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甲斐 之尋, 大屋 国益, 杉岡 洋一, Jeffrey H Owen
1991 年 40 巻 1 号 p.
393-396
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
A dermatome is an area of skin innervated by nerve fibers which pass through one spinal dorsal root. The aim of this experiment is to investigate the sensitivity and selectivity of dermatomal somatosensory evoked potential (DSEP) and peripheral antidromic sensory response (ASR) by selective rhizotomy (dorsalor ventral), using anesthetized monkey. The spinal cord at C4-T1 was exposed under anesthesia. In DSEP, we stimulated the dermatomes of deltoid, thumb, index finger and little finger, and recorded from cervical spine and scalp. ASR was recorded from peripheral dermatomes by stimulating C1-C2. The dorsal rhizotomy selectively demonstrated the decrease of amplitude or loss to the root lesion, and high sensitivity in both of DESP and ASR. Ventral rhizotomy showed no selectivity. The selectivity of DSEP and ASR suggested the usefulness for diagnosis of radiculopathies. Furthermore, ASR was evaluated to be a reliable method to spinal cord monitoring because of the simplicity or the accuracy.
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内田 芳雄, 杉岡 洋一
1991 年 40 巻 1 号 p.
397-399
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
We dissected 88 elbow joints of human cadavers. The mean age of these cadavers was 68.5 years. The presence of degeneration of the articular cartilage, osteophyte or free body was observed macroscopically. At first stage, articular degeneration develops at the posterior part of the crest which separates the capitulum from the trochlea and the medial ridge of the radial head. Following this, the cartilage of the capitulum and center of the radius head is degenerated and finally, the cartilage of the trochlea and trochlea groove is degenerated.
These suggest that the humeroradial joint takes more mechanical stress than the humeroulnar joint.
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計測値と断面の形について
原 真一郎, 小西 宏昭, 鳥越 雄喜, 岩崎 勝郎, 内藤 芳篤
1991 年 40 巻 1 号 p.
400-404
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Pedicle screw fixation is now routinely employed. Implantation safety depends upon anatomic constraints from the pedicles. We measured directly the lumbar pedicles of cadavera of 20 patients and observed the isthmus shape of the pedicles in the pedicle models. We found that some transverse diameters are smaller than 6.0mm and that the pedicles are almost round or oval shaped with the exception of those of fifth lumbar vertebra.
These informations on these variations might help to prevent failure of fixation and injury to vital structures.
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橋田 忠昭, 金子 和生, 河合 伸也, 田口 敏彦, 川上 不二夫, 中原 庸夫, 佐貫 浩一
1991 年 40 巻 1 号 p.
405-407
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
We carried out the automatic analysis of the EMG interference patterns with turns amplitude analysis technique.
7 cases of peripheral nerve injury, 2 cases of dermatomyositis, and 5 cases of free muscle transfer were examined.
Both of 2 cases of dermatomyositis showed myogenic patterns. But the majority of the data from the subjects of peripheral nerve injury were plotted within normal range.
In order to evaluate the change of interference pattern at each stage, we collected the data from transferred muscle after 4, 6, and 10 months since operation. At first turns number increased, and then mean amplitude increased.
This technique was useful to evaluate the EMG interference patterns quantitively and objectively.
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長弘 行雄, 田口 敏彦, 小田 裕胤, 浦野 正之, 大谷 武, 豊田 耕一郎, 河合 伸也
1991 年 40 巻 1 号 p.
408-409
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
The microvasuculature of corrosion casts of peripheral nerves and lumbosacral nerve roots in monkey were examined by scanning electron microscopy. Peripheral nerves had two different vascular systems that were intraneural capillaries and extraneural plexus. The main compensation mechanism which had a great role on a blood supply was latter one. However, the vascular system of lumbosacral nerve roots had few “shunt structure”, and was consisted of constant close network of capillaries, probably which was main compensation mechanism.
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家兎膝関節内における腱修復像の組織学的検討
井上 廣, 今村 宏太郎, 長谷 芳文, 平野 徹, 岩崎 勝郎
1991 年 40 巻 1 号 p.
