Electrocardiographic studies were performed on 21 persons of the divers were lived in Taneichi and Rikuchuyagi (Town) of Iwate prefecture.These were classified in 3 groups.In A group, the divers are healthy and working at present.In B group, the divers were suffered from caisson disease recently. (from one week to two weeks after onset).In C group, the divers were suffered from caisson disease in a long term and residual symptoms were seen eminently.The results obtained were as follows : 1. With regard to position type, normal position were found in 14 cases, left type in 6 cases and axis deviation predominated vertical position with clock wise rotation.2. All the case showed normal except a case which showed 0.08 second in P wave. Pulmonal and mitral P were not occurred in all the case.3. No case showed abnormal prolongation of P-Q interval.4. Prolongation of QRS interval were found in one case with bundle branch block. Notching and slurring of QRS were found in one case only.5. The author not observed the prolongation of Q-T interval, low voltage and arched elevation of ST segmant.6. The number of those with isolated low T wave amounted to one case and another one case of peaked T. The elevation and depression of ST segment not observed.7. There were no remarkable arhythmia excepting that some of them indicated the sinus bradycardia (8 cases) and right bundle branch block (one case).8. In precordial lead only one case in B group showed low T. Another one case in C group showed prolongation of the intrinsic factor.

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The pulmonary artery pressure response to tilting feet-down at an angle of 45° from the horizontal was studied on 37 patients : 20 cases of pulmonary disease, 17 cases of cardiac disease. The pressure response were put into three patterns ; type I, type II and type 0, which were classified by J. Mise previously. Type I : In ten minutes after tilting, the pulmonary artery pressure decreased gradually from 5 to 25mmHg, in 17 cases. The left ventricular failures such as mitral insufficiency and aortic insufficiency which have high wedge pressure were included in type I. The promotion of venous return to the left heart may be considered as a main cause of this pressure response.Type II : In 5 cases, the pressure rose more than 4mmHg over the control level after tilting. These five were cases of pulmonary hypertension due to pulmonary emphysema (1 case), bronchial asthma (2 cases), pheochromocytoma (1 case) and tight mitral stenosis (1 case). All of them had low wedge pressure except a case of tight mitral stenosis. Reflex restriction of the pulmonary vascular bed may be considered as a main cause of the pressure increase.Type 0 : Cases of pulmonary fibrosis, silicosis, moderate or slight mitral stenosis, pulmonary tuberculosis which had undergone operations such as lobectomy and thoracoplasty, and healthy cases were included in type 0.The systolic, diastolic and mean pressures of the pulmonary artery changed almost in a parallel manner in all of these types. The pulse pressure, however, of the pulmonary artery decreased after 45° tilting in almost all cases.The diagnostic value of these response patterns of pulmonary artery pressure due to a change from a horizontal position to a 45° tilt, was discussed.

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In 31 patients with pulmonary tuberculosis, the "wedge" pressure was measured and the "wedge" blood was drawn by cardiac catheterization. The results were as follows : A) In normal portion : "wedge" pressures were within normal range. The gas compositions of the "wedge" blood showed higher O₂ content and much lower CO₂ content than in arterial blood, whenever the "wedge" blood passed through the normal alveoli. The author designated the blood sample which showed such gas compositions as the "wedge" blood drawn in normal portion as "Super Aerated Blood". The "Super-Aeration" of the "wedge" blood is attributable mainly to diffusion of O₂ and CO₂ contained in the "wedge" blood through the normal alveoli.B) In tuberculous portion : "wedge" pressure curves were differed from those obtained in normal portion, and "wedge" pressures were so high that exceeded sometimes the pulmonary arterial mean pressure. The gas compositions of the "wedge" blood were not "Super Aerated" but nearly equal to those of adterial blood. These facts indicate nothing but the existence of precapillary anastomosis between the pulmonary and bronchial arterial system in tuberculous portion of the lung.

