Mitsuru Sakaguchi

SA 96 (N-(2-Mercapto-2-Methylpropanoyl)-L-Cysteine) in Rheumatoid Arthritis

SA 96 (N-(2-mercapto-2-methylpropanoyl)-L-cysteine) is a new sulfhydryl compound having a relatively similar chemical structure to Tiopronin and D-penicillamine. An open trial of SA 96 treatment (300 mg/day after meals for 16 weeks) was carried out in 11 patients with definite or classical rheumatoid arthritis and with therapeutic failure of previous gold salts and/or D-penicillamine therapy. Two cases were withdrawn from the trial, because of a side effect (hepatitis) in one patient and an unrelated illness in another. The results in the 9 patients completing the trial demonstrated statistically significant improvement in the clinical and laboratory measurements. A marked abatement of disease activity was noted in 5 of 9 patients who did not benefit from, or suffered a relapse during previous chrysotherapy and in 1 of 5 patients without benefit, or with relapse following previous D-penicillamine treatment. Among 4 patients who had discontinued D-penicillamine because of its intolerable cutaneous side effects, 3 patients completed the trial, with favourable results. The results of this trial seem to indicate that SA 96 is possibly of value as a slow-acting antirheumatic drug in some patients with therapeutic failure of gold salts or D-penicillamine.

A Case of Correction Osteotmy Using Locking Plate for Tibial Malunion

脛骨の変形治癒骨折に対して一期的に矯正骨切り術を施行後，locking plateを用いて内固定を行い良好な結果を得たので報告した．症例は58歳，男性．18歳時に交通事故で右脛腓骨骨折を受傷し，保存的治療を受けた．X線所見にて右膝の内側型変形性関節症を認め，脛骨上中1/3の部位にて約21°の内反変形を認めた．手術はまず腓骨を切骨し脛骨変形中心部にて骨切り，open wedgeにて矯正を行いlocking plateにて内固定を行った．術後6ケ月の現在，骨癒合良好で右膝痛も軽快しておりADLに支障はなく，正座も可能である．変形治癒骨折の矯正骨切術の方法としては従来のプレートによる方法では矯正位の獲得は容易であるがプレートのbendingを細かく行わないとスクリューで骨皮質をプレートに引き寄せる際に矯正位を失う可能性がある．locking plateにて内固定は矯正位の保持が容易であり有用であった．