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The thyroid carcinoma is rare in children and the optimal management is rather controversial. We report a case of a 7-year-old boy who had right neck masses and proved to be papillary thyroid carcinoma after near-total thyroidectomy. Post-operative 20 mCi radioiodine-131 (I-131) ablation scan, lung metastasis was suspected but the chest X ray was normal. After being lost to follow up for 4 years, the patient returned with the complaints of cough; the chest X ray was still normal. He then received 5 treatment with low dose (30 mCi) I-131 therapy and continued thyroxine replacement. Progressive decrease both of the thyroglobulin level and the intensity of radioactivity of lung were noted. After a total doses of 193 mCi I-131 therapy, neither pulmonary fibrosis nor bone marrow suppression was seen. Although the low dose (or = 30 mCi) I-131 therapy was recommended, it was limited for the ablation therapy of the remnant thyroid tissue. Upon consideration of economics and the convenience of not being admitted to the isolation room, the low dose I-131 therapy seems feasible for children with thyroid carcinoma with systemic disease. However, the long term efficacy needs further evaluation.

Cushing's syndrome with pregnancy is rare, and only about 60 cases have been reported. In the recent 4 years, 3 cases were diagnosed in Chang Gang Memorial Hospital. They presented with serious maternal complications early in the second month of pregnancy, including hypertension, proteinuria and lower leg edema. Unfortunately it was not diagnosed until the 20th week of pregnancy. They had the same hormone profile as other Cushing's syndrome patients who were not pregnant. Under the supportive treatment they had outcomes of two premature deliveries and one still birth. Just after delivery all patients received left adrenalectomy and pathology showed adenoma. All of them had good recovery courses. According to the literature, early treatment (surgical operation, medical treatment, or irradiation) could decrease maternal morbidity and fetal loss rate.

Pituitary Apoplexy is a rare but sometimes life threatening condition which requires prompt recognition and timely medical intervention to avoid catastrophic consequences. From January 1979 to June 1989 and total of one hundred and ninety eight pituitary tumor patients were operated on our hospital. Eighteen cases (9.1%) were diagnosed "pituitary apoplexy" according to histopathological findings. The group consisted of twelve men and six women ranging in age from twenty two to sixty one years with a mean of forty. There were three cases of prolactin-secreting adenomas (16.7%), four growth-hormone secreting adenomas (22.2%), and eleven nonfunctional adenomas (61.1%) with an incidence of 6.1%, 8.3%, and 11.4% respectively (P0.05). Clinical manifestation occurred acutely in 66.7% and nonacutely in 33.3%. The patients presented with headaches (100%), visual impairment (83.3%), visual field defects (66%), disturbed consciousness (22%), fever and meningismus (11%). Radiological examinations able to demonstrate abnormalities included plain skull films (84%), computed tomography (84.6%), and angiography (93.8%). Various investigations of endocrine function pre and post operatively showed a deficient gonad axis (53%, 62.5%), adrenal axis (26.7%, 56.2%), and thyroid axis (20%, 43.8%). Sixteen cases received a transsphenoid operation and three cases underwent a transfrontal craniotomy. No case of mortality was reported. Postoperative radiotherapy was given to nine cases and nine cases were followed up on a regular basis. Therefore, our retrospective study suggests that pituitary apoplexy is not uncommon and has an acute clinical presentation. No particular tumor type was prone to occur. Various radiological examinations could define perisellar abnormalities. With a decreasing order of hormone deficiency, gonad, adrenal and thyroid axis were observed during the course of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of modulators of cytochrome P450 and reduced glutathione (GSH) on the hepatotoxicity of enalapril maleate (EN) were investigated in Fischer 344 rats. Twenty-four hours following the administration of EN (1.5 to 1.8 g/kg), increased serum transaminases (ALT and AST) and hepatic necrosis were observed. Pretreatment of the animals with pregnenolone-16 alpha-carbonitrile, a selective inducer of the cytochrome P450IIIA gene subfamily, enhanced EN-induced hepatotoxicity, whereas pretreatment with the cytochrome P450 inhibitor, cobalt protoporphyrin, reduced the liver injury. Depletion of hepatic non-protein sulfhydryls (NPSHs), an indicator of GSH, by combined treatment with buthionine sulfoximine (BSO) and diethyl maleate (DEM) produced marked elevations in serum transaminases by 6 hr after EN treatment. Administered on its own, EN decreased hepatic NPSH content and when combined with the BSO/DEM pretreatment, the liver was nearly completely devoid of NPSHs. Protection from EN-induced hepatotoxicity was observed in animals administered L-2-oxothiazolidine-4-carboxylic acid, a cysteine precursor. Together, these observations suggest the involvement of cytochrome P450 in EN bioactivation and GSH in detoxification. The results corroborate previous in vitro observations pertaining to the mechanism of EN-induced cytotoxicity towards primary cultures of rat hepatocytes. Although the doses of EN used in this study were far in excess of therapeutic doses, under certain circumstances, this metabolism-mediated toxicologic mechanism could form the basis for idiosyncratic liver injury in patients receiving EN therapy.

