Primary pulmonary Hypertension is a rare disease of unknown etiology. Watanabe, S. et al. (Chiba Univ.) stated that 137 cases, including our 1 case, have been reported until 1974 in Japan.
We have experienced one autopsied case of primary pulmonary hypertension, a 37-years-old female, who was admitted to the hospital with a complaint of dyspnea in Dec. 1972. For the past 2 years, she had been suffering from dyspnea on exertion. On admission, she had marked cyanosis and slight edema. Second pulmonic valvular sound was splitted, but no murmur was audible. ASLO was 500×, CRP was (++), liver function test was normal, EKG revealed RVH without rBBB, chest X-P showed a dilated right main pulmonary artery with enlarged right ventricle. The pulmonary artery pressure were 100/45, mean 60mmHg, on the other hand, the cardiac catheterisation and angiography disclosed no shunt at any level. Because of clinical and physical findings, this case can be regarded as primary pulmonary hypertension.
Her condition gradually got worse, and in Aug. 1973, 8 months after admission she died.
Autopsy of this case revealed a right ventricle hypertrophy, and there was no congenital or acquired cardiovascular abnormality.
Histological findings in pulmonary arteries and artrioles revealed marked medial hypertrophy, intimal thickening and plexiform lesion, but there was not found cellular proliferation.
We discussed the etiology, symptoms, differential diagnosis, and clinical course of this disorder on literatures.
We conclude that the etiology of this disease is undetermined, and effective therapy is not found at present.

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Increases in the activities of cerebrospinal fluid enzymes (e. g. GOT, GPT, LDH, CPK and etc.) are frequently noted in various states of CNS disorders, but those mechanisms are complicated.
Enzymatic activities and gas analyses in CSF of a 24-years-old male after poisoning with Ethinamate taken for suicidal purpose were investigated. GOT, GPT and LDH activities in CSF were not so elevated. On the contrary, the activity of CSF-CPK was much increased to 87 units and pH and HCO^-₃ in CSF were decreased to 7.233 and 9.9 mEq per litter respectively and CSF oxygen tension diminished slightly.
In our investigation, we observe that in almost all cases of cerebrovascular insufficiency the CP'K activity tends to be greater than in the control and normal CPK cases in CVI scarecely consist in the region of the low levels in both pH and HCO^-₃.
Therefore we presume that the metabolic disorders such as hypoxia or acidosis might be one of factors by which the level of CPK in CSF might be elevated.

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On the 53 of the 87 cases of severely handicapped children (persons), urine was accumulated for 24 hours, using catheter or U-Bag. The followings were obtained for 27 cases of the children receiving no drugs,
1) The amount of urine excreted a day of the severely handicapped children was small (from 3 years and 11 months to 25 years and 11 months). Accordingly, water needs to such children particularly in summer. Therefore, it is necessary to include the time for giving water in their daily schedule besides at meals.
2) The total amount of amino acids excreted in urine comes to be 156.4-973 mg/day. There is a great difference between the above values and the values of 12.3-63.5 mg/day.
3) The amount of each free amino acid excreted in urine of severely handicapped children is shown.
4) From the results of the mean in the amount of each free amino acid excreted in urine, it was found that those in metionine, isoleusine, cystine and valine had a tendency to above lower values, but those in other amino acids showed normal values, respectively.
5) Most of the cases showed lower values in asparaginic acid, glutamic acid, proline, valine, cystine and arginine. In proline, 23 of 27 cases showed only trace. The data could be obtained only in 4 cases.
6) The amino acids with slight amount excreted and small dispersion at normal values, showed similar results for the severely handicapped children. But threonine and serine even in amino acids with large dispersion, showed lower values. In the amino acids with large amount excreted and large dispersion, glycine and histisine showed the same tendency but taurine showed lower values in two cases.
7) One case in glycine, 11 cases in histidine and 2 cases in lysine tended to excrete large amount, respectively, but only 2 cases showed higher values of the amount than the normal value.
8) In the composition of food, the amount of protein satisfies the necessary intake. The food is given as much as they want, but the intake of protein seems to be still small, as considered from the total amount of amino acids excreted in urine. Accordingly, in the cases where the weights increase only a little at the present meals, and the further increase of the intake can not be expected, the administration of amino acid drugs is considered to be necessary besides at meals.

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In previous report it was clarified that the zone of inhibition was formed by sputum without antibiotic by means of the cup diffusion technique using Bacillus subtilis as a test organism. Lysozyme is found in organs and secret ion of human and animals, and is known to have bacteriolytic action on certain bacteria.
In this report the effect of lysozyme on the zone of inhibition by sputum was evaluated.
1) The activity of lysozyme in sputum was ranged from 240 to 700 mcg/ml, and was higher in mucoid sputum than in purulent sputum.
2) The bacteriolytic action of lysozyme in sputum was considered to cause the formation of the zone of inhibition in cup diffusion technique.
3) In measuring the antibiotic level in sputum, the bacteria with low sensitivity against lysozyme should be selected as a test organism.

