An exact separation of the right ventricular excitation from the left ventricular excitation is difficult with electrocardiography in the bundle branch block. On the other hand, the activity of the two ventricles can be separated, if one records the relative timing of the onset of the ventricular contraction, because this timing is related to the velocity of the impulse conduction to each ventricle ; thus this method of study offers important informations supplementary to what electrocardiograms reveal. The a, author found in 2 cases of transient right bundle branch block that this conduction abnormality caused Q-RVs to be prolonged. However, from animal experiments and further clinical observations it became clear that one can not always judge the presence or absence of a ventricular asynchronism only on the basis of the Q-RVs measurement, mainly because the normal value of Q-RVs varied over a broad range. On the other hand it was possible to demonstrate the presence of a ventricular asynchronism decisively in cases with the right bundle branch block by recording the relative timing of the onset of the right and left ventricular contraction.

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The automatic bubble flowmeter with vacuum tubes which has been used so far is apt to be unreliable. In view of this, we have completed a reliable, easy-to-operate, automatic bubble flowmeter in which vacuum tubes are replaced by transistors. It has a U-shape glass tube and a time ordinator, which enables flow velocity to be recorded on smoked paper. It was impossible with the old bubble flowmeter with simple U-shape glass tube to determine flow volume above 250 cc/min. The new flowmeter tube is fitted with a bypass joining the necks which enables the total flow volume to be determined from the partial volume passing through the U-tube. By this method flow volume can now be determined up to 1250 cc/min. In addition this paper includes a report on determinations of cardiac output, coronary blood flow and femoral blood flow in animals, which were carried out with the new flowmeter.

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In Report II the author suggested that an important trigger mechanism of the adrenalin pulmonary edema was a relative increase in the venous return (over the left ventricular output) and that the mobilization of depot-blood was a cause of this increase in the venous return. In this part of study the author analysed the role of the autonomic nervous background of such an increase in venous return. It was suggested that a basic trigger mechanism of the adrenalin pulmonary edema was an abrupt increase in the venous return due to the mobilized depot blood flow, followed by an abrupt cessation of the blood circulation by arteriolar contraction. It appeared that such changes in the venous return were sympathetic in origin and that the parasympathetic nerve activity tended to slow the rate of the venous return.

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A case of primary pulmonary hypertension due to diffuse pulmonary arterioral thrombosis is reported of which the diagnosis was not affirmed before death but only after autopsy. The clinical symptoms and signs, laboratory findings, macroscopic and histopathological findings were compared with those of previous reports. Thus the reason why the diagnosis was so difficult to decide before death was made clear. The authors also reported that primary pulmonary hypertension and fibrosis were able to be differentiated from congestive heart failure by means of pulmonary function test after regitine administration.

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The author studied various patterns of the electrocardiogram associated with changes in the plasma electrolytes composition observed wave forms according to the principles deduced from a parallel study of the intracellular potential. The role of electrolyte in the pathogenesis of certain arrhythmias were also clarified.

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The purpose of this study is the quantitative analysis of the apical diastolic murmur in mitral stenosis. Phonocardiographically, this murmur can be classified into 7 types and there is a certain relation between these types and the severity of the disease. After exercise PA-pressure is elevated in cases of mitral stenosis and, simultaneously, the diastolic murmur changes its nature. The most striking change is that the diastolic murmur increases its amplitude throughout the different components. Since, by contrast, exercise causes no change in the amplitude of the apical 2nd sound, this sound can serve as the standard of reference to which the change in the amplitude of apical diastolic murmur can be compared. The timing of the apical diastolic murmur in the cardiac cycle has a close relation ship with the severity of mitral stenosis.

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Purpose Recently there is an increasing incidence of penicillin shock. In this department a systematic research has been conducted for the last several years on the problem of the shock on the basis of a hypothesis that a shock due to penicillin must be something analogus to a serum anaphylactic shock encountered in animals. The problem assigned to this author in this systematic research was about the change in the blood circulation and plasma proteins during a serum anaphylactic shock in animals. Method s Materials used were about 50 dogs weighting 10-20kg. For the sensitization they were injected with horse serum in dose of 0.2 cc/kg subcutaneously on every other day, this injection alternating with the intravenous injection of horse serum in dose of 1.0cc/kg on every other day, and for the total period of 10 consecutive days. After the completion of the sensitization, 3 weeks were allowed, and, after this latent period, animals were thrown into anaphylactic shock by the rapid intravenous injection of the horse serum in dose of 2.5-5 cc/kg. The femoral arterial blood pressure was transmitted through a vinyl tubing to a mercury manometer and recorded on kymographion. Plasma proteins concentration was measured by a refracto- meter of Hitachi type and the protein fraction pattern was examined by the paper-electro-phoresis. Where the anti-shock agents were used, animals were treated as follows : in the chlorpromazine group, they were injected with chlorpromazine in dose of 2 mg/kg intramuscularly 40 minutes before the provocation of a shock ; in adrenalin group, animals were injected with adrenalin in dose of 2-3mg together with the physiological saline solution by the drip infusion after a shock has been provoked ; in the prednisone group this drug was injected intramuscularly in dose of 3mg/ kg in 3 divided doses, i.e., 24 hours, 8 hours, and immediately before the provocation of shock.

