Lymphnodes have the architecture of network consisted of reticulum cells and reticulum fibres populated by lymphocytes and are divided into cortex and medulla. In the outer layer of the cortex there ane follicles consisted of B-cells and the inner layer, paracortical area, are mostly consisted of T-cells. Infection, inflammation and malignancy alter such architecture of lymphnodes and distribution of B-cells and T-cells as well. Alteration of B-cell clone causes changes of immunoglobulin synthesis. Lymphadenopathy associated with dysgammaglobulinemia is not unusual and changes of immunoglobulin are important in the diagnosis and prognosis of lymphadenopathy.

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Electric convulsive therapy (ECT) on which psychosomatic therapy was based, was replaced by psychotropic agents since it was invasive and caused noticeable defects of memory and occasionally irreversible damage. It is true, however, that ECT is very effective in some cases.
Forty-nine cases, who were hospitalized in psychiatric ward of the National Medical Center from 1963 to 1966, underwent 304 ECTs by the auricle application and 86 ECTs by the forehead application using muscle relaxants, general anesthesia by intubation and artificial respiration. The following results were obtained from electrocardiographic records taken immediately after stimulation, In the group which was not pretreated with atropine sulfate, cardiac arrest, block, auricular fibrillation and ventricular extrasystole occurred with frequencies of 45.4%, 68.0%, 9.1% and 81.8% respectively. Pretreatment with 0.5 mg of atropine reduced these frequencies to 0%, 26.3%, 0% and 52.6%. Various other types of arrhythmia were also clearly reduced in frequency by pretreament with atropine.
ECT produced cardiac arrest followed by various type of arrhythmia including block and sinus tachycardia was observed in all cases. The most frequently occurring arrhythmia was extrasystole. All of these adverse reactions were transient and reversible. They were considered to be mostly parasympathetic-excited central arrhythmia which could be relieved by pretreatment with atropine.
It is assumed that ECT is safe and effective in some cases in the presence of atropine, however careful physical control is mandatory, since it may cause malignant syndrome and sudden death.

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The electrocardiographic changes were analyzed in 49 patients admitted to our hospital in the period between 1963 and 1966. They underwent 390 ECTs. Of these, 86 ECTs were undertaken by the forehead application and 304 ECTs by the auricular application 3 times a day using muscle relaxants, general anesthesia with intubation and artificial respiration and pre-administration of 0.5 mg of atropine sulfate.
About 5 minutes of the interval were enough for the electrocardiogram and blood pressure to return to the pre-treatment values. After the first treatment of 40 cases of auricular application and 25 of forehead application, incidences of block group, ventricular extra-systoles and other arrhythmias were all higher in the cases of auricular application in which most electric current was considered to pass via the medulla oblongata and mid brain, but the kind of arrhythmias and the disappearance rate were unchanged.
In the 32 cases of auricular application and the 25 of forehead application to whom repeated therapies were performed 3 times a day, the condition of therapy except application of electrode was similar, but the frequency of arrhythmias decreased or even tended not to appear with an increase in the frequency of treatment. In particular, a marked difference was found between the first and the second treatment and this appeared to result from either habituation of the central nervous system to the electrical stimulus or from a strengthening of the defence mechanism.
Although ECT can be described these days as the classic therapy, the findings in this study suggest that the major impediment to the circulation system does not result from this treatment. In addition, in comparison with forehead application, auricular application does not cause compression fracture of the vertebrae nor post-treatment epilepsy. Furthermore, repeated therapy has an advantage in that it shows efficacy very rapidly, which can reduce the number of days required for the treatment.
There exists an opinion that ECT is a means providing for avoidance of crisis and a reappraisal is desired on the basis of adequate check and management, selection of procedure and strict selection of the patients for the treatment.

