Blood volume and cardiac output were determined in patients with chronic congestive heart failure by indicator dilution method with radiocardiography(RCG). Blood volume was increased in patients of Class III and IV (New York Heart Association), and many finding supported the conclusion that the blood volume played the role of a regulatory mechanism whereby the organism compensates for a lowered cardiac output. The ratio of cardiac output to blood volume, easily calculable from RCG, appeared to indicate the "severity index" of the chronic congestive (right-sided) heart failure. ADH and aldosterone were highly sensitive to the change in blood volume, a fact that indicates that there operates a physiological response to volume change in chronic congestive heart failure. Renal plasma flow had a positive correlation with cardiac output, and showed a lower value in cases with high venous pressure for the same cardiac output.

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The origin of serum acid ATPase was investigated. Lysosomes were the most likely origins of the enzyme, although direct evidence is not yet obtained. Acid ATPase levels in sera from patients with various diseases were high. Several interesting cases in regard to the enzyme were presented and discussed from the lysosomal point of view. Presence of acid ATPase isozyme in various organs and serum was evident. Human serum acid ATPase activity was electrophoretically associated with α and β-globulins and showed a minor peak with larger molecule and a major peak with smaller molecule (approx. 9×10⁴) on Sephadex G-200. Human serum acid ATPase activity was resolved into at least three peaks by DEAE-cellulose column chromatography.

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This experiment was carried out to evaluate heparin effect on the replacement of the autogenous femoral vein in dogs. Heparin was administered intramuscularly at a daily dosage of 6 to 9 mg per kg of body weight for 7 postoperative days. Clotting times were maintained 20 to 25 min. by Lee-White method. The administration of heparin seemed to improve the patency rate and to prevent the mural thrombi forming at the injured anastomotic intima. Furthermore, the administration did not inhibit the endothelial regeneration at anastomotic injured portion, but rather enhanced up to the 4th day.

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Comparative studies on the pulmonary function of cardiac patients during the day and night have been carried out by means of the spirometric examinations and gaseous analysis of the arterial blood. In the patients with nocturnal dyspnea accompanied by wheezing or abnormal breath sounds, there were more reduction of vital capacity, MMF, Pao₂, Paco₂, and Sao₂ but with some increase of respiratory frequency and minute ventilation during the night. These findings are indicative of further aggravation or occurrence of airway obstruction other than pulmonary congestion along with respiratory alkalosis during the attack stage of cardiac asthma.

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Measurements of airway resistance (AWR) have been attempted in normal subjects and in patients with cardiac disease, using the pressure type body plethysmograph modified to make it possible to change examinee's posture. In the cardiacs AWR was found to be increased as cardiac decompensation progressed, this seemed to be more pronounced in the supine position than the sitting. But the reduced AWR may be induced by inhalation of the bronchodilator. This suggests narrowing condition or spasmodic contraction of the airway, most of which are of reversible entity in the heart disease. Here the related other factors on AWR were also discussed.

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1. In order to reexamine ARlENS' hypothesis concerning a relation of an α and β action and the structure of catecholamine, an attempt was made to examine effects of pronethalol and 2-isopropylamino-6 methyl heptane (Metron) on blood pressure and heart rate in dogs. 2. Injection of 5.0 mg/kg of pronethalol caused a slight increase of heart rate and a slight fall of blood pressure, but injection of 10.0 mg/kg resulted in bradycardia and a marked fall of blood pressure. 3. When 2.0 mg/kg of Metron was injected, a transient increase of heart rate and a fall of blood pressure were observed, but after injection of 5.0 mf/kg, a bradycardia and a fall of a blood pressure were caused. When 5.0 mg/kg of Metron was injected after pretreatment of atropine, changes similar to those after injection of 2.0 mg/kg were observed. 4. A slight increase of heart rate and a fall of pressure after injection of pronethalol or Metron seem to indicate a mild β action. But following an increase of dosage of those drugs, a vagal omimetic action appeared, and a β action was not observed. However, pretreatment with atropine reproduced a β action. 5. Pronethalol and Metron had no catechol or phenyl radical, but still possessed a mild β action. Therefore, a β action seemed to relate to isopropylamino radical, and dihydroxyphenyl or hydroxyphenyl radical might be related with an increase of the intensity of a β action.

