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Progressive left facial hemiatrophy began in a boy at the age of 5 years. Over the next 20 years, he developed wasting of the left shoulder and arm muscles, ptosis of the eyelids, ophthalmoplegia, convergence nystagmus, pupillary dilatation, hemiparesis, seizures, and dysarthria. A pneumoencephalogram showed cerebellar hemiatrophy. Biopsy of the cerebellum revealed loss of and degenerative changes in Purkinje cells. A deltoid muscle biopsy studied by histochemical and enzymatic procedures was normal. There are many neurological and ophthalmological complications of progressive facial hemiatrophy. Seizures, ophthalmoparesis, and pupillary abnormalities are the most common. The aetiology and pathogenesis of the disease are unknown. The possibility that this is a `slow virus' disease is suggested.

A typical case of oculopharyngeal muscular dystrophy is reported. On electron microscopic study of a deltoid muscle biopsy, abnormal mitochondria and “fingerprint” inclusions were observed in numerous muscle fibers. The inclusions were composed of concentric lamellae of short electron-dense linear elements. Identical structures have been reported in three other myopathic disorders so that they cannot be regarded as a specific morphologic feature.

A unique case of an elastofibroma arising in the region of the deltoid muscle in a 53-year-old athletic male physician is reported. The lesion was characterized by abundant benign fibrous tissue and sparse accumulations of elastic fibers. The staining of the elastic fibers was accomplished by the use of special staining techniques and are compared to those of other elastofibromas. A review of the literature showed that 56 cases of elastofibroma have been reported to date. Only 2 of these were in an extrascapular site; in 6 patients the lesions were bilateral. The elastofibroma is a completely benign lesion which never recurs after excision. A discussion of the possible pathogenesis of this lesion based on observations of one of the authors (O.H.J.) and his colleagues is also presented. It is suggested that the elastofibroma is a degenerative pseudotumor resulting from local factors such as increased mechanical stress and/or nutritional derangement consequent to vascular involvement.

There are two possible causes that developed the restriction of joint range of motion after intramuscular injection.The first category is peripheral nerve injury after injection which fregently occurred in the radial nerve and the sciatic nerve. The others is degeneration or scar of the muscle tissue which encounter often in rectus femoris muscle in children.The contracture of shoulder joint due to deltoid muscle shortening secondary to the injection is very rare.This 34 year-old-female patient came to our clinic with pain and stiffness feeling on her right shoulder joint. We could get the history that she received repeated intramuscular injections to her right deltoid muscle for two years.She was operated and was found a whitish cord like scarred band, 1cm wide, in the posterior part of the deltoid which was removed subsequently.The histology showed marked atrophy, degeneration, and hyalinization of the muscle tissue.She got fairly good range of motion in the horizontal adduction at the shoulder joint after the surgery.Generally it is difficult to diagnosed this kind of disease on its early stage.This adult case was not dropery diagnosed for about two years.

Summary Samples of deltoid and gastrocnemius muscle from six patients with proven cirrhosis of the liver complicated by ascites and edema were analyzed and compared with similar analyses in normal human skeletal muscle. Four patients were studied by the metabolic balance technique under the following conditions: 1) a control period with an intake of 3.0 gm. of sodium chloride; 2) a similar diet with 45 gm. of cation exchange resin added daily; 3) similar diet but with an intake of 1.5 gm. of sodium chloride per day, together with 45 gm. of cation exchange resin; and 4) a final period comprising the conditions of the third period and the administration of mercurial diuretic on alternate days. The deltoid and gastrocnemius muscles were biopsied again at the conclusion of the entire study, following obvious decreases in the ascites and edema. The gastrocnemius and deltoid muscles of edematous cirrhotics contained an increased amount of extracellular water without significant alteration in intracellular water; the fluid content of the gastrocnemius exceeded that of the deltoid, reflecting the influence of gravitational factors. After disappearance of the obvious edema, the volume of extracellular fluid in the gastrocnemius muscle decreased; the extracellular fluid of deltoid muscle did not change significantly; both remained higher than normal. The combined concentrations of intracellular cations, sodium and potassium, did not differ significantly from the normal. The pattern of weight loss during therapy was partitioned by utilizing the balance data and revealed that, under the conditions of this study, the loss of edema fluid was isotonic and extracellular in composition.

