The importance of electrolytes on the cardiac physiology is well known. Recently is assumed that potassium has a fundamental role in the chemical process of muscle contraction (Szent-Gyoergyi) and pottassium and calcium are receiving special attention due to the role played in the effect of cardiac glucosides. The intimate relationship between the calcium and potassium and cardiac muscle can never be too emphasized.As vita-campher (trans-π-oxocampher) is a drug frequently used for acute cardiac insufficiency, in Japan, the study of its influence on the metabolism seems to be important clinically.The author administered calcium, potassium and vitacampher to dogs and studied their effects on the consumption of oxygen, utilization of lactic acid, pyruvic acid and glucose in the cardiac muscle by the method of coronary sinus catheterization. At the same time, using Rotameter the influence of these manoeuvre on the coronary flow was studied.

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Nervous control of the coronary circulation has long been studied, but many problems remain to be further investigated. In general, the coronary blood flow increases by the sympathetic nerve stimulation, and decreases by the vagal nerve stimulation. But, the stimulation of the sympathetic or vagal nerve to the heart produces significant changes in hemodynamic and metabolic factors, such as blood pressure, heart rate, vigor of contraction, ratio of systole/diastole, cardiac output, extravascular compression, massging action of the heart, oxygen consumption and metabolites. Therefore, it can not be simply concluded that the sympathetic nerve causes active coronary vasodilatation, while the vagal nerve causes active coronary vasoconstriction.In the present paper, the effects of the stimulation of the stellate ganglia upon the coronary blood flow were reported (in the next paper, the stimulation of the vagal nerve is to be reported). Experimental methods were same as already described in Part I of this study.

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Since 1934, Matthes has designed a recorder with two different filter-photocell systems using transmitted light. By these methods, he measured the ganeralized oxygen saturation change in order to study the hemodynamics in the cardio-pulmonary disorders. Since 1942, Millikan (1942), Hemingway (1984) and Wood (1949) have developed this method to the duble-scale ear oximeter method. While these investigators have attempted to measure the generalized oxygen saturation, we are trying to measure the local oxyhemoglobin concentration of the finger-tips. For this purpose we devised a new recording method using an ear oximeter, according to Wood's method.Our apparatus consists of following four parts : light source, filter-photocell system, control box, galvanometer and recorder.With this apparatus, we record the transmitted light volume of finger-tip under three conditions such as venous stagnation, arterial arrest and reactive hyperemia after releasing the arterial arrest.We can estimate the local oxyhemoglobin concentration from the extinction of both red and infrared systems, because the local oxyhemoglobin concentration is the function of the intensity of transmission factor in the red system (Ir) and the intensity of transmission factor in the infrared system (Iir), and these two variables can be measured from the record of transmission factors. As a matter of fact, we devised the following oxyhemoglobin index, from which we can estimate the local oxyhemoglobin concentration.Oxyhemoglobin index=(2-log₁₀Ir)/(2-log₁₀Iir) The change of oxyhemoglobin content is reverse to the one of index.With this method, we study the digital circulatory conditions. In a healthy subject, oxyhemoglobin index is about 1.0 and doesn't fluctuate by stagnation, arterial arrest or reactive hyperemia. In pale fingers of patients suffering from Buerger's or Raynaud's disease, the blood volume of the finger-tip is low and the oxyhemoglobin index is relatively high. Moreover, oxyhemoglobin index increases markedly after stagnation and arterial arrest, and is delayed in returning to its original value. In cyanotic fingers, the oxyhemoglobin index is relatively high, decreasing after stagnation, and increasing after arterial arrest. In red fingers, especially after local warming, the blood volume of the finger-tip is high, the oxyhemoglobin index approaches to 1.0, and the latter fluctuates little by stagnation, arterial arrest or reactive hyperemia.Thus by calculating the oxyhemoglobin index, we can express numerically the state of the color of the fingers, such as paleness, cyanosis or redness.

