The hint came to the authors from Mason and Braunwald's method and calculated on a new simple measuring method for systolic blood pressure in infants with photoelectroplethysmograph and the usual portable ECG recorder. The value of the authors' method was compared with the auscultation method in adults and elder children and further it was tried in several cases of premature infants.

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A fundamental and rather unexplored problem of the cardiovascular system is that having to do with the forces which determine the growth of vessels. All vessels begin as capillaries which enlarge gradually under the influence of certain forces. In recent year, physical forces which may contribute to the modification of the lumen, wall thickness, and degree of lipid infiltration of blood vessels have received considerable attention. A closely related problem is that having to do with the mechanism of local enlargements of vessels as poststenotic dilatation and aneurysms.

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In mitral stenosis, a specific pattern was observed in postero-anterior BCG, i.e., prominently large early systolic anterior H, prominently decreased posterior I, and prominently large diastolic posterior M. The amplitudes of these abnormal weves were large in severe cases and small in mild cases and a close correlationship was observed between the amplitudes of the above waves and mean pulmonary artery wedge pressure. The diagnosis of mitral stenosis and its severity on the basis of posteroanterior BCG was discussed.

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In cardiac surgery, many problems remain unsolved about the pulmonary hypertension with which congenital cardiac anomalies with left to right shunt, are accompanied. The author studied on the pulmonary hypertension with special reference to precapillary pulmonary hypertension in ventricular septal defect from both hemodynamic and histological aspects. And for the purpose of hemodynamic analysis of pulmonary hypertension, theoretical considerations on pulmonary circulation were presented. Forty nine cases of ventricular septal defect were studied. The routine right heart catheterization was performed. At operation lung biopsies were obtained immediately after thoracotomy, and microscopic preparations were stained with Verhoeff's elastic tissue stains counterstained with Van Gieson's connective tissue stains. Histological studies were carried out on small pulmonary arteries and arterioles, and the ratios of medial thickness to diameter of small muscular arteries were measured separately with eyepiece micrometer and were averaged. A) Theoretical Considerations on Pulmonary Circulation. becomes more remarkable if the heart rate does In hemodynamics, pressure and flow are the most fundamental factors, and the relationship between pressure and flow is characterized by many parameters as mechanical properties of circulatory system. As the parameters which constitute "Impedance", comliance, resistance and inertance are considered. The formulae to calculate Resistance, Compliance and Inertance of pulmonary arterial tree were presented, and from the analogy of the differential equation describing the mechanical impedance of wave propargation in a elastic tube to that of electronic circuit consisting of resistance, inductance and capacitance in series, a equivalent four terminal network for the circulation model of the pulmonary arterial tree was designed. Thus the input impedance in pulmonary arterial tree and the transfer function between pulmo-nary artery pressure and pulmonary arteriolar blood flow were discussed.