Lipemia retinalis was observed in an 11-year-old girl admitted to Children's Hospital in diabetic coma. In addition to the usual changes in intraocular lipemia, the fundi assumed a darker color during the period of recovery. A small, retinal hemorrhage occurred in the left eye during the second day, but disappeared completely within a week. On admission blood sugar was 335 mg. percent, cholesterol 2454 mg. percent, lipoid phosphorus 76 mg. percent and lecithin 1900 mg. percent. Retinal signs of lipemia persisted practically unchanged for three days even though the blood-fat values diminished sharply within 32 hours after admission. A Sudan-III stained frozen section of deltoid muscle taken 72 hours after admission revealed free and phagocytosed fat in vessel walls and perivascular tissues. The possibility of fat storage in the retinal vessels and surrounding tissue is discussed. From the Departments of Ophthalmology and Pediatrics, College of Medicine, State University of Iowa.

A method has been devised for determination of the glycogen content of human skeletal muscle, obtained with a needle biopsy technique.The method involves homogenization of the muscle specimens. The protein is precipitated with trichloroacetic acid. After precipitation of the glycogen with alcohol from the supernatant, it is hydrolyzed with sulphuric acid, and then determined as glucose with the orthotoluidine method.In 96 per cent of healthy subjects, the glycogen content of the quadriceps femoris muscle ranges from 0.95 to 2.0 g/100 g wet muscle (mean 1.39 g). The standard error of the method is 0.05 g/100 g, representing 3.5 per cent of the mean value. The glycogen content of the deltoid muscle (mean 0.98 g/100 g wet muscle) is significantly lower than that of the quadriceps femoris.A study was also made of the diurnal fluctuations in the muscle glycogen, both under normal conditions and during brief fasting. These fluctuations are found to be small and not uniform.

Electron microscopy of hypertrophic left deltoid muscle of a nineyear-old female diagnosed with neuro-ectodermal dysplasia and concomitant muscle hypertrophy was made. Satellite cells, similar in morphology to myoblasts, are found situated apposed to and beneath the basement lamina of muscle fibers. Satellite cells contain mitochondria, granular ER free ribosomes, polysomes and 50–100 A thick, randomly oriented filaments. Plasmalemmae of apposed satellite and muscle cells show varying numbers of caveolae and degrees of interdigitation similar to plasmalemmae between fusing myoblasts of embryonic muscle. Discontinuities in the muscle fiber plasmalemma and confluence, or overlie, of satellite cell and muscle fiber plasmalemmae are sometimes seen. One possible interpretation of the above evidence suggests that, in this example of muscle hypertrophy, satellite cells may assume myoblast-like properties and serve as focal points for muscle fiber enlargement during muscle hypertrophy.

In order to evaluate further the potential benefit of prophylactic intramuscular lidocaine administration in coronary artery disease, 24 patients with suspected acute myocardial infarction were given an intramuscular injection of lidocaine (10% solution) in the deltoid and gluteal muscles on consecutive days. Twelve patients received an intermediate dose (4 mg/kg), and 12 received a high dose (6 mg/kg) of lidocaine, and blood lidocaine levels were measured over a 4-hour study period. Intradeltoid injection produced higher blood lidocaine levels and more rapid development of peak blood levels than did intragluteal injection. Administration of high-dose lidocaine (average dose 450 mg) into the deltoid muscle produced the ideal combination of rapid peak blood levels (6.5 µg/ml ± 2.1 SEM at 5 min) and persistence of therapeutic levels (>1.5 µg/ml) for over 2 hours. Although drowsiness, paresthesias, slurred speech, and tinnitus occurred in seven of the 12 patients in the high-dose group, no major neurotoxicity, such as grand mal seizures, were observed, nor was there evidence of hypotension or increase in atrioventricular block. Prophylactic administration of high-dose 10% lidocaine into the deltoid muscle appears to have potential for reducing the early mortality following acute myocardial infarction.

The effects of room temperatures upon body temperatures were studied by measuring esophageal, nasopharyngeal, deltoid muscle, deltoid skin and fingertip temperatures in adults undergoing surgical operations not involving the body cavities. Patients were lightly anesthetized, paralyzed, and fully dra

A male, aged 37 years, suffered from giant cell tumor of the right humeral head was treated with prosthetic arthroplasty. A tumorous part of the humerus was as completely as possible resected, after that it was replaced by artificial humeral head made from acry-resin. The musculotendinous cuff cut off in this procedure was tightly sewed in a mass on the inside of the deltoid muscle, and the simultaneously loosed long tendon of the biceps muscle was located into a tunnel of the humeral head (artificial) as well as Nicola's operation in recurrent dislocation of the shoulder joint.In six months after the operation, functional disturbance of the right shoulder joint was lightly recognized only in abduction and internal rotation.

