We experienced two cases of the relatively rare tarsal tunnel syndrome caused by ganglion. In both cases (a 35-year-old male and a 19-year-old female), satisfactory results were obtained by extirpating the ganglion.
In the treatment of ganglion, it is important to trace it to the origin and extirpate it completely. In the tarsal tunnel, however, there are problems such as the existence of the ganglion beneath the posterior tibial nerve, the arteries and veins running along the nerve, the effects of tension on the nerve, and the often deep-seated sites including the subtalar joint. It is important to expose the posterior tibial nerve at a sufficiently proximal position.

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It has been estimated that 10per cent of all dislocations at a joint involve the clavicle. But dislocation of both ends of the clavicle is a rare injury. We experienced such a rare case.
A 49-year-old male struck his left shoulder when his motorbike collided with a bus. His roentgenograms showed a grade 3 dislocation of the acromioclavicular joint and a grade 3 anterosuperior dislocation of the sternoclavicular joint with fractures of the left 2nd, 3rd, 4th, and 5th ribs. We chose to treat the patient nonoperatively. He was given active range-of-motion exercises and weight training, as early as possible. Four years later, he had the full range of painless motion of the shoulder and full strength of the shoulder girdle muscle. The mechanism of this injury and its treatment are discussed.

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During 15 years since 1953, 28 cases (20 males, 8 females) with fracture dislocation of the hip were treated.
Average age at the accident was 33.8 years old (4 to 74 years in range). Mean follow up period was about 6 years (one to 15 years in range). The cases were grouped into 5 according to the Thompson-Epstein's classification; 13 in type 1, 5 in type 2, 2 in type 3, 0 in type 4, 8 in type 5.
Dislocation with the femoral head fracture corresponding to the type 5 were further divided into 4 groups by Pipkin's classification. Clinical results of 16 cases were satisfactory by primary closed reduction. Six cases treated by primary closed reduction and secondary open reduction of acetabular fracture showed good results. No relevant relation was found between the results and period from fracture to closed reduction. On the other hand, two cases of Pipkin's type 1 were cured with closed reduction. Two cases of the type 3 were treated by prosthetic replacement or arthrodesis. In Pipkin's type 4, two cases with the femoral head fracture of non-weight bearing area were good in clinical result only by open reduction of the acetabular fracture, but one case of weight bearing area fracture showed poor result. The most important factor relating to the clinical results was type of the femoral head fracture in the posterior fracture dislocation of the hip.

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Klinefelter's syndrome is eunuchoidism due to a sex chromosome aberration, and it is known to cause osteoporosis due to low testosterone levels. Recently, we encountered a patient with Klinefelter's syndrome (46 years old, male) and severe osteoporosis. He had a right femoral neck fracture, right calcaneal avulsion fracture, and multiple vertebral compression fractures (7th and 10th thorocic vertebrae, 1st and 3rd lumbar vertebrae). The femoral and calcaneal fractures were treated by open reduction, and testosterone was administered for his osteoporosis. The extent of osteoporosis was improved by the testosterone therapy according to the lumbar vertebral QCT value.

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Recently we have experienced three cases of psoas contracture in which the diagnosis was delayed because of the relative rarity of the condition. Flexion of the hip due to the psoas contracture suggested diseases involving the iliopsoas muscle. Computed tomography (CT) of the pelvic area is a very sensitive and rapid means for detecting such lesions. Two cases of psoas abscess and a rare osteochondroma of the inner wall of the ilium were correctly diagnosed by the use of the CT.

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Twenty shoulders with recurrent anterior dislocation were treated with a modified Bristow procedure.
The follow-up period ranged from 6 months to 17 years and 16 months. In this study, there were no redislocations. Seventy-five percent did not complain of pain, 69% had no difficulty in a daily living and 38% could play some sports. Ninety-four percent were subjectively satisfied with the results.
The mean loss of external rotation was 16.8 degrees. The modified Bristow procedure was an effective method of treating recurrent anterior dislocation of the shoulder.