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Changes in the intracellular potential has been explained by the fluxes of the cations, especially sodium and potassium ions, through the cell membrane. Calcium and magnesium ions also affect the intracellular potential. There have remained still many problems about effects of extracellular calcium and magnesium ions on the intracellular electrogram (ICEG). On the other hand, it is well-known that calcium ion has markedly inotropic action and plays an important role in excitation-contraction coupling. On the contrary, effect of magnesium ion on myocardial contractility seems to be a little. In the present experiments, the author investigated changes in ICEG, surface electrogram (SEG), and contractility of dog's heart muscle in situ subjected to the coronary injections of calcium and magnesium ions of the various concentrations. Methods Sixteen mongrel dogs weighing 8 to 15 kg were used. After anesthetized, the chest was opened, followed by venous injection of 5000 units of heparin. Then a major branch of the anterior descending coronary artery was exposed. In eight dogs, a carotid artery was connected to the major branch of the coronary artery through a polyethylene catheter with a three-way stopcock, and ICEG was taken simultaneously with unipolar SEG from a point on the epicardium supplied by this coronary artery. These methods were similar to those reported by PRINZMETAL, TOYOSHIMA and their colleagues. In the other dogs, a major branch of the anterior descending coronary artery was perfused by arterial blood from a femoral artery with a catheter. Thereafter, 'myocardial tension tracing (MTT), SEG, and left ventricular pressure curve (LVP) were recorded. The load transducer divised by HISADA et al. was used for recording MTT. LVP was obtained by a cardiac catheter inserted through a carotid artery into the left ventricle. The exposed epicardium was irrigated with Tyrode's solution through a polyethylene tube. The temperature of the solution was 35 to 37°C but remained constant during any experiment for the purpose of keeping a constant temperature on the cardiac surface.

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Recently, many studies have reported in which trials were made for applying digital computers to the pattern recognition of electrocardiograms (ECGs). It may be expected that an objective and quantitative interpretation of an ECG can be obtained quickly by the computer, provided that an appropriate program is set up. The process to reach a diagnosis would be followed exactly as written in the program by the computer which possesses remarkable properties such as a vast capacity of memory and a great accuracy and high speed in logical and analytical operations. However, one of the current problems in this field is to consider as to which one of different approaches is more adequate as the logical process in the interpretation of ECG's. In this paper, two diagnostic logics (or categorizers) currently in use were selected for comparison. One was derived from the principle of the logical decision tree and the other was from the principle of the joint probability. In this study, the discrimination of ECG's with or without myocardial infarction, as being considered to be important for the clinical use, was chosen as the subject to be tested for the advantages and disadvantages of these two categorizers as the diagnostic logic of the electrocardiographic interpretation. Material One hundred and one subjects of myocardial infarction (infarction) and 601 subjects without myocardial infarction (non-infarction) were selected. The non-infarction group consisted of 201 normals (Normal), 127 cases of left ventricular hypertrophy (LVH), 174 cases of right ventricular hypertrophy (RVH) and 99 cases of combined ventricular hypertrophy (CVH). The diagnosis of infarction was made on the bases of clinical findings, such as typical precordial pains lasting over one hour, the elevation of the activities of enzymes in the serum, such as glutamic oxaloacetic transaminase and lactic acid dehydrogenase, and serial ECG findings supportive of the history of an acute myocardial infarction. Individual conditions in the non-infarction group were diagnosed also on clinical findings, including history, blood pressure, 12-lead ECG's, X-ray films, phonocardiograms and the right heart catheterization.

