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Arthroscopic treatment of tibial plateau fractures were compared with open traditional methods retrospectively.Twenty-eight patients were included in this comparative study based on fracture patterns and divided into two groups. Using Schatzker's classification system, patients with type II (split depression), type III (isolated depression) fractures, or other fracture types were included. Nineteen of these patients were treated by arthroscopically assisted management (group S), and the remaining 9 underwent the conventional open method (group O).There was no significant difference between both groups in terms of duration of operation, postoperative flexion, and clinical results. In group S, however, the postoperative rehabilitation was easier and faster (the time to obtain 120 degrees of flexion was 4.6+/-3.9 weeks in group S, 9.1+/-8.6 weeks in group O). Furthermore, 16 of 19 patients (84%) in group S obtained an anatomical reduction (defined as2 mm of residual displacement after surgery), whereas in group O, only 5 of 9 patients (55%) had an anatomical reduction. Also, accurate diagnosis and treatment of any associated joint pathology was possible with arthroscopic management.The arthroscopic procedure is recommended in selected tibial plateau fractures.

Background: The occurrence of duplications of the amyloid precursor protein gene ( APP ) has been described in European families with early-onset familial Alzheimer disease (EO-FAD) and cerebral amyloid angiopathy. However, the contribution of APP duplication to the development of AD in other ethnic populations remains undetermined. Methods: The occurrence of APP duplication in probands from 25 families with FAD and 11 sporadic EO-AD cases in the Japanese population was examined by quantitative PCR and microarray-based comparative genomic hybridisation analyses. APP expression level was determined by real-time quantitative reverse-transcription (RT) PCR analysis using mRNA extracted from the peripheral blood of the patients. Results: We identified APP locus duplications in two unrelated EO-FAD families. The duplicated genomic regions in two patients of these families differed from each other. No APP duplication was found in the late-onset FAD families or sporadic EO-AD patients. The patients with APP duplication developed insidious memory disturbance in their fifties without intracerebral haemorrhage and epilepsy. Quantitative RT-PCR analysis showed the increased APP mRNA expression levels in these patients compared with those in age- and sex-matched controls. Conclusions: Our results suggest that APP duplication should be considered in patients with EO-FAD in various ethnic groups, and that increased APP mRNA expression level owing to APP duplication contributes to AD development.

A review was made of 62 operations in the elderly patients over the age of 65 years from 1972 to 1974. Seventy-seven percent of the patients were female. Twenty-eight operations were done to the femoral neck or trochanteric fractures. Internal fixations were ordinary done to the trochanteric fracture and the primary prosthetic replacements were performed in 11 cases out of 15 of the femoral neck fracture. Preoperative condition revealed hypertension in 18 patients, in whom cardiac disturbance was 5 and 27 patients had some pathologic ECG. Postoperative complication was urinary infection in 11, acute renal insufficiency, paralytic ileus and serum hepatitis in 2, respectively. No postoperative thromboembolism was observed.

We reviewed 16 trochanteric and 21 femoral neck fractures in last two years. Out of them 10 cases, which were 4 trochanteric and 6 neck fractures, were operated with a compression hip screw. All of trochanteric fracture united satisfactorily. Two of 6 neck fractures were secondary treated by prosthetic replacement from re-fracture by falling from the bed and technical failure.We paid special attention to the following points;1) varus dislocation of the fractured head is undesirable for use of the screw.2) A tip of the screw must be correctly installed in the center of the femoral head and is apart about 1cm from the surface of the head.

Total hip arthroplasty (T. H. A.) for complete dislocation has many problems. In order to perform the operation safer we attempted to do T. H. A. in two-stage, which consists of resection of the femoral head and skeletal traction of the femur before T. H. A., so as to obtain sufficient information of nerve palsy and of the site to place the socket.Case 1 A 53-year-old house-wife with 5cm dislocation of right hip. Eleven weeks later, the socket dislocated from the pelvis and grafted bone and screws were broken. Satisfactory result was obtained by re-operation with good function of the joint and muscles.Case 2 A 51-year-old male laborer with 8cm dislocation. Reposition was technically quite difficult. Leg discrepancy reduced to 2.5cm, but the abductor weakness remained.

During a year from June 1977 to May 1978, 14 limbs in 14 patients with non-union were sent to our hospital. They were 8 males and 6 females who were from 17 years to 60 years of age, average 36.4 years.We examined the causes of the non-union roentgenographically. The results are following.1. inadequate screw fixation, too short or erroneous location (7 cases)2. small intramedullary Kirschner wire or Kuntscher nail (3 cases)3. too short plating (1 case)4. incorrect indication of intramedullary nailing (1 case)5. inadequate external fixation (1 case)6. others (1 case)We treated them surgically by using of internal fixation and bone grafting. Successful results in 13 cases of 14 cases were obtained.

Glycol methacrylate-Quetol 523, introduced by Kushida (1977) for combined light and electronmicroscopy studies at low magnification, also permits application of immunofluorescence methods to semithin sections. To recover the antigenicity of proteins fixed with formaldehyde, abrupt dehydration before embedding and subsequent treatment of the semithin sections with protease were essential. Post-staining with suitable histological stains allows exact correlation of antigen localization with tissue structure.

Rupture of the long head of the biceps is not uncommon. We encountered six cases with seven tendons of the lesion in last one year. In three cases ruptures were caused by acute trauma. One of them had frequent injection of steroid hormone into the tendon sheath previous to the trauma. Three cases of the rest were spontaneous ruptures included a case with bilateral lesions and rupture of the rotator cuff.The diagnosis can be readily made from the history, symptoms and signs. Specially on inspection the swelling of the muscle belly is prominent on contraction.Surgical repair of the tendon either by suture to the bicipital groove or to the major pectral muscle or to the short head of the biceps obtained the satisfactory results. None of the procedure was done to the proximal cut end, but no trouble observed.Cases left non-treated presented any inconvenience in daily life. A case with massive avulsion of the rotator cuff showed marked degenerative periarthritic changes.

The patients were 8 year-old boy and his 9 year-old sister with blood consanguity between their parents and grand parents.Case 1. T. O. male, age 8.Normal birth with slight varus deformity of his right ankle which healed by manual redression and three-months fixation in a plaster cast. Walking started at the age of 1 year 4 months, when his mother noticed of pes equinus of his feet which progressed by aging.His condition was normal in general but marked bilateral equinus deformity of about 160° plantar flexion. He stood on his toes only. No other neuro-muscular disorder was observed. Lengthening of the Achilles tendons about 10 centimeter with the posterior capsulotomy of the ankle resulted in satisfactory correction of the deformity and in good standing and walking on his heels.Case 2. Y. O. female, age 9.Normal birth. At the age of 1 year 3 months when she started walking, equinus deformity of her feet was noticed. Deformity was less severe than that of her brother. Three centimeter lengthening of the Achilles tendons corrected the deformity.In those two cases no cause which resulted in the equinus deformity was discovered and these deformities were noticed when they started walking. Therefore, the cases might belong to the category of congenital pes equinus.