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Fibrodysplasia ossificans progressiva (FOP) is an extremely rare genetic condition characterized by congenital malformation and progressive heterotopic ossification (HO) caused by a recurrent single nucleotide substitution at position 617 in the ACVR1 gene. As the condition progresses, HO leads to joint ankylosis, breathing difficulties, and mouth-opening restriction, and it can shorten the patient's lifespan. This report describes 3 cases of FOP confirmed by genetic testing in patients with restricted mouth opening. Each patient presented a different onset and degree of jaw movement restriction. The anatomic ossification site of the mandibular joint was examined in each patient using reconstructed computed tomographic (CT) images and 3-dimensional reconstructed CT (3D-CT) images. A 29-year-old woman complained of jaw movement restriction since 13 years of age. 3D-CT image of the mandibular joint showed an osseous bridge, formed by the mandibular depressors that open the mouth, between the hyoid bone and the mentum of the mandible. A 39-year-old man presented with jaw movement restriction that developed at 3 years of age after a mouth injury. 3D-CT image of the jaw showed ankylosis of the jaw from ossification of the mandibular depressors that was worse than in patient 1. CT images showed no HO findings of the masticatory muscles. To the authors' knowledge, these are the first 2 case descriptions of the anatomic site of ankylosis involving HO of the mandibular depressors in the jaw resulting from FOP. In contrast, a 62-year-old bedridden woman with an interincisal distance longer than 10 mm (onset, 39 years of age) had no HO of the mandibular depressors and slight HO of the medial pterygoid muscle on the right and left sides. These findings suggest that restricted mouth opening varies according to the presence or absence of HO of the mandibular depressors.

To establish evidence-based therapy for motor rehabilitation of the upper limbs, we developed a desktop simple exercise machine for upper limbs (D-SEMUL) as a low-cost and high-quality rehabilitation robot. However, the psychological effects of the visual feedback (VF) after the training have not yet been assessed. We investigated the relationship between brain activations and VFs after training in this study. For this purpose, we developed a maze program for the D-SEMUL. Here, the function of the target score (visualized target) was measured as a motivating intervention. We recruited 10 subjects each for a control and an experimental group. Electroencephalogram (EEG) readings from the participants, while they were exposed to the VF after the training, were measured and analyzed to check for the presence of significant differences between two different VFs. Although the results demonstrated no significant differences in the scores among the two groups, the frontal regions of the brain demonstrated a significantly greater degree of activation for VF with target value than without it.

This paper proposed a tread-surface swing mechanism for lower limbs strength training devices. In the standing position and the training for lower limbs, if the tread-surface angle is inappropriate, then the posture of the knee joints will be affected, and knee adduction/valgus moments, which result to knee stress, will be generated. The target trainings are the front-back crossing and the right-left spread exercises. Regarding the swing of the tread-surface, it is necessary to realize a pitch/yaw rotation and a roll/yaw rotation for the former and the latter exercises, respectively. The mechanism we proposed has a further differential mechanism that utilizes the difference between pulley diameters. The translational movement force of the tread-part is transmitted as the torque of the swing motion for pitch, roll, and yaw by the effect of the differential mechanism. The rate of the swing angle can be changed by adjusting the pulley diameter. Rehabilitation and strength training that result in small knee joint stresses and that generate large muscle load cab pose great demand from people suffering from knee joint failure.

Upper-limb rehabilitation training for hemiplegic patients has been primarily conducted by human therapists, and, hence, their use of training methods and conditions strongly depends on their expertise. The force control and motion sensing functions of rehabilitation robots are expected to be used for the qualitative training/assessment in the next-generation computerized rehabilitation. In this study, we developed a desktop rehabilitation robot for upper limbs (D-SEMUL). In addition, we also assessed the usability of its user interface and the affinity (acceptance) of the training program with a questionnaire for elderly hemiplegic/non-hemiplegic participants (nine hemiplegic, five males and four females and seven non-hemiplegic, two males and five females). The results indicated that the touchscreen is acceptable for the user interface, and the background music used significantly affects the affinity of the program.

