Four different rabbit groups of Masugi nephritis were made : group with Masugi nephritis, group with Masugi nephritis previously treated with ACTH, cortisone and unilateral adrenalectomy. The picture of serum and urine protein were investigated electrophoretically and the changes of kidneys and adrenals were observed histopathologically and histochemically. From results obtained, authors concluded that the picture of serum and urine protein presented very similar findings to human nephrotic syndrome or nephronephritis in previously treated rabbits and from the histopathological changes we think to have proved that disharmony of adrenal function caused the change of glomerulitis and marked increase of pathological change in tubuli, and disharmony of pituitary-adrenocortical system participates in the genesis of nephrotic syndrome.

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The author studied the influence of ""hi"" acid and ""cho"" sulfate on capillary fragility and permeability of guinea pigs with experimental hemorrhagic diathesis (scurvy, thrombopenic purpura, vascular purpura). Capillary permeability is determined by the concentration of T-1824 in the plasma, and capillary fragility by the Borbely negative pressure method. Capillary permeability and fragility of normal male rats did not increase or decrease by administration of ""hi"" acid or ""cho"" sulfate. The increase of capillary permeability and fragility in experimental scorbutic guinea pigs was ameliorated by administration of Vitamin C or ""hi"" acid. ""hi"" acid seemed to inhibit the increase of capillary fragility and permeability in experimental thrombopenic purpuric guinea pigs. Increased capillary fragility of experimental vascular purpura was decreased by administration of ""hi"" acid. It seemed that ""cho"" sulfate did not ameliorate the increase of capillary permeability and fragility in the experimental hemorragic diathesis. Capillary fragility and permeability were not always parallel each others. In experimental vascular purpura, when the capillory fragility began to increase, the capillary permeability decreased. The contents of acid polysaccharides in blood vessel walls in animals with experimental hemorrhagic diathesis were approximately the same as in normal animals.

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By means of the Electric Conductivity Method, the Venous Return and the Venous Flow in several kinds of organs were measured in the same case. The author reported how the Electric Conductivity Method was applied in the human body, and indicated the Return Flow and its bodily distribution in respective regions in nine cases in normal cardiovascular condition.

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Carbohydrate metabolism of the liver in a resting and fasting condition (Part I), and during induced hypoxaemia by 10% O₂ gas inhalation (Part II), was studied in man by the hepatic venous catheterization method.1) Studies in Part I revealed that in the patients with hepatic diseases, there were a functional decrease in the hepatic mechanism for the blood sugar regulation, reduction in the glucose releasing ability of the liver and impairment of the hepatic lactate and pyruvate metabolism. About half of the patients with non-severe types of pulmonary tuberculosis showed abnormalities in carbohydrate metabolism of the liver, suggesting hepatic disturbance.Studies under induced hypoxaemia in Part II revealed that, in the normal subjects, the amount of hepatic glucose release was increased during the induced hypoxaemia, and the amounts of hepatic uptake of lactate and pyruvate were increased. In patients with hepatic disturbances, including those with pulmonary tuberculosis, the studies with hypoxaemia made the various abnormalities of the carbohydrate metabolism noted above more apparent and easy to understand.2) It was found that the amount of glucose supply to the liver regulates the amount of glucose release out of the liver. During the hypoxaemia the organism must cope with an increased extrahepatic demand for glucose as the result of increased anaerobic glycolysis, and adapt to the changed cardiac output. To this end the following sequence of events seem to take place ; an elevation of the hepatic inhibition-threshold of the glucose supply (as irritation) to the glucose release (as reaction) → increased glucose release out of the liver → increased arterial blood glucose concentration → increased glucose supply to the whole body, especially to main glucose consuming organs.In the cases with hepatic disturbances, this hepatic regulation of the blood sugar was reduced.