To understand pancreatic beta cell function in patients with non-insulin-dependent diabetes, we analyzed C-peptide response to glucagon in 101 nonketotic patients with onset of diabetes at over 25 years of age and duration of diabetes of more than one year. The fasting serum C-peptide values (FCP), maximal incremental (delta CP) and 6-minute (6'CP) serum C-peptide values after 1 mg of intravenous glucagon administration were not related to age at diagnosis (r = 0.12, 0.06 and 0.10, respectively), duration of diabetes (r = 0.15, 0.05 and 0.10, respectively), fasting plasma glucose concentrations (r = 0.01, 0.18 and 0.12, respectively) or glycohemoglobin (HbA1c, r = 0.13, 0.22 and 0.16, respectively). In contrast, they showed a clear positive correlation with body mass index (BMI, r = 0.36, 0.52 and 0.41, p0.001). In order to evaluate the beta cell function in patients with different responses to treatment modalities, a subgroup of 45 patients was divided into three groups: diet successes (DS, n = 14), oral hypoglycemic agent (OHA) successes (OS, n = 19) and OHA failure (OF, n = 12). Among the three groups, patients in the OF group had the longest duration of diabetes (9.4 +/- 1.9 years) and the lowest BMI (19.3 +/- 1.0 kg/m2). Serum C-peptide responses to glucagon were different in the three study groups. Patients in the DS group had the highest response and patients in the OF group had the lowest response. However, the differences in mean FCP, delta CP and 6'CP among the three groups were not statistically significant, and there was a wide overlap of individual C-peptide values.(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate the disease association with HLA-DR 3/4 heterozygotes, 1,074 subjects, who had been analyzed consecutively for HLA-DR antigens for organ transplantation or to study the disease association with HLA from June 1984 to June 1986, were enrolled in this study. Of these subjects, 278 had diabetes, 168 were healthy controls or donors, and 628 had other diseases. Of the 1,074 subjects, 35 subjects (3.2%) were DR 3/4 heterozygotes and 1,039 subjects (96.7%) were non-DR 3/4 heterozygotes. Among the 35 DR 3/4 positive subjects, 23 were diabetic (65.7%), two were healthy donors (5.7%), 10 had other diseases (28.5%) such as recurrent abortion (n = 3), hepatoma (n = 2), Graves' disease (n = 1), idiopathic hypoparathyroidism (n = 1), IgA nephropathy (n = 1), uveitis (n = 1) and gout (n = 1). Among the 23 DR 3/4 positive diabetics, 19 (82.6%) had insulin-dependent diabetes mellitus (IDDM), three (13.0%) had non-insulin-dependent diabetes mellitus (NIDDM), and one (4.3%) had maturity onset diabetes of the young (MODY). When these DR 3/4 positive diabetics were compared with the other disease and control/donor groups, significant increases in the relative risk were seen for IDDM patients (RR = 32.61, 43.80, respectively, p0.001). No significant association could be seen for NIDDM and MODY patients. In those non-diabetic patients positive for DR 3/4, there was no significant association with DR 3/4 heterozygotes. These findings suggest that: 1) DR 3/4 positive subjects are highly associated with IDDM; and 2) there is no significant association of DR 3/4 with NIDDM, MODY and other non-diabetic diseases.