Upper limb rehabilitation training for Hemiplegie patients has been conducted mainly by human therapists. Training methods and conditions depend strongly on their experience because of the wide range of individual differences between patients. The force control and sensing functions of rehabilitation robots are expected to be used for the qualitative assessment of next-generation computational rehabilitation. In this study, we developed a simple exercise machine for upper limbs (SEMUL) using an electro-rheological fluid brake, as a safe brake-type robotic rehabilitation system. We also developed a new upper limb training/assessment program, called "WIPE," for the SEMUL. Furthermore, we conducted clinical tests on twelve subjects (six each for the SEMUL training and for general training). We adopted the ABA design methodology for the clinical research tests. The motor functions of upper limbs were assessed using five clinical scores: Fugl-Meyer Assessment (FMA), Brunnstrome recovery stage, Simple Test for Evaluating Hand Function (STEF), Stroke Impairment Assessment Set (SIAS), and Motor Activity Log. Improvements of the FMA, STEF, and SIAS in the SEMUL training groups were found to be higher than those in the general training groups.

We present a new type of wafer probe card with resin film consisting of two beams. Resin film is embedded on both sides of the probe beam, having a thickness of 4 [μm] and made from polyimide. This proposed probe enables compliant structures with large overdrive to ensure high durability of the structure and controllable scrub motion to assure cleaning process. In this study, Matrix method is introduced for theoretical studies of the probe structure and commercial finite element code is used. Electrical contact resistance is determined by theoretical studies based on Holm's theory and experimentally by our measurement instrumentation respectively. The structure is proven theoretically to get appropriate scrub motion when it undergoes a large overdrive with preferable exhibited contact force. Moreover, all of these mechanical characteristics can be varied to know the values of the character of probes. The methodology having one of the most preferable characters of the contact-probe had been achieved.

Rehabilitation treatments are important not only for persons who have something wrong in their upper limb function because of disease or disorder. Also they have benefits for the aged to exercise to keep their upper limb function. Since movements of the upper limbs are complicated, various and indispensable for daily activities. Application of robotics and virtual reality technology makes possible for new training methods and exercises on upper limb rehabilitation and for quantitative evaluations to enhance the qualitative effect of training. The authors have involved in a project managed by NEDO (New Energy and Industrial Technology Development Organization as a semi-governmental organization under the Ministry of Economy, Trade and Industry, Japan), “Rehabilitation System for the Upper Limbs and Lower Limbs,” and developed a 3-D and 3-DOF exercise machine for upper limb (EMUL) in which safety kept by actuators using ER fluid. In this paper, the authors focus on an aspect of EMUL; it is a force display device. The authors report virtual reality software of EMUL for rehabilitation training. They also describe some pretest using those software performed by able bodied persons, for clinical treatments in future work.

Several kinds of ER fluids (ERF) have been developed and have been applied to some mechatronics devices and processing technologies. In many conventional applications of ERFs, these devices consist of bilateral electrodes to apply electric field in ERF. However, the electric field of several kV/mm may be necessary to generate an ER effect sufficiently for practical purposes. The gap between a pair of electrodes should be, therefore, maintained narrowly and exactly for fears of short-circuit. At the same time, this electrode system also requires an interconnection on driving parts. To improve these disadvantages, we proposed "one-sided patterned electrode" (OSPE) systems in previous works. In this report, we confirmed the flow characteristics of low molecular liquid crystal (LMLC) on OSPE. Next, we also confirmed the different characteristics depending on the pattern type. Depending on results of electro-static analysis, we conclude that such a difference may results from the directors of LC molecules derived by electric field.

