Introduction The technique of estimating pulmonary 'capillary' pressure established by Hellems and coworkers, is very important in the study of hemodynamics of pulmonary circulation. But many problems remain to be solved concerning pulmonary 'capillary' pressure (wedge pressure, WP). Now the focus of the dispute concentrates on the next two points : 1. Does WP indicate pulmonary capillary pressure, or some other pressure?2. Has the curve of WP a cyclic variation similar to that of left atrial pressure?It is the purpose of this report to solve these fundamental problems as for WP.Methods and results The pressure was recorded with the Hamilton-styled optic manometer made by ourselves, I take O point for pressures at the midpoint between the anterior and posterior chest wall. The average pressure was calculated of 2 breaths at least.1. Of the same person WP recording at the different branches of pulmonary artery were exactly or almost identical. I made further study on this subject.2. A normal dog was anesthetized by injecting 1cc of 1% morphine hydrochloride per 1kg of the body weight and inserted with the catheter both into the carotid vein and carotid artery. Pulmonary artery pressure and the pulmonary venous wedge pressure, WP and the left atrial pressure was recorded simultaneously.I was found to average 6.1mmHg in normal 9 dogs, and WP and mean left atrial pressure as recorded simultaneously were nearly identical, while mean venous WP and mean pulmonary artery pressure nearly identical.In some cases curve of WP had a cyclic variation similar to that of left atrial pressure, but in others no cyclic variation.In the former there was significant correlation between WP and left atrial pressure. However, in the latter such correlation were lacking. Also in the former it was observed that WP respiratory variation was in parallel to that of the left atrial pressure, while in the latter it was not observed. The zigzag of the WP curve which has no correlation with the left atrial pressure, -seemly caused by shaking of the catheter-did not seem to effect on the difference between WP and the left atrial pressure.Curve of WP lacked the depression corresponded to Y depression of left atrial pressure. Segment X, a wave designation by Maekawa as curve of suction, was somewhat less than the corresponding depression of left atrial pressure curve.3. Pulmonary embolism was produced in normal anesthetized dogs by injecting a one per cent suspension of lycopodium spores in volume of 20-30cc. into the vein of the fore-limb. Immediately after the injection, pulmonary artery pressure and venous WP elevated nearly in a parallel fashion, while WP and left atrial pressure remained unchanged.4. Following injection of lycopodium spores, air embolism was produced artificially with anticipation that air bubbles may occlude the lumen of larger vessels than those occluded by lycopodium. Venous WP falls down in some cases nearly equal to the level of WP after injection of air in contrast with a steeply elevation of pulmonary artery pressure. In other cases venous WP failed to descend so low as WP. WP remained still unchanged.In the test 3, the spore produced the embolism just beforehand the pulmonary capillary and at that part the pressure curve was apparently supposed to turn upwards.In the test 4, it was understood that the air produced the embolism in the larger vessels than those which the spore aid. But the places would vary in each cases. When the catheter comes into the small branches of the pulmonary artery, the blood pressure in the down-flow would be stopped of the pulmonary blood circulation. In this case, WP should show the blood pressure on the spot where the blood flow which is effective to the pressure appears for the first time in the down-flow.

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(1) With unipolar lead in the immersion experiment I have made a survey of the equipotential distribution of the heart, measuring the points of the same potential in the water and on the breast ; in the water the distribution is shown as concentric circles around the heart ; and on the breast, as radiant aspects around the part where the highest strom potential of plus and that of minus are shown.(2) Among the potentials at equidistant points from the heart, the potential of the right caudal position is lower than that of any position in other three directions.(3) The author's experiment with rabbits indicates that the specific resistance of various organ shows little difference between tissue and organ, that is, 9×10 ohm cm., though these results may show some changes depending upon the methods of measurement.

