In order to clarify the changes of the Krebs cycle occurring in myocardium working under conditions of anoxia, the capacities of oxidizing various substrates related to the cycle were studies in myocardial homogenates removed from rats killed after exposure to low pressure (310 mmHg) and CO-poisoning.As the method of the experimental CO-poisoning, the method of the intraperitoneal CO-administration inaugurated by T. Ishikawa in experiments on mouse and rabbits, was applied on a rat. For measuring the oxidizing capacity of a tissue, the Thunberg-tube was employed and the methylenblue decoloring time was assessed, to which the sodium salt, respectively, of lactate, pyruvate, citrate and succinate was added as substrates.

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Dilution method is clinically used to measure circulating blood volume and various body fluid spaces. For dilution method some nontoxic and stable substances which uniformly distribute exclusively into one compartment to be measured have to be selected. But practically we have had no such substances as good enough to be expected. Consequently it is most important to find the time when mixing of injected substance is performed and disappearance rate from the space becomes slow and constantly, though it is easy to determine it correctly. By using each single intravenous injection of T 1824 dye, Na²⁴Cl, Thiocyanate, Mannitol and NAAP solution in this study, the author tried to determine the reasonable sampling time and calculation method in human body.The theoretical bases are as folows : (1) Disapperarance coefficient (K)Dilution curves following single intravenous injection of these substances consist of many exponential curves, and it is considered that these curves during short time are approximate to one exponential curve. The equation of exponential curve is C=C₀e^-Kt (t : time, C₀ and C : concentration at time o and t, k : disappearance coefficient)When mixing is completed and slow disappearance continues, there should be correlations between disappearance coefficient and factors regulating disappearance. As these factors there are enumerated F/V(<cardiac output>/<space volume>), and excretion rate in the urine, and membrane permeability.(2) Simple method and extrapolation method It is corrected all disappearance quantity from the space by extrapolation method, while it does only excretion in the urine by simple method, measured from one blood sample and excreted quantity in the urine. When we have obtained the equal value between t₁-simple method and t₁-t₂ extrapolation method, there is steady state at t₁ that mixing is completed and disappearance continues only by way of urinary excretion.(3) Comparison of actually measured excretion in the urine to disappearance calculated from disappearance curve.If this ratio is acout 1. 0, it means that mixing is completed and disappearance from the space is nothing but excretion in the urine. If this ratio is less than 1. 0, distribution is incomplete.(4) Ascites, subcutaneous edema and cerebrospinal fluids etc.By comparing concentration in the ascites, subcutaneous edema and cerebrospinal fluids with plasma concentration at the same time, we can find distribution rate of the injected substance.Subjects : Normal group consists of 30 persons with 30 studies, cardiac group 33 patients with 40 studies and miscellaneous group 30 patients with 31 studies.Results : (1) T-1824 : There was positive correlation between disappearance coefficient (K) from 10 minutes to 2 hours and F/V(<cardiac output>/<total bloodvolume>) except for the patients with congestive heart failure in whom we found rather negative correlation. In the normal subjects mixing was completed at 10 minutes after injection, while in the decompensated cardiacs not yet completed. (2) Na²⁴ : These was positive correlation between K from 1 to 3 hours andF/V(<cardiac output>/<Na²⁴ space>) except for the patients with severe congestive heart failure. Na²⁴ space by 1 hour simple method was equal to slightly larger than extrapolated space from 1 to 3 hours. K from 1 to 3 hours was nearly similar to K from 3 to 6 hours in the normal. In the normal Na²⁴ space is suitable to be measured by 1 hour simple method or extrapolation method from 1 to 3 or 6 hours. But in the patients with severe congestive heart failure and marked edema or ascites the volume of distribution of Na²⁴ was unstable within 3 hours following injection.

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In chronic congestive heart failure, disturbances of renal hemodynamics have long been observed by many investigators ; in 1995 I reported the renal function in congestive failure.In this study, the relationship between renal and cardiovascular hemodynamic functions in 59 with valvular disease and, especially, in 9 with mitral stenosis before and after commissurotomy, was investigated. These patients were divided into 3 groups : Group I, 24 without cardiac decompensation, Group II, 23 with edema-free caridac decompensation and Group III, 17 with edema in the state of cardiac decompensation.1) In compensated group, RPF was 464 ± 95cc/min, GFR 111 ± 18cc/min and FF 0.258 ± 0.056. In Group II, RPF was 308 ± 64cc/min, GFR 94 ± 20cc/min and FF 0.309 ± 0.036. In Group III, RPF WAS 192 ± 72cc/min, GFR 73 ± 21cc/min and FF 0.407 ± 0.108.2) Between renal blood flow and venous congestion, consistent relationship was observed : Correlation coefficient between log RBF and log peripheral venous pressure was -0.7538, and that between log RBF and log inferior vena cava pressure -0.6354.3) Correlation coefficient between RBF and pulmonary capillary mean pressure was -0.8803, and that between log RBF and log pulmonary artery means pressure -0.6231. Thus, there is parallelism between renal and pulmonary hemodynamic functions.4) There was no consistent relationship between renal blood flow and cardiac index.Renal fraction of cardiac output in the state of decompensation was generally lower but not correlated to degree of venous congestion.5) Studies before and after commissurotomy in mitral stenosis showed a slight increase in RBF, GFR and cardiac output, but there was no correlation between RBF and cardiac index. Pulmonary arterial and capillary pressure were reduced significantly. The calculated total renal resistance was not changed, but Ra (afferent arteriolar resistance) increased significantly and Re (efferent arteriolar resistance) decreased insignificantly and the balance between Ra and Re was restored. Total pulmonary resistance was reduced markedly, but arteriolar resistance showed no change ; therefore, mitral valvular resistance was markedly reduced.In conclusion, renal hemodynamic functions show sensitively the states of circulatory alterations in heart disease. And the above-mentioned resuls coincide with the "backward-failure theory" about the congestive heart failure rather than the "forward-failure theory".

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