410-413
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
We engaged in experimental study modeled by Lundborg's studies in which he investigated the healing process of rabbit flexor tendon in synovial pouch of the knee joint. We studied the sutured tendons histologically which were placed in the rabbit knee joint and taken out after four five and six weeks. Adhesion of the sutured tendon to the synovial membrane was formed in strong granulation about the suturedsite but nonadhesive tendon was formed in weak granulation. We confirmed the intrinsic healing of tendon from this study.
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佐々木 誠人, 鈴木 勝己, 井上 仁郎
1991 年 40 巻 1 号 p.
414-417
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
The purpose of this study was to investigate whether joint sounds of gonarthrosis were changed by intraarticular injection therapy of high molecular weight sodium hyaluronate (SPH). SPH was administered to 17 patients (23 joints) with osteoarthritis from 4 to 10 times. The joint sounds were analyzed by phonoarthrography which we have been studying since 1980. Two examinations were done before the first injection and after the last one. The power values and the frequency spectrums obtained from the analyses were unchanged. It was concluded that administration of SPH had no influence on the joint sounds caused by patients suffering from gonarthrosis.
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赤嶺 卓哉, 田口 信教, 小笠原 悦子, 須藤 明治, 酒匂 崇, 松永 俊二, 井尻 幸成, 小城 琢朗
1991 年 40 巻 1 号 p.
418-420
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
We have investigated the effects of the low pressure environment (510mmHG) on the motor function in human. We have gotten some conclusions as below.
1) There are no significant effects on dorsal muscle function, dorsal muscle power and grasping power. 2) The significant decline of quick active function as finger-nose test was shown in the low pressure environment. 3) The significant delay of ulnar motor nerve conduction velocity was shown in the low pressure environment especially after loading exercise.
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飲料水中カルシウム含有量と骨塩量の比較検討
黒木 健次, 織部 安裕, 真角 昭吾
1991 年 40 巻 1 号 p.
421-426
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
We studied the relation between calcium ingestion and the amount of bone-salt observing the content of calcium in drinking water. The amount of bone-salt was examined comparatively by multiple scanning x-ray photodensitometry in old people living in Tsukumi City where areas showing a high calcium content in drinking water and areas showing a low content exist mixedly. In addition, the relation with the quantity of motion, obesity and criteria for osteoporosis at the regressive period were also studied.
As a result, significant differences were observed with obesty, quantity of motion and criteria for osteoporosis at the regressive period like the results of other investigators. But there was no significant difference in bone-salt regarding the content of calcium in drinking water.
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QCT法による腰椎の骨量
平松 隆, 久芳 昭紘, 高木 謙司郎, 岩崎 勝郎
1991 年 40 巻 1 号 p.
427-430
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
To investigate if there is correlation between the degree of osteopenia and likelihood to develop hip fracture, trabecular bone mineral density (BMD) of the third lumbar vertebra was measured by quantitative computed tomography (QCT) technique in 31 cases with hip fracture and 30 control ambulatory cases without hip, distal radius, or proximal humerus fracture. All examinees in the present study were women from 67 to 90 years of age in the hip fracture group and 65 to 90 years in the control group.
Results: The BMD distribution pattern of all cases in each group showed that BMD of the fracture group was significantly more than that of the control group. The BMD of the hip fracture group was less than that of the control group in age range 81-90 years, and more in age 71-80 years.
Conclusion: These facts suggest that the severity of spinal osteopenia has little to do directly with the incidence of hip fracture in the elderly, even if it can predispose it.
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山田 康人, 稗田 寛, 後藤 武史, 後藤 博史, 石橋 和順, 高森 博照
1991 年 40 巻 1 号 p.
431-434
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Quantitive Computed Tomography (QCT) is one of the most successful method in determining bone mineral content of the spine.
Lumbar mineral contents of one hundred patients (thirty-one males and sixty-nine females) were determined by the QCT method.
Following results were obtained.
1) In the female patients, bone mineral content of the lumbar spine severely decreased to marginal value of abnormality, boundary of their anomeria.