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On the normal duration of the Q-T interval in Europeans and Americans various formulas have been reported, as well known. But it is doubtful whether these formulas can be rightly applied to the Japanese. Up till now, there are only a few studies published on this problem. So, in order to determine the standard of the normal Q-T interval in the Japanese, the author has statistically investigated the standard limblead electrocardiograms in 356 instances of adult Japanese (203 men, 153 women ; the ages ranged from 15 to 45 years). The results are as follows : (1) According to "Chain-doublets Theory (Maekawa)" the electrical discharge due to contraction of the heart muscle continues just in the Q-T interval. Therefore, from the standpoint of the law of the heart (Starling), the Q-T interval must be in close relation to the preceding T-Q interval (the duration of the ventricular relaxation). This relationship can be expressed by the following equation, Q-T=15.7(T-Q)^0.22…(A) for males Q-T=15.56(T-Q)^0.22 for females Q-T=14.74(T-Q)^0.24 (Unit 1/100sec.)(2) The rejection limit of the Q-T interval in the above (A) equation can be given as follows, at the level of significance 5%, (Table I) (y₀-0.2198x₀-1.1963)²=0.0018+0.0006(x₀-1.6460)² where x₀=log T-Q y₀=log Q-T(3)In the same way, the relation of the Q-T interval to the cycle length (R-R interval) can be expressed as follows, Q-T=6.24(R-R)^0.40…(B) for males Q-T=5.92(R-R)^0.41 for females Q-T=6.05(R-R)^0.41 (Unit 1/100sec.)(4) The rejection limit of the Q-T interval in the above (B) equation can be given as follows, at the level of significance 5%, (Fig. 2) (y₀-0.4004x₀-0.7946)²=0.0012+0.0009(x₀-1.9069)² where x₀=log R-R y₀=log Q-T(5) A comparison was made of the abovementioned equation with the formula proposed by Hegglin and Holzmann or by Fridericia. These formulas deviate from each other as shown in Fig. 2. Consequently, the Q-T interval in a Japanese should be evaluated with the standard in the Japanese.

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The author analysed the relationship of the QT interval to the heart area in 122 cases which were considered under no influence of digitalis, quina alkaloid and abnormal conditions of any electrolyte, including heart disease, tuberculous disease, and others. The size of the heart was measured by a planimeter on the teleroentgenogram. The measured heart area divided by the normal heart area was termed the enlargement rate of heart area. The measured QT interval divided by the normal QT interval reported in the preceding article was termed the prolongation rate of QT interval. The results are as follows.(1) In 45 cases without myocardial damage demonstrable by clinical examinations, on the average, the prolongation rate of QT interval was about linearly proportional to the enlargement rate of heart area.(2) In 66 cases with myocardial damage without heart failure, on the average, the prolongation rate of QT interval was fairly proportional to the enlargement rate of heart area. But, as compared with in the cases without myocardial damage, the prolongation rate of QT interval to the enlargement rate of heart area was scattered more broadly, and the QT interval was prolonged to a lesser degree(3) In 11 cases with heart failure, the prolongation rate of QT interval to the enlargement rate of heart area was markedly decreased.(4) The above-mentioned date can be clearly interpreted from the standpoint of the law of the heart (Starling) and "Chain doublets Theory (Maekawa)". And it may be concluded that, the QT interval is prolonged proportionally to the increased quantity of the heart work and that, when the heart performs less work than that reguired, the prolongation of QT interval is in a lesser degree according to the decreased work.(5) Consequently, the clinical value of the QT interval lies in the deviation not from the normal QT interval, but from the QT interval which the healthy heart would show when it would work out the load required for that examined heart to do so.Therefore, clinically, the duration of the QT interval should be judged from the viewpoint of the heart work by putting something proportional to the quantity of the load required for the examined heart to work out, for instance the heart area, as a indicator.