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The purpose of this study is to find the relationship between myoglobin (Mb) and myocarditis. The experiment on the following various conditions was undergone : (1) the mixture of Mb with phosphatide (muscle). (2) the mixture of streptococcus hemolyticus and streptococcus viridans. (3) the combined steroidhormon plus NaH₂PO₄ and addition of heavy exercise. In the above condition the study was done to clarify the significance of Mb. Method The animals used are rabbits with an average initial body weight of 2 kg. The experiment was divided into following three parts. First experiment : The Mb used was extracted from the skeletal or heart muscle and diaphragm in rice-illness rabbits. The phosphatide extracted from skeletal muscle in rice-illness rabbits. The rabbits were sensitized by intravenous innoculations of the mixture with above mentioned Mb and phosphatide in one group of rabbits was injected for twenty days, the other group in the first phase was injected for five days and after two weeks treated again for five days. Second experiment : In the second experiment the rabbits were sensitized by intravenous innoculations of Mb which was extracted from normal rabbits, combined with streptococcus hemolyticus, streptococcus viridans and bovine serum. Third experiment : The normal rabbits were sensitized by intravenous innoculations of Mb of focal lesion (Oleum terebintinhae abscess). Furthermore the rabbits were treated with steroidhormon plus NaH₂PO₄ Mb or stressors (restraint or heavy exercise). Hydrocortisone and Predni-solone were used as the steroidhormon. After receiving treatment, the animals were bled to death. The histologic examination was made on the heart, lung, liver, spleen and adrenal gland. These organs were fixed with ten per cent formalin solution, embedded in paraffin and stained with hematoxylin and eosin.

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In a previous paper we have reported the increased sodium content of blood cells in edematous state and in patients with severe cardiovascular and renal diseases. The purpose of the present paper is to show the correlations between the sodium and potassium levels of blood cells and the renal excretion of them. Materials and Methods In 74 patients including 21 cases of acute and subacute glomerulonephritis, 1 9 of chronic glomerulonephritis, 3 of nephrotic syndrome, 18 of essential hypertension and nephrosclerosis, and 13 of heart diseases, clearance tests were performed by infusion of PAH and mannitol. Sodium and potassium reabsorption rates were calculated from the values of electrolyte clearance and of glomerular filtration rate. The U/P value, which represents the ratio of total sodium and potassium concentration in urine to that in blood plasma also was calculated. Some authors assume the free water clearance (CH₂₀) as CH₂₀=V-C_OSM where V is urinary volume and C_OSM is osmotic clearance, and solute-free water reabsorption (T^CH₂₀=C_osm-V From these equations CH₂₀=V(1-U_osm/P_osm) T^CH₂₀=V(U_osm/P_osm-1) can be induced. Then, if U_osm/P_osm is greater than unit, the subject should be supposed to be in a state to excrete more solute than water, and vice versa. Following this conception, the value of U/P may indicate whether the subject is in diuretic phase or in saluretic phase. Summary and Conclusion As a whole, sodium clearance was significantly correlated with GFR, but was markedly decreased in the cases whose GFR was below about half of normal value. It also showed smaller value when RPF was markedly decreased and markedly increased than normal. It was diminished in hyponatremic and in hypernatremic subjects, too. No definite correlation between the blood cell sodium level and the amount of sodium excretion was observed. It is accordingly conceivable that sodium clearance which represents the absolute amount of sodium excretion is regulated by body requirement of sodium to maintain the extracullular level within normal range. From the relationship between GFR and sodium reabsorption rate, the amount of sodium excretion were suggested to increase in acute glomerulonephritis and in some cases of essential hypertension. From the value of U/P however, it was also suggested that patients with acute or subacute glomerulonephritis were in more diuretic state than those with chronic ones.

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Introduction Separate measurement of the right and left pulmonary blood flow has been attempted by a number of workers, but all methods were of limited value in that they gave valid results only when a certain body of conditions were fulfilled. A new method was described by Fishman who combined the right heart catheterization and bronchospirometry and who subjected the lung on one side to a gas with high O₂ tension and the lung on the other side to the room air or a low O₂ gas ; with this method he estimated the gaseous composition of the pulmonary venous blood fairly accurately and calculated the rate of blood flow through each lung satisfactorily. The present author also used this method to study the differential pulmonary blood flow in patients with pulmonary tuberculosis. Materials and Methods A total of 13 cases with pulmonary tuberculosis (all male subjects) were subjected to the simultaneous right heart catheterization, bronchospirometry and the arterial cannulation. While the healthy lung was subjected to a O₂ mixture with nitrogen containing O₂ in amounts large enough to make the mixed arterial blood O₂ saturation 100%, the affected to the ambient air by such arrangements that each lung was connected to a separte open circuit. The expired air from each lung and the mixed arterial and venous blood were sampled simultaneously after more than 10 minutes have been allowed for the condition of examination to reach a steady state. In this way various data relating to the ventilatory activity of each lung were obtained as well as the gaseous composition of the mixed arterial and venous blood. The rate of blood flow through separate lungs and of the total pulmonary blood flow was calculated by Fick principle as follows :

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