2) Bone mineral contents of the cases of trochanteric fractures were less than the cases of femoral neck fracture.
3) The results of QCT method were related to the classification system on plain x-ray photographs.
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萩野 浩, 山本 吉藏
1991 年 40 巻 1 号 p.
435-437
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Recently there has been rapid evolution of non-invasive techniques to quantitate bone mineral density. However, radiographic photodensitometry is useful and convenient in clinical situations. We evaluated the bone mass in healthy children using digital image processing method (DIP) and compared the results with bone age and radial bone mineral density (RBMD).
Bone density of second metacarpus in 100 children without metabolic bone diseases were measured by DIP. Bone age was calculated according to Gleulich & Pyle atlas and RBMD was measured using single photon absorptiometry. The values of sigma GS/D and MCI increased with age, and those in females were slightly higher than in males. They were correlated well with chronological age, bone age and RBMD, and the most significant relation was seen between sigma GS/D and bone age.
We concluded that DIP is a useful method for the evaluation of bone mass as well as bone maturity in growing skeleton.
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小宮 節郎, 金江 浩, 成田 修吾, 井上 明生
1991 年 40 巻 1 号 p.
438-442
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Bone mineral density (BMD) in the patients with coxarthrosis (OA), ossification of posterior longitudinal ligament (OPLL), or metastatic bone tumor of prostatic cancer (PC) was examined by dual energy X-ray absorptiometry (DEXA). BMD in OA was slightly increased in the lumbar spine and total body, and markedly in the femoral neck. Factors regulating bone metabolism were in the normal range in chemical examinations. The increase in BMD in OA was considered to merely reflect the obestic tendency in those patients. BMD in OPLL was increased systemically. It seemed that some factor relating to the bone metabolism was present in OPLL. Patients with PC showed a marked elevation in BMD in metastatic portions. However, systemic BMD was higher in some cases and lower in other cases. This may depend on the volume of calcium transported from the intact bones to metastatic portions for new bone formation.
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高橋 正樹, 伊藤 伸之, 衛藤 正雄, 太田 雄三, 岩崎 勝郎
1991 年 40 巻 1 号 p.
443-447
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
We report a case of insufficiency of bilateral shoulder function associated with Noonan's syndrome. Noonan's syndrome is characterized by multiple congenital abonormalities similar to those of Turner's syndrome and by normal karyotype.
A 4-year-old male infant was presented to Nagasaki University Hospital for deformities around neck and shoulders. These deformities had been noted since birth but no treatment had been sought. His father was noticed to have similar deformities of neck and both shoulders but is not alive now.
Physical examination revealed obvious superior migration of both scapulae, and active abduction of bilateral shoulders were only 80°. And he also had webbed neck, hypertelorism, antimongolid slant, low hair line, low set ears, high arched palate and shield like chest. Though there were no signs of cardiac abnormalities. Chromosomal analysis demonstrated the normal male karyotype; Noonan syndrome was compatible. Roentgenograms revealed bilateral elevated scapulae with each shape of equilateral triangle and no omovertebral bone. Abduction of bilateral scaplae on A-P view were under 6° in active aboduction of shoulders.
We resected scaplae 1cm in width along the vertebral margin, released rhomboid muscles and lower part of trapezius muscles and corrected the webbed neck deformity in the first and second operation. Although the mobilitiy of scaplae increased, active shoulder abduction decreased to 70° after these operation. Defect of scapular abductor muscles was suspected. Then we transferred pectoralis major muscles to both scaplae. Abduction of the right scapula was improved to 28° after 2 years and abduction of right shoulder increased to 150°. Abduction of left scapula was 4° after 3 months. The obtainment of scapular abducting power and stability of scapulae may have contributed the improvement of shoulder abduction.
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前田 公, 吉良 秀秋, 藤樹 宏, 藤本 勝也, 川冨 正弘
1991 年 40 巻 1 号 p.
