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We investigated the time taken for a tear in the vascular portion of the meniscus to heal and whether free synovial grafting or the presence of basic fibroblast growth factor (bFGF) had a favorable effect on the reparatory process. Adult mongrel dogs were used, and a longitudinal tear, of about 5 mm, was made at the portion one-third of the periphery of the mid-portion of the medial meniscus. The animals were divided into three groups: free synovial graft group, in which a free synovial graft was performed; FGF group, in which animals were locally injected with bFGF at the peripheral synovium of the tear; and control group, in which animals the longitudinal tear was made, but no other procedures were performed. Animals were killed after various periods, and microangiograms and histological observations were made. In all groups, it took more than 16 weeks for the tear to heal. There was no significant histological difference between the free synovial graft group and the control group, but in the FGF group, chondrocyte-like round cells appeared earlier than in the other two groups, suggesting a favorable effect of bFGF on the reparatory process.

Six hundred surgical cases of lumbar intervertebral disc herniation were evaluated histologically for the presence of blood vessels. These patients ranged in age from 12 to 77 years. Blood vessels were observed in 57 of 101 cases of complete prolapse type of herniated disc (56.4%), 12 of 32 cases of incomplete prolapse type of herniated disc (37.5%), and 53 of 467 cases of protrusion type of intervertebral disc herniation (11.3%). The presence of blood vessels in intervertebral discs was also investigated in postmortem specimens. Blood vessels were observed in 293 of 616 intervertebral discs (T10-L5), in individuals older than 40 years of age from 100 postmortem spines. The specimen age range was 16-89 years. Most of the blood vessels seen in the extruded tissue, exposed to the epidural space in cases of complete and incomplete prolapse type of herniation, are thought to have been newly formed after herniation occurred. As invasion of the intervertebral disc by blood vessels was found to occur with the advance of age, it is possible that such blood vessels become extruded with the intervertebral disc tissue. The intervertebral disc may herniate posteriorly in three basic patterns. The first pattern is "protrusion type of herniated disc." In protrusion hernia type there is abnormal posterior bulging of the anulus fibrosus. The disc pathology is predominantly nucleus pulposus, and the peripheral layer of the anulus fibrosus remains attached to the vertebral body bony rim, however.(ABSTRACT TRUNCATED AT 250 WORDS)

To elucidate the mechanism of vascular thrombosis in patients with systemic lupus erythematosus and the lupus anticoagulant changes in factors associated with haemostasis were investigated. The lupus anticoagulant was associated with an increased incidence of thrombosis, particularly cerebral thrombosis. Concentrations of fibrinopeptide A and fibrinopeptide B beta 15-42 were significantly raised in the plasma of patients with systemic lupus erythematosus and the anticoagulant compared with concentrations in patients without the lupus anticoagulant. The tendency towards formation of thrombosis was not found in all lupus patients with the anticoagulant, however. Concentrations of thromboxane B2 were remarkably raised in the plasma of the two patients with the lupus anticoagulant who had recently had thrombosis. Concentrations of 6-keto-prostaglandin F1 alpha, protein C, antithrombin III, and plasminogen were similar in both groups. No significant decrease in serum stimulatory activity on prostacyclin production by cultured aortic endothelial cells was noted in lupus patients with the anticoagulant, but inhibition was present in the two patients with recent thrombosis. These results indicate that although patients with the lupus anticoagulant are not always in a hypercoagulable state, haemostatic abnormalities found in some patients with the anticoagulant may be predictive of thrombotic events.