Upper-limbs rehabilitative training for hemiplegic patients has been mainly conducted by occupational therapists (OT). Training methods and its conditions are strongly depending on the experiences of the OT, because of the wide range of individual differences of patients. We have developed WIPE software using the rehabilitation robot, SEMUL for a new assessment method for upper limbs occupational functions. Game levels and wiping power were proposed as assessment score in this study. Three hemiplegic patients were recruited in experiments. The wipe power shows clear difference between before and after the training.

New training methods and exercises for upper limbs rehabilitation are made possible by application of robotics and virtual reality technology. The technologies can also make quantitative evaluations and enhance the qualitative effect of training. We have joined a project managed by NEDO (New Energy and Industrial Technology Development Organization as a semi–governmental organization under the Ministry of Economy, Trade and Industry of Japan) 5-year Project, "Rehabilitation System for the Upper Limbs and Lower Limbs", and developed a 3–DOF exercise machine for upper limbs (EMUL) using ER actuators. In this paper, we also present the development of software for motion exercise trainings and some results of clinical evaluation. Moreover, it is discussed how ER actuators ensure the mechanical safety.

Movements of the upper limbs are indispensable for daily activities. It therefore is important for the aged to exercise to keep their upper limb function. When something is wrong with the upper limb function because of disease or disorder, rehabilitation along with medical treatment is needed to recover function. Application of robotics and virtual reality technology makes possible for new training methods and exercises on upper limb rehabilitation and for quantitative evaluations to enhance the qualitative effect of training. However, rehabilitation systems applying training within a three-dimensional to upper limbs have not been in practical use. In this paper, the authors report on development of a 3-DOF exercise machine for upper limb, which can be use as a motion guide robot or a force display device. Particularly, mechanical structure safety kept by actuators using ER fluid is mentioned.

Movements of the upper limbs are complicated, various and indispensable for daily activities. It, therefore, is important for the aged to exercise to keep their upper limb function. Also when something is wrong with the upper limb function because of disease or disorder, rehabilitation along with medical treatment is needed to recover function. Application of robotics and virtual reality technology makes possible for new training methods and exercises on upper limb rehabilitation and for quantitative evaluations to enhance the qualitative effect of training. We involved in a project managed by NEDO (New Energy and Industrial Technology Development Organization as a semi-governmental organization under the Ministry of Economy, Trade and Industry, Japan), “Rehabilitation System for the Upper Limbs and Lower Limbs, ”and developed a 3-D exercise machine for upper limb (EMUL) . In this paper, We described softwares to control the moving trajectory of the patients hand by EMUL. They were able to be applied the system to practical rehabilitation training such as passive exercise training, active-assistive exercise training or active exercise training.

Recently, an inexpensive digital camera that can equip with a fish-eye converter lens, FC-E8, has been available from Nikon. The converter has more than 180° view angle and lens distortion. The objectives of the present study were to develop a procedure for calibrating the view angle and lens distortion of the fish-eye converter, and to examine the effect of the calibration on light environment estimates. Based on unpublished data provided by the Electric Image Technical Center of Nikon, a 12-order poly-nomial expression for the calibration was derived. The expression enabled us to calibrate the view angle and lens distortion for all selectable resolution digital images. Using a Nikon Coolpix 990 digital camera with the fish-eye converter, 105 hemispherical photographs were taken in 15 stands, and then the canopy cover and weighted openness were measured as the light environment estimates. The calibrated estimates were significantly higher than uncalibrated ones, but the differences were comparatively small, with the average differences being 0.658% for canopy cover and 0.344% for weighted openness. A strongly positive correlation between calibrated and uncalibrated estimates was observed. Both slope and intercept of the regression lines of the calibrated estimate against the uncalibrated one were significantly different between canopy cover and weighted openness, suggesting that the calibration effect would be different among light environment estimates. In conclusion, we should pay attention to the view angle and lens distortion of the fish-eye converter in estimating light environments using the Coolpix digital camera.