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With a view to investigating the Peripheral Circulatory Insufficiency particularly in the field of surgical operations, the author has under-taken a circulatory analysis by means of modification of Wezler's methods which is among those used in connection with the physical methods for circulatory analysis. Two electric manometers, of the identical capacity, were attached to the carotic artery and the crural artery so as to record their pulse waves, from which were calculated the circulatory values by the Wezler formula. A total of 96 cases were subject to the investigation were examined before and after a surgical operation to observe the Circulatory Insufficiency throughout. The findings before the operations indicated 42% was accounted for the circulatory regulation of " Anspannungs " and in terms of diseases, the stomach cancer and cardia cancer cases claimed more than half in this category and those of the esophagus cancer nearly the half. The tachycardia cases at a resting period before the operation increased by 20%. In-stances of low cardiac output were noted in the patients of the cancer of digestive organs. The findings after the operations indicated that the majority of "Anspannungs" circulatory regulation took place right after the operations. A better circulatory condition after the operation was observed with a general anesthesia rather than with a spinal anesthesia. The fact that blood transfusion during the operation had a beneficial effect on the post operative low cardiac output behavior testified to the existence of a relationship between the two. Changes in the circulatory regulation owing to an operation were of the normal type but, depending on the nature of cases involved, there had appeared the patients who required the "Anspannungs " regulation immediately after their operations, only returning to the normal with the lapsing of time. It was also made clear that in such cases where the cardiac output was low both before and after the operations, the general tendency was to incur a circulatory insufficiency. In determining whether a case of low cardiac output occurred or not, indications were employed that before an operation the pulse pressure count was under 40 mmHg and after an operation the pulse pressure count was under 40 mmHg and the heart beat count was either over 100 or under 70. In the pre-operation study, 75% of the cases and post-operation study, 100 of the cases falling under the former category were diagnosed as being the low cardiac output. As the conclusions, it has been establised that though is a great deal of the "Anspannungs" circulatory regulation this is by no means a contraindication for any type of circulatory regulationin in surgical operation. A general anesthesia is preferred in a surgical operation, a blood transfusion during an operation had a beneficial effect on the subsequent low cardiac output, the use of some cardiotonic is recommended. On the determination of low cardiac output by means of the pulse pressure count is available especially immediately after the operation. Finally, it is considered that Wezler modification method is a useful tool in the precaution of the Peripheral Circulatory Insufficiency to be encountered in surgery.

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The organic diseases of the heart and great vessels, e.g. valvular regurgitation and/or stenosis, anomalous shunt between right and left side of the heart and so on, may produce disorder of blood stream and result in turbulance or impact of accerelated blood flow, which cause "organic heart murmur". The murmur is important for diagnosis of these cardiac abnormalities. "Functional cardiac murmur" is defined as a bruit which is produced only by functional exaggeration of blood flow velocity, and never based on any structural cardiovascular anomalies. The differentiation between these two different type of murmur, therefore, is very important and not always easy to achieve. There have been several reports concerning to the differentiation between two types of murmur, some of these include murmur caused by secondary hypertrophy of crardiac chamber in the category of "functional murmur" and some are inclined to exclude these type of murmur. So far the pathogenesis of functional murmur is persumed to be based on increased blood flow velocity. It is described that functional murmur is usually ejection type systolic murmur arising in the outflow tract of the right ventricle or across pulmonic valve. MACHII has presumed the mechanisrn as eddy current effects right behind the "trigonoidation" of pulmomic valves. The data obtained by intracardiac phonocardiography and direct surface phonocardiography, which indicate that main pulmonary artery is the point of maximal intensity in all of the cases, strongly suports the above conclusion. GROOM has demonstrated consistent occurrence of ejection type systolic murmur in all of the healthy materials regard-less sex or age using high gain high frequency phonocardiography in "sound proof room". So-called "functional murmur" s, i therefore, thought to be exaggeration of above mentioned bruit. Hyperthyroidism and anemia have been named as most typical exaggeration. Disappearance or diminution of functional murmur in these diseases after improvement of the conditions have been reported. The author has experimentally induced anemia in dogs by exchanging blood with Moriamin-P at a dosis of 20 cc per Kilogram bodyweight within 10 minutes. This procedure was repeated 4 times in succession. All of the animals have presented systolic murmur at the end of the experiment. Moramin-P has lower viscosity than that of blood. The same experiment using 2.5% gelatin solution, which has same viscosity as blood, instead of Moriamin-P has resulted systolic murmur in none of the animals. Another attempt to induce experimental hemolytic anemia was made by subcutaneous injection of phenylhydrazin in dosis of 10 mg pro die. 15 days after the first injection, hematocrit level has declined down to 15% and all of the animals have presented systolic anemic murmur. Hematocrit level reached down to its lowest level around 10 days after the first injection, when II-I time shortened to its minimal level, and the maximal intensity of the murmur and maximal increase in the area of the cardiac silhouette were observed 2 or 3 days later the time of minimal hematocrit.

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