Studies on intraventricular conduction in the presence of bundle branch blocks by using direct leads have been carried out by the investigators such as Sodi-Pallares, Prinzmetal and Scher. In spite of the bulk of data, they are far from completeness in explaining the detailed mechanism of the modification in conduction which occurs in these conditions.It is essential to obtain the over-all picture of the mechanism of conduction in bundle branch blocks for the refinement of theoretical explanations of the ECG patterns of clinical bundle branch blocks.Such a knowledge should offer an important clue to the function and its peculiarity of the specialized conducting muscle fibers. Thus, conductions in the ventricular free walls as well as the interventricular septum in experimentally produced B. B. B. in the canine heart were investigated in this study.Three types of electrodes for direct leads were employed, i. e., one for multiple lead recordings, one for contiguous bipolar leads, and one for unipolar leads, all of which were specially designed for the purposes of this study.The electrodes which were provided with arrowheads were pierced through the cardiac muscle while protected with an injection needle; this technique and the design of the electrodes permitted to fix the electrodes at one site without risk of shift during the experiment.The locations of the electrodes were checked after each experimental animal was dead.To produce B. B. B. experimentally, a sickleshaped scalpel was introduced into the cardiac cavity through the ventricular free wall to incise the portion of the septal muscle close inferiorly to the bifurcation of His' bundle.R.B.B.B. was obtained by cutting at a relatively small area in the anterior portion of the right septal surface, while L.B.B.B. was produced by cutting from the extreme front to the back at a level of 1 cm below the aortic valve; this difference may be due to the difference in the anatomical structures of the two B.B.An eight-channel direct-writing electrocardiograph and a two-beam cathode ray oscilloscope were used for recording.The paper in the electrocardiograph was run with a speed of 150 cm/sec.; the photographic paper of a continuous recording unit to record the waves on the oscilloscope was run with a speed of 20 cm/sec. Such high speeds were mandatory to register minute differences in time accurately.The peak of the main deflection of the contiguous bipolar lead was accepted as the indicator of the arrival time of activation; in unipolar lead ECGs, the onset of the steepest portion of their downward deflection was used. The time was measured from the earliest QRS onest of the multiple simultaneous recordings. These two indicators coincided each other very well as Durrer's observations.Results Incontrast to the conduction in the non-blocked side which remains the same as before, the conduction in the blocked side exhibits drastic changes.A) R.B.B.B.1. Epicardial surface of the right ventricular free wall In R.B.B.B., the excitation started at the portion of the posterior wall adjoining the septum, then the portion of the anterior wall adjoining the septum, spread from posterior to anterior, from below upward, and ended at the basal portion of the antero-lateral wall, while in the normal, the conduction started at the central lower area of the anterior surface, and ended at the basal portion of the portero-lateral or lateral wall.

