The relations of pulmonary hemodynamics and the urinary catecholamine were investigated in patients with elevated left atrial pressure, and also the effects of 100 per cent oxygen and sympathetic blocking agents, such as phentolamine and hexamethonium, on pulmonary circulation were studied. Noradrenaline and the ratio of noradrenaline to adrenaline were higher in mitral valvular disease compared with control subjects, and somewhat better correlation (r=0.62) was obtained between the ratio of noradrenaline to adrenaline and the pulmonary arteriolar resistance. Administration of sympathetic blocking agents and inhalation of 100 per cent oxygen were followed by the reduction in pulmonary arteriolar resistance, and the decrement was found to be remarkable in those with the higher control values. From these evidences it is concluded that the functional vasoconstriction due to the sympathetic hyperactivity can make an additional contribution to the pathogenesis of pulmonary hypertension in cases with elevated left atrial pressure.

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In order to clarify the contribution of pulmonary venous system to developing pulmonary hypertension when the left atrial pressure is elevated, simultaneous right and BROCKENBROUGH'S trans-septal left heart catheterization were carried out. Pulmonary venous resistance were increased when left atrial pressure exceeded 18mm Hg, and positive correlation was obtained between pulmonary arteriolar resistance and pulmonary venous resistance. The resistance in pulmonary venous system is in part responsible for development of the passive pulmonary hypertension as well. It is also suggested from the results of administration of noradrenaline during catheterization in mitral stenosis and the infusion of noradrenaline in normal dogs that catecholamine would be a contributory factor to increase in pulmonary venous resistance under the condition of elevated left atrial pressure.

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The theory and the procedure for the measurement of the ratio of hepatic arterial and portal flow with the method of electroconductivity, using saline as an indicator were reported. The ratio of hepatic arterial and portal flow of healthy dogs was 16.5±10 : 83.5±10 in average. And then studies were performed the hepatic circulation in hypoxic state and experimental pulmonary embolism of dogs. In hypoxic state, the portal flow was increased remarkably with the ratio of hepatic arterial flow decreased. In pulmonary embolism, increased hepatic arterial flow and decreased portal blood flow were demonstrated.

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The alteration of blood pressure in Spontaneously Hypertensive Rats (Okamoto and Aoki, hereafter abbreviated as SHR) was observed under various kinds of stresses and their hypertensive vascular lesions were histologically examined. 1) Effect of immobilization Seventy to 90 day-old SIR (male 38, female 16) and age-matched normotensive rats of Wistar strain (male 33, female 5, hereafter abbreviated as NR) were restrained supinely on a board for 2-10 hours daily, 100-130 hours in total during 20-30 days. a) Stress-loaded SIR showed a highly significant increase (p< 0.001) in blood pressure (male 29±16, female 29±11 mmHg) at the end of a series of stress-loadings in comparison with either control SIR (male 11±8, female 10±8 mmHg) or control NR (male 8±6, female 5±3 mmHg), and maintained it even one month after the final stress, while a slight elevation of blood pressure (11±8 mmHg) was observed only at the end of the stress-loadings in male NR. b) Stress-loaded SIR developed severe hypertension (over 210mmHg) during or after the stress-loadings in 8 out of 38 males, and pathological studies made on them revealed cerebral hemorrhage, abdominal hemorrhage, retinal bleeding, malignant and benign nephrosclerosis, periarteritis nodosa and angionecrosis in the various organs, some of which corresponded to the lesions in malignant hypertension. 2) Effect of combined visual, auditory and electric stimuli SIR and NR were loaded with a combined stress of high pitched buzzer (duration 3-7 sec., 5-6 times per min.), flickering of incandescent lamp (100V, 100W, 40-60 times per min.) and electric shock (20-40 V Alternating current of 60Hz, 0, 5-1 sec., 5-6 times per min.) for 1-4 hours daily from the 40th day up to the 18th week after birth. a) Stress-loaded NR (male 5, 141±7mmHg) showed a significantly (p<0.05) higher blood pressure (by 11-15 mmHg) than control NR (male 10, 126±7 mmHg) after the 6th week following the onset of the stress-loadings. b) Rise in blood pressure in stress-loaded SIR (male 4, 205 ±8 mmHg) was significantly (p< 0.01) greater than that in control SIR (male 4, 175±5 mmHg), and the increment of blood pressure ( 17-31 mmHg) in the former compared with the latter was evidently larger in comparison with that (11-15mmHg) of stress-loaded NR compared with control NR. 3) Effect of chronic cold exposure Ten SIR and 1 5 NR were exposed to cold temperature (2-10°C) from 3 to 4 months after birth for 7 weeks. In the 3rd week and 7th week of cold exposure the exposed SIR showed significantly (p<0.05, p<0.01) higher blood pressure (186±16, 207±15 mmHg) than nonexposed SIR (171±13, 182±21 mmHg), respectively, while no difference was noted between the exposed NR and nonexposed 13 NR. 4) These results provided an evidence that some kinds of chronic stress-loadings augment hypertension and aggravated hypertensive lesions in SIR and it is speculated that stress might activate the causative mechanisms of the spontaneous hypertension hypothetically supposed in the hypothalamo-medullary-autonomic nervous system and the hypothalamo-adeno-hypophyseo-adrenocortical and -thyroidal systems.

