The authors carried out clinical and statistical studies about 161 patients with atrial fibrillation, paroxysmal tachycardia and W.P.W. syndrome. All patients have been in-patient in Maekawa Clinic of Kyoto University Hospital from 1949 to 1958. The exact mechanism of production of these arrhythmias is not clear ; theories have ascribed the main factor responsible for the arrhythmia of non-cardiac orignin to the unstable nervous system, to "vegetative Dystonie", or to autonomic disturbance, but there is little definite evidence against or for these theories. Especially, the authors studied clinically these lone or idiopathic arrhythmias from the point of view of the spinal sympathetic nervous regulation of the heart. And it may be concluded that pathogenetic origin of the lone arrhythmia is disturbance of spinal sympathetic control of the heart beat.

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The author has studied the acid polysaccharides of arterial and venous walls with histo-chemical technique applying many dyeing methods and fermentative procedures, and has also investigated the possibility of detecting acid polysaccharides in capillary walls.By using the three staining methods (P.A.S. stain, colloid stain and tobuidine blue metachromasia stain) the author recognized that blood vessel walls contain acid polysaccharides from the intima through the media. After digestion by hyaluronidase or chondromucinase the red M. or the bright blue color of artery or vein disappeared, and the same results were obtained using elastase and trypsin. The former is probably explained by depolymerization of acid polysaccharides, and the latter is considered that protein combined with acid polysaccharides was decomposed, and the polysaccharides were liberated and dissolved away. Moreover, arterial walls exhibited M. at pH 1.0 toluidine blue or with toluidine blue in 1/1, 280, 000 solution, and also exhibited basophilia. But, vein remained all negative. That is, the M. substance in arterial walls is "cho" sulfate. The M. substance in venous walls is digested by chondromucinase ; this fact shows that the M. substance in venous walls is also "cho" sulfate, but considering the results of other staining methods it may be polysaccharides of a weak acid, namely "hi" acid. Further investigation is needed. Although the author tried many methods to study cement substance in capillary blood vessels, he could not prove by histo-chemical methods that it includes acid polysaccharides.

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Fundamental studies on the assay procedures and the fluctuations of the serum cholesterol were made. Subsequently, total serum cholesterol levels were measured in 434 healthy farmers from 13 to 69 years in rice-producing districts with a high frequency of cerebral hemorrhage and the findings were compared with those from the urban laborers and office workers. The total cholesterol levels obtained in this district were relatively low and this was presumed to be primarily due to their low fat intake. In the males, age 40-49 years, the mean cholesterol level of the farmers was nearly same as that of the urban laborers, but significantly lower than that of the urban office workers. The proportion of obesity in the farmers was smaller in comparison with that in the urban people and the cholesterol levels of the fatter of the farmers and the laborers were similar to those of the office workers with normal body weight.

