1) Evidence that renin is one of lysosomal enzymes was found. Among the subcellular fractions from the kidney and the liver, kidney lysosomal fraction almost exclusively had a non-dialyzable pressor substance. This was released from the particles by repeated freezing and thawing, and its reaction product with plasma was a heat-stable material which demonstrated a pressor effect with the characteristics of angiotensin. 2) The proportion of acid ATPase and acid phosphatase in the lysosomes of the kidney was different from that of the liver. Acid ATP-ase seemed to be released by freezing and thawing faster than acid phosphatase. The possible occurrence of acid ATPase distinct from acid phosphatase is discussed.

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In this examination the clinical significance of negative U wave was investigated in relation to age, sex, blood pressure, clinical diagnosis and other changes in ECG. 1) The incidence of negative U wave showed a marked increase in both sexes in age groups over 40 years of age and it increased rapidly as their age progressed. 2) The incidence of negative U wave increased remarkably both above 160mmHg systolic pressure and above 90mmHg diastolic pressure, and above these pressures it increased gradually as systolic and diastolic pressure became elevated. Namely, it increased remarkably in those patients who were clinically regarded as hypertensive. 3) The U wave inversion was frequently detected in the ECG of LVS, LBBB, myocardial infarction, myocardial damage and coronary insufficiency. 4) The U wave inversion was observed in leads V₅ and V₆ in remarkable high incidence ; in addition, the ST depression of more than 0.1 mV or T inversion in these leads were frequently accompanied by the U wave inversion. 5) Regarding clinical diagnosis, the appearance of negative U wave was closely connected with hypertensive diseases, myocardial infarction, angina pectoris, valvular diseases and congenital heart diseases. 6) U wave inversion was found twice as frequently among hypertensive patients whose condition was complicated by cardiac, cerebral or renal lesions, as among those with hypertension alone or associated with other diseases. 7) U wave inversion as an isolated abnormality was correlated considerably with hypertensive diseases or asymptomatic coronary sclerosis. 8) We should emphasize that in atypical anginal complaint associated with insignificant changes in ST segment or T waves the transient U wave inversion may be regarded as a reliable criterion of acute coronary insufficiency.

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In order to study the significance of the myocardial ammonia, the coronary arteriovenous differences of ammonia, amide-nitrogens and carbohydrates were deter-mined in normal mongrel dogs under some conditions. From the results obtained by ammonia administration, ammonia was shown to have an unfavorable influence on the carbohydrate metabolism, and the myocardial release of ammonia, glutamic acid and glutamine, and the extraction of α-ketoglutarate were observed. While during intraaortic balloon load, glutamic acid and glutamine tended to be extracted into the myocardium, and ammonia and α-ketoglutarate were released. It is suggested from the present study that glutamic acid and glutamine are important metabolites as nitrogen-rich storage and mobile reserves in the myocardium.

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On the basis of clinical experiences, psychic origin of a concave RS-T elevation was previously indicated by the author. In one of the preceding reports, an appearance of a concave RS-T elevation was demonstrated in a 30-year-old male and its disappearance in a 31-year-old female. This paper demonstrates the processes of appearance and disappearance of the concave RS-T elevation in one 36-year-old male. The patient had to live for some 40 days with his cousin suffer-ing from postoperative gastric cancer in the same hospital. Until the entry into the hospital the patient had affiliated himself with the structure-improving committee. He resigned his post because of his annoying subjective symptoms such as precordial discomfort, insomnia, anorexia and so on. The electrocardiogram which was normal on admission showed a concave RS-T elevation in left pre-cordial leads with a tapering, heightened T wave when his cousin was most serious. The concave RS-T elevation returned to normal some 70 days after the death of his cousin when the patient regained self-confidence and was completely asymptomatic.