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Myocardial metabolism in the coronary artery embolisation were studied on the total of 33 closed chest dogs with the technique of coronary sinus catheterization under the condition as natural as possible. Coronary artery embolisation was produced by the injection of suspension of Lycopodium spores through a catheter of 1mm diameter inserted into the left coronary artery under fluoroscopy. Coronary sinus outflow was measured on 4 dogs with the Morawitz canula modified by us. Following results were obtained.1) Immediately after the production of coronary artery embolisation, the decrease in coronary sinus outflow, amounting 17% in average, was observed and the mean arterial blood pressure showed a significant decrease, averaging 14 mmHg. About 2-3 minutes after the embolisation, the increase in coronary sinus outflow of 40% (2.5∼100%) was observed and the arteriaal blood pressure recovered slowly.2) With the rapid increase of coronary blood flow, simultaneous diminution in myocardial oxygen extraction coefficient, averaging 0.27 (0.10∼0.48), was observed and myocardial gas exchanging ratio increased to 0.99.3) Myocardial carbohydrate metabolism after the coronary artery embolisation was studied in 6 dogs. Myocardial glucose extraction ratio decreased 30 minutes after embolisation and in three cases of them the myocardial glucose extraction were in negative balance. Immediately after embolisation the myocardial extraction of lactate and pyruvate were significantly diminished and the concentration of lactate and pyruvate in coronary sinus blood exceeded those of arterial blood. These changes appeared to be rapidly reversible, but in one case of them myocardial lactate extraction were maintained in negative balance even 30 minutes after embolisation. Myocardial citrate extraction was reduced to negative balance, when the catheter was inserted into the coronary artery, but after the caronary artery embolisation, the negative citrate extraction was not significant.4) Within 3 hours following the coronary artery embolisation, the glutamic oxalacetic transaminase showed a marked increase in serum activity and reached a peak after 18-24 hours. Beyond this period decreased the SGO-T activity gradually.The activity of SGO-T in coronary vein blood exceeded 60 units from the arterial blood after 3 hours following embolisation.To short, after the coronary artery embolisation anaerobic glycolysis still proceeds in the heart muscle and the heart reacts rapidly with increased coronary flow to its local ischemia caused by embolisation.At that time, the accumulated anaerobic metabolates are washed out. The fact that lactate and pyruvate in coronary vein blood exceed those in arterial blood indicates incomplete oxidation of carbohydrate in the embolised heart muscle. When it begins to suffer necrosis, the activity of SGO-T in blood increases gradually.

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Using the method of Gibson et al., the concentration of endogenous heparin-like substance in blood was determined. Also the concentration of heparin-like substance in the different parts of aorta and pulmonary artery was determined by the same method after extraction of the substance from the tissue with potassium thiocyanate, and following results were obtained.1) In normal subjects, there was scarcely any sex difference in the concentration of heparin-like substance in blood, although the concentration tended to decrease gradually with advance in age.2) Heparin-like substance level in blood from the cases with myocardial infarction, angina pectoris, diabetes mellitus and hypertension was significantly lower than that from the normal subjects.In hypertension, heparin-like substance level in blood from cases with abnormal E. C. G. findings was significantly lower than that from cases without abnormal E. C. G. findings.3) The concentration of heparin-like substance in blood tended to decrease as the progress of the severity of atherosclerosis of the fundus oculi.4) There was approximatly inverse correlation between serum lipoprotein ratio (β+γ/α) and heparin-like substance level in blood.5) Concentration of heparin-like substance in pulmonary artery wall was higher than that in ascending or abdominal aorta.6) Concentration of heparin-like substance in arterial wall tended to decrease as the progress of the severity of calcification and atheromatous changes.From the results above descrived, it is concluded that heparin-like substance may play some important roles in development of atherosclerosis.

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Respiratory and circulatory function tests were done on three patients with severe acute pneumonia at the height of the disease. The course of the disease was followed with these tests. From the results obtained, the occurrence of hypoxemia and electrocardiographic changes were studied.1) Pulmonary function disturbance During the height of the disease, the changes found in the pulmonary function were a decrease in lung capacity and increases in the minute ventilatory volume and oxygen consumption. The blood gas analysis during this stage showed a marked decrease in the arterial blood oxygen saturation and partial pressure with a tendency of an increase in the arterial carbon dioxide partial pressure. No remarkable difference was found in the ventilatory function distubance between a case of bronchopneumonia with widely spread pathology on X-ray and a case of lobar pneumonia with the damage limited to one lobe, but the disturbance in the blood gas was stronger in the case of bronchopneumonia.2) Electrocardiographic changes The cases of lobar pneumonia with lowered arterial blood pressure showed only low T but the two cases of bronchopneumonia had low T and marked ST depression. Sinus tachycardia was seen in all cases.3) The cause of decreased arterial blood oxygen saturation Although it is commonly thought that there should be an increase in the ineffective pulmonary blood flow in such conditions as in the present cases, it was made clear that the decrease of alveolar air oxygen partial pressure and the disturbance of alveolar diffusion are the main factors which cause the decrease in the arterial blood oxygen saturation.4) The cause of the electrocardiographic changes By referring to the results obtained by coronary catheterization studies done in our medical department, it can be considered that the cause for the electrocardiographic changes in pneumonia is a decrease in the cardiac oxygen consumption while the cardiac work increases. And, it was made clear that, although the electrocardiographic findings may be minimal especially when the arterl blood pressure is low at the same time, the state of the patient should be estimated carefully by considering the results of various other tests.