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A3 months' survey of psychiatric consultation work was made at 24 national hospitals from Oct. 1 till Dec. 31, 1972, by the same way as reported in the 1st report in 1970.
All of the new patients referred to psychiatrists from other somatological clinics of hospitals were registered and totalled.
Results obtained are as follows:
1) 13.8% of all the new out-patients of these hospitals were referred to the psychiatric practice.
2) More than a half of the referred cases were from the medical department, others were, in the order of the number of cases, from the departments of surgery, orthopedic surgery, obstetrico-gynecology and otorhynolaryngology.
3) Somatic diseases:
Most of the cases from the medical department were those of nervous, circulatory and digestive disorders; those from surgery were the cases of injury, nervous disorders and tumor; those from orthopedics, injury, nervous disorders and regressive degeneration and those from obstetrico-gynecology, pregnancy with epilepsy and tumor; while those from otorhynolaryngology were inflammatory cases such as otitis media and tumor.
4) Psychiatric diagnoses:
In the order of number of cases, neurosis, organic mental diseases, epilepsy, psychogenous reaction, schizophrenia and manic-depressive psychosis were most common.
5) The duration of mental diseases in the referred cases was mostly within one month, while a, greater number of cases of depressive illness were less than 3 months.
6) 7.1% of all the referred cases were so severely disordered, mentally and somatically that they had to be admitted immediately to the psychiatric ward for treatment by both psychiatrists and somatologists under good nursing care,
7) Psychiatric diagnoses and treatment of 33.5% of the referred cases were informed to the doctors of somatological departments; who referred the cases to psychiatrists; 56.4% of the referred cases were treated at the psychiatric out-patient clinic; 4.0% were admitted immediately to the psychiatric ward; 4.5% were sent to the other psychiatric hospitals.

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Among the unhospitalized “active infectious TBC patients” whose actual conditions were previously reported, 455 patients were surveyed and examined two years later through public health centers. A clear tendency was observable in 414 patients (91%), whose 78 were positive for TBC bacilli in the examination of sputa at the end of 1971 and 336 were negative, and the following conclusions were obtained.
1) In terms of the prognosis of the 414 patients, the numbers being registered con-tinuously for medical treatment were 355, the cured 13, and those who moved 4, and the diseased 28. The cause of death of 12 patients was non-tuberculosis.
2) An improvement was noted in the great majority of the patients both in the pulmonary tuberculosis classification of the Japan Tuberculosis Society and in the sputa examination, and in the progress of conditions of the patients. There is a clear difference between the bacilli positive and the bacilli negative patients in aggravation of conditions of the pulmonary tuberculosis during two years.
3) The bacilli positive patients who had been a short period of time after the discover of the disease and these who had been in the hospital, progressed satisfactorily,
4) In this investigation, the bacilli positive patients who refused hospitalization at first for economic reasons such as house-hold economy or home management were persuaded tobe hospitalized finally.
5) The total number of the admitted patients in two years after the first investigation was 43, The bacilli positive were 20 (32.8%) and the negative 23 (8.4%). In many ad-mission cases of the bacilli positive there was a history of previous hospitalization.

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We reported a case of SLE of 22-years-old female with many psychiatric and neurological manifestations such as manic state, wild fancies, hallucinations, choreo-athetotic movement, tremor, diplopia and disturbance of consciousness. Each manifestation appeared in different periods and had remissions, just resembling to that of multiple sclerosis.
The reports of neurological complications in the patients with SLE in Japan throughout the past 20 years were reviewed. We think this case is the 8th case of SLE with choreo-athetotic movement in Japan.
The psychiatric manifestations of this case occured in during the period without steroid treatment.

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Primary atrial tumor is very rare, and is said to show few specific signs and symptoms clinically.
A 32-years-old male had been clinically suspected hepatic tumor, but autopsy findings revealed giant f ibrosarcoma of the left atrium. Clinical and pathological findings of this case were reported.

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The steady progress of medical science has made successful scientific approaches to various serious and strange diseases. One of the problems of primary concern today is the influence of an abnormal sex chromosome on a human body. In the field of obstetrics and gynecology, the abnormal sex chromosome is studied as a possible cause of malformation, sterility and miscarriage and an ever-increasing importance is being placed on the examination of the sex chromosome. We have come across a case in which a patient found Triple-X so-called Superfemale by accident during the routine medical examination gave birth to a normal girl, and wish to report it with some discussions.
The patient was a woman who had her first childbirth at the age of 26-years-old. When she was 25-years-old, she had throbbing and short breath and went to a certain hospital where her case was diagnosed as aortic stenosis. She was hospitalized and received close examination. She was determined as a case of Triple-X syndrome (47 XXX) in which there were combined a variety of congenital diseases, such as a webbed neck, low hair line, horizontal nystagmus, cataracta, a shortened thumb, small jaw and mental retardation. Triple-X syndrome is also called superfemale. She was warned of the necessity of careful consideration before marriage and childbirth in view of the large possibility that she might give birth to a baby having an abnormal chromosome.
In spite of the warning she was married to a man who was 23-years-old, and became pregnant after she had her last period for seven days from February 25, 1973. She had already been pregnant for three months when she came to this hospital. She delivered however, a normal girl weighing 2, 700 g. on December 3, 1973. The chromosomes of her baby, husband, parents and brethrens were inspected and all found normal.
The present case was a woman having a Triple-X chromosome and married to a man having a normal XY chromosome. It is theoretically possible that one of two babies of such a couple may present a case of Klinefelter syndrome if it is a boy, or a case of superfemale if a girl. Therefore, the present case in which a healthy baby was born has been quite fortunate, but may still present a difficult problem in this woman's further pregnancy and childbirth.

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As the hemolysis by injection is important, especially in regard to the contracture of quadriceps femoris muscles, we tested the hemolysis in vitro by 116 injections for intra-muscular used in our hospital. In addition we tested the osmotic pressure and pH. The following results were obtained,
(1) The rate of injections showed hemolysis was 58%, 42% of it discolored and 27% of all showed complete hemolysis.
(2) We observed hemolysis over 4000 m. o. s. or below 120 m. o. s., but we observed many injections showed complete hemolysis or in part even in near the physiological osmotic pressure.
(3) There were hemolysis and discolor below pH 3.0 or over pH 8.0, but many in-jections did even in neutral,
(4) We were unable to clear the relation between hemolysis and the chemical structures of intramuscular injection, but we have found some injections showed hemolysis in vitro related hemolytic anemia and contracture of quadriceps femoris muscle.

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