Nagoya Journal of Medical Science

Hypothalamo-pituitary functions in 60 cases of Cushing's disease have been followed up after transsphenoidal selective adenomectomy. The adenoma was found and selectively removed in 56 cases.
Remarkable clinical improvement followed within several months after selective adenomectomy in the successful cases, paralleled with endocrine results. Long follow-up studies demonstrated a recovery ofthe ACTH-cortisol system with restarting of the circadian rhythm and normal suppressibility to low-dose dexamethasone. The functions of the other anterior pituitary hormones such as GH, TSH, and gonadotropins also returned to normal after selective adenomectomy in the majority of the clinically cured cases.
These results strongly suggest that transsphenoidal pituitary exploration should be accepted as an initial treatment of Cushing's disease because of its high clinical remission rate in association with fair chance of radical cure and return to normal endocrine function.

For the purpose of studying the appropriate surgical treatment for thyroid cancer in the early stage, extended modified neck dissection was carried out to examine node metastasis bilaterally in 22 patients considered preoperatively to be in this stage. These patients presented with only one movable unilateral nodule in the thyroid with no clinical evidence of nodal involvement. At the time of operation, as many vital structures as possible were preserved intact, resulting in a favorable postoperative course with no remarkable sequelae except for Horner's syndrome in one case. Since it was impossible to preserve the blood supply to the parathyroid glands as a consequence of adequate dissection ofthe tracheoesophageal nodes, they were totally removed and autotransplantated into the major pectoral muscle. As many as 20 patients (90.9%) had node metastases somewhere in the neck, of which 12 (54.5%) were bilateral. Some 224 (13.0%) out of the 1719 nodes dissected proved to contain metastases. Ineach case nodal involvement was found to be scattered over the entire neck region except for the contralateral submandibular nodes. The incidence of metastases in the inferior jugular nodes, para- and pretracheal group of the upper mediastinal nodes was 68.2%, 50.0% and 45.5%, respectively, implying the necessity Of mediastinotomy where possible for better results. Node metastases were also found in 31.8% of patients ipsilaterally as well as in 13.6% of patients contralaterally in the tracheoesophageal groove, where is the most critical point in the operation. The metastatic incidence of nodes overlying the thyroid cartilage and ipsilateral superior jugular nodes was as high as 36.4% and 50.0%, respectively.
These results suggest that the thyroid cancer has already widely metastasized over the entire neck region at the time when the patient is diagnosed as having thyroid cancer, even if it is considered clinically to be in the early stage. Based upon these results, bilateral modified neck dissection, with mediastinotomy where possible, is considered the surgical treatment of choice for thyroid cancer. This operative method can be undertaken, according to our limited experience, without any remarkable complications or deleterious sequelae.

Sex differences in deaths from nineteen intractable diseases were devotedly examined by the 95 percent confidence interval for a ratio of male deaths to female deaths in 1977-1980. Japan. Few intractable diseases failed to demonstrate an appreciable difference in frequency between the sexes. What interestingly emerged from the analysis were an obvious female predominance in intractable diseases for which autoimmune mechanisms are presumably incriminated and either male or female predisposition to intractable diseases in which the vascular system is principally affected. Possible etiological implications of different frequency of disease by sex and age were also discussed. Sex- and age-oriented investigations are finally believed to be of eXlreme importance particularly for intnictable diseases.

Intracellular levels of the free amino acid taurine were measured in circulating granulocytes and mononuclear cells from 12 normal subjects and 27 patients with various types of leukemia, and in bone marrow cells from seven acute leukemias in blastic phase and 4 in remission. leukemic cells have consistently lower taurine levels compared to normal lymphocytes and granulocytes. Although taurine levels in the circulating granulocytes from patients with acute and chronic leukemias were normal, they were significantly lower in the group of patients with atypical AML. The lowest taurine levels were observed in ihe mononuclear cells from patients with AML and ALL followed by those from patients with CML and CLL, and then those from patients with a typical AML. In AML patients the levels increased to normal values during clinical remission. The bone marrow mononuclear cells of AML in the blastic phase also had lower taurine levels compared to these in remission just same as peripheral blood cells do. These observations on the alteration in taurine content of both mononuclear cells in peripheral blood and bone marrow may be useful as a biochemical marker in diagnosis as well as for prediction of relapse and effectiveness of chemotherapy on patients with various types of leukemia.

In order to know the influence of obstructive jaundice on the function of the liver and also to clarify the underlying factors involved in the recovery process after releasing biliary obstruction. the author examined the following parameters:
The respiratory function of the liver mitochondria, the activities of hepatic enzymes in serum and the ultrastructure of the liver.
Male Donryu rats were used for this investigation, in which the bile ducts ofthe rats were obstructed and. after a certain duration. were relased to allow for external bile drainage. The parameters mentioned above deteriorated due to obstructive jaundice, but recovered to some extent upon the release of the biliary obstruction. The recovery process depended on the length of the obstruction period. The longer the obstruction period persisted, the longer was the time required for recovery. Accordingly, it is desirable to perform biliary decompression as soon as possible. at least within a period of two weeks. Furthermore, after the release of obstructive jaundice, there existed a certain period of insufficient recovery of the mitochondrial function even when the biochemical data were completely normalized. This time lag ofthe recovery between mitochondrial function anq biochemical data might reflect a reduced reserve function of the liver. Belter understanding of the recovery process of the damaged liver is very important when considering major surgery after releasing obstructive jaundice.