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It is a recent trend that pulmonary functions are studied by the ventilation function, alveolar function and pulmonary circulation. When a venous catheterization is used, fine details of the pulmonary function can be obtained. This procedure test, however, is not very suitable for severaly ill patients because of its complicated manipulation and its load on the patients.The Oximetric Rebreath Test (ORT) originated in our clinic, has advantages over other tests that it is technically simple. Also, the test can cath even a relatively slight disturbance of the pulmonary function probably of oxygen intake without any discomfort to the patients. However, the nature of this method has not yet been fully clarified. According to Mito and Saji, the ORT and the vital capacity appear to have a tendency to correlate with eath other in cases of pulmonary tuberculosis, but hardly so in other pulmonary diseases. From this stand point, the significance of the ORT as a pulmonary function test is not yet clear. The author, therefore, attempted to study the correlation between abnormal ORT values and pulmonary functional disturbances found by the spirogram, venous catheterization etc. by the combined use of these tests and to make clear the essential significance of the abnormal ORT values in the pulmonary function test in general.Methods and Subjects : 1) The ORT is done, after application of the Ear-Oximeter to a patient's ear lobe, by having the patient make repeated breathing of the air in a bag of 5 to 6 liters in volume. At the point that arterial O₂ saturation begins to drop, the O₂ content of the air in the bag is measured by means of the Haldane or Scholander Gas Analyser. This value (O₂ vol%) is the ORT value. The grade of disturbance is determined in accordance with the criteria proposed by Saji who had revised somewhat the Mito's criteria. In the paper, however, the ORT value is given in terms of ter partial pressure instead of the volume percent.2) Test for ventilations : For this purpose the Aika-Benedict type respirometor was used, and for the measurement of residual gas volume an apparatus of the Keio University type was used. The expired gas was analysed by the Van Slyke-Neill's apparatus.3) Test for arterial blood gas : Blood samples were taken from the cubital artery. Blood gas analysis was done for O₂ and CO₂ content and capacity by the Van Slke-Neill's method and for O₂ and CO₂ partial pressure by a bubble balance method.4) Venous catheterization : In a fasting and resting state, a venous catheter is introduced into the pulmonaly arterial stem through the right ventricle, and the Fick's method was done, Analysis of the expired gas and blood gas was done. Analysis of the expired gas and blood gas was done by the above mentioned apparatus.5) Subjects for the tests consisted of 91 patients with pulmonary tuberculosis (73 males and 18 females) who are hospitalized in our hospital.Among these 91 cases, The ORT, spirometry and gas analysis of arterial blood were done in 51 cases, of which in 15 cases the pulmonary arterial catheterization was performed. In another 29 cases the catheterization and ORT were done. Also in a group of 11 cases the residual gas volume and the ORT were determined.Results and Conclusions 1) The correlation between the ORT and the various test : The ORT showed correlation with various tests. In the test of pulmonary capacity and ventilation it is well correlated with the % vital capacity, the % maximal breathing capacity, the % effective alveolar ventilation and the RV/TLC (residual volume/total lunge capacity) ratio. Concerning the pulmonary blood flow and the systemic arterial blood oxygen, the % of effective pulmonary blod flow, the arterial O₂ partial pressure and the alveolar-arterial O₂ pressure gradient are correlated well with the ORT values. [the rest omitted]

