The Japanese Circulation Society jointly has performed epidemiological study on cardiovascular diseases in Japan. The participants were 22 clinics of university hospital and hospitals affiliated to medical schools. We picked up rheumatic and coronary heart diseases and essential hypertension as the subjects for this study.We made adjustment for diagnostic criteria and subject matters and compiled reports on each case. We had some difficulty connected to this kind of investigation ; those were difference in practical manner of application of the diagnostic standard or in density of description of reports. For this reason some of the reports had to be omitted from this survey. Therefore, we can't say that our study was perfect, but we believe it was sufficient to reveal the present day trend of epidemiology of cardiovascular diseases in Japan and also it has an important meaning as a mile stone for this kind of research in Japan.

抄録全体を表示

The sinus node, the Tawara node and the sino-right and sino-left atrial systems were studied in the preceding report I and II. This report was carried out on the examination of the specific pathways connected between the sinus node and the Tawara node. The materials and methods were as same as that were stasted in report I.Results : The main pathways are summarized as follows.1) This system is named "Systema septo-angularis anterior".Namely, this system, arising from the projection of the head of the sinus node, passing over the cava venous appendage's angle, along the subendocardium in the Bachmann's bundle of the aortic side, arriving at the upper point of the angle of junction of the anterior right atrial septum with the right atrial body in the aortic side, descending along this angle, and then connecting with the main part of the Tawara node.2) This system is named "Systema septisinistra".Namely, this system, arising from the projection of the head of the sinus node, passes with the Systema septo-angularis anterior, arriving at the upper part of the later, further crossing the atrial septum to the left septal side. Also, it builds a small muscular bundle at the left atrial septum, and runs obliquely under and back in the subendocardium of the left atrial septum. After that, it connects with the left atrial bundle near the transitional part between the left atrial septum and the left posterior atrial body. Finally, it connects with the head side of the Tawara node by way of the left atrial bundle.3) This system is named "Systema septo-angularis posterior".Namely, this system, arising from the tail part of the sinus node, passes around the posterior body over the cava venous angle, entering into the right atrial septum in the upper part of the Torus Loweri, descending in the subendocardium of the posterior side of the right atrial septum near the junction of the atrial septum with the right atrial body, surrounding the coronary sinus under the Valvula Eustachi. Then, passing obliquely under and front, it connects with the head of the Tawara node.4) This system is named "Systema dextro-atrii caudalis".Namely, this system, arising from the tail part of the sinus node, descends along the Arteriola sini in the subepicardium of the anterior wall of the right atrial body, passing around the posterior side appoximately at the angle between the anterior body and the V. cava inferior in the level of the atrioventricular orifice. It then cnnects with the head of the atrial septum under the coronary sinus.5) The pathways connected with the head of the Tawara node are named "Right atrial bundle" and "Left atrial bundle".The right atrial bundle consists of the union with the Systema septo-angularis posterior and Systema dextro-atrii caudalis. This bundle situates at the subendocardium of the right atrial septum from the under part of the coronary sinus to the head of the Tawara node. The left atrial bundle connects with the Systema septi sinistra, and is situated at the subendocardium of the left atrial septum from the posterior part of the left atrial septum to the head of the Tawara node.6) In the Torus Loweri reported by Monckeberg or Scherf, the specific muscular fibers were not found.7) The so-called second node stated by Freund, Fukuhara and Takahashi was not observed.