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From the theoretical point of view, the concept of the ventricular gradient (VG) is thought to be interesting in the interpretation of the clinical electrocardiogram, but there has been few studies on the relationships between the ventricular gradient and the histologic findings of the ventricular myocardium.The author determined the frontal plane VG from the Einthoven's triangle with Leads 1 and 2 and the horizontal plane VG with Leads V₁ and V₆ in routine electrocardiograms of clinical and autopsied cases.Normal limits of the angle of the VG in fifty healthy young adults were determined. On the basis of these values, there were few abnormalities of the angle of VG in cases of complete right bundle branch block, transitional form to left ventricular strain pattern and so-called myocardial damage, but many abnormal cases were found in right or left ventricular hypertrophy and strain patterns. There were more abnormalities in frontal than in horizontal plane. In cases of right bundle branch block there was no abnormality in the cases which showed no clinical findings of organic heart disease. In right ventricular hypertrophy and strain patterns the author found more abnormalities of the angle of VG in the cases with severe congestive heart failure than without it, but there was no constant relationship between the grade of congestive heart failure and the magnitude of the VG. Furthermore there was no clear difference between the incidence of abnormal VG in congenital malformations of the heart and that in acquired mitral valvular diseases.The magnitude of the VG in both planes showed a tendency similar to the angle of VG, when the lower limit of its magnitude is regarded as 30 microvolt seconds.The manifest magnitude and angle of the VG in both planes obtained from 47 older patients (mean age, 68.5 years) were compared with the autopsied findings. In forty of these patients the magnitude and angle of the VG were compared with the histologic findings of the myocardium.Although no abnormality of the angle of the VG was seen in the autopsied cases with normal electrocardiogram, ther were many abnormalities in the directions of the VG in the cases which showed myocardial infarction or left ventricular hypertrophy and strain patterns.In 74% of the cases which showed abnormalities in the angle of the VG, moderate to severe myocardial fibrosis was seen, irrespective of the patterns of electrocardiogram. But, on the contrary, there was none or slight to mild fibrosis in 85% of the cases with normal VG and no cases of moderate or severe myocardial fibrosis were observed.The relationship between myocardial fibrosis and the magnitude of the VG was the same as that in the angle of VG and myocardial fibrosis.It is suggested that the determination of the VG, especially of its angle, is of clinical significance to decide whether the ST-T changes of the clinical electrocardiogram are based on myocardial damage or not, because the importance of the VG was confirmed by comparison with histologic findings of the heart.

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A variety attempts have been made over many years to produce persistent hypertension by surgical procedures on the kidney. But one of the difficulties to decide the exact role of the kidney in hypertension was that the hypertension should be produced without disturbances of renal excretory functions. Goldblatt and Page overcame this disadvantage by the application of constricting clamps on the renal arteries or by cellophane perinephritis.Here, I studied the renal hemodynamics in renal experimental hypertensions-Goldblatt's hypertension, Page's hypertension and nephrectomy. And then I attempted to evaluate the relationship between blood pressure and renal blood flow.In Goldblatt's experiment, 14 trained dogs were used. Renal plasma flow was determined by paraaminohippurate clearance method at low plasma level, glomerular filtration rate measured by sodium thiosulfate clearance method, and TmG was measured, too. These renal function studies were carried out every 1-2 weeks during the experimental period. Blood pressure was measured directly on the femoral artery with a needle connected to a mercury manometer.Among 14 Goldblatt's dogs, 2 were slightly, 1 moderately and 4 markedly hypertensive. Percentage of success was 50% It the cases with transient elevation of blood pressure were included in the group of success, it was 85.7%.Considering the experiment of Goldblatt's procedure, it seems as follows : 1) There exists relationship between RBF and elevation of blood pressure, 2) renal ischemia causes an elevation of blood pressure, and the elevated blood pressure saves ischemia, but on the other hand, it improves damages of the kidneys ; so there appears an improvement of the renal ischemia. In Goldblatt's hypertensin, a "dynamic equilibrium" is, therefore, observed between renal ischemia and blood pressure elevation, and 3) this "dynamic equilibrium" is probably produced by a humoral substance of renal origin which may be Maekawa's "Kidney-ATPase".In Page's procedure, 8 dogs were used. Among these subjects, 1 slightly, 1 moderately and 2 markedly hypertensive following Page's procedure. Percentage of success was 50%. If the cases with transient elevation of blood pressure were included in successful, percentage of success was 62.2%. But in cellophane perinephritis, RPF was decreased progressively and the blood pressure elevated more and more. Therefore, a "dynamic equilibrium" was not obtained between blood pressure and RPF. This point is the difference between Goldblatt's and Page's hypertension.By unilateral nephrectomy, a significant elevation of blood pressure did not occur.In conclusion, although there is parallelism between elevated blood pressure and decrease of renal plasma flow, it is not always the case in chronic stage. However, it is sure that a gradual decrease, especially a progressive decrease of RPF relates to the elevation of blood pressure.It follows therefore that : 1) The necessary condition of the kidney for the elevation of blood pressure is the "dynamic equilibrium" between ischemia and blood pressure elevation, which is related to the condition of kidney. It follows that the kidney is related to the pathogenesis of hypertension as merely one special condition.2) This special condition causes a disturbance of the ATP-ATPase system of kidney, and makes the release of ATPase of kidney into the blood stream possible.

