Electroencephalography of randomly chosen 14 cases in old age were compared with their clinical and pathological findings, included one admitted case with cerebrovascular disease suspect.
1. Among the cerebrovascular diseases, cases of Binswanger's type with the dominant lesion in the subcortical white matter were found about half of the cases. While the latter groups show clinically lacunar dementia, paranoic symptoms and moderate changes of personality, in most of the Binswanger's type, these signs were obscured by the much serious personality changes.
2. EEGs in Binswanger's type were often characterized by mono or polyphasic high voltage sharp waves with roughly periodicity and bilateral synchrony, which seemes to appear after a certain critical stage, and the typical pattern to be formed after several months.
3. Various types of degenerative diseases, such as senile dementia, presenile dementias and progressive supranuclear palsy, were described. Though the clinical and pathohistological changes in senile dementia were found relatively milder than Alzheimer's disease, the differences between their EEG changes were rather distinct.

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This study was designed to examine the body images, especially the images of the extremities of patients unable to walk with Duchenne muscular dystrophy (DMD).
One hundred and seventy-five male patients (9-27 years of age) and 790 healthy males (9-18 years of age) were tested with “constant sum method”. In this study 13 words for the upper extremities, 16 words for the lower extremities respectively were showed to the subjects. Then, they were asked to select five words and to distribute 100 points among them according to their choice.
The data obtained were analysed in the following way;
1) frequency: the frequency of the words selected
2) mean value: mean value of the score given to each word
3) modified mean value: mean value of the scores among those selected each word.
As to the upper extremities, the words which indicate function such as ‘have’ and ‘grasp’ were selected more frequently than the words which indicate figure, and the mean values were also high among the former group of the words.
In the mean values, no differences were found between the DMD and the control group in any words. However, significant differences were detected in the modified mean values; ‘open’ and ‘hit’ were high, but ‘have’ and ‘touch’ were low in the DMD patients.
Concerning the lower extremities, the frequencies as well as the mean values of the words which indicate function were also high in comparison with the words which indicate figure. But the DMD patients showed the tendency to choose the words which had less active meanings in the former group of the words.
The modified mean values of the lower extremities showed the significant differences between the DMD and the control group; ‘sit’ and ‘kick’ were high, but ‘walk’ was low in the DMD patients.
Comparison between the wheel-chair dependent patients and the bedridden patients groups disclosed that any differences did not exist in the frequencies, the mean values nor the modified mean values about the upper extremities.
As to the lower extremities, the bedridden patients more frequently selected the words which indicate function, and the mean values of these words were relatively high in them, however no differences were detected in the modified mean values between the wheel-chair dependent patients and the bedridden patients groups.

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We clinically investigated the process through which the pulmonary function of patients with progressive muscular dystrophy declined to respiratory failure. With the object of taking preventive measures against respiratory failure and heart failure, we made a joint study of the cardiopulmonary function. Clinical pictures of 232 cases with PMD were investigated by disease types—Duchenne type, limb-girdle type, and other types. The cases of Duchenne type were especially examined by disability stage.
(1) The cases of Duchenne type were found in large numbers in young patients of male sex, those of limb-girdle type in older patients, and the cases of other types were found in various ages.
(2) The results of the cases examined by disease types were summarized as follows:
1) The cases of the thoracic vertebrae scoliosis of more than 20°, of the contraction of thorax anteroposterior diameter and of cardio-thoracic rate >0.5 were respectively found in large numbers in Duchenne type.
2) As for enzyme system such as GOT, GPT, LDH or CPK, in 'limb-girdle type and in other types the normal cases were 70%. In Duchenne type the abnormal cases were about 60%, and the value of enzyme activity was high.
3) As for ventilatory function, the cases of %VC<59% were found in large numbers. The cases of heavy ventilatory disturbance with %VC<39% formed 43.5%. The normal cases of FEV_1.0% were more than 95% in each disease type. The normal cases of blood gas and SaO₂ were found 65%. The cases, the PaO₂ of which was less than 79mmHg, were found 40%. The cases being lower than the normal value of PaCO₂ were found both in Duchenne type and in other types. The cases with higher value of PaCO₂ were found 6.3% in each disease type. As for pH, the acidosis cases were found only in Duchenne type.
4) The cases, examined by EKG, pulmonary P wave, and right ventricle overloading, had no difference among the disease types.
(3) The results about cases of Duchenne type in each disability stage were summarized as follows:
1) With the progress of disability stage the cases of the thoracic vertebrae scoliosis and of the contraction of thorax anteroposterior diameter increased the more. The cardio-thoracic rate had no connection with the progress of disability stage.
2) As for enzyme system such as GOT, GPT, LDH or CPK, which was concerned with muscular metabolism, the value of its activity became lower with the progress of muscular atrophy or degeneration.
3) The ventilatory function of the patients in Duchenne type lowered with the progress of disability stage. The cases of PaO₂ below 79mmHg were about half. Lower value of PaCO₂ than the normal one formed about half of the cases of Duchenne type. Higher value of PaCO₂ was found in the cases above Stage VII. The cases, examined by EKG, pulmonary P wave and right ventricle overloading, had no difference among all disability stages. There was no relation between the results of EKG and the development of the disease. The results suggested the necessity of our synthetic judgement which should incorporate other medical ways to judge the cardio-function.