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This follow-up study was undertaken to obtain prospective data on the factors influencing mortality in a group of unselected consecutive patients with essential hypertension. Information of this type is indispensable to evaluate the course and prognosis of individual cases at their first visit and to make a plan for long-term management of this disease. Materials and Methods From 1956 to 1960, 2, 839 patients were admitted to the Second Medical Division of Tohoku University Hospital, of these 729 were hypertensive. Among these hypertensive patients, 313 were excluded from this study because of the following reasons ; secondary hypertension-224 complicated neoplastic disease on admission-13, death during hospitalization -28, and old age(over 70 years) on admission-48. A total of 416 patients with essential hypertension remained for prognostic evaluation in this study. By the end of this study, 404 cases, i.e. 97 per cent of the group, had been followed until death or for at least 4 years from admission. The duration of the longest followup was 9 years. In the case of death, the data and cause of death were investigated from their family and home doctors who issued death certificates. For the purpose of evaluating prognostic significance of various clinical and laboratory data which were obtained at the time of ad-mission, patients were classified according to the grading system discussed below. Blood pressure on admission was arbitrarily classified as grade I (below 179/99mmHg), grade 11 (180-199/100-119) and grade III (over 200/ 1 20). The involvement of the ocular fundi was classified as normal and group I to IV according to KEITH and WAGENER'S classification. The degree of cardiac enlargement deter-mined by radiogram of the chest was classified by cardio-thoracic ratios. Grade I indicates 1.90 or more, grade II 1.89-1.70, grade III 1.69-1.50 and grade IV 1.49 or less. Electrccardio-graphic patterns were classified as normal, borderline, non-specific ST-T changes, coronary heart disease, and left ventricular hypertrophy. Loft ventricular hypertrophy was subdivided further as grade I-high voltage, grade II-.high voltage with relatively low T waves, grade III -diphasic T waves with ST changes and grade IV-clearly inverted T waves with or without voltage or conduction defects. Notes were made in regard to whether or not patients had clinically normal hearts, signs and symptoms of congestive failure, or histories of angina pectoris or myocardial infarction. Presence of impaired renal function and albuminuria was also noted.

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As a result of radio-electrocardiographic examination during and after exercise on 25 patients with hiatus hernia S-T depression in excess of 1.0mm was recorded in 7 cases before meals, and in 19 cases after meals, respectively. The electrocardiograms of 7 probands who gave S-T depression during ante-cibum exercise were also abnormal after meals. None of the 14 healthy subjects with age distribution similar to those with hiatus hernia showed S-T depression over 1.0mm. When S-T depression of more than 0.5mm on exercise test was regarded as positive, however, 22 patients with hiatus hernia gave positive result, whereas only 3 control subjects were included in this category. Accordingly, it is concluded that patients with hiatus hernia frequentry give S-T depression on exercise test before and after meals. As far as the effect of meals was concerned, S-T depression of more than 1.0mm was recorded in 7 cases on exercise before meals, and in 19 cases after meals. Since all the 7 probands with ante-cibum electrocardiographic abnormalities gave postcibum changes as well, it seems that hiatal patients give positive electrocardiographic findings on exercise test particularly often after meals. Relative to this point, MORRIS and GILBERT et al. observed a reduced coronary flow during gastric dilatation and its recovery after atropine injection in dogs. They appear to at-tribute this change to the vago-vagal reflex. From this point of view, the author administered atropine subcutaneously on 8 subjects with S-T depression over 1.0 mm on post-cibum exercise. Only 2 patients retained significantly depressed S-T segment. Moreover, the author could hardly observe a deviation of S-T segment in Trendelenburg's position during or after meals. It has been assumed that in hiatus hernia coronary arteriosclerosis as a concurrent disorder contributes to abnormal electrocardio-graphic findings, because such abnormal patterns are often demonstrable in aged patients. The author could not confirm higher incidence of S-T depression in aged group, however, when the age was studied in these 25 patients. In addition, this S-T depression could hardly be judged as a true ischemic change from the following reasons: 1) all the S-T depressions were of junctional type; 2) change in Q-T interval were negligible; 3) the number of cases showing S-T depression on post-cibum exercise test decreased after atropine injection ; 4) LEPSCKlN, DIMOND, and SANO emphasized that the type of S-T segment was more important than the degree of S-T depression. The author consider that these electrocardiographic findings should belong to the Group I (normal reaction) or Group II (harmless atypical reaction) according to DIMOND. As far as systolic blood pressure, arteriosclerotic changes of eyeground, and S-T depression are concerned, it appears that the higher the grade of arteriosclerotic changes is, the deeper the S-T segment goes down. The author wishes to consider these types as Group I or Group II according to DIMOND on the following groundes: first, the degree of S-T depression also advanced in healthy controls ac-cording to age, although to a variable extent within the normal limits; second, all the S-T depression in cases of hiatus hernia were not of ischemic but of junctional type ; third, the incidence of S-T depression and precordial discomfort or pain decreased after atropine injection; fourth, there was little change in Q-T interval. He also attributes the mechanism responsible for S-T depression to gastric dilatation during meals, particularly vago-vagal reflex due to the distention of a hiatus hernia sac together with augmented myocardial oxygen consumption resulting from exercise. Since the mechanism of ST-T changes re-mains to be elucidated, the detaile are not beyond speculation and further studies are needed.

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