In order to differentiate various nodular goiters macroscopically, 457 cases of thyroid nodular lesions were studied. All of these lesions were removed surgically and ranged in size beyond 1 cm in diameter. Most cases belonged to T_1-3, and 33 lesions of papillary carcinoma belonged to T-4 according to 1978 T N M classification.
The gross features of nodular goiters were retrospectively investigated. They were classified as adenomatous nodules including so-called colloid adenoma, follicular adenoma, adenocarcinoma and others.
Gross appearances of cut surface varied in type: cystic (type C), degenerative and cystic (type D), and solid types including encapsulated (type S-1), distinctly circumscribed (type S-2), invasive (type S-3) and multi- nodular adenomatous goiter (type A). Thyroid cysts (type C) without tumorous lesions were benign.
Adenomatous nodules were well supplied with colloid, belonged to type D, S-1 and S-2, and their tissues were edematous, soft and cut surfaces were variegated but smooth.
The tissues of follicular adenoma appeared homogenous, tan-colored, dense, elastic firm in consistency. Most of these cases belonged to type S-1, and few were type D.
In cases of papillary adenocarcinoma (T_1-3), encapsulated cases of type D and S-1 were more frequent than non-encapsulated cases of S-2 and S-3. The tumor itself was firm or hard in half of the cases, but soft in a quarter of the cases. The cut surface of most cases was finely granulated, non-sanguineous, yellowish or grey-white, and uniform. Papillary, finger-like tissue was often seen in papillary cystadenocarcinoma.
Follicular adenocarcinomas (T_1-3) were almost encapsulated (type S-1) and generally cut surfaces were homogenous, opaque, tan or grey-white in color, but unexpectedly soft in consistency. A small number of them, especially of enlarged ones, showed variegated cut surfaces resulting from necrosis and hemorrhage. In this series, there was only one case of type A, but no cases of invasive follicular adenocarcinoma.

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The hypothalamic-pituitary-testicular function was evaluated in twenty-two male patients with hyperthyroidism. Loss of libido were present in 86.8% and gynecomastia was not observed in any of the cases.
1) Basal plasma LH, FSH, Testosterone and Estradiol levels were significantly higher than in normal men.
2) LH response to LH-RH test was exaggerated in eighteen of the twenty-two patients. FSH response to LH-RH test was normal in eighteen of the twenty-two patients. LH response after treatment became less sensitive than bofore treatment. FSH response after treatment did not change and remained within normal limits.
3) Testosterone response to HCG administration was blunt in ten of the eleven pa-tients. Estradiol response to HCG was exaggerated in six of the ten patients. Testoste-rone response to HCG after treatment became less sensitive than before treatment, but Estradiol response to HCG after treatment did not change significantly.
We concluded that male patients with hyperthyroidism have
1) partial failure of the Leydig cell function and
2) blunt response to the feedback effect of Estradiol.

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This report describes a case of pituitary dwarfism in a 24-year-old woman of 138.8 cm in height. The patient was born by breech presentation and was in a state of apparent death for a few hours immediately after delivery. Skull x-ray and skull CT scanning did not reveal any organic lesions in the brain and the visual field was normal. Osseous matu-ration was delayed and the bone age determined by X-ray films of the epiphysial center of the hand and wrist was calculated to be 14 years. In hormonal examinations, GH secre-tion was not stimulated by the administration of insulin, l-DOPA or glucagon-propranolol. No response of LH and FSH by LH-RH, delayed response of TSH and normal response of PRL by TRH infusion were shown, respectively. The patient did not complain of polyuria and polydipsia, and the basal ADH level in plasma was 1.75 pg/ml. Low levels of serum cortisol and plasma ACTH in the samples obtained in the morning such as 1.7-2.6 μg/dl and below 7.5-13.1 pg/ml, respectively, were shown, and both hormones were insufficently stimulated by insulin infusion. Twenty-four hour urinary 17-OHCS and 17-KS (0.5-4.2 mg and 0.9-2.5 mg per day, respectively) were also decreased, and the response of the urinary steroid metabolites were poor by metyrapone and were delayed by ACTH administration. The results for the pituitary-adrenal function indicated that the patient had suffered from partial secondary adrenal insufficiency in addition to complete GH deficiency. In spite of such a pathological state, clinical signs and symptoms of adrenal insufficiency during and after metyrapone and insulin administration were never manifested. One day about one month after the therapy by hGH was started, the patient suddenly developed high fever, nausea and general malaise, and lowering of blood pressure and mild lowering of serum sodium concentration were detected. These states, which subsided soon after the intra-venous infusion of cortisol, were considered to be inconsistent with those of acute adrenal insufficiency. Thus, it was speculated that the masked adrenal insufficiency in this case might have been manifested by the treatment with hGH.