448-452
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
A case of calcification simulating tumoral calcinosis was reported with the review of literature. A 41-year-old woman had been on maintenance hemodialysis after 1976 and developed a large mass around the knee joint in 1988. Serum calcium level had been controlled within normal range, whereas serum inorganic phosphate had been elevated to more than 11mg/dl after 1988. Parathyroid hormone (C-PTH) was less than 10ng/ml and X-ray findings were not characteristic of secondary hyperparathyroidism.
These findings suggested that elevation of serum inorganic phosphate was the most important factor for development of this calcification.
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山田 修, 奥江 章, 石崎 知樹, 松村 公志, 草場 謙, 福岡 真二, 田原 尚直, 徳永 真巳
1991 年 40 巻 1 号 p.
453-464
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Sisters came to our hospital complaining of short fingers and toes in 1984. The elder was 8 years old and the younger was 7 years old. They exhibited short metacarpal and metatarsal bones due to early epiphyseal closure on physical examination, and normal serum calcium, phosphorus and parathyroid hormone on laboratory findings, we diagnosed pseudopseudohypoparathyroidism. But they developed hypocalcemia and hyperphosphatemia with the growth spurt. Ellsworth-Howard test recently performed using human PTH showed positive urinary cyclic AMP response and negative phosphauric response, so we diagnosed them pseudohypoparathyroidism Type II by Drezner's classification.
We thought their serum calcium level had been barely within normal range with the normal level of circulating 1, 25-dihydroxyvitamin D because of a mild form of pseudohypoparathyroidism, but increased calcium requirement with the growth spurt caused hypocalcemia and hyperphosphatemia.
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時任 毅, 佐竹 孝之, 安竹 千恵, 宮房 成一, 江田 伊勢松
1991 年 40 巻 1 号 p.
465-469
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Nemaline myopathy is one of congenital myopathies, and Shy and co-workers described as a nonprogressive disease of skeletal muscle, which was associated with the presence of nemaline (rodlike structures) in muscle fibers (1963).
The present case report concerns a ten-year-old girl, who complained “running slow” chiefly. She represented proximal dominant muscle atrophy and weakness, and the muscle weakess is progressive. Muscle biopsy findings revealed typical rod bodies, hypoplastic type I fiber, and type I fiber predominance, thus we diagnosed the case as nemaline myopathy. We found out her respiratory system disorder due to muscle weakness, so we mean to do a careful clinical follow-up.
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井上 治, 島袋 博之, 新垣 宣貞, 大嶺 啓, 砂川 憲政, 茨木 邦夫
1991 年 40 巻 1 号 p.
470-475
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
The concentration of the acid and alkaline phosphatase (Acid P, Al-P) in cyst fluid, in bone marrow and in peripheral blood (serum) were evaluated in 12 cases of simple bone cysts (SBC). The highest concentration of Acid P and Al-P was observed in cyst fluid, and the concentration in bone marrow was higher than serum, except two cases of huge SBC's where the concentration of Al-P were decreased markedly in the cyst fluid. In beagle dogs, variable difference of Acid P or Al-P concentration in any bone marrows was observed in either proximal or distal extremities. The concentration of glucose, electrolytes, transaminase, etc in cyst fluid, bone marrow and serum was almost equivalent in a SBC. The etiology of SBC is reportedly the impaired evacuation of the cyst fluid. However, the cyst fluid presumably circulates with the bone marrow or the peripheral blood. Lower concentration of the phosphatase in serum is probably due to diffusion from higher concentration in bone marrow. However, the high concentration of the phosphatase in cyst fluid is presumably the release of Acid P by osteoclasts, or Al-P by osteoblasts. Therefore, when the activity of osteoclasts around the cyst is overwhelming, SBC may enlarge, or when the activity of osteoblasts around the cyst is overwhelming, SBC may subside.
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田口 勝規, 平野 徹, 神代 敏之, 岩崎 勝郎, 吉良 秀秋
1991 年 40 巻 1 号 p.
476-479
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
We present a case of periosteal ganglion in the distal metaphysis of the femur, in a 50 years old woman, which was confirmed by the surgery. Radiograms showed the cortical erosion and spicula formation mimicing the malignant bone tumors. However, no increased uptake was seen in the lesion by
99mTc-MDP scintigraphy. MRI suggested periosteal ganglion from the findings of its periosteal location and the content of low signal intensity in T
1 and high signal intensity in T
2.