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Nicotine has been believed to exert a vasoconstrictor action on the coronary vessels ; some investigators, however, recently claim a vaso-dilator action of the drug on the coronary vessels. No agreement has yet been reached on the action of ethyl alcohol as to whether it exerts a vaso-constrictor a vaso-dilator action on the coronary vessels. The author attempted to examine the action of both drugs on coronary circulation following the direct infusion of each drug into the left coronary artery through a coronary artery catheter in anesthetized, closed-chest dogs. Electrocardiographic changes were also studied.Method Using the same methods as in parts II, III and IV, the experiments were performed 12 times on 3 adult dogs. Leads C_ψD and C_ψS, representing right and left ventricular electrocardiogram respectively, were used in taking the serial electrocardiograms.Results(1) Nicotine(a) With 0.133 mg of nicotine coronary wedge pressure remained unchanged, and femoral arterial pressure rose slightly in the experiments with coronary artery perfusion from the dog's own femoral artery. With the same dose of the drug coronary blood flow increased in the experiments with coronary artery perfusion from a donor dog's femoral artery.(b) Infusion of 0.25 mg of nicotine caused a slight decrease in coronary blood flow with unchanged coronary wedge and femoral arterial pressures in the experiments with coronary artery perfusion from a donor dog's femoral artery.(c) Infusion of 0.4 mg of nicotine caused a slight decrease in coronary blood flow and unchanged coronary wedge and femoral arterial pressures in the experiments with coronary artery perfusion from a donor dog's femoral artery.(d) With 0.67 mg of nicotine coronary blood flow increased slightly, coronary wedge pressure remained unchanged, and femoral arterial pressure rose slightly in the experiments with coronary artery perfusion from the dog's own femoral artery. With the same dose of the drug coronary blood flow increased slightly and coronary wedge pressure remained unchanged in the experiments with coronary artery perfusion from a donor dog's femoral artery.(e) Infusion of 1.0 mg of nicotine slightly increased coronary blood flow in the experiments with coronary artery perfusion from the dog's own femoral artery. Coronary wedge pressure remained unchanged and femoral arterial pressure rose slightly.(2) Ethyl alcohol(A) Experiments with coronary artery perfusion from the dog's own femoral artery.(a) Infusion of 1.7% ethyl alcohol caused a slight increase followed by a decrease in coronary blood flow. Coronary wedge and femoral arterial pressures remained unchanged.(b) With 3.3% ethyl alcohol coronary blood flow decreased while coronary wedge and femoral arterial pressures showed no change.(c) With 5.0% ethyl alcohol coronary blood flow decreased and coronary wedge and femoral arterial pressures remained unchanged.(B) Experiments with coronary artery perfusion form a donor dog's femoral artery.(a) With 0.67% ethyl alcohol coronary blood flow increased, while coronory wedge pressure fell and femoral arterial pressure remained unchanged.(b) With 1.7% ethyl alcohol coronary blood flow increased slightly, coronary wedge pressure fell, and femoral arterial pressure remained unchanged in some and rose in other.(c) With 3.3% ethyl alcohol coronary blood flow decreased, coronary wedge pressure fell, and femoral arterial pressure remained unchanged.Conclusions(1) Nicotine exerts no direct action on the coronary vessels.(2) A small dose of ethyl alcohol tends to exert a vaso-dilator action, while a large dose causes vaso-constrictor of the coronary vessels.(3) Nicotine causes hardly any change in the electrocardiogram.(4) The more ethyl alcohol is used, the more the electrocardiogram changes. The changes are mostly depression of the S-T segment and inversion of the T wave.

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It is said that pnemoperitoneum can be used for the treatment of far advanced pulmonary tuberculosis due to the following reasons. First, pneumoperitoneum does not cause intrapleural complications, and its collapse effect is reversible. Second, its effects upon pulmonary function is relatively slight. A number of authors have found that the impairment of pulmonary function on account of pneumoperitoneum was generally insignificant. There are, however, some reports of the cases of severe pulmonary insufficiency. Therefore the indication for a pneumoperitoneum seems to be self limiting from the point of view of pulmonary function, and pneumoperitoneum can not always be safe in the cases of serious pulmonary insufficiency. But the studies on this point are still unsatisfactory.On the other hand there are a few reports about the effects of pneumoperitoneum on the pulmonary circulation, but the investigations have scarcely been performed of the pulmonary circulation in relation to the effects of pneumoperitoneum upon intrathoracic pressure. This paper reports the present author's results upon these points.Methods : The methods used for venous catheterisation etc. were similar to those described in the first report. The volume air refill during cardiac catheterization was 238-180 cc/kg for therapeutic use. The degree of lung collapse was estimated by dorso-ventral X ray film. It was estimated slight when the area becreased by the rising diaphragm was within one-third of one lung, moderate when the area decreased was from one-third to two-thirds of one lung, and high when it became over two-thirds of one lung. The subjects were 8 patients under pneumoperitoneum (Group I), and 2 patients under both pneumoperitoneum and other types of collapse therapies (Group II.).Results : 1) Group I : The decrease in VC and MBC was moderate (Table II). Minute ventilation tended to increase, but alveolar ventilation ratio was generally on the decrease. After the air refill the former increased, while the latter remained unchanged. Arterial O₂ saturation was nealy normal, but A-a O₂ tension gradient was increased, showing negative correlation with arterial O₂ tension (Fig 1). It was noticed that, after the air refill arterial O₂ saturation dropped in such cases where it was normal before the air refill, while on the other hand it rose where it was low before. Cardiac index tended to decrease, but it was increased after the air refill. Right auricular pressure tended to fall, but pulmonary arterial pressure was clearly elevated. Wedge pressure was normal. After the air refill remarkable changes were found neither in pulmonary arterial pressure nor in wedge pressure. Vascular resistance was found to have clearly increased both in pulmonary arteriolar and pulmonary vascular system. After the air refill, however, the latter remained unchanged while the former decreased. The work of right ventricle against pressure was normal.2) Group II : The decrease in VC was remarkable, and minute ventilation was clearly increased. But arterial O₂ saturation was extremely decreased in one case where measurement was successful, and elevated to its normal value after the air refill. Cardiac index was normal, but decreased distinctly after the air refill. Pulmonary arterial pressure was high, but its further elevation could not be noted after the air refill. Vascular resistance was clearly increased both in pulmonary arteriolar and in pulmonary vascular system, and the former remained unchanged after the air refill.3) The effects of phrenic paralysis upon a patient under pneumoperitoneum : Phrenic paralysis on the left side was performed during cardiac catheterization (Table V). Although minute ventilation was increased after operation, arterial O₂ saturation became remarkably low. [the rest omitted]