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We performed total parathyroidectomy for the 2 cases of renal secondary hyperpar-thyroidism and a part of the parathyroid gland was transplanted in the right arm intra-muscularly.
The two cases had the same interval between the start of hemodialysis and the appea-rance of the symptoms and their resected parathyroids weighed almost equally.
But the serum calcium levels immediately after the operation was remarkably different, i. e., in the first case we had to use intravenous Calcicol (Ca. gluconate) in an undiluted solution continuously for over 14 days after the operation (maximally 40 ampules per day);while in the second case it was necessary to use Calcicol only for 4 days after the operation (maximally 25 ampules per day) to avoid tetany.
Among the preoperative data, only alkali-phosphatase level was very different between two cases;i. e., 121.8 K. A. U. in the first case, 23.2 K. A. U. in the second case.
We did not find significant differences in the levels of serum PTH, Ca, and P, between two cases.
Thus, we concluded that the serum alkali-phosphatase level implies most precisely se-verity of the “hungry bone”in the secondary hyperparathyroidism.

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A 44 year old male was admitted to our hospital because of a bone fracture. Labora-tory examination upon admission revealed a high serum cholesterol level and this was examined in detail. Although he had no goiter, physical examination revealed slight edema on his face, mounding phenomenon at Biceps and diminished Achilles tendon reflex. Laboratory examination also showed low concentrations of serum T₃, T₄ and free T₄, and high concentration of TSH. Since elevated T₃RSU was observed in this patient, serum TBG concentration was measured, but it was not detectable. High serum CPK level and decreased creatinine clearance without proteinuria were also discovered. As no other diseases which might cause low TBG concentration were recognized and a low concentra-tion of TBG was also ascertaind in one of his daughters, this case was diagnosed as familial TBG deficiency associated with hypothyroidism.
Familial deficiency of TBG has frequently been reported in cases of hyperthyroidism. On the contrary, case reports of hypothyroidism are few up to the present. It might be only due to the fact that the ratio of free T₄ is increased in TBG deficiency, and this in-crease resulted in subclinical manifestation of symptoms of hypothyroidism. Therefore, careful examination in patients with hypothyroidism, paticularly in those who have slight or no symptoms of hypothyroidism, might detect much more cases with TBG deficiency in the future. The pathogenesis of renal insufficiency in this patient remains uncertain.

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A case of Klinefelter's syndrome and the healthy male (20 cases) were studied as to the recurrent chromosome breaks (fragile sites). Peripheral blood lymphocytes were cul-tured in some chromosome medium.
1) A folic acid-deficient culture medium supplemented with 10% fetal bovine serum (FBS).
2) RPMI-1640 medium supplemented with 20% FBS.
3) Aminopterin 0.05 μg/ml as an inhibitor of folic acid was added 24h before harvesting the cell to RPMI-1640 medium supplemented with 10% FBS.
4) Methotrexate 0.05 μg/ml as an inhibitor of folic acid was added 24h before harvesting the cell to RPMI-1640 medium supplemented with 10% FBS.
Air dried chromosome preparation was stained with the trypsin Giemsa method. (trypsin: 0.01%)
The presence of the fragile site chromosome in 296 or more of the metaphases was judged as positive.
The patient was 160 cm tall and weighed 63 kg. At the age of 51 an IQ of under 76 (WAIS) was found. Cytogenetic investigations showed the karyotype 47, XXY.
Hormonal investigations showed high follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and low testosterone. These findings were compatible with Klinefelter's syndrome.
We found fragile site chromosomes(5q12: 3%, 10q12: 5%, 6q12 or 13: 13%). The fragile sites were observed more frequently than the healthy male (20 cases). The Detectability of the fragile sites increased when Methotrexate 0.05 μg/m1 as an inhibitor of folic acid was used for the culture medium than when FA-MEM, RPMI-1640 or Aminopterin were used.

