The superior surfaces of the temporal lobes of both cerebral hemisphers of Japanese fetuses (23) and new-borns (5) were macroscopically observed and measured to clarify the development and lateralization of the auditory sense area during the course of embryonic growth. 1) The superior surfaces of the temporal lobes of the cerebral hemispheres were firstly visible in the cerebra of 6-month-old fetuses and then the surfaces were marked by occasional undulations in the 7 th month fetuses. Thus, differences appeared between Heschl's convolution (H1) and the planum temporale (Pt) in the 8th month. The morphological pattern of these areas had been divided into seven types in the adult cerebrum, but only the V type had been visible in fetuses, in addition to an alternative type, VI, in the new-bron. Generally, the left hemisphere was broader than the right; this was true in the European fetus as well. The courses of the terminal portion of the posterior branch in the lateral sulcus were horizontal in all left hemispheres and mostly ascending in the right ones. 2) The development of the auditory sense area appeared to be remarkable in the left hemisphere, as compared with the right, in accordance with the measurements of the joint angles of upper and lower margins and inclination angles, as well as with the lengths of lower margins on lateral fossa. 3) The lengths of perpendicular lines for several measurement points surrounded lateral fossa against the Forel line showed that the opercular area belonging to the frontal and parietal lobes tended to be more spread-out in the left side than in the right in examination of the month-by-month development of fetuses and new-borns.

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Time dose fractionation schemes in radiotherapy of malignant disease are now widely used everywhere. Ellis proposed the NSD (Nominal Standard Dose) concept and Kirk described CRE (Cumulative Radiation Effect), which was generalized as a form of NSD for the assessment of damage at the level of tolerance. Now, we propose BCD (Biological Cumulative Dose) and CF (Cumulative Factor : ‘r’, 0<r<1), which represents the decreasing rate of dose per fraction (d) per day. BCD approaches full tolerance dose and is considered as SED (Single Equivalent Dose) or SECE (Single Equivalent Cumulative Effect), because single irradiation and fractionated irradiation are represented by the same formula. Formulas of different fractionated treatment regimes can be expressed by‘d’and‘r’. CF (r) can be fixed by experimental data which were acquired on mice and pigs. The fact that‘r’is smaller when‘d’is smaller implies a lesser cumulative effect. The number of fractions (n) can be determined when cumulative dose approaches 90% of full tolerance dose. The BCD is calculated by‘n’and‘BCD/d’and can be expressed as follows: BCD=1800 (rad) . Close agreement between this value and NSD is obtained. In recordings on log-log graph paper with‘BCD/d’on the vertical axis and‘n’on the horizontal, the number of fractions that gives a dose equivalent to that of BCD can be indicated graphically on different fractionated treatment regimes.

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Twenty five cases of acute pancreatitis, of which 18 survived, are discussed and compared with other reports on pathogenesis, pathophysiology and the severity index of fatal pancreatitis. Fatal pancreatitis was likely to occur in cases of the disease which are accompanied by gallstones, and the prognosis for patients over 50 years of age has been poor. The most important clinical findings on the severity index were shock and renal failure and, although the specific laboratory markers were not decided, decreases of serum Ca and platelet and increases in BUN were suggested. Pathologically, the pancreas showed hemorrhagic necrosis and the kidney, cloudy edema and tubular necrosis. From the above results, we speculated that if the severity of pancreatitis were determined early enough and, thus, appropriate treatment for circulatory failure and renal injury applied, more patients might be saved.

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Hemodynamic changes after hemodialysis were analyzed in 18 patients who were treated for chronic renal failure. In each case, (males: 12; females: 6; Age: 25-58 (av. 38.9) ) cardiac catheterization was performed before and after hemodialysis. The following results were obtained: 1) Higher levels of left atrial (LA), pulmonary arterial (PA), right ventricular (RV) and right atrial (RA) pressure were noted in many patients who had hypertension before hemodialysis (especially in cases of Grades III and IV) . It was suggested that the hypertensive state before hemodialysis might easily give rise to right-side heart failure in such cases. Although ventricular stroke work index and total pulmonary resistance increased, total systemic peripheral resistance was within a normal range in many of these cases. 2) RA, RV and PA pressures decreased after hemodialysis. In patients with mild hypertension (Grades I and H), pressures were normalized after inital hemodialysis. Most of these changes can be explained by the reduction of the circulatory blood volume and the improvement of cardiac function. 3) The cases in Grades III and IV showed higher intracardiac pressures on predialysis study, and no significant improvement was obtained after initial hemodialysis. Therefore, frequent hemodialysis were required in these cases. 4) As a result, it is important to control blood in uremic patients suffering from hypertension in order to prevent congestive heart failure. Restriction on sodium and water intakes, frequent hemodialysis and/or appropriate administration of anti-hypertensive agents may be necessary for these patients.

