1) The random error of the coronary flow in the individual by the continuous local thermodilution method was examined by the comparison between nth and (n+1) measurements. The reproducibility in the great cardiac vein flow was 0.01±4.91% (mean±1SD) with the correlation coefficient of 0.95 and, in the coronary sinus ostial flow, was 0.18±2.30% (mean±1SD) with the correlation coefficient of 0.95 . 2) The variability of the flow between the individual was examined. In the control group, the great cardiac vein now was 64.7±19.9 ml/min, and the coronary sinus ostial flow was 111.4±15.2 ml/min. There were no significant difference between the control, the left ventricular hypertrophic and the myocardial ischemic groups. 3) The clinical significance of the measured flows were discussed.

View full abstract

Acidemia was induced in normal dogs by CO₂ administration. Plasma electrolyte concentration showed a rise of sodium and potassium and a fall of chloride. Electrocardiograms recorded at the same time showed T-wave changes which resembled those induced by KCl infusion in the same animals. Besides, QTC tended to decrease at that time to the same degree as in KCl infusion. However, the degree of hyperkalemia induced by the acidemia was much less remarkable than those by KCI infusion when both conditions were compared on the same level of T-wave changes. When the acidemia was suppressed with a solution of Tris-buffer (THAM) containing potassium, T-wave changes were also suppressed in spite of the rise of plasma potassium level. These findings suggest that 'some factors other than hyperkalemia caused the above electrocardiographic changes. Judging from the plasma electrolyte changes seen in the acidemia and from another observation that hypertonic NaCl or NaHCO₃ also causes similar electrocardiographic changes, it is concluded that the changes in gradients across cell membranes of multiple electrolytes, including potassium, sodium, hydrogen ion and so forth, are responsible for the electrocardiographic changes seen in acidemia.

View full abstract

A careful study was performed in two patients of idiopathic diabetes insipidus (DI) to assess the role of renal hemodynamic changes in antidiuresis induced by several agents commonly used for the treatment of DI patients.' In one patient, every one of chlorpropamide, clofibrate and thiazide caused a decrease in effective renal plasma flow (ERPF) by about 20% in association with a decrease in urine volume by 40-50%. No significant decrease in GFR was seen in the patient. In the other patient, every one of the above drugs caused a decrease not only in ERPF (by 25-40%) but also in GFR (by 25-35%) in association with a more remarkable decrease in urine volume (by 60-70%). These renal hemodynamic changes resembled those induced by the administration of exogenous vasopressin. Thus renal hemodynamic changes should be taken into consideration when one studies the mechanism of antidiuresis induced by the drugs mentioned above.

View full abstract

Forty-seven subjects with isolated complete right bundle branch block (CRBBB) were analyzed electrocardiographically and vectorcardiographically utilizing the Frank lead system. Two basic electrocardiographic patterns of group A and group B, and 5 vectorcardiographic patterns of type A, type Ab and type ab belonging to group A, and type aB and type B to group B, were identified. The duration of the S wave in lead II in group A was equal to or larger than 0.08 sec, while in group B it was equal to or below 0.08 sec. In group A, the mid-tempolar portion of QRS-loop was displaced more posteriorly, superiorly and to the right than that in group B. As regards the mean electrical axis, group A is generally closer to CRBBB with left anterior hemiblock (LAH) than group B, while group B is to CRBBB with left posterior hemiblock (LPH) than group A. Fifteen (79%) of 19 subjects with hypertension and/or atherosclerosis had the type A, type Ab and type ab QRS-loop patterns, 2 subjects with variant type of angina pectoris out of 4 exceptions showing the type B QRS-loop patterns. On the other hand, 6 of 7 subjects with chronic lung disease and 10 of 21 subjects with no evidence of cardiopulmonary disease had the type aB and type B QRS-loop patterns. Fortunately, a 62-year-old man with essential hypertension and bronchial asthma was found to have intermittent group A and group B of isolated CRBBB confirmed by 12-lead electrocardiogram (ECG) and vectorcardiogram (VCG). On the basis of these findings, it is suggested that there would be some difference in propagation of the cardiac impulse, induced by disease, between group A and group B.

