Frank lead vectorcardiograms of 17 catheterized patients of pulmonary stenosis with intact ventricular septum were reviewed in order to determine the usefulness of vectorcardiography as an indicator of the hemodynamic status. A close correlation was observed between the vectorcardiographic change and right ventricular pressure. Among the measurable parameters, the half-area QRS angle in the frontal plane, ratio of right/leftward QRS forces and maximum T angle were thought to be of great value for assessment of the severity of pulmonary stenosis.

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Upon analysis of QRS and T loops in Frank lead vectorcardiograms of 44 patients with autopsy proved pulmonary emphysema, the fairly large terminal portion of QRS loop directed to the right and superiorly with shift of the half-area QRS vector posteriorly and superiorly was found to be characteristic. A small or abnormally directed T loop was also frequently observed. Although thirteen of the 44 patients also had mild right ventricular hypertrophy, there was no significant vectorcardiographic difference between the groups with and without right ventricular hypertrophy. The direction of the terminal appendage in the sagittal and horizontal plane, Sx/Rx, Sy/Ry, and the ratio of the magnitude of terminal appendage to the maximum vector of the body of QRS loop in the frontal and horizontal plane provided good indices of the emphysema type vectorcardiogram. A set of criteria was proposed with the discussion on positivity and false positivity in the diagnosis of such condition.

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In thirteen anesthetized open chest dogs the left sympathetic stimulation decreased the systolic flow by augmented myocardial contractility and by sympathetic coronary vasoconstriction, while the diastolic flow was increased with the elevation of blood pressure. Both systolic and diastolic flows were increased after the stimulation suggesting metabolic vasodilatation. Coronary vasoconstriction and vasodilatation revealed parallel changes in systolic and diastolic flows. The right sympathetic stimulation induced marked tachycardia and decreased systolic and diastolic flows at the initial phase. Both systolic and diastolic flows were increased during the right sympathetic stimulation, indicating less positive inotropic effcet and less remarkable coronary vasoconstriction as well as the marked metabolic response to tachycardia.

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In order to determine the excretion pattern of urinary catecholamines and ensure the role of the catecholamines in the chronic congestive heart failure, 24-hour urinary catecholamines were determined by THI-method on 100 patients with chronic congestive heart failure caused by various underlying diseases. 1) The level of urinary catecholamines, especially that of norepinephrine, in both hydrolyzed and non-hydrolyzed form, were found to be increased progressively corresponding to the aggravation of severity of heart failure. This result suggests the extreme acceleration of sympathetic nervous system in congestive heart failure. 2) The observation that the elevation of venous pressure corresponded to an increase in urinary norepinephrine may be a reflection of the presence of neurohumoral regulation of venous pressure. 3) Correlation between the urinary norepinephrine value and decrease rate of vital capacity were observed. 4) There was fairly close correlation between the urinary norepinephrine value and renal plasma flow. This result suggests the contribution of sympatho-adrenal stimulation to the reduced renal hemodynamics in the heart failure. Fifteen patients were laid on time-course study. 5) The urinary norepinephrine level decreased gradually corresponding to the decrease in severity of heart failure. 6) The temporary rise in the urinary norepinephrine level was generally observed in the initial phase of digitalisation. It may be reasonable to assume that the augmented sympathetic nervous system may play a certain role, preferably supportive, to gain the effect of digitalis glycoside on the failing myocardium. 7) Five cases, including 3 with refractory heart failure, were treated with diuretics in addition to the digitalisation. The results obtained may indicate that the "enforced diuresis" by the diuretics, unlike "natural" or "physiologic diuresis" by digitalisation, may produce the augmented sympathetic nervous system until the occurrence of adaptation response to the conditions brought about by the "enforced diuresis" and that repeated performance of the "enforced diuresis" finally led the heart failure to refractory, and the patient to death when the reinforcement of the augmented sympathetic nervous system is deprived by its exhaustion. 8) Moreover, the indication that intensification of the heart failure was observed in the 2 cases laid on the administration of antiadrenergic drugs, may imply the adrenergic support to myocardial function regulating the heart failure. In conclusion, these results may be interpreted to mean with certainty that the sympathetic nervous system plays an important compensatory role in the circulatory regulation of patient to congestive heart failure.