View full abstract

1) A study is made of the VCG patterns using Grishman's and Kimura's cube system of 48 cases with complete right bundle branch block (RBBB) and 32 cases with incomplete RBBB, in comparison with 17 cases of mitral valvular disease showing rSR'-V₁ pattern (QRS duration <0.11 second) in the ECG (Table I). Relations between the configuration of the QRS loop and the subtype of RBBB in the ECG or the underlying disease, and those between the configuration of the T loop or S-T vector and the ventricular gradient are analysed.2) There is a certain relationship between the orientation of the QRS loop in the VCG and the subtype (following the classification by Bayley, Pardee, and Lepeschkin) of RBBB in the ECG in the frontal plane. In the present study, the aforementioned criteria of the classification is applied also for incomplete RBBB. Eight cases which resemble Subtype IVa, but having narrow S_III, are classified tentatively as Subtype IVa' (Fig. 1).The main part of the QRS loop of Grishman vector is mostly oriented to the right and inferiorly or to the left and inferiorly in Subtype I, to the left and inferiorly in Subtype II, III, IVa and IVa', and to the left and superiorly in Subtype IVb, Va and Vb, and that of Kimura vector is mostly oriented to the right and inferiorly or to the left and inferiorly in Subtype I and II, to the left and inferiorly or to the left and superiorly in Subtype III, to the left and inferiorly in Subtype IVa, IVa', IVb, and extended superiorly and inferiorly in Subtype Va and Vb.The terminal appendage of Grishman vector is mostly oriented to the right and superiorly or to the right and inferiorly in Subtype I and II, and to the right and superiorly in the other subtypes. The terminal appendage or terminal portion of Kimura vector is mostly oriented to the right and superiorly or to the right and inferiorly in Subtype I and III, to the right and inferiorly in Subtype II, and to the right and superiorly in the other subtypes. But the direction of inscription or the configuration of the QRS loop in the frontal and horizontal planes in each case is closely related to the underlying disease, and is different although these cases are classified into the same subtype.3) Group L.-In this group, 30 cases with hypertension or with left ventricular enlargement on the x-ray are included. The main part of the QRS loop of Grishman vector (Table III) is mostly inscribed in a counterclockwise direction in the frontal plane and in the horizontal plane, and the terminal appendage is mostly inscribed in a counterclockwise direction in the horizontal plane (Fig. 4, 6, 7). The main part of the QRS loop of Kimura vector (Table V) is mostly in a counterclockwise direction in the frontal plane (Fig. 17, 19, 21, 22).Appedix : In five cases with myocardial infarction and RBBB, the initial portion and the main part of the QRS loop of Grishman vector are displaced to the opposite direction of the infarcted area, and the main part of the QRS loop is mostly inscribed in a counterclockwise direction in the frontal plane (Fig. 8, 9). The configuration of the QRS loop of myocardial infarction of Kimura vector showing nearly the same configuration as that of Grishman vector. But in the cases with anterior infarction, the initial portion of the QRS loop of Kimura vector is sharply displaced to the opposite direction of the infarcted area (Fig. 23, 24).

View full abstract

The SVEC III lead system propoesd by Schmitt in 1955 has been shown to yield orthogonal components of the equivalent heart dipole with an accuracy of relative transfer impedances of ±5.8 per cent in angle and ±10.2 per cent in length, for a group of 9 source-dipole positions located at the corners and center of the cube having a volume of 8 cubic inches which surrounds the heart center of a torso model. By making use of this corrected lead system. scalar recordings of its component leads, X, Y, and Z were obtained for 303 healthy adult male subjects who were selected by proper sampling and strict screening tests. The material consisted of 182 aged American Caucasians (mean age : 58.1, range : 54 to 64), and 121 young Japanese (mean age : 24.2, range : 18 to 29).The range of normal variation of the deflections in each lead was determined as well as the mean spatial QRS and T vectors constructed from the X, Y, Z leads in order to examine the characteristics of performance of this lead system with relation to the human body as a basis for studies on pathologic series. Further, analyses of the effects of the differences in age, race and body build are briefly presented.Amplitudes of the QRS and T of Leads X, Y and Z, and the distribution of positive, diphasic and negative deflections in each lead were statistically observed. The QRS of Lead X was predominantly positive (91.8 per cent in the younger group); that of Lead Y, predominantly negative (93.5 per cent) and that of Lead Z showing an RS pattern with the S usually being greater than the R. The lower limit of the R/S ratio in Lead X was 1.3. The R/S ratio of Lead Z revealed a correlation with the azimuthal angle of mean spatial QRS vector (QRS-H°) which is perpendicular to the position of the QRS transitional zone in the conventional precordial leads, indicating that the R/S ratio tends to be smaller in the clockwise rotation of the QRS transition.The T wave of Lead X was always positive; that of Lead Y, always negative; and that of Lead Z was almost always positive-rarely plus-minus diphasic, but if a diphasic wave occurred it always showed a minimal negative comonent.The frontal QRS axis calculated from Leads X and Y showed a correlation with the Einthoven QRS axis (r : 0.678), although the normal range of the former item (mean : 49.8, S.D. : ±18.2) was narrower and more horizontal than that of the latter (mean : 64.3, S.D. : ±21.

