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A study was conducted to find out the effect of probiotic treated rice straw on chemical composition, total digestible nutrients, the fractional rate of degradation characteristics and in vitro gas production. Seven commercial probiotics (P1, P2, P3, P4, P5, P6 and P7) were used to treat rice straw. Probiotic treatment improved CP content. The response to urea treatment on CP content almost doubled the CP content of untreated straw. Trichoderma sp. and Aspergillus sp. also increased the CP content. However, the ADF content in the rice straw was similar to control but significantly (P

We examined the prognosis of adult proximal humeral fractures. In cases treated surgically, the JOA score was related to the timing of early rehabilitation. In addition, prognosis improved with eariy rehabilitation.In type 2 fracture cases, achieving a good clinical result was not related to the therapeutic method.In type 4 fracture cases, the clinical result achieved was not better in comparison with other fracture types. We recommend the use of the shoulder abduction brace in these cases in order to prevent shoulder contracture.

Three dimensional motion of the scapula during arm elevation in the scapular plane was measured and analyzed in patients with rotator cuff tears using a fluoroscope. Patients were asked to elevate both arms to a maximum abduction position in the scapular plane slowly from a resting position over a time span of ten seconds. During this movement several recordings were taken and then analyzed in a micro-computer. There was a great deal of variation in the elevation angle of the arm with rotator cuff tears. However, there were no significant differences in the upward rotation angles, both in the resting position and in the maximum elevated position between the affected side and contralateral side. Downward tilting angle in the maximum elevated position of the affected side was significantly greater than that of the normal side.The present study suggests that rotation of the scapula is not only maintained by the rotator cuff muscles but other shoulder girdle muscles are also responsible.

This study investigated the relation ship between the slope and shape of the acromion and the spur at the antero-inferior surface of the acromion no clarify the cause of subacromial impingement. This investigation was performed with 205 scapular dry bone specimens. The specimens of 107 males were used. Their ages ranged from 20 to 83 years with an average age of 56.5 years. The presence of acromial spurs was identified. All acromions were classified visually as type I (flat), type II (curved) or type II (hooked) as described by Bigliani et al. And the slope of the acromion was measured in all specimens.A spur at the antero-inferior surface was seen in 96 acromions (46.8%). And almost all spurs were located in the anterior one third of the acromion. In all specimens, fifty-six acromions (27.3%) were type I, one hundred and eight (52.7%) were type II and forty-one (20.0%) were type III. The type of acromion was not related to the presence or absence of a spur. The average slope of all acromions was 46±8°, that of acromions with spur was 44±7° and that of acromions without spur was 49±8°. There was a significant difference between the slope of the acromion with spur and acromions without spur. From this study it can be concluded that the type of acromion had no relation ship to subacromial impingement and the flattened slope of the acromion might be one cause of subacromial impingement.

Seventeen cases with fractures of the lower end of the humerus in adults were studied. Subjects consisted of 11 males, 6 females with a mean age of 35.5 years. We treated 1 case conservatively, 16 cases surgically. Patients who started active ROM exercise early after injury gained a wide ROM of the elbow and achieved satisfactory results in ADL. We recommend rigid fixation and early movement to achieve a satisfactory result.

This study reports the outcomes of surgical treatments for congenital elevation and hypoplasia of the scapula.6 shoulders of 5 patients with congenital elevation (1 Sprengel's deformity, 1 Noonan syndrome bilateral, 3 Klippel-Feil syndrome) and 1 patient with congenital hypoplasia of the scapula were treated surgically. They were followed-up for 2 months to 17 years 3 months (average: 7 years 4 months). There were 2 males and 4 females and their ages ranged from 3 to 15 years (average: 6 years 5 months).For the congenital elevation of the scapula, the Konig method was carried on 3 shoulders (in 1 case, Z-plasty was added for the webbed neck), and the Woodward method on 1 shoulder. The patient with the Noonan syndrome was operated on by osteotomy with release in 2 shoulders. In this bilateral case, for the weakness of the shoulder abductor, pectoralis major muscle transfer was added during reoperation. The congenital hypoplasia was treated with pectoralis major muscle transfer only.The range of motion of the shoulder and downward displacement of the inferior angle of the scapula were investigated in these patients.The average shoulder abduction angle improved from 99.2° to 140° at the final follow-up. The average downward displacement of the scapula was 6.2mm (-11mm to 26mm). Patients with Sprengel's deformity showed better results functionally and cosmetically compared to those with underlying diseases such as Klippel-Feil and Noonan syndrome. Patients with muscle hypoplasia around the shoulder girdle were treated with pectoralis major muscle transfer, and satisfactory functional improvement was observed, From these results, good results may be obtained for shoulder girdle muscle hypoplasia by pectoralis major muscle transfer to improve scapular abduction.