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Histometric and histochemical studies were performed on the two hypothalamic neurosecretory nuclei (i.e., the supraoptic and paraventricular nuclei) and a few other hypothalamic nuclei in spontaneously hypertensive rats (S.H. rats) and in rats with various forms of experimental hypertension. 1. The following results were obtained in the histometric study. (1) The cellular and nuclear size of the nerve cells of the supraoptic nucleus was significantly greater in the S.H. rats than in the controls throughout the pre-hypertensive, initial and advanced stages of hypertension. In the advanced stage cells were 30% and nuclei 20% larger than normal ; in the pre-hypertensive stage 17% and 12% and in the initial stage 7% and 8% larger, respectively. The nuclear and cellular size of the nerve cells in the supraoptic nucleus tended to be greater than normal in the rats with DOCA-hypertension and with renal infarction hypertension, although the number of cases examined, was too small (3 cases) to be significant. (2) The paraventricular nucleus of the S.H. rats showed nearly the same results as the supraoptic nucleus with significant differences except for the nuclear size in the pre-hypertensive stage. The cells were 14-19% larger than normal in all the stages, the nuclei less than 11% larger than normal. In the rats with experimental hypertension cellular and nuclear size tended to be greater than in the controls, but the number of cases examined was small (3 cases). (3) The cellular size of the nerve cells in the ventromedial nucleus in these hypertensive animals remained normal. 2. The following results were obtained in the histochemical study of neurosecretory material. The amount of neurosecretory material in the hypothalamic neurosecretory nuclei and posterior pituitary of most of these hypertensive animals was not very different from that in the controls, although it was more prominent in some.

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A study was made to establish an off-line system for the ECG diagnosis by digital computer. The joint probability was used as the main diagnostic logic, which was composed of the tailed probability. In this system, diagnoses by computer in 1392 ECG's consisted with those by physician's in more than eighty per cent. It was poined out that computer diagnoses are necessary to bring the reproducibility and accuracy in diagnosis to higher level in the various fields of the clinical medicine.

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Various types of "assisted circulation" have been considered as powerful measures for mechanical assistance to the failing heart. For the relief of left-sided heart failure, selective left ventricular bypass can be recommended. Arterial and coronary sinus blood were analyzed for oxygen content, lactate, and pyruvate before and during bypass, with or without a left ventricular vent in 8 dogs. Myocardial oxygen consumption, compared to controls, significantly decreased during bypass. Coronary sinus flow was not significantly changed. The decrease of excess lactate and increase of redox potential were significant during bypass with a left ventricular vent as compared with during bypass without such a vent. The data seem to indicate that selective left ventricular bypass provides no myocardial anaerobiosis but some evidence of the adequacy of myocardial perfusion.

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Molecular orbital energy of thiazide diuretics, ethacrynic acid, DPN, DPNH, FAD and FADH₂ was calculated by Simple-LCAOMO Method. ·K· values of the lowest vacant energy level and the highest occupied energy level of the compounds calculated were compared. It was suggested that furosemide, ethacrynic acid and quinethazone would interfere with the electron transport system in renal tubules. The diuretic action of these compounds might be due to their inhibitory effect on the redox sodium pump in renal tubules.

