The author encountered two rare cases of patellar ligament body rupture complicated with complex ligament damage and conducted investigations on the damaging mechanism from the viewpoint of ligament biomechanics. The load exerted on the patellar ligament reaches a maximum and ACL tension increases, when the knee joint is in a slight flexion (specifically at an angle of about 50 degrees). It can be inferred that changes in the mechanical strength of a bone-ligament-bone complex occur depending on stress orientation and action timing, which in turn cause differences in rupture site location.
A 12-year-old boy presented to our hospital complaining of a deformity and walking pain in his right ankle and foot after a fall from 1.5m height, 3 years and 3 months before at the of 8 years. The deformity was considered to be caused by a pylon fracture. Although the X-rays were retrospectively re-examined, no evidence of fracture was found at the early stage after the injury which could have accounted for the resultant deformity. The serial X-rays and the result of operative treatment of the deformity are presented.
A run over injury of the ankle in a traffic accident is considered high-energy trauma, which can cause severe damage of the musculoskeletal system. This paper focuses on the cases of children with open growth plates, and severe ankle trauma. In all 6 cases, the skin and soft tissues, tendons, and bones were involved. The skin and soft tissue injuries included massive skin defects or severe scar contractures, all of which were successfully covered with a free groin flap, harvested from the contralateral side. Tendon injuries, mostly defects, included isolated or combined ruptures of the tibialis anterior, extensor hallucis longus, or extensor digitorum longus, which were reconstructed with tendon transfers or grafts. A hammer toe deformity was apparent in one untreated case. Concerning bone injuries, there were 4 cases of epiphyseal fractures of the tibia and fibula, and 2 cases of epiphyseal injuries of supination-inversion type, one of which followed an open dislocation of the ankle joint. In these 2 cases, a residual varus deformity of the ankle occurred, and in one of them a leg lengthening procedure was recently performed due to 3cm shortening. Microsurgical flaps have resolved the difficulties with wound management, but epiphyseal injuries remain the serious problem in which additional procedures would be necessary.
We allowed early weight-bearing and ankle movement after operation for ankle fractures of supination-external rotation injury type. As this method gave better results in a follow-up, we think that this method can be applied to another fracture types too.
Thirty-eight patients under went operative treatment for fractures of the ankle. Their ages ranged from 15 to 76 with an average of 43 years. The factors which influenced the prognosis ware evaluated for these cases. It was found that the type and the stage of Lauge-Hansen's classification, etiology of the injury, the degree of reduction, age of the patient, crushed fragments, presence or absence of compression deformity and of the rupture to the deltoid ligament were the related factors. Evaluation of these factors would enable us to estimate the clinical results in some degree.
This fracture is variously classified, whereas, the therapeutic problems can be summarized in the following 3 items. 1. In terms of medial versus lateral malleolus, which should be considered to be more important? 2. Counter measures against severe damage of articular surface like trimalleolar fracture. 3. Cases possiblely resulting in osteoarthrosis of the ankle in future as predicted from an early stage. The purpose of this study is to devise therapeutic means fully considering the problematic points of injury of malleolus. The above cases were treated based on the following ideas. 1. For malleolar fracture, priority was given to the lateral malleolus rather than the medial malleolus, and the lateral malleolar fracture should be made reduction and fixation certain. 2. For the case possiblely causing severe contracture of the ankle joint after reduction of severe damage of malleolar site and trimalleolar fracture, calcaneus pin traction should be added.
The results of the treatments of 31 sprained ankles with positive anterior drawer signs were retrospectively reviewed. There were no differences in subjective symptoms and objective findings including the instability on stress X-ray at the time of follow-up examination among the three treatment groups: moist compression group; immobilization group; and operation group. Improvement of instability was slightly better in the operation group than in the immobilization group.
The lateral collateral ligament injury is often encountered, but treated as distorsion. Imperfect treatment results in instability and secondary osteoarthritis of the ankle joint. The clinical and radiographic results were reviewed in 24 patients of 37 injuries treated with primary suture of the lateral collateral ligament. The mean talar tilt angle improved to 5.2 degrees from 14.4 degrees, and the mean anterior drawer distance, to 4 millimeters from 7 millimeters. Post-traumatic instability was improved and clinical symptoms were decreased. We concluded that primary suture to acute injury of the collateral ligaments of the ankle joint Can result in stability and may prevent secondary osteoarthritis in the future.