Disturbance of the shoulder joint results from the uncoordinated movement of the shoulder girdle muscle and contracture of these shoulder muscles. The purpose of this study is to evaluate patients with birth palsy who were treated surgically to improve the shoulder function.9 shoulders of 9 patients with birth palsy were operated on. The average age at surgery was 12.8 years (range; 4 months to 12 years). The follow-up period was 4 months to 12 years with the average of 4 years 11 months. The reconstructions of shoulder functions were performed by muscle transfer in 7 patients and rotation osteotomy of the humerus in 2 patients. Muscle transfer operation was performed in patients who desired more elevation of the arm. Rotational osteotomy of the humerus was also performed on those who had reasonable elevation but with the arm in the internal rotation position due to muscle contracture. We transferred m. latissimus dorsi in 1 patient out of the 7 patients, m. pectoralis major and m. latissimus dorsi in 1 patient, m. trapezius and m. levator scapulae in 1 patient, and m. trapezius, m. levator scapulae and m. latissimus dorsi in 4 patients out of the 7. The range of motion of the shoulder joint was investigated pre and post operatively.The average preoperative flexion, abduction, and external rotation angles were 74.4°, 72.8° and 3.3°. At the final follow-up these improved to 106.7°, 95.6° and 16.1° respectively. In this series, most of the patients were satisfied with the results.

There are rarely few reports on the clavicular motion during elevation of the extremity. This is may due to the complicated shape of the clavicle and its three-dimensional movement. The purpose of this study is to analyze the movements of clavicle by using X-ray fluoroscope.The study was performed on a 21 years old female who had clavicular fracture a year ago and had fixation with plate and screws. She had no difference on both shoulder ROM when examined. In front of X-ray fluoroscope, she was asked to abduct her arm to full in 10 seconds, and the movements were recorded on videotape. From the location of plate and screws we analyzed the clavicular motion.The clavicle rotated clockwise in its long axis when viewing from the left sagittal plane. This movement increased constantly during the elevation of arm and reached 50 degrees at maximum abduction. In Frontal view, 25 degrees of upward movement was observed, where the majority of the movement was seen within 90 degrees of elevation.

Cubitus varus deformity is one of the most common complications associated with supracondylar elbow fractures. Madsen and Flynn et al reported that the rotational deformity at the fracture site was an important factor in varus deformity, and Madsen reported that ulnar displacement and angulation of the distal fragment might cause the same deformity.In 1993, we reported a useful method to measure humeral torsion using ultrasonography in the reduction of a supracondylar fracture. From 1990, eleven patients were treated by percutaneous pinning using sonography. In this article, we report the follow-up study of these patients.At follow-up, the carrying angle of the affected side was 0 to 16 degrees with an average of 7.5±4.8 degrees and that of the sound side was 5 to 16 degrees with an average of 8.8±3.8 degrees. The average degrees of extension and flexion of the affected side were 6.6 and 137.1 degres, respectively. There was no statistical difference between the sound and affected side.According to these good results, we recommend the use of ultrasonography in treating supracondylar fractures to prevent cubitus varus deformity.

Thirteen cases of elbow joint fracture dislocation in children treated at our hospital were reviewed clinically. There were 11 males and 2 females with an average age of 10.9 years. (range; 5-15 years). The average follow-up period was 8 years 10 months (range; 6 months-22 years). There were posterior dislocation in 8 cases, lateral dislocation in 2, anterior dislocation in 1, and 2 unknown types. Complicated fractures were mainly associated with medial epicondyle fracture in 6 cases and other fractures in 7 cases. The dislocation was reduced in all cases on the same day of the injury. Fracture treatment consisted of 2 conservative and 11 surgical intervention.They were evaluated by JOA score, then correlation between JOA score and age at injury, dislocation type, fracture type, method of treatment, immobilization period, and follow-up period were investigated.Postoperatively, average JOA score was 92.1 points (range; 74-100). Only immobilization period showed a significant correlation with the JOA score with a co-efficient correlation of 0.44. Moreover, considering the range of movement, only the flexion angle had significant relationship with immobilization period (correlation coefficient 0.55).From this study it can be suggested that reduction and osteosynthesis should be carried out as early as possible. Moreover, the elbow should not be immobilized no longer than it is necessary.

