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It has been shown with the method of electron microscopy that some days after the onset of the hyperfunction of the heart there arises in myocardial cells a significant augmentation of the mitochondrial mass along with a destruction of a part of the organelles. Later on after a considerable growth of the myocardial mass there occurs a normalization of the mass and structure of the mitochondria. In the latest stage of the process the destruction of mitochondria accompanied by a decrease of their mass is again observed. The obtained data are interpreted in the light of the concept of interrelation between the physiological function and the genetic apparatus of the differentiated cell.

In cases withvitium cordis only a part of work done by the ventricle is transformed into its external work. All the work performed by the ventricle may be designated as total work, whereas the ratio of external and total work is designated as mechanical efficiency of the ventricle. The study of the dynamics of external, total work and of the mechanical efficiency of the left ventricle in the process of progressive aortic stenosis development demonstrated that in the given experimental vitium cordis the energy losses for overcoming the blood flow resistance in the area of stenosis lead to a 4-fold reduction in the mechanical efficiency of the left ventricle (as compared to the normal).

Ľon n’a pas souvent ľoccasion ďanesthesier des patients souffrant ďhypercortico-surrenalisme. La bonne conduite de ces cas de surrenalectomie requiert une parfaite connaissance de la physiopathologie des syndromes ďhypercorticosurrenalisme.

It was shown in acute experiments on dogs that dysfunction of the left ventricle due to progressive stenosis of the aorta or aortopulmonary shunting is characterized by identical hemodynamic indices but in the former case it develops after a sharp increase of tension in the myocardium of the left ventricle, and in the latter case in the presence of an unchanged or slightly increased tension of the myocardium in this heart region. The dynamics of myocardial tension during the above-mentioned types of dysfunction do not depend substantially on whether the given index is calculated with or without regard to the area of the cross section of the left ventricle wall. The above findings corroborate the view that during a predominantly isometric hyperfunction of the heart (stenoses of the valve openings, hypertension), cardiac dysfunction results from exhaustion of the functional reserves of the myocardium, and during a predominantly isotonic hyperfunction (defects of the cardiac valves, arteriovenous shunting), it results from failure to mobilize these reserves.

Recently R. HARVEY [-4] and G. BENGEL [1] proved the existence and regularity theorems for hyperfunction solutions of single differential equations with constant coefficients. We extend their results to systems of differential equations with constant coefficients. Since the sheaf of hyperfunctions is flabby, we have therefore a flabby resolution of the sheaf of hyperfunction solutions of the homogeneous equation. If the system is elliptic, it is shown that any hyperfunction solution is analytic. Thus we obtain a concrete flabby resolution of the sheaf of regular solutions in terms of hyperfunctions. We apply this resolution first to the Cauchy-Riemann system and to single elliptic operators, and give a proof of the vanishing cohomology theorem by MALGRANGE [-10] for coherent analytic sheaves and G.BENGEL'S results [1] on P-functionals. Then applying the resolution to the exterior differentiation, we obtain a kind of the Alexander-Pontrjagin duality theorem and hence a purely analytic proof of the Jordan-Brouwer theorem.

Let P(#, D} be a linear partial differential operator with real analytic coefficients in a domain V in Rn+1 and let SC^ be a real analytic hypersurface non-characteristic with respect to P(#, D). The purpose of this paper is to show that every hyperfunction solution u of P(x, D)u = Q on one side of V\S has boundary values on S which are hyperfunctions of n variables on 5. This fact has been proved by H. Komatsu [_6~] and P. Schapira Q8] in the case where P(x, J9) is elliptic. Their method applies with minor modifications to the general operators. In §1 we show that the Cauchy-Kowalevsky theorem for the dual equation with the initial values on 5 is equivalent to a theorem of division of hyperfunction s with supports in 5 by the differential operator P(x, D). We define the boundary values in § 2 and prove the uniqueness of hyperfunction solutions of the Cauchy problems.

Coughing and throat clearing are vocally abusive activities that can be directly related to laryngeal disease. Methods of therapy include advising the patient to avoid or eliminate these activities, although the authors have found that few patients benefit from such suggestions. The action of coughing and throat clearing has been examined by means of indirect laryngoscopy and high-speed cinematography, and the stages of the cough from complete constriction of the folds to violent abduction are reviewed. Although the cough reflex is a natural protective mechanism that at times must be activated because of obstruction of the air tract, continual coughing and throat clearing frequently have a significant nonessential component. The actions may be due to an overawareness of secretions in the larynx, the fruitless use of coughing or throat clearing to eliminate pain or discomfort, or unconscious habit. Methods to treat this type of cough or throat clearing are explored, with special emphasis on the “silent cough,” a technique the authors devised as a substitute for unnecessary coughing or throat clearing. Case reports are presented to illustrate this method in therapy.