Synovitis of the subacromial bursa has been identified as a main source of shoulder pain in rotator cuff diseases. Little interest, however, has been paid into the synovitis of glenohumeral joint. The mRNA expression levels of interleukin-1beta (IL-1beta) and interleukin-1 receptor antagonists produced in the synovitis reflect the magnitude of inflammation. The present study was undertaken to determine the relationship between mRNA expression levels of IL-1beta and its receptor antagonists (secreted interleukin-1 receptor antagonist (IL-1ra) and intracellular IL-1ra) in the synovium of the glenohumeral joint and shoulder pain in rotator cuff diseases, analyzing the synovial specimens by reverse transcriptase polymerase chain reaction. Thirty-five patients with rotator cuff diseases were candidates. Based on the presence of cuff perforation, they were divided into two categories: 16 with non-perforating tears and 19 with perforating tears. The degree of shoulder pain was evaluated by use of a visual analogue scale. The pain degree of non-perforating tears was significantly greater than that of perforating tears (P < 0.01). In contrast, the expression levels of the cytokine-mRNAs were constitutively greater in perforating tears than in non-perforating tears (P < 0.01, respectively). The expression levels of the cytokine-mRNAs were inversely correlated with the degree of pain (IL-1beta: r = 0.930; secreted IL-1ra: r = 0.861; intracellular IL-1ra: r = 0.932, P < 0.001 respectively). These results suggest that the expression levels of the cytokine-mRNAs in the synovium of the glenohumeral joint contribute less to the generation of shoulder pain in rotator cuff diseases.

We developed a strength training device ‘ERIK’ having a controllable passive element by apply an electrorheological (ER) fluid. ERIK has a uniform-load mode and a uniform-velocity mode. In the uniform-load mode, ERIK provides a constant load generated by an ER fluid brake and can thus be used in isotonic exercise. In the uniform-velocity mode, ERIK provides a load moving at constant velocity through control of the ER brake and can thus be used in isokinetic exercise. In addition, the passive element of ERIK can switch between acting as a brake or clutch. In this paper, we compare the control performance of ERIK operated in brake and clutch modes in experiments.

Clinical and radiographic results of trochanteric osteotomy after revision hip arthroplasty in 62 hips were reviewed. The osteotomized fragment had been reattached using the Dall-Miles cable grip system in each hip. The patients' average age at operation was 64.4 years (range, 40-86 years). The average duration of follow-up was 30.0 months (range. 12-60 months). Trochanteric nonunion was found in 19 hips (30.6%). Trochanteric nonunion developed in 14 (38.9%) of 36 hips with each cable attached around the medial cortex bone, in 2 (16.7%) of 12 hips with each cable passed in a drill hole, and in 3 (21.4%) of 14 hips with one cable passed through a hole and the other attached around the medial cortex. Fragmentation developed in 18 hips (29.0%). In 3 of these 18, the fragments had migrated close to the acetabular component. Cable breakage was seen in 4 hips (6.5%), and bone absorption around the cable in the medial cortex was seen in 17 hips (27.4%). There were 16 hips (25.8%) that presented symptoms at the greater trochanter, including spontaneous pain and tenderness. When the Dall Miles cable grip device is used for reattachment of the greater trochanter, attention should be paid to the condition of the trochanteric bed, the tension of the abductor muscles, and to the placement of the cables and the H-shaped grip.

Excessive repetitive impacts in human walking lead to lower extremity orthopaedic disorders such as degenerative joint disease and prosthetic loosening. In this study, two planar models, corresponding to free or fixed ankle joints, were used to examine movements of the knee and ankle joints that affect foot impact forces and their attenuation during level walking. A kinetic approach was used to describe the relationship between the landing style of the leg and the impact at heel contact. Human subjects with free and fixed ankle joints were studied to verify the models. Free and fixed ankle groups showed a significant difference with regard to acceleration (p

Finite element analysis was performed using 3-dimensional models to examine the biomechanical characteristics of the femoral component in resurfacing hip arthroplasty. Stress concentration was observed in the cortical bone adjacent to the rim of the prosthesis. Stress shielding was observed in the anterosuperior regions on the cancellous bone cross-sections near the cup rim. These biomechanical characteristics may lead to complications such as femoral neck fractures in patients with osteopenic bone and long-term loosening.

