Primary osteoarthritis of the hip joint in Japan

Diagnostic criteria for primary osteoarthritis of the hip joint in the Japanese population were determined by the roentgenographic measurements of the center-edge (CE) angle, the Sharp angle, and the acetabular roof obliquity in 254 normal hips. Primary osteoarthritis must meet the following conditions: (1) absence of femoral head deformities; (2) a CE angle of Wiberg greater than 19 degrees; (3) a Sharp angle less than 45 degrees; and (4) acetabular roof obliquity less than 15 degrees. These measurements are taken from roentgenograms during the early stage of the disease. Under these criteria, primary osteoarthritis accounted for only 0.65% of 2000 consecutive cases of osteoarthritis. Observation of the natural course of primary osteoarthritis revealed two subtypes. The superolateral type developed from the subset of normal hips with a relatively greater degree of acetabular roof obliquity.

[Morphological changes of embryonic retina and tectum transplanted into the anterior eye chamber of adult rats]

Primordia of the retina and the tectum of different ages (13 to 20 embryonic days) were transplanted as single or double grafts into the anterior chamber of the eye of normal syngeneic adult rats (Fischer 344). After 2-37 weeks (mostly 4-16 weeks), host rats were sacrificed and their eyeballs were dissected, frozen and sliced to 10 microns thickness and examined histologically by using Nissl and acetylcholinesterase (AChE) stains. Survival of the retinal single grafts, the tectal single grafts and the double grafts of both tissues were 21.7% (5/23), 41.2% (14/34) and 73.9% (17/23), respectively. The single grafts of the retina surviving on the iris of the host anterior chamber were observed through the transparent cornea as an irregular, translucent and whitish masses, inside of which small blood vessels were seen to enter. The grafted tissues contained many darkly stained cells and formed tubular structures of varying sizes and in part exhibited rosette-like structures. The surviving single grafts of the tectum grew forming round, developing tissue on the host iris. The surface of the graft was smooth and vascularized. In Nissl sections, grafts contained large cells densely distributed, in particular in the center of the solid tissues. Areas of strong AChE-positive reaction in the graft were located close to the host iris. Double grafts of the retina and the tectum were observed on the host iris to fuse about 2 weeks after transplantation. On Nissl sections, the retinal part of the grafts of about 2 weeks (short term) of survival demonstrated rosette formation of two (i.e., inner and outer) layers composed of light and dark cells, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic management of carpal tunnel syndrome

This article describes a subcutaneous endoscopic operative procedure for carpal tunnel syndrome and analyzes its effectiveness using electrophysiological data. Subcutaneous transverse carpal ligament release under universal subcutaneous endoscope (USE) was performed using local anesthesia without pneumotourniquet in 54 hands of 45 patients since June 1986. The mean follow-up period was 13.8 months. Sensory disturbances began to subside immediately after the operation and disappeared within 2 months in all cases. After the disappearance of sensory disturbances, we performed postoperative electrophysiological studies in 27 patients (33 hands). Postoperative electrophysiological data were significantly improved in all cases. Patients did not suffer from any serious complications such as motor branch injuries of the median nerve, hypesthesia of the palm, or injuries of the superficial palmar arch. From these results, we conclude that the transverse carpal ligament can be safely incised by this procedure.

Free functional musculocutaneous transfer: electrophysiological studies

Transplanted autogenous muscles were electrophysiologically studied in 2 patients with forearm crush injury. Only fibrillation action potentials and positive sharp waves were seen at 1 month after the operation. Low-amplitude and short-duration muscular unit potentials (MUPs) appeared at 3 months and high-amplitude, long-duration and polyphasic MUPs were frequently seen at 6-7 months after the transplantation. The distal latencies of the evoked motor responses were gradually shortened from time to time and eventually became normal at about 1 year after the grafting. The mean consecutive difference became normal at about 6 months after the normalization of the distal latencies. We conclude that the motor endplate is functionally completed at about half a year after the completion of the myelination of the grafted nerve.