抄録全体を表示

The measuring of the venous pressure is one of the valuable clinical tests in the diagnosis of heart diseases, especially in the diagnosis of right ventricular heart failure and cardiac edema. In measuring the pressure, we generally follow the method advocated by Moritz and Tabora, namely, we choose the zero point 5 cm below the 4th sternocostal junction and measure with an apparatus of our own design.The average venous pressure in 95 normal cases in the age range of 15 to 70 years is 87.5±25.7 mm H₂O, with the maximum of 162 mm H₂O, and the minimum of 27 mm H₂O. The average in the age range of 15 to 19 years is 113.5 mm H₂O ; that in the range of 20 to 29 years is 86.7 mm H₂O ; that in the range of 30 to 39 years is 83.6 mm H₂O ; that in the range of 40 to 49 years is 78.1 mm H₂O ; and that of over 50 years is 64.8 mm H₂O, showing a decreasing tendency with advance in age.As regards the relationship between the venous pressure and the mean arterial pressure, it seems that in the case with a relatively high mean arterial pressure the venous pressure tends to be lower. However, there is no specific relationship between the venous pressure and the weight-to-height ratio.In case the abduction of the arm is changed to 90°, 45°, or 0°, a considerable variation can be observed in venous pressures. Judging from this, we believe that it is advisable to choose the angle of about 45° as the basis from which the angle is to be changed and then obtain the minimum pressure.

抄録全体を表示

1) The normal mean valve of aortic GO-T activity, which was determined by the present author for the first. Time in the world, was approximately 4, 300 Tonhazy unit in 44 examined rabbits, being equivalent to I/40 of hepatic activity meanwhile determined. The normal range of aortic GO-T activity was smaller in comparison with that of the hepatic and serum GO-T, as to suggest the possibility that the arterial tissue might be "Protein Stable".2) In lanolin-fed rabbits (L), marked rise and fall were noted in aortic GO-T activity in the cource of atherma formation. The abrupt depression in the enzymatic activity prior to the macroscopic atheroma development was particularly of interest.3) The development of atheromatous plague were found accelerated by both castration and androgen administration (CL and ACL), in case of the latter (ACL), depressin in aortic GO-T activity was extremely dramatic. Effects were hardly noticed on the occasion of estrogen administration (EC and ECL), neither enzymologically nor morphologically.4) Elevation in aortic and hepatic GO-T astivities were induced by thyroxin administration (T) and, contrarily, depression of the both was noticed when lipide administration was combined together (TL). Another "Pre-artheromatous" edpression in aortic GO-T activity was encountered on the occasion of thiourcil administration (M vs. ML), where atheramatous lesions developed, too.5) It was shown that the changes in aortic GO-T activity were peculiarly different from the hepatic and serum activities either when lanolin, estrogen, androgen or thiourcil was administered but thyroxin. The attitudes, hepatic and serum GO-T activities took, seemed always opposite each other. On the other hand, the degree of hypercholesteremia and/or of increase in L. I. were shown not always parallel to that of atheromatous lesions.6) From the fact that a definite tendency was noted upon the changes in aortic GO-T activity during atheroma formation, which have been observed on these series of in vitro experiment, it is suggested that glutamic acid metabolism of the aortic tissue may play an important role on genesis of atherosclerosis.

