Sixty lumbar facets were studied morphologically and in serial sections. The lumbar facets were prepared by cutting sagittally and horizontally at a thickness of 600 microns, and these facets were also observed macroscopically and roentogenologically. As a result of these examinations, the lumbar facets were found to be more coronal and horizontal with descent ; whereas, the area of the cartilage surface was apt to increase at the lower regions. In the upper facets, changes in the cartilage surface were found to be more of a consumptive nature and in the lower, more of a hypertrophic. In addition, the cartilage layer was thick in the middle of the coronal portion, but in the superior and the inferior it was thin ; also, the cartilage layer of the lower facets was found to be generally thin. Sclerosis of the subchondral bone was thick in the coronal portion.“Randwulste”was identified on the peripheral portion, and its width increased with descent. With regard to the synovial tabs found in the superior and the inferior recesses, they intervene among the joint spaces in 33 out 60 joints. In the inferior recess, impingement of the synovial tabs was found in 11 out of 60 joints preceding into the superior recess. In the degenerated facets, intervention of the synovial tabs into the joint spaces was considered to play a functional role. But, on the other hand, impingement of the synovial tabs into the inferior recess indirectly stimulates capsula articularis, thus causing low-back pain.

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Fetal and adult long bones, the connection between bone surface and surface fibres were observed using a scanning electron microscope. Fetal bones were observed in a 20-week-old fetus. The surface was rough and fibres were attached to the ridges. A small vessel was found in each groove, and each vessel was covered with fibres. There was no difference between the patterns of connection of the metaphysis and diaphysis. In a 40-week-old fetus, the surface had become smooth and lacunae had formed. The surface fibres were buried in the bone, were attached to the edges of the lacunae, or connected the vessel to the bone. There were large amounts of lacunae in the metaphysis. In observation of adult bones, there were a large number of lacunae in the metaphysis and a considerable amount of the lacunae had its own vessel. The surface vessels were covered with fibres. The lacunae in the diaphysis was shallow and not as great as in the metaphysis. The surface fibres of the diaphysis were connected to the collagen fibres of the bone. Also, the fibres were in bunches and were attached to the lacunae. In a 40-week-old fetus, the patterns of connection were almost completely formed and were the same as those of an adult. The roles of the connection between the fibrous layer of the periosteum and the bone surface were to anchor the surface fibres to the bone in order to protect it and to cover the surface vessels in order to protect them.

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This study attempts to clarify the internal structure of the patella and, furthermore, to consider its function. Patella were surgically removed from amputated limbs, dehydrated by alcohol solution and perfused in polyester resins. Samples (500μm) were observed by soft X-ray. Trabeculae in horizontal section were divided into tnree patterns by running scanner. The findings were as follows: Trabeculae are at right angles to the articular surface, cross in parallel along the articular surface, cross the superior surface of the patella. Trabeculae in the sagittal section were divided into four patterns and are at right angles to the articular surface. They cross in parallel along both medial and lateral articular surfaces and run obliquely toward the apex of the patella in the subarticular surface. Trabeculae traverse the patella in its superior surface. Trabeculae in a frontal section differ from the form in the horizontal and sagital sections and have a netlike structure. Patellar trabeculae rise with compression and tension forces, and trabeculae appear to be more easily influenced be dynamic effects rather than static. In a form of trabeculae, under tension, they are thick are continuous and sufficiently high density and have sturdy moorings in all directions. Accordinly, the patella works as a fulcrum on the articular surface of the femur condylus and is helpful for stabilization of the knee joint and in insuring smooth mobilization in the femur and tibia.

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In order to clarify the efficacy of dietary therapy, a way of treating hypertension, dietary guidance based on each patient's weekly diet was given once a week to 46 treated and untreated hypertensive factory workers. The dietary therapy was continued for 11 weeks, and its content was low sodium and low caloric and contained sufficient nutrition for the subjects to carry on their normal work duties. Blood pressure and body weight were measured weekly ; chest X-ray, eye-ground examination and ECG were performed before the onset of therapy ; urinalysis and biochemistry were conducted before and after this dietary therapy, as well. With dietary therapy, blood pressure fell gradually and body weight tended to decrease in both the treated and untreated patients. A significant relationship was observed between the rise in blood pressure and salt intake. Laboratory findings showed no marked changes. As a result, it seems that this dietary therapy is quite effective in the treatment of hypertension. This study is significant in that it tends to verify the importance of dietary therapy in the treatment of hypertension and in that workers who followed this program were able to maintain this dietary therapy in a group while leading their normal daily lives.

