The object of treatment of Legg-Calve-Perthes disease (L.C.P.D.) is to shorten the clinical course and minimize, or prevent residual deformity, This is accomplished by placing the femoral head deeply within the acetabulum, so that its articular surface is completely contained and maintaining a full range of motion, thereby preventing lateral extrusion of head, concentrated vertical loads and collapse. The purpose of this study was to determine the predicting value of prognosis and correlation of three different evaluating methods, when examining an identical series of radiographs to assess the effect of treatments, and to determine whether the result obtained by femoral osteotomy gave better result than those by non-surgical means. During the past ten years prior to writing, 89 patients with L.C.P.D. were treated by authors. Seventy eight (87.6%) patients were boys and 11 (12.4%) girls. Their ages at the time of initial visit ranged from 2 to 13 years. Twelve (13.5%) patients had bilateral and 77 had unilateral involvement for a total of 101 hips. They were analysed according to Catteralls classification, and also comparative study was done for 32 patients who were followed up over 15 months. The longest follow-up was 5 years and 2 months. They were divided into 2 groups: clildren in group A were treated by rest and abduction brace,. followed over 3 years and 3 months in average, and children in group B were treated, by intertro-chanteric osteotomy, followed over 2 years and 6 months in average. End results for 32 cases were evaluated at each follow-up time by Length/Width Index (L/W.I.) of femoral neck (Robichon, 1974), Migration Index (M.I.) and Spherical quotient (S.Q.) of capital femoral epiphysis (Edsberg et al, 1979). L/W.I.,M.I, S.Q. were used not only as the method of evaluation, but also were used as a predicting the prospective clinical course during the treatment by regular measurement whether it takes the good course or not. Results obtained were as follows: 1. 21(20.8%) were classified as group I, 30(29.7%) as group Il. 31(30.7%) as group III and 19 (18.8%) as group IV. 43 children (42.6%) on their initial visit were found to have this diasbling hip condition at stage II (necrosis and early fragmentation stage). 2. Regardless of the type of treatment, good results were obtained in younger children under age of 7 years, and in mild form as in group I, and lI. Also good, results were obtained in the cases who had treatment at early stage of the disease. No difference was found in the end results between girls and boys when they had same degree of head involvement. 3. In 14 surgically-treated patients, the good results were obtained in 9(64.3%) when assessed by L/W I. 10(75.4%) by M.I., and 7(50%) by S.Q., while in 18 conservatively treated patients good results were obtained in 8(44.4%) when assessed by L/W I. in 6(33.3%) by M.I., and 7(38.7%) by S.Q.. This fact means that S.Q. under-estimates the results of well-treated cases, while M.I. seemingly over-estimates them. 4. when X-rays of the hips were taken in different position's, different L/W Indices were unexpectedly obtained; these deviations in assessment may be listed as a drawback. Migration Index can prognosticate the healing process of the disease during treatment, if the index together with medial joint space is measured repeatedly with certain intervals. Also it is difficult to obtain accurately the S. Q. by measurements because of difficulty locating the center of fragmentary head, but it is considered the best method assessing the end-result at the healed stage. S.Q. expresses the head spherocity, while the M. I. expresses the degree of head coverage and the neck L/W.I. expresses the indirectly amount of neck deformity. 5. When the clinical course is assessed by three evaluating methods, occasionally these three results contradict to each other and do not show similar prognostic tendency or trend. The reason is that neck L/W Index and Spherical quotient indicate directly the progress of the disease while Migration Inex receases only the state of femoral head containment and there by indirectly indicates ensuing prospective course when containment is good, and do not indicate the state of severity of the involved head. 6. In this study, the result of surgically treated patients were superior to those of conservatively treated patients.
Acetabulum ; Braces ; Child ; Classification ; Congenital Abnormalities ; Containment of Biohazards ; Epiphyses ; Female ; Femur Neck ; Follow-Up Studies ; Head ; Hip ; Humans ; Joints ; Legg-Calve-Perthes Disease ; Methods ; Neck ; Osteotomy ; Prognosis ; Prospective Studies ; Range of Motion, Articular ; Writing

Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament has been thought very rare. We also had experienced only nine cases of above injury in our center during 5.5 years from January, 1976 to June, 1981. Eight cases of them were followed for an average of the thirteen months, but one of them was eliminated from the study because follow-up study was impossible for the case. The purposes of this paper are to present eight cases of isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament and to discuss the causes and mechanisms of the injury and the method of screw fixation for the avulsed fracture fragment. Seven were injured by traffic accident and one by fall on the knee. All cases seemed to be injured by the force directed against the flexed knee which violently stroke the anterior surface of the proximal end of the tibia or inferior portion of the knee and drove it backwards. We found the tear of posterior capsule only in one patient who was seeming injured by extensive force. All cases were treated operatively by means of screw fixation, and excellent results were obtained in five cases, good in two, and fair in one case.
Accidents, Traffic ; Follow-Up Studies ; Humans ; Knee ; Methods ; Posterior Cruciate Ligament ; Stroke ; Tears ; Tibia

Since Palmer's introduction of the torn medial collateral ligament, many clinical and anatomical studies were performed. But any reconstructive procedure of the medial collateral ligament of the knee known to us, has not solved the problem completely yet. The purpose of present study is to describe a technique of reconstruction, socalled Tatsuzawa's tenodesis surgery of transposed semitendinosus tendon, and is to report the clinical results of 45 cases treated by his procedure between April 1976 and June 1981. In addition, significance of the procerdure was compared with the result of primary closure group of the torn ligament. Tatsuzawa's procedure consists of reinforcement surgery of the repaired or unrepaired torn medial collateral ligament with forwardly transposed semitendinosus. The semitendinosus tendon was brought forward to lie adjacent to deep layer of the medial collateral ligament. The transposed part of the tendon was sutured throughout its length to the medial collateral ligament and to the medial aspect of the tibia and femoral condyle. Because the direction of transposed tendon as similar to the direction of fibers of medial collateral ligament, the procedure was very simple and anatomical one, and had some functional advantages. In this series some old cases are treated only with tendon reinforcement operation without repairing the laxed torn ligament. The results of the surgery were evaluated by the Asais modification of the Feltons evaluation criteria. Results obtained were as follows: 1. In semitendinosus tenodesis with or without primary repair of the torn ligament, satisfactory results were obtained (excellent and good) in 33 cases (73.3%). But in 20 cases of the primary repair group, the satisfactory results were obtained in 11 cases (55%). More satisfactory results were obtained with the semitendinosus tendon reinforcement operation of the torn ligament than only with primary repair. 2. In 29 cases with fresh injury of the medial collateral ligament in which the primary repair together with the tendon reinforcement procedure was performed, satisfactory (excellent and good) results were obtained in 72.4% (21 cases), and in 16 untreated old cases in which only the tendon reinforcement procedure were done, satisfactory results were obtained in 75%. 3. In 5 cases having medial collateral and anterior cruciate ligaments tear, excellent results were obtained in 3. This explains that semitendinosus tendon reinforcement procedure is the key one of the reconstructive operative procedures. It is thought that the procedure is also effective for the anterior cruciate tear to provide the anterior instability.
Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Knee ; Ligaments ; Surgical Procedures, Operative ; Tears ; Tendons ; Tenodesis ; Tibia

It is well known that early diagnosis and early treatment is very important for the patient with congenital dislocation of the hip joint to provide a favorable function in the whole life. The goal of treatment, which is either conservative or operative, is to replace the dislocated hip into the socketand restore its anatomical position. If the head is reduced lately, it may subluxate or redislocate. As a result, secondary osteoarthritis will be complicated in such hips at a laterdate The most cases of congenital dislocation of hip have a increased anteversion and vaglus deformity. It is known that these deformity are cause of redislocation or subluxation, and should be corrected by varus or derotational varus osteotomy to restore for normal cephalocotyloid relationship. We analized 18 residual subluxation of hips which had been treated by derotational varus osteotomy. The results obtained are as follows. 1. Regardless of the age at the time of osteotomy and the amount of varization, the neck-shaft angle corrected to nearly normal in all cases within 3 years after the osteotomy. 2. Acetabular development, indicated by acetabular index, was satisfactory when the osteotomy was done before 4 years, but unsatisfactory in the cases after 4 years of age. 3. Coxa valga epiphysialis of the subluxated head corrected spontaenously after osteotomy in all cases. 4. Subluxated head, indicated by C-E angle and migration percentage, reduced in the cases who had by the derotational varus osteotomy in patients below age of 4 years, but it persisted without further luxation in the cases over 4 years of age.
Acetabulum ; Congenital Abnormalities ; Coxa Valga ; Dislocations ; Early Diagnosis ; Head ; Hip Joint ; Hip ; Humans ; Osteoarthritis ; Osteotomy

