Thorough understanding of pulmonary disability is indispensable for discussing the problems of pulmonary insufficiency. According to Comroe, pulmonary insufficiency is the impairment of alveolar gas exchange and pulmonary disability is the inability of pulmonary functions in carrying on normal way of life. For further inquiries, it is proposed to consider this problem on the standpoint of pulmonary reserve ability. What is meant by pulmonary reserve ability is the combined reserve ability of vascular bed (hypercirculating ability) and the reserve ability of alveolar ventilation (hyperventilating ability) under loading. Tests were made by the use of cardiac catheter under loading, and when findings were plotted on the graph having the effective alveolar ventilation increase rate (hyperventilating ability) on the vertical line and the rate of changes in the total vascular resistance (hypercirculating ability) on the horizontal line, following conclusions were drawn : a. Patients with considerable hypercirculating ability and hyperventilating ability are the cases of sufficient pulmonary reserve ability. b. Patients with considerable hypercirculating ability but with poor hyperventilating ability are the cases of pulmonary disability. c. Patients with poor hypercirculating ability and also with poor hyperventilating ability are the cases of pulmonary insufficiency and disability. d. Patients with considerable hyperventilating ability but with poor hypercirculating ability are the cases of pulmonary insufficiency but not disability. They appear to have fairly large reserve ability but heavy labors should be avoided as there is a danger of inviting right ventricular failure. Cases plotted below the mean level are, of course, the cases having the mechanical disturbance of ventilation, and further analysis of those patients can be made by the use of viscoelastogram. Namely, patients with high compliance and high resistance are the patients of obstructive type ventilation and those with low compliance and high resistance are the patients of restrictive type ventilation. Thus, proper treatment can be given on those patients by classifying them in this manner. Namely, patients shown to have high compliance but high resistance on viscoelastogram can be treated by IPPB, those with low compliance and low resistance by decortication. While, those with low compliance and high resistance are difficult to expect favourable effects from any treatment. By the treatments stated above, some of the patients of pulmonary disability, whose reserve ability is not fully utilized by the presence of the mechanical disturbance of ventilation, can be shifted from (b) to (a). It is extremely difficult, however, to expect the shifting of patients from (c) to (a), and moreover, not a single case has been experienced, being shifted from (d) to (a). Thus, it can be concluded that the most important point of the treatment of pulmonary disability is the improvement of the mechanical disturbance of ventilation (Fig. 9). As for pulmonary insufficiency, it is the disturbance of capacity and efficiency of ventilation and circulation. While, the treatment of insufficiency has mostly been directed on the improvement of efficiency alone. For example, pneumonectomy of the destroyed lung can produce remarkable improvement in the efficiency of both ventilation and circulation of the patient. Decortication of the pleural callosity, while, may improve the efficiency of pulmonary functions, but it is difficult to expect the increase of vital capacity by this treatment.

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We reported previously chemical and physical properties of the dextran sulphate which we synthesized newly. Intravenous administration of this preparation inhibited the atherosclerosis induced with lanolin feeding in rabbits and depressed hypercholesterolemia. The fat content and weight of spleen were slightly heavier than that of control animals. The metachromatic substances in atheroma and walls of aortae were not different between dextran sulphate treated and control animals.

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The repeated intravenous administration of dextran sulphate which we synthesized decreased serum total cholesterol, especially free cholesterol in several patients, without the prolongation of clotting time of blood.

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As the dextran sulphate which we synthesized has a low molecular weight, the intestinal absorption of this dextran sulphate was considered. The clearing activity and clotting time were measured after oral administration of this preactivity and clotting time were measured after oral administration of this preparation. And it was confirmed that this preparation is absorbed from the intestine in both man and dog. The improvement of lipid metabolism in aged human subjects was observed by the oral administration of this preparation.

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Intracellular action potentials and the spread of the excitation in the right atrium were investigated on a whole specimen of a dog's or rabbit's right atrium by means of microelectorde method. The excitation was originated at a certain point of sinoatrial node and was transmitted very slowly in all directions in the node. The sinus excitation was transmitted rapidly through crista terminalis being transmitted to mm. pectinati. The atrial roof was activated by the stimuli coming from mm. pectinati. The thicker the muscle bundle, the faster the conduction and the longer the action potential duration. Conduction rate of the excitation through crista terminalis was about 1.5 meter per second and that in sinoatrial node was about 0.1 meter per second. The author could not observe any highly differentiated specific conduction system in the atrium like His' bundle or Purkinje fiber in the ventricles.