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The problem of suicides among mentally ill patients in open door treatment programs has received scarce attention. Of late, the psychiatric community has gone toward a more community-centered, open approach to treatment of the mentally ill ; therefore, the opportunity for genuine social interaction has been broadened. When considering prevention of suicide, under the present conditions, it is important for one to understand the realities of suicides among mentally ill patients during the past 20 years. Among the mentally ill receiving the open door approach to treatment at Showa University's Karasuyama Mental Hospital, in patient suicides numbered 28 ; twenty five cases among these were schizophrenics. Out-patient suicides numbered 36 (20 were schizophrenics) . This paper analyses and examines the relationship between suicides and age or the possible connection, if any, to the open door approach to treatment and, also, the scene of suicide, means used and motivation for the act were considered. Statistics show that the rate of suicides among the mentally ill is 20-fold that for the normal population. However, it was found that only 10% of the in-patients at our hospital had not attempted suicide at one time or another. But in spite of showing a rising trend, there have been only 2 successful suicides in our hospital. The ages of those attempting suicide were, for the most part, in the twenties or thirties and the average hospitalization period among these was less than five to fifteen years. But, in spite of the new open door approach to treatment at Karasuyama Mental Hospital and the resulting expansion of opportunities for meaningful social interaction, the rate of suicides among our out-patients has increased. By the time Karasuyama Mental Hospital started the open door system of therapy, there had been suicides within the closed door system, but there were not any within this system after 1967, when our hospital completed the open door system. Spring and Autumn are, generally, periods during which many suicides occur, but the above generalization does not hold true for the schizophrenic personality ; they tend to commit suicide, in the case of those in the open door ward, during the daytime, and many carry this out away from the hospital. The means of suicide are often public, such as jumping in front of a train or from a building. These means are probably choosen because they assure success. In the case of patients within the closed door system, their means, of course, are totally dissimilar to those used by patients in the open door system. Many commit suicide. Great differences also existed between age and type of mental illness in the patients studied. Motivations for committing suicide are classified in this paper as follows : a) worsening of psychosis b) an awareness of a means of suicide c) lack of awareness that a particular act will result in death. Type A, in the case of out-patients, was the one. The others came under type B. In the case of Type B, findings bare out the importance of a more highly developed psychiatric system. Curing psychosis often results in eliminating the suicidal drive, but, in the case of Type B, close cooperation of patients' families and other involved persons is needed to help the patient. In the case of Type C, this study showed that a potentially suicidal patient's cries for help must not be ignored. The problem of out-patient suicides hasj been showing marked increased tendency in the past years ; therefore, now and in the future, an approach to the prevention of suicide among this group will be a major theme under study by the psychiatric community.

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Long a topic of discussion, the rather heterogenous clinical types of schizophrenia are studied here on a case by case basis in view of symptoms and clinical course. At present, the so-called“atypical psychosis”with periodicity and good prognosis has been observed and is reported. The author has studied one family's history which corresponded to atypical psychosis, showing the hereditary model of autosomal dominant and a feature of multiple incidence of bronchial asthma at Karasuyama Mental Hospital affiliated with Showa University. This study is intended to clarify the hereditary proclivity toward atypical psychosis with symptoms identical to“disease entities”among the cases of schizophrenia judged as hereditarly heterogenous, with reference to a survey from the viewpoint of internal medicine to treat physical ailments such as bronchial asthma. The study of this specific family's history having closer relationship genetically strongly suggests a hereditary dependence and, also, it positively endorses Mitsuda's study rerognizing the presence of hereditary heterogeneity among schizophrenia and, further, it strongly supports Inoue's study which drew a similar conclusion in a study of monozygotic twins. The advancement of somatopathological studies such as this will certainly become the genesis for a resolution of the problem of nosological proclivities toward atypical psychosis and will be the basis for reconstruction of nosological classifications of endogenous psychosis.

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In about half the investigated cases, serum amylase level fell below 90 % of the pretreatment value when it was measured during oral and intravenous glucose tolerance test in man. A negative correlation was obtained between the rate of increase of serum glucose level and that of decrease in serum amylase value. In rats, the serum amylase level was decreased after intravenous carbohydrate administration, among which glucose showed the greatest effect and fructose had no effect at all. This result suggested that aldehydes might play some role in the mechanism of the decreased amylase level in serum as compared to the function of ketose. This was shown to be likely by the observation that intravenously injected acetaldehyde and glyceraldehyde decreased serum amylase levels. On the other hand, the amylase value was not influenced by insulin, glucagon or adrenalin administration. In partially hepatectomized rats, amylase level was unchanged after carbohydrate injection. It was thus concluded that the liver plays a role in regulation of serum amylase level.

