The continuous surveys of the incidence and relative frequencies of congenital heart disease in school children have been carried out in Otsu City since 1960 and in whole Shiga Prefecture since 1967. From the surveys of about 116, 000 school children until the end of 1968, the incidence of congenital heart disease was estimated to be 0.3 per cent. The incidence and relative frequencies of congenital heart disease are similar to those of the same ages in Western countries. It is, however, different from the Western investigations that aortic stenosis and coarctation of the aorta were not almost observed in our surveys.

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A series of basic and clinical studies on a new anti-anginal agent, Bay a 1040, revealed the following facts. 1. With the artificial perfusion of a large branch of the coronary artery under a constant pressure head in closed-chest dogs, and with intracoronary injection as a bolus of 0.1ml, 1.0μg of Bay a 1040 produced a transient and minimal decrease in the mean coronary resistance to flow without any change in blood pressures. With 5μg/kg injected intravenously, the mean resistance to flow decreased in the coronary area that was not exposed to the circulating Bay a 1040. From these observations it is probable that Bay a 1040 produces a mild "active" coronary dilatation as well as "passive" coronary dilatation. 2. With 5μg/kg injected intravenously in open-chest dogs, the evoked circulatory change was that of transient dilatation of the systemic resistance vessels without any change in the capacitance of the circulatory system. 3. Middle-aged patients with ischemic heart disease responded to the oral administration of 20mg with "dilatation" of the systemic resistance vessels. Left ventricular external work and pressure-time-product were also diminished. 4. A clinical trial with cross-over design revealed an outstanding . "preventive" efficacy of this agent, as given in daily dose of 60mg in 3 divided portions, on the occurrence of anginal attacks in the patients with ischemic heart disease.

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The ischemic insult due to experimental embolization of coronary artery has consistently resulted in a depression of the ventricular function manifested by the conventional hemodynamic variables. In those animals which survived the initial catastrophy, circulatory manifestation of the myocardial failure could be no more seen in these standard parameters, which were considered to allow assessment of the pump action of the loading heart but not the intrinsic property of muscle mechanics. Application of force-velocity relation to ischemic heart disease has been criticized for the series elastic modulus is assumed to differ in those hearts with structural alterations. However, on the basis of the proof in the literature that the active stiffness cannot be affected in the subacute stage of myocardial infarction¹⁵. Velocity of the contractile element (Vce) was calculated using the same coefficient of series elasticity for four weeks after the embolization. Vmax determined by extrapolation of stress-velocity curve to zero stress offered constant evidence of impaired myocardial function, and good correlation was observed between the morphological alteration and the decrement of the value of Vmax in observation at four week interval. Consequently, Vmax can be regarded as one which directly expresses a contractile state of the myocardium in quantitative terms.

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The effect of undesirable sound (random noise of ca 100 phon) on the cerebral circulation was investigated by means of the ultrasonic Doppler apparatus in 10 normal young and elderly males. Increase of the blood flow was conspicuously observed in all the subjects after the onset of the noise. The increasing rate of the blood flow in the internal carotid artery and the vertebral artery was not coincident. The dissociation of the blood flow change in the two arteries is discussed. Headache and discomfort due to the noise were observed in all the subjects. Moreover, disturbance of sleep was observed in two cases. The above facts suggest that severe and repeated noise induces abnormality of cerebral circulation and various kinds of psychosomatic diseases.

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A case of a 6 year old boy is presented in which unilateral renal artery stenosis assumed to be congenital based on histological findings and subsequent malignant nephrosclerosis of the contralateral kidney and nephrotic syndrome probably due to gross albuminuria were observed.

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The effects of catecholamines on the oxidative phosphorylation of mitochondria and superprecipitation of myosin B was studied. Mitochondrial oxidative phosphorylations was inhibited by catecholamines. But super-precipitation of myosin B was activated by isoproterenol when the superprecipitation was inhibited by the microsomal fraction.

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1) Catecholamines induced shortening of plateau and total duration of action potential and increase of contraction and shortening of the time to peak tension and of the total duration of contraction of the rabbit ventricular muscle. Some parallelism was found between the electrical and mechanical changes. 2) The findings suggest the following: isoproterenol utilizes chiefly the extracellular calcium for its inotropic action. Norepinephrine shows an inotropic action by mobilizing in addition the intracellular calcium, and the contraction by this action is depressed by potassium. Both have little relation with sodium in their inotropic action.

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Positive inotropic action of norepinephrine were demonstrated in rabbit heart that was perfused by solution containing various calcium concentration. In these experiments, the changes of calcium content in subcellular fractions of myocardium were observed. 1) The calcium concentration in each subcellular fraction of myocardium was increased in the state of increasing contractile force by norepinephrine. Especially, there are similar pattern of changes between calcium concentration in heavy microsome fraction and contractile force of myocardium. 2) Increase of cardiac rate had no effects on the changes of calcium concentration in myocardium. These phenomena induced by norepinephrine were inhibited by pretreatment of propranolol. Thus, it should be emphasized that calcium ion in cardiac sarcoplasmic reticulum plays an important role in increasing contractile force by norepinephrine.