We reported twenty-six cases of avulsion fractures induced by sprains of the ankle joint. Most of them were results of avulsion by lateral ligaments or peroneus brevis tendon. But some of them were results of avulsion by other ligaments. We should be careful not to misdiagnose these injuries by taking three-directional plain radiograms, and adding str ss radiograms if necessary. These avulsion fractures occur not only in children whose skeletals are relatively weaker than ligaments and in adolescent who often engaged in sports activity, but also in the middle aged or older women. This fact suggests that osteoporosis is one of the factors inducing avulsion fractures rather than ligamentous injuries. We treated these fractures with success, prescribing walking boots cast for four weeks.
Cases of the triplane fracture and the juvenile fracture of Tillaux, which are thought to be rare in the adolescent distal tibial epiphysis, were reported with an emphasis on their diagnosis, treatment and mechanism of injury. Six triplane fractures and 3 juvenile fractures of Tillaux in our hospital were reviewed. The causes of injury were trauma in playing sports and fall down. The ages at injury ranged from 11 to 15 years old. All cases were ascertained by plain radiographs at the time of injury and two cases were examined with CT scan. All cases of Tillaux fractures and four cases of the triplane fracture underwent open reduction and internal fixation and the others were treated with casting after closed or open reduction. This study sugested the following: 1) The roentgen stereophotogrammetric analysis i. e. CT scan or tomography provided the recognition of accurate fracture lines. 2) Open reduction resulted in better anatomical alignment. 3) It was clear from the mechanism of injury, that an external rotation force caused a Tillaux fracture, and that the combination of plantar flexion and strong external rotation produced the triplane fracture to the epiphyseal plate of the ankle at the time of maturity.
Twenty three patients with epiphyseal injuries of the ankle joint were treated in our hospital from 1982 to 1988. Eighteen patients were reviewed after an average follow-up of 2 years and 1 month. According to Dias's classification, fracture types included PEER-8, SER-5, SI-3, Triplane fracture-1 and other physeal injury-1. Salter-Harris Type I or II included 16, III or IV included 2 in the tibial epiphseal injuries of the ankle joint. Good clinical results were obtained in all cases but radiographically, a varus deformity of 18 degrees was observed in 1 case of the PEER type. In conclusion, close clinical observation is important even in Salter-Harris Type I or II. Dias's classification is of value to diagnosis and therapy.
In this report, seventeen cases with epiphyseal injuries of the ankle were reviewed: 16 cases were caused by a traumatic lesion and one resulted from the careless penetration of the epiphysis a large Kirschner wire used for the treatment of a tibial shaft fracture. The age of the patients at the time of the injury averaged 11 years and 2 months, ranging from 3 to 15 years. The average follow-up period was 4 years and 3 months. A varus deformity of the ankle was observed in 2 cases. The factors which influenced the prognosis were discussed and following results were obtained. First, partial growth arrest would occur not only in Salter-Harris type IV fractures of the epiphysis, but also in type II fractures. Second, anatomical reduction of the fracture is the most important factor in preventing growth disturbance. Third, careless penetration through the growth plate with pins or screws should be avoided. Fourth, on the occasion of a premature partial growth arrest, excision of the osseous bridge is necessary in early childhood.
The authors review the clinical and roentgenographic results of 34 malunited ankle fractures in 33 patients treated at Kyushu Rosai hospital from 1978 to 1987. Proximal displacement of the tibial malleolus is left in the adduction fracture, while proximal and lateral displacement of the fibular malleolus remains in the lateral rotation fracture and in the abduction fracture. The clinical and roentgenographic results were worst in the ankle fractures with valgus displacement of the tales due to proximal displacement of the fibular malleolus. Correction of fibular shortening and of lateral rotation of the fibula is most important.
Forty-four patients with malleolar fractures of the ankle were treated during 1985-1988, in Moji-Rousai hospital. Twenty-four patients were reviewed after follow up of more than 6 months. We classified them into 3 groups (Good, Fair, Poor) according to our own clinical criteria. The following conclusions were obtained by our study. 1) Good clinical results were obtained in 12 cases (50%), 10 cases (42%) were included in “Fair” group and 2 cases (8%) were evaluated “Poor”. 2) The mean age of “Fair and Poor” group was older than that of “Good” group. 3) More patients with displacement of the tales after injury were included in “Fair and Poor” group than “Good” group.