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The oximetric rebreath test (ORT) has proven to be an useful method in the physiological studies of pulmonary functions in our laboratory, since Hara and Mito originated it in 1952. The studies involving the ORT have been reported in detail by Mito and Saji.The present study was designed to recomfirm the significance of this test by comparing it with other pulmonary function tests in 103 cases of various cardiac and pulmonary diseases, such as pulmonary tuberculosis, acute pneumonia, bronchial asthma, pulmonary emphysema, pleuritis, various heart diseases and epidemic hepatitis. Especially, correlations between the ORT values and other pulmonary function values, such as ventilation volume, oxygen partial pressure in arterial blood (Pao₂) and its related alveolar oxygen pressure (PAO₂), were studied by performing these tests in the same patient, while they were breathing air in a resting state.Results 1. The correlation between the ORT value and arterial oxygen partial pressur : A significant negative correlation between the ORT value and the Pao₂ was recognized in the total number of cases (r=-0.573, p<0.01). The details concerning different disease groups are as follows : Pneumonia : in this disease, the ORT values were from 117 to 132 mmHg. (in normal subject, below 115 mm Hg.) and the Pao₂ were from 92 to 40 mmHg. The two has a highly significant negative correlation between each other (r=-0.948, p<0.01).Pulmonary tuberculosis : in this disease, the ORT values were from 110 to 135 mmHg. and the Pao₂ were from 99 to 75 mmHg. The two had a significant negative correlation between each other (r=-0.809, p<0.01).Heart diseases : in these cases, the ORT values were from 114 to 126 mmHg. and the Pao₂ were from 98 to 73 mmHg. The two had a significant negative correlation between each other (r=-0.656, 0.02<p<0.05).Epidemic hepatitis : in this disease, the ORT values were from 108 to 125 mmHg. and the Pao₂ were from 98 to 85 mmHg. The two had a significant negative correlation between each other (r=-0.618, 0.02<p<0.05).Further studies are required in bronchial asthma, pulmonary emphysema and pleuritis, to increase the number of cases.2. The significance of the elevation of the ORT value (oxygen partial pressure in the rebreath bag) : The ORT values were higher in the group of patients who have reduced arterial oxygen partial pressures than in normal subjects.The reason for this can be explained with Bohr's oxyhemoglobin dissociation curve as follows : When an initial decrease in the Pao₂ is present, an additional decrerse in the Pao₂ will cause more decrease in the SaO₂ than in subjects who have a normal, i.e., a higher Pao₂ in the beginning, due to the nature of the curve. Since the ORT value, i.e., O₂ partial pressure in the rebreath bag, is measured when the Sao₂ begins to fall (actually when it falls about 4 %), subjects with the initial decrease in the Pao₂ will register this fall more easily than those who have a normal Pao₂ in the beginning.From the above explanation, it can be understood why the group of patients with a normal PAO₂ and a normal Pao₂ have low ORT values (below 115 mmHg.), and in the group of patients with functional disturbances of the lung, i.e., in the cases in which the Pao₂ were reduced or in the cases where the Pao₂ was close to normal but the PAO₂ was elevated, the ORT values tend to be elevated. 3. [the rest omitted]

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The effect of pure oxygen breathing on the pulmonary circulation has been reported in animal by Von Euler and Liljestrand, O. Nisell, Straud and Rahn, and in human by Dressler et al, who concluded that the failling of the pulmonary arterial pressure, observed in this condition, was induced by dilatation of the pulmonary vasculature and was not resulted from a decrease in the cardiac output. The author studied on the effects of the pure oxygen breathing on the pulmonary circulation in patients with pulmonary tuberculosis. The mechanism of the falling of the pulmonary arterial pressure is discussed in this article.Materials and Method : Seven patients with pulmonary tuberculosis studied are consisted of three minimal, two moderately advanced and two far advanced cases, on the bases of the classification of the American Tuberculosis Association.The same methods and apparatus as described in the former chapter were used. The arterial oxygen saturation in pure oxygen breathing was calculated with a refererence to the results of Fasciolo and Chiodi, and all values over 100 percent were described as 100 percent.Results : In all cases, the pulmonary arterial pressure was fallen by the pure oxygen breathing and the fall was more marked in the systolic pressure than in the diastolic. Respiratory fluctation of the pulmonary arterial pressure became more marked when the patients were in the pure oxygen breathing.In few cases, reduction of the pulse pressure of the pulmonary artery in the oxygen breathing was found, and in the other cases except for two of far advanced cases, fall of the pulmonary arterial pressure continued for a considerably long period, in maximum around 20 minutes after cessation of the pure oxygen breathing.In four cases, wedge pressures were the same or slightly high in the pure oxygen breathing than those in the normal breathing.In four cases out of six oxygen saturation of the arterial blood reached 100 percent, but in the remaining two far advanced cases it did not reach 100 percent in the pure oxygen breathing.The pulse rates in the pure oxygen breathing were different in the cases examined, without a definite tendency.The shape of the pulmonary arterial pressure curve in the pure oxygen breathing showed the expansion of the elastic elevation, in contrast to the shape in hypoxia. Discussion and Summary : Six patients with pulmonary tuberculosis were studied by the right heart catheterization technique on the pulmonary arterial pressure in the oxygen breathing. Lowering of the pulmonary arterial pressure was observed, continuing for a considerably long time after the cessation.The following causes could be considered for the fall of the pulmonary arterial pressure in the pure oxygen breathing, as described previously by Dressler et al ; 1) decrease of the cardiac output, 2) fall of the pulmonary venous or left atrial pressure, and 3) dilatation of the pulmonary vasculature.It was impossible to known whether the cardiac output was decreased or not in the pure oxygen breathing ; because lack of the definite changes in the pulse pressure and pulse rate was remarkable in a series of studies presented here, both of which were postulated as good marks indicating changes in the cardiac output.Judging from the results obtained in the hypoxia study, it is of doubt that changes in the cardiac output are responsible for the falling of the pulmonary arterial pressure in pure oxygen breathing. In the pure oxygen breathing, the falling of the pulmonary venous or left atriel pressure is not thought to be occurred, because of being observed no changes or the elevation in the wedge pressure, which probably indicates the former two pressures.Therefore, the falling of the pulmonary arterial pressure, occurred in the pure oxygen breathing, should be caused by dilatation of the pulmonary vasculature.The changes in the shape of the pulmonary arterial pressure curve illustrated in Fig. 18 seem to show directly the dilatation of the peri