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Since 1964, the Shodai-formula Depression-Rating-Scale (D.R.S.) has been used as a method to inventory depression. Very recently, the revised version, D.R.S.-S₇₈ was experimentally devised, and the reliability, validity and correlatibility of this inventory's questions were assessed. The results were compared to those of the Japanese version of the HamiltonRating-Scale (H.R.S.), and objective check list. The following are the results after comparison : 1) The correlaton coefficient of D.R.S.-S₇₈ among the total marks of reliability on re-testing was notably high. 2) Means of the total marks for both scales were high for the control group, the neurotic group and the depressed group. A t-test on the difference of the means for each of the three groups was used in order to examine the validity of the scale. Findings showed that the H.R.S. was at the 5% level for the neurotic and depressed groups, and that the marks were significantly higher at the 1 % level for all of them. 3) By classifying 152 cases subjectively, using D.R.S.-S₇₈ and H.R.S. simultaneously in the diagnosis and age, correlative indices were obtained in classification by diagnosis on the total points of D.R.S.-S₇₈ and H.R.S. for each group, as well as in between the corresponding items of both tests and points taken in total. Thereby, a comparative review of the features was arrived at. 4) As a result, the correlation with the total overall marks after D.R.S.-S₇₈ well reflected the total marks in all groups, except for in cases of switching of mania, improvement or depersonal symptoms. In particular, the overall items in which high correlation was noted, such as anxiety-agitation-depression, retardation of thought processes, misanthropy or hypohondriasis, may be regarded as the indices of a depressive state. 5) The revised version can, of course, evaluates, like the former D.R.S., the degree of depression in total marks. In addition, the D.R.S.-S₇₈ allows us to grasp the degree of depression simply with the marks for the overall items in the groups and, also, it enables us to compare the course of the symptoms forming the depressive state from the marks obtained in the other nine groups. However, concerning labelling of each disorder, that which is not reflected in the H.R.S. is sometimes supplemented by the D.R.S._-78, and vice versa; therefore, the combined use of both scales may enable us to grasp the depressive state more accurately. It has been concluded from this that the D.R.S.-S₇₈ cannot be said to be a definitively accurate scale for the differential diagnosis or confirmed diagnosis of depression. As compared with the former D.R.S., however, it is by far a simpler and more useful clinical scale.

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For more than 10 years, as of Septemder 1979, we have treated 501 chronic schizophrenic patients at Karasuyama Mental Hospital, affiliated with Showa University. Among these, 14 chose to marry. Five couples among them are still married to date, and 2 of these couples have since divorced. The lengths of their married lives range from 3 to 15 years. In this paper, we take up these couples and investigate marriage between schizophrenic patients, mainly the relationship, if any, between their conditions (that is the degree of schizophrenia) and the states of their marriages. We judged the degree of schizophrenia based on 3 items, mental condition, adaptability to society and the capacity to carry on normal daily life. And these items were each rated in 3 ways: “favorable”, “fair”and“unfavororable”, but these three ratings are related to one another. 1) On the average, husbands were judged to be“favorable”and wives to be“intermediate”. At any rate, the husband played the role of stabilizer to the same degree as the wife or to a greater degree. 2) Each one of the couples was respectively labelled as“favorable”or“fair”when they made the decision to marry and were able to maintain their unions. It is not anticipated that both individuals in the couple would always be simultaneously in full control or able to deal effectively with life. 3) Even when married individuals fall under the“fair”category of the foregoing 3 items, it is quite possible for them to live normally with the support of mental health workers and other concerned individuals. 4) In the event that both married schizophrenics are judged to be“unfavorable”considerably more support is needed from mental health workers, but, with the worsening of their disorders, the chances for them maintaining any sort of fulfulling marriage are poor.