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Introduction Reports are scanty about this problem except some reporting that right ventricular preponderance is popular among young individuals with pulmonary tuberculosis, and left ventricular preponderance among aged individuals with pulmonary tuberculosis. This section of report is intended to examine the relationship between findings of the φ-pattern and sex or age.Method and Result Age distribution of the patients examined, 453 males and 247 females, was as follows : in descending order of the size of population, 328 cases of age 20-29; 162 cases of 30-39; 89 cases of 19 or below; 73 cases of 40-49 ; 48 cases of 51 or above. With such age distribution in mind, elecrocardiographical findings as described in Report 1 were analysed.Excluding 6 cases of low voltage out of 700 cases, materials here discussed include 451 males and 243 females. In males, frequency of incidence was, in descending order, normal type, vertical type, right axis deviation, level type, left axis deviation. In female, however, level type fell on the 3rd, right axis deviation on the 4th seat. Female-male comparison in term of respective position type disclosed the following : normal type, vertical type, especially the latter were of low incidence in females, while level type, left axis deviation were of twice as high frequency in female as in male. Along with age, normal type became less and less frequent, while vertical type became more popular, reaching a point where normal type-vertical type relation is inverted. Along with age, level type, left axis deviation decreased their incidence, while right axis deviation became popular. This was so in male, but not in female.Male had normal T wave with high frequency, but, on the contrary, female showed abnormal T wave in an overwhelming majority. Such abnormal T wave in female was severe in grade and it included many cases of low voltage. In young individuals incidence of abnormal T wave was rather popular; however, as age increases, normal T wave usurped abnormal wave more and more. Low voltage had a tendency to occur more popularly at higher ages. This relation held for male, but not readily for female. Degree of T wave abnormalities became severer along with age and this applies to male distinctly than to female.Discussion In view of the fact that right axis deviation is popular in healthy young individuals and left axis deviation in aged individuals, it appears problematical to adhere to the hitherto accepted view that young patients with pulmonary tuberculosis show right ventricular preponderance with high frequency. The basis of hitherto accepted view, that is, the right ventricular preponderance results from right ventricular overloading, owing to an increased resistance to the pulmonary circulation, is itself free to conjecture. In this paper the author will abstain from discussing the validity of such view, partly because there is a glaring evidence, according to this study of the author's, that right axis deviation occurs with nearly the same frequency in healthy population and patients population. Vertical type is popular among young individuals. It increases quite remarkably with age. Normal type, level type, left axis deviation decreases along with age. This distribution is different from that holding for healthy population. It also differes from hitherto reported distribution of position type among the patients with pulmonary tuberculosis. That level type left axis deviation are frequent in association with normal T wave in female patients appears to reflect the effect of similar distribution that occurs in healthy female population. In association with abnormal T wave there occurs increase in incidence of vertical type, right axis deviation, special feature of pulmonary tuberculosis, suggesting possible close relation between abnormal T wave and abnormalities in position type.Along with age normal T wave becomes popular and abnormal T wave less popular, and low voltage increases.

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Electrocardiographic studies were performed on 918 aged persons who were admitted to the Yokufukai (old people's home), most of them were over 60 years old. The frequencies of appearance of abnormal findings were discussed in relation to their age. Although the positive number of subjects of this study were 918, as mentioned above, the relative number of cases that were made the subjects of these statistics were 1110, since such person as has been observed during the period covering two decades, was counted as two cases. Pathological findings included all abnormalities such as prolongation of the P-Q interval, prolongation of the Q-T interval, extrasystole, inverted T wave or depression of RS-T segment or abnormal RS-T segment and T wave, bundle branch block, auricular fibrillation and myocardial infarction, except low voltage. However, detailed study was not attempted in S-A blocks and A-V blocks, because of their rarity.The results obtained were as follows : 1) Abnormal patterns were found in 611 out of 1110 (55.1%), i. e., more than half of the total cases. It has also been made clear that the older the subjects, the oftener the frequencies of the abnormal electrocardiograms come out.2) The incidence of extrasystole was 14.4% (160 out of 1110 cases), in that supra-ventricular extrasystole was 9.8% and ventricular extrasystole was 4.5%, the former being much more frequently seen than the latter. There was a close correlation between the frequency of extrasystole and the age.3) The prologation of Q-T interval (by formula of Hegglin and Holzmann) was encountered in 220 out of 1110 cases (19.8%). Similarly its incidence paralleled with the increase of age.4) The prolongation of P-Q interval was found in 37 out of 1110 cases (3.3%). Its relationship to the age was also confirmed.5) The number of cases with bundle branch block was 56 (5.0%), 4.5% of which was the right B. B. B. and 0.5% was the left B. B. B.. Frequencies of these abnormalities were higher in older age groups.6) The number of those with isolated inversion of the T wave amounted to 184 cases (16.5%). No evident correlationship between this abnormality and the years of age was confirmed.7) The number of those with isolated depression of the RS-T segment amounted to 58 cases (5.2%). Its frequency increase with increase in age.8) The number of those with the abnormal RS-T segment and T wave amounted to 203 cases (18.3%). The frequency evidently paralleled with years of age.9) The number of cases with auricular fibrillation was 23 (2.1%) and that with myocardial infarction 34 (3.1%), their frequencies being higher in older age grops.