To determine whether there is an intrinsic defect in T cells from patients with systemic lupus erythematosus (SLE), we studied signal transduction systems, assaying the total protein kinase C (PKC) levels and the phorbol myristate acetate (PMA)-induced activation of PKC in PHA-treated T cells. T cells from SLE patients showed a decrease in proliferation in response to PMA, but not to PHA, thereby suggesting the existence of an intrinsic abnormality in the PKC-mediated activation pathway. Total PKC activity in the T cells from SLE patients was significantly decreased. Although stimulation with PMA induced a translocation of PKC from the cytosol to the particulate fraction, translocated PKC activity after 2 nM PMA treatment was decreased in the SLE T cells. Furthermore, PMA-induced phosphorylation of 80-kDa substrates was also decreased in SLE T cells. These results suggest that there is a reduced PKC activity and an impaired PKC activation in response to PMA in the SLE T cells, a finding which may explain, if partially, the defect in T cell activation in patients with SLE.

Mixed connective tissue disease (MCTD) is characterized as a benign rheumatic disease with a favorable response to therapy. When pulmonary hypertension is a complication, however, it is often reported to be fatal. A 32-year-old female patient with MCTD who had developed rapidly progressive pulmonary hypertension and disseminated intravascular coagulopathy was admitted to our hospital and was successfully treated with corticosteroids and anticoagulants. The failure of microcirculation due to coagulopathy is considered to be one of the possible entities of pulmonary hypertension.

We determined the incidence of herpes zoster (HZ) in 119 patients with systemic lupus erythematosus (SLE). HZ occurred in 56 patients (47%), and 9 patients had had HZ even before SLE developed. After diagnosis of SLE, an incidence of zoster was high, 5.45 cases per 100 person-years. It was found that the susceptibility to HZ was not related to the presence of renal disorder or maximum dose of corticosteroids. The patients with SLE who had had HZ showed significantly higher antibody titers than those without a history of HZ and normal subjects as assayed by both complement fixation technique and neutralization test. On the other had, only 17 of 55 patients (31%) with SLE showed positive skin reactions to varicella zoster virus (VZV) antigen, whereas all 15 normal subjects had positive reactions. In the patients who were receiving less than 10 mg/day of prednisolone, 11 of 17 (65%) had positive skin reactions to VZV antigen, whereas only 4 of 31 (13%) patients who were receiving 10 mg/day or more prednisolone showed positive reactions. It was of interest that in 7 patients with SLE who had not received corticosteroids, only 2 (29%) patients showed positive skin reactions to VZV antigen. These results suggest that high incidence of HZ in patients with SLE is probably due to an impaired cellular immunity because of both underlying disease and corticosteroid treatment.

We investigated the incidence of herpes zoster (HZ) and the immunological state to HZ in patients with rheumatoid arthritis (RA) and mixed connective tissue disease (MCTD) in comparison with systemic lupus erythematosus (SLE). HZ occurred in 6 (25%) out of 24 patients with RA and 4 (22%) out of 18 patients with MCTD. One patient had had HZ before the diagnosis of RA. On the other hand, all 4 patients with MCTD had had HZ before the diagnosis of MCTD. The patients with RA and MCTD showed normal or higher antibody titers to varicella zoster virus (VZV) than normal subjects as assayed by both complement fixation technique and neutralization test. However, the antibody levels were not very high compared to those in patients with SLE. On the other hand, only 7 (50%) of 14 patients with RA and 4 (40%) of 10 patients with MCTD showed positive skin reactions to VZV antigen, whereas all 15 normal subjects had positive reactions. Thus, cellular immunity to VZV was thought to be impaired in these diseases. In the patients who were receiving less than 10 mg/day of prednisolone, 7 (64%) of 11 had positive skin reactions in RA patients and 3 (60%) out of 5 patients with MCTD, whereas none (0%) out of 3 patients with RA and 1 (20%) out of 5 patients with MCTD who were receiving 10 mg/day or more prednisolone showed positive skin reactions. These results suggest that the high incidence of HZ in patients with RA and MCTD is probably due to an impaired cellular immunity as in the case of SLE.