Neutropenia is a major cause of chemotherapy-induced morbidity. This study examines the effect of ImuVert on the course of neutropenia from Cytoxan and Adriamycin. In adult rats treated with either Cytoxan or Adriamycin and ImuVert, the absolute neutrophil count remained above 7,000 and 2,000, respectively, for the duration of ImuVert therapy. In contrast, in the control Cytoxan group the absolute neutrophil count reached 300/mm3 on day 5 and remained below 1,000 from day 4 through day 7. In the Adriamycin control group, the nadir absolute neutrophil count reached 600/mm3 on day 7 and remained below 100 from day 6 through day 8. C3H/EJ mice (endotoxin-hyporesponsive) treated with Cytoxan developed an absolute neutrophil count below 1,000 from day 4 through day 7. In contrast, in the group concomitantly treated with ImuVert, the nadir absolute neutrophil count remained below 1,000 only on days 4 and 5. The authors conclude that stimulation of endogenous cytokine production by ImuVert may provide a potentially useful approach to bone marrow rescue from chemotherapy.

In vagotomized rats, cerebral compression (CC) produced marked increase in arterial pressure and pulmonary hemorrhagic edema (PHE). We studied the effects of a vasodilator and an oxidant scavenger to delineate the role of hemodynamic and permeability factors in this type of neurogenic PHE. Infusion of sodium nitroprusside at a dose of 5 micrograms/kg/min significantly reduced the CC-induced pressor response by 14% and the lung edema by 41%. A dose of 10 micrograms/kg/min blocked the pressor response by 51%, and completely prevented the lung injury. Dimethylthiourea (DMTU), a potent scavenger for oxidants such as hydroxyl radical and hydrogen peroxide, in doses of 300 and 600 mg/kg was pretreated 15 min before CC. Although DMTU was shown to block the permeability lung damage caused by phorbol myristate acetate (a neutrophil activator), this agent did not exert any effect on the CC-induced pressor response and lung injury. The data indicate that granulocyte-mediated oxidants such as hydroxyl radical and hydrogen peroxide do not appear to be involved in this type of neurogenic lung pathology. The results support the concept that PHE induced by intracranial hypertension is initiated by hemodynamic changes in the systemic and pulmonary circulation. Hydrostatic effect plays a major role in this type of neurogenic lung pathology.

Chemotherapy-induced alopecia is a distressing problem to the cancer patient for which currently there is no effective preventive measure. Recently ImuVert, a biologic response modifier, has been shown to protect from cytarabine-induced alopecia in the young rat model, but not from alopecia induced by cyclophosphamide. In the present study, the rat model was used to examine the effect of N-acetylcysteine on the course of alopecia from cyclophosphamide and of ImuVert plus N-acetylcysteine on alopecia induced by cytarabine-cyclophosphamide combination. The following observations were made: (1) Cyclophosphamide-induced alopecia could be effectively prevented by N-acetylcysteine, administered parenterally or applied topically in liposomes. (2) Alopecia caused by the combination of cyclophosphamide and cytarabine could be prevented by the parenteral or topical administration of ImuVert plus N-acetylcysteine. The potential applicability of these observations to the clinical settings remains to be determined.

Retrospective analysis of 11 Chinese patients with Graves' thyrotoxicosis developing agranulocytosis during anti-thyroid treatment was done. Seven of them received methimazole and 4 received carbimazole. None of the 11 patients had taken propylthiouracil. The major chief complaints were high fever (100%), chillness (91%), and sore throat (73%). The duration of drug treatment prior to the detection of agranulocytosis ranged from 13 to 63 days (mean +/- 1SE: 33.1 +/- 16.1). At the time of agranulocytosis detected, the peripheral leukocyte counts were 0.5 to 2.1 X 1000/mm3 (mean +/- 1SE: 1.05 +/- 0.47 X 1000/mm3), absolute neutrophil counts 0 to 450/mm3 (mean +/- 1SE: 54.27 +/- 132.12/mm3), and hemoglobin 8.2 to 15.9 g/dl (mean +/- 1SE: 11.85 +/- 2.24 gm/dl). Three of the 11 patients had positive bacterial blood cultures. The recovery time of absolute neutrophil counts above 500/mm3 ranged from 3 to 25 days (mean +/- 1SE: 10.5 +/- 6.6) after discontinuation of antithyroid drugs. Mortality was found in 2 of them (18%).

