The possibility of diagnosing nodular thyroid disease by computed tomography (CT) of the body has been investigated. CT findings in 41 patients with nodular thyroid disease were compared with the pathology of the resected thyroid glands.
The results obtained were as follows:
1) An irregular wall of the tumor was observed in 80% of malignant lesions and a smooth wall of the tumor was found in 73.3% of benign lesions. A heterogeneous internal structure of the tumor was observed in 72.2% of malignant lesions. There was no correlation between homogeneous internal structure and diagnosis of benignancy or malignancy.
2) Calcification was observed in 20 out of 41 cases (48.8%). Benign lesions were revealed in 25% of the cases (4 out of 16) and malignant lesions in 64% of the cases (16 out of 25). Comma on circular calcification was usually observed in benign lesions. Scattered or coarse irregular type was frequently seen in malignant lesions.
3) Cystic degeneration was observed in 22 out of 41 cases (53.7%). Benign lesions were revealed in 87% of the cases (14 out of 16) and malignant lesions in 32% of the cases (8 out of 25). An irregular wall of the cystic degeneration was observed in 87.5% of malignant lesions and a smooth wall of the cystic degeneration was found in 92.7% of benign lesions. The patterns of cystic degeneration were classified into 3 types ; full moon, semilunar and horse shoe types. Furthermore, the full moon types were also classified into 3 subtypes; solitary, multiple and doughnut types. The data suggests that malignant lesions are easily diagnosed by recognition of an irregular wall and semilunar and horse shoe patterns, while benign lesions are diagnosed by a smooth wall and a full moon pattern. Adenomatous goiter tended to have the multiple full moon appearance.
In conclusion, CT is valuable in establishing diagnosis of nodular thyroid disease.

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Since the discovery of intravenous administration of a glucose solution to reduce the cerebrospinal fluid pressure by Weed and McKibben, the treatment of intracranial hypertension with hypertonic solution has been widely used in the neurological field. Javid and Settlage demonstrated the clinical usefulness of intravenous administration of urea have been reported, such as rebound phenomenon, inflammatory reaction of vessels, hemoglobinuria and so on. These side effects are not observed in intravenous administration of mannitol. Therefore, the mannitol solution has been widely used in the management of raised intracranial pressure (ICP). This paper reports on the effect of hypertonic solution of mannitol on raised intracranial pressure by use of the method of epidural pressure recordings of 45 postoperative patients.
The diagnoses of the above patients were as follows : 23 cerebral aneurysms, 14 brain tumors, 6 hypertensive intracerebral hemorrhages and 2 cerebral contusions. Two groups were classified by the infusion dosage and the rate of mannitol. Group A: 0.5 g/kg of mannitol infused within 15, 30 and 60 minutes, and group B: 1.0g/kg of mannitol infused within 30, 60 and 90 minutes.
Results:
1) Over 23% reduction of ICP was observed in every group by the administration of mannitol solution as compared with the average of the initial ICP levels. In group B, the faster the infusion rate was, the lower was the level of raised ICP.
2) In every group, the slower the infusion rate of the same dosage of mannitol solution, the longer the reduction time of ICP lasted.
3) A rebound phenomenon was found in 12% of all administered cases.
It was concluded that the optimal dosage and the rate of mannitol infusion was 0.5g/kg within 60 minutes and/or 1.0g/kg within 60 minutes.