This study elucidated the factors causing spur formation at the greater tuberosity and lesser tubercle of the humerus.260 shoulder joints of 138 preserved skeletons were investigated. The average age at the time of death was 58.7 years (range, 20-86 years).Presence of spur in the acromion and in the tuberosities of the humerus were observed macroscopically. The angle formed by the tangent line of the front of the condyles and that of the bicipital groove was also measured.The incidence of spur formation was statistically higher with increasing age. There was a statistical relationship between presence of spur at the humerus and also at the acromion.According to Neer, elevation of the arm in the anatomical position of external rotation causes the critical area to pass under the anterior process of the acromion. However, this study revealed that the presence of more spurs in the tuberosities makes the humerus statistically internally rotated. Therefore, it may be suggested that the incidence of bony spurs is not only due to impingement, but rotation of the humerus and other factors are also responsible.

This study reports the outcomes of 4 different methods for approaching the elbow joint. 20 elbows of 20 patients were operated on for treatment of primary osteoarthrosis of the elbow joint. The approach methods were as follows; 7 Kashiwagi, 7 Anterior, 5 Anterior-posterior and 1 Tsuge.There were 27 males and 3 females ranging in age from 32 to 66 years with an average of 49.3 years. The average follow-up period was 5 years 1 month (range: 7 months to 13 years 1 month). Pre and postoperative (at final follow-up) JOA scores, osteoarthritic changes in radiogram were investigated and their relation ship with the follow-up period analysed.Regardless of the approach methods, the average JOA score improved from 62.9 points to 84.9 points after surgery. There was no significant difference among all the methods described above.In the Kashiwagi approach there is a disadvantage in reaching the anterior part of the elbow, therefore, for the last 15 years we prefer to use the anterior approach because of its wide range of exposure. However, in case of osteophytes in the olecranon fossa, the posterior approach can be added and a satisfactory result obtained. In elbows with severe deformity due to osteophytes, the Tsuge method can be considered.

The avascular necrosis of the humaral head is less common than femoral head necrosis. The purpose of this study is to evaluate the patients with atraumatic avascular necrosis of the Numeral head, clinicaly and radiologicaly.Six patients (11 shoulders) were examined. Among them 4 patients had femoral head necrosis as well. Predisposing causes were steroid therapy in 6 shoulders of 3 patients and caisson disease in 5 shoulders. There were 4 males and 2 females. The average age was 47 years (33 to 59 years). The mean follow-up period was 7 years 5 months. Six shoulders were treated coservatively and in 5 shoulders arthroplasty was performed.In the radiographic examination, 10 shoulders had normal articular surface (stage I), one had deformed articular surface (stage II) and no osteoarthritis (stage III) at first visit. Progression of the radiographic stage was observed in 9 shoulders. clinical results were evaluated by JOA score. The average JOA score of non-operated patients at initial examination was 88.7 and at the recent examination that was 87.8. On the other hand, in patients with arthroplasty the average JOA score improved from 54.8 to 84.7. (excluding one case).Initially subchondral translucent line or linear opacity were seen in most of the cases which were progressive. Patients with severe pain (JOA score below 70) required arthroplasty and a satisfactory results were obtained except one case.

Cubitus varus deformity after supracondylar fracture in children is caused by varus angulation and internal rotation of the distal fragment. An ultrasonographic measurement has been reported as a method of measuring the rotational deformity of the humerus. Yamamoto measured the rotation angle of the glenohumeral joint to clarify the rotational deformity of the distal fragment (Yamamoto's method). This paper presents a comparison of the ultrasonographic measurement and Yamamoto's method.Twenty-five patients with supracondylar fractures were examined for rotational deformity of the humerus using both methods. They were followed for an average of 8 years (2-13 years). The ultrasonographically measured angle of the sound side subtracted from the affected side (HT') was on average 6.9±8.8°, and that of Yamamoto's method (IR') -1.4±16.9°.If HT' and IR' both measured the rotational deformity of the distal fragment, then both angles should be the same. However, there was a distinct difference between them, as IR' was affected by limitation of internal rotation of the glenohumeral joint.From this study, when we recommend that when evaluating rotational deformity of the distal fragment by Yamamoto's method, it is important to remember that IR' is affected by glenohumeral movement.