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In the practice of cardiac catheterization, it is difficult to obtain a correct pulmonary arterial wedging partly because the pulmonary arteries narrow down fairly steeply before reaching peripheries, partly because these arteries are rich in ramifications. Therefore, as Dexter already pointed out, it is necessary to establish the criteria, enabling the indentification of true pulmonary arterial wedge pressure (W. P.). The author have investigated such criteria for W. P. in 18 patients and 10 normal adults.1) For correct wedge pressure measurement the following conditions should be fulfilled : blood samples, obtained from wedged catheter after discarding at least the first 5 cc of the blood should have a slightly higher value in oxygen content and quite equal value in hematocrit percentage in comparing with that of systemic arterial blood. The W. P. curve should show typical venous a, c and v-waves.2) In many cases there have been distortion in the W. P. curve caused by the dumping effect of pulmonary vascular beds and by the heart sound or the displacement of catheter due to the ventricular contraction. These distorting effects may be avoided by the correction of the catheter position in the heart, and by the utilization of the manometer, having adequate pressure charateristics or dumping.3) In such criteria, the author have measured normal wedge pressure in 10 normal adults.

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The author have studied pulmonary circulatory dynamics in 21 patients with left heart failure, of which 15 were suffering from mitral valve disease.1) In all 4 cases of aortic regurgitation both pulmonary arterial pressure and wedge pressure were elevated, especially in the case with auricular fibrillation or flutter. In a case of constrictive adhesive pericarditis right ventricular diastolic pressure was high, suggesting the preclueded ventricular dilatation by constriction of pericardium. In a case of essential hypertension pulmonary arterial and wedge pressure showed a slight elevation, as an initial sign of backward congestion.2) In patients with mitral valve disease, pulmonary arterial and wedge pressure showed slight to marked elevation according to the severity of disease. In cases without objective symptomes the pulmonary arterial pressure remained normal but the wedge pressure in all cases showed elevation. In general cardiac output decreased.3) Little correlation between pulmonary blood pressure and systemic arterial oxygen saturation was observed. Circulating blood volume, red blood cell count and peripheral blood hemoglobin content increased in all cases.4) In cases, complicated with auricular fibrillation or flutter the wedge pressure contour showed no a-waves and embryonic c-waves followed by diminished or deformed suction curve (X-valley) and a large prominent v-waves. Effects of mitral valve regurgitation should to be deduced from the deformed X-valley. Because of the increased vascular tone by the elevated pulmonary venous pressure, the left atrial pressure variation was reflected with high fidelity in the pulmonary arterial wedge pressure curve. In cases with mitral valve stenosis and with normal sinus rythm prominent a-wave was observed.5) The author have proved indirectly the "atrial suction theory" (Maekawa) through the data, indicating the elevation of wedge pressure as the initial sign of left heart failure.

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The author has studied the pulmonary circulatory dynamics in 6 patients with bronchial asthma. In every cases the author has studied also the effects of intravenous injection of Theophyllinethylendiamine on the pulmonary circulatory dynamics.1) In all 6 cases both pulmonary arterial pressure and pulmonary arterial wedge pressure (W. P.) was slightly higher than normal. The W. P. contours have reflected the left atrial pressure variation with high fidelity.2) Intravenous infusions of 250 mg Theophyllinethylendiamine induced prompt reduction of W. P. to the normal or subnormal value.3) According to these data the author has concluded that the concept of increased pulmonary venous wall tone in bronchial asthma designated by M. Takino may be true.

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