Tohru Akita

Ludloff's medial approach for open reduction of congenital dislocation of the hip

We reviewed 33 patients (35 hips) after open reduction of congenital dislocation of the hip using Ludloffs medial approach. The mean age at the time of operation was 14 months (5 to 29) and at the time of final follow-up 20.1 years (15 to 24) giving a mean duration of follow-up of 19.4 years (14 to 23). We evaluated the radiological results by the Severin classification and the extent of avascular necrosis using the criteria of Kalamchi. At the latest review 16 hips (45.7%) were in Severin groups I or II (acceptable results) and 19 (54.3%) in Severin groups III, IV or V (unacceptable results). There was evidence of avascular necrosis in 15 hips (42.9%). The radiological results began to become worse at about the age of ten years when type-II avascular changes presented. We conclude that Ludloffs medial approach for open reduction is unsatisfactory for the treatment of congenital dislocation since about half of our patients required additional operations.

Signet ring cell carcinoma of the breast

A rare case of signet ring cell (SRC) carcinoma of the breast occurring in a 51‐year‐old female is presented. She was first admitted under the diagnosis of gastric carcinoma. Incidentally, a right breast tumor was detected and double cancer was thus suspected clinically. Concurrent right mastectomy and partial gastrectomy were performed. Histologic examination on the removed tumors revealed infiltration of numerous SRCs. The signet ring appearance of tumor cells resulted from formation of a large intracytoplasmic globule. From this unique cytologic feature along with the presence of in situ lesion in the breast tumor, it was concluded that the gastric malignancy was a sequela of metastasis of infiltrating lobular carcinoma. Wide‐spread metastases later occurred, especially on the serosal surfaces. The importance for the knowledge about the unique metastatic pattern of SRC carcinoma of the breast was emphasized. Acta pathol. jpn. 34: 875∼880, 1984.

LUDLOFF’S MEDIAL APPROACH FOR OPEN REDUCTION OF CONGENITAL DISLOCATION OF THE HIP

We reviewed 33 patients (35 hips) after open reduction of congenital dislocation of the hip using Ludloff’s medial approach. The mean age at the time of operation was 14 months (5 to 29) and at the time of final follow-up 20.1 years (15 to 24) giving a mean duration of follow-up of 19.4 years (14 to 23). We evaluated the radiological results by the Severin classification and the extent of avascular necrosis using the criteria of Kalamchi.At the latest review 16 hips (45.7%) were in Severin groups I or II (acceptable results) and 19 (54.3%) in Severin groups III, IV or V (unacceptable results). There was evidence of avascular necrosis in 15 hips (42.9%). The radiological results began to become worse at about the age of ten years when type-II avascular changes presented.We conclude that Ludloff’s medial approach for open reduction is unsatisfactory for the treatment of congenital dislocation since about half of our patients required additional operations.