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Two cases of Münchhausen Syndrome were reported. They were 69-and 68-years-old women and their characteristic clinical findings were as follows:
(1) Their common premorbid character were timid, industrious and punctilious. Furthermore in case 1, she tended to tell a falsehood and they manifested a lie in the course of the illness.
(2) The onset of the illness were involutional and presenile periods.
(3) The incentive of the illness were laparotomy in case 1 and loss of eyesight after glaucoma operation in case 2.
(4) The great number of hospital peregrination were seen in both cases.
(5) The psychotic symptoms were seen;cenestopathy, delusional idea in case 1 and delusion, hallucination in case 2.
(6) There were the unique contact and character;the former was one-sided and she required persistently medical treatment, and the latter was selfassertive, selfcentered and they told a lie.
From these findings they were Münchhansen Syndrome. Case 1 was typical type of this syndrome and case 2 was the variation. This syndrome seems to include psychotic type.

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This study is a controlled of locally applied DSCG in 18 cases troublesome allergic conjunctivitis. DSCG, in a 3% solution, instilled into each patients eye 4 times daily.
1. 14 cases out of 18 improved their complete loss of eye symptoms. 11 cases were within 3 days, 2 cases were within 7 days and 1 case was within 2 weeks.
2. 1 case out of 18 responded with immediate mild stinging after instillation of the drops, but instillation of eye drops, 2 times daily, seemed succesful and after 4 weeks troublesome eye symptoms were partially reduced.
3. 3 cases out of 18 were not useful, 2 cases complained severe stinging after instillation of the drops and 1 case developed local swelling around the eye lids.
4. When instillation of eye drops was discontinued, allergic eye symptoms developed afterward. DSCG ophthalmic solution was not succesful in controlling allergic conjunctivitis completely.
5. There are no known side effects from DSCG ophthalmic solution as cortico-steroid.
We consider that DSCG ophthalmic solution is a useful method for the treatment of allergic conjunctivitis.

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General factors affecting fetal growth rate were prospectively studied. Subjects were healthy 306 women who entered in Okura National Hospital and delivered normal full term baby (birth-weight was above 2, 500g) during Aug. 1977 to May 1978.
Among the factors, toxemia, smoking habit and maternal alcohol intake during pregnancy were statistically significant. Our results suggest that small to moderate alcohol intake during pregnancy might affect decreased infant birth weight. Further precise study about smoking habit and alcohol intake during pregnancy are presently investigating.

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The therapeutic purposes for patients having cleft of the lip, jaw and palate will be achieved only when all of the integral elements of therapy, namely the plastic surgery, correction of the dysphonia and obtaining readiness for jaw growth and normal bite occlusion are completed.
In reality however, there are not many cases whose three elementary parts of the therapy are completely carried out. Lack of any of these three elements of the therapy is now being taken up as a social problem in view of the medical therapeutic welfare administration.
Thus, we felt challenged by the need for research for establishing the actual status of such problems now in existence in Japan and for developing a supervisory therpeutic system under which the therapies and post-therapeutic care will be most adequately carried out, and with this purpose in mind, we made a survey on handling of the patients having cleft of the lip, jaw and palate at national hospitals. The procedure of the survey was, a format with questions was sent to 90 national hospitals throughout Japan, addressed to their obstetrics, orthopedics, plastic surgery, oto-rhino-laryngology and dental departments, asking for their answers, so that collection of all the cases reported to these institutions in the 3 years covering 1975-1977 would be possible by us, and our study and discussion them could also be carried out.
The results of the survey were as follows:
1. The rate of births of the population having cleft of the lip, jaw and palate in the 3 years was, 0.153% in 1975 0.134% in '76 and 0.178 in '77, the average being 0150%;one in each 664.7 persons.
2. The number of infants born with cleft of the lip, jaw and palate in the 3 years was 142, of whom, by type of rupture, 68 had cleft of the lip, jaw and palate, 52 had cleft lip and 30 had cleft palate.
3. The number of institutions conducting plastic surgery to the cases of cleft of the lip, jaw and palate was, 15 oto-rhino-laryngology departments, 3 orthopedic departments, 2 plastic surgery departments and 4 dental departments.
4. The number of institution having specialists in postoperative speech therapy was only one, which was Nagoya Hospital.
5. The number of institutions conducting dental treatment to cleft of the lip, jaw and palate patients was 5, and that conducting orthosis to jaw and teeth conditions was the Second Tokyo National Hospital.
6. At the above 5 institutions, 4 teams were organized for team work approach to these therapeutic problems.