Summary The popliteal efferent lymphatics were cannulated in sheep of two categories, seronegative or immune to Chlamydia psittaci. Following subcutaneous injection of live C. psittaci or control material into the draining area of the popliteal node, sequential samples of efferent lymph were collected and analysed. Both categories of sheep responded to C. psittaci with increased outputs of lymphocytes and blast cells. Numbers of blast cells rose both absolutely and as a proportion of the total. Plasmablasts increased in number only in seronegative sheep. Outputs of total T ceils (CDS+), helper T cells (CD4+), cytotoxic/suppressor T cells (CD8+) and non-helper, non-suppressor T cells (T19) were maximal 4 and 7 days after challenge in immune and seronegative sheep, respectively. Proportionally, CD4+ T cells declined, CD8+ T cells increased and T19 cells were unaltered with time after infection. Chlamydial antigens could not be demonstrated in the cells of efferent lymph by an immunoperoxidase method. The results of this preliminary study show that both T and B cell responses are involved in immunity to C. psittaci.

Chronic ulcers are well-known complication of diabetes mellitus, often compounded by infection. Healing of lesions is problematic in some cases using conventional treatment. We have treated a group of six hospitalized diabetic patients with chronic ulcer by a combined regimen consisting of metabolic control, parenteral antibiotics, growth factor and porcine graft-young collagenous wettable membrane (YCWM) treatment. Five of our uncontrolled group had their ulcers improved at 87 +/- 37.6 hospital days after 45.8 +/- 20.2 days of growth factor and YCWM treatment. In conclusion, growth factor and porcine graft-YCWM therapy may be promising as an alternative choice in treatment of chronic diabetic ulcer.

From July 1984 to June 1989, 24 cases with hypercalcemia and surgical proof of parathyroid adenoma or carcinoma received preoperative parathyroid sonographic examination in Chang Gung Memorial Hospital. There were 10 male patients with mean age of 51.5 +/- 12.3, and 14 female patients with mean age of 49.4 +/- 12.6. Parathyroid enlargement was detected by sonography examination in 22 of the 24 cases. The maximal diameter of the enlarged parathyroid in this series ranged from 1 cm to 3 cm. The accuracy of case diagnosis with sonography is 83.3%. In 96 parathyroid glands examined by sonography, the sensitivity is 83.3%, the specificity is 95.8% and the positive predictive value is 87%. From the results, it suggests that parathyroid sonography can be used as the first line localization method to detect parathyroid enlargement in hypercalcemia patients.

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One hundred and fifty three patients with Graves' hyperthyroidism treated with I-131 from March 1984 to September 1988 were analyzed. The dose of I-131 was given according to the formula: 100 microCi/gm x estimated thyroid size (gm) x 100/24 hr I-131 uptake (%) The mean dose was 5.41 mCi and the maximum dose was 7 mCi. After one year of follow up, 45 patients (29.4%) were euthyroid, 35 patients (22.9%) became hypothyroid, and 73 patients (47.7%) were persistently hyperthyroid. Discriminant analysis of pretreatment variables suggested that those patients who were still hyperthyroid at the end of the first year had significantly larger goiter size, and higher serum T4 and T3 levels. Men had greater incidence of relapse. Besides, those who had received antithyroid drug before I-131 therapy had a significantly higher incidence of failure. As compared with previous studies, our report had a significantly higher incidence (22.9%) of hypothyroidism one year after I-131 therapy, which may be due to recognition of subclinical hypothyroidism through TSH assay.

Thyrotoxicosis may cause osteopenia and lead to increased risk of fractures. From July 1988 to March 1989, 88 hyperthyroid patients and 65 age, sex matched normal controls were enrolled for lumbar spine bone mineral density (BMD) study. Significantly lower BMD values can be found in premenopausal hyperthyroid women (1.233 gm/cm2 vs 1.317 gm/cm2, p less than p less than 0.05). In the group of thyrotoxicosis, no linear correlation can be found between BMD and the degree of hyperthyroidism (N = 84, r = 0.01 and N = 74, r = 0.054 as comparing BMD to T4 and T3, respectively). After treatment with antithyroid drugs (ATD) for 3 months, BMD did not change significantly (1.258 gm/cm2 vs 1.242 gm/cm2, p = 0.02) in the hyperthyroid patients. Therefore, premenopausal hyperthyroid women have lower BMD than premenopausal euthyroid women. The treatment of hyperthyroidism after 3 months' course did not increase lumbar spine BMD.