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A follow-up study on 280 cases of over sixty years of age who showed normal electrocardiogram when first seen at Yokufukai was made and age, blood pressure, left transverse cardiac diameter by fluoroskopy, urine excretion tests were discussed in relation to abnormal electrocardiographic findings.1) The rate of appearance of abnormal electrocardiographic findings was higher in persons of over seventy years of age than in those of over sixty, showing that the older the subjects were, the higher the rate became.2) The subjects were divided into two groups, one of which was composed of those who showed over 9 cm of left transverse cardiac diameter and the other was composed of those with under 8 cm of diameter. The rate of appearance of abnormal findings was distinctly higher with the former group than the latter.3) The rate of appearance of abnormal electrocardiographic findings was lower in persons in whom highest gravity of their urine was above 1020 than in those whose graviry of urine was short of 1015. This fact was interpreted to indicate that the renal function had much to do with the change of electrocardiograms.4) There was a close interrelationship between an elevation of systolic and diastolic blood pressure and the rate of appearance of pathologic electrocardiographic findings. Especially an elevation of diastolic blood pressure had much to do with the rate.5) Of four factors which were heretofore discussed in regards to abnormal electrocardiographic findings, hypertension had the greatest influence on the electrocardiographic changes, renal insufficiency the second, the dilatation of the left heart the third and fourthly age had the least influence.6) The relation between prolongation of the Q-T interval or extrasystole and subsequent appearance of abnormal electrocardiogram for those who had not any other abnormality other than those above mentioned on the first electrocardiographic examination is closer than the relation between age and the rate of appearance of abnormal electrocardiogram, but distinctly more remote than the relation between blood pressure, renal function, dilatation of the heart and the rate of appearance of abnormal electrocardiogram.

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A follow-up study was made on 918 aged people during the period of Jan. 1947 to Jan. 1953. The result are as follows : 1) The death rate of those with abnormal electrocardiogram is higher than that of normal electrocardiogram.2) Mortality rate of those with prolongation of the P-Q interval equals that of those with normal electrocardiogram. It can be said, therefore, that prolongation of the P-Q interval is of no significance.3) Mortality rate of those with prolongation of the Q-T interval is 16.2% in the first year and 13.5% in the second year and is higher than that of normal electrocardiogram. Prolongation of the Q-T interval is considered to have some prognostic significance.4) The extrasystole has a similar meaning with prolongation of the Q-T interval in aged persons.5) Mortality rate of those with right bundle branch block equals that of those with normal electrocardiogram or less. Accordingly right B.B.B. has almost no prognostic significance.6) Isolated inversion of the T wave has a great prognostic value. The greater the number of leads with isolated inversion of the T wave, the worse the prognosis becomes. Both Nehb's lead and aV lead seem to have no less a value than standard limb lead. T_{I II} inversion is more important than T_{II III} inversion in determining prognosis, but there is no difference in significance between T_{I II} inversion and T_{I II III} inversion.7) Isolated depression of the RS-T segment is more important than isolated inversion of the T wave. Depression of RS-T_{I II} is more serious than depression of RS-T_{II III}.8) Prognosis of those with abnormal RS-T segment and T wave is not decisively poorer than those with isolated depression of the RS-T segment. So it is clear that abnormal RS-T segment is more important than T wave.9)Mortality rate of auricular fibrillation with abnormal RS-T segment and T wave equals that of abnormal RS-T segment and T wave, so it seems that auricular fibrillation has nothing to do with prognosis.10) Myocardial infarction presents a serious problem, its immediate mortality rate being 26 percent and first year's mortality rate 72 percent. As to the location of the infarction, the highest mortality rate is seen in anteroposterior infarction. There is no difference between anterior myocardial infarction and posterior infarction.11) Summarizing of heretofore discussed prognostic significance of all abnormal electrocardiographic findings, prognostic value is recognized in order of myocardial infarction, the abnormal RS-T segment and T wave, isolated depression of the RS-T segment, isolated inversion of the T wave, prologation of the Q-T interval and extrasystole. Auricular fibrillation, right B.B.B. and prolongation of the P-Q interval have almost nothing to do with prognosis.

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