Deltoid muscle activity in holding arm was studied in order to determine the allowable above-shoulder work area for longer operation.The surface electromyogram of the deltoid muscle was integrated and printed out as digit counts per second. Mean maximum duration of the isometric contraction of the muscle was 322sec. for 30% and 131sec. for 50% of the individual maximum strength. The principal component analysis of the integrated values of the electromyogram for 20 samples demonstrated that the predominant component changed at 3/10 to 4/10 of the maximum duration. This coincided with the appearance of the muscle pain.The deltoid muscle activity was measured at different points in the saggital plane passing the acromion. It was as high as 30% of the maximum contraction at overhead regions and the contour line for 10% activity was the line between the vertex and the horizontal arm reach.It is concluded that the work area over the head should be avoided for operation lasting for tens of seconds, and for operations lasting a few minutes the vertex-to-horizontal reach line should not be exceeded, to prevent the shnulder fatigue.

A technique was developed for calculating the force generated by individual muscles that contribute to isometric abduction of the upper limb in the coronal plane with the humerus medially rotated. The instantaneous center of rotation was located and used to indicate the muscles that had a force component which contributed to the force of abduction. Mathematical relationships were obtained for the forces of the individual muscles as a function of their respective ‘effective’ or physiological cross-sectional areas. The effective cross-sectional area was expressed as a function of the maximum thickness of the middle fibers of the deltoid muscle — a parameter that could be measured easily on an X-ray film. The static equilibrium equation about the instantaneous center of rotation could be solved. Any of the forces involved in abduction could be expressed as a function of the measured force of abduction. In the process of applying this technique, certain functions of the muscles involved in the abduction of the upper limb were clarified.

1. Three cases of abduction contracture of the shoulder caused by fibrosis of the intermediate part of the deltoid muscle are described. 2. Treatment by removal of the affected part of the muscle was successful in each case. 3. Histological findings are described and the nature of the condition is discussed.

Electron microscopic and enzyme histochemical studies were performed on the cerebellum and the ocular and deltoid muscles from a 38 year old woman who developed bilateral ptosis at the age of nine years. Histologically the cerebellum appeared normal. The biopsies of three ocular muscles showed varying sizes of muscle fibers which were rounded and contained increased numbers of subsarcolemmal nuclei. The deltoid muscle stained by hematoxylin and eosin appeared normal, but the trichrome stain showed increased numbers of red granules within the sarcolemma corresponding ultrastructurally to increased numbers of abnormal mitochondria. These abnormal mitochondria displayed increased reaction products with LDH, NADH and SDH preparations, while the muscle gave normal reaction in phosphorylase, PAS and myosin ATP preparations. Chemical studies on the cerebellum showed normal proteolipids, glycolipids and phospholipids. Ultrastructurally, the cerebellum, the myofibers of three ocular muscles and the deltoid muscle exhibited abnormal mitochondria which showed peculiarly arranged circular cristae. They frequently contained paracrystalline structures which consisted of individual tubules arranged in a helical pattern. Frequently, the abnormal mitochondria were replaced by dense rectangular inclusions and occasionally showed complete transition to crystalline structures.

The shape and size of the deltoid muscle in man is well known. It is because of the size and extension to the acromion that a dominant position is occupied by the deltoid. It is superficial in its whole extent, having a U-shaped origin over the glenohumeral joint, and attached to the clavicle by its anterior fibres, acromion by its medial fibres, and spine of the scapula by its posterior fibres. All the fibres converge on to the lateral aspect of the humerus and are inserted in a V-shaped impression above the radial groove. In man the muscle has doubled in mass over the mammalian form. In the primitive mammal, for example, the opossum, the muscle is 20% by weight of the scapulohumeral musculature, while in man it is 40%. In the chimpanzee it is 37%.

1 . A case is described in which complete transposition of the latissimus dorsi muscle with its neurovascular pedicle was performed to compensate for complete paralysis of the triceps and partial paralysis of the posterior part of the deltoid muscle. 2. Muscle necrosis did not occur to any significant degree. 3. Strong substitute triceps function was achieved.