The incidence of herpes zoster was determined in patients with systemic lupus erythematosus (SLE) and the cellular and humoral immunity to varicella zoster virus (VZV) investigated in 45 of these 92 patients. The incidence of herpes zoster was high, occurring in 40 patients (43%), though it was benign in all. Patients with SLE who had had zoster showed significantly higher antibody titres than normal subjects. On the other hand, only 13 of 43 (30%) patients with SLE showed positive delayed hypersensitivity skin reactions to VZV antigen, despite a history of infections with VZV, whereas all 15 normal subjects had positive reactions. Skin reactions to VZV correlated directly with the ratio of OKT4+ to OKT8+ T cells and inversely with the dose of corticosteroids. These results suggest that the high incidence of herpes zoster in patients with SLE is probably due to defects in cellular immunity and that normal or higher titres of antibodies to VZV will not act as a preventive against zoster. In addition, reactivation of VZV, whether symptomatic or not, seemed often to occur in patients with SLE.

Sera from 69 adult prostitutes, 139 juveniles in the reformatory for boys, and 63 juveniles in the reformatory for girls, were collected between 1986 and 1987 in Fukuoka City. These samples were tested for the presence of antibody to human T-cell leukemia virus type-I (anti-HTLV-I), for hepatitis B surface antigen (HBsAg), and for antibody to hepatitis B core antigen (anti-HBc). The juveniles in the reformatory for girls were surveyed for the incidence of venereal diseases (VD) and for a history of intravenous drug use. Anti-HTLV-I was detected in 5.8% of the prostitutes, 0.7% of the boys, and 1.6% of the girls. Prevalence of anti-HTLV-I among the prostitutes was higher than that among the controls, but no significant difference was recognized. HBsAg was detected in 7.2% of the prostitutes, but was absent in the boys and girls. Prevalence of HBsAg among the prostitutes was higher than that among the controls, but no significant difference was recognized. Anti-HBs was detected in 39.1% of the prostitutes, 10.1% of the juvenile boys, and 17.5% of the juvenile girls. In each group prevalence of anti-HBc was higher than that in the controls. Especially between the prostitutes and the controls a significant difference was recognized (p less than 0.005). In the reformatory for girls anti-HBc was detected in 40.0% of 11 girls who were exposed to VD and in 7.0% of 43 girls who were not exposed to VD. Prevalence of anti-HBc among the exposed group was significantly higher than that among the non-exposed group (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

当科の全身性エリテマトーデス(以下SLE)142例を診断時年齢により, 20歳未満の若年群27例, 20歳以上40歳未満の好発年齢群91例, 40歳以上の高齢群24例の3群に分け,臨床症状,予後,とくにこれまで報告の少ない合併症についてretrospectiveに検討した.従来の報告どおり,蝶形紅斑,口腔潰瘍,発熱,腎症,とくにネフローゼ症候群を呈する症例が若年群に多かった.しかし,今までの報告と異なり漿膜炎,とくに心膜炎の頻度が若年群に有意に多くみられた.検査成績でも,若年群は従来報告されているように,低補体の頻度,抗DNA抗体の陽性率が高く,治療でも大量のステロイド剤を必要とする傾向にあり,パルス療 法,免疫抑制剤の併用率も高かった.合併症では大腿骨頭壊死が有意に若年群に多く,若年発症は危険因子の1つと考えられた.一方,帯状疱疹,血栓症は各群ともほぼ同じ頻度で合併しており,年齢との関係はみられなかった.若年群は予後も不良であり,若年発症は予後不良因子と考えられた.一方,今回の検討では高齢群に大きな特徴はみられなかった.

Spinal neurenteric cyst is an uncommon congenital cyst and is frequently found in the cervical region. Two additinal cases are reported and a review of the other 41 cases depicted in the Japanese literature is made, in comparison with the cases reported by Wilkins and Odom.14