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As previously seported, we can determine from ballistocardiogram the pulse volume at the end of aorta. As this blood volume is the one which goes to legs, we can estimate how much blood is distributed to legs, and how much to abdominal region (especially to kidney). By this principle the authour investigated the distribution of blood in congestive heart failure and its recovering phase. In congestive heart failure, relatively much blood goes to legs, and in recovering state relatively little blood goes to legs. This fact means that congestive heart failure belongs to same pattern as that of exercise, anemia, fever time in regard to the distribution of blood i.e. this pattern indicates the increase of demand of blood in muscular regious. As more blood goes to legs in congestive heart failure, if other conditions equal, more blood returns to heart, reversely as less blood goes to legs in recovering phase, if other conditions equal, less blood returns to heart, it means that distribution of blood tends to in one sense negate the functional state of heart. In other words, when cardiac output diminishes in congestive heart failure, much blood would be able to return to heart by change of distribution of blood, that may not actually but virtually promote the cardiac action. So called backward congestion is, I think, this virtual promotion of cardiac action. When this vertual promotion become actual, it is recovering state. In recovering state, as less blood returns to heart by means of distribution of blood, if other conditions equal, it negates the increasing tendency of cardiac output in recovering state i.e. cardiac function is not so strongly promoted as expected. Thus heart is protected from too much venous return. Diuresis can be regarded as a important expression of this protecting mechanism of heart.

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The Lutembacher's syndrome is one of the very rare diseases. A few reports concerned have been presented in Japan, and there were only two cases that were diagnosed as Lutembacher's syndrome with cardiac catheterization.We report here a case in which we suspected the diagnosis of Lutembacher's syndrome, first by means of routine clinical examinations and finally confirmed the diagnosis by cardiac catheterization.The patient was a 62 year-old, married female. Chief complaints were palpitation and edema of the whole body. Her family and personal history were not significant. When she was a child her family physician told her that her heart was "weak", but she had 9 deliverys and no trouble with her daily life.The physical examination revealed; An enlargement of the area of cardiac dullness to both sides, and the cardiac pulsation was palpated over a large area near the sixth intercostal space and the center of this area was 3 cm left of the midclavicular line. Slight systolic, and rumbling diastolic murmurs were heard at the cardiac apex. There were also a strong systolic murmur and an accentuation and separation of the second sound at the auscultatory area of the pulmonary ostium (Fig. 1, Fig. 5).Arterial blood pressure was 140/80 mmHg. Venous pressure was 250 mm H₂O. The congested liver was palpated and signs of congestive kidney were present in the urine. On a X-ray of the heart (Fig. 2), we observed a hill-formed enlargement of the second left arch, enlagement of the third and forth left arches and the second right arch. On an oblique X-ray of the heart (Fig. 3), we saw the enlarged shadow of the left auricule and pulmonary artery. Hilar dancing was seen with the fluorescopic examination. On the electrocardiogram we found auricular fibrillation with premature ventriclar beats, a high degree of right ventriclar hypertrophy and right axis deviation (Fig. 4).From the above findings we suspected the Lutembacher's syndrome and the cardiac catheterization was performed for its confirmation.The results of cardiac catheterization (Tab. 1, Fig 6) : The O₂-content of the blood in the right auricule (11.8%) was 3% higher than that of the vena cava cranialis and caudalis (7.9∼9.6%). This fact shows the presence of a left-to-right shunt in the area of the right auricule.The calculated blood flows were as follows : The flow of the systemic circulation was 5.3 l/m, that of the pulmonary circulation was 12.6 l/m and that of the interatrial shunt was 7.3 l/m. Consequently, the blood flow of the pulmonary circulation was more than twice as that of the systemic circulation.The intercardiac pressures were as follows : In the right auricule the maximum, the minimum and the mean values were 29, 14 and 20 mmHg ; in the right ventricle 93, 0 and 43 mmHG ; and in the pulmonary artery 80, 32 and 47 mmHg. The values of the pulmonary arterial wedge pressure were 37, 21 and 29 mmHg. Each of these values were remarkably higher than normal.Diagnosis : In order to interpret the meaning of these values we compared the values of our case with those found in the literature (Tab. 2).Three types of left-to-right shunts in the area of the right auricule, which are not complicated with mitral disturbances (II, a. b. c.), can be excluded, because there is no raise of the right auricular pressure, while in our case the right auricular pressure is remarkably elevated. In mitralstenosis which is not complicated with an interatrial comunication (III), the right auricular pressure is not raised as high as in our case. In cases of left-to-right shunt, in the area of the right auricule, other than interatrial communications, which are complicated with mitral disturbances (IV, a. b.), the right auricular pressure would not be elevated, hence those cases should be excluded.

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