Background: Left atrial (LA) volume (LAV) is related to left ventricular (LV) diastolic function and has a prognostically importance in patients with paroxysmal atrial fibrillation (PAF). Purpose: The aims of this study were to evaluate association between LAV using three-dimensional (3D) echocardiography and LV diastolic function and investigate clinical utility of LAV in patients with PAF. Methods: Fifteen PAF patients (PAF group; 7 men, mean age 65±10 years) and 20 normal subjects (controls; 16 men, mean age 44±10 years) who underwent conventional echocardiography, tissue Doppler imaging, and 3D echocardiography were enrolled. LA diameter (LAD) was measured by M-mode echocardiography and corrected by body surface area (LADI). LAV was measured by using the biplane Simpson (BS) method from 4- and 2-chamber views (LAV-BS) and 3D echocardiography (LAV-3D) and corrected by body surface area. Mitral early diastolic peak velocity (E) and myocardial early diastolic peak velocity (E′) at septal annulus was measured and the ratio of E to E′ (E/E′) was calculated. Results: LAD, LADI, LAV-BS, and LAV-3D in PAF group were significantly larger than those in controls. In PAF patients, LAV-3D significantly correlated with LAV-BS (p<0.001, r=0.92), LAD (p<0.01, r=0.50), and LADI (p<0.01, r=0.80). E/E′ significantly correlated with LAV-BS (p<0.01, r=0.38) and LAV-BS (p<0.01, r=0.32), but not with LAD or LADI (p=NS). Using optimal thresholds of LAD (>37 mm), LADI (>21 mm/m2), LAV-BS (>27 ml/m²), and LAV-3D (>29 ml/m²) for identifying patients with PAF, the sensitivity among the four groups was comparable, however, the specificity in LAD (75%, p<0.05) was significantly lower than that in LAV-BS (100%) and LAV-3D (100%). Conclusions: In PAF patients, LAV-BS and LAV-3D associate with LV diastolic function and appear to be superior to LAD for differentiation of controls from PAF patients.

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fracuture, which occurs in a limited ages before closure of distal tibial epiphysis, is relativery rare. We experienced 5 such cases aged from 10 to 15 years old. The treatment methods and results were reported.
The causes of injuries include 1 case of sport injury, 3 cases of falling down from the bicycles, and 1 case of falling down accident. Diagnosis is possible with 4 views of simple bone X-ray pictures. For detecting more detail bone fracture displacement, combining applications of tomography, CT, MRI, etc are useful. We performed anatomical reduction and fixation in cases with more than 2mm displacement on the joint surfase. All of our cases with more than 2mm displacement were treated with open reduction and internal fixation. The ultimate results are excellent, showing no deformity, plan or limitation of ROM.

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Cases of the 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 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 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 fracture to the epiphyseal plate of the ankle at the time of maturity.

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We report 7 cases of the fracture of the distal tibia (5 males and 2 females). The age at injury ranged from 12.1 to 16.4. The average age of the male cases was 15.0, and that of female cases was 12.4. One case which did not show displacement was treated with casting without reduction, five cases underwent surgical treatments after open reduction, and the last case underwent performed percutaneous internal fixation after manual reduction with K-wire.
All cases showed good results without pain, restriction of the range of motion, or deformity. Anatomical alignment is important, and reduction is necessary if displacement is evident.

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【はじめに】 fractureは脛骨遠位骨端線離開の特殊型であり，骨折面が矢状面，水平面，前額面の3平面を有するもので比較的稀な骨折である．今回我々はその2症例を経験したので報告する．【症例1】15歳男子，サッカー中に右足関節を外反強制し受傷．単純X線にてlateral fractureを認めた．受傷翌日に手術を行った．術後は3週間の外固定を行い，術後3ケ月から荷重訓練を開始した．【症例2】13歳男子，ラグビー中にタックルを受けて転倒し受傷．単純X線にてlateral fractureを認めた．受傷後2日に手術を行った．術後は4週間の外固定を行い，術後3ケ月から荷重訓練を開始した．【考察】 fractureの予後は骨端線早期閉鎖による後遺症出現の可能性があるが，手術治療によって可能な限り正確な解剖学的整復位を得ることは良好な治療成績につながると考えられた．