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1. Distribution of cellular catecholamine in the sympathetic neurons of superior cervical ganglia of the rats was studied by fluorescence method of FALCK and HILLARP. A total of 10 male spontaneously hypertensive rats (OKAMOTO and Awoke) (consisting of 5 animals of 40 to 50 days of age and 5 rats of 4 to 5 months of age) and 10 male normotensive control rats of Wistar strain were subjected to examination. 2. The sympathetic neurons in the superior cervical ganglia of the normotensive rats showed specific formaldehyde-induced green or yellow-green fluorescence, which is due to the presence of noradrenaline. The cell populations with such specific fluorescence were heterogeneous in respect of fluorescence intensity. 3. The fundamental fluorescence microscopical feature in the ganglionic neurons of the spontaneously hypertensive rats did not differ from that of the controls. However, by statistical analysis of distribution of cell populations in respect to fluorescence intensity, the significant increase of frequency of intensely fluorescent nerve cells was proved in 4 of 5 spontaneously hypertensive rats of 40 to 50 days of age and 4 of 5 spontaneously hypertensive rats of 4 to 5 months of age. 4. From the above results, possible augmentation of sympathetic neural activity in the spontaneously hypertensive rats was assumed and discussed in relation to the significance of catecholamine in the sympathetic ganglionic neurons.

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1. Histometric, enzyme histochemical, and fluorescence and electron microscopic studies were performed on the superior cervical sympathetic ganglia of rats with experimentally induced hypertension and those of normotensive control rats. DOCA hypertension, renal infarction hypertension, and cerebral hypertension were induced in normotensive Wistar strain rats (with original blood pressures below 150 mmHg). The hypertensive animals were sacrificed and examined, some in the acute and some in the chronic stage of hypertension, and their ganglia were compared with those of normal controls. 2. The rats with DOCA implantation and l% saline ingestion developed sustained hypertension beginning after about three weeks of treatment and lasting till death (DOCA hypertension). The body weight of these animals was significantly lower than that of the controls through the experimental period. The rats with bilateral ligation of the posterior branches of the renal arteries became hypertensive within a few days after operation, and hypertension was maintained thereafter (renal infarction hypertension). The body weight of these animals was lower than that of the controls only in the acute stage. The rats with bilateral internal carotid artery dissection developed hypertension one week after operation (cerebral hypertension). It was slightly labile in the acute stage, but sustained in the chronic stage. No gross physical changes were found in this group. 3. Histometrically, the following findings were noted. The sympathetic ganglia of the rats with DOCA hypertension showed no remarkable changes in the acute stage, but the ganglia tended to increase in weight and the nerve cell bodies became significantly enlarged in the chronic stage. In the acute stage in rats with renal infarction hypertension, only the ganglia weighed more than those of the controls. However in the chronic stage, the weight and volume of the ganglia, and the size of the nerve cells and their nuclei, were significantly greater than those of the controls. The rats with cerebral hypertension in the acute stage had heavier ganglia and larger nuclei than normal rats. In the chronic stage, there was definite hypertrophy of both ganglia and neurons. 4. Enzyme histochemical findings were as follows.