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A total of 90 psychiatric patients with somatic complication has been transfered to this hospital between 1965 and 1983.
1) The number of medical institutions which requested the acceptance of the patients were 9 including all the mental hospitals located in the adjacent community.
2) Eighty-three point four percent (83.4%) of the patients was in the age of between 25 and 65 and 12.2% was over 65 years of age. Fourty-eight point nine percent (48.9%) of the patients had been compulsorily hospitalized in conformity with the Mental Health Act.
3) Psychiatric Diagnoses:
Schizophrenia was the largest in number (64.4%) among psychiatric diseases of the patients, which was followed by toxic psychosis (14.4%), anergasia (1096) and epilepsy (5.6%)
4) Somatic Diseases: Somatic complications by percentage were; surgical cases (53.3%), internal and orthopedic cases (12.2% respectively) and gynecological cases (7.8%). Malignant tumor and fracture were most commonly seen.
5) Treatment of the Somatic Complication:
Fifty percent (50%) of the patients underwent operation, 36.7% underwent conservative treatment and 13.3% underwent precise examination. Fifty-two point one percent (52.1%) of surgical complications and 72.7% of orthopedic cases were operated on.
6) The Prognosis of the Complications:
Sixty-three point three percent (63.3%) of the patients were cured, 17.8% improved, 8.9% remained unchanged and 10% died. Seventy-two point two percent (72.2%) of the patients with complications were cured or improved and these patients were readmitted to the hospitals where they had been before. Nine patients died of malignant tumor, peritonitis and pneumonia, etc.
7) The duration of hospitalization was relatively long and 68.9% of the patients were in this hospital for one week to three months. Fifteen point six percent (15.6%) of the patients were hospitalized for as long as three to six months. Among these long-staying patients, a considerable number of malignant tumor and fracture of the femur was observed.

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Criminality of twenty-two patients with schizophrenia was psychiatrically analyzed.
The following results were obtained:
1. Twelve patients (54.5%) committed their crimes after five or more years of the onset of the illness. Only two patients committed their crimes within one year.
2. With respect to the types of the crimes, there were eight violence crimes, six property crimes, six damage crimes. Six patients who committed homicide or set fire, attempted suicide.
3. Most of the sufferers by violence were their families and most of the damaged houses by firesetting were their own houses.
4. Half of the crimes was related to the abnormal symptoms including delusion, hallucination, etc.
5. Twelve patients (54.5%) received no therapy.
6. Home environments, or human relations of many patients were poor.

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During the past 3 years from 1980 to 1983, the Joint Research Group performed the studies on a total of 285 patients with childhood and preadolescent schizophrenia in 9 hospitals of the National Sanatorium. The standpoint of this research was based on a personality development, especially with respect to ego development, and on a longitudinal observation of the course of the illness, that is, evolutional psychopathological aspect.
Classification of the cases were as in the followings; 1. infantile type (onset until 10 years old), 2. prepuberty type (until 13 or 14 years old) and puberty type (until 15 or 16 years old), 3. preadolescent type (until 17 or 18 years old). The characteristics of the cases of infantile type were autistic symptom and regressive or retarded behaviors. The cases of the prepuberty type showed vague hallucination and delusion, and that of the puberty type showed more definite delusion and ego disturbance. In addition, the cases of the latter two types were associated with various violences in home, school refusal and obsessional symptoms. The cases of the preadolescent type were more socialized, and often showed juvenile delinquency.
These characteristics of symptoms, course, prognosis and treatment of the childhood schizophrenia were age-dependent. Moreover, these characteristics were transformed into the latter type in succession. These were more closely related to the difference of ego development than to the peculiarity of the illness. Furthermore, these symptoms were influenced pathoplastically by the surroundings of their home and school.
In order to treat these patients, acceptance of their psychiatric attitude is most important for the regressive behaviors by immature personality.