Those findings have been discussed on the points of the image diagnosis.
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新門 裕三, 酒匂 崇, 梅津 龍哉, 田中 信次, 伊藤 博史, 松永 俊二, 橋口 雅尚, 福元 隆史, 森本 典夫, 長野 芳幸
1991 年 40 巻 1 号 p.
480-482
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
We treated eleven cases of subungual exostosis. Three male and eight female patients aged 3 to 46 years (mean, 14.1 years) were included. All cases showed nail deformity and pain in the involved area at the first visit. Although eight of eleven cases (72.2%) had the exostosis on the great toe, one case with multiple exostosis showed subungual exostosis on the right index finger and left ring finger. All cases were treated by excision of the tumors. There was no local recurrence, however residual nail deformities were recognized in two cases. Although confirmed episode of significant trauma was seen only in one case, repeated minor trauma was considered the main cause of this disease. Local excision is the treatment of choice. It is essential that fibrocartilaginous cap must be completely excised to prevent recurrence.
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内田 仁, 増田 頼昭, 高木 一広, 中村 道利, 曽根 勝, 森内 昭
1991 年 40 巻 1 号 p.
483-486
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
A rare case of periosteal osteosarcoma arising in the distal part of right femoral bone of a 24-year-old man is reported.
Radiographically, the tumor was located at the surface of cortex with perpendicular spicula.
After marginal excision, chemotherapy and limb-salvage surgery were performed.
Histologically, the tumor was moderately differentiated and chondroblastic. Some areas were composed of spindle cells that had foci of lace-like osteoid and frequently trabecular-appearing young bone was observed.
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鳥取部 光司, 長鶴 義隆, 帖佐 悦男, 田島 直也
1991 年 40 巻 1 号 p.
487-490
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Fibrous dysplasia of the femoral neck is a serious clinical problem because structural stability is destroyed.
We experienced treating four patients with monostotic fibrous dysplasia of the femoral neck. One of the patients was male and three were female, whose ages were 16 to 41 years. Two patients were treated with curettage of lesions of fibrous dysplasia and autogenous cancellous bone-grafting, together with vascular bundle transpla ntation. One patient was treated with curettage and cortical bone-grafting, and the other with corrective osteotomy for coxa vara after a pathological fracture.
In the treatment of symptomatic fibrous dysplasia several surgical approaches have been uesd with varying success. Curettage and autogenous cancellous bone-grafting are used primarily as a means of filling small defects and inducing bone formation. But radical excision is being abandoned, since it is now recognized that removal of all dysplastic tissue is not needed to achieve a satisfactory result. So autogenous cortical bone is chosen for reconstructing large defects that require strength and is used primarily as supporting struts. When a symptomatic deformity is continued, corrective osteotomy is indicated to obtain normal biomechanical values of the hip.
Our treatment plans are as follows;
1) prevention of deformity and fracture
2) corrective osteotomy for a symptomatic deformity
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舟橋 敦, 伊地知 正光, 宮崎 弘, 李 新一, 竹内 一哉
1991 年 40 巻 1 号 p.
491-494
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
A sixteen-ear-old boy came to our hospital complaining of the prominence of bony mass with audible and palpable grating localized at the medial side of the right scapula. Regular anteroposterior and tangential view of the scapula showed a bony mass on the sixth rib. At operation, there was an inflamed bursa containing bloody fluid between the scap ula and the sixth rib. The tumor was removed from the right sixth rib. Histological examination showed it to be an osteochondroma.
Snapping scapula (scapulothoracic syndrome) is a relatively common clincal condition. It may be attributed to two underlying causes: (1) changes in the interposed soft tissues, the muscles, and the bursae between the scapula and the chest wall and (2) changes in the congruence between anterior scapular surface and underlying chest wall.
The snapping scapula of this case was due to the projection of an exostosis of the right sixth rib and the inflamed bursae between the scapula and exostosis.
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岩城 彰, 牛島 正博, 一瀬 幸人, 川崎 雅之, 原 信之
1991 年 40 巻 1 号 p.