In order to observe histological changes in the extruded and sequestrated intervertebral disc, we conducted pathological and immunological examinations of herniated disc materials taken at the time of discectomy. There were 49 disc materials (from 38 men and 10 women [aged 19 to 78 years; average, 36.6 years]). The herniation was classified into four types, based on the intraoperative observations: protrusion (P), subligamentous extrusion (SE), transligamentous extrusion (TE), and sequestration (S). There were 19 P type discs, 3 SE type, 10 TE type, and 17 S type. The surgical specimens were stained with hematoxylin-eosin, as well as immunohistological staining with the labelled streptavidin biotin method, using human T-cell, human B-cell, and human macrophage antibodies. Inflammatory-cell infiltration was observed at the border of the disc. These findings were present in 19 discs (70%) of the 27 discs of TE and S types (10 TE and 17 S types), but were not seen in the 22 discs of P and SE types (19 P and 3 SE types). Immunohistological staining of the area with inflammatory-cell infiltration revealed the presence of T cells and macrophages, which suggested that this cell infiltration originated from T cells and macrophages, and that the spontaneous resorption of the disc may have resulted from the phagocytic activities of these cells.

A 76-year-old female was admitted to our hospital because of fever and the right pleural effusion. On the analysis of pleural effusion, the total cell count was 6720/microliter with 95% lymphocytes, and ADA was 38.1 U/l. The culture of pleural effusion was negative, and the smear and PCR for Mycobacterium were also negative. For examinations, we performed eterography that showed cicatricial strictures of intestine. X-ray examination of the colonated colonoscopy showed ulcers (circular type), shortening of the colon, Bauhin's value insufficiency and diverticulum-like deformity. Then, she was diagnosed as intestinal tuberculosis. The smear and PCR of biopsy specimens from the lesion were positive, and antituberculotic therapy was effective. Finally, the culture of pleural effusion for Mycobacterium tuberculosis was positive after 8 weeks. We thought intestinal examination may be useful for the diagnosis of tuberculosis, when lymphocyte-rich exudative pleural effusion of unknown etiology is seen.

A new anthracycline derivative, SM5887, in combination with commonly used anticancer agents was evaluated against T-cell leukemia MOLT-3 and human osteosarcoma MG-63 cell lines in culture. MOLT-3 and MG-63 cells were incubated with various concentrations of 13-hydroxy SM5887 (SM5887-OH, the active metabolite of SM5887) and other drugs for 3 and 4 days, respectively. Cell growth inhibition was determined by MTT assay. The antitumor effects of the drug combinations at 80% inhibitory concentration (IC80) were analyzed by the isobologram of Steel and Peckham. In MOLT-3 cells, SM5887-OH had additive effects with bleomycin, etoposide, doxorubicin, cisplatin, mitomycin-C, 4-hydroperoxy ifosfamide, 5-fluorouracil, cytarabine, and vincristine, whereas it had mainly protective (marked antagonistic) effects with methotrexate. In MG-63 cells, SM5887-OH had additive effects with bleomycin, etoposide, doxorubicin, cisplatin, mitomycin-C, 4-hydroperoxy ifosfamide; mainly subadditive (mild antagonistic) effects with 5-fluorouracil and cytarabine; and mainly protective (marked antagonistic) effects with vincristine and methotrexate. These findings suggest that SM5887 is suitable for simultaneous administration with bleomycin, etoposide, doxorubicin, cisplatin, mitomycin-C, or ifosfamide and not suitable for simultaneous administration with methotrexate. The effects of SM5887 in combination with 5-fluorouracil, cytarabine or vincristine may be variable, depending on cell lines. To find optimal combinations, further in vitro and in vivo studies of antitumor activity and toxicity appear to be warranted.

We describe the use of a peroneal vascular transinterosseous island flap for the resurfacing of a prepatellar skin defect in 2 patients. Being a fasciocutaneous flap, the peroneal flap is thin, and the location of perforators is easily and safely detected with a Doppler flowmeter. When used as a vascular island flap, either a distal pedicle or a proximal pedicle can be used. The peroneal flap can be used as either a free flap or a vascularized fibular and fasciocutaneous flap. It may, therefore, be applied to compound skin, subcutaneous tissue, and bone defects in the lower extremities. A peroneal vascular transinterosseous island flap can reach a prepatellar skin defect, whereas the peroneal island flap with conventional proximal pedicle cannot.

