1. The blood pressure in patients with liver injury was correlated with the pathological findings in biopsy specimens and laboratory examinations. 2. In acute hepatitis, liver cirrhosis, and cholangitis, blood pressure tended to be lower than in other diseases. 3. Among patients with liver cirrhosis, none had hypertension. 4. In patients with necrosis and degeneration of liver cells, blood pressure tended to be low, and the incidence of hypotension was higher than in those without such morphological changes. The reduction of blood pressure appeared to be more prominent in patients with more severe injury, especially of the parenchyma cells. 5. In cases of liver cirrhosis, a low serum albumin level was correlated with reduction of blood pressure.

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Abnormal electrocardiographic findings were detected in considerably high percentage in patients with diseases of the liver such as hepatitis, cirrhosis and hepatic cancer. As the most common abnormalities, lowering of T wave, depression of ST segment, low voltage and prolongation of QT duration were observed. These electrocardiographic changes were correlated with aging of the patients and severity of the clinical symptoms. It was noticed that the grade of the electrocardiographic changes had marked correlation with the lowering of serum protein level, especially that of serum albumin level in cirrhosis. The abnormal electrocardiogram was found in all patients with less than 5.5g/dl of serum protein level or with less than 2.0g/dl of serum albumin level. The electrocardiographic findings were also correlated with some abnor-malities of serum electrolyte level such as hyper-or hypopotassemia, changes of serum Na/K ratio and hypocalcemia. In addition, the relationship between " Verfliessen " of ST-T junction(Wuhr-mann) or Hegglin's syndrome and dysproteine-mia or dyselectrolytemia was investigated. From the above results, it was suggested that dyspro-teinemia, dyselectrolytemia or combinations of these metabolic disorders were responsible for the electrocardiographic findings. As to the prognostic significant of the electrocardiographic findings, it seemed more valuable to follow up the change of T/P ratio in comparison with that of QT/TQ ratio. Finally, the relationship between the electrocardiographic changes and pathological findings of the heart was discussed to some extent.

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The senile cases of myocardosis complicated with hypoproteinemia showed always the abundant mucoid degeneration in the myocardium. The cases of energetic-dynamic heart insufficiency showed the mucoid degenerotion less frequently than those of the myocardosis, however, the former showed the more marked interstitial edema than the latter.

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The myocardial changes appearing in the cases of liver cirrhosis have been observed morphologically and discussed. In the cases of liver cirrhosis there is no peculiar lesion in the myocardium except for edematous process of the cardiac muscle fiber as well as the interstitium. For the study of myocardial lesions observed in the cases of metabolic disturbances, is necessary to study the metabolism of the myocardial fiber morphologically hereafter.

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A total of fourty-eight cases of various cardiovascular diseases were throughly examined clinico-pathologically, classifying according to the types and degrees of CHF into four groups, namely A-, B-, C-, and D-groups, of which, however, D-group alone was essentially free of apparent CHF and thus to be considered as the control to the others. Thus from these studies there may be revealed to some extent the characteristic correlations between the clinical features and the pathological findings, especially concerned with the therapeutic responsibilities thereof. In conclusion it may be emphasized in this paper that the active or progressive myocardial degeneration not infrequently leading to some protracted shock-like states without evident backward congestion as typically demonstrated in the present A-group may be mainly responsible for the so-called "refractory " CHF in the strict sense, though there the mechanical factors such as valvular deformities per se seem rather mild, and in general vice versa as verified somewhat in the other groups.

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(1) Out of 300 autopsy cases in Yokufuen (old people's home) during the last 3 years, 26 cases were diagnosed as cor pulmonale : 20 cases as pulmonary emphysema and 6 cases as pulmonary tuberculosis. Although the emphysema is much more common in men, no marked sex difference was noted in the rate of development of cor pulmonale from pulmonary emphysema. (2) Histological examination showed a marked thickening of the intima and media throughout the arterioles, muscular arteries and elastic arteries of the pulmonary vessels. Intima fibrosis and the increase of elastica were also found. These changes are seconday manifestations of the disturbances in pulmonary circulation. (3) From the studies with post-mortem pulmonary arteriography, the morphological factor in the cause of pulmonary hypertension is considered to be loss of pulmonary vascular bed. (4) Effects of hypoxia, hypercapnia, intrapulmonary air pressure and drugs on the pulmonary vascular resistance were tested in the thoracotomized dogs. The results challenge the concept that the tone of pulmonary vessel plays an important role in the cause of pulmonary hypertension. The data suggest that the regulation of pulmonary circulation may be determined by intrapulmonary air pressure. (5) There are many cases of cor pulmonale in which a physiological abnormality rather than the morphological changes of pulmonary vascular bed is the determinant of the pulmonary hypertension. Disability of the heart in these cases can be relieved by the treatment. Therapeutic efforts are directed not only at the treatment of the heart failure but also toward the elimination the results of pulmonary dysfunction.

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1. An initial single injection of strophanthine G made it possible to appreciate the therapeutic efficiency of the ensuing digitalis regimen. Increase in cardiac output of more than 140 per cent fallowing the single injection of strophanthine is a reasonable proof to show a remarkable efficacy of digitalization, and therapeutic benefit would be expected when cardiac output became below 120 per cent or even reduced. 2. Cardiac patients who underwent a course of digitalis therapy may be classifiable into four types of natriuretic patterns. These patterns usually accord with the increase of cardiac out-put except for the patients with the relatively high level of urinary sodium prior to the medication. 3. When the patients were successfully treated with digitalis, urinary output of adrenaline was increased in the first few day and reduced, while urinary adrenaline/noradrenaline ratio was high. However, when digitalis failed to improve the clinical condition, no significant variation of urinary adrenline to be observed : at time, even a noticeable reduction would be found when urinary adrenaline/nor-adrenaline ratio was low. 4. It is assumed from these results that there seemed to be intimate relation existing between the digitalis effcetiveness and the ad-renal medullary hormone.

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