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Electron microscope observations were made on the specialized tissues from the distal portion of the common bundle, the bundle branches, the false tendons, and their subendocardial ramifications in the dog heart. All these tissues have shown certain common structural features ; some of them being obviously different from the ultrastructure of ordinary cardiac muscle cells. The specialized musculature is also cellular in nature ; each cell being joined end to end at the intercalated discs and separated from the interstitium by the sarcolemma. The intercalated discs are identical in structure with those of ordinary myocardial cells. The sarcoplasm is occasionally large and the sarcolemma appears to be relieved of its typical " scalloped " outline except where the contracted myofibrils approach the sarcolemma. Although the myofibrils have the same structure as in ordinary myocardial fibers and run in general along the long axis of the cells, they are occasionally scanty and may branch in various directions in the sarcoplasm. The sarcosomes appear to be significantly smaller in size than in ordinary cardiac muscle cells. The smooth surfaced elements of the sarcoplasmic reticulum seem to be arranged in the surroundings of myofibrils as in ordinary myocardial cells and are occasionally conspicuously developed in the enlarged sarcoplasm and very close to the sarcosomes and pinocytotic vesicles. One of the characteristic features of the Purkinje fibers of this animal is the presence of rough surfaced elements of the sarcoplasmic reticulum. Some of them tend to be in parallel arrangement. With prior lead hydroxide staining, dense granules, 12-90m/μ in diameter, may occur in the sarcoplasmic matrix. Although their occurrence varies from section to section, they may represent deposits of glycogen. Occasionally a Golgi apparatus is seen in the perinuclear sarcoplasm. The structure of nuclei in the Purkinje fibers is similar to that of ordianry myocardial nuclei. Besides capillaries, fibrocytes and collagen fibrils, non-myelinated nerve fibers are occasionally found in the vicinity of the sarcolemma.

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Ca⁺⁺欠乏状態におけるカエル縫工筋の細動を肉眼的ならびに顕微鏡的に鰯察し,更に細胞内活動電位記録を行なって,筋細動のメカニズムと筋線維間に現われる干渉現象とに考察を加え,以下のような結果を得た.1)肉眼的観察で筋細動は経過にしたがって,全体に汎っている時期,部分的に止る時期,止まっているがなんらかの刺激で再び細動を起こす時期,および刺激にも全く反応しなくなる時期の四つがあり,心房細動の様相に類似している.興奮の発生は筋の断端に近く,特に骨盤側1/3附近に限局して認められ,興奮の波及はほぼ1/3に止まって筋全体に及ばない.2)顕微鏡的観察で筋線維は数本から10数本の束となって,束ごとに一定の頻度で細動し,各束の問に殆んど同期性はない.なお細動する筋線維に隣接しながら全く細動せぬ筋線維も多く,細動時興奮は筋線維の一点に発して拡がるが線維の全長に及ばず,終了は多く減衰性である.3)細胞内活動電位記録でPace-maker potential,Small potential,独立のSpike PotentialおよびNegatire small potentialが観察される.4)Pace-maker potentialは興奮発生部位の筋線維に多く証明され,ある閾値を越えると1ないし数ヶのSpike potentialを誘発する.5)Small potentialは持統50mSおよび大きさ10mV.以下で明らかにPace-maker potentialとは異なっているが,一定の静止電位を有し,律動性であり,ある閾値を越えるとPace-maker potentialと,ひとしくSpike potentlalを誘発し,その他summationの現象および群形成をも生じて,平滑筋興奮の筋から筋への伝播に関係するintercellular junction potentialのそれに近似する.6)筋線維から筋線維への興奮の伝播はSmall potentialを介して行なわれるものと考えられる.7)Spike potentialにはprepotentialを伴わぬものがあり,これは筋線維間の興奮伝播に関与しない.8)Negative small potentialは興奮している筋線維に隣接する静止線維に認められるが,10mV.以下で決してSpikepotentialを伴わず,電気的短絡路のない場令の隣接筋線維の興奮に基ずく,extrinsic currentによるpseudohyper polarisationと考えられる.9)Small potentia1やこれに伴うSpike potentialにおける群形成は,variable mutiplepathwayならびにmultiple reentryの可能性を指摘するものである.10)骨格筋には本来自動性がなく,筋線維間に組織学的にも機能的にも連絡をもたないが,Ca⁺⁺が欠乏すると筋線維はなんらかの影響のもとにPace-maker cellの性状を帯びて自動性が生じ,また筋線維問にも電気的短絡ができて干渉現象が起こり,更に興奮は異所性に多発したPace-maker cellからvariable multiple pathwayを通り,またmultiple reentryを起こして伝播し,かくて筋細動が発生するものと推測され,この問各種potentialは有機的な関連で消長するであろう.