1. 1. A simple transacromial operative procedure for exposure of the shoulder joint is presented. 2. 2. Use of this procedure over a number of years proves: it insures adequate exposure of the shoulder joint so that repair of torn tendons is easily carried out; it is safe because no harm can be done to the vessels and nerves of the deltoid muscle; and it gives an excellent cosmetic result.

A double-blind study was undertaken to test the hypothesis that a prophylactic injection of 300 mg of lidocaine as a 10 per cent solution into the deltoid muscle would prevent death for two hours after injection during the pre-hospital phase of acute myocardial infarction. Two hundred and thirty-three Australian family physicians randomly administered lidocaine or placebo to their patients at the earliest suspicion of acute infarction. Patients over 70 years, with heart rate

The resting membrane potential difference (Em) of skeletal muscle was measured in 26 normal human subjects, 7 patients with mild illness, and 21 patients with severe, debilitating medical disorders. A closed transcutaneous approach to the muscle was made by needle puncture and the Em was measured utilizing standard Ling electrodes. Measurements revealed an Em of -88 +/-3.8 mv in healthy subjects and -89 +/-2.1 mv in patients hospitalized for minor medical problems. The mean Em in 21 in-hospital patients, judged to be severely ill clinically from a variety of causes, was -66.3 +/-9.0 mv. Open deltoid muscle biopsies were performed in 7 of the healthy subjects and in 13 of the severely ill group. Estimation of the intra-extracellular water partition was made by calculating the chloride space from the previously measured Em. Analysis of the muscle samples revealed no significant difference in the intra-extracellular potassium ratios of the two groups biopsied. Intracellular Na(+) concentrations were uniformly increased in the muscle samples of the severely ill subjects and averaged 42.3% higher than those of the normal subjects. The mechanisms which might account for the elevation of intracellular Na(+) and a depression of Em independent of changes in intra-extracellular K(+) ratios are discussed and it is suggested that this defect may be a generalized cellular abnormality which is a common quality of serious illnesses.

T HE problem of recurrent dislocation of the shoulder has troubled orthopedists and surgeons for many years. Numerous theories as to the pathogenesis have been advanced but the following are most commonly accepted. Some authorities, notably Bankhart,’ have described a detachment (usually traumatic) of the glenoid Iabrum from the antero-inferior rim of the glenoid which permits anterior and inferior dislocation of the humeral head. Others (Hill and Sacks) d escribed an abnorma1 groove in the posterolateral quadrant of the humeral head which they believe facilitated recurrent dislocation. Still others, DePalma2 in particular, have found by anatomic studies of a11 ages that the above labral and humeral defects are concomitant with increasing age, but that in the later decades of life, while the bone and labral defects increased in frequency and severity, the incidence of recurrent dislocation declined. From these observations DePalma postulated that other factors must be involved, being convinced that the real causative factor was a tearing and relaxation of the musculotendinous cuff of the shoulder plus a stretching of the other auxiliary stabilizing structures such as the glenohumeral Iigaments and the deltoid muscle. This relaxation permits excessive external rotation of the humeral head which predisposes to dislocation. This postulate is concurred with and appears to account for all the elements necessary to explain this phenomenon. Attempts to correct this disabling condition have been legion. Watson-Jones3 states that sixty different operations have been described. These divide themselves into four classes: tion. This method has not been conspicuously successful. Various suspension operations, such as the Henderson5 and NicolaG procedures, attempting to “snug-up” the humeral head in the glenoid cavity by tendinous slings. These slings passing through bony channels tend to atrophy, become relaxed and finally disintegrate. Bankhart and Putti-Platt believed that by reattaching the glenoid labrum (the typical Bankhartian lesion) or reinforcing the antero-inferior capsule, recurrent dislocations might be prevented. This method has been widely used. In 1945 Magnuson’ proposed an approach to this problem which he believed met all of the factors involved. Recurrent dislocation occurs with the arm in abduction and external rotation. Magnuson believed that by limiting the range of these two types of motion dislocation would be less apt to recur. His method transfers the normal insertion of the subscapularis tendon from the lesser tuberosity to a point distal to the greater tuberosity, thus providing a dynamic musculotendinous sling about the humeral head holding it up, and in internal rotation, preventing dislocation. The author has found this method to be both simple and successful.