抄録全体を表示

The mass survey on coronary artery disease (CAD) was perfomed during the period of 1956 to 1958 in Tokyo. This study was concerned with the incidence and grade of CAD in four male populations aged above 40, and the methods of laboratory examination and the criteria of clinical diagnosis of CAD were also discussed.Inquiry of detailed medical history and physical examination including blood pressure measurement were carried out by physician. In addition, height and Weight were measured, and ECG and chest X-ray film were examined.Total number studied at initial examination was 1122 cases which were classified into four populations, namely, officers, clerks, professors and medical practitioners.Of these cases, 487 were reexamined in 1 to 2 years follow-up period.The classification of CAD was based upon the criteaia shown below : GROUR I : Infarction.GROUP A : 1) Coronary T 2) Positive exercise test 3) Abnormal S-T deviation (over 0.05 mV.) with B. P. under 179/99 mmHg.GROUP B : Abnormal ST-T deviation and/or significant cardiac enlargement with B. P. over 180/100 mmHg.GROUP C : 1) Low voltage 2) Prolongation of PQ interval (over 0.20") 3) Bundle-branch block 4) Prolongation of QRS complex (over 0.01") 5) Abnormal ST-T deviation (under 0.05 mV.) with B. P. under 179/99mmHg. 6) Significant cardiac enlargement with B. P. under 179/99 mmHg. 7) Arrhythmia beginning after middle age.GROUP D^* : Hypertension (over 160/90 mmHg.) without electrocardiographic. and roentgenologic abnormalities GROUP E^* : No abnormalities.(^*Group D and E are not CAD.)1) In 32.8 per cent of all cases, hypertension over 160/90 mmHg. was found, and prevalence rate of hypertension showed a positive correlation with age and relative weight. But there were no differences in prevalence of hypertension between four populations.2) There were no cases with myocardial infarction, but group A was found in 2 to 3 per cent, group B in 9.3 per cent and group C in 24.8 per cent of apparently healthy indiviauals.3) Diagnosis of group A was made in 1.0 per cent of cases aged 40 to 49 years, in 3.8 per cent of 50 to 59, in 7.7 per cent of above 60. The prevalence rate of CAD was increased with age.4) The prevalence of CAD was higher in cases with high levels of blood pressure and/or relative weight than those with normal or low levels.5) Significant relationship of CAD to diet, smoking and alcohol intake was not demonstrated.6) The incidence of myocardial infarction or sudden death among 487 cases, which were reexamined at 1 to 2 years' follow-up survey, was 0.4 per cent (2 cases) and that of group A was 1.0 per cent (5 cases). All these cases showed some abnormal findings at the initial examination.7) In 1 to 2 years' follow-up period, no incidence of myocardial infarction or angina pectoris was seen in the group which was diagnosed as group A, suggesting the necessity of health control by mass survey.

抄録全体を表示

Recent observations in the field of lipid chemistry have suggested that disturbances in serum lipid metabolism may be responsible for the progression of the human atherosclerosis.The disturbances are (1) an elevation of the total serum cholesterol and (2) an increase in the concentration of certain serum lipoproteins, particularly those in beta-fraction.Thus, in order to establish a relationship between disturbances of the serum lipids and the coronary atherosclerosis, the determinations of the serum cholesterol and lipoprotein index (beta-fraction/alpha-fraction) were made on 329 officers and clerks.Then, 75 cases were reexamined one year after the initial examination and the reliability of blood lipid levels as a precaution for incidence of CAD was evaluated.1) In both the normal and the abnormal groups, most of the cases with high relative weight had high levels of total serum cholesterol and/or lipoprotein index. Higher average levels of total serum cholesterol and lipoprotein index in abnormal group than in normal may be caused by the fact that former group includes many cases with high relative weight.2) The group with aggravation in one year period had larger number of cases with high levels of total cholesterol and/or lipoprotein index at the first examination as compared with the group without aggravation.3) It was found that high levels of total serum cholesterol and/or lipoprotein index were associated not only with coronary atherosclerosis, but with overweight and with attacks of myocardial infarction or angina pectoris.4) For the evaluation of total serum cholesterol or lipoprotein index as an index of coronary atherosclerosis, relative weight and/or incidence of coronary heart disease must be considered.