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The purpose of this study is to describe the effects of a hypertonic solution of glycerol on raised intracranial pressure (ICP) by epidural pressure recordings of 45 postoperative patients.
These cases included 23 cerebral aneurysms, 14 brain tumors, 6 hypertensive intracerebral hemorrhages and 2 cerebral contusions. Glycerol was prepared as 10% solution, in which 5% fructose was added as an antihemolysis agents. Two groups were classified by the infusion dosage and the rate of glycerol. Group A : 0.5 g/kg of glycerol infused within 30, 60 and 90 minutes. Group B: 1.0 g/kg of glycerol infused within 60, 120 and 180 minutes.
Results
1) When glycerol solution was administered, over 23% reduction of ICP was observed in both groups as compared with the average of the initial ICP levels. The slower the infusion rate, the lower was the level of ICP.
2) In both groups, the slower the infusion rate of the same dosage of glycerol solution, the longer the reduction time of ICP lasted.
3) A rebound phenomenon was found in about 38% of all administered cases. However, the rebound phenomenon was found in less than 20% when glycerol was infused within 30 minutes in group A and infused within 120 minutes in group B. On the other hand, the rebound phenomenon was found in more than 50% when infused within 60 minutes in group A and infused within 180 minutes in group B.
It was concluded that the optimal dosage and the rate of glycerol infusion was 1.0 g/kg within 120 minutes.

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Escherichia coli strains isolated from the urine and stools of outpatients with urianry tract infections, from the stools of hospitalized parturient women and infants, and from the vulvar smear and stools of pregnant women visiting hospital were studied to know the relationship between serologic distribution of E. coli and hemolytic and necrotic activities. The following findings were obtained:
1) The number of E. coli strains of 0-1, 0-2, 0-4 and 0-6 accounted for about a half of 358 strains which proved to be of a different distribution from that of E. coli found in the normal stooL
2) Out of 358 strains 109 (30.4%) were found to be hemolytic. This means that incidence of hemolytic strains is higher than that found in the normal stool.
3) E. coli strains of 0-4 and 0-6 proved to have a particularly high incidence of hemolytic strains, whereas the strains of 0-1 and 0-13 showed a low ratio.
4) The necrotic activity of E. coli was studied in 177 strains in which 37.2% of the strains were determined as necrotic.
5) The strains of 0-4, 0-6 and 0-18 showed a high ratio of necrotic activity.
6) E. coli strains of 0-1, 0-2, 0-4, 0-6, 0-18 and 0-75 isolated from the urinary tract infection cases were collectively designated as a special type and the others as a general type.
A comparison between the two types of strains showed a different ratio of necrotic incidence, 49.6% for the special type and 6.0% for the general type.
7) Examination of the relationship between hemolytic and necrotic activities showed that 73.8% of 65 hemolytic strains were necrotic, whereas 34.8% of 112 non-hemolytic strains were found to be necrotic ; on the other hand, 55.1% of 87 necrotic strains were hemolytic, whereas 18.8 % of 90 non-necrotic strains were found to be hemolytic.
Thus, a correlation was demonstrated between the two activities.
8) The strains of 0-4 constituted 84.2% of the hemolytic strains while the strains of 0-6 85.2% of the necrotic strains.
The percentage of the strains which were necrotic but non-hemolytic was 60.6% for 0-1 and 80.0% for 0-18.

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Influenzaviruses isolated from throat swab specimans collected in Thailand and the Philippines in August 1979. January 1981 were studied by the HI test. Eighty-five strains from Thailand comprised 12 AH 1, 69 AH 3 and four B viruses, whereas 14 strains from the Philippines were 12 AH 3 and two B viruses. The AH 1 viruses were isolated before May 1980, the AH 3 during the whole period of this study, and B in May. August 1980. Some AH 1 viruses isolated in Thailand showed antigenic similarity to A/USSR/92/77 which prevailed in Japan a few years before. Most of the AH 3 viruses isolated from Thailand resembled A/Tokyo/1/77, A/Bangkok/1/79 or A/Aichi/1/80, being not so different from Japanese isolates during the same period. However, a similar antigenic drift of AH 3 virus was found in A/Bangkok/138/80, isolated in August, and A/Kyoto/C-1/81, isolated in January. A possibility of the occurrence of the same antigenically drifted variants in Japan and South-East Asia is discussed.