View full abstract

The specific conducitng systems in the atrial portion have been discussed physiologically and histologically by many investigators for a long times. Namely, on one hand, Rothberger & Scherf, Condrelli, Maekawa, Takayasu, Koch, Monckeberg, Holmes, Tandler, Thorel, Nomura, Wakayama and Kung have affirmed its existence. On the other hand, Glomset & Birge, Tamura, Sodi-pallares, Koor were not agreeable. The author performed the histological examination to expain the point of these rival opinions.Methods : The atrial portion in normal 34 dog's hearts were studied by means of the serial transverse and longitudinal sections. The sections of the heart muscles were stained mainly by the Van-gieson's method, and for reference, some by the Best's carmin glycogen method and Mallory's azan method.Standard of the specific muscular fibers : They were the speciallized muscles in the group of the connective tissue, nervous tissue and arteries etc. as the muscular bundles which were similar to the so-called Purkinje's fibers, namely rich in protoplasma and poor in myofibrille with small and massed muscles. Also in the atrial portion, they were finer than the ordinary heart muscles and similar to the tissue of the sinus node and the Tawara node.Results : In this report, mainly, the sinus node and Tawara node were examined. The results were as follows.1) The sinus node was observed. clearly in all the investigated dog's hearts. They were organized by so-called specific cardiac muscular fibers. The findings of the situation, form and fine structure were nearly agreeable with the past reports by many investigators (Keith & Flack, W. Koch and the others).2) The Tawara node was observed clearly in all the hearts.A) Histological fine structure was nearly the same as the findings reported by Tawara and the other investigators.B) On the situation of the Tawara node; In 7 cases of the 26 dogs sacrificed for this study, they were situated near the coronary sinus. In another 19 cases, ther were situated at the Trigonum fibrosum dextrum from the middle part of the atrial septum.C) On the form of the Tawara node at the Trigonum fibrosum dextrum; It formed a triangular shape so that the base was at the aortic side and apex was at the orifice of the coronary sinus. A further triangular conical shape that had the base built by this triangle was formed. The apex of the triangular conical shape was connected with the Systema septo-angularis anterior, to be stated later. And the apex of the side to the coronary sinus was connected with the left and right atrial bundles. The apex to the Septum membranaceum was connected with the His bundle.D) The so-called second node stated by Freund, Takahashi and Fukuhara was not found near the orifice of the coronary sinus.

View full abstract

Since the sinus node was discovered, two different theories were discussed on the atrial stimulus conduction, namely one through the specific heart muscle, and the other, radiation spread through the proper muscle. And by the theory which recognized the stimulus conduction system between the sinus node and atrio-ventricular node, it's existence was surmized in the interatrial septum.Then, in this paper, the spread of the excitation on the surface of the interatrial septum was studied.The isolated dog's hearts were perfused by Langendorff's technique and placed in the great vessel. As perfused solution, the defibrinated blood was added to Lock's solution. The E. C. G. was recorded simultaneously by means of the direct unipolar leads with the different electrodes, one at the interatrial septum and the other at the sinus node in the superior vena cava and the indifferent electrode at the great vessel.The excitation arrival was measured at many points of the interatrial septum. The time arrival in the intrinsic deflection was at the point it crossed the zero-line by "chain doublet theory" which Prof. Maekawa advocated.The summary and conclusion of this study are as follows : The electrical leads were performed at the right surface of interatrial septum in 10 cases and at the left surface of interatrial septum in 6 cases. 1) The excitation spreaded earliest at times around the orifice of the superior vena cava and next from the cranial area to the caudal area of the Torus Loweri and then to the inferior vena cava side on the atrial septum, neighbourhood of the atrio-ventricular node and coronary sinus. 2) The arrival of the excitation at the neighbourhood of the atrioventricular node was delayed commonly as compared with it at the other area of the right side of the interatrial septum, but it was found that the excitation at a point arrived earlier than the other point on the neighbourhood of the atrioventricular node in some cases. 3) The excitation at the left side of the interatrial septum arrived in various ways but generally it was thought that the excitation were caused along the muscle bundle which was related by Osawa from the anteriorsuperior area of the interatrial septum to the other areas. 4) By the results of this study, it could not be confirmed that the specific pathways were between the sinus node and atrio-ventricular node, and also the excitation was diffusive.

