Direct epicardial electrocardiograms were recorded in 97 cases of normal hearts and various heart diseases, and the patterns of the QRS complex of the chest lead electrocardiograms were analysed with normal heart, left or right ventricular hypertrophy, combined ventricular hypertrophy, and right bundle branch block. In the case of the left ventricular hypertrophy the left chest ECG agreed well with the direct epicardial ECG. In the case of right ventricular hypertrophy the right chest ECG may be a mere reflection of the potential variations at the base of the right ventricle or conus arteriosus. The right bundle branch block of the mitral stenosis appears to be not due to a genuine conduction disturbance but to represent the potential variations in the base of the right ventricle.

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The electrocardiographic changes were more highly correlated with changes of myocardial oxygen consumption per cardiac load than with changes of myocardial oxygen consumption themselves, and did not correlated with changes of coronary flow in the clinical experiment of induced anoxemia with coronary sinus and right heart catheterization.

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The authors have analysed the strain pattern electrocardiogram of the left precordial lead from the vector-cardiographic view-point and concluded that changes in T vector were closely related with the so-called " Myogene Dilatation " from clinico-physiological observations and the observation of the response to therapy and exercise tests.

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The author previously reported on "Pressure Efficiency in Respiration", has reached some conclusion upon undertaking a series of tests in reference to the various values of ventilatory mechanics as well as common pulmonary function test. As mentioned in the first part of this report, the author considered that the value obtained by "Pressure Efficiency in Respiration" is the objective value rather than the theoretical value of respiratory work, this value decreases with the advance of congestive heart failure and increases during its medical treatment and shows in proportion to the symptom of dyspnea. The reports were also made then that Regitine (=Phenantolamine) was proved to be useful in the diagnosis of pulmonary congestion and discussion was done on several items in relation to the decrease of pulmonary compliance in congestive heart failure.

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In the previous report the author analysed the relationship between the incidence of pulmonary edema and the change in the femoral artery pressure and suggested that the pulmonary edema took place on the input side of the heart when the load on the heart is increased beyond a critical limit, the load being thrown on the heart when it tries to pump blood into a system of high blood pressure. In this report the author studied the relationship between the adrenalin pulmonary edema and venous return. The pulmonary edema is prevented from taking place by a variety of means, i.e., the ligation of a unilateral femoral vein, pulmonary arteriolar blockade by lycopodium spores and the bleeding. This fact indicates that the incidence of a relative increase in the venous return over output is an important trigger mechanism of the adrenalin pulmonary edema. At the same time it was suggested that the mobilization of depot blood was a cause of this relative increase in the venous return.

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The term "cerebral vascular lesions" in this report includes cerebral arteriosclerosis and cerebral apoplexy. The cerebral arteriosclerosis is not only the cause of various cerebral symptoms, but important as the basis of cerebral vascular accidents. The cerebral arteriography is an excellent method for the diagnosis of cerebral atherosclerosis as well as for the etiologic and differential diagnosis of cerebral stroke. There have hitherto been many angiographic studies of cerebral stroke, but few attentions have been paid to the angiographic study of cerebral atherosclerosis. The author has performed arteriography on 60 cases of the aged with cerebral vascular lesions, the results of which are reported here. Method 1. The arteriography and observation of eyegrounds were performed on 60 cases, and mesurement of cerebral circulation on 24 cases, with cerebral vascular lesions, aging 50 to 80. 2. The arteriography was performed transcutaneously, using 60% Urographin or 50% Hypaque as contrast medium. The patients were injected with 40% papaverinum hydrochloricum for safety 30 minutes before arteriography. For the prevention of complications, general anesthesia was applied using thiopental sodium. In each arteriography, 10cc. of Urografin or Hypaque was used. 3. The cerebral circulation was measured by the N₂O-method of Kety & Schmidt. 4. The observation of eyegrounds was made according to the Keith-Wagener classification. Results A. Cerebral arteriosclerosis The arteriographic grades of sclerosis, classified according chiefly to Brobeil and Riischede, were compared to retinal vascular changes, subjective symptoms, and cerebral hemodynamics values. 1. A rough relation was found between retinal findings (KW) and the grade of arteriographic sclerosis. 2. There was a tendency for the subjective symptoms, such as headache, drumming in the ear, and vertigo to increase with the arteriographic grade of sclerosis. 3. The comparison of cerebral circulation to arteriographic grade of sclerosis and retinal findings (KW) is as follows :