We assessed the unloading effect of the patellar tendon-bearing (PTB) cast in five healthy volunteers using a new system for analysis of dynamic plantar pressure. We devised a method to improve the unloading effect of the PTB cast, and tested this using the same system. Our findings showed that the conventional PTB cast only achieved unloading of 30% of the body-weight and that the part of the cast on the leg had a more important role in the unloading than that which was in contact with the patellar tendon. When the depth of the free space under the foot inside the PTB cast was 1, 2 and 3 cm, the unloading effect was 60%, 80% and 98%, respectively. The unloading effect of the conventional PTB cast was disappointing at only 30% of body-weight. It was improved by producing a space between the sole of the foot and the cast, and was adjustable by altering the depth of this space.

24 Shoulders of 12 patients with Rheumatoid Arthritis were examined with plain X ray (A-P view) and ultrasonography (US). The anterior, superior and posterior aspects of the shoulder were scanned in the transverse plane.Findings of the US were compared with those of X ray according to Larsen's classification. Even in early stages of Larsen's classification in which X-ray could not detect remarkable changes, effusion, atrophy of the rotator cuff, were detected by US. In more moderate stages, the ratio of detecting the findings of atrophy of the rotator cuff, rotator cuff tear, atrophy of limbs and erosion increased in US scanning. These results suggest that US is useful for evaluating the conditions of the shoulder joint in RA.

We analysed the results of the conservative treatment for cervical spondylotic myelopathy in 51 cases, but not for the other 24 cases operated on soon; Spinal cord with compression was assessed with magnetic resonance imaging, during the period from 1995 to 1997 when they were first seen. A number of aetiological variables were investigated to determine the factors for the change in the condition.Overall 11 cases improved, 7 cases remained the same, and 33 cases deteriorated. In each grade of cervical myelopathy, there were more cases of deterioration than no change or improvement. No significant factor was found.In conclusion, it was confirmed that the operative treatment was the first choice for cervical spondylotic myelopathy. The data suggested that the operative time should be at the early stage of cervical myelopathy.

Ten cases of de Quervain disease were examined by ultrasound. Three were treated with surgical method. Ultrasound examinations were performed with 7.5MHz transducers. We classified the patterns of the septum in the first extensor compartment of the wrist into three groups, complete type, incomplete type, and no septum type. According to this classification, seven cases were of the incomplete type, and the other three cases were of no septum type. Three cases treated with the operative method were of the incomplete type. Ultrasound examination seems to be useful for the diagnosis of the Quervain disease.

(1) 人工股関節再置換術9例10手術の大腿骨の処置にCCGバンドを使用した.(2) 6例に骨癒合が得られたが, 2例は感染の再燃, 1例はステムの設置不良と異種金属によると思われる弛みを起こして, 再手術が必要であったが, このバンドが原因とは考えられなかった.(3) このバンドの欠点としては, 高価格と締結強度が弱いことであった.

Foot pressures in RA patients during gait were measured, and the biomechanical effects of the foot orthoses for RA patients were evaluated.Twelve female RA patients who had food pain during gait were examined, and eight healthy female subjects were matched for age and weight. The foot pressures during gait were measured using the F-Scan program. The Kistler force plate was employed for accuracy. Peak pressure distributions and loading forces were measured, and the effects of the foot orthosis were evaluated.The foot pressures were significantly lower with orthoses than those without orthoses both in the RA and the control groups. Redistribution of the planter pressure was found and the pressures under the forefoot and the hindfoot were reduced with the orthoses. However, the pressures under the midfoot were found to increase with the orthoses.We conclude that significant pressure relief and redistribution are achieved by the specially designed foot orthosis, and the RA patients' suffering from foot pain during walking can be significantly alleviated when they walked with the orthoses. This type of orthosis may play an important role in treating RA patients with foot pain.

