Ether anesthesia is very important method in Japan, but it has far more dangerous effect for children than adult. As the cause of it, the children is at a disadvantage in anatomical and physiological conditions. The remarkable dangerous elements are anoxia, acidosis, acceleration of secretion, rising of body temperature, disorder of liver function and dehydration, etc. Then I emphasize the preventive methods of these dangerous elements.
83 cases of congenital dislocation of the hip joint in infants under one year of age were treated non-operatively and were observed radiographically for 0.5-3.0 years after the treatment, the very good healing was 73.5%. Among the numbers 40 cases were treated with reinforced baby wraps which is a simple procedure for every mother in keeping the baby's hips in abduction. The very good healing was 57.5%. The indication for that procedure may be as follows: 1) Hypoplasia. 2) When a diagnosis of dislocation is difficult for account of absence of the femur head in radiograph. 3) Subdislocation which may be easy reduced by the simple abduction of the hip, without remarkable noises. 4) If it would not be successful despite the procedure continued for 2-3 months, the other treatment should be followed.
Wir hatten bei 2 Fällen von der Subluxation des Hüftgelenks durch die Pfannenplastik eine guten Erfolge erzielt, und wir berichten erste Mittelung über deren Operationsmethode und Ergebnisse. Über die Resultate unserer experimentellen Forschung dieses Problems und die noch weiteren klinischen Erfahrungen sollen wir noch später bekanntmachen.
I report about comparatively rare instance that healthy fifty-three years old labor had fractures of nine places at a time though I could not find any other mortal injury. The places are as following, (1) Fractures of the eleventh in right and twelfth in left of the ribs. (2) Fractures of the ninth and twelfth dorsal vertebra bodies. (3) Fractures of the first, second and third transversal processes of spine in left side. (4) Fracture of the left ilium. (5) Fracture of the left acetabulum of hip. (6) Fracture of the left ischium. (7) Fracture of the left femur. (8) Fractures of the lower end of both the tibia and fibula in left. Fracture of the anterior margin of the left tibia. (9) Fracture of the lower end of the left radius.
The authors experienced a case of the fracture of the right scapula by the first electroshock therapy in 49 years man. The fracture healed without any functional troubles by the plaster of Paris bandage in the abducto-upper position of the upper limb. This mechanism would owe to the abnormal contraction of the rhomboideus and teres muscles. As might be necessary to the treatment of the psychiatrical area, the electro-shock therapy must be forced with precautions not to bring a disturbance of bones and joints. And as for the therapy, there happens less disturbance than the first time, it would be the most important matter to manage one protectively.
The author measured the amount of 17-ketosteroid (17-K-S.) in the urine in several orthopedic diseases, and important results obtained were as follows: 1. Rheumatoid arthritis. In 19 cases of rheumatoid arthritis, the amounts of 17-K-S. were evidently less than in healthy persons of same sex and age, and they were in inverse proportion to sedimentation rate. Although the amounts of 17-K-S. didn't increase after administration of Salicylamin (daily dose of 6gm.), Irgapyrin (5cc) and DOCA (5mg) with Vitamin C (500mg), they were increased moderately by T. T. G. (50γ), and remarkably by ACTH (10mg) and Cortisone (120mg). 2. Tuberculosis of bone and joint. The average value of urinary 14-K-S. excretion in 11 patients with tuberculosis of bone and joint was also less than that in healthy persons, however, the individual amount of them varied largely and showed no relation to sedimentation rate. 3. Effects of operation on children. After the orthopedic operations, such as arthrodesis, osteotomy and drilling of femoral head, the amount of 17-K-S. increased slightly during a week.
These were found not rarely according to my investigation. (1) Those golfers suffering from the fracture of ribs were mostly the beginners who got the injuries during the time in less than 6 months or so after starting to play the game and their ages were extending from 39 years to 51 years and 7 months old. (2) The fractures of ribs were found between 3rd and 9th rib. However, many cases of them were found mostly between the 4th and the 7th rib. (3) The number of fractured bones were from 1 to 5, average 2.4 for each one. I found the tendency of increasing number of more fractured bones from 3 to 5 for those who commenced the game at some 50 years old or thereabout comparing with that of young players. (4) The parts of fracture were generally fixed at a certain place, that is; at left side back ribs and all of those sufferers were right handed men. (5) The cause of breaking out of this fracture is presumed to come out from exhaustion of muscular strength of muscles attached to ribs.
Author experienced last three years ninety-six injuries of bicycle race champions, in kokura including 37 bruises, 25 cerebral concussions, 19 fractures, 8 contusions, 5 abrasions, and 2 other cases. Among 20 fractures, fifteen were clavicles, one was the re-fractures in the same part, and one thrice in the same part. Age; fifty-six cases are found, especially in 21 to 25 year-old champions, and next to them come 16 to 20. Seasons, many injuries occured in winter and a few in autumn. There was no death case. In the final races or grand races, the injuries are comparatively rare, for the best grade champions take part in it. Recently the injured and patients who go to hospital in the race have decreased than before.