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Rupture of the long head of the biceps brachii is a comparatively rare disease. Most of the patients are middle-aged or older, and a history of trauma is clear in some cases and not in others. However, many cases come to the hospital complaining of abnomalities in the upper arm and weakness.
Operative therapy is the main form of treatment, but there are cases which are overlooked or left untreated.
We have experienced four cases, including two new cases and two old cases, since 1986. They are reported here with some discussions.

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In a 15 year-old girl with good health from birth, a thoracic spinal tumor was detected on a routine chest roentgenogram. The neurological examination was normal, however the plain chest roentgenogram showed a left mediastinal mass. Myelogram showed the incomplete block of dye column around Th₁₀. Isovist CT scan revealed the extradural tumor, which destructed part of the left Th₁₀ vertebral arch and transverse process. Axial images of MRI finely showed the extradural and paravertebral tumor, which existed in the Th₁₀ vertebral body anterolaterally. Although the tumor protruded into the pleura and beside the descending aorta, it didn't compress the dural theca. Cubic configuration of a dumb-bell tumor, in the case of differential development, was possibly grasped by MRI, and such examinations were very useful for the operation. In the present case, a thoracic spinal dumb-bell tumor could be removed without difficulty by costotransversectomy, and the postoperative course was well.

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As a part of a series of investigations on the usefulness of MRI in the evaluation of the spinal disorders, we made a study comparing it with operative findings in lumbar disc herniation.
MRI was performed on 19 patients (21 discs) treated by surgery. Using sagittal T₂ weighted images, their MRI was classified into 4 types (I, II, III and IV) and compared with operative findings; bulging, protrusion, extrusion and sequestration. We investigated also the migration and location (left or right) of disc herniation.
Operation showed all the discs classified as Type III and IV in MRI to be extrusion or sequestration. Of 7 discs with Type I and II images, however, 3 were found to be sequestration. There was a 90% agreement between MRI and operative findings for the direction of migration. For the level and location there was an 86% agreement in multiple disc degeneration and an 100% agreement in single disc degeneration.
Although T₁ weighted images provided delineation of the herniated disc, an agreement with operative findings was not so good as might have been expected. In this respect T₂ weighted images were useful to some extent, but an agreement was 52%.
Surgery can therefore be performed without myelography when only one disc is degenerated and MRI is compatible with its clinical findings.

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Malignant fibrous histiocytoma (MFH) of bones in the hand has rarely been reported. A case of MFH involving a metacarpal bone is reported. This case was a 46-year-old female with a firm lump of her right hand. The tumor originated in the second metacarpal bone widely invaded to the surrounding soft tissue. The extent of the tumor involvement, especially in the soft tissue was clearly defined with magnetic resonance imaging (MRI). Radical resection was performed with a below-elbow amputation according to the Enneking surgical staging system (SSS). One and a half years later she has no evidence of local recurrence or metastasis. Although the SSS is useful in deciding the operative method for malignant bone tumors, further local concept should be added to maintain function of the hand.

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A retrospective study of 8 patients with cauda equina tumors is presented. Clinically, initial features of these tumors were quite similar to lumbar disc lesions, and the most common symptom was pain (low back pain and/or leg pain). 3 patients complained of pain without neurological deficits before the operation, and the average duration of this symptom was 32 months; another 5 patients had both pain and neurological deficits, and the duration was 10.5 months. The correct diagnosis was confirmed by myelography or MRI. All patients were treated by laminectomy and excision of the tumor, and they all recovered completely. A histological examination was performed in all cases, and all of them were neurinoma. It is important to diagnose these tumors before irreversible damage occurs. Symptpoms and signs relating to the tumors are as follows; pain which does not respond to conservative treatments, nocturnal pain, absence or diminution of deep tendon reflexes of the legs, bilateral limited SLR, sensory change of perineum, bladder disfunction, or muscle weakness.

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