The amplitude changes of the third and atrial sounds before and after double MASTER'S two-step test were analysed in 60 cases of ischemic and/or hypertensive heart disease and 60 normal subjects using direct-writing phonocardiograph. After exercise both third and atrial sounds in the heart disease group showed greater increase in the amplitude and delay in restoration to the pre-exercise level than those of control group. The differences were statistically significant. In some cases with ischemic heart disease definite gallop rhythm developed after exercise despite negative MASTER'S test. First and second sounds, however, revealed no remarkable differences in post-exercise amplitude changes between two groups. Left ventricular hypotonicity and elevation of the end-diastolic pressure may be responsible for the accentuation of these diastolic extra-sounds in diseased group.

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1) There was no consistent correlation between serum acid ATPase activity and serum acid phosphomonoesterase in pH-activity curves or in the clinico-statistical study. 2) A distinct positive correlatioh between systolic or diastolic blood pressure and serum acid ATPase activity was observed in one group including 44 patients with essential hypertension and 38 normal subjects. A positive correlation between diastolic blood pressure and serum acid ATPase activity was also observed in another group including only 44 patients with essential hypertension. A positive correlation between systolic blood pressure and serum alkaline ATPase activity was found in one group including 43 patients with essential hypertension and 36 normal subjects. 3) Elevated serum acid or alkaline ATPase activities were observed in patients with liver diseases or congestive heart failure except in patients with essential hypertension. 4) A distinct correlation between serum alkaline ATPase activity and serum alkaline phosphomonoesterase was observed in the clinico-statistical study, although there were several cases in which serum alkaline ATPase activities were within the normal range in spite of increased serum alkaline phos-phornonoesterase activities. The detailed interrelation between them remains to be clarified.

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A case of atrio-ventricular communication syndrome has been reported. The case was 24 year-old house wife, mother of a child. Necropsy has indicated the anomaly similar to the type I of GERBODE'S classification. Clinically, she had presented pansystolic murmur with intense systolic thrill in the lower sternal region. She died of congestive heart failure. Postmortem examination had also indicated the complication of subacute bacterial endocarditis with ruptured aneurysm of Valsalva sinus resulting in communication between right atria and root of aorta. Literature review of this syndrome has been made, in which similarity of clinical picture to ASD and VSD in regard to data of right heart catheterization and heart sound finding, respectively and also rather higher incidence of complication of SBE are emphasized.

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The intramolecular negative formal charges of urea, methylurea, acetamide, 1-3-dimetylurea and thiourea were calculated by Simple-Linear-Combination of Atomic-Orbital and Molecular-Orbital Method. Then, these charges were divided by (molecular radius)^2-3 or (MR-D)^2-3. By this calculation, a new index showing the intensity of negative charge around the molecule was obtained. The order of the magnitude of these indices agreed well with that of ability to enhance urinary osmolality or water reabsorption in renal medulla of dogs shown by RABINOWITZ et al, and that of the accumulation strenghth of these substances into the renal medulla in anti-diuretic low-protein rats shown by TRUNIGER et al.

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This is a preliminary report of a new technique of mitral valve replacement with a homologous aortic valve. Our experimental studies showed low operative mortality and excellent hemodynamic results up to date, No thromboembolic complication has been observed. The fate of homologous cardiac valve is discussed. One successful human mitral valve replacement with up-side down homologous aortic valve is reported.

