Eiichi Udagawa

The aetiology and treatment of simple bone cysts

The internal pressure of simple bone cysts was found to be slightly higher than the normal pressure of the bone marrow in the contralateral limb. The pressure within the cyst was measured during drilling with a Kirschner wire; it gradually decreased as the number of drill-holes increased. The PO2 of the cyst fluid was markedly lower than that of either venous or arterial blood measured synchronously. It is suggested that venous obstruction in the bone is the likely cause of these cysts. Seven patients with simple bone cysts were treated by the multiple drill-hole method, and the clinical outcome was excellent. Multiple drilling may prove to be the treatment of choice for simple bone cysts in the younger patient, as it presents fewer hazards than other procedures.

Toxicity of silica-containing calcium phosphate glasses demonstrated in mice

Suspensions of calcium phosphate glass containing various concentrations of silica (glass composition (moles): 100 Ca(PO3)2 to x SiO2,x = 0, 5, 10, 15 or 40) dispersed in normal saline were injected intraperitoneally into C57BL/6 mice to determine the mortality within 30 days. The mortality was 0/10, 3/10, 9/10, 10/10 and 10/10 at x = 0, 5, 10, 15 and 40 mol of silica, respectively. By means of inductively coupled plasma analysis, the amount of dissolved silica (Si4+) in water at 37 degrees C from the calcium phosphate glass depended on the amount of silica in the glasses. The mortality of mice was directly proportional to the silica content of the glass injected intraperitoneally. These results clearly show that the dissolved silica (Si4+) from the glass, monomeric or low molecular silicic anion, is highly toxic. The SiO2 component in biomaterials has toxic potential when dissolved in the body.

Sternocostoclavicular hyperostosis. A report of nineteen cases, with special reference to etiology and treatment.

The cases of nineteen patients with sternocostoclavicular hyperostosis were reviewed retrospectively. Of particular interest were the responses to antibiotics and prostaglandin inhibitors. The prostaglandin inhibitors relieved the pain within three to four weeks in sixteen of eighteen patients so treated. However, the inhibitors gradually became less effective in most patients. Oral antibiotics were more effective than the inhibitors in relieving the pain of eight of the eleven patients who were given antibiotics. Pustulosis palmaris and plantaris, commonly associated with sternocostoclavicular hyperostosis, diminished after antibiotic therapy, as did the chest pain in most patients. The similarities between the age and sex distributions and the responses to antibiotics of the patients with sternocostoclavicular hyperostosis and those with pustulosis suggest that these disorders have a common etiology, and that the pustulosis may be a so-called bacterid reaction and the hyperostosis, a manifestation of a systemic reaction to a focal infection.

Entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis

The authors report a case of entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis. This entrapment neuropathy was found distal to the inferior retinaculum that causes the anterior tarsal tunnel syndrome. Surgical decompression of the deep peroneal nerve that was entrapped by the extensor hallucis brevis relieved the symptoms. This condition, like the anterior tarsal tunnel syndrome, deserves attention.

Fracture of the posterior medial tubercle of the talus treated by internal fixation: a report of two cases.

A fracture through the posterior medial tubercle of the talus is quite rare. Although excision of the bone fragments has been reported previously in this fracture, cases of internal fixation of the posterior medial tubercle of the talus have not been reported. Two patients are described who presented with a fracture through the posterior medial tubercle of the talus which was treated with internal fixation. Our patients appeared normal on physical examination and returned to work, with no evidence of avascular necrosis of the fragments.

Anatomy and pathophysiology of the popliteal tendon area in the lateral meniscus: 1. Arthroscopic and anatomical investigation.

An arthroscopic and anatomical investigation was performed to define the abnormal conditions of the popliteal tendon area in a lateral meniscus. Arthroscopic findings for 100 patients and anatomical observations of 10 amputated knees were analyzed. Five of the 10 dissected menisci were also examined histologically. Menisco-tibial coronary ligaments were classified into two types, as follows: type I--a coronary ligament covering an entire popliteal tendon beneath the meniscus; type II--a popliteal tendon visible beneath the meniscus through defects of the coronary ligament. Twenty-one of 100 cases were classified as type I, and 79 were classified as type II. Three of the 10 anatomical dissections were type I, and the remaining 7 were type II. Menisci in which the type I coronary ligaments were thought to be torn and menisci with type II coronary ligaments showed a rather marked mobility, but no conclusion could be reached.

Anatomy and pathophysiology of the popliteal tendon area in the lateral meniscus: 2. Clinical investigation

Treatment of abnormal mobility of the popliteal tendon area of the lateral meniscus is described. Twenty-seven patients who exhibited an abnormally mobile posterior segment with no obvious ruptures in the lateral meniscus were directly examined by us after an average of 4 years and 3 months from the time of the arthroscopic procedure. The main complaints associated with this condition before the surgery were pain and locking during deep knee flexions. The patients were divided into three groups according to surgical method: partial meniscectomy, subtotal meniscectomy, or meniscal repair. The subtotal meniscectomy and repair groups showed significantly higher scores than the partial meniscectomy group. A locking phenomenon recurred in one case of the meniscal repair group. In this case, the menisco-femoral coronary ligament posterior to the popliteal tunnel could not be sutured.

Transient osteoporosis of the hip in the first trimester of pregnancy

SummaryA patient with transient osteoporosis of the hip in her first trimester of pregnancy is reported in this study. Rapid symptomatic improvement after artificial abortion was observed. These findings exclude pressure on the obturator nerve, Sudecks osteodystrophy, venous obstruction, and excessive demand of proteins and calcium in the etiology of this condition. Rather it is here suggested that chemical or hormonal factors related to pregnancy play an important role in the etiology.ZusammenfassungEs wird über eine Patientin mit transitorischer Osteoporose der Hüfte während der ersten 3 Monate der Schwangerschaft berichtet. Nach Interruptio wurde eine schnelle symptomatische Besserung beobachtet. Dies schließt Druck auf den Nervus obturatorius, Sudecksche Dystrophie, venöse Stauung, übermäßiger Bedarf an Proteinen und Kalzium als ätiologische Momente der Veränderung aus. Stattdessen nehmen die Autoren eher an, daß chemische oder hormonelle Faktoren, die im Zusammenhang mit der Schwangerschaft stehen, eine entscheidende Rolle in der Ätiologie spielen.

HLA phenotypes in patients who have osteosarcoma.

Human leukocyte antigen (HLA) phenotypes were studied in twenty Japanese patients who had typical osteosarcoma. The HLA-A11 phenotype was found in ten (50 per cent) of the twenty patients, compared with 16.6 per cent of 235 control subjects (chi square = 13.248; p less than 0.0005)--an odds ratio of 5.026. These data suggest that major histocompatibility complex-linked genes may determine susceptibility to osteosarcoma.

Dynamic analysis of anterior tibial translation during isokinetic quadriceps femoris muscle concentric contraction exercise

Abstract Using a knee motion analyser, we have studied anterior tibial translation under a range of loading conditions in normal and anterior cruciate ligament (ACL) deficient knees. Anterior displacement in excess of that observed in passive knee flexion was noted in a static Lachman test. Anterior tibial displacement in normal knees increased steadily as the knee was extended from 60° flexion reaching a maximum at 20° flexion for active motion and 25° flexion during isokinetic exercising. In ACL-deficient knees anterior tibial translation was significantly greater than for normal knees, reaching a maximum of 15° during both active motion and isokinetic exercising. The values for isokinetic exercising were greater than those noted during active exercising in both groups. We concluded that isokinetic exercising in the early post anterior cruciate reconstruction period should be restricted to flexion angles greater than 30°.