This article presents a new method for the measurement of humeral torsion with the use of ultrasonography and discusses clinical applications of the method such as the evaluation of cubitus varus deformity after a supracondylar elbow fracture. Torsion angle increased 14 degrees from the time the patients were newborns to when they were adults. No significant difference was found between the right and left sides in healthy subjects. When humeral shaft or supracondylar fractures are treated, or when rotational deformities of the humerus are corrected, this method of measurement is very practical, because the humeral torsion of the unaffected side provides a standard for the individual. With this method of measuring humeral torsion, we also found that cubitus varus deformity after supracondylar fracture in children is caused not only by an increase in varus angulation but also by internal rotation of the distal fragment.

Patients receiving long-term hemodialysis frequently develop orthopaedic complications such as renal osteodystrophy and carpal tunnel syndrome. Kuntz and colleagues reported a new syndrome named destructive spondylarthropathy (DSA). We experienced four cases of DSA who required surgical treatment. Patients included one male and three females with an average age of 60 years (range 54-72 years). The mean duration of follow-up was eleven months (range 7-16 months) and the length of hemodialysis ranged from 8 to 17 years (mean 12 years). All patients had myelopathy along with radiculopathy. We performed anterior cervical spinal fusion (ASF) in three cases and posterior cervical spinal fusion using a rectangular rod in one case. Mean recovery rate using Hirabayashi's method was 59% (range 0-100). Histological examination of the disc was carried out in three cases with ASF and amyloid deposits were found in two. In two case of ASF group, bone union was insufficient.

The incidence of Methicillin-resistant Staphylococcus aureus (MRSA) infections of the joints or bones has increased in recent years. MRSA is less sensitibe to many types of antibiotics, making it a very difficult infection to treat. We treated two patients who had arthritis caused by MRSA, one in the shoulder joint and the other in the hip joint. The patient with arthritis of the shoulder joint had curettage five times followed by surgical treatment with a musculocutaneous flap of Latissimus dorsi. Another patient with paralysis from the spinal level Th7, developed a decubitus MRSA infection of the sacral region and left sided coxarthritis caused by MRSA. In this patient, the decubitus ulcer was treated using a rotation flap, and the coxarthritis was treated with a muscle flap of Rectus Femoris and Vastus Lateralis after three courses of curettage. Recurrence of MRSA infection has not been noted in these two patients for at least one year since their last operation.Musculocutaneous flaps are a good method for treating large dead spaces caused by MRSA infections around joints or over bones.

Most of the examinations for diagnosing recurrent anterior shoulder dislocation are invasive, however MRI is non-inasive, and is widely used recently.Pre-operative MRI of 20 patients (15 males 5 females) with recurrent anterior dislocation of the shoulder were investigated. All cases underwent arthroscopic examination followed by modified Bristow's operation. SET 1 and MPGRT2* weighted images were obtained in the horizontal and scapular coronal planes of the shoulder (signa 1.5 Tesla MRI). We evaluated MRI findings on the Hill-Sachs lesion and Bankart lesion and then compared these with arthroscopic and operative findings. MRI showed 14 with Hill-Sachs lesions, and 6 without it. However arthroscopic examination revealed 12 out of 14 Hill-Sachs lesions, in 2 cases the lesions could not be clearly observed, and in cases without Hill-Sachs lesions, 2 cases had false negative findings on arthroscopy. The sensitivity of MRI in the diagnosis of Hill-Sachs lesions was 86% and the specificity was 100%.Regarding the Bankart lesion, MRI showed 18 positive and 2 negative cases. However, at surgery 17 had Bankart lesions and 3 cases did not have the lesion. Which means one false positive case was diagnosed by MRI. The sensitivity of MRI in the diagnosis of Bankart lesions was 100% and the specificity was 67%.We divided the Bankart lesion cases into three groups; defect of labrum, avulsion or tear of labrum and honey Bankart. From MRI findings there were 9, 7, and 2 cases respectively.Defect of the labrum and honey Bankart coincided with operative findings. However, in the avulsion or tear group, 4 showed avulsion or tear, 2 had defect of the labrum and the remaining one showed no abnormality.