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(I) ELECTROCARDIOGRAM OF THE NORMAL RABBITS Of late years an increasing number of patients are enjoying the outcome of the clinical application of electrocardiography. The normal standard of the rabbit electrocardiogram is necessary. Animal experiments employing electrocardiography are found only a few in Europe and America as well as in Japan. As to the study of specific lead electrocardiogram of a rabbit (chest-lead and esophageal-lead), Rothberger & Scherfs "Study on the sinus-node by the ano-esophageal lead" is one of few good papers. The rabbit is used in the animal experiment of electrocardiogram, but its normal standard is not fully known.Accordingly, the author tried to establish the basic observations in the rabbit : before the author experimented on the allergic myocarditis, the author examined the electrocardiograms of the normal rabbits and the day-to-day difference of limb lead electrocardiogram, the localization of the chest and the esophageal lead electrocardiogram and analyzed the electrocardiograms of the normal rabbits and took the statistics of them.Methods : The white adult rabbit was used, and fixed on the table on its back, its electrocardiogram was taken after inserting electrode in the rabbit and keeping it quiet for 10 minutes. The position of the electrode was in comformity with the Joint Recommendations of the American Heart Association and Cardiac Society of Great Britain.Results and Conclusion 1) The day-to-day difference in the limb lead electrocardiogram : If the photographing condition (the time of the animal fixation, empty stomach, posture, etc.) is well controlled, the axis of the electrocardiogram is stabilized and the day-to-day difference is small. (Table I)2) Chest lead electrocardiogram : (12 rabbits) Two electrocardiograms were taken : one, when the distant electrode is in the right foreleg (CR) and the other, in the left hind leg (CF) : the position of the distant electrode is thus rotated by 180°. The two are like each other. (Fig. 1) Namely, it is considered that when distant electrode is in the right foreleg (CR) or the left hind leg (CF) chest electrocardiograms shows nearly relative unipolarization. Intrinsic effect is found much in the from C₁ to C₄. The locality where there is maximum voltage is from C₁ to C₃. Transitional zone is also there. (Table II). And C₅ and C₆ show a little localization from the anatomical point of view and electrocardiographic point of view. (Fig. 2)3) The esophegeal lead electrocardiogram : (12 rabbits) The P and T wave, and QRS complex in the esophageal lead are all inverted, especially P wave and QRS complex begin to invert sharply when different electrode is nearer the head than the heart ; when it is approaching the heart, P wave and QRS complex are diphasic (from negative to positive). When it passes auricle or ventricle, they are positive. (Fig. 3) Intrinsic effect is found between O₁₃ and O₁₇. The transitional zone of P wave and QRS complex are all found between O₁₆ and O₁₇. And their maximum voltages are found between O₁₆ and O₁₇. (Table III) The pattern of OR and OF resembles each other. (Fig. 4) Accordingly, they have relative unipolarization, but unipolarization in chest lead is superior to that in the esophageal lead from the anatomical point of view and electrocardiographic point of view. (Fig. 5) The unipolarization of OF is purer than that of OR.4) The abnormal electrocardiogram of the normal rabbit, the abnormal electrocardiogram of the normal rabbit is caused chiefly by heterotopic stimulus formation ; they are : sinus bradycardia, auricular premature beat, blocked auricular extrasystole, and ventricular escaped rhythm, etc.5) The statistical observation of rabbit electrocardiogram 48 adult rabbits were observed. [the rest omitted]