View full abstract

1. In ten rabbits an operation to induce aortic valvular stenosis was performed. The rabbits were sacrificed two, three or four weeks after the operation and the myocardium was examined by means of electron microscopy. In the same rabbits H³-digoxin or H³-digitoxin was administered intravenously before the animals were sacrificed and the distribution of cardiac glycoside in the myocardium was examined by means of autoradiography. Similar studies were conducted in six normal rabbits. 2. Electron micrographs showed the myocardium of normal rabbits in a highly contracted state with a mean Z-Z interval of 1.2μ. In two weeks after the operation, electron micrographs of the myocardium showed decrease in glycogen granules, widening of Z-band, swelling of mitochondria, disappearance of cristae and matrix and swelling and widening of sarcoplasmic reticulum. In three weeks after the operation a very large number of mitochondria of various sizes were observed around myofibrils, thus occupying most of the intracellular space and presenting a picture of mitochondriosis. In four weeks or more after the operation, glycogen granules and mitochondria were decreased. Some cristae and matrix had disappeared and vacuoles and dense bodies were observed. A-band and H-band had disppeared in some myofibrils, thus presenting an amorphous picture. 3. The uptake of digoxin or digitoxin in the myocardium was the greatest in 1 1/2 to 2 hours or 4 to 8 hours, respectively, after the intravenous administration both in control and operated groups. The uptake was greater in the operated group sacrificed three weeks or more after the operation than in the control group. There was no significant difference in uptake between the left and right ventricles. 4. Grains of cardiac glycoside were observed in A-band, Z-band, T-system and mitochondria both in the control and operated groups. This indicated that cardiac glycoside acted not only on T-system but also on actomyosin system. In rabbits sacrificed three weeks or more after the operation, grains were also observed in M-line.

View full abstract

A study of the cardiac output and other parameters of oxygen transport was carried out in coronary patients during treadmill exercise to maximal levels. The last minutes of symptom limited treadmill exercise were characterized by plateau levels of both the cardiac output and oxygen intake, indicating that maximal values for these parameters had been attained. Coronary patients in this study were characterized by marked restrictions in oxygen transport due entirely to a restricted maximal cardiac output. At submaximal levels of exercise the relationship of cardiac output to oxygen intake in these coronary patients was similar to normal subjects. The maximal cardiac output is a fundamental and sensitive indicator of the circulatory impairment that results from coronary disease.

View full abstract

It has been experienced that the bundle branch block pattern disappears and the QRS interval is shortened only when some premature beats are accompanied by bundle branch block, which is an extremely rare phenomenon. Several cases of this rare phenomenon, making the bundle branch conduction appear temporarily normalized, have been reported since Wilson and Herrmann's description of it in 1920. In this paper, we will describe an extremely rare phenomenon of normalization in the proper bundle branch block pattern, resulting from the mutual intraventricular fusion of the atrial premature beat and the ventricular premature beat in I case of right bundle branch block and I case of left bundle branch block. Case 1. The ECG shown in Fig. I is the V₁ lead, exhiviting the right bundle branch block in the sinus rhythm. In the upper tracing (A), the atrial premature beats (APB) appear at the fourth beat and the final eighth beat, the coupling time being 0.56 to 0.57 sec. The sixth beat is one of the ventricular premature beats (VPB) exhiviting a typical left bundle branch block pattern, the coupling time being about 0.55 sec. In the lower tracing (B), the same atrial premature beats (APB) appear at the second beat, and the final eighth beat and the QRS complex at the fourth beat (FPB) show a pattern (rS type: QRS interval; 0.08 sec.) suggesting almost normal conduction of the bundle branch. Such a singular phenomenon can be observed provided the following 3 conditions are satisfied as shown in Fig. 2: i) existence of bundle branch block, ii) existence of atrial premature beats and ventricular premature beats originating from the distal region of the bundle branch block, and iii) approximation of the coupling times in these different premature beats. When these three conditions are satisfied, it is very likely that the supraventricular impulse will be fused with the ventricular impulse in the cardiac ventricle. As in this case, the left ventricle (normal side) is discharged from the atrial Premature impulse and the right ventricle (blocked side) is simultaneously discharged from the right ventricular impulse in the right bundle branch block. In other words, the retardation of the depolarization process of the ventricles characteristic of the bundle branch block disappears and the QRS interval, as well as the QRS pattern, is normalized.

