A sixty-five years old housewife began to complain the right upper abdominal pain in February,1972, and was admitted in December of the year with the suspect to hepatoma. During the first admission, she had noted the discomfort in the right upper quadrant of the abdomen, which was described as a lasting tractive'pain and severe pain aggrevated either by deep inspilation or by lying on the left side, but her general condition was almost successful. In 1973, the patient has been complaining of abdominal distention and ascites. The abdominal tumor gradually enlarged, and she died in April,1973.
The abdominal tumor was situated in the subphrenic and retroperitoneal space, looked a gray-brown child-head sized, firm tumor revealed an area of central necrosis, and infiltrated into the liver tissue. The metastatic foci could be detected in few regional lymph nodes. Histological examinations disclosed the tumor to be composed of richly cellular and undifferentiated mesenchymal cells and islands of differentiated cartilage. There were many binucleated chondroblasts as well as occasional multinucleate forms. Calcification in the chondroid matrix occured focally, but direct formation of osteoid was absent The extraosseous mesenchymal chondrosarcoma was reported, and this was discussed on ref ferences.

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In an attempt to clarify the mechanism of neuroleptanalgesia in the central nervous system, changes were studied of the thresholds of arousal reaction and evoked m uscular discharge following stimuli on the rabbit brain stem reticular formation.
1) The threshold of arousal reaction following stimulation a t 100 Hz of the brain stem reticular formation resulted in increase by administration of droperidol or fentanyl citrate. When droperidol and fentanyl citrate were administered in combination at a ratio of 50 1the threshold showed a marked elevation over a single administration. The rate of increase in the threshold of combined administration revealed about the added sum of single administration.
2) The threshold of evoked muscular discharge of the fore and hind limbs following stimulation at 100 Hz of the brain stem reticular formation resulted in increase by administration of droperidol or fentanyl citrate. The combined administration likewise led to increase in the threshold of muscular discharge, but in a less degree than in arousal reaction.
3) The type of muscular discharge following stimulation of the brain stem reticular formation was generally a tonic type or a tonic phasic type in the fore limb, and a tonic phasic type in the hind limb. Administration of droperidol or fentanyl citrate or both resulted in few changes in the type of muscular discharge.
4) Since the combined administration inhibited arousal reaction to a considerable degree, it seemed favorable to be used in operation, considering increase of the threshold of arousal reaction. It did not show so strong an inhibition of muscular discharge so that a discussion was made as to the necessity of simultaneous use of muscle relaxants in operation.

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In lung cancers, the symptoms and signs due to metastatic lesions may be frequently more predominant than those due to the primary focus. Here reported is a case of lung cancer with unu sual initial manifestations.
The patient, a 60 years old housewife, non-smoker, complained of headache and nausea without any symptoms of the respiratory tract. Physical examinations revealed enlarged cervical lymph-nodes, slight neck stiffness and some signs of central nerve disturbances, but body temperature was normal.
CSF obtained by lumbar puncture was bloody and contained increased number of lymphocytes with abnormal cells probably malignant.
X-ray films showed a small tumor-l ike shadow with 15 mm diameter in the right upper lung field, as well as osteolytic changes in the left 8th rib, in the right iliac bone, as well as in the right tibia. The tumor-like shado w in the lung, supposed to be the primary focus, was very small in proportion to the numerous bone lesions. Autopsy revealed primary lung can cer, histologically adenoacanthoma with wide-spread metastases, although metastatic meningeal carcinomatosis was not confirmed, opening of her scalp not being allowed by the relatives of the patient.

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In the present paper, two cases of syndrome (neuro-vegetatif) malin have been reported and discussed mainly from the semeiological view point. Since 1960, when Delay described this syndrome, it has been the object of psychiatrists' attention in France, while it was introduced in Japan by Otsuka and his collaborators in 1974 for the first time. According to Itoh, the syndrome is not so rare as Delay estimated but so frequent that psychiatrists have to pay attention to physical conditions of patients under neuroleptic medication. Incidentally the authors experienced two shizophrenics who presented severe neuro-vegetative symptoms consisting of high fever, extrapyramidal symptoms and dehydration due to excessive sweating. Paricularly, a case was suffered from a rapid developement of decubitus, which represents the trophic disturbance.
It is important to differentiate this syndr ome from lethal catatonia(catatonie pernicieuse). The authors' patients fell into stupor that seemed to be accopanied by a certain disturbance of alertness at the onset of the syndrome, while the lethal catatonia would usually present psychomotor excitement. Moreover, so severe extrapyramidal symptoms as seen in our cases are not common in patient with lethal catatonia. Above all, the close relationship between administration, particularly parenteral application, of neuroleptica and onset of the syndrome is the most decisive factor as far as the diagnosis is concerned. Etiology of the syndrome is yet unclear in the mean time, but it appears that the syndrome may have some etiological similarity to malignant hyperthermia due to anesthesia. Since the mortality of the syndrome is as high as nearly 30%, it is important for prevention and early discovery of the syndrome malin to bear the possible risk in mind in case of drug treatment with psychotropic agents such as potent neuroleptica.