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The case was a 15-year-old boy. He was born to a 29-year-old father and a 34-year-old mother for their first child. His parents were phenotypically normal showing no evidence for mental deficiency. His mother has no history of spontaneous abortion, stillbirth, congenital malformation, exposure to atomic bomb and consanguinity. She had no abnormalities during her pregnancy. The delivery was mature at 40 weeks of gestation but was complicated and prolonged by a weak labor pain and the mother was operated on with Caesarian section. The birthweight was 3400 g. He suffered from bronchial asthma and seizure when he was 1 year old. Since then his development was generally retarded.
On clinical examination of this child, developmental retardation, mental retardation; idiocy, speech disorder, seizure, behavioral disorder; hyperactivity, stereotypical behavior etc., and bronchial asthma was noted but cranio-facial dysmorphism or malformation were not seen.
Slides for chromosome studies were made on leucocyte cultures. The G-banding differential staining was applied for the chromosome identifications. Karyotype analyses were made on each for conventional and G-banding slides.
The karyotype of the patient obtained from the conventional gimsa specimens showed 46 chromosomes in which the No.9 chromosome had an unusually shortend long arm (46. XY, 9q-). The G-banding analysis made it possible to reveal that the deleted segment of No.9 chromosome was the secondary constriction (del (9) (q11q13)).

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We experienced a case of schizophrenia complicated by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) caused by antipsychotic agents. The case mainly had the delusion of possession, was suffering from a lumbar compression fracture by suicidal attempt under the influence of delusion. Any antipsychotic agents did not improve symptoms. She persistently had hyponatremia due to SIADH caused by the adverse effect of the drugs. The patient repeatedly attempted suicide in the process of treatment. We considered this case extremely difficult to be cured.
We applied the non-convulsive electric shock therapy with the muscle relaxant to this case. As a result of that, not only the delusion of possession disappeared, but the serum electrolytes level returned to the normal range, and the patient could leave the hospital after a good course of recovery.
We reviewed, along with presenting this case, the treatment of side effects of antipsychotic agents and of somatic complications: the indication and the method of ECT to this kind of cases; and cooperative system between psychiatric department and the other departments in the general hospital.

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We reported results of pregnancies in 50 cases of epileptic mothers treated at the department of EEG center, Nagoya National Hospital between Apr. 1973 and Mar. 1983 According to the international classification of epilepsy, the patients were classified into 26 cases of complex partial epilepsy, 4 cases of simple partial epilepsy, 14 cases of primary generalized epilepsy, 1 case of secondary generalized epilepsy and 5 cases of unclassified epilepsy. Ages when they became pregnant ranged from 19 to 35 and the average was 25.7 years old. Except for artificial abortions, numbers of pregnancy were from 1 to 4 in each case, and a total number of pregnancy was 83.
Following results were obtained from theses materials.
(1) The incidence of spontaneous abortion was 19.3% (16 cases) and that of congenital malformation was 9.0% (6 cases). The lesions of congenital malformation were 2 cases of atrial septal defect and the other four cases were torticollis, retentio testis, spina bifida and cleft lip and palate.
(2) The risk of spontaneous abortion was related to the high frequency of convulsive seizures during pregnancy.
(3) The risk of both spontaneous abortion and teratogenesis increased as the number of anticonvulsive drugs increased, and ratio of malformation for one drug, two drugs and more than three drugs were 0%, 14.8%, and 22, 2%, respectively.
(4) Teratogenic risk of TMO was remarkably high compared with that of the other drugs.
(5) Average daily dose of each antiepileptic drug in cases of congenital anomalies tended to increase compared to cases without congenital anomaly.

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This report describes a patient with cerebral palsy complicated with severe acroparalysis who underwent pregnancy and partus. Case:
M.O., 27-year-old female.
She developed cerebral palsy 3-months after having a temperature of 40°C continuously for 1 week. She has been recognized as a 1st-grade disabled person.
Family history:
Her mother has been diagnosed as psychotic; however, details are unknown. One elder and one younger sister have no abnormalities.
Marriage:
She was married to a 27-year-old healthy man at the age of 27.
Present illness:
She cannot take care of herself due to severe acroparalysis, being helped by her husband and volunteers. It is possible to exchange words with her, although it is difficult to understand what she says because of aphasia. Both she and her husband are eager to have a baby but cannot find any facilities being willing to handle her delivery.
During pregnancy:
She had a normal course during pregnancy without showing any remarkable abnormalities.
She underwent a cesarean section because of the impossibility of natural delivery.
She delivered a 2, 810 g female baby with an Apgar score of 10 and no external abnormalities. The puerperal course was uneventful; her milk flew well. She was discharged on the 12th postoperative day. Neither mother nor child showed any abnormalities on physical checkup after 1 month.