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Several problems in Rotor's syndrome were studied with respect to the effects of aging on the pigment metabolism, and its differences from Dubin-Johnson syndrome.
In six cases of Rotor's syndrome examined at least twice at an average interval of 10.5±6.5 years, no significant increase was found in the total (TB) and direct (DB) bilirubin in the serum between the initial and the last examination. However, indirect bilirubin increased from 1.21±0.72 mg/dl to 2.28±1.00 mg/dl (p<0.05), the DB/TB ratio decreased from 77.3±6.6% to 64.4±8.7% (p<0.05) and BSP retentions at 45 minutes increased from 26.8±10.9% to 45.3±14.9% (p<0.05). A significant positive correlation between the values of BSP retained at 45 minutes and the age of the patients was observed (p <0.01) in a total of 10 cases of Rotor's syndrome, including four other cases that were examined only once.
No reelevation of BSP on the disappearance curves was observed in 17 examinations of these 10 cases of Rotor's syndrome. However, reelevation of BSP was noted in all of the 10 cases of Dubin-Johnson syndrome examined separately.
Five cases of Dubin-Johnson syndrome and one case of Rotor's syndrome were loaded intravenously with dehydrocholic acid following 45. minute BSP tests. Fifteen minutes later the values of retained BSP increased in all of the 5 cases of Dubin-Johnson syndrome but decreased in a single case of Rotor's syndrome.
These results imply that abnormalities in pigment metabolism intensify with age in Rotor's syndrome, and that Rotor's syndrome is a distinct pathophysiological entity different from Dubin-Johnson syndrome.

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Laboratory model experiments were made with the object of clarifying the vital state of El Tor cholera vibrio (ETCV) in coastal sea water, sewage, city water and river water, comparing the results with those obtained in phosphate buffer solution and sterilized water. Their survival rates were calculated at the water temperature at which the samples were collected in summer and winter. Into the sample water, ETCV was added at the rate 10⁵/ml.
Additional experiments were performed in 0.1% Peptone solution to determine the effects of NaC1 concentrations, pH and temperature on the survival rate. The results obtained were as follows:
1) As the time elapsed, the number of surviving ETCV decreased in all water samples with the exception of sea water. When the interval of decrease (in days) from its initial population to its 1/10 (T 1/10) or 1/100 (T 1/100) level was used as the survival time, the indices T 1/10 or T 1/100 at 25°C were greater than those at 15°C.
2) The relation between the survival rate and the number of coliform or other culturable bacteria was inverse.
3) ETCV multiplied fairly well in 2 and 3% NaC1 solution, whereas the multiplication was poor in 1% and 4%.
4) It was unsuccessful to clarify the connection between the ETCV survival rate and pH, BOD or COD. However, in Peptone solution, the multiplication of ETCV was more pronounced in neutral environment and in acid or in alkali.

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The dynamics of cerebrospinal fluid in twelve cases of arachnoid cysts in the middle cranial fossa was examined by using CT-cisternography. RI-cisternography was also performed in nine patients combined with CT-cisternography. According to the results of CT-cisternography obtained from twelve cases, the cysts were classified into four types. The classification was based on the kinetics of cyst fluid, namely the extent of entry and stasis of Metrizamide into the cyst and early clearance from it. Type I showed early filling of Metrizamide into the cyst and early clearance from it. Type II showed early filling of Metrizamide and delayed clearance. Type Ill showed delayed filling of Metrizamide and delayed clearance. Type IV demonstrated no intracystic filling of Metrizamide. In Type I, II and III, there existed communication between the cyst and its adjacent subarachnoid space. Namely they were communicating cysts. Type IV were non-communicating cyst. Type I and II were all clinically asymptomatic. All cases with intracranial hypertension belonged to Type N. Accordingly, it can be said that there were close correlations between CT-cisternographic results and the clinical findings. On the other hand, RI-cisternography demonstrated communicating cysts in all nine cases. Thus there was no clear relationship between RI-cisternographic findings and clinical symptoms. Using nonirritating radioisotope in a small quantity as a tracer RI-cisternography can provide useful information concerning the flow pattern of cerebrospinal fluid. However, the spatial resolution of RI-cisternography in the present state of technology does not reach that of CT-cisternography. Thus, it can be concluded that CTcisternography is very useful in determining the surgical indication and is also of great value in detecting a possible recurrence of the cyst. From the present study it seems to be obvious that CT-cisternography is more useful than RI-cisternography in the study of arachnoid cysts in the middle cranial fossa.