No abstract available.
Purpura, Thrombocytopenic, Idiopathic*

The effect of exercise on plasma insulin, free fatty acid, and glucose uptake and glycogen concentration in soleus, and intravenous glucose tolerance of streptozotocin treated, diabetic Sprague-Dawley rats were studied. Diabetic-trained animals were subjected to a regular program of treadmill running for 4 weeks. Seventy-two hours after the last training session, basal and insulin-stimulated glucose uptake was studied in incubated strips (about 20 mg) of soleus muscle in vitro. Glucose tolerance was measured with intravenous infusion of 0.5 g glucose/kg body weight. In diabetic rats, training was associated with increase glucose uptake in basal and maximal insulin concentrations, decreased fasting glucose concentrations, and increased muscle glycogen levels, but there were no changes in glucose tolerance curve and plasma insulin concentrations. These results suggest that regular running program for 4 weeks improve responsiveness of insulin on soleus muscle, but fails to cause improvement of impaired intravenous glucose tolerance in mild degree streptozotocin induced diabetic rats.
Animals ; Body Weight ; Exercise* ; Fasting ; Glucose Tolerance Test* ; Glucose* ; Glycogen ; In Vitro Techniques ; Infusions, Intravenous ; Insulin ; Muscle, Skeletal ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Running ; Streptozocin*

No abstract available.
Adrenocorticotropic Hormone*

No abstract available.
Leukemia, Myelogenous, Chronic, BCR-ABL Positive*

Multiple cerebral infarction developed in a 36-year-old woman with adenocarcinoma of the right lung with direct cardiac invasion. Neurological examination and brain MRI showed findings of ordinary infarction. Transesophageal echocardiography showed left atrial pedunculated mass which was the potential source of embolism. We report a rare case who had such multiple spontaneous tumor emboli large enough to result in clinically detectable cerebral infarction.
Adenocarcinoma ; Adult ; Brain ; Cerebral Infarction* ; Echocardiography, Transesophageal ; Embolism ; Female ; Humans ; Infarction ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Neoplastic Cells, Circulating ; Neurologic Examination

The influence of normal late pregnancy on insulin action and insulin secretion was studied in the Sprague-Dawley female rats. On 20th day after mating, intravenous glucose tolerance test(IVGTI) was performed in non pregnant control and pregnant rats. As results of IVGTT, glucose disappearance rate was not significantly different in both groups, but secretory response of insulin was significantly(p<0.05) increased in pregnant rat. And the ratio of insulin/ .glucose was significantly higher in pregnant rats, which means existence of insulin resistance. These insulin resistance was overcomed by increased secretory response of pancreatic insulin. Insulinogenic index( A insulin/glucose - 5 min) was highly significantly (r=0.62, p<0.01) correlated with progesterone concentration. Glycogen level and amounts of "C-glucose incorporated into glycogen after IVGTT were significantly(p<0. 05) decreased in the liver, but were not changed significantly in soleus. Glycogen synthase activity of soleus and liver was not differ significantly in the both groups. Insulin binding at varying concentrations of insulin to crude membrane of pregnant liver was not significantly different from control. In conclusions, although these pregnant rats were normal glucose tolerance due to increased secretory response of insulin, that was correlated with progesterone concentration, pregnant rat had insulin resistance. The mechanisms of insulin resistance were not related to defect of insulin binding phase and glycogen synthase, but suggest pre-receptor and/or postreceptor phase.
Animals ; Female ; Glucose ; Glucose Tolerance Test ; Glycogen ; Glycogen Synthase ; Humans ; Insulin Resistance* ; Insulin* ; Liver ; Membranes ; Pregnancy ; Progesterone ; Rats* ; Rats, Sprague-Dawley ; Receptor, Insulin