-Monophasic action potentials which were obtained by suction electrode from toad ventricle did not show change in its amplitude with varying temperature. But the integral of a monophasic action potential decreased hyperbolically with rising temperature and the integral per minute, the area obtained by multiplying a single area with pulse rate, increased linearly with temperature. The relationship to temperature of mechanical work of the ventricle contraction and its work per minute was the same as in the case of the integral of action potential. That is to say, there was found a linear relationship between the work per minute and the integral of the action potential per minute. These observations suggest that, for the coupling of the mechanical work and the electrical phenomena of the heart, electrostatic treatments are needed.

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-As an approach to the problem of localized segmental alteration in the autonomic or somatic nerve fiber activity, more than a hundred human subjects have been examined for the incidence and distribution of skin areas characterized by abrupt local deviations in "capillary fragility"-skin areas where petechiae count was different with large gradients above or below the level of neighbouring areas and where the local state of blood flow or blood vessels was presumably different with sharp demarcation from that in adjacent skin areas. Such areas (aberrant areas) were elicited even from apparently healthy individuals. Many aberrant areas simulated strips of sensory dermatomes, and their patterns in each individual were reproducible with limited fidelity over a period of weeks and months. The author presented several suggestive evidences that at least some aberrant areas were neurogenic in origin, arising on the basis of localized somato-autonomic alterations in the spinal cord or nerve roots.

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-The petechiodermographic pattern characteristic to each of the four diseases was studied. Individuals with the peptic ulcer had "rise areas" suggestive, within limits, of a local vasodilatation, frequently in skin areas lateral to D7-D8 spinous process. Individuals with the "abdominal neurosis" had "rise areas" frequently in skin areas lateral to D10-L4 spinous process. Regarding the neurocirculatory asthenia the evidence was not strong, but data indirectly suggested the cranialward concentration of aberrant areas in this condition. Concerning the essential hypertension the evidence was again not strong, but data were suggestive of the presence of localized vasoconstriction in skin areas of lower thoracic to upper lumbar segments. The authors also examined the effect of autonomic drugs on the general "capillary fragility" and investigated possible relations between the gastrointestinal motility (as an index of vagal activity) and the general "capillary fragility". No simple "laws" could be found to govern the "capillary fragility", but the observed variations in "capillary fragility" in a small number of cases suggested that the cutaneous vasodilatation was the possible cause of increased "capillary fragility" at least in some cases.

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Coronary sinus catheterization was performed on men with normal heart and those with coronary sclerosis, and on dogs with normal heart and those with coronary vascular lesions. Effects of hypoxia upon cardiac oxygen metabolism, especially on regulation of the coronary blood flow were studied. Results were as follows : 1) with regard to the rate of increase in coronary blood flow due to hypoxia, there was no statistical significance of differences between the group of normal men and that of coronary sclerosis. In dogs, however, the rate of increase was lower in dogs with coronary vascular lesions than in the normal dogs.2) In men, there was inverse correlation between the rate of decrease in arterial oxygen saturation and the rate of increase in coronary blood flow due to hypoxia.3) As for the rate of decrease in coronary sinus oxygen tension due to hypoxia, there was no statistical significance of differences between the two groups of men. In dogs, the rate of decrease was less in the group of coronary lesions than in the normal. The rate of decrease in arthrio-coronary venous difference due to hypoxia was less in the dogs with coronary lesions than in normal dogs, though in men there was no statistical significance between the two groups.4) In resting state there seemed to be an inverse correlation between the coronary blood flow and the arterio-coronary venous oxygen difference. The correlation became more apparent when hypoxic state was induced. In the coronary groups of both men and dogs, the increase in coronary blood flow was not so much as it should be expected from the decrease in the arterio-coronary venous oxygen difference.5) In men, there was good inverse correlation between coronary sinus oxygen tension and myocardial oxygen extraction coefficient in hypoxic state, as well as in resting state.6) In hypoxic state in men, release of potassium from myocardium was noted in 6 of 9 cases with coronary sclerosis. In 5 of these 6, there was an increase in myocardial oxygen extraction coefficient.On the contrary, myocardial oxygen extraction coefficient was decreased or not changed in those in which there was measurable myocardial uptake of potassium or no arterio-coronary venous potassium difference.