495-497
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Metastatic carcinoma in the hand is very rare. We now report a case of the metastatic lesion to the distal part of the finger from lung cancer, diagnosed by biopsy as squamous cell carcinoma. A 64-year-old man presented with a swelling and pain of the distal phalanx of the left ring finger. The swelling with blister had increased in size, resulting in ulcer formation. X-rays of the involved finger showed an area of lytic destruction of the distal phalanx. Amputation at the proximal phalanx of the left ring finger was performed, and pain was completely vanished. Histological examination showed well differentiated squamous cell carcinoma, similar to the primary lung lesion. Metastases to the hand from other malignant tumors are very rare, the incidence of hand involvement being 0.2% of all osseous metastases. Clinical manifestations resemble inflammatory diseases, such as whitlow, felon, osteomyelitis or gout. A high degree of suspicion, radiographs and biopsy help to clinch a correct diagnosis. A diagnosis of metastasis to the hand connotes a poor prognosis, proclaiming well-advanced and disseminated disease, which indicates that almost all patients are dead within six months.
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中馬 広一, 岩本 幸英, 大石 年秀, 杉岡 洋一, 福間 久俊, 別府 保男, 横山 良平, 増田 祥男, 牛島 正博
1991 年 40 巻 1 号 p.
498-502
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Malignant bone tumors of the distal fibula are rare and only thin tissue covers fibula. Amputation has been selected for surgical treatments. Recent neoadjuvant chemotheraphy makes primary lesions controlled and local surgery is tried for high grade osteosarcoma or Ewing's sarcoma.
We had two cases of malignant bone tumor of the distal fibula and tried to resect these high malignant bone tumors. Patients had a malignant fibrous histiocytoma and osteosarcoma. We reconstructed malleolus with bone graft from ipsilateral fibula diaphyseal bone. Two patients have no local recurrence and no functional disturbance for about three years since operation. But radiography show the valgus deformity of the ankle and the atrophy of grafted bone. It is necessary to follow these bony changes in future.
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神代 敏之, 平野 徹, 岩崎 勝郎, 今村 宏太郎, 長谷 芳文
1991 年 40 巻 1 号 p.
503-506
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
The functions of the preserved limbs were evaluated in 15 patients with malignant bone tumors about the knee by Enneking's criteria. The skeletal defects, after the resection of the tumors, were reconstructed with endoprosthetic replacement in 8 patients and with arthrodesis using free vascularized fibular graft in 4 patients. Remaining 3 patients underwent wide resection alone, knee rotation plasty and intraoperative radiotherapy, respectively.
Functional evaluation showed excellent in one, good in 7, fair in 5, and poor in 2, with the mean follow-up period of 33 months. The patient treated with intraoperative radiotherapy showed an excellent function.
It suggests that intraoperative radiotherapy would be of use in securing the best possible function of the affected limbs.
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葉 山泉, 高岸 直人, 諌山 照刀, 樋口 善友, 吉武 研三, 張 敬範
1991 年 40 巻 1 号 p.
507-511
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Limb-saving surgery plays an increasingly important role in the treatment of malignant tumors of the extremities.
This type of surgery may pose special problems in longterm survivors. The different possibilities of reconstruction after a tumor resection and repercussions in growth are discussed.
Case 1. In this ten year old girl with osteosarcoma of the left distal femur, wide excision of the tumor site and a total knee replacement were done in September 1983, Two years postoperatively she presented late hematogenous infection of total knee replacement. Three times of surgery, debridement only, remove of prosthesis and two stage revision, wase done. In September 1989 rotationplasty were done because of uncontrolled infection. Case 2. In this twentytwo year old female with malignant fibrous histiocytoma of the left proximal tibia, wide excision of the tumor site and a total knee replacement were done in December 1983. Four years postoperatively she presented patellar tendon rupture, In July 1988 repair of the tendon with the use dacron ligament prosthesis to reattatch the tendon to the tibial component were done. To date, they had been followed for seven years with good function of limb, but without any indication of either local recurrence or metastases.