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Epilepsy is mainly treated with chontinuous administration of anti-epileptic agents. Accordigly, it is necessary to watch“drug compliance” as one of the factors greatly affecting the carrying on of normal everyday life and control of epileptic seizures. In the present study, 150 patients were randomly selected out of 320 epileptic ambulatory patients treated periodically with anti-epileptic agents at the Out-Clinic, Department of psychiatry, Showa University School of Medicine. By the use of a questionnaire-method over a period of 6 months, interviews were conducted with subjects and their family members. At that time, 51 (34.0%) had ceased taking medication. Then, a significant parallel relationship was observed in drug-taking attitude and therapeutic efficacy. The relationship between the feature of a patient who failed to take the drug and therapeutic efficacy was as follows : Many patients were over 40 years of age. No parallel relationship could be found between the age-factor and therapeutic efficacy. In clas-sification of epileptic seizures, many showed partial seizures, and therapeutic efficacy was poor. A significantly large number of seizures were observed in patients with affected temporal lobes, and their therapeutic results were poor. A significantly large number of seizures of seizurts were observed in patients affected by personality or character disorders, and therapeutic efficacy was poor. Less of the patients failed to take their medication when a physician was directly in charge at the Out-Clinic, and it might be possible to prevent drug defaulting by making the patient consult with a specific physician at each visit; however, in view of therapeutic efficacy, uncontrolled cases of seizures would have consulted a specific physician. Family members were often helpful in preventing patients from defaulting on taking their medication. Epileptic seizures were more often observed in those patients living alone and unemployed. Also, in their cases, efficacy of treatment was poor. In addition, background was greatly affected by family relationships in some cases; thus, the report suggests the necessity of social welfare assistance for these patients. Among the reasons for defaulting on taking medication, the first was the concern about the occurrence of side-effects; the most noteworthy among these was concern over possible teratogenic effects of the drug on the part of women in the child-bearing years. The second major reason was based on“Epileptischer Optimismus”. Considering the above items, by establishing a clinical regimen for epileptic patients, it is possible not only to control seizures, but also to maintain favorable adaptation to society, thereby, a sizeable contribution can be made to the treatment of epileptic patients.

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The fine surface structure of dog gastric mucosa was observed by scanning electron microscopy. Firstly, we examined the normal gastric mucosal surface: These samples were biopsied from the stomachs of three dogs of about three months of age. 1) In the fundic gland area, gastric small pits (foveolae) were systemically formed with round glandular lumen, which was separated in multiple branches and with an uniformly thick surrounding wall. 2) In the pyloric gland area, foveolae consisted of oval-shaped, simple tubular and slightly irregular glandular lumen. And the surrounding wall was thicker than in normal fundic glands. 3) In the intermediate zone, the structure of the foveolae was seen to be composed by a mixture of the modes of the fundic and pyloric glands. Next, the abnormal gastric mucosa produced by ENNG was studied. Gastric carcinoma in the dog is known to be frequently induced by oral administration of pellets immersed in N-Ethyl-N'-nitro-N-nitrosoguanidine (ENNG) solution. 1) elevated lesions: a) Malignant mucosal surface was rough and jagged and the foveolae con-sisted of irregularly deformed glandular lumen. d) In benign mucosal surface, the foveolae were seen as a structureless surface devoid of glandular lumen. 2) Depressed lesions: a) In the case of exposed cancer, the structural arrangement in the gastric surface was lost, while, even in the unexposed cancer, deformed glandular lumen could be noted. b) In early gastric cancer, the gastric small pits (foveolae) of signet-ring cell carcinoma consisted of a jagged, irregular surrounding wall and round glandular lumen. The pits of tubular adenocarcinoma consisted of a thick, irregular wall and of oval-shaped glandular lumen.

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Gastric secretory responses to tetra-gastrin, serum gastrin, insulin and IgE concentration were investigated in 50 patients with peptic ulcers (40 cases of gastric ulcers and 10 of duodenal ulcers) . In patients with active ulcers, gastric secretion levels were greater in recurrent cases than in cases of initial onset. Pepsin output was higher in the old than in the middle-aged. Serum gastrin concentration was within a normal range in cases with duodenal ulcers, while it was a higher than normal range (140 pg/ml) in 8 cases of gastric ulcer. And, gastrin concentration was detected at a higher level in ulcers of the mid- and under-stomach as compared to that of the upper stomach. The serum insulin concentration was in a higher than normal range (20μμ/ml) in 23 cases of peptic ulcers (20 cases of gastric ulcer and 3 of duodenal ulcer) . A higher than normal (1000 I. U./ml) serum IgE concentration was not de-tected. The IgE value was, however, higher in recurrent cases than in those of initial ulcer onset.

