Two cases of rotator cuff tear caused by large subacromial spur are presented.
Case 1. A 59-year-old farmer developed night pain in the right shoulder during four months. Plain roentgenogram showed large subacromial spur, but only sonogram could be detected bursal side partial thickness rotator cuff tear. Surgery was performed at which 15 x 10 mm bursal side incomplete tear was found in the supraspinatus tendon. Wedge resection and side to side suture following anterior acromioplasty was carried out.
Case 2. A 56-year-old carpenter struck on h is right shoulder and increased insidious pain for six months. Large subacromial spur was showed on plain roentgenogram and massive cuff tear was revealed by arthro- and sonogram. At surgery it was found that anterior edge of 20 x 40 mm spur attenuated torn cuff end. Tear was repaired with McLaughlin technique after anterior acromioplasty.

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The existence of long-latency responses following M and H waves in the complex muscular action potential elicited by stimulation of peripheral nerves was reported by Upton et al. This electrical potential, called the C-response, is applied to examinations in central nervous system diseases. However, the pathway and details on fundamental types of waveforms have not yet been clarified. The main purpose of this study is to classify the waveforms of the C-response, based on the analysis of waveforms. To investigate the type of C-responses, we developed a modified superimposing method. We also investigated the types in different age groups. Fifty-seven healthy individuals (30 males and 27 females) aged between 20 and 73 (average age: 43.1 years old) were enrolled as subjects. All subjects were instructed to oppose the thumb against the little finger of their dominant hands so that the abductor pollicis brevis was in voluntary isometric contraction; subsequently, electrical stimuli were repeatedly applied to the median nerve at the wrist. The stimuli had a strength of 110% of the threshold value of the M wave. The electrical potential was recorded with surface electrodes placed on the muscle belly of the abductor pollicis brevis. In each measurement, 200 waveforms were averaged. A Neuropack 8 (Nihon Kohden, Co., Ltd.) was used for recording and analysis of electromyograms. Measured negative peak latencies (ms) were divided by the subjects' heights (m) to obtaining the corrected latencies per unit height. The time axis of a waveform was also corrected with each height, and shifted so that the latency of the negative peak of the H wave was observed at the same position (modified superimposing method) . Then, the position where the negative peak of the C-response appeared most frequently was examined.
We clarified that C-responses have three types. C-responses have two major negative peaks basically, C1 and C2 (the latency of C1 is shorter than that of C2) . Type 1 has only C2; Type 2 has C1 and C2; Type 3 has both C1 and C2 but the latency of C2 is shorter than that of Type 2. Type 1 was observed in 37 cases (64.9%) , Type 2 in 15 cases (26.3%) , and Type 3 in 5 cases (8.8%) . The incidence of each C-response type depended on the age of the subjects, Type 1 was observed frequently in young subjects, and Types 2 and 3 were observed more frequently as the age of the subjects increased.

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〔目的〕超音波画像診断装置を用いて，多裂筋を含む横突棘筋の従来の筋電図の電極貼付け位置の妥当性を検討する．〔対象〕健常成人男性20名とした．〔方法〕腹臥位にてL2，L4棘突起から外側3 cm，6 cmの右側腰部4部位を撮影し，各部位で表層に存在する筋，棘突起から横突棘筋外縁までと最表層までの距離を計測した．〔結果〕日本人の若年者においては，L2，L4レベルともに棘突起3 cm外側に横突棘筋は多くの例で存在せず，最長筋をはじめとした外側筋群が存在していた．〔結語〕L2，L4棘突起から外側3 cmの部位における電極貼り付け位置は多裂筋ではなく，外側筋群の筋活動を測定していた可能性がある．したがって，従来の研究結果は貼り付け位置を再考する必要が示唆された．

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〔目的〕体幹と骨盤の動きを必要とする座位に着目し，骨盤の傾斜角度の違いが背筋群の筋活動に与える影響を検討した。〔対象〕腰痛の既往のない健常成人男性10名。〔方法〕測定肢位を骨盤軽度後傾位（以下後傾位）と骨盤軽度前傾位（以下前傾位）とし，課題を安静座位と腹部引き込み運動とし，肢位と課題の組み合わせの4条件下での腰部脊柱起立筋と腰部多裂筋の筋電図を導出した。課題間の比較は，一元配置分散分析後，多重比較検定を実施した。〔結果〕安静座位と腹部引き込み運動の課題において，多裂筋の筋活動は後傾位に対し前傾位で有意に増加したが，脊柱起立筋の筋活動に有意な差はなかった。これは骨盤前傾作用として多裂筋の筋活動が増加したと考える。〔結語〕前傾位は脊柱起立筋の筋活動を有意に増大することなく，選択的に多裂筋の筋活動を高めることができる姿勢と考える。

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In recent years, diagnostic imaging methods, such as computed tomography, magnetic resonance imaging, and ultrasonography, have improved greatly and are now used to examine most internal organs. Recently, cytological diagnosis has been actively performed with diagnostic imaging, and treatment can often be started without diagnosis by excisional biopsy. However, few institutions perform rapid cytological diagnosis, and the usefulness of this rapid cytological diagnosis is not widely known. In our hospital, rapid cytological diagnosis has been performed routinely for 20 years. We perform rapid cytological diagnosis at the outpatient clinic, during operation, and even at autopsy, and have confirmed it to be useful. The main purpose of rapid cytological diagnosis at the outpatient clinic is to relieve patients from anxiety as soon as possible by providing early diagnosis and treatment. Rapid cytological diagnosis is often done for superficial sites, such as the breasts, thyroid glands, salivary glands, and lymph nodes. Intraoperative rapid cytological diagnosis has been performed to increase diagnostic accuracy. It is useful for body fluids, necrotic tissues, and small tissue samples that are not suitable for frozen section. Furthermore, if an infectious disease, such as tuberculosis, is suspected, an impression cytology specimen fixed in an alcohol solution is useful for biosafety. A rapid diagnosis at autopsy is important to inform the bereaved family about the cause of death and to ensure an accurate death certificate. Moreover, it is significant to diagnose by impression cytology for biosafety. Furthermore, we discuss about the usefulness of a rapid immunostaining method which is actively performed in our department for a rapid cytological diagnosis.