View full abstract

The changes of cholesterol transport mechanism in hypercholesterolemia of cholesterol-fed chicks were examined by means of starch electrophoresis.The mean value of serum total cholesterol in chicks (RO group) receiving normal mash diet supplemented by 5 per cent cottonseed oil was 83 mg per cent. Cholesterol content in albumin and α₁-globulin, α₂-globulin, β-I, β-II, β-III and γ-globulin was 47 mg%, 8 mg%, 3.5mg%, 3.6 mg%, 16 mg% and 5 mg%, respectively. In other words, cholesterol content was highest in albumin and α₁-globulin.In COI group, the serum total cholesterol was 281 mg per cent. Cholesterol content in albumin and α₁-globulin, α₂-globulin, β-I, β-II, β-III globulin and γ-globulin was 62 mg%, 20 mg%, 56 mg%, 82 mg%, 51 mg% and 12 mg%, respectively. Cholesterol increased in each protein fraction, but the degree of increase was not similar. It increased more markedly in β-I and β-II of β-globulin.In COII group, the serum total cholesterol was 1158 mg per cent. Cholesterol centent in albumin and α₁-globulin, α₂-globulin, β-I, β-II, β-III and γ-globulin was 113 mg%, 301 mg%, 383mg%, 366 mg%, 38 mg% and 16 mg% respectively. Cholesterol increased markedly and was highest in α₂-globulin, β-I and β-II.While the β-lipoprotein/α-lipoprotein ratio which was determined by paper electrophoresis was 4.6 in RO group, the β-lipoprotein cholesterol/α-lipoprotein cholesterol ratio was 0.50. In COI proup, the β-lipoprotein/α-lipoprotein ratio and β-lipoprotein ratio and β-lipoprotein cholesterol/α-lipoprotein cholesterol ratio were 21.7 and 21.6 respectively.

View full abstract

While considerable attention has been given to the effects of hypercholesterolemia on the aorta and coronary vessels, limited work has deen done on the tendency to lipid infiltration of the cerebral arteries. In the present study I have given particular attention to the effects of cholesterol feeding on the tendency to lipid infiltration of the cerebral arteries, and have examined the effect of estrogen adminisrtation on these and other arteries.Chicks receiving a normal mash diet showed no arterial fatty infiltration or atheroma. When the diet was supplemented for 8 weeks with 2 per cent cholesterol and 5 per cent cottonseed oil, hypercholesterolemia resulted and lipid infiltrations were observed grossly as well as microscopically in the aorta. Lipid in filtration in the arteries of brain, heart, kidney, liver and spleen was also demonstrated. However, the intrapulmonary arteries showed no atherosclerotic chahges.Administration of estrogen to chicks on this cholesterolised diet resulted in a somewhat higher cholesterolemia and a more marked lipid infiltration of the aorta. However, the intima of the coronary arteries was free from fatty infiltrations. The intracerebral arteries and intrarenal arteries showed similar marked reduction in lipid infilration. The arteries of liver and spleen remained unprotected.