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A∼aD show the differences between the mean partial pressure of alveolar O₂, CO₂ and N₂ gases and arterial ones. These will be explained in three parts, A) physiological significances, B) clinical significances, and C) problems in the measurements, with special reference to the concept of the alveolar gas and its actual condition. A) Physiological significances. The uneven distribution of ventilation causes A-aDO₂, a-ADCO₂ and a-ADN₂, while that of perfusion causes only a-ADCO₂. It was confirmed that A-aDO₂ and a-ADCO₂ were chiefly reflective of the group of alveoli with low ventilation-perfusion-ratio and its perfusion fraction was higher than the ventilation fraction, and that a-ADCO₂ was chiefly reflective of the alveolar group with high ventilation-perfusion-ratio and its ventilation fraction was higher than that of perfusion fraction. Moreover, it was mentioned as the problems to evaluate that A-aDO₂ increased according to the anatomical shunts and the trouble of diffusion through alveolar membranes, a-ADCO₂ was caused by the uneven distributions of both ventilation and perfusion, and in the pulmonary embolism only by the macroembolus, and that they were easily false positive in the case with the dead space hyperventilation in the air ways. B) Clinical significances. In many obstructive lung diseases studied, the alveolar dead space ventilation ratio was correlative with the a-ADCO₂ (r=0.927) and was roughly correlative with the A-aDO₂ (r= 0.528). When the ventilation-perfusion-ratio was over 4.0, the ventilation equivalence (not only) for O₂ but also for CO₂ increased, therefore in cardiopulmonary diseases with a-ADCO₂, the alveolar ventilations calculated from the alveolar air equation substituting values of arterial carbon dioxide tensions were influenced to be underestimated as to the a-ADCO₂, consequently the net volume i.e. the real space of air was not revealed. The shunt like effects were exponentially correlative with the A-aDO₂ (physiol. (QS)/(QT) = 1.5e^{0.047(A-aDO₂)}). The carbon QT monoxide diffusing capacity reduced in both cases with the increased A-aDO₂ and with the increased a-ADCO₂. Neither the A-aDO₂ nor the a-ADCO₂ correlated with the FEV₁/VC. The total pulmonary vascular resistance correlated roughly with the A-aDO₂ and the a-ADCO₂ respectively (r=0.522, r=0.660). The A-aDO₂ had negative correlation with the arterial oxygen tensions (r=-0.765), while the a-ADCO₂ were roughly correlative with the arterial carbon dioxide tensions (r= 0.643).

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With the increasing number of death from the occlusive disease of the coronary artery during recent years, any reliable diagnostic method and positive remedy for the disease have been more eagerly pursued by many investigators. However, many curative means for the disease have their limits in respect of their indications and effects, and it may safely be said that we have not a decisive one as yet. For a correct diagnosis of the region and extent of a lesion, various kinds of coronary arteriography are thought to be indispensable. The author as well as his associates has studied and satisfactorily practiced a new method for coronary arteriography ; "Coronary Arteriography Using Successive Diastolic Injections". In this method contrast medium injected into the aortic root during ventricular diastole is minimally diluted with blood in the aortic root and reaches the coronary artery tree at a higher concentration, with the relative lack of blood flow in the root and with the maximum rate of coronary artery blood flow. On the basis of this principle, the author has developed a new method for administrating the medicines for the coronary artery disease, styling this method "Selective Coronary Artery Infusion Technique (SCAIT)". If the efficacy of this technique is confirmed, this technique attains its important significance for the treatment of the surgically incurable coronary heart disease with severe cardiac failure and for the pre- and post-operative treatment of coronary embolism or myocardial infarction. This study was undertaken to evaluate the effectiveness and its clinical applicability of this technique as a remedy for the coronary artery disease. Technique : The pump used for infusion in this study was a Davol Heart Pump Model 8500, which was capable to inject agents at any phase in the cardiac cycle in synchronization with R wave. A pump ventricle with two valves and tubings including an agent reservoir and a catheter were specially designed. A catheter used in this study was a polyethylene tubing with the inside diameter of 1.5 or 2.0 mm and with a length of 30 or 50 cm. A catheter was inserted through the right common carotid artery into the aorta, its tip being placed 0.5 to 2.0 cm above the aortic valve.