Magnetic resonance imaging and histopathology in femoral head necrosis

We correlated preoperative magnetic resonance (MR) images and histopathology of eight femoral heads from patients with osteonecrosis. The signal intensity of the MR image was low in the area where fibrovascular tissue, disintegrated fibrovascular tissue, or amorphous necrotic material occupied the medullary space. On the other hand, the necrotic marrow without revascularization showed high signal intensity. Osteonecrosis can be detected by MR imaging as soon as a certain amount of bone marrow is replaced by fibrovascular tissue.

Three-loop technique for A2 pulley reconstruction

A three-loop technique of secondary A2 pulley reconstruction has been developed by the authors. This method was applied to six fingers of six patients. The average follow-up period was 21 months and ranged from a minimum of 9 months to a maximum of 3 years. Total active motion of metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints improved by 30 degrees on the average from the preoperative 175 degrees to the postoperative 205 degrees. Similarly, tip palm distance showed an improvement of 10 mm on the average from the preoperative 32 mm to the postoperative 22 mm. Satisfactory grip functions were restored for all patients after the secondary pulley reconstruction.

[Subcutaneous operation and examination under the universal endoscope]

Endoscopes are mainly used to study the internal structures of organs and tissues with inherent space. These include the gastrointestinal tract, abdominal space and joint space. The standard endoscope, however, cannot be used to evaluate tissues without such space. We have invented a new type of operation tube to be used with the arthroscope. This combination enables us to study subcutaneous soft tissues without inherent space. Our new device is a powerful tool to be used for evaluation of subcutaneous soft tissues in any part of the body. Surgical procedures can also be carried out with this device. Areas of future applications of our device will be extremely wide including orthopaedic surgery, plastic surgery and general surgery. The presentation will discuss the procedure for utilizing this new instrument.

Mutagenicity of a series of N-alkyl-, N-hydroxyalkyl-, N-haloalkyl- and N-carboxyalkyl-N-nitrosoureas in Escherichia coli tester strains: dependence on the uvrA DNA-repair system

A series of N-alkyl-, N-hydroxyalkyl-, N-haloalkyl- and N-carboxyalkyl-N-nitrosoureas and some related derivatives were tested for mutagenicity in E. coli B (Arg-) H/r30R (wild-type) and its isogenic Hs30R (uvrA) tester strains. Mutagenic potency in Hs30R, in general, appears to depend on the substituent (-OH, -OCH3, -halogen, -COO- or -COOCH3) on the alkyl group, rather than the chain length or branching of the alkyl group. On the other hand, mutagenic potency in the wild-type H/r30R strain depends on buliness of the substituent and alkyl moiety. The term "uvrA-dependence" of mutation frequency is then defined as the ratio of the mutation frequency in Hs30R versus that in H/r30R at 1 mM dose of mutagens. Its dependence on structure is also discussed. A good correlation was found with the van der Waals volume of the substituted alkyl group, except for compounds having a carboxyalkyl or a branched alkyl group. The carboxyalkyl derivatives are the most weakly mutagenic and most seriously "uvrA-dependent", probably due to the negative charge of the molecule. The possibility of forming epoxides and lactones from N-hydroxyalkyl- and N-carboxyalkyl-N-nitrosoureas, respectively, and their participation in mutagenic potency are discussed. An attempt to correlate the partition property and activation rate of the N-nitrosoureas with mutagenic characteristics proved unsuccessful.

Projections of extraocular muscle primary afferent neurons to the trigeminal sensory complex in the cat as studied with the transganglionic transport of horseradish peroxidase

The central projections of extraocular muscle primary afferent neurons were examined in the cat by means of transganglionic axonal transport of wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP). Injections of the extraocular muscle with WGA-HRP resulted in transganglionic terminal labeling within the ipsilateral trigeminal sensory complex. Although the density of trigeminal projections varied among cases, labeled axons and terminals were heavily and consistently found within the rostroventral portion of the pars oralis of the spinal trigeminal nucleus. The caudal part of the trigeminal principal sensory nucleus occasionally contained moderate labeling but very few deposits of HRP reaction product were noted in the pars interporalis and pars caudalis of the spinal trigeminal nucleus.