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Various morphological changes of the pulmonary blood vessels, such as thickening of the intima and media in the arteries, have been reported to occur in chronic cor pulmonale. The author studied on the morphological changes of the arteries in the lung obtained from 26 cases of chronic cor pulmonale caused by various chronic pulmonary diseases. Relation between morphological changes of the pulmonary arteries and various pulmonary disorders was also studied. Materials and Methods As pathological criteria for chronic cor pulmonale, OHTSU and SHOZAWA pointed out the following four morphological changes; (1) hypertrophy of the right ventricular wall, (2) sclerotic changes in the pulmonary arteries, (3) retention of abundant volume of blood in the venous system at the time of autopsy, (4) absence of the primary disorders in the heart. All cases selected in this investigation satisfy the above four criteria and furthermore the author selected the cases in which the apex of the heart was consisted of the right ventricle. Diagnosis of right ventricular hypertrophy was made when thickness of the ventricular muscular wall was more than 5 mm in the central area of the right ventricle. Cauastive disorders of chronic cor pulmonale were primary pulmonary arteriosclerosis, chronic pulmonary emphysema, pulmonary tuberculosis. silicotuberculosis, pulmonary fibrosis, anthracosis, atelectasis and others. As a control, five cases in which no abnormalities were found in the heart and lung were similarly examined. Specimens were taken from the each lobe of the lung and fixed in 10 per cent formalin. The sections were prepared from parafin embedded blocks and stained with Weigert's stain for elastic fibers, Verhoeff's method for elastic fibers, Masson's trichrome stain and Azan-Mallory stain.

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Frequency of digitalis intoxication is rapidly increasing, due to the prevailing of clinical use of the drug, for example, acute digitalization which is based upon development of its injection and combined use of thiazide diuretics, etc. On the other hand, mechanism of digitalis intoxication is scarcely made clear. Accordingly, in this experiment, the author attempted to examine on some features in the acute digitalis-intoxication, especially regarding the following two points, and intended to clarity mechanism of this intoxication by analyzing the results. 1. Pathological states was examined from the following 4 items on the heart in acute digitalis intoxication. (1) Electrocardiography (2) Serum electrolyte (3) Carbohydrate and electrolyte metabolism of the heart muscle (4) Potassium content of the heart muscle 2. The author also experimentally investigated the clinically wellknown fact that the heart muscle metabolically disturbed is apt to get into digitalis intoxication, compared with the normal heart muscle. Methods : As a digitalis agent, stropepside was used, which is one of "monosides" having the fundamental form as the action-structure of "digitalis" effect and shows immedite effect. Male healthy dogs weighing 10kg were used as the experimental animals, and sodium hexabarbiturate as anesthetics. Experiment-1 : Electrocardiography in the acuts strospeside intoxication At constant anesthetic state, normality of ECG was confirmed from the variation statistically treated ECGs of 50 dogs. Strosepside (0.15-0.50mg/kg), dissolved with physiological saline to 10cc in total, was injected intravenously during 2 minutes. For the control animals, 10cc of physiological saline only was injected. ECG was recorded before the injection and 1, 2, 4 minutes after and afterwards at intervals of 2 minutes up to 60 minutes on 9 Leads (I, II, III, aV_R, aV_L, aV_F and V₁, V₃, V₅). Experiment-2 : Serum electrolyte in the acute strospeside intoxication.

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It is well known that vagus nerves have some effects of occurrence and disappearance of arrhythmia, and also that cardiac glycoside with antiarrhythmic action has the references to the action of vagus nerves. Mechanism of the antiarrhythmic action of cardiac glycoside has been clarified. Some points, however, are yet unknown. In the present experiment, the effects of vagal stimulation and cardiac glycoside on excitability were studied on the canine heart in situ. Method : Twenty-nine adult mongrel dogs were used for this experiment. Dogs were anesthetized with intravenous administration of pentobarbital sodium, 30 to 40 mg per kg of body weight. Under artificial respiration, the chest of dog was opened. Bipolar electrodes used for recording were inserted into the endocardium of the atrium and the ventricle. The electrode was consisted of two insulated copper wires of 80μ in each diameter. Those bare tips were sharply bent as fish hook. Unipolar electrode was used for stimulating. In order to measure the absolute refractory period (A.R.P.), the total refractory period (T.R.P.) and the diastolic threshold (D.T, ), the heart was artificially driven at constant frequency of 160∼250 cycles per minute. When the knob switch was pushed down, the first action potential resulting from the heart activation was introduced to the stimulator as a triggering signal. The stimulator for evocation of extrasystole was arranged to deliver a square pulse with a desired delay from the onset of the triggering signal. The test stimulus was given unipolarly through the cathodal terminal in the atrium. The distant electrode placed on the right hind leg served as the anode. The intensity of test stimulus was varied within the range from the diastolic threshold to the intensity of about 40 times as large as the diastolic threshold. For the recording of electrograms, the cathode ray oscilloscope and long recording camera were used. The film speed was 20 to 50cm per second. A.R.P., T.R.P. and D.T. were calculated by the strength-interval curve (S-I curve), which was made by plotting the shortest intervals required to evoke the excitation for various intensities.

