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Objectives The objective of this study was to evaluate the effect of age on myocardial function assessed by two-dimensional speckle-tracking echocardiography (2D-STE) in healthy dogs. Animals Thirty-two healthy Beagles were used. Methods Myocardial function was assessed in each dog by using 2D-STE, and the results were compared between young and old dogs. Results The myocardial deformations in systole, besides the apical rotation rate, were not significantly different between young and old dogs. In contrast, the early diastolic circumferential strain rate, basal rotation rate, and torsion rate were significantly lower in old dogs than in young dogs (P = 0.03, P = 0.033, and P = 0.015, respectively). Late diastolic longitudinal and radial strain rates were significantly higher in old dogs than in young dogs (P = 0.002 and P = 0.018, respectively). Conclusions Young and old dogs showed similar systolic myocardial deformations, but significant differences in the values of some diastolic deformation variables were found between young and old dogs, highlighting the need for using age-matched control subjects in studies of diastolic function.

Congenital absence of the tibia is a rare congenital anomaly causing marked shortening of the involved extremity.A long-term case of congenital absence of the tibia is reported. A 13-year-old boy entered our hospital for correction of his ankle and foot deformity, and lower leg lengthening using the I lizarov method. His absence belonged to the Ib type according to Jones' clssification.At 1 year and 2 months he had Brown's procedure and at 3 years of age ankle arthrodesis had been performed with remarkable equinovarus. Roentgenologically we can observe that his fibula widered and lergthened compared to normal.

We reported a case of the large fibular defect caused by osteomyelitis of fibula of a 20 years old male. He was hospitalized with the fractures of tibia and fibula in another hospital because of traffic accident. He was treated by osteosynthesis of tibia and fibula but suffered the large defect of the distal fibula (8cm long) with the equinovarus deformity due to osteomyelitis. We lengthened the fibula and then corrected the equinovarus deformity but was difficult to reduct the anterior dislocation of talus because of the narrowness of the ankle joint. So it can be thought that correction of the deformitry should be considered first before lengthening the fibula.

Five cases of fracture and non-union of the lower extremities were treated by the Ilizarov method from August, 1989 to October, 1991.case 1: A 45-year old female, infected non-union of a femoral supracondylar fracturecase 2: A 23-year old male, non-union of the tibiacase 3: A 72-year old male, tibia condylar fracturecase 4: A 45-year old female, tibial andylar fracturecase 5: A 13-year male, diaphyseal fracture of the tibia and fibyra having mediotorsio cruris due to fracture in the pastThe complication of pin track infection occured in four cases, but all healed using antibiotics. The Ilizarov method was very useful not only various fractures, but also infected non-union.

There are few reports to discuss the prognosis of the inferior instability of the shoulder. The purpose of this study is to compare the results of natural course and those of the pectoralis major transfer for the inferior instabilty. From 1975 to 1988, 48 patients were diagnosed as inferior instability of the shoulder and were followed from 2 to 11 years. According to the complaints, 19 patients were observed as natural course (natural group) and 29 patients (34 shoulders) were operated on (operated group), and there was no difference in the degree of instability between the two groups.All patients except two did not improve the inferior instability at their follow-up consultations (average, 4.3 years) in the natural group. And the two patients who were followed for 9.9 years and 11 years respectively, showed no instability. But the number of the patients who complain the feeling of subluxation were decreased among the natural group. The average instability of the operated group were improved from 38% to 16%. Four patients among the natural group and ten patints among the operated group did not complain at the follow-up. The number of patients who complained the shoulder stiffness were increased among the operated group at the follow-up. There were no osteoathrotic changes in the natural group.These results suggested that the operative indication should be made carefully for the patients who complain the shoulder stiffness and the feeling of subluxation of the shoulder.

We have studied the prognostic factors affecting the survival rate in 11 patients with chondrosarcoma. Of those, six died of multiple pulmonary metastases and the overall 5-year survival rate was 38.4%.The most significant prognostic factor was the histologic grade, and the 5-year survival rates in grade 1, 2, 3 were 100%, 0%, 25%, respectively. The location of the chondrosarcoma, and whether it was a peripheral or a central type, also seemed to be a good prognostic factor. The 5-year survival rate of the peripheral type was 66.7% as compared with 21.4% for the central type. Adjuvant therapy such as chemotherapy and irradiation had no effect on the survival rate.

The purpose of this study is to dofine the indications for a modified Mitchell's procedure in hallux valgus. 42 feet corrected with this procedure were followed up for an avarage 2 years and 10 months.We reviewed each patient's postoperative result individually and measured the hallux valgus angle, the intermetatarsal angle and the tibial sesamoid position from the radiographs.We obtained good subjective results when the hallux valgus angle before surgery was less than 45 degrees.There was a correlation between the hallux valgus angle before surgery and at follow up.As mentioned above, a good indication for the modified Mitchell's procedure is less than 45 degrees of hallux valgus before surgery.