View full abstract

The author described in the previous report that the crude Kidney-ATPase (fraction W) extracted from rats with Weber-Edsall's solution had marked and sustaining pressor effects in both systolic and diastolic pressure, when it was injected into anesthetized rats. This experiment was performed to produce sustained hypertension in rats by repeated administrations of Kidney-ATPase.(1) The Dog-Kidney-ATPase (3-1 cc) was injected into the abdominal cavity of 6 rats for 10-11 days, but the blood pressure was not elevated. In a few days the tails of rats became edematous, hemorrhagic and ulcerated. When the crude Kidney-ATPase was furtheremore injected in succession, general condition of animals became worse and their tails became necrotic at the same time. Histologically, the author found edematous and necrotic changes in tails, hemorrnage in the media of tail artery in two rats, but changes in kidney were slight.(2) In order to avoid allergic reactions, the crude Rat-Kidney-ATPase (1-3 cc) was injected into abdominal cavity of 6 rats for 26 days, and then with an interval of 15 days injected subcutaneously 4 of 6 rats for 15 days, but the blood pressure had not elevated. The histologic changes in kidney were slight. Capillary bleeding, cell infiltration and degeneration of heart muscle were found in the hearts of 3 rats, which showed edema and bleeding in the end of tails. The fact suggests that an intimate relation consists in pathological changes between the heart and tail.These two experiments revealed that the crude Kidney-ATPase had a vasotoxic factor besides the pressor factor.

View full abstract

The author made histopathological study on various types of experimental hypertension, i. e., renal, neurogenic, salt loading or DCA hypertension.Special attention has been paid to the relation between the observed histological lesion and the magnitude of hypertension or the method whereby to produce hypertension, in an effort to disclose the underlying mechanism of experimental hypertension. The results were as follows : 1. Different methods whereby to produce hypertension result in similar histological change which is of essentially the same character with that of hypertension in man.2. With regard to neurogenic hypertension, magnitude of renal lesion was independent upon that of hypertension. Instead, it was rather linearly proportionate to the length of time allowed after the peformance of operation.3. As to renal hypertension, magnitude of renal lesion was not proportionate with that of hypertension. Moreover, pronounced renal lesion occurred in the absence of hypertension.4. Abruptly developing hypertension of severe degree resulting from pressoreceptor denerving or renal hypertension-inducing procedure was found to cause enlargement of glomeruli and exudation into the Bowman's capsular space.5. In salt hypertension induced animals, most pronounced lesion occurred in fully loaded animals. However, no clear relation existed between the magnitude of lesion and that of hypertension. With cessation of salt loading, blood pressure gradually fell off and it appeared that the histological lesion regressed roughly proportionately to the length of cessation. This regression, if it is such, of histological lesion appeared due, not to the fall of blood pressure, but to the cessation of salt loading itself.6. In DCA hypertensive animals there occurred enlargement of convoluted tubule as it was the case with salt hypertension. This change occurred in great severity in those treated in conjugation with salt. With same degree of hypertension, this lesion was pronounced exclusively in unilaterally nephrectomized rats. In DCA hypertension as well as in salt hypertension, therefore, important is the retention of sodium.7. No definite relation existed between the hypertrophy of the heart and hypertension or its duration.8. Generally, the more extensive the injuried area, the more striking the hypertension.It is concluded that the elevation of blood pressure can not be simpley correlated to the lesion in the kidney, heart and blood bessels with classical inference of cause and result, that the two, on the contrary, should rather be treated as a unity. The author approves the theory, which explains the matter clearly, the disturbance in ATP-ATPase system causes elevation of blood pressure, and at the same time, lesion of blood bessels.

View full abstract

1. Changes in wave form of B.C.G. induced by the weight of a wooden shin-bar were studied in 7 cases (6 normal, 1 coarctation of the aorta) by placing the bar mounted a Smith' type pickup on the upper and the lower shins. In both situations especially in the latter, (1) IJ-segment amplitude, (2) JK : IJ ratio and (3) diastolic waves were augmented.2. In the above cases, the effect of the fixing device on the B.C.G. was studied. By the use of this fixing device, there was only a slight increase in IJ-amplitude, but no increase in other two subjects.3.By comparing them with the waves simultaneously recorded by von Wittern's table, it is concluded that all the above three changes are due to incompleteness of recording techniques.By measuring the natural frequencies and damping factors of human body and shin-bar, and by assuming the main frequency component of IJ-, JK-segment from their wave durations, I considered that the above wave form distortions were due to the vibrations of each component of the complex vibrating system composed of table (base), body structure and shin-bar.