Insulin autoimmune syndrome is a syndrome consisting of fasting hypoglycemia, hyperinsulinemia and detectable insulin-binding antibodies in patients who have never been exposed to exogenous insulin. Four cases who developed symptoms of hypoglycemic attack with self-limited duration and spontaneous remission were collected in our hospital from 1984 to 1988. The elevated serum total and free insulin and C-peptide levels, as well as the titer of insulin autoantibodies, decreased gradually; but insulin autoantibodies were still present in the serum for more than six months after the initial episodes of hypoglycemia. Three of four patients had Graves' disease and developed the syndrome after methimazole treatment. The fourth one had a history of hemorrhagic cystitis and denied history of specific drug exposure. The cause or stimulus for insulin autoantibody formation is still unknown, but drugs containing a sulfhydryl group like methimazole may play a role in the development of the syndrome. Extremely high insulin antibodies in patients with fasting hypoglycemia along with elevated serum levels of insulin and C-peptide suggest a diagnosis of insulin autoimmune syndrome and usually exclude the possibility of insulinoma or factitious hypoglycemia.

We report a case of congenital hypothyroidism, presenting with growth and mental retardation since childhood, but in which the diagnosis was not made until he was 17 years old. Because of such an unusually long delay in treatment, we focussed on the growth catch-up. This included the change of skeletal growth, puberty and mentality after a 4-year treatment period. He was 114 cm in height (height age 5.5 years) with the upper segment measuring 60 cm and lower segment 54 cm (U/L ratio 1.1). His bone age was that of a six year old and he had no secondary sexual characteristics. IQ testing showed a full scale IQ of 68, verbal IQ 74 and performance IQ 64. After 4 years of treatment, his height caught up to 152 cm (height age 12.5 years), with the upper segment 77.2 cm, and that of lower segment 74.8 cm (U/L ratio 1.03). The bone age had advanced to that of a 17 year old. His pubic hair emerged after 18 months of therapy (at a chronologic age of 18.5 years), accompanied by a normalization of testosterone and a normal response to a GnRH test. His IQ test was rechecked after 2 years of treatment. His full scale IQ was 78, verbal IQ 77 and performance IQ 83. In the mean time, the patient got a job being more alert, active and self-confident following his growth catch-up.

After primary infection with Chlamydia psittaci in the draining area of the popliteal lymph node, viable organisms could be isolated from the efferent lymph only before the primary immune response developed. The lymph antibody response, as assayed by the complement fixation and immunofluorescence (IF) antibody tests, showed a rise in titre that peaked ∼2 weeks after infection. Immunoblotting revealed that antibodies produced during this period were predominantly directed against the major outer membrane protein (MOMP). In secondary infection of convalescent sheep, an elevated IF antibody titre, already present in the lymph and blood, could not be boosted. Viable organisms could not be isolated from these sheep. Antibodies produced reacted to 12–14 bands in the immunoblot profile including the MOMP band. These potentially immunoprotective antigens, particularly MOMP, should be considered as useful candidates for an improved vaccine against ovine enzootic abortion, in further investigations.

Background: The technique of percutaneous catheterization of the subclavian vein by the infraclavicular approach is dependent on the location of the subclavian vein in relation to the clavicle. The purpose of this study was to analyze the anatomic relationship between these two structures and how it is influenced by changes in shoulder positioning. Methods: Dissections of the infraclavicular region were performed in seven fresh cadavers and linear measurements made to determine the extent of overlap between the vein and the clavicle in different shoulder positions. Results: When the shoulder was in neutral position, the subclavian vein was overlapped by the medial third or more of the clavicle and this segment of bone was able to serve as a landmark for the vein. However, shoulder elevation displaced the clavicle cephalad and reduced the degree of overlap. Mild shoulder retraction increased the area of contact between the vein and the undersurface of the clavicle, whereas protraction lifted the clavicle off the vein. Conclusion: Infraclavicular subclavian venipuncture should be performed with shoulders in a neutral position and also in slight retraction. An appreciation of the anatomic relationship between the clavicle and the subclavian vein is the key to successful execution of this technique.

This 4-year prospective randomized study is designed to compare the effectiveness and complication rates of the Nova T and MLCu250 inserted immediately postabortion. At the cut-off date (30 November 1983), all patients in the first cohort of 400 women had completed at least 12 months of use. At this stage of the trial, no significant differences had emerged between the two devices in any of the standard termination categories.