Fracture of the ankle is frequently encounted in clinical practice. For its therapy it the necessary not only to repair the joint anatomically but also to stabilize joint on loading the body. Sixty cases of ankle fractures were treated surgically in our hospital from 1982 to 1988. The patients were studied according to the classification of fracture by Lauge-Hansen. The clinical results were good in 34 cases, fair in 17 cases, poor in 2 cases by Burwell.
We reviewed the results of 59 malleolar fractures treated in the last 5 years and followed for more than 12 months. 9 poor cases were analyzed for the factors inducing poor results. Residual displacement and instability of the ankle brought about serious impairments of activity of daily living. Anatomical reduction of the lateral side of the ankle, especially the lateral malleolus, plays the most important role in the management of the ankle fracture. Internal fixation with tibia bolts or screws is necessary in case of the separation at the distal tibio-fibular syndesmosis.
Seventy-three patients with malleolar fractures of the ankle were treated during 1983-1988. Fractures were classified into SA type (17.8%), SER type (38.4%), PER type (9.6%), PA type (24.6%), and PD type (9.6%) as defined by Lauge-Hansen. The ankles were assessed in terms of relationship between radiographical and clinical results. The clinical result was evaluated by questionaire and “excellent” answers were obtained in 75.4%, especially in the SA and PA type of Lauge-Hansen classification. The radiographical result of reduction was evaluated by Burwell's criteria and talocrural angle. An anatomical reduction was obtained in 71.2%. The ratio of Talo-Tibial (TT)/medial clear space (MCS) of the final radiography was found to be decreased in “poor” cases and those with developed osteoarthritis. The end-result was found to correlate with anatomical reduction and TT/MCS, but not with the talocrural angle.
This paper presents an analysis of the results of the treatment of ankle fractures. A follow-up study was performed on 78 of 112 cases of ankle fractures treated surgically between 1977 and 1988. The fractures were grouped into five types according to the classification of Lauge-Hansen. The subjective clinical results were good in 70, fair in 5 and poor in 3. The objective results were good in 61, fair in 13 and poor in 4 according to Gregory's evaluation. Anatomical reduction and rigid fixation significantly affected the clinical results.
We observed lumbar pelvic rhythm with videocamera making landmarks on the body surface. Materials were divided into 3 groups as follows; control group (average age, 17.4 years), middle aged group (average, 35.4 years) and patient group with lumbar osteoarthritis (average 75.4, years). In control group, activities occured in both lumbar spine and pelvis on any range of trunk flexion. The ratio of lumbar flexion to trunk was significantly greater in below 50 degrees of trunk flexion than in above 50 degrees. We supposed this discrepancy to be lumbar pelvic rhythm. The rhythm which had been seen in control group was not obvious in middle aged group and patient group. The ratio of lumbar flexion to trunk flexion was significantly smaller in patient group than in the others.
An experimental study was carried out on the pathophysiology of tethered cord syndrome. In twenty-four cats, spinal cord traction impairment was created by lumbosacral cord traction. Spinal monitoring was performed using the spinal evoked potentials.
The purpose of this paper is an introduction of the method of quantitative evaluation of spasticity and voluntary motor function of the lower limbs in spinal spasticity, using the Cybex-II. We studied 10 cases of normal subjects and 20 cases of spinal Spasticity. We could analyse the torque-curves and the evoked muscle action potential-curves which were measured by Cybex-II and surface electromyograms by means of personal computer 9801. We considered that the quantitative evaluation of spasticity and voluntary movement in spinal spasticity might be possible.
We measured the ratio of type I collagen to type II collagen in 8 herniated discs obtained from patients which underwent discectomy by the new method we established; SDS-PAGE. In young patients, only type II collagen was found in the herniated discs, however, with aging, type II collagen decreased and type I appeared. We concluded that these results support the decrease of the hydrophilic characteristic of the degenerative disc.
We attempted to record the thoracic evoked spinal cord potential by stimulation of intercostal nerve in cats to level diagnosis and evaluation of spinal cord function. The recording electrode was applied in the dorsal epidural space and the reference electrode was placed in the paravertebral muscles. The basic waveform consisted of two major components; a triphasic spike and negative wave, named P1, P2, N1 and N2, in order of their polarities and latencies. The latency of N1 progressively increased at the more cranial recording sites and the N1 response diminished cranially with sectioning of the spinal cord. The amplitude of N2 was decreased by high frequency stimulation, and was considered post-synaptic potential. We confirmed that thoracic evoked spinal cord potential stimulation of the intercostal nerve is useful to level diagnosis from experimental study of acute spinal cord compression.