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We investigated the effects of free skin grafts performed over the total plantar surface for treatment of unilateral injuries to the plantar region prior to total development of the foot. These effects were studied by means of calculations based on actual measurements and X-ray images, as well as by Computerized Tomography, and the following results were obtained. There were differences found in foot length, width, height and in the area of the sole between the normal and injured feet during the development period and these differences tended to be heigthened somewhat by the end of the developmental period. Inhibition of development was marked in peripheral areas, and it appeared that this was a natural result of growth of growth inhibition of the plantar skin and subcutaneous tissue which received the direct wound. There was also inhibition of development of the bone which serves as tissue support, although this was not grave.

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Hemiballism of the right limbs developed after cerebral infarction in an 83-year-old female patient. On admission, examination revealed hemiballism of the right limbs, monologia, disorientation of thought and motor skills, irritability and the absence of DTR in the right upper limb. Without aggressive treatment, however, involuntary movement disappeared after 18 days, and she was discharged on her own power. CT scan demonstrated a low density area in the left fronto-parietal lobe. However, no obvious abnormality in bilateral subthalamic nuclei was observed. Although the contralateral subthalamic body of Luys is involved in most instances, lesions have been reported to exist in the cerebral cortex, thalamus, corpus striatum, internal capsule and brain stem in some cases. The prognosis for this disease has been generally considered to be fatal. However, this case demonstrated an atypical lesion in CT scan, and spontaneous recovery from hemiballism took place within three weeks. Previous reports on hemiballism were reviewed, and responsive lesions and the prognosis for this case were discussed.

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The authors recently examined a case of cryptococcal meningitis with simultaneous involvement of facial skin. A 73-year-old man was admitted to the Fujigaoka Hospital because of facial exanthema with headache followed by a fugue-like state. Cryptococcus neof ormans were isolated from the specimens of skin biopsy and CSF. Cases of this sort are relatively rare and cryptococcal meningitis, in most cases, begins with neurological symptoms such as meningeal signs, headaches and consciousness disorders followed by skin lesions. The combined therapy of Amphotericin B and 5-fluorocytosine was attempted and was remarkably beneficial in the eradication of clinical symptoms in this case and resulted in the disappearance of cryptococcus neoformans in CSF. Although the sugar value of CSF returned to the normal range at a relatively early stage, the number of cells and the protein value remained high until the subject's discharge. The sugar value was though to be the most useful index of improvement in the treatment for cryptococcal meningitis.

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An 81-year-old male was admitted to our hospital in Sept., 1980 to closely examine his anemic condition. Physical examination revealed anemia and slight jaundice. The spleen was palpable 2fb below the costal margin and the liver was also palpable 2fb. Hemoglobin was 6.8g/dl, reticulocytes 43.9%, RBC 171×10⁴/cmm, WBC 6900/cmm and the platelets were 28×10⁴/cmm. Serum bilirubin was 3.0mg/dl (1.3 direct reacting), haptoglobin was absent, LDH 1158 IU/1 and urine hemosiderin were weakly positive. Peripheral blood film revealed numerous spherocytes, erythroblasts and hypersegmented neutrophils. Bone marrow study revealed erythroid hyperplasia without“megaloblastoid”features. RBC survival [T1/2] was 10 days. Repeated Coombs-test with polyspecific, anti-IgG, -IgA, -IgM, -IgD, -C3 and -C4 antisera were negative. Indirect Coombs-tests with enzyme-treated red cells were also negative. Tests for non-immunologic causes of hemolytic anemia were negative. The patient was diagnosed as Coombs-negative autoimmune hemolytic anemia and, thus, was treated with 40 mg/day of prednisolone. The patient responded to prednisolone and, by the 21 st day, medication was tapered off. Two months from the onset of treatment, he went into remission and neutrophilic hypersegmentation disappeared. Serum vitamin B₁₂ and folate were normal and other evidence indicating coexistent megaloblastic anemia could not be detected. Neutrophilic hypersegmentation might be related to the autoimmune mechanism of the disease, since hypersegmented neutrophils disappeared following the recovery from anemia.

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