7, 14 and 28 days, the rabbits were killed, and radiographic and histological examinations were performed. After 4 days, new bone formation was observed histologically at the marginal area of the drilled cavity and after 28 days, the cavity was almost filled with new bone. Fibrin Sealant was absorbed gradually and disappeared completely after 28 days.
Two holes of each rabbit were filled, one with the mixture of calcitonin-Fibrin Sealant, another with Fibrin Sealant only. The result of this experiment showed that after 14 days, no significant difference in bone regeneration between these two holes could be found, but after 28 days, the amount of new bone tended to be larger in the hole filled with calcitonin-Fibrin Sealant than in that of Fibrin Sealant only.

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Kinetic changes in number and distribution of mast cells during fracture healing in rats were examined.
A transverse fracture was made in the tibial shaft of rats (Wistar strain, male, 8w) by the original fracture production apparatus. The fractured leg was left unsplinted. Histological specimens including whole healing callus were obtained at various times after the fracture.
Mast cells appeared in the old marrow near the internal callus 2 weeks after the fracture. At about 5 weeks, they appeared in the whole new marrow of the external callus where remodeling is in advance. At this time, degranulated mast cells were dominant. The number of mast cells gradually decreased in parallel with the decrescent bone resorption.
These results suggest that mast cells play an important role in bone resorption during remodeling.

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Cellular components, collagen and proteoglycan of bone tissue were reported to have immunogenisity. But immunogenisity of collagen and proteoglycan are weak. Cellular components of bone tissue which express MHC antigen play key role of graft rejection in fresh bone allotransplantation.
The purpose of this study was to detect MHC antigen expressing cells in bone tissue using immunohistochemistry.
Following conclusions were obtained through this study.
(1) Expression of MHC class I antigen was found in osteocyte and osteoblast.
(2) Expression of MHC class I antigen in osteocyte and osteoblast showed diversity.
(3) Canal containing cells of vessels in cortical bone express MHC class I and class II antigens.
(4) The expression of MHC antigens on bone tissue may be influenced by allo-antigen stimulation.
(5) The expression of MHC antigens in osteocyte and osteoblast could be detected after decalcification of the bone tissue.

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We had already reported the result of the vasucularized bone allografts in dogs with immunosuppression. This paper shows the early result after withdrawal of Cyclosporin (CyA) or FK506 (FK).
Dogs with CyA have got partial bone union of the end of the graft and complete bone union of the other end of the graft. After wirhdrawal of CyA, the partial bone union of the end showed bone resorption and complete bone union of the other end kept bone union in the plane radiogram. Two weeks after the graft had little uptake and fourteen weeks after it had re-uptake by bone scintigram.
Dogs with FK have got non-union of the both ends of the graft, after withdrawal of FK it have still had non-union in the plane radiogram and got no uptake by bone scintigram twenty-three weeks after.

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A cytotoxicity test of biomaterials (nickel, chromium, and iron) using carboxyfluorescein diacetate (CFDA) was performed with rat fetal lung fibroblast (RFL-Fb). Cytotoxicity of chromium and nickel on viability of RFL-Fb was severe and the number of viable cells was decreased dose-dependently. However, cytotoxicity of iron on RFL-Fb was not detected. This method might be reliable to detect cytotoxicity of biomaterials on various kinds of cells.

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Biomaterials were exposed to tryptic soy broth containing cells of Staphylococcus E-46 with antibiotics (Cefaloridine 100mg). In group 1, the biomaterials and the antibiotics were put into the broth at the same time. In group 2, the biomaterials were put into the broth at an interval of seven hours after the injection of the antibiotics, and in group 3, at an interval of nineteen hours. After twenty-four hours exposure, the biomaterials of each group were removed for count of bacteria on their surface. Many laboratory data have shown that almost all of free bacteria are killed in two hours under the presence of antibiotics. In this experment, however, there was statistically no difference between groups in the numbers of bacteria on biomaterials. This suggests that the special mechanism exists in the growth of the bacteria on biomaterials. Ultrastructural studies, reported previously, have shown that biofilm develops around the bacteria on the surface of a biomaterial. We reported that the resistance to antibiotics might increase with the growth of biofilm surrounding bacteria on a biomaterial. The result of this experiment supports this speculation.

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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 FK506 (FK) shortly before serum transfer suppressed passive arthritis completely. In contrast, treatment with cyclosporin A (CsA) didn't suppress this passive arthritis. Both FK-treated and CsA-treated, serum transferred rats failed to develop arthritis 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.

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Articular cartilage and subchondral bone of spontaneous osteoarthritis of ICR mouse knees were studied by transmission electron microscopy. The most characteristic finding of this mouse knee was chondrocyte necrosis of calcified cartilage before apparent osteoarthritic changes of cartilage. Early ultrastructural changes of the osteoarthritic cartilage included degeneration and disappearance of superficial discoid chondrocytes, microscar formation in the superficial layer, degeneration of deep-layer chondrocytes, and atrophy or degeneration of osteocytes in the subchondral bone. In advanced osteoarthritis, there was a various degree of cartilage loss and most of the cells in remaining cartilage and subchondral bone were necrotic. These findings resembled aging changes of the articular cartilage, however, the changes seen in osteoarthritic cartilage were thought to be severer, more frequent and more extensive than those in aging cartilage. Though proliferative changes such as chondrocyte clusters and osteophyte formation were not observed, there were some chondrocytes with abundant rough endoplasmic reticulum, mitochondria and Golgi complex. Densely packed thick collagen fibrils were often seen in contact with those cells. These thick collagen fibrils, which are similar to fibrils found in microscars, may be formed as a result of reparative reaction of cartilage chondrocytes.