Spinal evoked potentials by median nerve stimulation were recorded on the cervical dura over the dorsal column in cats. The basic waveform consisted of two negative potentials, namely, N I and N II in order of latency. N I was a spike wave which had a short duration and a high amplitude, and two peaks occasionally. The peak latency was about 2ms. N II was a slow wave which had a long duration and a low amplitude. The peak latency was from 3ms to 4ms. The amplitudes of N I and N II were maximum around the 6th cervical spine, and furthermore at upper cervical and thoracic lesions, negative potentials could be recorded. The effect of stimulus intensity, stimulus duration, stimulus frequency, position of ref erence and recording electrodes were investigated on N I and N II.
The early diagnosis of traumatic atlanto-axial dislocation in children is difficult because of the accompanied other trauma and the difficulty of communication. Recently we experienced two cases of old atlantoaxial dislocation in children and the results of operative treatment were satisfactory. We discussed the utility of early diagnosis and the treatment of old atlanto-axial dislocation in children.
We studied six cases of atlanto-axial dislocation treated by occipito cervical instrumentation. The diagnosis was RA in two cases and malignant tumors in four cases. The alignment of the upper cervical spine was severely destroyed in all cases. In the cases of RA, the clinical results and mechanical fixation of the instruments were good, but vertical redislocation between the atlanto-axial joint occurred on rentogenographic examination. Though all cases of malignant tumors died within four months after the operation, the symptomatic evaluation, including relief of pain, was excellent. In conclusion, occipito-cervical fusion with a modified U rod seemed to be the most useful instrumentation in selected cases.
We believe that spontaneous reduction of fracture-dislocation of the cervical spine may occur. We found two groups of patients to have spontaneous reduction based on resultant operative findings. Group 1: Initial radiograph on admission showed normal alignment but operative findings showed a pattern of fracture dislocation. Group 2: Radiograph at previous hospital showed fracture dislocation but initial radiograph on admission showed normal alignment. Group 1 had 9 patients and Group 2 had 3 patients. The results indicated that we must consider that spontaneous reduction of a fracture dislocation of the cervical spine can occuve in patients with acute injury to the cervical spine.
We reported the technique and the application of the lumbar sympathetic ganglion block to the spinal cord injured patients in this paper. The result was as follows: Four of six patients (67%) received lumbar sympathetic ganglion block were effective and detrusor-urethral sphincter dissynergia was improved. We thought that this result was due to the relaxation of the internal urethral sphincter, because this region was abundant in α-adrenargic receptors and was regulated by the sympathetic nerve (lower abdominal nerve). We considered that lumbar sympathetic ganglion block was useful for spinal cord injured patients with severe incontinence due to the spasms of the internal urethral sphincter.
A case of an aneurysmal bone cyst which occurred in the upper thoracic spine was reported. The patient was a thirty-eight year old male, who was at first diagnosed as having a mediastinal neoplasm, accidentally on medical checkup. Close examination, MRI, CT, angiography etc, was performed, and finally biopsy by mediastinal scopy was done. The definite diagnosis was aneurysmal bone cyst. Lytic lesions of the second and third vertebral bodies and adhesion of the cyst wall with the esophagus were found during the surgery. Appropriate treatment of the lesions consisted of curettage and iliac crest bone graft. After the operation, the patient had progressed favorably for seven months.
Cervical selective radiculography and nerve root block were carried out on 15 cases with cervical radicular symptoms from 1987 to 1989. Six of 15 cases were of cervical disc herniation and nine were of cervical spondylotic radiculopathy. The mean follow-up was 14 months. The clinical results of nerve root block were excellent in 2 cases, good in 8 cases, fair in 5 cases and there were no poor cases. Selective radiculography and block were usefull to decide the level of cervical radicular lesion. Nerve root block was useful as a conservative treatment for cervical radiculopathy.
Five cases, aged from 39 to 54 years, which showed the segmental sign with cervical disc herniation, were investigated. All of them initially complained of numbness and/or sensory disturbance of a unilateral upper extremity. Their symptoms showed the segmental sign one or two levels below the protruded disc level. The differential diagnosis between these and radiculopathy cases was difficult by neurological sign only, although MRI in addition to the neurological sign was extremely useful.