The role of recostruction by means of a rotation plasty versus other methods of recostruction, and the repair of the tendon using ligament prosthesis and autotendon to reattatch the tendon to the tibial component is specially cosidered.
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小宮 節郎, 金江 浩, 南谷 和仁, 中島 雅典, 平岡 弘二, 井上 明生
1991 年 40 巻 1 号 p.
512-517
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Cases of unusual osteosarcoma comprising parosteal osteosarcoma, intraosseous well differentiated osteosarcoma, postradiation osteosarcoma, epithelioid osteosarcoma, and MFH-like osteosarcoma were reported. They were apparently differed from conventional osteosarcoma in the point of biologic activity and prognosis. Osteosarcoma is, therefore, considered as a heterogeneic tumor. It is important to make an exact diagnosis and to make an appropriate treatment depending on the diagnosis.
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島袋 博之, 井上 治, 新垣 宣貞, 茨木 邦夫
1991 年 40 巻 1 号 p.
518-522
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Althogh Tru-cut needle biopsy is becoming a useful device for the diagnosis of breast cancer etc, Tru-cut biopsy for soft tissue tumors in the extrimities is rarely repoted. Therefore, we report our cases for soft tissue tumors or bone tumors infiltrating to soft tissue. 35 patients (male, 14; female, 21), composed of five malignant soft tissue tumors, three malignant bone tumors, 16 benign soft tissue tumors, two benign bone tumors, and nine non-tumorous lesions, are reported. The core specimen, 2mm in diameter, taken by Tru-cut biopsy was prepared for HE staning and or frozen section as well as Gimsa staining. In 35 cases diagnosed by Tru-cut biopsy, 28 cases concurred with the final diagnosis by the surgically resected specimens. One malignant soft tissue tumor of differenciated liposarcoma was diagnosed as benign soft tissue tumor of lipoma. No benign tumors were diagnosed as malignant. Two benign tumors of desmoplastic fibroma and haemangioma were diagnosed as non-tumorous lesion of fibrosis. Two non-tumorous lesion of epidermoid cysts could not be diagnosed. Two benign tumors of haemangiomas were diagnosed falsely due to erroneous sampling. Tru-cut needle biopsy can be carried out in out-patient clinics, and it is beneficial for the screening of benign or malignant soft tissue tumors.
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飯田 博幸, 大慈弥 裕之, 尾上 英俊, 葉 山泉, 諫山 照刀, 深掘 雄蔵, 下河邉 建彦, 後藤 英文, 大里 徳浩, 高岸 直人
1991 年 40 巻 1 号 p.
523-526
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Three patients with three different types of vascular tumors of the hand were treated using an Nd-YAG laser. The patients, one male and two females were aged 32, 15, and 51 years old, respectively. The resection of the venous hemangioma in the right palm and little finger of the 32 year old male resulted in a good range of motion, good function, and a pain free state. Equally good results were achieved in both a 15-year-old female, who had cavernous hemangiomas in her left thumb, index, and middle fingers; and a 51-year-old female, who had spindle cell hemangioendotherioma in her right elbow and right hand. Partial excisions were performed in all three cases because the tumors involved digital or ulnar nerves. Blood loss was minimal (averaged 230 grams) compared with usual surgical excisions. The Nd-YAG laser is the only current laser capable of direct tissue contact and the best possible available thermal coagulator giving good penetration with distinct advantage in this type of surgery.
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細川 哲, 岩本 幸英, 中馬 広一, 杉岡 洋一
1991 年 40 巻 1 号 p.
527-529
発行日: 1991/11/25
公開日: 2010/02/25
ジャーナル
フリー
Additional wide resections have been performed for the patients with malignant soft part tumors. The correlation between the prognosis of the patients and the following four items were evaluated: 1) the interval between simple excision and additional wide resection, 2) existance of recurrent tumor, 3) surgical margin of the additional wide resection, and 4) histological diagnosis. The histological diagnosis alone was well related to the prognosis of the patients. The incidence of the recurrence was high in the cases with MFH. In the cases with MFH, tumors recurred even after resection with wide margins.
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