Traumatic posterior (sub) luxation of the shoulder is not well understood because it is an uncommon condition. This disease may be classified into two groups: habitual and voluntary. We treated six cases of the habitual (sub) luxation, who had no history of trauma initiating the (sub) luxation. Diagnosis was made by clinical observations and radiographs. The routine radiographs and arthrograms showed no abnomalities. Stress radiographs were made and these demonstrated posterior (sub) luxation. The operative procedure consisted of posterior glenoid osteotomy and capsulorraphy. Five shoulders that were followed up for one year or more after the operation were graded excellent.

Ninety-nine cases of supracondylar fracture of the humerus in children were followed-up from 1 to 13 years with an average length of 4 years and 2 months. Supracondylar fractures were classified by Holmberg's classification. They were treated by fixation with plaster cast, plaster cast after manipulation, percutaneous pinning or open reduction. We studied about the range of motion (R. O. M.) and varus or valgus deformity of the elbow after the treatment. Baumann's angle at reduction correlated well with carring angle at the last follow-up (correlation coeficient r=0.79). There were no relationship between the R. O. M. and deformity of the elbow and the degree of displacement of distal fragment after the treatment. The deformity and abnormal R. O. M. of the elbow were essentially caused by incomplete reduction. decrease of the tilting angle led to the limitation of flexion of the elbow. If the conservative treatment is not acceptable to get the good aligment, open reduction must be considered.

For osteoarthritis of the elbow, Kashiwagi-Outerbridge arthroplasty has been mainly employed at the Nagasaki University Hospital. This procedure however has several problems. The soft tissue in the anterior component cause flexion contracture and cannot be treated, also the osteophyte and loosebodies in the anterior parts cannot be eliminated completely, because its approach is a posterior one. Therefore, the anterior approach has been most often employed recently. In this paper, surgical techniques, results and indications are discussed. This procedure was employed in 5 elbows of 5 patients who had limitation of elbow flexion as a result of osteophytes of the coronoid process and loosebodies in the anterior parts. In two cases where they also involved the posterior element, an opening in the coronoid fossa was added. All patients were male and their ages averaged 39.4 years (range, 35 to 44 years). Preoperative range of motion, 99 degrees in flexion and -16 degrees in extension changed to 137 degrees in flexion and -5 degrees in extension on average following suvgery. Pain was eliminated in 4 cases and decreased in one case. Although there are some misgivings about using the anterior approach for the elbow, mainly because of possible injury to the nerve and vessels, such serious complications were not experienced in this series. The anterior approach for osteoarthritis of the elbow has many benefits, so this procedure is recommended.

We have experienced 11 cases of Lord Madreporique total hip arthroplasty; its prosthesis constitutes an irregular rough surface created by multitude of small beads which provide retentive support for newly formed bone, without the need for surgical bone cement. Acetabular component consists of a metallic ring made of chromium-colbalt alloy and a polyethylene core. The ages of our cases were younger than those of Charnley's THR, ranging from 34 to 68 years with an average age of 53.9 years. The acetabula of our cases were nondysplastic or slightly damaged. The most important factors of the surgical techniques were to set the screw ring at 45 degrees of tilt and 10 degrees of anteversion, and to set the stem at 10 degrees of anteversion. In this series there were two cases of postoperative luxation which had more than 55 degrees of tilt of the screw ring, and two cases of fracture in the trochanteric region and femoral shaft.

We have performed reconstruction of the pelvic ring with proximal tibia amputated in hemipelvectomy for the metastatic pelvic bone tumor. Comparing the value of this procedure between the case with this reconstruction and the other with hemipelvectomy alone, it was found that the former case had better ability of weight-bearing at the end of the stump and had less degree of the scoliosis.It was therefore suggested that the hemipelvectomy with pelvic ring reconstruction had superiority to the hemipelvectomy alone in use of post surgical prosthesis.

Zirconia ceramics is characterized by higher strength and higher toughness, as compared with other bioceramics.In order to evaluate the biocompatibility ofof the zirconia ceramics with bone, two implants were inserted into the mature rabbit's femur intramedulaary. One of these implants was from zirconia and the other from K-wire.Four rabbits were sacrificed, at one, four, eight, and twelve weeks after operation respectivery? The speciments of femurs were fixed in formalin, decalcified and embedded in paraffin. The paraffin sections were stained with H & E, and Azan stain.One week after operation, thin fibrous band with conective tissue was observed, but the infiltraction of inflammatory cells was almost nil in the tissue around zirconia ceramics pins.Four weeks after operation, more of the thinner fibrous was observed around zirconia than one week after. Eight and twelve weeks after operation, none of the tissue reaction was observed around zirconia.However, in the tissue around k-wire pins, thick fibrous band with conective at tissue and some inflammatory cell infiltration was observed at one week after insertion. Thereafter, at four to eight weeks after insertion, tissue reaction was observed and twelve weeks later none of this was observed around the K-wire.

