Adrenal catecholamine contents were measured spectrofluorometrically by CROUT'S method in 29 male spontaneously hypertensive rats at the prehypertensive, early and advanced hypertensive stages and in 24 age-matched male normotensive Wistar rats. Adrenal noradrenaline contents per adrenal, per animal, and per gram of adrenal weight in spontaneously hypertensive rats were almost twice as high as those in the controls throughout these stages. Adrenaline contents per adrenal were larger in the early hypertensive stage in the former rats, especially in the advanced one, but no great differences in adrenaline content per gram of adrenal weight were noted between the former and latter groups.

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The present study was made on the influence of acute change in plasma sodium level on the renin secretion in the anesthetized dog. Plasma sodium concentration was reduced by a peritoneal dialysis with low sodium lavage solution, and was returned by administration of hypertonic saline solution. The renin secretion markedly increased following a reduction of the plasma sodium level, and decreased following administration of hypertonic saline solution.

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Present studies have been undertaken to make observations on the possible correlation between heparin and LPL activity from the viewpoint of the mechanism for disposing ability of alimentary lipemia. In vitro study has revealed the fact that releasing of LPL from the rat's tissue was responsible to the biochemical action of heparin. Following the intraarterial or intravenous infusion of heparin, LPL seemed to be released rapidly, suggesting that LPL may be mobilized from the vascular wall or adjacent tissues. No difference of plasma LPL activity after heparin injection in the fasting state between young healthy persons and patients with atherosclerosis was found. Moreover no difference could be observed between the effect of heparin injection on the changes of plasma OD and LPL activities following fat intake in the controls and patients. An assumption was made that deficiency of apoenzyme could not be considered for the interpretation of disturbance in disposing ability of absorbed fat. Heparin-like substance in plasma was measured in the groups on fasting and postalimentary state. Plasma contents of heparin-like substance on fasting are found to be lower on the patients than the controls. One hour increase after fat intake failed to occur in the former, contrary to the latter, thus it is assumed that with the atherosclerotic patients the deficiency of heparin with disturbed releasing biochemical process are the responsible factor concerned. Further, the disturbed disposing ability of NEFA from blood stream is another factor to be considered in the abnormal metabolic process following fat absorption.

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Adrenergic innervations of the peripheral blood vessels of the Spontaneously Hypertensive Rats (OKAMOTO and AOKI) (SHR) were studied by the highly specific and sensitive fluorescence method, in comparison with those of normotensive control rats, and the following results were obtained. 1) Anterior cerebral and middle cerebral arteries over 1 50/h in diameter showed slightly augmented fluorescence in adrenergic nerve terminals in the SHR, but in those less than 150μ in diameter there was no obvious difference in fluorescence between the SHR and controls. 2) Other main cerebral arteries and their branches exhibited the similar distribution of adrenergic innervations and apparent difference in fluorescence was not seen. The more the main cerebral arteries branched out to the distal the more scanty became the tendency in fluorescence distributions, and there was no specific adrenergic fluorescence of the arteries in the intracerebral portion except in the infundibular area. 3) Marked augmented adrenergic fluorescences were seen in the choroidal arteries 50-15μ in diameter in the SHR and granules or cloudlets, called the varicosities of the nerve terminals, were larger than those of controls. 4) The dilated and constricted portions of the intestinal small arteries 100-40μ in diameter in the SHR always revealed augmented fluorescence and granules or cloudlets of fluorescence were larger and more intense than those of controls. 5) The adrenergic fluorescence of small coronary arteries in the SHR was numerous and increased in number. 6) These augmented fluorescences were observed throughout the three stages of hypertension; that is, the prehypertensive, initial, and advanced stages, respectively. 7) The obtained augmented fluorescence in the SHR showed a clear increase in quantity examined by three quantitative methods. 8) Above-mentioned findings suggested that noradrenaline, as the neurotransmitter, of the peripheral blood vessels may accelerate vascular function and play some important roles in the pathogenesis of the SHR.