A Review of the literature on the voice disorders which have endocrinological causes was made.Hoarseness occurs in hypothyroidism, while a sort of asthenia of voice in hyperthyroidism. By hyper-parathyroidism, rarely aphonia can be produced, and in cases of acromegaly, discent of voice ranges and of pitch levels of speaking voice often take place.Virilization of female voice is seen not only in case of hyperfunction of the adrenal cortex, but as a kind of by-effect of androgenic substances on vocally normal women.Concerning the sex-glands, moreover, hoarseness which happens during pregnancy, voice changes in the menstruation, vocal alterations owing to castration, mutational voice disturbances and so forth were related.Causations of these phoniatric disorders were discussed in relation to the pathological changes found in larynges, and several interesting problems to be solved were pointed out.

IN man, in a large proportion of cases in which the cranial skiagram gives evidence of cranial dysplasia, there is found, clinically, evidence of past or present disturbance of pituitary function either during the growth period, subsequent to it, or throughout life. Such disturbance, whether it be on the side of hyperfunction, hypofunction, or a period of the former followed by a phase of the latter, we shall describe under the general heading “Pituitary Dysfunction.” By cranial dysplasia we mean such abnormality in form or structure that the skull can be regarded as “malformed,” the degree of this being subject to wide variation, ranging from a proportion and structure which cannot be regarded as outside the zone of supposedly normal variation, to gross deformity. Thus, the skull may be proportionate in its component parts and structure, the abnormality lying in its being too large or too small for the sex and age of the patient; the facial component may be disproportionate to the size of the brain-case ...

To elucidate motor function of the stomach manometric as well as electromyographic study of the pylorus of the canine stomach was carried out following transections and end-to-end anastomoses at various levels such as proximal 1/3, and 1/2, distal 1/3 and 1/4, and 4, 3, 2, and 1 cm from the pyloric ring.The hyperfunction of the pylorus with higher contraction pressure, prolonged discharge interval and more frequent anti-peristalsis appeared following transections between the levels of 1/2 of the organ and 4 cm from the pyloric ring. The most remarkable hyperfunction was noted following the distal 1/3 transection.Following transections within 2 cm from the pyloric ring, hyperfunction of the pyloric ring was still present on electromyogram but the contraction pressure became below the control value.

A N ANALYSIS of the factors possibly responsible for the low glucose toler′ JLJL ance of the Yale strain of Mus norvegicus albinus as compared with that of the Wistar strain early directed the attention of the authors to the r6le of the anterior pituitary (i). The striking difference between the growth rates of the two strains maintained on the same diet and under the same con′ ditions associated with a higher fasting blood sugar in the more rapidly grow′ing Yale strain suggested a comparison of the two strains on the basis of other phenomena associated with a hyperactivity or unbalanced activity of the pars anterior. In the present communication the two strains have been compared using as the criteria: (a) epinephrine tolerance, (b) insulin toler′ance, (c) water balance, (d) sterility, (e) growth and (f) body fat.

22 patients with hyperplasia and adenomas of the parathyroid glands were studied and reviewed. They form the basis of this report, which emphasizes the idiosyncracies and vagaries of this disease. The diagnosis of hyperparathyroidism is reported in context with the clinical picture, and the overall relationship of this condition to multiple endocrine adenomatosis is explored in some depth. A specific patient review is made which illustrates the odd clinical behavior of parathyroid hyperfunction; 3 patients with cancers are studied in detail. Surgical management is discussed and concentrates on the more vexing aspects of parathyroid identification, adenomas vs. hyperplasia, recurrent disease and cancer.

I have presented five cases of ovarian hypofunction, with ovarian pain, all of whom were benefited by excision of one or both ovarian cortices. Another case, of hyperfunction with pain has apparently been relieved functionally and subjectively by excision of part of each ovary, combined with almost complete decortization. Surgical treatment of ovarian dysfunction should have a very limited field of usefulness, but it is my opinion that there is a place for it if we are to utilize all the facilities at our command. Many of these patients become actually psychic, due to almost constant pain, and with their inordinate fear of the consequences of abnormal sex functions. Partial decortization alone appears to be beneficial in relieving ovarian hypofunction, and pain. Excision of a segment of ovarian parenchyma, usually without decortization, may be beneficial in some obstinate cases, in dealing with hyperfunction. A combination of the procedures might be undertaken if ovarian pain accompanies hyperfunction. I realize that the cases presented are not complete from the standpoint of an endocrinologist, and his criticism might be that they were not adequately treated from a medical standpoint. Furthermore the number of cases is too small to warrant definite conclusions. However, I present them for your discussion and judgment.

