The study is concerned with renal release of renin responding to intravenous administration of synthetic angiotensin II-asp¹-β-amide (Hypertensin, CIBA) in the dogs with acute renal ischemia produced by aortic clamping and those with chronic renal hypertension caused by main renal artery clamping. Contralateral kidney was removed in both types of the experiment. Renin release was not inhibited but rather augmented when small amount of angiotensin (0, 2 ng/kg/min) was infused. The response was not observed in the denervated kidney with acute ischemia. In control dogs without renal ischemia renin release was suppressed with increasing amount of angiotensin administered.

View full abstract

A quantative description for histological observation of myocardial lesion was proposed. Left venticle was divided into 25 divisions. Whole paraffin sections were made from each of them, and stained by haematoxylin-eosin and Azan method. The extent and kind of myocardial lesions of these samples were examined histologically. The results of the examination were described by "myocardial lesion profile" (M.P.) which was theoretically similar to Gore's atherosclerotic profile, M.P. was changed to "myocardial lesion index" (M.I.) by a simple calculation. It is possible to express the grade of pathologic changes of myocardium as a number of myocardial lesion index. The grades of the myocardial lesions could be compared quantitatively with those of other samples. The mean values of index in many cases can be also obtained. It was shown that the myocardial lesions of hypertensive hearts were much severer than those of non-hypertensive ones. The lesions of the former were severest at the upper ventricular septum near the aortic ostium ; it might be the hemodynamic influences of blood pressure which becomes highest at the aortic ostium (Fig.14).

View full abstract

DC cardioversion for chronic atrial fibrillation was carried out in 32 patients for 58 times using a R-synchronized DC cardioverter. The cardioversion was successful in 49 trials out of 58 (85%) and, in 29 patients of 32 (9 %). Nineteen (33 per cent of 58 trials or 59 per cent of 32 patients) have been maintained normal sinus rhythm for the period ranging from two months to two years. There was no intimate relation between the success or maintenance rate of cardioversion and the severity of the underlying disease indicated by functional classification, duration of atrial fibrillation, cardio-thoracic ratio in chest film or preoperative mean left atrial pressure. The most important factor which determined the results of cardioversion was surgical correctability of underlying disease. Quinidine administration at a maintenance dose appeared to be of limited value for the long-term result of successful cardioversion. Resting cardiac index showed slight or not so remarkable increase with cardioversion, although, it showed significant (+24%) increase in exertional cardiac index. Circulating blood volume increased 3 to 4 per cent at rest and 8 per cent on exercise with restoration of normal sinus rhythm. There seemed to run a risk of bringing lung edema for the patient of disturbed mitral function with this increase. Mean pulmonary circulation time showed 18 per cent of shortening at rest and 16 per cent on exercise. Stroke volume on exercise remained unchanged in comparison to the resting level after cardioversion, while it showed remarkable decrease during arrhythmia. This means that increase of heart rate with exercise brings the increase of cardiac output after cardioversion. Atrial fibrillation should be converted immediately after surgical repair of the underlying diseases. Even if recurrence follows within a few days, normal sinus rhythm can be expected to bring some benefits to patients in the postoperative crisis. No remarkable complication has been experienced during this study.

View full abstract

This paper will discuss the disturbances in acid-base regulation that occurs in congestive heart failure. The study consists of four parts. 1) The pH, Pco₂, Po₂, and [HCO₃^-] of arterial blood and serum electrolytes in congestive heart failure. 2) Serial studies of the acid-base balance disturbance in some patients treated with digitalis and diuretics. 3) Short-term experiments in which patients were treated with digitalis or diuretic for a week or so. 4). The effect of efficacious diuretic furosemide upon the acid-base balance.

View full abstract

In order to investigate the cause of the QRS loop change in right ventricular hypertrophy, the present authors have employed their constructed method of the QRS loop. 1) increasing the vectors of the right ventricle including the right side of the septum and 2) prolongation of depolarization process in the right ventricle are required to construct the QRS loops in systolic overload of the ventricle. Next, 1) increasing the vectors of the right ventricle (the increasing ratio of the vectors in the anterior and lateral wall of the right ventricle are larger than that in the posterior wall) and 2) delay of the start of the depolarization process in the right ventricle are necessary in diastolic overload of the right ventricle. Then, the reason of difference of the QRS loops in systolic and diastolic overload is discussed.