1) The cases are often seen, in which the infant fracture of tibia the is subperiosteal fracture. Beside, they are almost the single fracture without the fracture of fibula. 2) The subperiosteal fracture of tibia have possibility to happen easily by only very slight external force. And we often meet those cases in which we are unable to recognize any dislocation or movability. So we take sometimes them for the simple contusions. But in these cases, the functional disorder, for which the patients are unable to stand or walk, appear remarkably. And the local tenderness is recognized in the all cases. 3) The greater part of the region of fracture is below from 1/3, of tibia, including the boundary part of the middle and the lower of it. 4) The condition of fracture is torsionfracture, and the fracture-line runs spirally, obliqualy and long, from the upper behind and the outside to the lower front and the inside.
The atrophy of the muscles of foot is generally observed in case of flat-foot. But how can it be testified by means of electromyographic impression, and what form of impression do the muscles show? I have examined the clectromgogram of musculus abductor hallucis and musculus flexor hallucis longus in standing position, by means of the measurement of the electric discharge of the neuromuscular unit. The results obtained are as follows: 1) The sway of the discharge intervals of the neuromuscular unit of the flat-foot is wider than of the normal one. 2) The discharge intervals in case of the flat-foot are shorter than those of the normal one. These results, I suppose, reveal the fact that the foot muscles of the flat-foot patients should more easily be tired than those of normal ones.
From the observation of the electromyograms of the normal and the wounded antigravity muscles of rabbits (M. vastus lateralis and M. vastus intermedius), the following results were obtained: I. Normal electromyogram The wave form is almost diphasic or triphasic, the amplitude is mostly 500-1, 500μV, the duration is about 3-8 msec., and the frequency is approximately 5-8c/s. II. Abnormal electromyogram of the wounded position a) Case of slight wound The electromyogram becomes normal after about six weeks from the time of injury. The process is shown by the following schema; electrical silence—fibrillation voltage →complex NMU voltage—normal NMU voltage. →reinnervation voltage. b) Case of severe wound The electromyogram does not becarn enormal. Electrical silence—fibrillation voltage—electrical silence.
The author experienced recently a rare case of a burn death in a patient suffering from Perthes' disease, treated with celluloid appliance. the patient, five years old boy, ran all the way for about fifty metres to home in a blaze after having caught fire in playing with fire, and he died in fifty hours. Although the cause of his death is his playing with wood fire, there is no gainsaying for the celluloid appliance. Therefore, it would be necessary not only for the patients with celluloid appliauce to take care of themselves, but also to make the orthopedic appeiance with the incombustible materials.
So far as joint mouse is concerned, we have not comparatively many reports in the our country but I had experienced a patient, a man of 31 years of age, who is suffered from osteochondrom in the right knee joint. He distorted the right knee joint in the training of Judo and had undergone the treatment of neuralgia, but he was not well. Far feeling awfully pain during walk, he consulted me on the 16th, October 1953. Symptoms at first are as follows: Muscle in the right leg is generally shrunk, but nojoint fluid. The bending angle in the knee joint is 170 deg. (self-moving) and 145 deg. (passive). Above 145 deg, he felled awfully pain with crepitation. X-rays showed that about 15 joint mouses, which were operated away, from little finger to fore-finger great, some distinct and other indistinct, exist around the knee joint. Histological changes of the joint mouses were hyaline degeneration and some parts of them were nekrois. In 2 weeks after operation, he became so good that he could bend the right knee joint until 75 degrees and extend until 180 degrees.
A boy, aged 10 years, noticed a walnut-sized tumor below his right fibular head, and complained of limp and loss of dorsiflexion of his great toe during last four months. On pressure the tumor, he complained of radiating pain to his great toe. He remembered to be contused two years ago on the lateral area of right knee. The symptoms were caused by the ganglion in ramus m. tibialis ant. of peroneal nerve, which was proved by the operation.
By means of the papermethod, we have made a sensitivity test of staphylococci to antibiotics. The results of its test upon 53 strains of staphylococci are shown as follows: sensitivity to penicillin has been seen in 23 cases (43%), aureomycin 34 cases (64%), terramycin 21 cases (40%), and ilotycin all cases (100%)—especially shown high degree of its effect. Furthermore, streptomycin 44 cases (83%), while chloromycetin none. In our conclusion we consider, after actually adapting the therapy of antibiotics for some cases on the basis of above mentioned test, that it is worth for its clinical adaptation to be availed.