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Four major neutral glycolipids and six major acidic glycolipids were isolated from 4 to 6 month-old bovine fetal articular cartilages. The constitutents of sugars and fatty acids of those neutral glycolipids and gangliosides were investigated by thin-layer chromatography and gas-liquid chromatography. The four major neutral glycolipids were identified as glucocerebroside, lactosylceramide, triglycosylceramide and paragloboside. The major gangliosides was chiefly consisted of mono- and di-sialoganglioside. Three of six gangliosides were identified as GM₃, GD₁ and GD₃. The others were named GM₁ (Glu-NAc) and GM₂ (Glu-NAc) . Bovine fetal cartilage tissue contained lacto series (GM₂, GM₃ and GD₃) and gangliotetraose series (GD₁), as major ganglioside. No common characterization in the distribution of major fatty acids of neutral glycolipids and gangliosides was observed.

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A 34-year-old man suffering from bronchial tuberculosis came to us for treatment of chronic coughing, sputum discharge and dyspnea. Severe stenosis was discovered in the right bronchus by tomography, bronchography and bronchial fiberscopy. Reconstruction of the right bronchus was performed under neuroleptanesthesia supplemented with epidural anesthesia. During the reconstruction of right bronchus, unilateral ventilation was done inserting a tracheal tube into the left bronchus with the aid of the surgeon; hypoxia and hypercapnia did not occur. The operation was uneventful. Here, the problems of anesthetic management of tracheo-bronchial reconstruction were reported.

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The results of 10mg nifedipine (Adalat) administration sub-lingually during nitrousoxide-oxygen-halothane (GOP) anesthesia were as follows: 1) Hypotensive effects of nifedipine were only seen in hypertensive patients. Nieedipine did not produce any effect on the normotensive group. 2) There was no difference between the rates of systolic and diastolic blood pressure decreases. 3) The hypotensive effects of nifedipine started within 5 minuted after administration, and blood pressure decreased by degrees for 15 minutes. Nifedipine's total effect lasted for 40 minutes. 4) The appearance of the hypotensive effect of nifedipine depended on blood pressure immediately before its administration rather than on the patient's causal blood pressure condition. 5) There was on significant change in pulse rate. Case report: we reported a case of sudden drug-related onset of drop in blood pressure, as well as arrhythmia by nifedipine administration.

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In this report, a case of giant soft tissue tumor of the ring finger is described in detail. The patient, a health 33-year-old man, was referred to our clinic because of an asymptomatic tumor of the right ring finger. The tumor was elastic, soft, circumscribed and the size of a pigeonegg. There was no tenderness or neurological deficit. Ordinary photography revealed a smooth indentation of the middle phalanx due to the tumor. Upon resecting the tumor, it was found no to contact neurovascular units, but it compressed the extensor tendon. Histological examination revealed a neurilemmoma composed of organized elements : Antoni A cells, Antoni B cells and palisadings. The origin of this tumor is discussed here.

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A 15-year-old adolescent was admitted to our hospital on Sept. 27, 1956, complaining of general fatigue. Physical examination revealed anemia and hemorrhagic diathesis without hepatosplenomegaly. He was diagnosed as having aplastic anemia by findings on pancytopenia, relative lymphocytosis and hypoplastic bone marrow, although hemolytic tests including Ham's test, were not performed. After discharge, he remained well until November, 1981, a month prior to his second admission. He was, by that time, 40 years old. We again noted severe anemia, icterus and hemoglobinuria. The hematocrit was 18.8%, RBC 207×10⁴/cmm, Hb 6.1g/dl. The white-cell count was 2200, with 35% neutrophils, 49% lymphocytes, 14% monocytes and 2% basophils. The platelet count was 19.5×10⁴/cmm. A bone marrow examination revealed hypercellurarity and erythroid hyperplasia. The serum LDH was 2000IU/L, total bilirubin 2.4mg/dl, and inconjugated bilirubin 1.2mg/dl. RBC survival (T1/2) was 17.5 days. Ham's test, sugar water test and Inulin test were all positive. He was diagnosed as suffering from paroxysmal nocturnal hemoglobinuria (PNH) . On first admission, marked anisocytosis and poikilocytosis were found in peripheral blood, and red urine was noted after transfusion. These findings were sometimes seen in PNH but rare in aplastic anemia, and the diagnosis in the case of the first admission should probably have been PNH. Although PNH is a chronic disease, most patients survive approximately ten years after diagnosis. This patient survived much longer, with a remission lasting 25 years.

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