To investigate the development of the blood vessels forming the secondary ossification center in the femoral heads of growing rats, we observed the specimens of the proximal femurs having vascular casts using both an optical and a scanning electron microscopy (SEM). Histologically, the vascular invasion occurred from the lateral part of the cartilaginous epiphysis, prior to the appearance of the ossification center. The vascular casts were prominent within the cellular spaces consisting of a few hypertrophic chondrocytes. The SEM study suggested that the vascular buds had peculiar structures and invaded the cartilaginous epiphysis by breaking through the cellular spaces. The blood vessels budded out from the arch of the lateral epiphyseal vessels toward the femoral heads. The sizes of the large-caliber vascular buds of about 50 microns in diameter were similar to those of the cellular spaces, and they penetrated into the epiphysis by repeated merging and branching. Many deep impressions were noted on the surface of the vascular buds, and the tips showed the peculiar shape similar to a suction cup.

The torsion dystonia is a rare disorder resembling athetosis characterized by abnormal involuntary movements and postures produced by muscle spasm. In patients with athetosis, cervical radiculopathy or myelopathy often occurs during adult life. However, we experienced a patient who had cervical radiculomyelopathy associated with torsion dystonia. In 1996, a 54 years old female visited our hospital due to gait disturbance and pain in the right upper extremity associated with involuntary movements of her head and neck. Her symptoms first appeared at the age of four, which gradually aggravated and she was diagnosed as idiopathic torsion dystonia by neurologist.Neurological examination showed cervical radiculomyelopathy. Radiographs and imaging investigations revealed instability, degenerative changes and compression of spinal cord at the C3/4 level. Initially, we followed Matsuo's method by releasing selective muscles to minimize the involuntary movements. As a second step, two months later, anterior body fusion at C3/4 level was carried out. Her cervical spine was immobilized with halo vest for 6 weeks without any inconvenience. Bone union was achieved by 6 months postoperatively and her symptoms were decreased.In cervical radiculomyelopathy associated with abnormal involuntary movement, cervical fusion operation following selective muscle release is an effective surgical option.

Cubitus varus deformity is a common complication after supracondylar fracture of the humerus. The reason of this complication is thought to be due to the varus and internal rotation of the distal fragment. The varus position of the distal fragment can be controlled, but not by X-ray examination, and the internal rotation by ultrasonographical examination of the humeral torsion. However it has been reported that humeral torsion changes with age. Consequently we measured the humeral torsion using ultrasonography to investigate the changes in the humeral torsion with age as well as laterality.103 males and 98 females, aged between 2 to 18 with a mean age of 10.7 years, were investigated. The results show that humeral torsion increases with age, and there exists no significant difference in laterality and gender in humeral torsion.These results are considered useful for the treatment humeral shaft fracture and the correction of internal rotational deformity after supracondylar fracture of the humerus by measuring the contra lateral side.

Electrokinetic processing has been used to inject representative cationic and anionic nutrients into soil layers, which have widely different hydraulic and electrical conductivities. In this case, using parallel clay and sand layers and at a practical current density, ammonium ion concentrations reached 300-35x0 mg/L in the sand and 250–300 mg/L in the clay layer, while the respective values for sulfate ion were 900–1,000mg/L and 1,000–1,200mg/L. This demonstrates the potential for bio-electrokinetic enhancement by nutrient injection for those sites which cannot be bioremediated by natural attenuation alone. Although considerable electroosmosis occurred at the neutral pH of the system, the anions could be injected upstream about one meter by 1,028 hours of processing. Both the power consumption costs and the process rates arepracticable for the injection of such process additives.

Imaging of the Bankart lesion for the patients with reccurent dislocation of the shoulder is useful for making the pre-operative planning. We compared CT arthrography (CTA) with MR arthrography (MRA), and investigated the usefulness of CTA and MRA for the diagnosis.6 patients (6 shoulders) with reccurent anterior dislocation of the shoulder were evaluated with CTA and MRA. There were 5 males and one female, their age ranged from 17 to 40 years (average age 28 years at the time of operation). CT was taken after injecting 20ml of air in the joint space. MRA was done with itraarticular injection of 20ml of Gd-DTPA and T1 images were taken in transverse and oblique sagittal plane. All of them underwent arthroscopy follwed by modified Bristow's operation. The findings of both MRA and CTA were verified with the arthroscopic and operative findings.Absence of labrum in one case and displacement of the labrum in three cases could be seen in both CTA and MRA. In two cases there was only tear without any displcement, both these cases could be diagnosed by MRA, however, CTA missed one case. On the other hand, considering two osseous Bankart lesions, MRA could not detect one case, whereas CTA could diagnose the both. In four cases there was detachment of the anterior capsule, which could be seen in both CTA and MRA. However, MRA has an upper hand in detecting the anterior inferior glenohumeral ligament.