View full abstract

By the use of ballistocardiograph of modified von Wittern's table which has natural frequency of 0.6 cps. and is capable of taking simultaneous two directional records, longitudinal and lateral or sagital records were taken on 6 cases with pulmonary stenosis, 6 cases with patent ductus arteriousus, 11 cases with atrial septal defect, 8 cases with ventricular septal defect and 5 cases with coarctation of the aorta, and these records were analysed from the view points of hemodynamics studied by right heart catheterization. Thus the following results were gained.1. Pulmonary stenosis : Longitudinal IJ_M showed a tendency to be decreased but Ra and IK/IJ ratio had a tendency to be decreased. In cases with elevated right ventricular pressure, as compared to those of low right ventricular pressure, the ratio of amplitude of lateral and sagital systolic wave complex to that of longitudinal IJ_M tended to be increased. There was also a tendency for R-I interval to be shortened and for R-J interval to be prolonged.2. Patent ductus arteriosus : Longitudinal IJ_M, Ra and JK/IJ ratio showed a tendency to be increased and HI/IJ ratio tended to be decreased. In cases with great shunt flow (shunt rate of more than 50%) and elevated pulmonary arterial pressure, lateral and sagital systolic wave complex showed a marked increase in the amplitude. R-J and R-K interval ahd a tendency to be shortened. On the other hand, they were prolonged in two post-oprative cases.3. Atrial septal defect : Longitudinal IJ_M and Ra showed a tendency to be decreased. In cases with high shunt rate and elevated right ventricular pressure, lateral and sagital systolic wave complex showed a increased amplitude. R-I and R-J interval tended to be shortened.4. Ventricular septal defect : Longitudinal IJ_M and Ra showed a tendency to be decreased. In cases with high shunt rate, there was an increase in amplitude of lateral and/or sagital systolic wave complex. The increase in the amplitude was slight in cases with right to left shunt.5. Coarctation of the aorta : Longitudinal IJ_M and HI/IJ ratio tended to be increased and in all cases JK/IJ ratio showed a marked decrease.6. In deseases with left to right shunt flow (patent ductus arteriosus, atrial septal defect and ventricular septal defect), there was a positive correlation between shunt rate and the ratio of resultant force vector of lateral and sagital component to longitudinal force vector.

View full abstract

The authors described here our experiences of treating 130 patients with neurocirculatory asthenia or allied neuroses admitted to Maekawa Clinic of Kyoto University from 1954 to 1957. Namely, we investigated the effect of the rest, tranquilizer, Mephenesin, Bellergal and adrenal steroid hormones upon various somatic symptoms of these patients, for example, general lassitude, insomnia, headache, dizziness, tinnitus, stiff neck, stiffness of the shoulder, palpitation, dyspnea, discomfort of the chest, chest pain, nausea & vomiting, abdominal discomfort, abdominal pain, constipation, and diarrhea etc.1)In two third of the patients, their various complaints in their numbers and severity have subsided after about one week bed rest following the admission. Complaints subsided or improved by the rest were as follows : i. e. chest pain, discomfort of the chest, palpitation, dizziness, dyspnea, constipation, and general lassitude. But abdominal pain, stiff neck, stiffness of the shoulder and tinnitus were not much improved.For the obstinated complaints which still existed even after the bed rest;2) Tranquilizer was effective upon insomnia, nausea & vomiting, and was slightly effective for palpitation which is one of the four cardinal symptoms of neurocirculatory asthenia-palpitation, dyspnea, chest pain and general lassitude.3) Mephenesin was specially effective upon headache, dizziness, dyspnea, stiffness of the shoulder and the neck, and slightly effective upon insomnia, and palpitation.4) Bellergal was effective upon headache, dizziness, palpitation, dyspnea, stiffness of the shoulder and the neck.5) Adrenal steroid hormones were effective upon stiffness of the shoulder and the neck, palpitation, dyspnea, chest pain and discomfort of the chest.6) Intrathecal injection of hydrocortisone was effective upon sciatica, but concerning this injection, further research for the technic will be necessary.

View full abstract