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It is believed that the pathogenesis of diabetic peripheral neuropathy involves a variety of factors including vascular disturbances and metabolic disorders. In the present study, we investigated the therapeutic effect of prostaglandin E₁ (PGE₁) in the patient with diabetic peripheral neuropathy, since PGE1 is known to increase blood flow and have antiplatelet aggregation activities as well as a potent peripheral vasodilator activity. Fourty μg. of PGE₁ was given to four patients twice daily by intravenous drip infusion. The treatment lasted for a month.
Subjective symptoms of diabetic peripheral neuropathy including spontaneous pain and hypesthesia of legs were improved. In 2 of the 4 patients only a slight numbness remained in the tips of the feet. However, no beneficial effect on the Achilles tendon reflex and patellar reflex was observed.
These results suggest that PGE₁ is a useful drug to improve the subjective symptoms of diabetic peripheral neuropathy.

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A series of ointment was prepared. Hydrophilic macrogol, hydrophobic vaseline and witepsol were used as base materials. Each ointment contained insulin (eight units per gram weight). In order to study in vivo release of insulin from each ointment, blood glucose was measured after application of the materials on the rat abdominal muscles.
The initial fall of the blood glucose caused by the insulin-witepsol ointment was almost as same as that caused by the insulin-saline solution. However, the duration of the hypo-glycemic period of the insulin-witepsol ointment was shorter than that of insulin-saline solution. After the application of the insulin-vaseline ointment, the blood glucose de-creased more gradually and the hypoglycemic state continued for a longer period.
Insulin-macrogol ointment, which was made completely of commercially available mate-rials, has a least blood lowering effect and a shortest hypoglycemic period. Clinically, Insulin-macrogol ointment was applied on a skin ulcer in diabetics, and no side effect was observed.

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Our several examples of genetic counseling for Duchenne Muscular Dystrophy (DMD) were demonstrated.
Main points were suggested as follows:
1. So-called carriers are not so simple, patients with DMD do not always develop even frotn definite carriers. Especially in the case whose father shows such enzyme abnor-mality as CPK, ALD, healthy sons without DMD are also born at higher rate. We sup-pose that paternity must be deeply correlated.
2. In most occasions, clients have patients with DMD in their pedigree, and they ask us whether there are any problems about their marriage and having children. Counselor must be reliable and persuasive enough to make them realize the real situation with rea-sonable judgement.
Some clients are nervous and pessimistic even though their probability of having children with DMD is none or very low. It is of great importance and actually a good treatment for them to encourage and help and explain them that they are at no risk.
3. When mother of the carrier becomes pregnant, I think it's very inhuman to inter-rupt all male fetus by amniocentesis. It would be desirable and helpful to make accurate judgement based on an experienced case study by lots of carrier detection data including paternal side.
4. Presence of patients with DMD in inpatient or outpatient clinic itself may be an unknowing and incidental event from the standpoint of poor technique for the detection of carrier and for the genetic counseling.

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A study of finger deformity was performed in 42 cases with Duchenne type muscular dystrophy.
The results were as follows.
1. Thirty-nine cases showed finger deformity.
2. Most characteristic deformity was hyperextension of PIP joint, and typical swan neck deformity was seen in only one case.
3. The finger deformity beginning at PIP joint of middle finger developed later at DIP joint and MP joint.
4. The degree of deformity was more prominent in the left fingers than in the right.

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We measured the serum total cholesterol (T-C), high density lipoprotein cholesterol (HDL-C), low density lipoprotein (LDL), very low density lipoprotein (VLDL) by enzyme method (T-C), precipitate method (HDL-C) and BLF reagents (LDL, VLDL from Eiken), and the following results were obtained.
1) The serum T-C, HDL-C, LDL and VLDL in normal controls (male 20, female 20) were 167.3±35.1 mg/dl, 54.1±13.8 mg/dl, 319±72.3 mg /dl, 106±52.8 mg/dl for male indivi-duals; 169.3±24.7 mg/dl, 58.9±13.3 mg, /dl, 330±62.3 mg/dl, 113±38.1 mg/dl for female indi-viduals, respectively.
2) The serum T-C, HDL-C, LDL and VLDL of PMD were 158.9±36.4 mg/dl, 36-4±8.8 mg/dl, 334.6±91.6 mg/dl, 130.4±107.6 mg/dl for male patients with Duchenne type PMD, 107.2±40.2 mg/dl, 40.2±8.9 mg/dl, 316.9±103.9 mg/dl, 170.4±101.3 mg/dl for male patients with LG type PMD;194.7±55.9 mg/dl, 41.5±16.4 mg/dl, 364.3±75.4 mg/dl, 171.9±224.2 mg/dl for male patients with other diseases; 189±64.3 mg/dl, 43.8±9.9 mg/dl, 436.5±138.4 mg/dl, 96.2±38.1 mg/dl for female patients with LG type PMD;230±33.9 mg/dl, 41.5±7.4 mg/dl, 498.8±111.3 mg/dl, 271.3±210.3 mg/dl for female patients with FSH type PMD;180.4±49.5 mg/dl, 49.0±19.2 mg/dl, 361.4±157.6 mg/dl, 102.3±56.6 mg/dl for female patients with other diseases.
The HDL-C and % HDL-C (HDL-C/T-C) were low in the patients with PMD (espe-cially obese patients). It has been described that low HDL-C level is related to the de-velopment of arteriosclerosis, so we have to carefully observe serum T-C, HDL-C, LDL and VLDL levels in patients with PMD at regular intervals.