View full abstract

A case of acute myocardial infarction caused by the dissecting aneurysm of the aorta which extended to the ostium of the left coronary artery was described. As a cause of death of the dissecting aneurysm of the aorta, myocardial infarction is very rare. Several cases of myocardial infarction with the same origin were reviewed.

View full abstract

The purpose of this paper is to report the histopathological findings and quantitative evaluation of glomerular enlargement in the kidney from patients with cyanotic congenital heart disease. Comparison between morphological changes of kidneys and certain clinical findings was also attempted. Material and Method Histological examination and histometrical measurements of glomerular size were performed in thirty-six kidneys from congenital cyanotic heart disease. Included were' 25 patients with tetralogy of Fallot, 3 with transposition of great vessels, 3 with truncus arteriosus and 5 with miscellaneous cardiac malformations with cyanosis. They ranged in age from 7 days to 29 years, with an average of 8.5 years. Thirty-three control cases were selected, at random from the autopsy files, as fulfilling the following criteria of "normality" : the absence of congenital heart disease; the presence of both kidneys without significant rend disease: the absence of congestive heart failure and blood dyscrasia. These cases were chosen to cover the age range from newborn to 27 years with an average age of 9.1 years. Two sections of each kidney were reviewed. Tissues were fixed in 10 per cent formalin and embedded in paraffin. All preparations were stained with hematoxylin and eosin and peridic acid-Schiff. Technique of Measurement: A measure of average glomerular size was performed in each case by means of an optical micrometer. Two linear measurements were made for each of 100 glomeruli with apparent vascular poles. The first measurement "A" was the maximum distance across Bowman's capsule : the second, "B", the maximum distance across Bowman's capsule at right angles to the first measurement. A cross-sectional glomerular area was calculated by 1/4πAB. For statistical analysis, P≤0.01 was considered to be significant.

View full abstract

Recent observations have demonstrated that the renin-angiotensin system is concerned with the regulation of aldosterone secretion and blood pressure, and measurement of plasma renin activity (PRA) can contribute to a great extent to the evaluation of patients with hypertension. It has been already certified that PRA is significantly and extremely suppressed in patients with primary aldosteronism. The following experiments were studied about the most effective diagnostics of primary aldosteronism, the optimum and convenient conditions for measuring PRA in sodium restriction and upright position and furthermore the incidence of primary aldosteronism among patients with essential hypertension, and evaluation of the renin-angiotensin-aldosterone system in patients with various kinds of hypertension. Materials and Methods. 76 patients with essential hypertension 4 with renovascular hypertension, 10 with primary aldosteronism and 9 normal subjects were examined in these studies. Each subject was fed on a diet containing various amounts of sodium (300mEq, 130mEq, 30-40mEq) for at least three days prior to study. A sample of peripheral venous blood was obtained in the morning after overnight recumbency and after two to four hours of upright position plus thiazide administratoin (Fig. 1). PRA was measured by BOUCHER'S method and urinary aldosterone was determined by blue tetrazolium coloration (or double isotope derivative method) utilizing our new systems of thin layer chromatography instead of paper chromatography because of the economy of time and cost without the sacrifice of accuracy (Fig.2, 3). R Results: Recumbent PRA was a little more increased in a group taking 130 mEq/day sodium than 300 mEq/day sodium and more effectively increased in a severe restriction of sodium intake (30-40 mEq) and most definitely increased on a low sodium diet combined with upright ambulation. Each subject should be fed on a low sodium diet for at least four days to examine PRA (Table I and II). The study on an optimum time for measuring PRA increase in upright ambulation showed a maximum increase after 180-240 min as compared with values obtained after 60 minutes, but usually showed the almost sufficient values after 120 minutes (Fig. 5).