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NEp content and turnover rate following α-MPT were examined in rat heart after the use of several drugs. 1) Turnover rate were decreased by all of three anti-anginal agents, but, remarkbly by nitrate and propranolol, while slightly by prenylamine which lowered NEp content in the heart. Through these observations it seemed that the suppression of adrenergic activity might be one of the pharmacological mechanism of anti-anginal agents. 2) Atropine, hexamethonium and hydrocortisone showed no effect on NEp level in heart, but dexamethasone lowered NEp con-tent. Turnover rate were suppressed by dexamethasone, accelerated by atropine, but not changed by hydrocortisone and hexamethonium. It is suggested that not only the sympathetic system, but also the adrenocortical function, especially glucocorticoid fraction, are one of the factors regulating NEp synthesis. Since the adrenergic mechanism is very complicated, further study in being made to elucidate these problems.

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In order to evaluate a role of sympatho-adrenomedullary system in the causative mechanism of the anginal attack, the electrocardiographic and hemodynamic changes following the administration of physiological dose of catecholamines were observed in 74 patients with ischemic heart disease, in 51 normal subjects and 16 patients with essential hypertension. Following the administration of 0.2μg/kg/ min. of noradrenaline and 0.1μg/kg/min. of adrenaline the ischemic changes in electrocardiogram evaluated according to Master's criteria were found in 46 out of 64, 58 out of 62 patients, none of 33 and 5 out of 38 normal subjects, none of 10 and 7 out of 14 hypertensive patients, respectively. On the other hand, angiotensin-II (0.015μg/kg/min.) showed positive electrocardiogram in only 6 out of 26 patients. Noradrenaline and adrenaline produced a decrease and a increase of heart rate, respectively, neither of which showed any difference between patients and normal subjects. Noradrenaline increased both systolic and diastolic pressure and adrenaline increased systolic pressure and reduced diastolic pressure. These changes were significantly greater in the patients with ischemic heart disease as compared with those in normal subjects. Moreover, catecholamines and Master's exercise test produced significantly greater increase of cardiac effort index in the patient group. And the patients who showed greater increase of this index was associated with the higher incidence of positive electrocardiogram and the tendency was more remarkable in adrenaline than noradrenaline. Following the infusion of angiotensin-II the ischemic change on electrocardiogram was rarely observed despite of marked elevation of the cardiac effort index. Based on these findings, the importance of the sympatho-adrenomedullary system in the precipitation of anginal attack was discussed.

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The studies of renal circulation and electrolyte metabolism in liver disease are mostly based on the patients in resting state except those investigating the reaction of renal function against water, Na load and other medical agent. Consequently the detail of the functional disorder is not made clear. In the present study the patients with liver disease are given low oxygen gas inhalation as a stress, with a view to investigating the influence on the renal circulation and electrolyte metabolism under such condition. And, by comparing its result with the same with normal adults and various patients reported by with clinical symptoms of the patients with liver disease, it will be made clear whether latent renal disorder exists or not. By doing so, the kinds and extents of functional disorder in the kidney of patients with liver disease will be investigated as the purpose of this study. Method The standard renal clearance methods were employed simultaneously while 10 per cent O₂ inhalation was carried out. Before and after the low oxygen gas inhalation, determinations of renal circulation and electrolyte metabolism. Material 45 patients with liver disease (12 cases of acute hepatitis, 19 of chronic hepatitis and 14 of cirrhosis) aged ranging from 20 to 64 (34 men and 11 women). Classification (1) Classified by disease Acute hepatitis : (without anamnesis history of hepatitis and diagnosed on general clinical examination). Chronic hepatitis : (in which recovery of acute hepatitis is delayed by more than 4 months, and diagnosed on general clinical examination). Cirrhosis : (diagnosed on general clinical examination). In respect to chronic hepatitis and cirrhosis, liver biopsy was carried out, to confirm the diagnosis. (2) Classified by age A group : (younger than 39 age). B group : (older than 40 age). (3) Classified by RBF in a resting state α group : (more than 760 ml/min). β group : (less than 759 ml/min).

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The aim of the present report is to investigate the pathogenesis of the shoulder-hand syndrome (SHS) coming after myocardial infarction and frequent anginal attacks. Methods The incidence, onset, sex difference, age and the site of infarction were observed as for the cases of myocardial infarction and coronary insufficiency accompanied by SHS, admitted to The 2nd Tokyo National Hospital during past 5 years. EMG were recorded in 14 myocardial infarction and 2 coronary insufficiency cases followed by SHS concerning the following muscles ; Mm. trapezius, deltoideus, biceps brach., triceps brach., brachioradialis, flexor carpi radialis, extensor digitorum communis, abductor digiti quinti, flexor pollicis brev., and extensor pollicis brev.. Moreover, complement fixation reaction (CFR) for the antigen of necrotic heart muscle and cervical cord died from myocardial infarction, electrophoresis and immuno-electrophoresis were attempted in 15 SHS cases. On the other had, to clarify the pathogenesis, animal experiments were performed. Myocardial infarction was artificially made by ligation of the branch of coronary arteries in 55 rabbits. ECG, EMG, evoked EMG, gel diffusion test (Ouchterlony's method) and CFR against the antigen of necrotic heart muscle and involved cervical cord were followed up in these rabbits before and every 2 weeks after the infarction. Then, they were exsanguinated from 4 to 8 weeks after the infarction and pathological studies and immunological studies with fluorescent antibody technique were attempted in these excised section preparation of ischemic heart muscle and cervical cord. Anti-rabbit γ-globulin goat serum conjugated with Fluorescein isothiocyanate was used in that technique and blocking test was simultaneously carried out with unlabelled anti-rabbit γ-globulin goat serum.

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