A 65-year-old male entered the Yamaguchi Red Cross Hospital with a tentative diagnosis of ventricular tachycardia. However, continuous ECG registration disclosed a presence of "f" waves, indicating that the basic rhythm was atrial fibrillation with a rapid ventricular response. Immediately, a rapid digitalization was instituted with lanatoside C. After digitalization, ECG showed a) atrial fibrillation with anomalous QRS complexes in the form of type A WPW syndrome, b) atrial fibrillation with intermittent complete AV block with normally configurated AV nodal QRS complexes, c) atrial fibrillation with normal and anomalous QRS complexes and idioventricular beats following the normally configurated nodal QRS complexes, d) sinus rhythm with apparently normal and anomalous QRS complexes and supraventricular premature beats of anomalous configuration and e) sinus rhythm with anomalous QRS complexes in the form of type A WPW syndrome. The duration of the anomalous QRS complex in sinus rhythm was shorter than that in atrial fibrillation.

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The Frank lead vectorcardiograms of 31 catheterized cases of atrial septal defect of secundum type were reviewed and the results were correlated with the hemodynamic observations. Although no definite relationship was demonstrated between the vectorcardiographic measurements and the hemodynamic data, there was a significant correlation between the QRS patterns in the frontal plane and the right/left ventricular work ratios. The vectorcardiograms were thought to be of some value for assessment of the severity of right ventricular overloading in atrial septal defect.

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There have been reported very few studies on the relationship between the various types of vectorcardiographic patterns and the degrees of the clinical severity in the cases of the tetralogy of Fallot. The purposes of this paper are to present some characteristics of vectorcardiograms (VCGs) of Fallot syndrome including triology and pentalogy as well as tetralogy, and to classify them into some groups according to the vectorcardiographic configurations and their directions of inscription displaying the clinical severity of Fallot syndrome. Subjects and Method Using the Frank lead system in the supine position, the VCGS in three standard planes (frontal, horizontal and left sagittal planes) were recorded on 85 subjects of Fallot syndrome which was confirmed by clinical, roentgenological, electrocardiographic and other laboratory methods, including angiocardiography and cardiac catheterization. With the machine of Nihonkoden VCG RM-150, X, Y, and Z scalar VCGs were recorded simultaneously at a paper speed of 100mm/sec and VCG loops in three planes were also simultaneously photographed on 35 mm film with a Canon osciloscopic camera. Pictures enlarged in the precise magnification as a scale of 1 mV calibration to 4.0cm were provided to the analysis. With the phonocardiograph of Fukuda AC-21S, phonocardiograms were recorded at a paper speed of 100mm/sec on the apex, the second, the third and the fourth intercostal space at the left sternal border, which were considered to have some roles of indicator of the severity. Classification of VCG Loops There was found plenty of variation in VCG patterns in the cases of Fallot syndrome. The classification was made on the basis of the characteristics of the configurations and the directions of inscription of QRS sE loops in the horizontal plane.

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To evaluate the renal countercurrent system, authors already reported the significance of the urinary concentrating ability (mOsm/kg H₂O) and the index of renal water economy. In this paper, the significance of negative free water clearance, one of the important indices which were considered to express the renal countercurrent system, was examined. Material and Method 1) The relation between osmolal clearance and negative free water clearance in the healthy human subjects : Fishberg's concentration test was performed for twenty year-old healthy girls (twenty students of the Nursing School of Osaka University) under the dietary condition of 70g protein and 10g salt. Near the third urinary voiding, blood was taken from the each person. Urinary osmolality and serum osmolality were measured by Advance osmometer. Urinary volume was also measured. Then, osmolal clearance and free water clearance were calculated by the formula generally used. 2) The relation between osmolal clearance and negative free water clearance in the patients with renal diseases. Fishberg's concentration test was performed for eighteen out-patients of the renal diseases clinic in our faculty. The procedures were same as that of the healthy person except a strict dietary condition. 3) The relation between osmolal clearance and free water clearance in the healthy human subjects and the patients with renal diseases under a condition of a gradual change of urine flow. Three healthy human subjects, three patients with chronic glomerulonephritis and three patients with chronic pyelonephritis were fasted and their urinary volume was gradually increased, then decreased by a careful control of water drinking. Each urinary volume was measured at twenty minutes period. Urinary and serum osmolality were measured by Fiske Os mometer. Then, the calculation was performed as the previous experiments.

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Cases of essential hypertension are predominant among the so-called hypertensive. However, its etiology still remains unclarified, since it is likely to be with various factors. Hemodynamically essential hypertension resembles conditions following injection of noradrenaline. Since the study of experimental hypertension caused by a stricture of the renal artery, a role played by the renin-angiotensin system has been considered to be of importance in developing essential hypertension. It is known, that cases of essential hypertension show an accelerated pressure response to catecholamines and angiotensin although there is no increase in either of these agents. It is of interest to find reports that hypertension was induced in dogs by a constriction of the internal carotid artery or ligation of the basilar artery, and that angiotensin enhanced pressor response following a constriction of cerebral blood vessels and it had central hypertensive effect. It is thus considered that cerebral circulation plays a very important role in the etiology of hypertension. The present study was carried out in solving that problem. Materials and Methods 1. Cerebral circulation in patients with juvenile essential hypertension Patients with juvenile essential hypertension below 34 years of age were studied in comparison with normotensive subjects about the same age. Older subjects were excluded, because their cerebral blood flow tends to decrease as their age advance and their cerebral vascular reactivity is affected by organic changes in cerebral blood vessels. The cerebral blood flow was measured by the nitrous oxide method of KETY and SCHMIDT, as modified by AIZAWA or SCHEINBERG and STEAD, blood gas analysis was made by the manometric technique of VAN SLYKE and NEILL, and measurements of blood pH and blood gas tension were made by means of an I.L. meter.

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The criteria which have been proposed by various authors for electrocardiographic diagnosis of left ventricular hypertrophy have common difficulties of considerably high percentage of false positive and negative cases. This may be ascribed to insufficient statistical consideration in settling the critical values for left ventricular hypertrophy and independent use of individual electrocardiographic findings. Because electrocardiographic pattern of left ventricular hypertrophy is regarded as a reflection of imbalance between the left and right ventricles, bipolar leads must be more useful than unipolar for this purpose. Routine 12 leads, however, do not include bipolar leads which reflect anteroposterior component of spatial vector loops. In this respect, the author used orthogonal electrocardiogram. Materials and Methods Orthogonal scalar leads were recorded by the Frank's lead system in 52 patients (32 males and 20 females, age ranged from 34 to 70 years) with sustained hypertension and 20 patients (11 males and 9 females, age ranged from 36 to 70 years) with aortic insufficiency. The cases showing bundle branch block were excluded from the subjects. Chest electrodes were placed in the fourth intercostal space as recommended by LANGER and others for patients in the supine position. The polarities of leads were determined so as to produce the positive deflection in lead X by leftward component of vectors, in lead Y by downward, and in lead Z by forward. As normal subjects, 56 persons (47 males, and 9 females, age ranged from 20 to 68 years), without clinical evidence of heart diseases and other conditions likely to influence on the electrocardiogram, were used. Results Comparing several electrocardiographic measurements between hypertensive and normal subjects, amplitude of Rx and Sz and duration of QRS were observed to be significantly greater in the former, and amplitude of Ry, Rz, Tx and Ty were larger in the latter (p<0.001). In aortic insufficiency amplitude of Rx and duration of QRS were significantly greater and amplitudes of Tx and Ty were smaller than those in normal subjects (p<0.001). There was no significant difference in any measurements between hypertension and aortic insufficiency.

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