Our objectives were to evaluate synovectomy of the wrist in patients with rheumatoid arthritis (RA), and compare the Sauvr-Kapandji and Darrach procedures from clinical and radiographical aspects. Twenty-seven patients (34 joints) with RA after synovectomy of the wrist were enrolled. The average duration after surgery was 3.6 years. The patients were divided into two groups according to their surgical procedures: 20 patients (25 joints) underwent synovectomy with the Sauvr-Kapandji procedure (SK group) and seven patients (nine joints) underwent synovectomy with the Darrach procedure (D group). Palmar-flexion was reduced (P < 0.005) and supination was improved (P < 0.001) in the SK group. An increase of dorsiflexion and supination was observed in the D group (P < 0.03). Radial rotation and ulnar drift showed no significant change between pre-surgery and last follow-up radiographs. The ulnar shift showed a significant increase (P < 0.05) in the D group, while no change was observed in the SK group. Carpal height ratio also decreased significantly in the D group (P < 0.02). Thus, symptoms such as joint pain and swelling, markedly improved in both groups, and both procedures seemed satisfactory; however, carpal shift is not rare when using the Darrach procedure, and therefore we conclude the Sauvr-Kapandji procedure is more preferable at synovectomy of the wrist in patients with RA.

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Telangiectatic osteosarcoma (TOS) which occurred in the metaphysis of the right femoral bone in a 13‐year‐old female was reported. It showed osteolytic and cystic lesion without sclerotic change on roentgenogram and consisted histologlcally of various sized blood‐filled spaces lined by layers of round to oval tumor cells in the thin fibrous septa. In some solid areas, a proliferation of atypical tumor cells with large prominent nucleoli was evident, embedded in the lace‐like osteoid tissue. Mitotic cells were easily encountered. A large population of tumor cells revealed high alkaline phosphatase activity as well as 5'‐nucleotidase activity, indicative of osteogenic cell origin. Ultrastructurally, they showed osteogenic characteristics of well‐developed rough endoplasmic reticula, cytoplasmic microfibrils, and dense bodies, but not for those of endothelial cells. In this report, we suggest that alkaline phosphatase activity in biopsy and surgical specimens is useful for distinguishing TOS from other osteolytic bone tumors, with regard to its ontogenic discussion.1987.

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