Pathological Enlargement Research Articles

Twelve years' experience of antithyroid treatment.

SINCE thiouracil was introduced to clinical therapeutics in I943, antithyroid treatment for thyrotoxicosis has widely increased and proved more and more effective as the years have passed, partly as the result of experience but also through the use of more effective agents, such as carbimazole and methimazole. It is thus possible now to assess their relative value in comparison with surgical treatment, which before I943 was the only treatment possible and still is the treatment of choice for a proportion of cases sent to the physician in consultation. Recently Trotter (I96I) reviewed his experience over a period of io years using thiouracil and methyl thiouracil. He found that it was necessary to abandon treatment in 44% of 70 cases owing to the presence of too large a goitre in some cases and, in others, on account of the necessity for prolongation of courses for more than two years. 45% were satisfactorily maintained euthyroid for io years and a smaller number (3I%) were given courses of less than two years' duration. Yet for patients successfully treated the inconvenience of hospital admission, the anxieties and fears of operation and the disadvantage of permanent hypothyroidism-sometimes seen following both operation and radioiodine-have been avoided. The present paper illustrates the improved results using carbimazole, and the merit of particular care both in the selection of suitable patients and in dosage control. In I948 I commenced the careful selection of suitable cases for medical treatment from those sent for opinions, at the same time referring those to surgical colleagues considered unsuitable for antithyroid therapy. The present study is of the results and potentiality of treatment with methyl thiouracil since 1948 and carbimazole since 1953. The chief value of the study lies in the personal selection of cases and control of therapy by one doctor, with the helpful co-operation of clinical assistants through courses of treatment and follow-up periods. Throughout I have had the co-operation of surgical colleagues who have operated on all cases referred to them and who have themselves referred several cases for antithyroid therapy. Clinical Material Since I948, 27I cases of thyroid disorder have been referred for personal opinions concerning treatment and diagnosis, and in all these, pathological enlargement of the thyroid was apparent. Of 194 cases showing toxic features, 32 cases were referred direct for surgical treatment, which was invariably carried out. The high proportion selected for antithyroid therapy is no doubt attributable, to a certain extent, to preliminary selection of cases by general practitioners and surgical colleagues. Most of these patients were seen at out-patient clinics dealing primarily with general medicine, while about 25% were seen in private practice.

The combined activity of the spleen and other organs

In experimental splenomegaly of white rats caused by the intraperitoneal injection of methylcellulose the velocity of protein renovation is found to be decreased in the liver (determined by the test of radioactive methionine incorporation into the liver proteins). The urea-forming function of the liver is also disturbed (tested of the urea synthesis by the liver sections). Experiments demonstrated that the pathological enlargement of the spleen with the disturbance of its functions reduces the antianemic factor content of the liver. This may to a certain extent explain the anemia occurring in various diseases connected with splenomegaly.

Some Distinct Types of Distribution of Cytoplasmic Ribonucleic Acid with Related Changes of Cytochondria in Liver Cells under Normal and Pathological Conditions

1. The difference of the staining behavior of nucleoproteins contained in chromatin and ergastoplasm or nucleoli against several basic dyes (pyronine-methyl green, thionine, etc.), which has recently been discussed by the author (1948a, b, c), may be distinguished terminologically as follows: chromatin is eubasophile while ergastoplasm and nucleoli are heterobasophile.2. The morphological changes of heterobasophile ergastoplasm (ribonucleic acid) and cytochondria of liver cells under normal and pathological conditions have been classified into four main types and described in detail. The important characteristics of these types consist in appearance, disappearance, and distribution of the ribonucleic acid and relative quantity and dimension of the cytochondria. The four types may, for convenience sake, be called 1. normal type, 2. reacting type, 3. mortal type or “catastrophe”, and 4. recovering type.3. The nucleotide and protein natures of ergastoplasm and their implications in cell metabolism, the localization of ribonucleic acids in the cytoplasm, the relation of the morphological changes of ergastoplasm and of cytochondria to pathological consumption of body proteins, and the mechanisms of pathological enlargement of cytochondria have been discussed.Lastly, it is my pleasant duty to express my hearty thanks to Dr. O. MINOUCHI who led me into this field of cytology always helping me with very instructive and valuabe advice throughout the course of this study. I am also indebted to the members of Medico-Biological Institute of Minophagen Pharmaceutical Co., and especially to Messrs. I. SATO, Zoological Institute of Kyoto University, and T. HAMA, Zoological Institute of Tokyo University, for their kind assistance and criticism.

The thymus myth

(1) Pathological enlargement of the thymus is probably diagnosed far too often, and often on erroneous grounds. (2) All other possible causes of upper respiratory obstruction should be excluded before a definite diagnosis is made. Direct inspection of the larynx should always be carried out, and will usually result in a diagnosis of congenital laryngeal stridor. (3) Thymic deaths are probably a myth. The error in diagnosis Usually results from mistaking the normal large thymus found in cases of sudden death in children for a pathological condition.

An orthodiagraphic study of 291 college students who showed no evidence of heart disease

1. 1. Orthodiagrams were made in 291 male students between the ages of sixteen and twenty-six years, with no evidence of cardiovascular disease. 2. 2. The measurements suggest that the predicted figures of Eyster and Hodges may be too high for young male adults: that the predicted area is approximately 10 per cent too high, and the predicted transverse diameter 0.5 cm. too long. 3. 3. Hearts which were small in the frontal plane frequently had a small anteroposterior diameter. 4. 4. The shape of the heart varied greatly. It was influenced by (a) physique, (b) height of diaphragm, (c) shape of chest, and (d) spinal deformity. In the vertical or ptotic heart the region of the pulmonary artery was frequently prominent. When combined with a straight left border, it sometimes simulated a “mitral heart”. 5. 5. In many cases the shadow of the proximal portion of the descending aorta could be seen above the heart. 6. 6. Measurements of the heart size as well as empirical determinations of cardiac shape should be interpreted with a knowledge of their limitations. In many instances the presence or absence of pathological enlargement of the heart cannot be determined on the basis of x-ray measurements alone. 7. 7. In patients without demonstrable cardiac disease there may be an association between the small heart and tachycardia on one hand, and between the large heart and bradycardia on the other. However, our data do not supply convincing evidence upon this question.

PATHOLOGICAL ENLARGEMENT OF RESIN CANALS IN PICEA

PATHOLOGICAL ENLARGEMENT OF RESIN CANALS IN PICEA

HYPOPHYSIS TUMOURS IN DOMESTIC ANIMALS

After thyroidectomy, hypertrophy of the pituitary body, with obvious formation of colloid substance has been repeatedly described. In rabbits, Stieda found that nine weeks after the extirpation of the thyroid gland, the weight of the hypophysis had doubled. Also after castration, enlargement of this organ has been observed in man, the rabbit and in birds. Exceptions have, however, been reported. Hans Kühn came to the conclusion that castration is of no influence on the dimensions and the weight of the pituitary body in horses (Dissertation, Bern, 1910). Pathological enlargement of the hypophysis can take rise in three different ways: (1) originating from rests of the hypophysis vesicle, (2) originating from the ependyma of the infundibular canal, (3) by hyperplasia of the glandular part. Rests of the hypophysis vesicle are often met with in quite normal hypophyses as small cysts, lined with epithelium. These occur regularly in ruminants, pigs and carnivores, but not in horses. When they can be demonstrated