We investigated the correlation between the severity of cervical myelopathy and MRI findings.Anterior cervical decompression and fusion in 70 patients with cervical myelopathy were prospectively assessed with MRI. The degree of compressed deformities in the cervical cord on sagittal T1-weighted MRI was classified into three groups: retraction (54%), improvement (39%), or unchanged (7%). Good correlation was observed between the severity of the cervical myelopathy (the Japanese Orthopaedic Association score, recovery rate and duration of symptoms) and the deformity of the cervical cord on sagittal T1-weighted MRI (p

Thirty-four patients who had received previous lumbar disk surgery underwent multiply operated back of the same level for lumbar disk herniation. The leading primary causes were adhesion (35%), relapse (24%), and degeneration (23%). The case showing the worst multiply operated back had adheisin that did not improve as much as in the other cases (average improvement 23%) and the most unstable results. Factors related to unsuccessful multiphy operated back were scar formation, adhesive arachinoditis, nerve root injury at yhe previous operation, multiple operation, and psychogenic factor. Multiply operated back of the same level for lumbar disk herniation was adequately treated by repeat ed discectomy using a microscope. It is important to understand signs, such as symptoms, and take into consideration opinions and portraits that indicate the necessity of surgery in individual cases.

Macroscopic synovitis of the glenohumeral joint is frequently seen during arthroscopy in patients with anterior instability. Interleukin-1beta is known to be expressed in inflamed tissue, to correlate with the magnitude of inflammation, and to affect articular cartilage in the joint. We hypothesized that chronic synovitis may occur in the glenohumeral joint in patients with anterior instability. The purpose of this study was to examine the expression of interleukin-1beta in the synovium of the glenohumeral joint with anterior instability and to discuss its clinicopathologic significance. Specimens of synovial tissue around the greater tuberosity in the subacromial synovium (as controls) and around the rotator interval in the glenohumeral synovium were obtained from 10 patients who had anterior instability without signs of subacromial impingement. Semiquantitative reverse transcriptase-polymerase chain reaction was used to compare the levels of interleukin-1beta mRNA expression in the glenohumeral joint with those in the subacromial bursa. We also employed immunohistochemistry and in situ reverse transcriptase-polymerase chain reaction to detect the cells producing interleukin-1beta protein and mRNA. The levels of interleukin-1beta mRNA expression were significantly higher in the glenohumeral joint than in the subacromial bursa (p < 0.01). Histology showed nonspecific inflammation in all 10 samples of glenohumeral synovium, whereas no inflammation was seen in seven of 10 samples of subacromial synovium. Immunohistochemistry identified interleukin-1beta protein in the vessels and inflammatory and synovial cells (from lining to sublining layers) in synovium of the glenohumeral joint, whereas immunoreactivity was negative in seven subacromial bursa. The remaining three synovial specimens of subacromial bursa, however, showed positive immunoreactivity that was unremarkable and confined around the vessels. In situ reverse transcriptase-polymerase chain reaction was exclusively performed in the synovial specimens of the glenohumeral joint, which exhibited a positive reaction (in the same kinds of cells as seen with immunohistochemistry) in the lining and sublining layers and to a lesser extent in the stroma. Thus, our data confirmed the increased production of interleukin-1beta in the synovium of the glenohumeral joint in patients with anterior instability, suggesting the presence of chronic inflammation at the site. We conclude that this chronic synovitis may be partly associated with the development of dislocation arthropathy in the long term.

We report a case of dedifferentiated leiomyosarcoma. The patient was a 56 year-old man. The tumor was local recurrence in the right greater pectoral muscle after radiotherapy and chemotherapy. Tumor showed typical moderately leiomyosarcoma with dedifferentiated component. This component was revealed as pleomorphic malignant fibrous histiocytoma as a result of immunohistochemistry. These results indicated dedifferentiated components derive from loose muscle features due to dedifferentiation. We diagnosed this case as dedifferentiated leiomyosarcoma.