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It has been demonstrated that pulsing electromagnetic fields (PEMFs) have osteogenic action in vitro and in vivo. It has also been shown that PEMFs stimulated mRNA expression of bone morphogenetic protein (BMP)-2 and -4 in chick embryonic calvaria. However, the effects of PEMFs on the gene expression of other BMPs are still unclear. The current study was undertaken to examine the effects of PEMFs on the gene expression of BMPs (BMP-1 to -7) in SV 40 large T antigen immortalized human osteoblastic cells (SV-HFO cells) by reverse transcription-polymerase chain reaction(RT-PCR). When the cells were 75% confluent, the cells were continuously exposed by the PEMFs for l and 6 hr, respectively. PEMFs reproducibly and markedly increased the mRNA for BMP -2, -4, and -5 in SV-HFO cells after 6 hr. These results indicate that the osteogenic effect of PEMFs may be, in part, mediated by up-regulation of bone morphogenetic protein -2, -4, and -5 in human osteoblastic cells in vitro.

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An anchorage period in jawbone of implant material is very important for the treatment needing oral implants, and it appears to be considerably effective during the convalescing period. The author suggested that the period was shortened by pulsing electromagnetic fields (PEMFs) which was used in the treatment of pseudoarthrosis in orthopedic cases. However, the effect of PEMFs on an osteogenic cell cultured on the implant material surface was not investigated quantitatively. The purpose of this study was to obtain the quantitative measurement for effects of PEMFs on osteogenic cell. Cells were placed on the three kinds of implant materials (singlecrystal aluminum oxide, polycrystal aluminum oxide, titanium) and then the cells were cultured by PEMFs.
The Osteogenic cell which was used in this study was the MC3T3-E1 cell line. Cells were placed as 6 × 10³ cells on the implant materials, and cultured in 2 ml of α-MEM supplemented with 10%fetal bovine serum and 60 μg/ml of kanamycinesulfate. Cells were maintaind at 37 ℃ in a fully humidified atomosphere of 5% CO₂ in air. The medium was changed every 3 days. Cells were exposed to vertically directed PEMFs (3 gauss, 25 μsec,100 Hz) by placing the culture dishes between the helmholtz coils. Experimental cultured samples were continuously exposed for 5, 7, and 9 days.
In this study, the findings can be concluded as follows:
1. The PEMFs stimulated for 3 gauss, 25 μsec, 100 Hz to the clone MC3T3-E1 cells on these implant materials were DNA and protein content. This suggests that PEMFs stimulation promoted osteogenic cell proliferation on the implant materials.
2. The result of 1. revealed that these implant materials were not inhibited and the effect was to promote cell proliferation by PEMFs.
3. The clone MC3T3-E1 cells on these implant materials were increased for alkaline phosphatase activity and hydroxyproline content. This suggests that PEMFs stimulation promoted osteogenic cell differentiation.
4. This study indicated that a titanium material had an inclination for further promoting cell proliferation and differentiation than a singlecrystal and polycrystal aluminum oxide material.
PEMFs stimulation promoted ostogenic cell proliferation and differentiation on the implant materials.

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Orthopedic cases of bone fracture have been treated by pulsing electromagnetic fields (PEMFs) which has the enhances quick healing. This study was to observe the cell proliferation and differentiation found in PEMFs to better understand its possible value in dental procedures.
The MC3T3-E1 cells were inoculated intoφ35 mm plastic dishes containing 2 ml α-MEM supplemented with 10% fetal bovine serum at 37℃ in a humidified atmosphere of 5% CO₂. The medium was changed every 3 days. The cells were exposed to vertically directed PEMFs by placing the culture dishes between the φ70 mm helmholtz coils.
Results of the study indicated the following:
1. The best parameter of stimulation effect on DNA synthesis was 3 gauss, 25 μsec,100 Hz. The incorporation of ³H-thymidine increased the control cultures not exposed to the fields by up to 92% (p＜0.001,t-test).
2. As compared to the controls, the DNA content in the stimulated samples had a significant 126% increase (p＜0.001, t-test) after 3 days and 36% increase (p＜0.05, t-test) after 6 days.
3. The best parameter of stimulation effect on alkaline phosphatase (ALPase) activity was 3 gauss, 25 μsec, 100 Hz. ALPase activity increased the controls by up to 28% (p＜0.01, t-test).
4. Exposed cells and controls were examined by phase-contrast micrograph. The cells did not show a considerable change in morphology.
From the above results, PEMFs (3 gauss, 25 μ sec,100 Hz) stimulation promoted osteogenic cell proliferation and differentiation. On the basis of these results, I feel that this treatment can be used in the field of dentistry.

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