Three hundred thirty-six cases of differentiated carcinoma of the thyroid treated with systematic modified neck dissection were investigated as to the clinicopathological aspects of lymph node metastases and the metastatic patterns. Lymph node metastases were observed in 261 cases or 77.7% of all the cases. Metastatic rates were 80.7% in papillary carcinoma and 52.8% in follicular carcinoma. Lymph node metastases were found more frequently in the younger patients. The metastases were present in 63.6% of 33 cares of minimal carcinoma less than 1.0 cm in diameter and 69.1% of primary tumor without adhesion to the surrounding tissues. The metastases were frequently located the paratracheal nodes (60.1%), the inferior internal jugular nodes (52.4%) and the pretracheal nodes (38.1%). Contralateral metastases of regional lymph nodes were found in 35.7% (paratracheal nodes : 28.2%, inferior internal jugular nodes : 12.7%). Therefore, it is suggested that the metastasis of regional lymph node first occurs in the paratracheal nodes, sequentially in the inferior internal jugular or pretracheal nodes and further extends to other groups of nodes. As invasion of surrounding tissues by primary tumor became more extensive, the incidence of metastasis increased. In cases of papillary carcinoma of the thyroid, the initial metastatic foci within a lymph node showed a follicular pattern. And when these lesions grew larger, the histological feature of the metastatic tumor in the node resembled the papillary structure of the primary tumor.
In conclusion, modified radical neck dissection for thyroid cancer should usually be performed with the dissection of the ipsilateral regional lymph nodes as well as contralateral paratracheal and inferior internal jugular nodes.

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Aspects of the use of injectable antibiotics, isolation frequency of bacteria and frequencies of drug-resistant strains in some bacteria in Tatebayashi Kosei Hospital during a recent three-year period were studied. In 1982, 1983 and 1984, the yearly amount of antibiotic consumption was 85, 000 ; 73, 000 and 69, 000 ampules and vials and 91, 80 and 73 kilograms, respectively. During the three years, cephems (61-63%) and penicillins (20-21%) were the most frequently used, followed by aminoglycosides (10-12%) and fosfomycin (3-4%). The consumption of chloramphenicol, erythromycin, doxycycline and lincomycin was markedly lower. There was a decrease in the isolation frequency of bacteria in 1984 when compared with that of in 1982 and 1983. Approximately 70% of the bacteria isolated from clinical specimens were gram-negative bacilli. From 1982 through 1984, the frequencies of ampicillin-resistant S. aureus, cefazolin-resistant E. coli, sulbenicillin-resistant Ps. aeruginosa and cefotaxime-resistant Serratia were 13-17%, 1-3%, 47-52% and 1-3%, respectively.

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