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Although many reports have accumulated concerning the adrenaline pulmonary edema, including notable papers by Luisada, its pathogenetic mechanism has not been sufficiently clarified experimentally. The author studied the problem of adrenaline pulmonary edema chiefly from the aspect of the pulmonary lymph circulation, and obtained the following results.I. The effect of the intravenously administered adrenaline on the pulmonapy lymph circulation.Methods : Adult dogs weighing 7 to 12 kg under anesthesia were injected with adrenaline intravenously and examined for the pulmonary lymph flow, the protein concentration in the lymph, femoral artery blood pressure and rate of respiration. Animals were divided into 4 groups according to the dose of adrenaline injected ; i.e., 0.2 mg/kg, 0.5 mg/kg, 1 mg/kg, and 2 mg/kg, and each injection took about 30-60 seconds.Results : With small doses of adrenaline (1 mg/kg or less) the pulmonary lymph flow was unchanged. With 2 mg/kg injected intravenously, the pulmonary lymph flow was increased 2 folds up to 25 times original rate. The lymph became macroscopically hemorrhagic. The protein concentration in the lymph was increased both in the group of 1 mg/kg and that of 2 mg/kg. The femoral artery pressure and the rate of respiration were reduced throughout different groups. Since 2 mg/kg of adrenaline was found to always and un-mistakably increase the lymph flow, this dose of adrenaline was used in the following part of the experiment to increase the rate of the lymph flow.II. The effect of the artificial respiration on the pulmonary lymph circulation under the influence of the intravenous adrenaline.Since the respiratory movement gravely affects the pulmonary lymp flow, as was shown in the preceding chapter, it appears necessary to evaluate the extent to which the state of apnea or reduced respiration accompanying the injection of adrenaline may have diminished the otherwise increased pulmonary lymph flow under this circumstance. To study this point, the action of adrenaline to change the rate of respiration was eliminated by keeping the animals under the artificial respiration.Methods : The conditions of the artificial respiration were set in such way that animals were placed under something very close to the natural respiration ; and adrenaline was injected only after the initial fluctuations in the pulmonary lymph flow due to the switching to artificial respiration have disappeared, and the rate of the lymph flow became stabilized.Restlts : The rate of pulmonary lymph flow began to increase immediately following the intravenous injection of adrenaline, there was no transient period of decreased lymph flow, such as noted previously owing to the adrenaline-induced apnea. This observation made it clear that the transient decrease in the pulmonary lymph flow with the intravenous injection of adrenaline was secondary to the change in the respiratory movement.III. The effect of the repeated injection of adrenaline on the pulmonary lymph circulation.Method : After a single injection of adrenaline caused the pulmonary lymph flow to increase and then return to the initial level, the same dose of adrenaline was injected repeatedly.Results : If adrenaline was injected in one and the same animal repeatedly in the same dose, the proportion of the increase in the pulmonary lymph flow and protein concentration in the lymph was smaller after subsequent injections than after the initial injection. The proportion of increase in the femoral artery blood pressure was similarly diminished, and so was the proportion of the reduction in rate of respiration.IV. The effect of ligation the femoral veins bilaterally on the pulmonary lymph circulation under the influence of adrenaline.Methods and Results : Immediately after the intravenous injection of adrenaline, the femoral veins were ligated bilaterally with threads. Under this circumstance, the pulmonary lymph flow and protein concentration of the lymph showed no incr

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