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Since it was made possible by the technique of coronary sinus catheterization to study the myocardial metabolism under physiological conditions, a number of investigation using this technique have been made and they clarified that glucose, pyruvate, lactate, acetate and fatty acids may serve as fuel for energy production in the heart. Little work, however, has been published on the myocardial metabolism of amino acids. In 1954, Bing, studying the utilization of amino acids in the human heart by the method of coronary sinus catheterization, concluded that the human heart can utilize considerable quantities of amino acids, and during infusion of amino acids (Aminosol) the rise in arterial amino acid concentration produced a disproportionate increase in the myocardial extraction. However, he studied principally the myocardial extraction of total amino acid nitrogen, without pursuing in parallel observations the behavior of individual amino acids.In the present paper, studies have been made on the myocardial amino acid metabolism with special regard to amino acid fractions in normal as well as liver-impaired dogs, using the coronary sinus catheterization. Furthermore, observations have been carried out on the effects of infusion of amino acid preparations (glutamic acid, alanine, and Moriamin S) on the changes in the metabolism of amino acids.Methods : Simultaneous blood samples were drawn from the coronary sinus and femoral artery for analysis. Coronary venous blood was obtained by means of direct catheterization of the coronary sinus. Total blood amino acid nitrogen was measured according to the procedure of Albanase and Irby, and individual plasma amino acid fractions, to the method of high valtage paper electrophoresis. Blood glucose, pyruvate and lactate were determined, respectively, by methods of Somogyi and Nelson, Freedmann and Haugen, and Barker and Summerson. The manometric method of Van Slyke and Neil was used for blood gas (O₂, CO₂) analysis. The coronary arteriovenous differences of total amino acid nitrogen, individual amino acid, carbohydrates and blood gases were estimated in normal dogs. Some of these dogs were orally administered with carbon tetrachloride, 1 cc per kg and they were catheterized again in from five to seven days to study the myocardial amino acid metabolism during the liver injury. In addition, for the purpose of studying the effects of amino acid preparation on the cardiac metabolism, 3.3% glutamic acid and 3.3% alaninc solution, and mixed amino acids-preparation (Moriamin S) were respectively infused intravenously at a rate of 50-60 drops per minute to them and samples were drawn five minutes after the onset of, and thirty minutes following the cessation of the infusion.Results : 1) In about a half of 200 normal cases the coronary arterio-venous differences of total amino acid nitrogen were negative; viz. 88 cases negative, 82 cases positive and 30 cases almost zero. It seemed unlikely that there was such a definite extraction of amino acid nitrogen as reported by Bing. (Fig. 2)Concerning the individual amino acid fractions, A₁ (Glu), A₂ (Asp) and B₁ (Arg) showed a tendency to be excreted, and N₅ (Ala) and N₄ (Val, Leu, Ileu), to be extracted. (Fig. 3)2) With the administration of 3.3% glutamic acid solution to normal dogs, the coronary blood concentration of total amino acid nitrogen was increased markedly, and its coronary A-V difference slightly. As to amino acid fractions, the extraction of A₁ (Glu) was increased, and, on the contrary, N₅ (Ala), B₁ (Arg) and N₄ (Val, Leu, Ileu) showed a tendency to be excreted. There was inconsistent behaivar cancerning the carbohydrate metabolism. The myocardial O₂ extraction increased and the cardiac respiratory quotient depressed. (Fig. 4, 5)3) With the administration of 3. [the rest omitted]

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It is a well known fact that the ST-depression in electrocardiogram occurs in coronary insufficiency and other heart diseases. Many authorities have regarded the ST depression as a reciprocal effect of the ST elevation which must be occuring in damaged endocardium.Using direct lead from the surface of the epicardium and reducing the blood pressure artificially by controlled bleeding, Prinzmetal and Toyoshima et al produced a primary S-T depression which was not due to any other myocardial lesion. Furthermore, they reported that this S-T depression occured sporadically in the heart muscles and projected to the chest leads as an S-T depression.To ascertain whether the S-T depression in the chest leads after the blood pressure has been reduced is due to the effects of the S-T depression area that is found sporadically in subepicardium, or due to the S-T elevated-area found in the subendocardium (which has hitherto been said), the author attempted to reduced the blood pressure and, after the blood pressure had been reduced, investigate the electrocardiogram through the use of the combination of a direct unipolar lead, a chest lead and an intramural lead.Method : The author employed dogs which were anesthetized with "Oltopan Sodium", the dogs then were given artificial respiration and their chest was opened to explose the heart. The blood pressure was taken before and after the controled bleeding and the electrocardiograms were recorded by the use of special direct electrodes.Result : A series of the experiments were performed for the following three purpose; namely, A) the comparison of electrocardiographic changes between the precordial and the direct leads on an epicardial or endocardial surface, B) the comparison between the epicardial and the endocardial eads, C) the observation of electrocardiographic changes in the intramural leads.A) Comparison between the precordial lead and the direct lead : It was observed that the R-ST deviation caused by a fall in the blood pressure scarcely occured uniformly, but in most cases insularly. A similar R-ST deviation was found in the chest lead where the potential changes in the epicardial area would be reflected most noticeably. The ST deviation in the epicardial lead, however, was not always accompanied by an ST deviation in any standard chest lead. That is, there was a dead zone in the six standard chest leads.B) Comparison between the epi- and endocardial leads.The ST deviation was observed more frequently in the epicardial lead than in the endocardial lead. It was shown that the ST depression became more noticeable at a certain level of the blood pressure. There is no rule for the successive changes of the T waves and there is no time relationship between an ST deviation and changes of the T waves in any of the direct leads. A transient ST elevation was observed in the majority of cases prior to the depression. An ST deviation was influenced from time to time by the amount or the speed of bleeding.C) Comparison among the intramural leads.With a gradual decrease in the blood pressure the ST deviation could be increasingly seen in the intramural lead. This effect also could be seen more noticeably in the outer layer of the muscle.The author performed another series of experiments in order to ascertain whether or not these ST deviations were caused by a fall in the blood pressure. It was shown that these deviations could be restored either by the administration of pressor drugs or by blood transfusion. After the blood pressure was drastically decreased to 20 mmHg or less, the ST deviation could not be restored by an increase of the pressure, and the dogs died. An amplitude and/or a pattern of the QRS complex was influenced by a fall in the blood pressure. As a rule, the amplitude increases at first and then decreases after a further fall in the blood pressure. [the rest omitted]