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The purpose of this paper is to report satisfactory prolonged mechanical support with Extracorporeal Assisted Circulation (EAC) for a failed heart, i. e. partial perfusion with a pump-oxygenator or the pump alone. The apparatus for EAC consists of a venous reservoir a metal-finger pump (SIGMA-MOTOR Model TM-2) and a foam oxygenator which may be used if it becomes necessary. A venous cannula is inserted through either one of the jugular or femoral veins into the vena cava near the right atrium. A part of the vena caval blood then is withdrawn by gravity drainage, and pumped into the aorta through an arterial cannula inserted into one of the femoral arteries; however, during the periods the oxygenator is used, the oxygenated blood is perfused. A) EXPERIMENTAL STUDIES 1) Prolonged partial perfusion with a pump-oxygenator was applied to healthy mongrel dogs. The cardiac output, the aortic pressure curve, the electrocardiogram, the arterial and venous pressures, and various physical signs were recorded. Aortography was performed by injecting 1ml of 76% Urografin per kg of body weight into the arterial line during the perfusion. Nine of the 12 dogs survived after proprolonged perfusion and no evident histological change as a result of this procedure was found in the 3 dogs that died seemingly due to postoperative hemorrhage or technical error. The reduction of the cardiac output during the partial perfusion was approximately equal to the perfusion rate. According to the aortographic observations, an adequate flow rate of EAC should be less than 50ml/kg/min, because, below that rate, when an arterial cannula is inserted into one of the femoral arteries, embolization in the cerebral and coronary arteries can not occur. Nevertheless, in clinical application it seems reasonable to conclude that an optimal flow rate should be selected case by case. The combined aortic pressure curve due to pulsations of both the heart and pump during partial perfusion was observed ; however, as far as the subject is concerned, changes in the pressure curve may not be significant.

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It is well known that the hypoxia causes the pulmonary arterial pressure to rise, and many investigators ascribed this to the constriction of pulmonary blood vessels. Acoording to Kato who subjected the patients with pulmonary tuberculosis to 14% O₂ gas, the observed rise in the pulmonary arterial pressure was due to an increase in the pulmonary vascular resistance owing to the contraction of pulmonary blood vessels. A different opinion has been recently voiced by Fishman who subjected a unilateral lung, of man, to the ambient air, and next, to 10% O₂ gas, while subjecting the contralateral lung to 25-33 O₂ gas and who found no change in the rate of blood flow through the hypoxic lung and pulmonary artery blood pressure. Thus he was led to a conclusion opposed to the view of V. Euler that the hypoxia acted directly on the pulmonary blood vessels. A previous report was made by the present author on the differential pulmonary blood flow in patients with pulmonary tuberculosis. This paper aims to report a study where the affected lung was subjected to a 10% O₂ gas and where the effect of such maneuvre on the blood flow through the hypoxic lung was studied. MATERIALS AND METHODS Materials used were 5 cases out of the previously reported series and one new case, bringing the total to 6. They were subjected to the right heart catheterization, broncho-spirometry and arterial cannulation simultaneously. First, the healthy lung was subjected to a high O₂ gas, while subjecting the affected lung to the ambient air, and the differential blood flow was measured under this circum-stance as the control observation. Next, the air-way to the affected lung was switched to a source of 10-12% O₂ gas and another determination of the differential pulmonary blood flow was made after allowing a certain period of time. In this way the effect of unilateral hypoxla on the affected lung was studied. At different stages of the experiment arterial blood samples were withdrawn and analysed for O₂ tension (PaO₂) and CO₂ tension (PaCO₂) and hematocrit (Hta) ; pH of the arterial blood was calculated from Singer and Histings' nomogram⁹⁰⁾.

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I. We recognized the gathering picture of five juxtaglomerular cells, in which endoplasmic reticulum was noted, on the investigation ofjuxtaglomerular apparatus by electronmicroscope. And we guessed the secretory function of these cells. On the following experiment we administered cortisone or AC TH to normal male albino rats, the increase of granules in the juxtaglomerular cell and juxtaglomerular index were noted 7 days after the administration while the decrease of these were noted 20 days after. From these observations, it was conceived that juxtaglomerular apparatus was effected humorally by hormone. II. If Kurotsu's b "sympathetrc zone" or c "parasympathetic zone" in the hypothalamus of normal male rabbits was lesioned or stimulated by electrode, the decrease of granules in the juxtaglomerular index on syrnpatic state and no alteration nor marked increase of that on parasympatic state were noted. On the experiment with adrenalin hydrochloride or pilocarpin hydrochloride, the glanules in the juxtaglomerular cell and juxtaglomerular index decreased with the former and the granules in the juxtaglomerular cell increased slightly with the latter. From these experiments, it was persumed that juxtaglomerular apparatus was effected by autonomic nerve, considerably by sympathetic nerve, and releases the substances for vasoconstrrctron

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