In this report, two cases of cervical disease are discussed which showed similar symptoms to thoracic myelopathy based on their neurological signs recognized mainly in the lower limbs and trunk. Case 1 is a 46 year-old male. He had numbness of the left lower limb and left side of trunk at onset, which gradually increased. However he had no motor disturbance of the extremities. Case 2 is a 38 year-old female. She had numbness, pain and muscular weakness of the right lower limb at onset, which gradually increased and was accompanied by slight motor weakness of the both lower limbs. Deep tendon reflexes of the lower limbs were hyperactive in both cases. A sensory disturbance was noticed below the level of Th6 in case 1 and below the level of Th4 in case 2. A spastic gait was recognized in case 2. No sensory or motor disturbance in the upper limbs, except positive Wartenberg's reflex in the both hands, was recognized in case 1. Deep tendon reflexes of the upper limbs were slightly hyperactive and Wartenberg's reflex was positive in case 2. After studies of myelography, CTM and MRI, the diagnosis of case 1 was cervical spondylotic myelopathy and case 2 was Arnold-Chiari malformation.
Two cases of cervical myelopathy with calcification of the ligamentum flava were reported. Characteristic clinical findings were reviewed, and genetic mechanisms of calcification of the ligamentum flava were discussed. One of our cases was the oldest woman (81 years old) of all reported authors cases. Since she showed a tendency of renal dysfunction, this was suspected to be associated with the cause of calcification of the ligamentum flava.
Many cervical orthoses are used as an oftertreatment of cervical operations. We have treated these cases satisfactorily with a cervical orthosis which was developed at Yamaguchi University since 1988. This orthosis is designed to be similar to the SOMI brace, but can limit the movement of the cervical spine better than the SOMI brace because of high occipital supports with a vercro-band. Further, since the mandibular support can be moved, the patient can eat meals comfortably. This orthosis has good adjustability, comfort, and excellent cervical motion control.
Many radiographic methods of determining bone density have been available for many years. We have used microdensitometry (MD) and quantitative computed tomography (QCT), on the grounds that MD measures cortical bone density and QCT can be used to directly measure the trabecular bone. We measured the vertebral body using CaCO3 phantom and the 2nd metacarpal bone with MD in 40 osteoporotic women, and compared with two methods in this paper. Correlation coefficient with CaCO3 value was 0.4809 for MCI (p<0.01), 0.5828 for GSmax (p<0.01), 0.6441 for SigmaGS/D (p<0.01). There was good correlation between the indicies of MD and the CaCO3 value of QCT.
This paper describes the study of bone rarefaction in 37 patients with low back pain, bone fracture and dental rarefaction after gastrectomy. Our investigations included laboratory tests and radiological measurements of bone mineral content. Serum calcium and phosphate levels were maintained within normal range but alkaline phosphatase was elevated in 8 patients and the level was a good correlation with the degree of bone rarefaction. PTH was impaired in 14 patients and was just below the normal range in 12 patients. Vertebral compression fractures were present 19.5% in males, and 21.1% in females. Bone mineral content was severely decreased in 3 patients and was slightly or moderately decreased in 23 patients, but was normal in 11 patients. Bone rarefaction after gastrectomy was assessed in 26 patients and was attributed to low turn-over osteoporosis.
A cell line of giant cell tumor of bone has been established in our laboratory. The cultured cells are composed of mononuclear cells alone. The cells are found to express phenotypes of both osteoclast and monocyte-macrophage, and are considered as a good model for studing bone resorption. In the present study, it was examined whether or not the mononuclear cells produce prostaglandin E2 (PGE2) using radioimmunoassay kit. The production of PGE2 was found and was supressed by indomethacin, dexamethasone, and Eel calcitonin. The production of PGE2 was low. Secreted PGE2 thus may not play a central role on bone resorption. However, the evaluation of the level of PGE2 may be useful for studying the metabolism of osteoclasts using this cell line.