We reviewed 26 cases of Bioceram cemented total hip replacements for the rapidly destructive coxarthrosis. The long term results of the operation were evaluated in terms of function and radiology. Of 26 cases, 15 cases (57%) were found to be clear zone at the acetabular component Loosening in 6 hips (23%) and revision in 3 hips (12%) were found in an average follow up of 106 months.As the cystic change of the acetabulum appeared more clearly in the preoperative radiographs, the clear zone around the acetabular component after total hip replacement tended to appear higher in the last follow-up.

Two patients with osteoid osteoma treated by a percutaneous excision under a X-ray-guided technique are described. They include a 13-year-old boy with osteoid osteoma in the femoral neck and a 13-year-old boy with tumor in the tibia. After inserting a Kirschner-wire to the nidus under X-ray guidance, a 7mm-diameter trephine needle was advanced through the wire. Nidus was successfully resected into a fan-shape without causing any problems, and no recurrence was seen. Our technique is simple, safe, and minimum to treat patients with osteoid osteoma.

Here we describe Aspergillus osteomyelitis of the tibia in a 9-year-old boy who has an autosomal recessive form of chronic granulomatous disease (CGD). The patient showed a p67-phagocyte oxidase (phox) deficiency, which is rare type of CGD in Japan. The initial treatment which consisted of surgical debridement and antibiotic therapy with amphotericin B (AMPH), did not control the infection. Aspergillus fumigatus (A. fumigatus) pure isolated from drainage fluid and necrotic bone tissue demonstrated less susceptible to antifungal agents, including AMPH, fluconazole and flucytosine. Recombinant interferon gamma was then administrated, and it was effective in controlling the course of severe invasive aspergillosis. This report indicates the use of interferon gamma might be helpful in control for Aspergillus osteomyelitis of the tibia in a child with CGD demonstrated p67-phox deficiency refractory to conventional therapy with AMPH.

Giant-cell tumor is predominantly a benign condition, but it can evolve into a malignant tumor or metastasize to the lung. Transformation of benign giant-cell tumor into sarcoma is relatively common after radiation therapy. We report here a case of a patient who had local recurrence seven years after marginal resection and radiation therapy for a giant-cell tumor of the sacrum. One years after initial operation, the patient returned to us because of a lump in the lower abdomen, and re-resection of the tumor and radiation therapy (50Gy) were performed. Microscopic examination showed the typical feature of benign giant-cell tumor. Seven years after the radiation therapy, low back pain developed gradually and a computerized tomography showed a huge tumor of the pelvic space. Histological features of the tumor indicated malignant transformation into fibrosarcoma.

We studied the results of treatment using spacers of cement with antibiotics for an infected hip joint in 11 cases, during the period from September 1994 to October 1998. Five cases were male and 6 were female. Their mean age was 65 years, with age ranging from 26 to 80 years. The infected hip joints involved coxitis purulenta in 3 cases, an infected prosthesis in 7 cases, and an infected girdlestone in 1 case. The mean follow-up period was 1.6 years, ranging from 5 days to 4.1 years. At first, we removed the prosthesis or resected the femoral head, and performed curettage. Next, we inserted spacers made from cement with antibiotics, modeled on a unipolar prosthesis. Seven cases (63.6%) responded, while the other 4 cases (36.4%) did not respond. A new prosthesis could be replaced in 5 cases. The mean follow-up period after replacing the prosthesis was 2 years, with range from 1 month to 3.9 years. These 5 replacements have not relapsed. We have concluded that this treatment was effective.