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Many reports have been made of the spontaneous improvement of hypertension after the development of liver diseases ; however, the mechanism of this fact remains obscure. It is imaginated that an angiotensin destroying substance, so-called angiotensinase, is responsible somehow for the mechanism of the reduction of high blood pressure observed in the patients with liver diseases since angiotensinase probably helps regulate the plasma and tissue concentrations of angiotensin and hence its potent physiologic effects. From this standpoint, the experiments were divised to investigate first the change of plasma angiotensinase activity in patients with hepatobiliary diseases and second that in rats with hepatic damages induced by carbon tetrachloride or ligation of the common bile duct. Material and Methods. 1) Clinical Observations. Observations were made on 74 patients with hepatobiliary diseases and 50 patients with other miscellaneous diseases. Angiotensinase activity was determined by a method based on the degradation of pressor activity of synthetic valine-5-angiotensin II-aspartic-β-amide by fresh heparinized plasma from fasting subjects. Blood pressure was recorded by means of a mercury manometer connected with the carotid artery of a rat weighing 150-200g anesthetized with pentobarbital sodium. 2) Experimental Observations. Observations were made on 21 control and 21 experimental male Wistar rats weighing 200-250g maintained on Oriental MF rat chow . Hepatic injuries were induced as follows ; 1. acute carbon tetrachloride intoxication, twenty-four hours after carbon tetrachloride injection (0.5 ml of 20 % carbon tetrachloride olive oil solution per 100g body weight subcutaneously) 2. chronic carbon tetrachloride intoxication, after carbon tetrachloride injections once a week for 6 weeks. 3. obstructive jaundice, one week after ligation of the common bile duct. Livers of experimental and control animals were examined microscopically at the end of the experiment. Angiotensinase activities of plasma and of liver homogenates were determined by the method mentioned previously.

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Phonocardiographic study has played a very important role in the diagnosis of the congenital and acquired heart disease. Many studies were devoted to interpret the phonocardiogram in these congenital and acquired heart disease in the aid of informations from either detailed clinical examinations including cardiac catheterization, and cardiac surgery or autopsy. The purpose of this report is to contribute to analyze the hemodynamic mechanism which cause wide split interval and the accentuation of the pulmonic component of the second heart sound in ASD. Materials and Methods This study was based on an analysis of the phonocardiogram obtained from 1) 39 cases of the uncomplicated ostium secundum defect, 2) 9 cases of the isolated ostium primum defect, 3) 8 cases of the atrial septal defect with the pulmonic valvular stenosis and 4) 64 normal subjects. Right heart catheterization was performed in all cases of ASD and their diagnosis was confirmed by either surgery or autopsy. Several items of the phonocardiographic findings such as Q-IIA, Q-IIP and IIA-IIP intervals and IIP/IIA (ratio of amplitudes) were measured on the medium frequency phonocardiograms recorded at the upper part of the left sternal border with use of Fukuda-Electro AC 21-S. Following values were adopted as hemodynamic factors in relation to IIA-IIP interval and IIP/IIA: 1) right ventricular systolic pressure (RVSP), 2) systolic pressure gradient across the pulmonic valve (RVSP-PBSP), 3) pulmonary/systemic flow ratio (Q_P/Q_S), 4) index of maximum flow resistance at the right ventricular outflow tract ( (RVSP-RBSP)/(Q_P/Q_S)), 5) index of pulmonary peripheral vascular resistance ((MPHP-MPWP)/(Q_P/Q_S)), where MPHP denoted mean pulmonary hilar pressure and MPWP denoted mean pulmonary wedge pressure, 6) index of normalized right ventricular pressure work ((1/7.6)·RVMP·Q_P/Q_S), 7) and index of right ventricular velocity work (RVSP-PBSP)·(Q_P/Q_S). Data were analyzed on the basis of the small sampling theory.

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