抄録全体を表示

Ketone bodies as β-hydroxybutyric acid increase frequently in diabetes mellitus, and butyric acid may be produced in the intermediate products of fat metabolism and increase in diabetes. As diabetes is frequently attended with hypertension, it seems that the disturbance of metabolism is related to the development of hypertension. From this point of view, the author researched for the cause of hypertension by producing experimentally the pattern of diabetes, and then investigated the pressor effect of butyric acid, which were injected into normal and preessoreceptor denerved dogs, and furtheremore injected butyric acid intravenously for long time in order to produce sustained hypertension.(1) 200 mg. of butyric acid was injected into vein or pulmonary artery of two normal anesthetized dogs. By the first administration, butyric acid unconstant reaction in systemic blood pressure (mean), which was pressor or depressor. By the second administration, butyric acid showed no remarkable changes in systemic pressure. Butyric acid had a slight depressor or pressor effect in pulmonary pressure (mean).(2) 200 mg. of butyric acid was injected into vein or pulmonary artery of five anesthetized dogs, whose buffer nerves had been sectioned off, because such dogs react sensitively to pressor substances. Butyric acid had pressor effect of 6-54 mmHg in systemic blood pressure (mean) at 10 of 13 times, but had depressor effect of 10-24 mmHg at 3 times. The second and third administration of butyric acid had less pressor effect than the first administration, perhaps due to socalled tachyphylaxis. Butyric acid had pressor effect of 2-8 mmHg in pulmonary pressure (mean).(3) In order to produce sustained hypertension experimentally, 10-40 mg. of butyric acid was repeatedly injected intravenously into two normal dogs, which were given orally with 0.25-0.5 mg of atropine sulphate for a time. The blood pressure did not rise in one dog, but in another it was elevated to 160-180 mmHg and sustained. Histologic changes in kidney were marked, simulating the changes in experimental renal hypertensive animals. These changes were founed in two dogs, with or without hypertension, suggesting that these renal lesions were not proportional to the degree of hypertension.These experiments showed that the disturbance of metabolism played an important role in the development of hypertension, but specific metabolic disturbance induced by a chemical substance as butyric acid were not sufficient to yield satisfactory results. Therefore Professor Maekawa postulated a new theory that the true cause of hypertension might be disturbances of the ATP-ATPase system of cardiovascular system, from his extensive experimental and clinical studies.

抄録全体を表示

Glomerular filtration rate (GFR), Cosm, C_H2O and T^C_H2O were measured in water diuresis and also in antidiuresis to investigate the homeostatic mechanism of renal tubules in the diseased kidney.The term Cosm/GFR (×100) indicates the amount of osmolar water in the urine per 100 ml of GFR. In the recovery stage of acute nephritis slightly low value for Cosm/GFR was noted, suggesting that glomerular impairment exceeds tubular impairment. Conversely, below 50cc/min of GFR an ever-increasing volume of Cosm/GFR was brought about in chronic nephritis and a marked increase was noted in chronic renal failure. Urine flow during antidiuresis also increased in both of these conditions.These facts suggest that so-called osmotic diuresis has occurred because of the fact that an ever-decreasing number of functioning nephrons continue to excrete an essentially constant amount of solute, although little change in the total amount of solute in urine in advanced renal disease was noted.The significant correlation was found between C_H2O and GFR and between T^C_H2O and GFR, while C_H2O/GFR was within the normal range in acute and chronic nephritis, even in renal failure it was not markedly decreased. T^C_H2O/GFR, however, did not indicate constant value.The concentrating mechanism seems to be impaired before the diluting mechanism. Though C_H2O/GFR and T^C_H2O/GFR were not markedly decreased in chronic renl failure, urine osmolarity in both hydration and dehydration was almost equal to serum osmolarity, because of the marked increase of osmolar water per 100 ml of glomerular filtration.In nephrotic syndrome Cosm and T^C_H2O were almost equal to those of chronic nephritis, but C_H2O was decreased.Serum osmolarity in the early stage of acute nephritis was slightly elevated but was normal in the recovery stage.In chronic renal failure serum osmolarity was elevated as NPN rose. In some cases with nephrotic syndrome, serum osmolarity was also slightly elevated in spite of the fact that electrolyte and NPN were within normal range.

抄録全体を表示

In experimental hypopotassemia by hemadlialysis for 2hours, plasma potassium decreased down to 2.66 mEq/L, and decreases of RPF and GFR were found. However, increase of urine flow was not observed, this must be related that efficiency of the artificial kidney was not enough to cause intracellular potassium deficiency due to short duration of dialysis.In experimental hyperpotassamia by injection of 1.12% potassium chloride solution, decrease of GFR was observed. In cases with decreased GFR, RPF was also diminished, and so the decrease of GFR may be associated with change of RPF in hyperpotassemia.

抄録全体を表示