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A Case of De Sanctis-Cacchione syndrome, a syndrome of xeroderma pigmentosum with neurological manifestations, was reported. A 21-year-old woman developed sun sensitive skin lesions at the age of ten days. At the age of one year, a diagnosis of xeroderma pigmentosum was made because of mental retardation and skin lesions. Since the age of 10, she had been aware of hearing loss. During the past 8 years, her gait has increasingly worsened. On examination she appeared severely retarded in mentation. There was severe bilateral deafness. She could speak a few words. There was diffuse muscle weakness with foot deformity, ataxia and positive Babinski's sign. Because UDS measured by autoradiography showed less than 2%, a diagnosis of De Sanctis-Cacchione syndrome was made. CT showed moderate dilatation of ventricles, marked bilateral temporal lobe atrophy and diffuse cerebral cortical atrophy. The brain stem appeared small. Cerebellar atrophy was not apparent. In chromosome analysis, the incidences of spontaneous SCEs measured by BrdU-AG method were higher than in normal cells.
Conclusion: Our results suggested that in a case of DSC syndrome the incidences of spontaneous SCEs were higher. Further studies are necessary to clarify whether these resuts are true or not.

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We report two cases of microgeodic disease that was described for the first time by Maroteaux in 1979. This disease is characteristic of unknown etiology, and the lesion is confined to the fingers of infants and it regresses spontaneously. The X-ray examination shows small geodes in phalanges of the affected fingers.
Case 1: A seven-year-old boy was referred to us in January 1983, complaining of swelling, pain and local heat on his right index. He had spindle-shaped swelling, faint local heat and tenderness on the middle phalange of the finger. An X-ray film revealed condensation of the bone shadow at the diaphysis with small radiolucent spots and also rarefaction of the bone shadow at the metaphysic with marginal erosion.
Case 2: An 11-year-old boy was referred to us in March, complaining of frostbite like symptom on the middle phalange of his right middle finger. The physiological and radiological findings were very similar to those of case 1.
We reviewed Japanese cases about this disease, although Y. Sugiura reported the first case in Japan in 1974.
They occurred sporadically in winter from December to March, at any age of children with male predominance. The affected portions were limited to fingers or toes, especially their middle phalanges (approximately 90%). The etiology was not defined yet, but one of the most important factors was the disturbance of circulation by coldness. It was, however, interesting to find that there were many cases reported in Chubu and Kinki districts but few reports in Tohoku and Hokkaido, the nothern parts of Japan.

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A 60-year-old female had been suffered from abdominal pain, vomiting and difficulty in breathing for 8 years, which were caused by chronic and delayed traumatic diaphragmatic hernia. Repair of diaphragmatic hernia was carried out via posterolateral thoracotomy.
The defect of diaphragm was repaired by double layered plication. The function of the left lung was extremely diminished because of adhesion of the left lung into the adjacent organs, so decortication was performed.
After the operation, the patient was free from almost all subjective complaints, but recovery of the left pulmonary function was not satisfactory.

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Twelve patients with severe cancer pain was treated by epidural injection of morphine. A considerable diminution of pain was reported in all patients. Side effects were not seen in 66% of the patients and no significant changes in blood pressure, heart rate and arterial blood gas data within thirty minutes after epidural injection of morphine justified the use of this technique. Bacteriological cultures from indwelling catheters and patient's skin revealed no micro-organisms.
This study suggests that epidural morphine is one of the best treatment for cancer pain.

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Four cases of verruca vulgaris and 4 cases of molluscum contagiosum were treated by injection of methotrexate into the tumor itself. The concentration of 5 mg/ml of the drug had better effects than the more diluted solutions. Molluscum contagiosum disappeared within 2 or 3 weeks after the beginning of the treatment, and verruca vulgaris also disappeared within the same periods but required many more repeated injections. Except for the slight pain at the time of injection, there were no side effects during the treatment.

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