The major histocompatibility complex antigen expressed in transplanted organs acts as both stimulators and targets in cells mediating rejection. In the organ allotranplantation it was reported that the nature of antigen, tissue location, and antigenic density may influence the course of development or intensity of the rejection process. The purpose of this study was to investigate modification of location and intensity of the MHC antigen expressing cells in allografted bone tissue using immunohistochemistry. Following conclusions were obtained through this study. (1) Some osteocytes expressed MHC Class I antigen in the normal rat bone tissue. (2) Expression of MHC Class I antigen in osteocytes showed diversity. (3) The expression of MHC Class I antigens in osteocytes on allografted bone tissue increased with time after bone allograft transplantation. (4) Three weeks after allograft transplantation, severe decrease of osteocytes on allografted bone tissue was investigated and almost all remaining osteocytes expressed MHC Class I antigen strongly on allografted bone tissue in DA to F344 strain combination. (5) MHC Class I antigens might play an important role in bone allograft rejection as seen in other organs in the rat.
The purpose of this work was to obtain the data on the revascularization and bone formation of allogeneic bone grafts. Windows 0.5cm wide and 2cm long were cut in the iliac bones of rabbits, and the bone grafts were inserted into these defects. The experiments were done using frozen and fresh allogeneic bone grafts. It was found that frozen and fresh allogeneic bone grafts were revascularized almost in the same manner, but there was one case involving fresh allogeneic bone which had delayed vessel penetration even after four weeks. Revascularization was observed prior to bone formation, and the absence of vascularization was associated with the absence of bone formation.
To study the healing mechanism of vascularized bone allograft, we performed experimental studies on genetically defined rats. In this paper, we mainly report our experimental model for vascularized bone allograft transplantation, which applies to the reconstruction of large bone defects, excluding joints, using radiological assessment in evaluating the viability of bone graft in this experimental model. The model employed in this study, was a vascularized tibiofibula from one genetically defined rat transplanted in an orthotopic, same limb, although the knee joint was removed to another genetically defined rat. Under anesthesia, the right tibiofibula was isolated with the femoral vascular bundle of a donor rat. The femoral artery and vein were dissected free from the groin to the popliteal fossa, keeping the saphenous artery and vein intact. The musculature just around the tibiofibula was also kept intact, so as not to damage the main vascular bundles in the lower leg during dissection. The knee joint was disarticulated and the joint surface was completely removed. The distal diaphysis was transected just proximal to the tibiofibula synostosis. In the recipient rat, the right lower limb including the knee joint, approximately 20mm in length, was removed to prepare a recipient bed, keeping the surrouding soft tissue intact. Donor tibiofibula with its vascular bundle was transferred orthotopically. First, the bone was fixed to the recipient bone using an intramedullary Kirschner wire. Next, the graft femoral vessels were microsurgically anastomosed end-to-end to the host popliteal vessels individually. As a control, we also made a non-vascularized bone allograft model. Soft tissues including periosteum around the graft bone were removed and grafted in the same way as the vascularized bone allograft model. Cyclosporin A (10mg/kg/day) was used for immunosuppression of the allograft. For methods of postoperative assessment, we used soft X-ray and bone scintigraphy. A positive scintiscan within the first week following surgery indicated the viability of the bone allograft under immunosupression in vascularized bone allograft. Callus formation from bone allograft on the second to third postoperative week also indicated the viability of bone allograft under immunosupression in vascularized bone allograft. The healing process of vascularized bone allograft from the osteosynthesis could be observed as a model of a segmental massive bone graft. Vascularity of grafted bone and it's rejection can be monitored using bone scintigraphy and soft X-ray. For these reasons, the model presented in this study should be useful for experimental studies on vascularized bone allograft transplantation to study the healing mechanism of the segmental massive bone graft, excluding joints.
Recently, pulsing electromagnetic field (PEMF) stimulation has been used for the treatment of delayed unions and non-unions clinically, but the mechanism is not clearly known. As a result, we investigated the effect of PEMFs on costal growth-cartilage cells of rabbits in culture. Cell growth and the ability of DNA synthesis and glycosaminoglycan (GAG) synthesis in the cells were measured. A PEMF generator was made in this department by using Helmholtz coil. Repetitive pulse burst (RPB) with a burst width of 76ms, a pulse width of 230μs and 6.4Hz was passed through this coil. The magnetic field strength reached 4 Gauss at the point where culture dishes were positioned. Growth-cartilage cells were isolated from New Zealand White rabbits (_??_ 300-600g). Culture medium was HamF-12 with 10% FCS. The ability of DNA synthesis was measured by 3H-thymidine incorporation. The ability of GAG synthesis was measured by 35S-sulfuric acid incorporation. We concluded that PEMF stimulation tended to promote cell growth and metabolism, especially immediately after stimulation.