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In the present communication, the auther has reported a case of atypical encephalitis which presented psychic disorders suggestive of catatonic symptoms at the onset and a benign prognosis in the end. Based on clinical features,90 days of the course would be devided into four stages; four days of prodromal stage when the patient had complained of cold in the head, six days of initial stage when she had shown psychic disorders resembling catatonic stupor,36 days of acme stage when she had continuously presented serious disturbances of consciousness such as delirium and coma, and 44 days of reconvalescence stage when she had shown emotional irritability. The patient showed a transient maniacal excitement which seemed to be of psychogenic origin right after the discharge from hospital but she was fully cured without any residual disorder after all.
When the patient was showing a catatonic stupor at the initial stage, the re were neither inflammatory nor degenerative signs in the neurological investigations and laboratory examinations. However, in reviewing the whole course of her case, the author considers that behind the psychic symptoms at the initial stage there may be a certain disturbance of consciousness, particularly an alteration of extent of consciousness rather than that of clarity of the alertness, which could be detected by some means.
EEG findings went almost abreast of clinical ones, in par ticular disturbance of alertness were apparently in pallarel with slowing of predominant activity at the acme stage. Moreover, EEG abnormality preceded the disturbance of alertness and lasted 15 months after the recoverry from it. In this regard, the author has stressed the necessity and importance of careful EEG examination in case of patients with possible disturbances of consciousness associated with psychotic syndrome.

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1,059 delinquent auto-drivers were studied with electroencephalograph, psychological test and simulated driving system, and their results were rated 1 through 5 for the purpose of analyzing possible relationships between any two parameters in the aid of multivariate analytic treatments such as simple correlation coefficient matrix, principal component analysis and factor analysis using Varimax rotation. In the correlation matrices, there were significantly high positive correlation between “exactness of motion” or “emotional stability” and “driving technique”, and between “psychic activeness” and “impulse controllability”. In the principal component and factor analyses, EEG was almost independent from every psychological parameters, while “age” and “driving technique” were also independent from EEG and psychological traits. The psychological parameters are devided into three factor groups; emotional factor, intellectual factor and psychomotor factor. The factor loadings of psychological and the other parameters were not correlated with EEG abnormality, so that it appears rather important whether EEG abnormality is absent or not, as there seems to be not only quantitative but also qualitative difference between “Normal EEG” group and “Problem EEG” group. What the autors have confirmed the independency of examination results suggests a usefulness of this kind of examination battery in subjects whom the authors employed in the present study.

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The present authors have studied the significance of personality inventory such as MMPI and YG test by deviding 172 psychiatric patients, who were tested with the both two methods, into five groups from A through E type based on the results of YG test, by drawing the averaged MMPI group profiles, and. by comparing their characteristics with each other.41.5% of the patients were schizophrenic,17.7% were of atypical psychosec,12.2% were neurotic and the rest were miscellaneous, mainly psychotic. St atistically significant difference between sexes have been found in Pt (psychasthenia scale) and D (depression scale) of Type A Group, in L (lie score), F (validity score) and K (K score)of Type D Group, and common but non significant difference have been rather impressive in all the five types disregarding sex. It is vary interesting that the profiles indicated the neutralization of female patients in Mf (masculinity-femininity scale) much more than that of male patients, as one feels in daily practice. The MMPI profiles of Type B and Type E groups, which are interpreted as emotionally instable and socially maladjusted, active or inactive, have shown more markedly pathological traits than Type C and Type D groups, which are known as stable and adjusted in general evaluation of YG profiles. Thus, it may be concluded that the both personality inventories are quite useful and significant as the rating scale of clinical state in the case of psyhciatric patients rather than as the personality test to figure out the contour of basic personality in the case of psychological subjects. Few groups whose profiles presented a little deviated results from the others can be explained by the deviated distribution of patients' diseases. The authors believe that the present study has been significant at least as an orientative one in order to push on studies of the test results in various psychotic patients.