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Cardiocerebral apoplexy (CCA) is known to occur as apoplexy-like symptome after myocardial infarction. However, no detailed histopathological studies of this disease entity have ever been made.
To clarify the definition of CCA, the brains and hearts of 35 acute myocardial infarction cases and 20 control cases (control group) from autopsy materials were pathomorphologically examined.
The clinical neurologic signs were also encountered.
Macroscopic brain disorders observed in 14 acute myocardial infarction cases (brain disorder group) consisted of either acute or old infarction changes. Besides, cases with no macroscopic brain disorders (no brain disorder group) were also seen. The degree of macroscopic changes in cardiocerebrovascular systems of examined cases became slighter in order from brain disorder group, no disorder group and to control group. Microscopic observation of brain parenchyma of no brain disorder group and control group were compaired with those of cerebral bleeding cases.
As the result, although various changes (ischemic, pre-infarctive, softening) were seen in the brains of both no disorder group and control group, no disorder group revealed more or less striking change than control group.
These changes were justified as not specific for myocardial infarction, and seen to be slighter than those of cerebral bleeding cases. The reason was explained on the bases of assumption that the brain circulatory derangement in cases of myocardial infarction is resulted from the indirect effect of the ischemic process, why the circulatory derangement in cerebral bleeding is directly resulted from the ischemic process involve in brain tissue.
The pathomorphological observation of brain and heart in examined acute myocardial infarction cases was summarized as follows and might be classified with 3 types.
1) Acute disorders in brain and heart which occures simultaneously: Pathomorphologic CCA in a narrow sense (3 cases).
2) Acute disorder in heart and old disorder in brain: Pathomorphologic CCA in a broad sense (11 cases).
3) Acute disorder in heart without macroscopic change in brain, in spite of the clinical neurologic manifestations: Clinical CCA (5 cases).
In conclusion, pathomorphologic CCA could be justified as a extreme type of acute ischemic disorder which occures simultaneously in various organs particulary in heart and brain.

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The author has performed an investigation on the cellular injury induced by infection of the leptospira ictero-hemorrhagica.
The results obtained were as follows:
1) The light microscopic investigation revealed massive hemorrhagic pneumonia, hemorrhagic foci of liver necrosis which subsequently lead to cause generalized jaundice, tubular necrosis of kidney and hemorrhagic glomerulonephritis. The above-mentioned changes appeared to be most outspoken at 7 days after inoculation.
2) The electron microscopic investigation revealed the following findings.
i) In the lung, extensive retention of the proteineous material as well as accumulation of the cellular debris was striking. Interstitial edema and edematous swelling of the fibrocollagenous fibers were also discernible. The endothelial cell swelling and disintegration which eventually lead to destruction of the blood-air barrier were striking. Simultaneously extensive type 1 and II epithelial cell disintegration was encountered.
ii) In the liver, extensive swelling and disintegration of the mitochondria as well as loss of mitochondrial cristae, decrease of glycogen particulates, disintegration of the rough and smooth surfaced endoplasmic reticulum were very striking. As a matter of fact, destruction of the sinusoidal lining cells was very extensive. Most strikingly, spiral bodies, identifiable as leptospiral organism which revealed selective stainability to the PAM impregnation technique were dispersed in the cytoplasm and inter-cellular spaces.
iii) In the kidney, the glomerular capillary vessels were induced in vigorous destruction. The endothelial cells were induced in striking destruction and the basement membrane revealed poor distinction, slight thickening. The swelling of the epithelial cells as well as increased lysosomes was also striking. Extensive foci of necrosis of tubular epithelium and granular cast formation were frequently noted.
3) It was concluded that the leptospira ictero-hemorrhagica strain possess the specific property to destruct the blood-tissue barrier in various visceral organs which subsequently cause functional dysfunction of the micro-circulatory system. The toxic or immunological enchancement will be contributory in causing tissue injury in this particular disease condition.

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