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We studied the effect of the serum of the patients with Perthes' disease on chondrocytes. We made monolayer culture of chondrocytes, The serum of normal children and patients was added to chondrocytes. We measured cell number, protein and glycosaminoglycan in one dish for seven days. We found that the serum of patients with Perthes' disease inhibited multiplication and differentiation in comparison with the serum of normal children. In addition, according to the concentration of somatomedin, the effect on chondrocytes was different. We speculated that the low level of samatomedin has a bearing on the cause of Perthes' disease.

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The supraspinous ligament, which was taken during surgery, was observed by means of SEM in order to clarify ossification process of the ligament.
At the attachment of the bone, ligament's insertion is divided into four zones as Cooper described. The attachment of the bone has the structure of enthesis. Closer to the ossification, various changes were observed, such as thinness and branching of fibrils, bridging between fibrils, irregular network of fibrils and deposit of granular substance.

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The purpose of this paper is to report morphological features of the cells in the human posterior longitudinal ligament, including its attachment to the vertebral bodies, and of the cultured cells derived from PLL. We used the transmission electron microscopy to observe the cells. Far from its vertebral attachment, the main constituent cells in PLL are fibroblasts. The closer to the vertebral bodies fibroblasts become degenerative, and chondrocytes are observed in the irregular collagen fibers. The closer still more, calcium deposits on the collagen fibers, and osteocytes become the dominant cells. Compared with these three types of cells fibroblast, chondrocyte, and osteocyte in PLL, the cultured cells resemble fibroblasts.

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A case of adult onset Fanconi's syndrome was presented. A 45-year-old female, complaining of walking pain of the both hips, was hospitalized in our clinic on February 19, 1986. She arose from the floor “climbig on the legs” and walked swaying. She complained of hip pain on gait but passive motion of her hips was painless and the range of motion was normal. Clinically, weakness was present in the muscles of the limbs. Looser's zone in both femoral necks, diffuse bone atrophy of the pelvis and femurs were shown on radiograms. Laboratory findings revealed a feature and other examinations were made, but we could not find any findings to confirm multiple myeloma. The patient was given Shohl's solution 1-a-OH-D3 by mouth. Two months after admission, muscle weakness disappeared and serum P, serum Cl and acidosis were normalized, but alkaline phosphatase level remained elevated. Renal dysfunction was unchanged. Now she is continuing the treatment during 22 months, she has no complaint and her laboratory findings, radiological and histological findings but renal function are in normal condition. We are observing the renal function and the appearance of cause of Fanconi's syndrome because we can not abandon the possibility of multiple myeloma or macrogloburinemia.

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A 41-year-old female with renal tubular acidosis showed osteomalacia and pseudo-fracture of bilateral femoral necks. She had been treated with Shohl's fluid or NaHCO₃, and acidosis was almost corrected, but hypophosphathemia and hypokalemia continued. So instead of these drugs, Uralyt-U was administered. As a result, acidosis was corrected and serum levels of P and K became normal. Uralyt-U was effective for this patient with renal tubular acidosis.

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We report a case of Gaucher's disease with several orthopedic problems. A 4-year-old. girl was admitted to our hospital with fractured right humerus. She had hepatosplenomegaly and pancytopenia, and had been diagnosed as Gaucher's disease in other hospital. We diagnosed pathological fracture which later healed by conservative therapy. Later she complained of left hip joint pain due to avascular necrosis of the femoral head. She was treated with indirect traction and pain soon resolved.

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Freeman-Sheldon syndrome is characteristic of whistling face, flexion contracture of fingers and congenital club foot etc..
A four-day-old baby girl with this syndrome consulted our clinic for her bilateral club foot deformities. Because of her physical undergrowth and rigid deformity resisting to manipulation, postero-lateral release operation was done at the age of 14 months. Pre-operative laboratory data showed increased creatine-phosphokinase (170IU). The anticipated malignant hyperthermia during operation under general anesthesia began to occur, but was managed to avoid severe condition by cooling treatment done at its early stage. Due to the above fact, we think this syndrome may have a possibility of myogenic origin. She can stand and walk by herself somehow or other 6 months after operation.

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Thirty-seven spinal cord injury patients admitted in the Nagasaki Rosai Hospital were investigated concerning the incidence and the sites of heterotopic ossification (HO). The incidence of HO was 65% in all patients. There was no difference in the incidence of HO between patients with cervical cord lesion and thoracic cord lesion. HO was most frequently seen in the hip joint with the incidence of 49% of all patients. The incidence of HO was 83% in the flaccid cases and 36% in the spastic cases. HO appeared in almost all the cervical cord injury patients with flaccid paralysis. Neither the age of patients nor the period after the injury was related to the occurrence of HO.

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