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Perforation of the interventricular septum following acute myocardial infarction is considered to be an extremely rare complication. This disease was first recorded by Latham (1845), and Brunn (1923) made the first ante-mortem diagnosis. Later Zucker, Oblath, Bond, Reiff, and Sanders published papers concerning the disease. Thus, a considerable number of reports have so far been made public in the Western countries, where this complication is fairly well known. However, in Japan, where cases of myocardial infarction are relatively few, this particular complication likewise is a rather rare occurrence, and only three cases have so far been reported by Ishii, Kitamoto and Murao. Of them, Murao alone has reported on a case with an ante-mortem diagnosis.The present author and his collaborators have recently made an ante-mortem diagnosis of perforation of the interventricular septum following acute myocardial infarction, which was confirmed with autopsy, about which a report is herewith submitted. Also a review of the domestic foreign literature has been made.(Case Report) 57 years of age, male, occupation;medical doctor Past history : The patient had been healthy and had not suffered from severe disease. While working as the director of a certain army hospital during the World War II, he had several anginal attacks per year. Each attack, however, subsided after brief rest, causing no adverse effect on his discharge of daily duties. After the war, he worked at a clinic. He was kept busy, and especially when he was tired, he would often complain of palpitation, dyspnea and slight dizziness. Each of these complaints, however, subsided after brief rest, and he himself was under the impression that he was suffering probably from neurocirculatory asthenia.Since about ten years ago, he was conscious that he had hypertension (160/110 mmHg), but no treatment of the hypertension was done. Cardiac murmurs had never been noted before the present hospitalization.Present illness : On June 2, 1958, he suddenly complained of retrosternal pain and epigastric pain, accompanied with chills, fever, vomitting and dyspnea. The pain irradiated over the right back, right shoulder and right arm, and especially the right arm became numb. With injections of morphine, the pain could not be abated. He suffered from the pain for three consecutive days.On June 8, his condition slightly improved and he left bed. On June 9, as he took breakfast, a violent retrosternal and epigastric pain re-curred. This attack was severe than the previous one, and refused to subside even with the administration of narcotics. It was followed by sweating, difficulty in respiration and cyanosis. He was immediately hospitalized in the Department of Internal Medicine of this hospital Findings at the time of hospitalization : The skin was dry and subjaundiced. Temperature stood at 39°C. Puls was 132, fine and regular, and tension was extremely unsatisfactory. Blood pressure was 90/85 mmHg. The patient appeared to be in agony with orthopnea.Cardiac dullness was enlarged 1 f. b. to the left and right. In auscultation, a harsh grade IV systolic murmur, resembling a maladie de Roger's murmur, with systolic thrill was heard, loudest at the third and fourth intercostal space to the left of the sternum. The murmur radiated to the apex and the basis of the heart. From the third intercostal space at the left parasternal line to the apex, a grade II diastolic murmur was heard at one time. The lungs were clear. The liver and spleen were not palpable.The laboratory findings, as shown in Table I, included neutrophilic leucocytosis, markedly increased sedimentation rate and increase of non protein nitrogen. In the electrocardiogram, a typical antero-septal infarction was indicated. (Fig. 1).In the light of these findings, acute myocardial infarction, and perforation of the interventricular septum following it, were diagnosed. [the rest omitted]

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