View full abstract

There is considerable evidence that the juxtaglomerular apparatus is the site for the production and release of renin. Up to the present, various methods for the staining of the juxtaglomerular apparatus have been reported. But it is difficult to observe the juxtaglomerular apparatus in various forms of diseases definitely in spite of these various methods for the staining. In the present report, we observed the morphology of the juxtaglomerular apparatus by light microscope in epon-embedded 0.51μ thick sections, and demonstrated that this method was greatly useful for the observation of the juxtaglomerular apparatus. Method. Renal tissues taken from human subjects and rat were fixed in Bouin solution and embedded in Epon 812 by the method of Luft. The blocks were cut by the ultramicrotome in 0.51μ thick sections. After then, the epoxy resin was rernov-ed by the method of Mayor and his associates. The sections were stained with the method of Bowie. Results. In sections of eponembedded tissue, the staining properties by the method of Bowie were similar to those in paraffin sections. Comparing to paraffin sections, as the ipon-embedded sections were cut thinner, the definite appearance of the juxtaglomerular apparatus were observed. Especially the degree of granulality in the juxtaglomerular cells in hyman was observed more clearly than that in paraffin sections. Discussion: Since 1924, when Sugiyama in Japan first described the specific morphology of the wall of the afferent arteriole, the juxtaglomerular apparatus, several staining methods for the juxtaglomerular apparatus have been introduced. Utilizing these staining methods, it has become possible to determine the physiological activities of the juxtaglomerular apparatus, to some extent. But even today, in spite of the improvement of various methods for the staining, it is difficult to observe the degree of granulality in human definitely. The one of the causes seems to depend on the fact that the glomerular vascular pole is not easily found by the previous methods. Then we employed the method of the observation of epn-embedded tissues by light microscope, which 0.51μ sections were made and the glomerular vascular pole was easily and clearly found. In addition, in spite of having removed the epoxy resin by the method of Mayor et al., staining properties of the juxtaglomerular apparatus were not different from those in paraffin sections. Therefore, in order to observe the physiological activities of the juxtaglornerular apparatus in human more definitely, this method seems to be more useful than the previous methods. Conclusion. We observed the morphology of the juxtaglomerular apparatus by light microscope in epon-embedded 0.51μ thick sections. Juxtaglomerular cells and granules were easily and clearly observed in epon-ernbedded sections rather than in paraffin sections.

View full abstract

Since Einthoven, all electrocardiogram have been taken with a standardization of one millivolt per I cm and it has often been observed that this standardization was not enough to survey the low voltage deflections. There have been only a few studies with amplified writing of electrocardiogram, in recent years, and because of this the present work has been undertaken. A few year ago, the author studied "High Amplitude Electrocardiography" of five fold standardization by a biophysical preamplifier. But, some differences between the author's high amplitude electrocardiogram and the usual electrocardiogram had not been made clear as yet. In this investigation, the author tried to compare a measured value of the usual electrocardiogram with that of the high amplitude electrocardiogram which was taken synchronously. Materials and Method: Materials are 203 cases which contain hypertension, arteriosclerosis, heart disease and hepatic disease. The employed electrocardiograph was Polycorder M-51 (Hayakawa Electric Co., Ltd.). The usual electrocardiograph was taken on an electrocardiographic preamplifier with a standardization of one millivolt per I cm, and the high amplitude electrocardiograph was taken on a biophysical preamplifier with a standardization of one milivolt per 5 cm, i.e. five-fold enlargement. The electrocardiogram was taken with a high cut filter of 30 cycle/sec to prevent the intervention of an electrocardiogram. Both, the high amplitude electrocardiogram and the usual one were taken on an electrooscillograph with a paper speed of 60 mm per second and a scale of 1/100 second. Measurement of the various waves of the electrocardiogram were generally taken by using the standard lead II. When ST depression occurred the standard limb leads or lead V₅ Was used. A preliminary survey showed that the U wave tended to be broadest and tallest in chest leads and therefore these were used for detailed study. Generally, a survey of each deflection was done by the routine twelve lead.

View full abstract