There was a very interesting editorial some 2 years ago in the Journal of Bone and Joint Surgery (75-A: 159–161), entitled “Orthopedics at a Crossroads” by Augusto Sarmiento. In this article he commented

The pathogenesis of avascular necrosis of bone (ANB) was investigated in 111 patients with systemic lupus erythematosus (SLE) (24 with ANB, 87 without ANB); patients' ages, corticosteroid treatment, clinical and laboratory features associated with SLE, and haemostatic profiles were all taken into account. The mean ages of patients with and without ANB at the time of diagnosis of SLE was 24.1 and 31.2 years respectively. The mean maximal daily dose of prednisolone in the group with ANB was 50.8 mg, which was significantly higher than the dose (41.8 mg) in the group without ANB. Disease features of SLE, such as Raynaud's phenomenon, hyperlipidaemia, nephrotic syndrome, hypertension, and disease activity, were not found to be related to ANB. The percentage of patients who had lupus anticoagulant as well as a shorter activated partial thromboplastin time was greater in those with ANB than in those without. Multiple factors may be involved in the pathogenesis of ANB in SLE, and it is suggested that haemostatic abnormalities, which could be influenced by corticosteroids and young ages, play some part in the development of ANB.

Three hundred sixty-eight intervertebral discs (T11/12-L5/S1) were obtained at autopsy from 61 individuals (36 male, 25 female) ranging from 25 to 85 years of age, and subsequently examined histopathologically as sagittal-sectioned specimens with special reference to the cartilaginous plates. The numbers of cartilaginous foci found in fissured and ruptured regions of the plates were found to increase with age, and were considered to represent a restoration mechanism. Measurement of the cartilaginous plate/intervertebral disc antero-posterior length ratio showed a decrease with age in intervertebral discs from the same spinal level. Therefore, cartilage cell proliferation in the vertebral body rim was found following rupture of the outer layer of the annulus fibrosus and was thought to be one of the causes of spur formation in spondylosis deformans. When the changes in a cartilaginous plate with aging were accompanied by destructive processes of the vertebrae such as osteoporosis or metastatic cancer, an increase in the height of the disc, or ballooning, developed. On the other hand, when degeneration of the intervertebral disc increased and the nucleus pulposus collapsed, the height of the disc decreased. Thus, although the cartilaginous plate exhibits a restoration mechanism, degeneration with age progresses, resulting in various disc lesions.

Seventy Japanese patients with systemic lupus erythematosus (SLE) were studied to define clinical and laboratory characteristics of lupus anticoagulant (LA). To detect LA activity, a mixing test of APTT was performed according to the method of Colaco et al., using the 1:5 diluted phospholipid reagent. As a result, LA was found in the plasma of 11 of 70 patients (16%) with SLE. The incidence of spontaneous abortion in LA-positive and LA-negative women were 7 of 18 pregnancies (39%) and 7 of 73 pregnancies (10%), respectively. The difference was highly significant (p

On this paper the authors document a case of unilateral ulnar neuropathy that developed in a 56-year-old Japanese man who had bilateral hypoplasia of humeral trochlea and severe degenerative changes in the both elbow joints. The patient is the oldest in the reported cases. Pathomechanism of the nerve paresis in this peculiar condition is discussed.

Vascularized grafting with segments of fibula was performed in four men with aseptic necrosis of the femoral head. The patients were restricted to relatively young individuals in whom the necrosis seemed to be confined to two-thirds or less of the femoral head and in whom the outer shell of the femoral head appeared relatively well preserved. The operative technique is described, and the interim results from follow-up ranging from one year, two months to three years, eight months are reported. Three of the four hips became asymptomatic after surgery with x-ray films showing no progression of the necrosis or deformity. In one hip, however, mild pain, bony absorption, and some progression of the deformity persisted. Although the final results in these four cases remain to be seen, vascularized fibular grafting will find a place in the treatment of early avascular necrosis of the femoral head.