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The present paper has demonstrated whether there was certain difference or not in the development of the function of so-called spacial orientation between normal and totally blind children, as it is thought, in author's opinion, to be not a central organ to perceive sensory stimuli, but a functional rneclanism to receive stimuli.
On the other hand, in order to analyse the deve lopment of EEG basic rhythms, electroencephalographical survey was held to those children from a view point o f neurophysiological development. For this purp ose, the author applied a series of tests composed of the body naming test, calculation test, finger naming test, right-left discrimination test, Kinsbourine and Warrington's test, Delage modified test, five point test, topographical and spacial orientation test and others.
The res u lts were as follows:
1) There was no significant difference of influences between visual and tactile perception upon this function in both groups.
2) It was found that various plysiological factors played an important role in this function.
3) While this function was integrated and matured with aging, certain personal functions were to be added at any stage and made rapid or sudden progress from 4 to 8 age.
4) This function was not only the central function which received many stimuli from peripheral portions, but also the dynamic function which lead to the conception “ not the perception without the behavior”
5) It was interesting to have observed increase with age of occipital a rhythms in normal children on one hand and of parietal a rhythms in totally blind children on the o ther.
6) It was suggested that the develpment of EEG basic rhythms had relation to the sensori-motor factor including the function of so-called spacial orientation.

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The author has been studying degenerative changes of the brain in the case of presenile dementia in the aid of computerized transverse axial scanning (computer tomography)since 1976. In the present paper the author has reported clinical features and evolutions of seven patients with presenile dementia, of whom two were diagnosed as Pick's disease and five as Alzheimer's disease exclusively from the clinical viewpoint, with reference to Polaroid pictures of computer tomographic print-outs. At the same, their results have been compared with those who are regarded as normal and with one who are diagnosed as senile dementia.
In th e case of Pick's disease, a marked enlargement of ventricular system were commonly found in the two cases particularly in the anterior portions, while in the case of Alzheimer's disease, such an enlargement were not seen in three cases but only in two cases. Two cases of Alzheimer's disease showed a generalized enlargement of the ventricular system and little enlargement of the cerebral sulci, while the three cases presented no marked enlargement of the ventricular system but of cerebral sulci and fissures. The patient with senile dementia showed moderate enlargements of cerebral sulci, fissures and ventricular system, which were seen in one of the latter three patients with Alzheimer's disease. It is of particular interest that the two patients with Alzheimer's disease have been differentiable from the other three based on the difference of clinical features whether or not there were specific local syndromes of the brain such as aphasia, agnosia and apraxia. Actually, computer tomography is quite useful in the clinical diagnosis of presenile dementia.

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The present author has studied from various viewpoint 14 patients who had epileptiform convulsive disorders under choronic Meprobamate intoxication and 47 additional cases which were already reported in Japanese and other languages.
1) There were no specific convulsive predi sposition and family history in the author's cases. Remarkable personality disorder of these cases were often seen in the peoples who addicted any drugs and others. They had no intellectual defect.
2) Generally, convulsive seizure broke out when one took Meprobamate more than 3g daily over one to several years.
3) In the literature, ev ery other author understood that these convulsive seizures had occured only as abstinence syndrom. It is certain that the majorities of these convulsions occur as abstinence syndrom but others occur during the intake of this drug. Delirium or disturbance of alertness also would develop likeweise. The present author differentiated four types regardig to the occurrence of convulsive seizure as well as the intake of this drug. A: Convulsion precipitated by abrupt withdrawal. B: Convulsion which occured during intake of this drug. C: Convulsion which occured under marked consciousness disturbance. D: Convulsion which occured particularly during the treatment of marked consiousness disturbance. Clinical types mentioned above were not always same in one patient.
4) A lmost all the convulsive seizures appeared to be of epileptic nature but they often came out in the form of status epilepticus.
5) Neurological signs and s ymptoms such as fever, nausea, vomiting, shaking and ataxia would frequently accompanied convulsions.
6) Before and after convulsion, the r e was stormy consciousness disturbance which was certainly different from initial and postical twilight state. Convulsive seizures associated with fever and neurological symptoms and severe consciousness disturbance tend to have the form of status epilepticus. Therefore these signs and symtoms suggest some serious oragnic brain damage. In this regard, the present author discovered in the literatures three cases, of whom two died during status epilepticus and the other got into comatose with fever from delirium.
7) EEG finding s showed convulsive readiness under Meprobamate abuse, so it is quite natural that the convulsive seizure appears even under its abuse. Moreover, some focal signs in EEG suggest localized damage.
8) It was not effective to gi ve Meprobamate for the treatment of abstinence syndrome. When, once convulsion and related disorder happened to occur, such disorders would reoccur short after re-use of Meprobamate. However, if a patient does not fall in abuse again, another convulsive disorder does not occur and clinical outcome is very favourable, so that it is not necessary to prolong anticonvulsant medication. These convulsive disorders do not look over as accidental outbursts in the patient with convulsive predisposition or as rebound phenomena after long abuse of Meprobamate that has mild anticonvulsant action.

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