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【はじめに】脛骨遠位端 fractureは『矢状面・水平面・前額面の3つの骨折面を持つ骨折』と定義された脛骨遠位骨端離開の特殊型である．本症の2例を経験したので報告する．【症例1】13歳，女性．サッカー中に右足関節を外反強制されて受傷．同日腰椎麻酔下に徒手整復を行い，ギプス固定とした．6週後にギプスを除去し，9週後にスポーツ（サッカー）に復帰した．【症例2】16歳，男性．木から転落して受傷．受傷後2日目に腰椎麻酔下に徒手整復を試みるも整復困難であったため，観血的整復，スクリュー固定を行った．術後3日目からROM訓練を開始し，術後4週から部分荷重，術後6週で全荷重とした．2例とも疼痛やROM制限はなく，X線像でも問題なく経過良好であった．【考察】本症では転位が2 mm以上の場合は整復が必要とする報告が多い．早期の徒手整復および観血的整復・内固定により，いずれも良好な結果が得られた．

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【はじめに】

骨折は骨端線閉鎖時期におこる稀な骨折であり，骨膜嵌入により非観血的整復は困難になり得るという報告がある^6）．一方成書には徒手整復で2 mm未満の転位まで整復できれば観血的整復を行わないとの記載があり^2），我々もこれに従っている．当院での治療法と成績について報告する．【対象と方法】当院で手術を施行し，6ヶ月以上観察可能であった5例5足を対象とした．平均年齢は13.2歳，全例男児であった．受傷機転はサッカー4足，転落1足であった．骨折型は外側型4足，内側型1足，手術までの日数は平均1.4日であった．【結果】全例，非観血的整復後に経皮的固定を行った（KW 3足，KW＋CCS 2足）．全例に骨癒合が得られた．【考察】受傷早期に全例に非観血的整復および経皮的固定を行った．術後成績は良好であった．

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The purpose of this study is to study the mechanism of injury and to introduce a reduction method. 13 cases of fracture in the distal tibial epiphysis treated in our hospital were reviewed clinically. There were 8 males and 5 females with an average age of 13.1 years old (range; 9 to 14 years). The average follow up period was 2 years 2 months (range; 6 months to 7.5 years). 8 cases were forced planter flexion-external rotation of the ankle at injury, only external rotation was seen in a case except for other unexplained cases. All cases were challenged closed reduction under spinal anesthesia, of which 7 cases required open reduction and internal fixation.
They recorded 98.2 points with the JOA score at follow-up. The length gap of the lower extremities was not explained clearly. The external rotation force of the ankle, in addition to the planter flexion force, is the most suspectable cause of the occurrence of fracture. Manual reduction with K-wire inserted displaced fragments of the tibia is useful for cases which reject closed reduction.

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We studied the mechanism of injury, treatment, and prognosis in six cases of fracture of the distal tibial epiphysis. Subjects included 4 boys and 2 girls with an average age at injury of 13 years 2 months (rarge: 10-14.5 years). Athletic activity was the cause of the fracture in five cases, with a fall the cause in the other case. Four cases were treated with a cast after closed reduction. Two cases required open reduction and internal fixation. All cases showed good clinical result on follow-up. This study suggested the following: The mechanism of injury is forced plantar flexion and external rotation of the ankle. If the fracture shows more than two millimeters of displacement after closed reduction, it requires open reduction and internal fixation.

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Eleven cases with epiphyseal injuries of the distal tibia in children were treated by percutaneous pin fixation. In all cases, satisfactory results were obtained without deformity and growth disturbance of the ankle. Percutaneous pin was fixation was an easy and effective treatment for epiphyseal injuries of the distal tibia which required closed reduction.

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A rare case of a thirteen-year-old man with the right two-fragment distal tibial epiphyseal fracture was reported. The use of tomograms and CT-scans to determine the diagnosis and accuracy of reduction was quite important. This fracture was suspected to occur with a supination external rotation injury involving the diastasis of the antero-lateral epiphyseal plate, the fibular fracture, and no ligament rupture. This fracture was considered to be a good indication for open reduction because it was possible to fix without injury of the epiphyseal plate.

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