Biomedical subjects
Publications and source records attributed to N Tsuyama.
Ninety brachial plexus lesions have been examined by myelography and the results classified into six types. These were compared against the level of lesion found at exploration of the brachial plexus with electrophysiological investigations carried out during the operation. The results show that myelography can be a reliable and useful pre-exploratory measure to assess the level of the lesion of each injured root.
One hundred seventy-nine patients with root avulsion brachial plexus injuries were treated with direct nerve crossing with the intercostal nerve and 159 cases were followed more than 1 1/2 years after the operation. When suture was done to the musculocutaneous nerve, 90% of 10 children who had operation within 7 months of injury and 81.8% of 110 adults, younger than 40 years with operation within 6 months of injury regained grade 3 or 4 elbow flexion power. This direct method seems to produce better results than those of nerve crossing, which uses intermediary nerve grafts.
Involuntary activity of transferred intercostal motor units was examined in patients with brachial plexus injury. Since the internal intercostal nerves were detached from the thorax to reinnervate the musculus biceps brachii, it was possible to record pure intercostal motor activity in humans. Respiratory activity was seen in the latter part of the expiratory phase, thus dividing the phase into two substages (E1 and E2) by the onset of the activity. CO2 rebreathing prolonged the duration of the intercostal motor activity and increased the tidal activity as determined from the integration curve. There was a close linear correlation between these two variables. These observations indicate that expiratory activity and its duration are actively controlled in humans.
One hundred ninety-eight cases of postganglionic brachial plexus injury with no signs of combined damage to preganglionic sites were treated conservatively. Among them, 50 whole, 32 upper and 13 lower type injuries were followed up for at least 2 years and the course of the progression of the individual muscle was observed. In the whole type, 44% showed good functional recovery, although some of them needed reconstructive surgery. Thirty-eight percent recovered usefully only in the muscles innervated by upper roots. Three out of 50 cases did not recover at all. There were no particular differences between the whole and upper types with regard to the recovery rate of the arm muscles. However, the upper type showed better functional recovery than the whole type. If the muscles innervated by upper roots could gain a strength of M1 before 9 months after injury, and muscles innervated by lower roots reached M1 before 12 months, their final results were more than M3. But muscles with a strength of less than M2 at 18 months did not recover to more than M3. The muscular power at 24 months was almost the same as the final results. About half of the postganglionic brachial plexus injuries which did not combine preganglionic lesions showed favorable spontaneous recovery with conservative treatment. At the exploration of the brachial plexus, if the somatosensory evoked potential test is positive, which negates the possibility of root avulsion, and also if there is no definite discontinuity of the postganglionic nerves, it should be treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Ossification of the posterior longitudinal ligament of the spine (OPLL) is a newly recognized entity. As the incidence of this disease was exceptionally high in Japan, the Japanese Ministry of Public Health and Welfare instituted a special commission for the investigation of this perplexing disease; since 1975 this committee has performed an intensive study of 2100 patients with OPLL in Japan. An epidemiologic study was conducted by this group in Japan and in eastern Asiatic countries. Symptoms and disabilities caused by the disease were described. Roentgenographic findings were classified as continuous, segmental, mixed, or localized. OPLL at the thoracic and lumbar levels combined with ossification of the yellow ligament was described, and the risk of spinal cord damage as well as the importance of tomography and computerized tomographic scanning were stressed. No conclusions were reached concerning etiology, but common findings included a generalized hyperostotic tendency, a tendency for abnormal glucose metabolism, and low enteral calcium absorption. A relatively high hereditary occurrence was noted. Conservative and surgical treatment methods were described, with particular reference to spinal canal-widening operations.
Orthopedic surgery in Japan has developed markedly since the end of the Second World War and at present many subspecialty study groups cover various aspects of basic orthopedic and clinical research. The main trends and topics of orthopedic surgery in Japan are presented as examples of recent or representative works.
We have used the Pavlik harness in the treatment of congenital dislocation of the knee in six knees in five patients, with satisfactory results. We believe that the muscles in the thigh which cross both the hip and knee joints, the rectus femoris and hamstrings, play an important role in the spontaneous reduction of the joint. Full correction is not always obtained, our results are comparable with those described by other authors. We consider that the advantages of using the harness are that a spontaneous correction can be obtained, maximal correction can be obtained after three months of treatment and the method is safer than others used.
Calcitonin has been considered to be useful in the treatment of osteoporosis due to its remarkable suppressive action on bone resorption as well as its putative stimulative effect on bone formation. However, its usefullness, especially the effect for decreasing the loss of bone mass in osteoporosis has not been proved substantially. We have studied this point using eel calcitonin derivative, elcatonin , in relatively low doses with and without calcium supplement. Bone mass was evaluated by microdensitometry of the roentgenograms of the second metacarpal bone. One hundred and thirty cases of postmenopausal and senile osteoporotics were divided into the following four groups and studied for six months: A) calcium and elcatonin treated group, B) calcium treated group, C) elcatonin treated group, D) control group. Elcatonin was administered intramuscularly 10 units once a week, and calcium was given 700 mg for every day. The results of metacarpal densitometry revealed the signs of significant increase of the bone mass in the calcium and elcatonin treated (A) group compared with the control (D) group, while the changes in the other groups (B and C) were not significant. It was shown that elcatonin had the significant analgesic effect for the back pain in the patients. Serum iPTH was not increased and the antibody for elcatonin was not detected in elcatonin treated patients. Although the study period is rather short, necessitating further studies, at present, our study suggests that the use of calcitonin with calcium supplements had the place in the treatment of osteoporosis.