Since May, 1986, Whiteside OrthoLoc Total Knee System was used in Twenty cases. Eleven cases (12 knees) who had had total knee replacement were followed-up for more than 3 months (ave. 6.7 months) after surgery. Nine cases (10 knees) had osteoarthritis (OA) and Two cases (2 knees) had rheumatoid arthritis (RA). Ten of the cases were female and 1 was male whose average age was 63.5 years.Using the criteria described by three universities, the clinical results were evaluated. The score was improved from 44.9±4.9 to 79.5±2.4 and roentgenographical results showed that FTA were improved from 187.8°±4.9° to 174.1°±2.6°.Good results were obtained in all cases, however, in some cases the small-size component was relatively small especially in its transverse diameter and it should be replaced in the near future.

A review of thirty cases of the modified Bristow procedure for recurrent anterior shoulder dislocation is presented. The follow-up ranged from 6 months to 12 years and 2 months, with a mean of 3 years and 5 months. In our series there were no redislocations. 93% did not complain of pain and 70% had no difficulty in a daily living. All patients were subjectively satisfied with the procedure. The patients were asked to grade their results from 0 to 10 points and the average results, as graded by the patients, was 9.3 points. Three patients were not capable of returning to sports after the operation because they feared having a recurrence. The Mean loss of external rotation was 8.6 degrees. Roentgenograms at follow-up revealed that two had non-union of the bone block, two had loosened screws and two had broken screws.

The results of marginal excision and irradiation (3, 000-5, 000cGy) in 9 patients with liposarcoma of soft tissue were analyzed to determine the effectiveness of radiation therapy. Only one out of 9 patients, who received 3000cGy, developed a local recurrence at 3 years and 3 months after surgery. The 5-year actuarial local control rate was 84.7%, which was similar to that by radical and/or curative wide resection in soft tissue sarcomas. In addition, histological examination disclosed that a liposarcoma with preoperative radiation fell into almost necrosis.It suggests that the combination of conservative surgery and radiation therapy in the treatment of liposarcomas is of use to maintain a functional limb.

Forty-nine patients who were hospitalized in Nagasaki University between February, 1977 and July, 1985, were examined in order to know the trend about the bacterial infections of bones and joints.Most of the bacillus in 37 cases of osteomyelitis and in 12 cases of pyogenic arthritis were staphylococcus aureus. There was a tendency of increase of the subacute and chronic types of osteomyelitis, and the pyogenic arthritis which was followed by puncture of the knee joint. Our results suggested that while diagnosing the osteomyelitis, the recognition of the existence of the subacute osteomyelitis is very important, and that we must pay more attention to prevent the iatrogenic infection.

An eighteen-year-old girl with Marfan syndrome, who was complicated with osteosarcoma of right humerus, was reported. She had the disorders of the skeleton (arachnodactyly, severe scoliosis and pectus excavatum), the eye (ectopia lentis and myopia) and the heart (mitral valve prolapse). According to these findings, she was diagnosed as Marfan syndrome by Pyeritz's criteria.In Nov. 1985, she felt right shoulder pain and swelling and radiograms showed the abnormal shadow in the right proximal humerus. Bone biopsy disclosed typical histological appearance of osteogenic sarcoma and forequater amputation was carried out on May 15, 1986.Relationship between the systemic disorders of the skeleton like Marfan syndrome and the occurrence of malignant bone tumor was discussed.

Tow cases, which might have been opportunistic infection in the early post-operative state, are reported in this paper.Case 1, a 60-year-old male, developed spticemia on the 22nd day after a synovectomy for suppurative arthritis of the left knee. He had a 13 years history of steroid medication following pituitary adenoma resection.Case 2, a 60-year-old, female, developed pueumonia 4 days after T. K. R.. The bacillus involved was strongly suspected to be a Legionella pneumophila. This patient's basic disease was rheumatoid arthritis.These two cases had similarities of situation, for example their general condition before the onset of infection and antibiotic medication after the operationo; these infections took a similar course. The number of aged patients who have complications following operations for basic diseases has been increasing in the orthopaedic field. We must always, therefore, pay attention to the possibility of the opportunistic infection in the management of such cases.