This paper investigates the optimum control of a heat exchanger having internal heat sources from a reference steady state to a desired value. Both the wall and coolant are treated as distributed-parameter systems. Under certain constraints inherent in the operating conditions and physical limitations of the heat exchanger, the control function of the system, i.e. the heat generation rate which minimizes the deviation of the temperature distribution from an assigned pattern at a given time, is found through the use of a linear programming method. The effects of physical parameters on the optimal control function and the temperature response and distribution are examined. Experimental results are presented which compare favorably with the theoretical analysis. Heat exchangers to which these results apply include the electrical heater, a chemical reactor in which a chemical reaction occurs within the solid walls and a heterogeneous nuclear reactor.

An analysis is made of compressible laminar boundary layer over an insulated or isothermal flat plate moving with an arbitrary time-variant velocity in a viscous fluid. Consideration is given to the "small-time" solution, which may be applied to the plate in the early stages of flow unsteadiness. Theoretical results are given for the velocity, temperature, skin friction, heat-transfer rate from the isothermal plate, and wall temperature of the insulated plate. Nomenclature A, a, an) B = const C = const defined by Eq. (5) Cf = skin friction Cp = specific heat at constant pressure F, Fij ... = functions related to temperature profile for an adiabatic plate; as defined by Eq. (5a) for U(t) = Atm and Beat', as defined by Eq. (14a) for an arbitrary U(t) = functions related to velocity profile; as defined by Eq. (4) for U(t) = Atm and Be"*; as defined by Eq. (13) for an arbitrary U(t) = functions related to temperature profile for an isothermal plate; as defined by Eq. (5b) for U(t) = Atm and Beat', as defined by Eq. (14b) for an arbitrary U(t) H, H^ ... = functions related to temperature profile for an isothermal plate; as defined by Eq. (5b) for U(t) = AtQ and Be"*; as defined by Eq. (14b) for an arbitrary U(t) k = thermal conductivity

The Widal test was performed on 90 blood specimens from typhoid fever patients, on 21 blood specimens from nontyphoid salmonellosis patients and on 46 nontyphoid febrile patients. Of 90 typhoid fever patients, 58 (64.4%) had H agglutinin titer of 1:160 or more and 55 (61.1%) had O agglutinin titer of 1:160 or more. Salmonella typhi H and/or O titer of 1:160 or more occurred in 70 (77.8%) of 90 typhoid fever patients and in 5 (23.8%) of 21 nontyphoid salmonellosis. Only one of the 46 (2.2%) nontyphoid febrile patients showed O agglutinin titer of 1:160, a case which was proven subsequently to be a case of systemic lupus erythematosus. Either O or H can reach to diagnostic level during the first week of typhoid fever, and can be helpful in diagnosis of the illness. In view of the high specificity (91.0%), sensitivity (77.8%) and accuracy (83.4%), the Widal test still has value in the diagnosis of typhoid fever.

A 59-year-old female patient presented with conscious disturbance and hyponatremia. Baseline endocrine studies revealed secondary hypothyroidism and hypoadrenalism. Further studies of skull X-ray, brain CT scan, dynamic endocrine tests and visual field examination favored pituitary tumor with panhypopitutarism. Trans-sphenoid surgical intervention was arranged. However the management was changed because the preoperative carotid angiography revealed the mass lesion over the cavernous sinus region was an aneurysm, not a pituitary tumor. The patient refused surgical intervention for the aneurysm and received thyroxine and cortisone replacement until the present time. Because the surgical treatment of an aneurysm is different from a pituitary tumor, we reported this case to emphasize the importance of routine carotid angiography in the evaluation of the sellar mass.

To examine the relationship between HLA antigens and Type 2 non-insulin-dependent diabetes (NIDDM), 72 patients were studied and compared with 282 controls. Twenty of 72 patients had an associated non-toxic goiter. The clinical features of the goitrous diabetic patients were similar to those without goiter except that those with goiter were predominantly female (95%). Of the 46 antigens assayed, only A10 was increased in the 72 diabetics when compared with the controls (12.5 vs 5.7%, RR = 2.37, chi 2 = 4.07, p less than 0.05), but statistically this was not significant after p value correction. In the patients with goiter, antigens A2, A9, A10, B27, BW46, CW1, DR1, DR5, DR8, DRW9 showed 2 folds or greater differences in frequencies when compared to the non-goitrous diabetics. However, only A2 had a significant decrease in the former as compared with the latter (30.0 vs 59.6%, chi 2 = 5.07, p less than 0.05), but this was also statistically insignificant. The present study showed no significant HLA associations in Chinese NIDDM patients with or without non-toxic goiter, and the distribution of each antigen was not related to the presence or absence of goiter.