With the intention of estimating the extent and site of damage in brachial plexus injuries which involve close to the root outlet and also the distal portion, cortical somatosensory evoked potentials (SEP) were recorded in 21 patients by directly stimulating the exposed brachial plexus. In 38 avulsed nerve roots which showed positive sensory action potentials (SNAP)/nerve action potentials (NAP) in their peripheral part, 15 roots (nine patients) were apparently in continuity and confirmed as root avulsion injury by the absence of cortical SEP. However, 11 roots (ten patients) which showed neither SNAP nor SEP would suggest either extensive lesions involving root and more distal segment or a combination of root avulsion and postganglionic injury. Fourteen patients who showed a positive Tinel's sign had at least one root with a postganglionic type lesion, but cortical SEP evoked by stimulation of the most proximal root zone sometimes revealed a reduced amplitude and prolonged latency. This would indicate the retrograde extension of damage. To confirm the extent and degree of the nerve lesions in brachial plexus injuries, an intraoperative SEP and NAP recording is very useful, practical, and also indispensable.
We compared the preoperative and postoperative pulmonary function of thirty-one scoliotic patients ranging in age from nine to twenty-five years. The mean postoperative follow-up period was three years and eight months. Twenty patients were treated by a posterior procedure with Harrington instrumentation. At more than two years postoperatively a significant improvement in the pulmonary function was noted, particularly in patients with a preoperative curve of less than 90 degrees (Cobb angle) and in those in whom the correction was greater than 30 per cent. The remaining eleven patients were treated by an anterior procedure, primarily a Dwyer operation, with or without posterior Harrington instrumentation. These patients manifested no remarkable improvement in pulmonary function more than two years after surgery; three patients showed deterioration. The results of tests performed less than two years postoperatively showed no improvement in pulmonary function, irrespective of the types of assessments used. We attribute our long-term improvements to a shortening of the postoperative period of plaster-cast immobilization and to the use of a plastic corset which allowed relatively free chest motion. We suggest that the Dwyer operation should be restricted to patients with a severe spinal deformity.
Many studies of the pathogenesis of ossification of posterior longitudinal ligaments (OPLL) have been reported, and both general and local factors have been pointed out. In case a longitudinal ligament is affected by both the general and local OPLL factors for many years, the shape and size of the cervical vertebral bodies and the arrangement of the cervical spinal column might be affected. The relation between OPLL and disc degeneration, the morphology of the facet joint and the change of longitudinal ligament tension has been reported by many authors. But the relation between OPLL and the shape, size and arrangement of cervical vertebral bodies has not been reported. We selected X-ray films of the lateral view of cervical spines which had been taken at our hospital since 1975. The subjects consisted of 190 cases in Group I and 189 cases in Group II. Half of Group I had OPLL, of which 71 were males and 24 females. The other half of Group I was composed of 95 cases (CS) of cervical spondylosis of the same sex and age distribution. Group II comprised 189 cases, all males aged 49 yrs. Of them, 41 were OPLL cases, 102 CS, and 46 normal subjects. The X-ray films of Group II were taken during medical examinations. The height, antero-posterior diameter of the cervical vertebral bodies and the antero-posterior diameter of the cervical spinal canals were measured and examined for kyphosis between the two neighbouring cervical vertebral bodies, disc space narrowing and Barsony ossification. The height and antero-posterior diameter of the cervical vertebral bodies were compared among the following groups. 1) the 3 groups divided according to age (-49,50-59,60-75 yrs.), 2) segmental type with non-segmental type, 3) OPLL only at C3 and C4 with OPLL only at C5, C6, and C7. The results were as follows: The cervical vertebral bodies of OPLL were taller and wider than those of CS. Cervical vertebral bodies of the older group were shorter and wider than those of the younger groups in both OPLL and CS. THe relative height (C3 = I) of OPLL group was very close to Normal group. The cervical vertebral bodies of non-segmental type were taller but not wider than those of segmental type of OPLL group. The C3 and C4 vertebral bodies with OPLL only at C3 and C4 were taller, but not wider than those with OPLL only at C5, C6 and C7. The antero-posterior diameter of cervical spinal canal of OPLL was narrower than CS group. The above data indicate the following: 1) With advance in age, cervical vertebral bodies become lower and wider. 2) The cervical vertebral body of OPLL is taller and wider than that of CS. 3) The level of OPLL and the type of OPLL have a relation to the height of cervical vertebral body. 4) The cervical vertebral bodies which have OPLL are wider than non-OPLL. But the level and the type of OPLL have no relation with the A-P diameter of the cervical vertebral body.
This paper reports on Mietens' syndrome which is characterized by mental retardation, growth failure, flexion contracture of the elbows, dislocation of the radius, abnormally short ulna and radius, bilateral corneal opacity, horizontal and rotational nystagmus, strabismus and a small pointed nose with depressed root. This is the second on the Mietens' syndrome.
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