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It is reported that the measurement of serum myoglobin (Mb) levels is useful to eval-uate the conditions of several kinds of diseases in which cardiac or skeletal muscles are damaged. We carried out the basic studies using Mb measurement kit (Eiken) by radioimmuno-assay (double antibody method) and measured serum Mb levels of progressive muscular dystrophy (PMD) and the other similar muscular diseases. Good results were obtained in the repeatability test, recovery test and dilution test. The serum Mb levels of normal adults (n=30), Duchenne type PMD (D-t, n=24), limb girdle type PMD (LG-t, n=14), facioscaplohumeral type PMD (FSH-t, n=1), congenital muscular dystrophy (CMD, n=3), myotonic dystrophy (MD, n=3) and the other muscular diseases (OMD, n=12) were 38.6±15.8 ng/ml, 479.5±522.7 ng/ml, 135.0±58.6 ng/ml, 48 ng/ml, 735±756 ng/ml, 93.7±15.5 ng/ml and 38.1+24.6 ng/ml (mean±SD), respectively. In D-t and LG-t, the serum Mb levels were significantly high (both p<0.001). Furthermore, we studied the correlation with the serum Mb and the serum creatine phosphokinase levels that were measured at the same time in PMD and the coefficients of correlation were r=0.667 (p<0.001) in D-t, r=0.889 (p<0.001) in LG-t, r=0.600 in CMD, r=0.885 in MD and r=0.705 (p<0.05) in OMD. <
In muscular diseases, the measurements of serum Mb levels were useful for the di-agnosis of neurogenic origin or muscular origin, and for the differential diagnosis of types of PMD, and could tell us the condition of the damaged muscles.

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A study of chromosome in five patients with congenital muscular dystrophy was per-formed. The lymphocytes from peripheral blood were cultured in a folic acid-deficient culture medium. The presence of the fragile site in 2% or more of the metaphases was judged as positive. The fragile site at 6q12 or 13 was found in a patient with Fukuyama type congenital muscular dystrophy (FCMD). Because viral etiology was postulated for FCMD, we considered that the presence of the fragile site might be associated with FCMD. Thus, many patients with FCMD should be studied for the fragile site.

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HLA typing was performed in 93 patients with DMDs and their parents and other pa-tients with PMDs using a standard microlymphocytotoxicity test.
We confirmed the strong correlation with specific HLA antigens and its order in fre-quency in patients with DMD and their parents.
A slight increase in A10, AW33 and a slight decrease in A28, BW40, BW63 were char-acteristic as compared to male nephrotic controls.
BW6 was the most frequent locus including control groups but exceptionally BW4 was significantly frequent in SPMA.
The genetic significance of these HLA typing pattern was also discussed.

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Although the etiology of progressive muscular dystrophy (PMD) is uknown, recently clinical improvement has been reported in patients with PMD treated by calcium antagonists, such as diltiazem, nicardipine and verapamil. The objective of this study was to evalute the effectiveness of 40-60 mg of oral nicardipine given daily to 20 men with PMD for 8 months to 2(2/3) years. Its effectiveness was determind by ADL, CPK and grip strength test. Grip strength was measured by a sensitive digital ergometer. The following results were obtained.
1) No significant changes occurred in ADL and CPK. 2) In only 2 boys (9 and 11 years old) grip strength increased significantly after nica-rdipine treatment.
3) Mild side effects were occasionally observed, but transient. These results sugges-ted that nicardipine might have beneficial effects in only younger boys with PMD.

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