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Since the extrapleural synthetic resin plombage (hereafter abbreviated as plombage) was proposed by Nagaishi, it has sprad rapidly owing to its merit that it could dispense with the resection of ribs and could evoke the collapse of lesions selectively, thus making its disturbance upon pulmonary function rather slight. But in a little while it became to be scarcely practiced, chiefly according to the untoward postoperative complications. When plombage was adopted, studies on cardiopulmonary function were scarcely performed, and therefore there have been only a few reports on its effects upon cardiopulmonary function. This paper reports the present author's results of venous catheterization etc. on patients operated under plombage.Methods : The methods used for the venous catheterization etc. were similar to those in the first report of the present studies. The subjects were 5 patients under plombage, and one of them was similarly examined before operation.Results : The decrease in VC was pretty remarkable, while the decrease in MBC remained relatively slight. Minute ventilation was increased, but alveolar ventilation was normal, so alveolar ventilation ratio was found to be low. Arterial O₂ saturation was normal, but in one of these patients, on whom muscular exercise was imposed, arterial O₂ saturation dropped remarkably after exercise.Cardiac index tended to decrease in general, and it was decreased more remarkably in the group with high collapse than with moderate, and there was found statistically a significant difference between the two groups.Concerning pulmonary circulation, right auricular pressure was normal, but in the group with high collapse right ventricular pressure and pulmonary arterial pressure were both remarkably elevated, and the latter showed a significant difference between the two groups. Pulmonary arterial pressure showed a negative and a positive correlation with cardiac index and vascular resistance respectively.Vascular resistance was increased both in pulmonary arteriolar and in pulmonary vascular, and it was more remarkably in the group with high collapse than in the other. There was found a significant difference between the two groups. Work of right ventricle against pressure was normal.Comparing the results of one patient before and after operation, the decrease in VC remained very slight in spite of his high collapse, and arterial O₂ saturation was elevated slightly, while both right ventricular pressure and pulmonary arterial pressure were clearly elevated after operation. Cardiac index decreased slightly and pulmonary vascular resistance increased remarkably after operation.Discussion and Conclusion : The decrease of VC in patients under plombage was greater than its decrease in tuberculous patients whose lesions were nearly the same. This may be due to the inevitable collapse of some amount of healthy lung parenchyma and to the pleural thickening complicated by operation. On the other hand the decrease of MBC after this operation was lighter than that of the tuberculous patients with lesions of similar degree. This is considered to be due to the needlessness of the resection of ribs and to the selective collapse of the lesions.Arterial O₂ saturation was normal in general, and it was even elevated after operation in one of these patients. This is to be explained by the following facts. First, some amount of venous admixture coming from lesions decreased by the collapse of tuberculous part of the lung. Second, this operation does not injure the ventilation-perfusion relationships in other parts of the lung because the ribs are not resected. Thus any clear pulmonary insufficiency was not found at rest, while in one patient with high collapse arterial O₂ saturation dropped remarkably after muscular exercise. This shows the decrease of pulmonary functional reserve, so clinicians must always be careful for it. [the rest omitted]

