Hiroshi Fujii

Transtibial amputation with plantar flap for congenital deficiency of the tibia

Disarticulation of the knee has been the preferred treatment for the severe type (Type Ia and Type Ib classification of Jones et al) of congenital deficiency of the tibia because of marked flexion contracture of the knee and loss of quadriceps function. In such cases, the disarticulated stump is often small and poorly covered by soft tissues because of dysplastic femoral condyles and calf muscles. Therefore, stump complications after disarticulation may prevent early aggressive walking exercises and delay independent ambulation. To overcome this problem, a greater weightbearing surface was created by a transtibial amputation with a short stump of the fibula using the flexed knee. By this method, the distal femoral condyle and the anterior surface of the fibula were used for weightbearing. In addition, coverage of the new weightbearing area by a neurovascular pedicled sensate plantar flap provided a more tolerable weightbearing site. The purpose of the current study was to report a 5-year-old boy with bilateral congenital total deficiency of both tibias, who was treated using this technique. The patient was ambulating independently 15 weeks after surgery. A transtibial amputation with a plantar flap is an alternative procedure to knee disarticulation for the severe type of congenital deficiency of the tibia.

Rescurable Pulmonary Embolism after Spinal Surgery -A Case Report-

We experienced one case of pulmonary embolism in a patient after spinal surgery over the past two years. The patient was a 51-years-old man who had experienced deep vein thrombosis in the past. He under went anterior spinal fusion for C6/7 disc hernia.5 days after the operation, he suddenly experienced respiratory difficulty. Though his consciousness was clear, and his vital signs were stable, even after 3L pure oxygen supplied, his arterial saturation rate was low at 74%. We supplied 10L oxygen, used an Ambu bag, kept his venous line, and injected lactolingel, His chest pain was relieved and his arterial saturation rate improved to 95%. To investigate the cause, we examined his arterial blood gas, ECG, and chest X-p, and suspecting pulmonary embolism, we consulted cardiologists. In the UCG, the right ventricle hed apparently enlarged, and angiography showed that his right pulmonary artery the patient restricted by 80% due to thrombosis. We diagnosed as having pulmonary embolism, attempted cardiac cathetelization, and injected urokinase, the thrombosis was reduced by 1/3, and the patient survived.

Study of Surgical Treatment for Vertebral Osteomyelitis

In the 12 years from 1989 to 2000, we operated on 27 patients with vertebral osteomyelitis. The patients included 17 males and 10 females with a mean ago of 62.4 years (range: 42 to 83 years). Generally, anterior fusion is performed on patients with vertebral osteomyelitis. However we treated 9 patients out of 27 by posterior fusion using Luque rods, because of their poor general condition. Our study showed that this low invasive poeration is useful for patients with poor general conditions (elderey patients, hemodialysis patients, etc.).

Continuation Method for Dynamic Economic Load Dispatch with Emission Constraints

Abstract This paper presents a method for solving a dynamic economic load dispatch problem of electric power systems. Since the expected system load varies over a given time horizon, the sum of generator outputs must follows the system load subject to power-rate limits on generators. In order to solve the dynamic ELD problem, the continuation method is employed in this paper. It is shown that each generator output is expressed as a piecewise-linear function of a continuation parameter, and this fact enables us to obtain the optimal solution efficiently. Numerical tests for a model system indicate the validity and effectiveness of the proposed method.