[Study on the toxicity of SF-1008C (II): Subacute toxicity study in rats]

The toxicity of an elemental diet (SF-1008C) for hepatic failure and recovery after administration were investigated in Sprague-Dawley rats. The rats were orally administered the drug in doses of 10, 20 and 30 g/kg/day for five weeks, after which, recovery was studied for five weeks. The results were summarized as below: In the 30 g/kg/day group, decreases in food and water consumption were observed, while the body weight gain and the rate of body weight gain were high compared to the treated control group. In addition, urinary pH and serum total protein were lower, and serum glucose and calcium levels were higher than in the treated control group, but these results were not considered to be due to the drug's toxicity. In the 20 and 10 g/kg/day groups, a slight decrease in food consumption was observed, though the rate of body weight gain was higher than in the treated control group. Slight decreases in urinary pH and serum total protein were observed, but were not considered to be due to the toxic effect of the drug. From the above results, it was concluded that the maximal non-effect dose of SF-1008C in oral administration was 30 g/kg/day, which was the maximally applicable dose in rats.

[Study on the toxicity of SF-1008C (I): Acute toxicity study in mice and rats]

The oral acute toxicity studies of SF-1008C, an elemental diet for hepatic failure, and its components (peptide and rice oil) were evaluated in ICR mice and Sprague-Dawley rats. The following results were obtained. Mortality; The minimum lethal doses for SF-1008C in male and female mice and rats were higher than 40 g/kg. The minimum lethal doses for peptide in male and female mice and rats were higher than 6 g/kg. The minimum lethal doses for rice oil in male and female mice and rats were higher than 20 ml/kg. General symptoms; the major signs observed were loose stool in the mice treated with SF-1008C, yellowish brown urine in the rats treated with SF-1008C or peptide and diarrhea in the rats treated with rice oil. Body weight and food consumption; decrease in food consumption and slight decrease in body weight gain were observed in the female mice treated with SF-1008C, peptide and rice oil, but the decrease was not dose-dependent. Decrease in food consumption was also observed in the male and female rats treated with of SF-1008C and rice oil, but the decrease was not dose-dependent. Body weight, however, did not show significant change in any group of rats. Gross pathology; no drug-related changes in organs and tissues were observed by necropsy in any group of mice or rats. Based on these results, the acute toxicities of SF-1008C and its components were low, respectively.

[Natural courses of coxarthrosis and indication of rotational acetabular osteotomy]

Many factors may influence the development of the secondary osteoarthritis which might have originated from congenital dislocation, subluxation, or acetabular dysplasia of the hip. Accurate prediction of the development of osteoarthritis may be essential to initiate a proper treatment for those patients. We studied whether various acetabular indices could serve as the parameters in predicting the future degenerative changes. Our findings indicated that those indicators did not suggest the future course of the development of osteoarthritis. However, osteoarthritis may appear in younger ages when CE angle is extremely low. And the assessment of the hip congruity has an important factor in predicting any osteoarthritic changes. In those cases, the deranged anatomy of the hip must be corrected to prevent further development of osteoarthritis. There is a wide range of choices for the operative treatment of the dysplastic hip. We are doing the uniquely designed acetabular osteotomy since 1968. This procedure, rotational acetabular osteotomy, is basically the same as Wagner's spherical acetabular osteotomy, or Eppright's dial osteotomy, in which a circumacetabular osteotomy is also done. This operation is indicated for those patients whose hips show such incongruity that degenerative arthritis is inevitable, or in the early stage of degenerative arthritis. We discussed the indications of rotational acetabular osteotomy, by comparing clinically and roentgenologically with the cases in which natural courses were followed up for a long time.

Rotational acetabular osteotomy for the dysplastic hip

A circumacetabular osteotomy of the acetabulum was initially done at the University of Tokyo Hospital by one of us (H. T.) in 1968. This procedure, which rotates the acetabulum, was designed to correct a dysplastic acetabulum in adolescents and adults. The surgical exposure combines both an anterior and a posterior approach. Between 1974 and 1982 this operation was performed on 103 patients (120 hips) with acetabular dysplasia, some showing early degenerative arthritis. The forty-five hips (forty-one patients) that form the basis of this report were followed for three years to eight years and ten months (average, four years and six months). Thirty hips showed only acetabular dysplasia, and fifteen were in the early stage of degenerative arthritis. The ages of the patients at the time of operation ranged from eleven to forty-two years, the majority being in the second or third decade of life. All of the forty-five hips had a preoperative center-edge angle of 10 degrees or less, but most of them had a nearly normal value after surgery. In the majority of the hips either limp or pain with exertion, or both, had disappeared, and a satisfactory range of motion had been restored.