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Hemodynamic responce to physical excercise has been studied in various diseased status and the response has been compared to those of normal control group. It is also the purpose of this study to make comparative evaluation of the hemodynamic response to excercise between the group of patients with stenosis of mitral or pulmonic valvular orifice and the group of patients with atrial septal defect or normal healthy subjects, in which excercise response was expressed as a ratio of increase in cardiac output to increase in oxygen consumption per unit of time. Methods ; 3 healthy normal subjects, 7 cases of mitral stenosis, 5 cases of pulmonic stenosis and 4 cases of atrial septal defect were chosen for this study. All the mitral stenosis and pulmonic stenosis cases were of milder condition and presented no clinical symptoms in their routine daily life. Right heart catheterization was performed according to the COURNAND'S method at rest and after measurements of cardiac output and pulmonary arterial pressure, patients were put on leg exercise and the measurements were repeated during the fifth minutes excercise. Cardiac output was measured from arterio-venous oxygen difference and oxygen consumption per minute using the FICK's formula. Results ; In the normal control group, restring cardiac index was ranged between 4.80 and 5.39 l/min./M², and the response index to excercise, as a ratio of increase in cardiac output in ml/increase in oxygen uptake in hundred ml was ranged between 800 and 900 ml/min.. Pulmonary arterial pressure went up less than 5 mmHg over the control pressure value. In mitral stenosis group, cardiac index was ranged between 2.13 and 4.40 ml/ min./M² and the ratio of increase in cardiac output to increase in oxygen consumption during excercise was less than 800 ml/min. with one exception, which showed 943 ml/min.. In all the cases of this group, significant elevation of pulmonary arterial and wedge pressure were observed during exercise. In the pulmonic stenosis group, exercise index was less than 800 ml/min. in 3 cases. In the ASD group, all 4 cases have shown definitely greater value of exercise index exceeding 1000 ml/min. Conclusion ; Even in clinically silent cases of mitral stenosis or pulmonic stenosis, hemodynamic response to exercise indicated as a ratio of increase in cardiac output to in-crease in oxygen uptake is significantly less than 800 ml/min., contrasting to the data obtained in the group of ASD patients presented exceedingly greater value of normal range between 800 and 900 ml/min.

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It is the purpose of this paper to present the results of the correlative study between hemodynamic and lung function data obtained in the group of patients of mitral valvular disease of rather milder degree. Special references have been made on interrelation between the oxygen cost of breathing estimated as a ratio of increase in oxygen consumption to voluntary increase in ventilation and hemodynamic variations in mitral stenosis cases. Methods : 13 milder cases of mitral stenosis (grade 1 and 2 by New York Heart Association's classification), 2 moderate cases of mitral stenosis (grade 3), 2 cases of mitral regurgitation of grade 2, a case of grade 3 mitral regurgitation, 3 cases of grade 2 mitral stenosis and regurgitation and 12 normal subjects as the control group were studied either by right heart catheterization or by pulmonary function tests. Right heart catheterization was performed by the method originally described by COURNAND. Vital capacity, timed vital capacity and maximal breathing capacity were measured by COLLINS' type spirometer using direct writing and integral pens. Oxygen cost of breathing was measured by the method similar to that described by BADER and others. Respiratory valve was constructed by connecting two "J" valves, which occupied dead space of 60 ml including mouth piece. The inspiratory side of the valve was left open to room air and the expiratory. side was connected to TISSOT's respirometer. Test was performed in the early morning during the post-absorptive status and in sitting position. After the collection of 3 minutes' ventilation, subjects were encouraged to perform voluntary hyperventilation reaching up to 10, 15, 20 and over 20 l/min. if possible. Expired air was analyzed into oxygen and carbon dioxide content using SCHOLANDER'S microgasanalyzer. Results : Significant reduction in vital capacity was observed in two cases of grade 3 mitral stenosis and a case of grade 3 mitral regurgitation, remaining 18 cases have shown normal or minimally reduced vital capacity. No case has shown significant reduction in MBC and timed vital capacity. While, oxygen cost of breathing was significantly higher in all three cases of grade 3 group, and no significant increase was observed in all the cases of grade 1 and 2 group. Positive and negative correlations were found between oxygen cost of breathing and mean pulmonary arterial pressure and cardiac index, respectively. Especially higher correlation was found between oxygen cost of breathing and mitral valvular orifice estimated at the time of com-missurotomia. In three cases, oxygen cost of breathing significantly reduced postoperatively. Conclusion : Oxygen cost of breathing ap-pears to be more sensitive test reflecting the tightness of mitral valve as compared to vital capacity, timed vital capacity and maximal breathing capacity.

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