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In order to elucidate the significance of ammonia in the myocardium, the dynamic changes of the related substances were studied mainly in the rabbit myocardium. In the experimentally hypertrophied heart, ammonia and urea were slightly in-creased, while ATP, high energy phosphate and total nucleotide were decreased. A significant negative correlation was noted between total nucleotide and heart weight/body weight. When ammonia was administered, increases in ammonia, glutamine, and urea were noted in both hypertrophied and normal heart. When acute pressure loading through intermittent obstruction of rabbit aorta was conducted, increases in ammonia, urea, and AMP were noted in both hypertrophied and normal heart while glutamine initially decreased and then increased in the normal heart. ATP and total nucleotide showed a tendency of decrease in both normal and hypertrophied heart.

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Tension period, isometric contraction time and ejection time were measured in 20 normal subjects and 72 patients with nonvalvular heart disease to evaluate the usefulness of the duration of left ventricular systoles as an index of the ventricular performance. Left ventricular function could not be manifested with only one of those durations. The ratio of ejection time to isometric contraction time demonstrated a parallelism to changes in left ventricular performance. Serial observations of this ratio offer a convenient detection for the changes in left ventricular per-formance.

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Plasma renin activity was measured in seven patients with pheochromocytoma. Increased plasma renin activity was consistently observed in five cases, in whom urinary excretion of noradrenaline was higher than that of adrenaline. In one patient, there occurred a progressive rise in plasma renin activity with a proportionate increase in urinary excretion of noradrenaline. On the other hand, plasma renin activity remained to be normal in the remaining cases, in whom adrenaline excretion was dominant as compared with noradrenaline excretion. These findings could be reproduced in nineteen dogs, when they were infused intravenously with noradrenaline, adrenaline, methoxamine and metaraminol. On the infusion of noradrenaline, plasma renin activity was significantly increased. In contrast, adrenaline infusion caused no change in plasma renin activity. However, in dogs premedicated with a beta-receptor blocking agent, plasma renin activity was significantly increased in response to adrenaline infusion. These findings suggest that increased plasma renin activity in pheochromocytoma is due to renal ischemia resulting from the vasoconstrictive action of noradrenaline secreted from the tumors.

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Hemodynamic effects of propranolol in 23 Patients with congenital heart disease were studied at cardiac catheterization. Fifteen cases with pulmonary stenosis showed elevation of pulmonary artery pressure and depression of right ventricular pressure, maximum dp/dt of right ventricle and blood pressure with statistic significants after propranolol injection. In 4 cases with marked elevation of pulmonary artery pressure without significant change of right ventricular pressure, localized muscular stenosis of right ventricular outflow tract without valvular or severe valve ring stenosis were proved by surgery. Propranolol would be usefull to know the nature of pulmonary stenosis.

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Cases with a complete superior displacement of the QRS loop were studied. They had no close relation to myocardial infarction. This type of the QRS loop was considered to be caused not by inferior infarction, but by a special type of incomplete intraventricular block, and was designated as Toyama-Suzuki's Syndrome.