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Introduction Studies on arteriosclerosis have been under-taken by many investigators from pathological and biochemical aspects since Anitschkow et al. succeeded in inducing the experimental atheromatous plaque in the cholesterol fed rabbits. In recent years the ultracentrifugal method introduced by Gofman et al, has been in general use as the most excellent method for the study of serum lipoproteins, and by this method it has been recognized that most of the serum lipids exist in the form of lipo-proteins. In Japan, Oshima, Yasugi and their co-workers have been undertaking studies on the relationships between serum lipoproteins and the development of arteriosclerosis by means of the ultracentrifuge. They reported that increases in the levels of Sf 0-20 and Sf 20-400 Iipoprotein fractions bear the significant relationships to the development of arteriosclerosis, but that the total cholesterol level does not always have a significant relation-ship thereto. It was further reported regarding lipoprotein metabolism (1) that heparin possesses_s a lipemia-clearing activity, (2) that heparin activates lipoprotein lipase which de-composes neutral fat component of the lipoprotein into fatty acid and glycerin and (3) that heparin when injected produces a decrease in the Sf 20-400 Iipoprotein fraction and an increase in the serum cholesterol level and inhibits arteriosclerosis formation (This is not a definitive assertion). The present study has been undertaken to detect any presence of atherogenesis due to neutral fat in the rabbits, and to compare the lipid metabolisms between lanolin-fed and neutral fat-fed rabbits. Method Subjects : Male rabbits weighing 2-3kg were used and they were divided into three groups : a normal group which was placed on an ordinary diet, a lanolin-fed group was further sub-divided into two groups which consisted of the following, lanolin-fed group (3 gm of lanolin /day for a period of 90 days) and lanolin-heparin-fed group (3gm of lanolin/day and 5mg of heparin/twice a week for a period of 90 lays. Lanolin was administered larally and heparin was administered intravenously.), and a neutral fat-fed groupwhich was given by oral route 10 gm of hydrogenerated cocoanuts oil daily for a period of 150 days.

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Many opinions or theories have been expressed about whether or not the application of X-ray irradiation causes myocardial damage, but it has not yet cone to a conclusion. It has long been known that the X-ray irradiation gives heart muscle a histological change, but no literature which prescribed on metabolism under the X-ray irradiation has been found yet. When X-ray irradiation is applied to a living body, via autonomic nerve or acting as a stress, it may bring about some effect on the whole body in the end, and especially when the application of X-ray irradiation is limited to heart, it gives heart muscle various degenerations ; region near the epicardium, which is irradiated more directly, is influenced more severely, and the changes of the coronary vessel wall are more delayed. So it is supposed that X-ray irradiation will have a direct influence to the cells of the heart muscle. The experiments were performed to see how carbohydrate metabolism in the cells of heart muscle will be influenced when X-ray irradiation was applied. Experiment I. On the carbohydrate and creatine metabolism : 1) Coronary sinus catheterization was per-formed upon normal anaesthetized dogs. 4000r of X-ray (estimated dosis at the surface of the heart muscle) was applied to the heart. Before and 30 minutes, 1 hour and 2 hours after X-ray irradiation blood was sampled from the coronary vein and femoral artery, and the content of glucose, pyruvic and lactic acid and creative were measured. 2) Twenty minutes after 1000r X-ray irradiation (group I), or 40 minutes (group II), or two hours (group III) after 4000r X-ray irradiation on the rabbit, the animals were bled to death, and then differences between the heart muscle homogenates irradiated and not irradiated respectively, were compared. The respective heart muscle homogenates were divided into two; one was deproteinized with trichlor-acetic acid, and then glycogen, pyruvic and lactic acid of the filtrate were measured; the other was deproteinized with sulfuric acid and sodium tangstate, and then glucose, creative and creatinine of the filtrate were measured. 2. After destroying the brain and the spinal cord of the toad, thoracotomy was performed, the pericard was opened and 6925r of X-ray was applied to the heart. Twenty minutes later, a part of the heart muscle was resected and the lactic dehydrogenase activity was measured by Neiland method, recording the changes of the absorbance of 340mμ at 25°C.

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