Sixteen patients with myelographically, angiographically, and/or surgically proven vascular malformation of the spinal cord were studied and the following results were obtained. Age at onset of symptoms varied, but was mostly under 40 years. The most commoninitial symptom was pain. Spinal subarachnoid hemorrhage, intermittent claudication and segmental cutaneous hemangioma showed less than 50 percent incidence, but were considerably specific to the malformation. Muscular atrophy was frequently encountered in the legs, and was asymmetrical in distribution. Urinary dysfunction was characterized by early occurrence and a severity disproportionate to paresis. Sensory deficit to all modalities was most common, and a sensory disturbance involving loss of both pain and temperature sensation early in the course of the disease served as a clue to diagnosis. Weakness and abnormalities of deep reflexes in the legs tended to change from spastic to flaccid as the disorder progressed. Neurological features were patchy affliction of the spinal cord and a combined upper and lower motor neuron deficit in the legs. Three modes of development characterized the course of the disease : " Chronic progressive, " " episodic " and "apoplectic." The first was most common, and the other two gave clear indications of a vascular origin. Myelographic and angiographical demonstration of abnormally dilated and contorted vessels was essential to diagnosis of the malformation.

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Changes in plasma ACTH, plasma cortisol (PC) and plasma aldosterone (PA) were serially investigated in a thyrotoxic patient (K. T.) with a paralytic attack induced by glucose and insulin infusion (GI). Also, changes in PC and PA in five patients with an induced complete quadriplegia were compared to those in four patients in whoman infusion produced slight or no paralysis of the legs or arms. In patient K.T., basal levels of plasma ACTH, PC and PA were within normal. Induction of a paralytic attack was not associated with any changes in PC and PA. Plasma ACTH before the onset of attack also was normal. During the development of complete quadriplegia, plasma ACTH rapidly increased in parallel with somewhat delayed increases in PC and PA. In five patients with an induced complete quadriplegia, the mean values of PC and PA were normal in baseline and did not show any significant changes either 15min before or after the onset of attack. At the stage of complete quadriplegia, PC significantly increased in parallel with an increase in PA. On the other hand, in four patients with a slight or no paralysis of the legs or arms, changes in PC and PA were insignificant during observation period of 180 min. These results demonstrate that an induction of paralytic attack can be produced without endogenous ACTH excess. However, during the development of complete quadriplegia ACTH might partly contribute to an augmented secretion of aldosterone, because the simultaneous rises of PC and PA were noted at the stage of complete quadriplegia.

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The relation of the TRH test to the triiodothyronine (T₃) suppression test was investigated in 43 patients with hyperthyroidism receiving antithyroid drugs for 6 to 27 months. All patients under study were in a euthyroid state, estimated by serum triiodothyronine uptake (T₃U), thyroxine (T₄), triiodothyronine (T₃) and free thyroxine index (FT₄I). The value for 24-hr, uptake after T3 administration was less than 20%in 18 cases, out of which the response to TRH was normal in 15 cases and was absent in 3 cases. On the other hand, out of 25 cases with a 24-hr, uptake value of more than 20%, the response to TRH was absent in 18 cases and was normal in 7 cases. The result of the TRH test correlated well with that from the T₃ suppression test in 33 of 43 cases while in the other 10 cases the responsiveness of thyroid function to TRH was dissociated from its suppressibility with T₃. This finding suggests that the TRH test cannot be a substitute for the T₃ suppression test.

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The maximalrate of reduction of the left ventricular pressure (peak negative dp/dt) was studied in 25 cases with hypertrophic cardiomyopathy (HCM), 4 cases with congestive cardiomyopathy (COCM) and 10 control subjects. Peak negative dp/dt was significantly less in HCM(972±286 mmHg/sec) and COCM(1181±437 mmHg/sec) than that in control subjects (2140±266mmHg/sec). A ratio of positive to negative peak dp/dt was increased in HCM alone, indicating a dissociation between positive and negative peak dp/dt. When the indices of distensibility and compliance were calculated by the method of Gaasch et al, significant correlations were observed between peak negative dp/dt and dV/dP (r=0.74, p>0.001) and between peak negative dp/dt·EEDP and dV/dP·V (r=0.91, p<0.001) in HCM and control subjects. Thus, peak negative dp/dt seemed to be affected by alterations in the diastolic properties of the left ventricle and to be a valuable index of left ventricular relaxation.

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Two cases with chronic external ophthalmoplegia were presented. In addition to ptosis and extraocular palsy, they had optic atrophy, pigmentary degeneration of retinae, loss of hearing, dysphonia, dysphagia, facial weakness, abnormal CSF protein, myopathy of limbs, myasthenic phenomenon, peipheral neuropathy, cerebellar ataxia, decreased intelligence, cardiac abnormality, or abnormal stature. The mitochondrial abnormality and accumulation of lipid droplets were demonstrated by electron microscopy in the biopsy of muscles of both cases. For the time being, the "Kearns-Shy syndrome" was considered to be the most proper term to this disorder.

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A patient with Sheehan's syndrome who later developped diabetes mellitus is described. Endocrinological examinations revealed panhypopituitarism and impaired insulin and excessive glucagon secretion which was compatible with the findings of primary diabetes mellitus. Daily maintenance therapy was adequately provided with hydrocortisone, thyroxine and only 4U of insulin.

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