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Although a remarkable development has been achieved in cardiac surgery for many kinds of congenital and acquired cardiac diseases, a lot of problems remain unsolved in regard to the treatment of coronary artery disease which holds an important position in acquired cardiac diseases. During ventricular diastole, coronary blood flow, in general, reaches the maximum rate with the relative lack of flow in the forward direction in the aortic root because of the closure of the aortic valve. In the previous studies on Synchronized Arterial Counterpulsation, a method of assisted circulation for left-sided heart failure, the authors noticed that this method caused remarked increase of coronary blood flow. Thus, the authors presumed that the coronary arteries could be selectively opacified with contrast medium infused by a special pump (Davol Heart Pump) used in this method. This presumption has been experimentally and clinically proved to be valid in Coronary Arteriography Using Successive Diastolic Injections. Since, in the next series of the studies, the authors confirmed that an agent such as Evans Blue infused into the aortic root by this method of successive diastolic injections more rapidly reached the coronary arteries at a much higher concentration, it appeared reasonable that this infusion method might be the most rational one for administrating such agents as fibrinolysin, anticoagulants, coronary dilators, etc. which should desirably act directly upon the coranary artery and/or the myocardium. The author has designated this method "Selective Coronary Artery Infusion", and has investigated to evaluate the possibility of its clinical application. It is an indisputable fact that there is a limit to the effect or the indication of the medical and surgical treatments of coronary insufficiency. The clinical usefulness and effect of Selective Coronary Artery Infusion may be highly expectable, since tne administration of the above agents by this method is a more rational and positive means than any medical remedy and has a possibility to be applied to the pre- and post-operative managements in the surgical treatment.

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It is well known that chronic obstructive pulmonary diseases cause disturbances of pulmonary circulation and right ventricular hypertrophy, and the electrocardiogram and vector-cardiogram in these diseases are considerably characteristic. It seems reasonable to predict that right ventricular hypertrophy develops in the presence of chronic pulmonary diseases. The pressent study was made on possible relation between electrocardiographic and vectorcardiographic findings and the disturbances of pulmonary ventilatory function in patients with chronic pulmonary diseases i.e., chronic pulmonary emphysema, chronic bronchitis and bronchial asthma. Materials and Methods One hundred and eighty-nine cases with chronic pulmonary diseases, 50 cases with chronic bronchitis, 90 cases with bronchial asthma, and 49 cases with chronic pulmonary emphysema were studied. Forty cases without cardiopulmonary disease were studied as controls. The chest was x-rayed and conventional twelve leads electrocardiograms and vectorcardiograms on Frank's lead system were recorded at the same time. These cases were examined as to their pulmonary ventilatory function (13.5L). Pulmonary residual volume was determined in some cases of each group with Godalt's pulmo-analyser. FEV₁ %, MVV % and RV/TLC (%) were studied. Electrocardiogram and vectorcardiogram were discussed on the basis of electrocardiographic and vectorcardiographic findings in reference to the grade of pulmonary ventilatory dysfunction. Results Electrocardiographic findings : The incidences of Pulmonary P, Gothic P and low voltage were higher in patients with chronic pulmonary emphysema than in those with chronic bronchitis and bronchial asthma. The amplitudes of P wave in II, III and aV_F was greater in patients with chronic pulmonary disease than controls, especially in cases with severe dysfunction of pulmonary ventilation. P wave higher than 0.25mV was rather frequent among the cases with severe disorders of pulmonary ventilatory function.

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