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The basic principle of Synchronized Arterial Counterpulsation (SAC-P), as described by Clauss in 1961, appears to be both simple and sound on first inspection. If the blood is removed from the aorta just before and during ventricular systole, the resistance against which the left ventricle must eject can be reduced. The same volume of blood is then returned during ventricular diastole, possibly raising the aortic diastolic pressure and aiding the peripheral perfusion, particularly the coronary perfusion. Controversy, however, continues regarding the effect of this procedure. In the previous studies on assisted circulation, the authors satisfactorily demonstrated favorable hemodynamical changes during SAC-P, but it was thought that only hemodynamical study could not fully clarify its effect on the myocardium. Therefore, so as to assess the effect of SAC-P, the author has attempted to investigate the changes in the coronary hemodynamics and oxygen metabolism of the myocardium induced by SAC-P and to evaluate its effect in aspect of the myocardial oxygen metabolism. In order to prove the effect of this procedure, such parameters as the coronary sinus blood flow, coronary vascular resistance, exchange of oxygen, lactate and pyruvate between the aortic blood and the myocardium, lactate-pyruvate ratio (L/P ratio), myocardial excess lactate (XL) and redox potential (ΔEh) were determined. Lactate and pyruvate are of interest in the myocardial metabolism for two reasons: (1) The myocardium is the main mammalian tissue known to be capable of utilizing lactate as a substrate for energy production; and (2) lactate and pyruvate hold an important position in relation to anaerobic metabolism. Myocardial excess lactate (XL) and redox potential (ΔEh), calculated by the arterio-venous concentration of the two substrates, have been considered as the indicators of cellular oxygenation and are used quantitatively as a measure of anaerobic rate in myocardial metabolism. Thus, the author has attempted to find out the most useful of all parameters measured, in order to estimate the effect of SAC-P on the myocardium with rapidity and accuracy. The pump used in this study was a Davol Heart Pump Model 8500, which was connected to a cannule inserted into the aortic root through the brachiocephalic artery or the abdominal aorta. After pericardiotomy the catheters for the pressure-measurement and the blood sampling were inserted into the left ventricle and the aorta.

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Synchronized Arterial Counterpulsation, advocated by Harken and associates in 1961, is a type of assisted circulation for left-sided heart failure. With this procedure performed, the blood ejected from the left ventricle is sucked into a blind pump ventricle during left ventricular ejection by means of a pump which operates in synchronization with cardiac activity. During ventricular diastole the blood is then returned to the arterial tree by the pump. Thus, an inversion of phases of the aortic pressure curve takes place by this procedure. Using healthy adult mongrel dogs, the author has made attempts to investigate the hemodynamic effects of Synchronized Arterial Counterpulsation in which an arterial cannula was inserted through the abdominal aorta into the aortic arch. The pump used in the studies was the Davol Heart Pump Model 8500, which is able to operate in synchronization with the electrocardiographic R wave and is regulatable with regard to its systolic delay from the R wave, its systolic and diastolic duration and its stroke volume. Total right ventricular bypass was performed in these experiments for measuring cardiac out-put, which was accounted for output of the pump for the bypass, Sigmamotor Model TM-2. The following parameters were adopted for evaluating the hemodynamic effects of Synchronized Arterial Counterpulsation : the pressure curves in the aorta and the left ventricle, cardiac output, coronary sinus blood flow, myocardial oxygen consumption, the Tension-Time Index, the external and internal work of the left ventricle, efficiency of the left ventricular work, and others. Therefore, in order to examine the changes in these parameters by this procedure, aortic and left ventricular pressure as well as cardiac output were measured and recorded, and the aortic and coronary sinus blood was sampled to be examined. All of the above-mentioned parameters were satisfactorily monitored in 12 dogs, which were divided into group I and II according to results. In group I, 6 dogs showed a decrease in left ventricular pressure, a decrease in myocardial oxygen consumption and an increase in coronary sinus blood flow. The remaining 6 dogs, classified as group II, did not show at least one of the changes in three parameters.