Twenty-one cases of osteosarcoma in the knee region were summarized in this series and the relation between clinicopathological findings and prognosis was studied. Treatment of those cases were divided into 3 groups as follows; group I (amputation, 3 cases), group II (adjuvant chemotherapy and amputation, 10 cases) and group III (high-dose radiotherapy with combination chemotherapy and surgical treatment, 8 cases) respectively. Ten cases of survival more than 4 years consisted of 5 of 10 cases in group II and 5 of 8 cases in group III. No significant differences of prognosis between groups II and III were recognized.According to radiological findings, 21 cases were classified into 3 types; osteolytic type (5 cases), sclerotic type (6 cases) and mixed type (10 cases), On the relation between radiological classification and prognosis, 5 cases of sclerotic type died. It suggests that sclerotic change in the roentgenogram is one of the poor prognostic findings.Histological classification of the cases in this series consisted of fibroblastic type (MFH-like, 5 cases), osteoblastic type (11 cases) and chondroblastic type (4 cases).The survival rate of fibroblastic type with severe cellular atypism is higher than that of osteoblastic type with mild atypism.

The surgical treatment of disability of the elbow due to muscle weakness from brachial plexus palsy or other palalysis has been concerned with the restoration of flexion. And sometimes sufficient power to lock the elbow in extension while the patient is arising from a bed or chair is an important asset.This report includes 21 flexoplasties and two extensor plasties which were performed from 1971 to 1987. According to the paralytic status of the patient, the choice of the reconstructive method has been decided. The methods include the intercostal nerves transfer (13 cases), Steindler's method (6 cases), the latissimus dorsi transplantation (3 cases) and the transposition of the biceps brachii (1 case).The results of intercostal nerves transfer were influenced by the patient's age at the operation, and the power of the elbow flexor became 3 or 4 after one year from the surgery. The good flexor power was obtained by the Steindler's or latissimus dorsi transplantation method.

Local control of Ewing's sarcoma by preoperative treatment was observed histologically using surgically resected specimens. As preoperative treatment, 3 patients with Ewing's sarcoma in left humerus (case 1), right humerus (case 2) and right ilium (case 3) were treated with low dose irradiation of 30 Gy and combination chemotherapy of vincristine, adriamycin and cyclophosphamide. Wide resections were performed in case 1 and case 2 for limb-salvage, while hemipelvectomy was done in case 3.In the histological examination of the resected specimens, extensive necrosis was seen in the greater part of the tumor of case 1. A thick fibrous capsule making the border clear was newly formed between a small viable tumor cell nest and its surrounding soft tissue. The whole tumors of case 2 and case 3 fell into complete necrosis.These findings seemed to be of use to facilitate the complete excision of Ewing's sarcoma to prevent a local recurrence.

We investigated 10 cases treated by Judet's mobilization procedure which resulted in contracture because of the femoral shaft fracture (5 cases), supuraepicondyle fracture of the femur (1 case), epicondyle fracture of the femur (3 cases) and femoral nerve palsy (post ten-don-transfer-operation, 1 case). An average post-operative follow-up period was 5yrs. and 6mos.At follow-up examination, they had almost the same value of the knee flexion as those obtained during the operation.The factors that related to the results were suggested to be the value of the knee flexion during operation and the operation time.

We have had three experiences of cystic lesions in the proximal tibial epiphysis, which had been suspected to be bone tumors at first, but turned out to be not. The three cases were a 55-year-old female, a 61-year-old female and a 67-year-old male. At first we thought these cases were bone tumors, particulary benign tumors, rather than chronic osteomyelitis because the lesions were located in the epiphysis. The final diagnoses were respectively tuberculous arthritis, non-specific chronic osteomyelitis and staphylococcal osteomyelitis. It has been said that it is difficult to differentiate osteomyelitis from bone tumor. Bone scintigram, CT scan and angiography are most advantageous assistant test methods for differential diagnosis. However, these methods still cannot be between the two, definitely relied on to differentiate in spite of accurate extentional exposure of the lesion. Due the recent spread of antibiotics, non-specific osteomyelitis has been increasing and tuberculous osteomyelitis or arthritis can not get be disregarded. This makes the differentiation more difficult. The purpose of this report is to study such miscellaneneous cases.

Gait analysis by ground reaction force measurement was performed on 17 cases of primary osteosarcoma around the knee treated by limb salvage procedure (eight cases) and by ablative surgery (nine cases). From the patterns of the ground reaction force, it was difficult to distinguish functionally which operative method was better. The only significant difference between them showed the locus of the center of pressure calculated by the vertical component of the ground reaction force. It was was revealed that the limb salvage procedure group had better function than the ablative surgery group, provided that the normal function of the foot could be preserved in the former group. On the other hand, measurement of the ground reaction force was useful in evaluating the recovery process of walking in the same patient.