Fluorescent whitening agents (FWAs) have been manufactured since 1950 in Japan. Now, they are used very widely in the fields of paper, textile, and detergent industries.Discussions were given to the results of medical surveys and studies on the safety of the FWAs derived particularly from diaminostilbene disulphonate.The FWAs can be considered to be safe both in chronic and acute toxicities.Further, possibility of the FWAs' contamination to human skin or table-wares from papers and textiles was examined.The results showed that the degrees of contamination were very small or negligible.As a conclusion, the FWAs are practically nontoxic even if they are taken into human bodies, though they can not migrate to human skin from papers or textiles containing the FWAs.

A retrospective study was conducted in 122 patients with idiopathic scoliosis who were followed for more than 2 years. There were 58 patients who showed 5 degrees (Cobb) or more progression, and 41 patients who showed no progression. Only those who did not receive any treatment or who failed to comply with brace treatment were selected, to eliminate the effect of treatment. In the early phase of the study, 12 parameters were put into a multivariate analysis to observe the relative weight of each of them, which led the authors to eliminate the following five parameters: 1) Cobb angle, 2) rotation of the apical vertebra, 3) deviation of the apical vertebra, 4) Risser's expected correction: (standing angle--supine angle) X 3, and 5) maturation index of the iliac apophysis. Through a multiple regression analysis, an equation was obtained to correlate the predictive and the real progression within 10 degrees deviation.

This study was performed in order to understand the reasons why the metastasis of malignancy into the disc is rare in contrast to the commonly seen vertebral metastasis. By histopathologic studies of 14 vertebral columns with vertebral metastases of various malignant tumors and 616 disc specimens, the authors found three pathways for an intravertebral tumor to invade into the adjacent disc: 1) direct infiltration from the rim of the vertebral body not covered by the cartilagenous plate, 2) infiltration from the side of the vertebral body close to the vertebral corner, through the subspace beneath the longitudinal ligament, and 3) hematogenous invasion via small vessels in the subspace beneath the longitudinal ligament. The authors concluded that the cartilagenous plate between the vertebral body and the disc as well as high intradiscal pressure would be acting as a barrier against tumor invasion from the vertebral body into the disc, and suggests that gradual increase of capillaries in the disc with age may enhance hematogenous invasion into the disc in rare occasions.

An osteogenic sarcoma of the tibia occurred in an eight-year-old boy with epidermolysis bullosa dystrophica hereditaria (EBDH) (Hallopeau-Siemens type). The patient had had the congenital skin disease since the time of birth. A painful swelling appeared in the proximal portion of his right tibia, which was diagnosed as osteogenic sarcoma on biopsy study. The patient died of massive pulmonary metastases and cachexia four months after the onset of the tumor. Osteogenic sarcoma in a patient with EBDH seems not to have been previously reported. EBDH has been known to be occasionally associated with squamous cell carcinoma. Whether an impairment of the patient's defense mechanism by the chronic skin disease might have enhanced the rapid progression of the associated bone malignancy is unknown.

The hepatic involvement of 57 patients with systemic lupus erythematosus (SLE) was studied with special reference to liver membrane autoantibody (LMA). Liver abnormalities were found predominantly in patients with active SLE (27/48 (56%) in active SLE v 3/20 (15%) in inactive SLE). They were, however, rather mild or moderate and tended to disappear as the disease activity of SLE decreased. In this respect the liver abnormalities observed in this study differed from those in patients with lupoid hepatitis. The incidence of LMA in active SLE (8/11 (73%] was significantly greater than that in inactive SLE (4/12 (33%)). The mean LMA index value in active SLE was 8.3, which was also greater than the 2.9 in inactive SLE. Furthermore, in active SLE the mean LMA titre was significantly higher in patients with liver abnormalities than in those without. These results suggest that LMA may be associated with the activity of SLE and may be one of the factors which cause transient liver abnormalities.