Asphyxiating thoracic dystrophy (ATD) was first described by Jeune et al in 1954. The main features are a narrow, constricted rib cage and generalized chondrodystrophy with shortlimbed dwarfism. A case of ATD is reported. A boy was 4years 9month old. He had a episode of cardiorespiratory arrest in infancy. He was first seen at our hospital with spastic quadriplegia caused by intracranial hemorrhage. He was admitted in order to have an operation for dislocation of rt-hip joint.
We reported a pedigree with multiple epiphyseal dysplasia. The first case was a 55-year-old woman. On roentgenogram, abnormal lesions were seen in her hips, knees, ankles and spine. Her mother, son and grand-daughter also suffered from the same disease.
We investigated 7 cases of acromegaly with osteoarthropathy. In 4 cases of these, symptoms of osteoarthropathy occurred at early phase of acromegaly and preceded the diagnosis of acromegaly. Arthropathy of peripheral joints was same as conditions of osteoarthrosis and it's osteoarthritic changes such as osteophyte were obvious compared with their age. About changes in spine, symptoms due to compression by posterior elements presented as lumbar spinal canal stenosis. Patients who were diagnosed as lumbar spinal canal stenosis might have acromegalic signs if they were relatively young.
Three cases of osteomalacia caused by intravenous administration of saccharated ferric oxide were reported. Three cases were female with ages of 51, 55 and 61 years old. They received saccharated ferric oxide intravenouslly for anemia, just before having back pain, low back pain and hip joint pain due to osteomalacia. Their serum Ca and P were low and alkalinphosphatase was high. At their undecalcified thin sections of the iliac bone, osteoid surface and osteoid bone volume were increased, and little tetracycline had been taken, so that mineralization had been disturbed.
A rare case of renal tubular acidosis associated with hypoparathyroidism is reported. A 38-year-old man came to our department suffering from pain in his left thigh. Upon X-ray examination, subtrochanteric fracture of the left femur, osteosclerosis of spine and tubular bone, and basal ganglia calcification were seen. Upon biochemical examination, hypokalemia, hypocalcemia, hyperchloremia and metabolic acidosis were found. From the finding of NH4Cl loading test and biocarbonate loading test, this case was diagnosed as distal renal tubular acidosis. The finding of the i-PTH and Ellsworth-Howard test suggested that this case was associated with idiopathic hypoparathyroidism. The fracture was treated successfully with osteosynthesis.
We investigated the administration of etidronic acid to patients with painful calcification around the joint. There were six patients, who were all women aged 35-55. Five were around the shoulder and one was around the knee. Their primary subjective complaint was severe pain and primary objective finding was limitation of range of motion. All patients had calcifications found on plain radiographs. We administered etidronic acid, at a dosage of 400mg per day. The period of administration was from 10 days to 12 weeks and the period of follow up was from 2 months to 2 years. As their symptoms improved, the calcifications reduced in size or disappeared on plain radiographs. In the future, we will consider etidronic acid useful in the treatment of the calcification around the joint.
In the previous study we reported the calcification-promoting effect of triiodothyronine (T3) in the growth plate of HEBP-induced-rickets rats in soft tissue radiographs. The present study corroborates the same effect histologically. T3 treated rats showed increased thickness and cell number of the hypertrophic cell zone when compared to the control group. It is suggested that T3 can stimulate maturation and growth of the hypertrophic cells, and subsequently enhanced calcification, i. e. calcification-promoting effect.
In a selected group of 1 year to 70-year-old Japanese, 720 healthy subjects (380 males and 340 females) were investigated by examinating the joint hypermobility with the scoring system devised by Carter and Wilkinson. The following results were obtained. Joint hypermobility was greater in females than males. Joint hypermobility of upper limb was greater than that of the lower limb joint laxity decreased with age.
We investigated 960 hips (267 cases in female and 213 cases in male) of normal infants (one month to twelve months) radiographically. The mean age was 5.7 months for the females and 5.2 months for males. The mean acetabular angle was 23±3.9°in females and 21.2±3.8°in males, which were significantly different (p<0.01). Concerning the shape of acetabular beak, there was more advanced development in males than in females. The first appearance of the nucleus of the femoral capital epiphysis occurred between 3 and 8 months of age; at 5.6±1.0 months in females and 5.5±1.1 in males.