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He was five-years-old at entering this hospital. When he was frustrated in satisfying his requirements he showed the stiff-necked feeling and the rude attitude (for example, beating his own head violently and so on).
After a half year remedial education in institution on him, we got an effective result. However, whenever he saw or joined his parents at visiting hours or stopping-out days (to stay at his own house), we found that he often went worse mentally and psychologically than he used to.
Then, we were sure that there would be any problem in him as regards his parents, and so we examined the relation between him and his parents, and discussed how to educate him in remedial education in institution. We made up a seven-step diagram by choosing rating scale in order to look into their human relation. Then, by means of this, we analyzed his parents' attitude to him and compared with control group (twenty children) in a kindergarten we requested.
Judging from our examination, it was obvious that the parents' attitude to their son gave him an important effect.
Now, one, who work at the ward for serious handicapped children with behavioral problem, should not only protect or treat them, but also aim at a higher remedial education.
In order to carry our purpose, it is necessary that we should give their parents our support for treatment and development, as well as give them remedial education. Besides, the thing mentioned above is an important part of remedial education in institution on serious multiple handicapped children with behavioral problem, I think.

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From April 1975 to March 1978, weekly or biweekly treatment and counseling were done for 91 mentally handicapped children (23 autistic and 68 mentally retarded) and for their parents. During the period, 78 days were spent for the treatment and counseling. The average days a child and his parent attended were 5.2. Majority of the children attended only 2 days or less. A third part of them dropped out, though further treatment was needed. Generally the children and their parents visited our clinic as their second or third institution.
These data would indicate that mentally handicapped children and their parents are apt to wander from an institution to another institution seeking seemingly better treatment or counseling. Their wandering from institution to institution would be caused by such a psychological factor as parental anxiety regarding the child's developmental disorders, although it would also depend upon the ability of the institution to treat the child.
We found there are five stages that the parental attitudes towards their child's developmental disorders sequentially change. It seems important to determine at which stage the parents stand to apply the appropriate counseling. Such appropriate therapeutic counseling would affect to decrease the wandering.
It was concluded that the therapeutic counseling adjusted to the stage of the parental attitudes as well as the intensive co-operation with other institutions would offer the substantial services for the mentally handicapped children and their parents.

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In a 16-storied 1, 006 beds general hospital (662 beds now in use), our ward has 38 beds occupied on the southern half of its 6th floor, and is staffed by 3 psychiatrists, 14 nurses and no other paramedical staffs.
In this ward, 387 in-patients including functional (endogenous) psychoses 215, 55.6%, neuroses 89, 23%, and organic psychoses 83, 21.4%, have been treated during the period from Oct. 1973 through Aug. 1978, of these in patients 93 cases, 24%, have had major somatic complications.
Of these somatic patients, 38 cases were accepted from our own out-patient clinic to our ward, 24 from other wards or clinics of our hospital, and 15 were transferred from other mental hospitals and other psychiatric clinics.
These 93 somatic complicated cases treated under the cooperative and consultative works by us and other specialists of our hospital are as follows: medical diseases 50 (cardiovascular diseases, diabetics, collagen diseases, leukemias, etc.), surgical cases 15 (13 cases were breast cancer and gastric ulcer etc.), orthopedics 6, neurosurgicals 4, ophthalmologics 4, otorhinolaryngologics, obstetrics & gynecologics, urologics and radiologics, respectively 1-3.
The follow-up study of these somatic cases are: 72 discharged (completely cured 18, betterment 33, psychiatrically insufficient recoverd 9, death 6) and 14(368% of our 38 beds) still remained in our ward by August 1978.
Treating somatic and non-somatic cases in the same closed ward and giving a glimpse of the work undertaken by making a concerted efforts of our ward-and hospital staffs, we candidly took note of several points to cope with this expanded role.
Although one of the main active works in the psychiatric ward of a general hospital is to treat somatic complicated cases, in order to fulfill this work successfully from not only somatic but also psychiatric view-point, enough medical, paramedical and nursing staffs are needed with more rooms, wards and other facilities. And also, we need rather a wider diffusion of the psychiatric attitude and of psychiatric knowledge among other general hospital staffs in order to enlist their cooperation by our initiative and consultative effort.

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