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A 41-year old patient with anomalous origin of the left coronary artery from the pulmonary artery was reported. The anomalous vessel was demonstrated by an aortography and its orifice by a selective pulmonary arteriography. Because of progression of disability and to prevent possible sudden death, ligation of the anomalous vessel was successfully done. This case was the third one in whom operative treatment was successfully carried out in the older age group. Since operation, his chest pain disappeared but there was no remarkable improvement of heart size or electrocardiograms. It was emphasized that the recognition of the hemodynamic change was important for the surgical treatment of this anomaly. Some comments on the diagnostic problems were made.

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Introduction: There has been world wide popularity of prosthetic replacement for the severely destroyed cardiac valve with malfunction. Total number of 289 cases of 336 of prostheses have been replaced for them until end of March, 1968. Among them, author made phonocardiographic analysis postoperatively. It is believed that this method display the considerable accuracy of hemodynamic statement or function of the cardiac valve without painstaking to the patient. With this method of analysis, hemodynamic improvement had been compared with various prostheses replaced, including new type of prosthesis, Wada hingeless valve. Method: Total number of 105 cases were selected for the phonocardiographic analysis. They were all followed up more than 3 months after surgery. Fifty-five cases of them were mitral and rest were aortic replacement. These were 2 to 51 year-old in age. Fifty of them were male and 55 female. In mitral replacements, there are 36 of Starr-Edwards, 10 of Wada hingeless, 6 of SmeloffCutter and 3 of Kay-Shiley valve. In aortic, these are 38 of Starr-Edwards, 8 of SmeloffCutter and 4 of Wada hingeless valve. Cardiac sound was recorded using crystal micro-phone and traced photographically. At the same time, apexcardiogram and carotid pulse wave were traced in selected cases. These data were compared in each other and normal person. Result. At mitral position of ball or disc valve, there noted clear and high pitched opening and closing sound both in auscultation and phonocardiogram. However, in cases of the replacement with Wada hingeless valve, there noted opening sound in 50% phonocardiographically and no opening sound in auscultation. There are mild prolongation of Q-Mitral Closing Valve Sound interval (Q-MCVS) when compared with Q-1 interval of normal heart. There are prolongation of II-Mitral Opening Valve Sound interval (Q-MOVS) than preoperative value of II-OS interval in cases of mitral stenosis. II-MOVS proportionally decrease with the rate of cardiac beat. When atrial fibrillation exists, there showed prolongation of Q-MCVS and shortening of II-MOVS than that of sinus rhythm. Three of them showed that Q-MCVS and II-MOVS changed proportionally increase and decrease respectively with the preceding R-R interval. There recorded sometimes extra-sound (Rotating Ball Sound, RBS and Rebounding Leaflet Sound, RLS) which some due to prosthetic valve itself. Upon the analysis of the cases who regurgitation and malfunction of prosthesis postoperatively, it noted appearance of the murmur and changes of II-MOVS phonocardiographically. These phonocardiographic changes are important clue which decides reoperation for the malfunctioned valve in time. At aortic replacements, there noted systolic murmur of ejection type in all cases. Wada hingeless valve recorded the least prosthetic opening sound. It was observed that Q-M₁ interval prolonged slightly than normal in the group of sinus rhythm and more in the group of atrial fibriffa-tion. There are almost normal value in M₁-Aortic Opening Valve Sound (M₁-AOVS) and Aortic Opening Valve Sound-Aortic Closing Valve Sound interval (AOVS-ACVS). There recorded extra sounds (RBSRLS) in 42 % of aortic replacement. It was considered to be non-specific hemodynamically . In analysis of carotid pulse wave, it indicated the lateral flow obstruction and stenosis of valvular orifice in some cases. Unlike to the cases of mitral replacement, there obtained no qualitative results phonocardiographically to the grade of regurgitation developed postoperatively. Conclusion: In summary, after the prosthetic replacement of the cardiac valves it revealed prosthetic opening sound and systolic murmur of ejection type at aortic replacements. Otherwise, it showed approximately normal value in each intervals phonocardiographically. [the rest omitted]

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