It has been common ground with all observers that tests of vestibular function in cases of Meniere's syndrome are of no value because of the conflicting results. One patient will show hyperfunction and another will show hypofunction in the affected ear, while a third will show no difference between the two sides. The fact of these variations in function between individual patients cannot be gainsaid, but I submit that the deduction made from this fact, that vestibular tests are valueless in this condition, is fallacious. That function varies is surely evidence enough that the results mean something if only sufficient information is at hand to assess them. This paper will, I hope, show that such information is now available. THE QUANTITATIVE COLD CALORIC TEST In a recent communication 1 a method of performing the cold caloric test was described which conforms to clinical requirements in that it is not too elaborate

Compensatory hyperfunction of the heart in vitium cordis, hypertension and other diseases of the circulatory system connected with the cardiac overstrain of long duration represents the main factor in preservation of normal hemodynamic indices and clinical compensation. The rate of protein synthesis in the myocardium was studied under conditions of compensatory cardiac hyperfunction provoked by experimentally induced vitium cordis. As established, rapid development of hypertrophy during the first emergency stage of compensatory hyperfunction is accompanied by an intensified rate of protein synthesis (it about doubles). In the second stage of relatively stable hyperfunction the rate of protein synthesis is normal, while at the third stage — characterized by cardiosclerosis and progressive exhaustion —it is reduced 2–2.5 times. This depression of the normal renovation process of the protein myocardial structures may bring about a change in the contractile proteins of the heart, thus playing an important role in the development of cardiosclerosis and cardiac insufficiency.

Compensatory hyperfunction of the left ventricle after ligating off part of its muscle results in cardiac insufficiency, followed by a relatively stable compensation. The glycogen content of the working part of the myocardium of the left ventricle fell to a low level soon after ligation, and was still at this level a month after operation. This is evidence of diminution in the potential energy resources of the heart. The lactic and pyruvic acid contents did not vary substantially.

A 25-year-old woman is described who had suspected hyperfunction of the adrenal cortex. She complained of fatiguability, excessive hair growth, and attacks of swelling of the face, hands, and ankles. Moreover she had a ;moon face', hypertension, a ;buffalo hump', and livid striae of the loins and hypogastrium. Adrenal function tests yielded values which could not be clearly interpreted. Operation showed a ;black adenoma' of the adrenal cortex on the right side. As far as it is known this is the first published case of this extremely rare lesion which was operated upon and caused nearly complete remission of the endocrine disturbance.

The variation in both the clinical and biochemical response to administered adrenal steroids or corticotropin suggests that naturally occurring adrenal hypercorticism might not always be manifested as fully developed Cushing's syndrome. Until recently, the diagnosis of adrenal hyperfunction depended for the most part on typical clinical findings, since analytical methods for the corticosteroids were not quantitatively reliable. Within the past few years newer methods of steroid analysis have been developed which permit a more accurate measure of cortical function. One of these procedures (1, 2) has been used extensively in the course of evaluating many patients with one or more of the features of Cushing's syndrome. Among these were patients with obesity, hirsutism, diabetes, osteoporosis or hypertension. The 2 patients who are the subject of this report were found to have cortical hyperfunction. Their appearance so belied Cushing's syndrome that the correct diagnosis had not been made by many competent o...

Laboratory diagnosis of diseases of the adrenal cortex has become greatly simplified in the past 10 years. Now, instead of looking for secondary changes caused by excess or deficiency of adrenocort...

Excerpt Elsewhere in this issue1, 2are reported two further instances of a striking and as yet imperfectly understood association between intrathoracic neoplasms and adrenal cortical hyperplasia an...

A case of intrathoracic pheochromocytoma in a child 3 years old with hirsutism, physical and mental underdevelopment, increased urinary corticoids output and some others unusual clinical features is described. The case is particularly interesting not only for the rarety of the localization, but for the even more rare association between medullary and cortical hyperfunction. The latter has been described in few cases, but never in an extradrenal pheochromocytoma. The patient has been diagnosed preoperatively, operated upon successfully and followed up for about 2 years; particular attention has been put in the ECG which preoperatively showed signs of marked left ventricular hypertrophy and postoperatively an increasing of the signs, which disappeared only after several months. Likewise the catecolamines output which was very high at the beginning has remained over normal even several months after removal of the tumor. Conversely disappearance of the physical signs and improuvement in the general conditions has been dramatic soon after the operation. In regard of the pathogenesis of the syndrome, the authors describe the two main interpretations: a) stimulation of the cortical by the hyperadrenalinaemia through the hypophysis and b) association of cortical and medullary hyperfunction in the same tumor. They think the latter one is the more probable.