We have studied 35 patients (25 female and 10 male) with low-back pain who were managed with aquatic exercises after an appropriate period of treatment for their condition in the medical institution. The exercises employed consisted of strengthening exercises for the abdominal, gluteal, and leg muscles, stretching of the back, hip, hamstrings, and calf muscles, walking in water, and swimming. All the patients had been participating in the exercise program for more than 6 months. The frequency of performing exercises was once a week for 7 patients, twice a week for 19, and 3 or more times a week for the remaining patients. The method used in this study was a survey questionnaire which was composed of questions about the patient's physical and psychological condition. Those patients who had performed exercises twice or more in a week showed a more significant improvement in the physical score than those who performed exercises only once a week. More than 90% of the patients felt they had improved after 6 months of participation in the program. The improvement in physical score was independent of the initial ability in swimming. The results obtained suggested that exercises in water may be one of the most useful modes of exercise for a patient with low-back pain.

A spinal epidural hematoma may result from one of many causes, including coagulopathy, trauma, a vascular lesion, iatrogenesis, and spontaneous occurrence2,4,6,7,11,12. Groen and van Alphen7 reviewed the cases of 333 patients who had a spontaneous spinal epidural hematoma; they had excluded patients in whom the hematoma had occurred after a traumatic episode involving spinal dislocation or fracture, after epidural anethesia, after diagnostic lumbar puncture, after an operation, or in association with a tumor in the spinal canal. Of the 333 patients, forty (12 per cent) had a lumbar epidural hematoma. Overall, fifty-five (17 per cent) of the patients were younger than twenty years old, and only four (7 per cent) of these young patients had a spontaneous lumbar epidural hematoma. Boyd and Pear reported that a hematoma caudad to the level of the conus medullaris was more likely to be chronic because the spinal roots appear to tolerate pressure better than the spinal cord does. In a review of the literature, we found four cases of lumbar epidural hematoma in patients who were younger than twenty years old3,7,17,21, and we compared these cases with that of our patient. A chronic spinal epidural hematoma is rare in young patients; it occurred in only two of the patients, including ours. We report the case of a young patient who had a chronic lumbar epidural hematoma and spondylolysis at the third lumbar vertebra. The patient, a seventeen-year-old high-school student, had radicular pain in the left lower extremity when he was first seen by us in 1991. He was a rugby player (center prop position number three), and, in early December 1991, he had pain on the left side of the low back …

The subacromial bursa is recognized as a site associated with the shoulder pain caused by rotator cuff disease in the middle-aged and elderly. Substance P is contained in primary afferent nerves, and its quantity increases during chronic pain. The amount of substance P in the subacromial bursa of patients with rotator cuff disease was examined. Radioimmunoassay and immunohistochemistry were employed to quantify and localize substance P. The preoperative pain level was measured with a visual analogue scale with 0 as no pain, 5 as moderate, and 10 as severe. Thirty-seven patients that had undergone operation were divided into two groups: one composed of 19 patients with subacromial bursitis and a partial-thickness tear of the rotator cuff (nonperforated cuff) and the other composed of 18 patients with a full-thickness tear (perforated cuff). Subacromial bursae obtained from seven fresh cadavers with no shoulder pain before death were used as controls. The visual analogue scale showed significantly greater pain in the group with the nonperforated rotator cuff than in the group with the perforated cuff. Consistent with these results, the amount of substance P in the subacromial bursa was significantly greater in the former group than in the latter. Nerve fibers immunoreactive to substance P were localized around the vessels, with a larger number of fibers in the group with the nonperforated rotator cuff. Therefore, an increased amount of substance P in the subacromial bursa appears to correlate with the pain caused by rotator cuff disease.

We retrospectively studied autologous blood transfusion in 65 cases of hip and knee arthroplasty. The cases consisted of 10 males and 45 females whose age ranged from 34 to 81, with an average age of 61.3 years.Autologous blood was preserved by liquid, and in 35 cases, Erythropoietin (EPO) was intravenously administrated 3 times a week.We have been performing autologous blood transfusion on patients treated with hip and knee arthroplasty since 1990, and the method allows us to avoid homologous transfusion in 88.9% of our patients.