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(1) STUDIES OF THE CAPILLARIES IN ESSENTIAL HYPERTENSION AND NEPHRITIS.Since there are a number of discussions on the differentiation between the essential hypertension and renal hypertension, the author examined and compared the skin capillaries of nephritic patients with those of the cases with essential hypertension. The aim of these observations was to determine the difference between the essential hypertension and renal hypertension.Materials and methods : 160 cases with essential hypertension, and 55 nephritis patients were selected and compared with persons who had normal blood-pressure. The last group included 45 subjects admitted to the ""human dock"" station who had normal blood-pressure and had no past history of hypertension, nephritis or infectious diseases and who did not show impaired renal functions in the urine test, PSP test, renal clearance and Fishberg's test.The examination of the capillaries was done at room temperature (15°C-25°C) ; cedar oil was dropped on the cuticle of the left and right digiti annulares which were placed on the same level with the heart. A Columbia Cutaneous Photographic microscope, with 5x ocular and 11x objective, was used.The capillaries were examined for the following items : the width of the arterial limb, the width of the venous limbs, width of the loop, length of the arterial limbs, the number of visible capillaries, the number of windings, etc. The state of the blood-stream was examined for the following items : the continuity of the blood-stream, the degree of the fullness, the presence or absence of granules, and the velocity ; further, the subpapillary venous pleuxus was examined and measured with the aid of micrometer (μ). The blood-pressure was measured by the Riva-Rocci mercury manometer after keeping the patient in the supine position for 15 minutes.Result : (1) Capillaries of the persons with normal blood-pressures.The average width of the arterial limb is 7.7 μ and the average width of the venous limb is 10.5 μ. The average degree of winding is 0.21. The blood-streams were continuous and non-granular, and the fullness was good. The average blood-stream velocity was 172 μ/sec. (Fig. 1-8).(2) Capillaries of patients with essential hypertension.The average width of the arterial limb in 160 patients with essential hypertension was 6.8 μ and the average width of the venous limb was 9.9 μ. The average degree of winding was 0.32. There was a tendency that the blood-pressure rose the blood-stream became granular with lack of fullness and continuousness. The velocity of the stream averaged 124 μ/sec., a finding which is a considerably different from that of the patients with normal blood-pressures (Fig. 9-21).(3) Capillaries of patients with nephritis.Observation was made on 22 cases with acute nephritis and 33 cases with chronic nephritis. The average width of the arterial limb was 6.4 μ and the average of the venous limb was 12.0 μ. The average of the degree of winding was 0.78. In acute nephritis 20 cases had windings in over one third of their capillaries. In chronic nephritis 28 cases had windings in more than one third of the capillaries. Seven cases of acute nephritis and 20 cases of chronic nephritis showed continuous blood-streams. Satisfactory fullness was seen in 6 cases with acute nephritis and 12 cases of chronic nephritis ; and 20 and 29 cases, respectively, showed granular blood-streams. The average velocity of the blood-stream in the former is 125.4 μ/sec. and that in the latter, 129.3 μ/sec. Next, 18 patients were selected who had high blood-pressure. The average width of the arterial limb was 5.7 μ and the average width of the venous limb was 12.1 μ. The average degree of winding was 0.71 and there were 15 patients who had winding in over one third of the capillaries. [the rest omitted]

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