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Since the report of MOTLEY(1952), oxygen, bronchodilators and antibiotics, are inspirated by means of the intermittent positive pressure breathing (IPPB) to obtain a therapeutic effect on the ventilatory impairment due to the obstructive lung disease. This procedure has been proved effective, but it is known that it is less effective upon the chronic pulmonary emphysema than upon the bronchial asthma. The studies were performed on five cases of chronic pulmonary emphysema and six cases of bronchial asthma, to clarify the effectiveness of IPPB itself by comparing the therapeutic effects on the patients with the results during voluntary hyperventilation (VH) of similar ventilatory volume. Analysis of blood gas and expired air and measurements of alveolar gas exchange were made on the subjects at rest, during IPPB and during VH. General pulmonary function was also examined at rest. Right-sided cardiac catheterization was performed on all cases and the measurements were made in each of the states. The results were as follows: 1) Changes of blood gas In chronic pulmonary emphysema, during IPPB, arterial oxygen tension (PaO₂) rose from 62.4mmHg ±3.6 to 81.0mmHg ±8.9 (increase of 30%), and arterial CO₂ tension (PaCO₂) fell from 52.4mmHg ±5.7 to 45.8mmHg ±8.2 (de-crease of 13%). PaO₂ increased by 8.2mmHg and PaCO₂ decreased by 2.0mmHg during IPPB as compared with those during VH. In bronchial asthma, PaO₂ rose from 78.0mm-Hg ±10.7 to 90.3mmHg ±9.9 (increase of 16%) and PaCO₂ fell from 45.5mmHg ±3.9 to 38.1mmHg ±7.8 (decrease of 16%). PaO₂ increased by 5.0mmHg and PaCO₂ decreased by 2.0mm-Hg during IPPB as compared with those during VH. 2) Pulmonary gas exchanges a) The ratio of each space to the total lung capacity (Li/L_T) In chronic pulmonary emphysema, the volume fraction of the fast ventilated space increased from 6.0% ±1.6 to 9.2% ±2.6 during IPPB and to 8.4% ±2.5 during VH. In bronchial asthma, it increased from 11.3% ±6.2 to 18.5% ±4.8 during IPPB and to 17.2% ±6.6 during VH. Volume fraction of the normal ventilated space (L₂/L_T) rose from 18.8% ±2.6 to 24.0% ±2.8 during IPPB and to 26.4% ±8.3 during VH in chronic pulmonary emphysema. In bronchial asthma, it decreased from 37.0% ±4.4 to 35.0% ±13.5 during IPPB and to 36.2% ±14.5 during VH.

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Since the complication of tricuspid insufficiency has often been experienced at open heart surgery, the necessity of the preoperative establishment of its diagnosis was keenly felt. However, it was in many cases difficult to make an exact diagnosis of tricuspid insufficiency preoperatively on clinical features or by other diagnostic procedures heretofore in use. Thus, the present author has made it a clue to its diagnosis to determine the regurgitation visually by conducting right ventricular angiography and compare it with the preoperative findings obtained. Materials and Methods 1) On 382 cases out of the patients with heart disease or disease of the chest treated at our Institute for Cardiovascular Diseases, Kurume University, angiocardiography of the right ventricle was performed. The presence of regurgitation of a contrast medium to the right atrium was examined thoroughly and its degree was divided into Grade 0, I, II, and III. 2) On 27 cases with no shunt in which tricuspid insufficiency was demonstrated at open heart surgery at the Second Department of Surgery, Kurume University, and on 15 cases of acquired heart diseases without having tricuspid insufficiency, 42 cases in total, the degree of regurgitation, clinical findings, phonocardiograms, electrocardiograms, chest X-rays, and the hemodynamic examination were investigated. More-over the relation between restenosis of the mitral valve and tricuspid insufficiency and the nature of the tricuspid valve recognized at operation or at autopsy were discussed. 3) On 64 cases in which right ventricular angiography was first conducted and then the presence of tricuspid insufficiency and its grade were identified at operation the findings obtained at angiography and those at operation were comparatively studied. At angiography, an angiographic catheter NIH, 7F-9F, was introduced from the brachial vein or the great saphenous vein. Introduction of the catheter into the right ventricle was carried out under the fluoroscope and ascertained by the measurement of pressure curve as well as by the blood letting. In addition, the site of the tip of the catheter at right ventricular angiography was compared with the angiographic findings. As a contrast medium a 76 per cent urografin of 1.0-1.5 ml/kg was employed and injection was made at pressure of 7-10kg/cm² by using an Elema-Schoenander's automatic injection unit. Electrocardiograms, the injection time and the phase of photography were recorded simultaneously.

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