At the diseased site of chronic osteomyelitis and the suppurative imflammation with fistula, staphylococci were seen chiefly and when penicillin was given intramuscularly, the staphylococci in the pus did not disappear but had gained resistance to the drug in the early stage. The infection by penicillin-resistant staphylococci appears to have a tendency to be seen frequently. It is absolutely necessary to perform the sensitivity test of causative agents of the infection to several antibiotics to search for any antibiotic available before starting the treatment. In most cases the test is found to agree with the results of clinical application according to the auther's experience. In many respects the tablets method was superior to the ones ordinarily used so far such as the dilution test. Tablets method can be performed more easily, quickly and exactly. Author found 24 penicillin-resistant strains among 36 strains of staphylococci (67%) isolated from fistula. The staphylococci in the secreting fluid taken from fistula had acquired resistance to penicillin in the early stage but the staphylococcus isolated from operatively removed sequestra were sensitive to antibiotics.
One of us, A. Miyazaki, has already reported on the reaction of the rabbit's spine to the long durated overwork, compelled by way of the method in the J. Journal of clinical and experiment medicine 25; 271, 1948. We have following up further and obtained the following results. The Experiments of longer duration and rather few times of exercise lead to the result that, intratrabecular resorption and hypertrophy of the trabeculae, not observed by former experiment, are remarkable. By the short durated and frequently repeated exercises, on the other hand, we observed the resorption of compact bones, hypertrophy of the trabeculare, new bone formation in the bone narrow, hindrance of the growth of epiphyseal cartilage and the partial necrosis of the epiphyseal ossicle.
I will report on influences on the bone growingg when hypophysectomy after Oyama's method, sacrified 96 rats. I have been experienced for 14 weeks after hypophysectomy. The hypophysectomy causes an immediate cessation on the bony growth, body weight and body length. Summary of the experimental results; 1) After hypophysectomy the rat was suppressed bony growth hardly, but had not entirely suspended the development of the length diameter of long bones. 2) Histological changes of bone growth; 5 days, after hypophysectomy, I have observed the epiphyseal cartilages becoming narrow, and degenerated. After 2 weeks, the columnar arrangement of cartilage cells become irregular, after 3 weeks the bony cortex has been thinned, after 6 weeks the changes in all zone of epiphyseal cartilages, after 14 weeks, the trabeculae was almost disappearance, calcification was suspended. The epiphyseal cartilages persisted long after the normal period for its ossification, but cartilage cells entirely degenerated. 3) The diameter of epiphyseal uncalcified portion was constant (after Li Evans method). 4) In the hypopbysectomized rats, I hove observed great changes in thyroid, gonads and adrenal cortex, small changes in thymus and Paro tis, and no changes in Parathyroid. The brain weight was equal.
Author examined by electrophoretic method the serum protein of 59 patients with tuberculous bones and joints and 19 patients with back pain. The results obtained were as follows: 1. The levels of total protein in sera increased usually in the series of the patients with tuberculous bones and joints, especially in those who were complicated with abscess, sinus and pulmonary and renal tuberculosis. 2. As to the components of sera, it was measured to decrease albumin and to increase total globulin. 3. Analysis of each component of globulin showed the increased α- and γ-globulin, remaining β-globulin constantly. 4. The changes of levels of total protein in sera and their components didn't relate to the sites of lesions, but to the complications, and became evident over the value of 20mm of sedimentation rate.
The joint tuberculosis was treated in our clinic after three principles, plaster of gypsum fixation for children, arthrodesis for adult, and osteotomy for contractured joints in bad position. We have 29 cases of tuberculosis of the hip joint followed up more than 2 years and 8 cases of knee joint tuberculosis too, treated non-operatively; (1) Not a case of hip joint tuberculosis was healed with movability. The date of healing by way of arthrodesis, are shorter than those of treated by non operative means. Surgery, therefore, should be done on a proper occasion. There is a growing tendency to make sinuses when the osteotomy for contracture of the hip was done but failed to complete osseous ankylosis. (2) In the knee joint, on the contrary, we have had the cases healed with good movement, but these are exclusively limited to the tuberctulosis of synovial membrane in children. As to the duration of fixation in cases of children, more than 3 years are required whatever the general and joints condition are very good.
By means of the histological and histochemical methods, we studied the puncturing skin graft in animal and experiments. The results are as follows: 1. The punctured full thickness skin grafts are supplied from the host to the epidermis through the punctured canal and the crevice of tissue within several hours, therefore there is hardly danger of necrosis. 2. Generally, a grafted skin is supplied nutrient gradually around the skin flap, through the crevice of tissue. Therefore, there is danger of necrosis if skin grafts were very thick and large. Clinical experience: 1. We have experienced on 11 patients (22 locals.) who are suffered from contraction of scar tissue by puncturing full thickness skin graft, and the performances were all led to success. (largest 140cm2.: success) 2. Operative technique. I transplanted full thickness skin to the wound after removing of scar tissue, with general attention, and then punctured the grafting skin by the injection's needle. (30 Punctures, per 10cm2.) The bandage and fixation were tried with general attention.