Reconstruction of a large tibial defect with a free vascularized fibular graft

A successful reconstruction of a large tibial defect with a free vascularized fibular graft is presented. The fibular graft demonstrated a significant hypertrophy 2 years postoperatively.

A new socket design for the dysplastic acetabulum in total hip replacement

A special socket was designed by holography for total hip replacement for the treatment of the dysplastic acetabulum and correction of the deformation pattern. Excellent clinical results of 12 cases demonstrate that the special socket design provides good stability as well as favorable redistribution of mechanical forces about the hip joint.

[Painful hip joint with epiphyseal dysplasia (author's transl)]

Among patients who visited our hip clinic, eighteen patients from ten families were diagnosed as mild or atypical cases of spondyloepiphyseal dysplasia or multiple epiphyseal dysplasia. Clinical and X-ray examinations of these patients showed common characteristic features as follows. 1. They usually had short stature but were not dwarfs. Their facial features and body proportions did not suggest hereditary bone dysplasia. 2. Although the disease might be transmitted in an autosomal dominant manner, its occurrence among these families was found to be sporadic. 3. Symptoms of the hip joint mainly resulted from limited range of motion, coxalgia being usually less than expected from X-ray findings. 4. Joints were always affected bilaterally although the degree might be different on each side. 5. In the majority of the cases, the spine, shoulder (in 7 cases), knee (in 6 cases), elbow (in 3 cases), ankle, and wrist joint (in 2 cases) were also affected. 6. Characteristic X-ray findings of the hip joints were as follows. a) Coxa vara, flattening or rectanglar deformity of the femoral head and shortening of the femoral neck. b) The trabecular pattern of the femoral head was irregular and subchondral cysts were often observed. c) Joint space was relatively better restored than expected from the deformity and subchondral bony changes of the femoral head. Spondyloepiphyseal dysplasia and multiple epiphyseal dysplasia are genetic disorders of the epiphyseal and apophyseal cartilage. The hip joint is loading greater mechanical force than any other joint. In both spondyloepiphyseal dysplasia and multiple epiphyseal dysplasia, the hip joint is always affected. As the hip joint is most vulnerable when there is some disorder of the epiphyseal cartilage, it is probably the only detectable abnormal joint. In relatively short period (1972-1978), the diagnosis of mild or atypical spondyloepiphyseal dysplasia was made in 18 patients in our hip clinic. This means that the mild or atypical cases of spondyloepiphyseal dysplasia is not so rare as expected. They might be misdiagnosed as aseptic necrosis, deformity of the femoral head due to Perthes disease or primary osteoarthrosis. An extreme care should be taken when we examine such patients.

Slipped capital femoral epiphysis. A study of 68 cases in the eastern half area of Japan

Slipped capital femoral epiphysis is an uncommon disease among children in Japan. Eighty-one hips in 68 patients collected in the eastern half area of Japan were examined and studies in reference to the incidence, clinical characteristics, and results of treatment. The estimated yearly incidence rate in boys was 0.3 to 0.5 per 100,000 in the population between 10 and 14 years old. The higher incidence of boys (a 5.8 to 1 predilection for males) was characteristic. The disease was extremely rare in girls. Although Japanese children are generally neither as tall nor as heavy as Americans or Europeans, these patients were relatively taller and also much heavier than average. One of the reasons why children of Japan are not susceptible to slipped epiphysis may be explained by the Japanese physique. Satisfactory results were found in less than half the cases. Poor results were mainly caused by complications such as avascular necrosis and acute cartilage necrosis. The incidence of the latter complication was 20.7 per cent in 58 hips followed longer than a year and a half. The method of treatment seems not necessarily related to the development of chondrolysis. This complication is caused by an unknown genetic factor.