Subdeltoid bursitis in its acute stages has hitherto been treated by rest to prevent primarily further traumatism to the bursa from motions which cause it to impinge on the coraco-acromial ligament. Counter-irritation, especially with the Paquelin cautery or hot air, has been employed together with the use of ice-bags for the pain. In most instances even with this treatment progress is not particularly rapid, a fact which can be readily appreciated from the sheltered position of the bursa beneath the deltoid muscle. Any treatment in which motion is permitted is sure to be slow owing to the renewed traumatisms to the already distended bursa. One of the most distressing difficulties is the loss of sleep due to the inability of the patients to find a comfortable position or to their being awakened by pain from any unconscious motion that brings the bursa between the ligament and the head of the humerus.

There are three soft tissue signs that may alert the clinician and radiologist to the possibility of subluxation of the acromio-clavicular joint. (1) The extra-synovial fat of the subdeltoid bursa and the fat on the cephalic aspect of the supraspinatus muscle run parallel to the under surface of the acromion and the outer end of the clavicle. In subluxation and dislocation of the acromio-clavicular joint, the clavicle moves in a cephalic direction and a thin triangular gap appears between this normally placed fat and the outer end of the clavicle. (2) The oedema and haematoma produces a mass lesion over the outer end of the clavicle and the acromion process and this displaces the deep fascia in a cephalic direction. (3) The “beak-shaped” origin of deltoid muscle becomes “squared off” in the antero-posterior view by the blood and oedema extending downwards under the aponeurosis on and into the origin of deltoid muscle.

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The patient described in this report was a 23-year-old woman who had two attacks of proximal muscle weakness which remitted spontaneously. The first lasted a few weeks, and the second began a year later and lasted about 2.5 years. Weakness was not affected by corticosteroid, oestrogen-progestogen or dietary therapy. There was a selective and unusual pattern of weakness without atrophy of the proximal limb girdle and neck muscles. Her parents were first cousins. Biochemical studies of muscle biopsies taken at the beginning and at the height of her second attack showed the amount of triglyceride to be more than three times the normal level. Histochemical stains showed this to be located within the muscle fibres. There were also morphological abnormalities and excessive numbers of skeletal muscle mitochondria, particularly in the second deltoid muscle biopsy. The fatty acid composition of the triglyceride was not abnormal. The tricaproin lipase activity of muscle was normal. The nature of the biochemical defect in this case is discussed.

SummaryCapillary resistance was measured by a negative pressure technique on 135 female and 135 male healthy subjects, in the area over the insertion of the deltoid muscle. No significant differences were noted between the two sexes, but the capillary resistance fell with increasing age.No differences were observed between decade-matched female rheumatoid patients who had never received corticosteroid therapy and healthy female controls. No significant difference was noted in age and decade-matched female rheumatoid patients receiving long-term low dosage oral corticosteroid therapy and healthy female controls.No correlation was found between the capillary resistance and any of the clinical or laboratory findings in the rheumatoid patients, with the exception of purpura. Patients with very low capillary resistance had purpura, whether or not they were on corticosteroid therapy.

The normal subdeltoid bursa is not visible on the plain films of the shoulder. The extrasynovial fat is clearly defined, however, deep to deltoid along the outer margin of the upper end of the humerus for about 2·5 cm. It is about 1–2 mm wide. It passes up deep to the deltoid muscle and on to the under-surface of the acromion process in the form of a thin crescent. When the bursa is enlarged by synovial fluid or by synovial thickening, or both, as in rheumatoid arthritis, it can be visible on the plain radiographs. In some cases the bursa is not clearly separated from the deltoid and presents as a mass lesion. (1) Direct evidence. The bursa can be seen as a mass lesion between the humeral shaft and the deep surface of deltoid. It has a well-defined lower lateral, caudal and medial margin outlined by extrasynovial fat. (2) Indirect evidence. The bursal enlargement acts merely as a mass lesion, displacing the deltoid muscle laterally, away from the humeral shaft and causing the deltoid just distal ...

The treatment of pulmonary tuberculosis with mercury has been highly extolled in the past few years by Dr. Barton Lisle Wright, of the United States Navy. The results obtained seemed so remarkably successful that a series of cases were selected and were placed under the mercury treatment. A variety of cases were selected in an endeavor to ascertain in which type the treatment gave the best results. The classification of the different stages of the disease is the same as the one adopted by the National Association for the Study and Prevention of Tuberculosis. The treatment consisted in the administration of a sterile solution of mercury succinimid in 1/5 gr. doses every second day, as advocated by the originator of this method of treatment. The hypodermatic injections were given into different portions of the body, including the buttocks, loose tissues of back and abdomen, and into the deltoid muscle. An