View full abstract

The steady state level of overall circulatory function might be defined by the interrelation-ship with the following factors; how much volume of blood is filled within the closed system of circulation, and, in this connection, how adequately the blood could be circulated. In fact, according to Guyton, when considering the system seperately; cardiac function has been described as a function of two determinations, cardiac output and atrial pressure which correlates with inflow volume (Starling's law); while the peripheral circulation has been described as the function of veneous return and mean circulatory pressure, which correlates linearly with total blood volume. Thus one can integrate both cardiac and peripheral system into one closed loop system as a function of the flow and the volume. Meanwhile, so-called radiocardiogram (RCG) has gained its popularity because of its atraumatic convieniency both for patients and physicians, resulting cardiac output and total serum volume. On the basis of the mentioned view point, it is felt to be necessary for the cardiac output and the total blood volume or serum volume to be in pertinent place in order to make a handy tool for evaluation of the steady state level of circulatory function. The purpose of present manuscript are (1) to deduce normal predicted values of these two determinants by statistical analysis, and (2) to classify various states of hemodynamic abnormalities in the term of deviation from the normal prediction. Method and Subjects More than 500 subjects who had been examined by the routine RCG test were slected for the present investigation. Ranging from eight months infant to seventy-five years old subject, 133 cases were selected as normal subjects. As for subjects with non-cardiac disease with hemodynamic abnormalities, 25 cases of hyperthyroidism, 7 cases of iron deficiency anemia and 12 cases of primary aldosteronism were selected. As for subjects with cardiac diseases with hemodynamic abnormalities, 37 cases of essential hypertension, 7 cases of ischemic heart disease and 28 case of mitral valve disease were selected. These subjects were subclassified into the one with or without congestive heart failure above third degree. Furthermore, hypertension group was subclassified into the subjects under or above thirty-five years olds.

View full abstract

Twenty mongrel dogs were used and the effects of the vasodilator "Praxilene" (2 mg/Kg i.v.) on cerebral blood flood flow (CBF), oxygen availability (O₂a) and intracranial pressure (ICP) were srudied in acute intracranial hypertension produced by slow inflation of epidural balloon and in cerebral edema produced by epidural application of dry ice for ten minutes. The local CBF was measured by the heat clearance method with double thermister or thermocouple, while measuring O₂a by polarograph using open tip type of platinum electrode with the diameter of 50 to 270μ. ICP was measured by epidural microballoon method. In normal controls, CBF was increased for 9.6 minutes after the administration of Praxilene (2 mg/Kg i.v.) approximately as much' as that after 10% CO₂ inhalation of 4 or 5 minutes, and the elevation of O₂a was paralleled to the increase of CBF. But ICP was elevated by mean 7.2 mmHg by the administration of Praxilene, while 10% CO₂ inhalation elevated ICP by mean 18.7 mmHg. Therefore, Praxilene increased CBF with less increase of ICP than 10% CO₂ inhalation. In acute intracranial hypertension by epidural balloon compression, CBF and O₂a were not increased so much by the administration of Praxilene as controls with normal ICP. When ICP was raised to the level higher than 30 to 50 mmHg, Praxilene induced further increase of ICP and the harmful effects on systemic circulation such as hypotension, arrhythmia and bradycardia. Under these condition CBF and O₂a were no longer increased. Cerebral edema was produced in five experiments. CSF pressure was measured by cisternal puncture at 24 to 48 hours after injury. It was ranged from 8 to 11 mmHg in all cases. CBF and O₂a were measured in the lesion and in the contralateral normal area. O₂a electrode was located at the same point where CBF electrode was inserted. In two of five experiments, CBF and O₂a were not increased within the lesion by the administration of Praxilene In other three experiments, CBF was increased slightly by it, but the effects of Praxilene to CBF and O₂a were abolished when ICP was elevated to the level of 25 to 30 mmHg by hydrostatic infusion of artificial CSF into the cisterna magna. However, in these condition CBF and O₂a were increased by it in the contralateral normal area. These effects would be probably due to the decrease of the vasoreactivity to the vasodilator "Praxilene" and the abnormal hemodynamics within the lesion due to the regionally increased ICP. In some cases, it was noticed that O₂a was not increased in spite of increase of CBF within the lesion by the administration of Praxilene or 10% CO₂ inhalation. This would demonstrate that there were some regions within the lesion where the increased CBF was non-nutritional. In conclusion, the effect of vasodilator "Praxilene" would not be expected in the patients with intracranial hypertension more than 30 to 50 mmHg, and in those with cerebral edema even if ICP is not elevated.

View full abstract

Cardiogenic shock was produced in dogs by embolization of the circumflex or anterior descending branches of left coronary artery. The shock plasma was processed through selective ultrafiltration and fractionated by gel-filtration column chromatography into six distinct peaks A, B, C, D, E, and F in the descending order of molecular weights. The fourth peak termed D contained the total MDF (Myocardial Depressant Factor) activity of the row plasma. The control plasma obtained at zero time prior to coronary embolization, yielded none or negligible peak D virtually devoid of myocardial depressant activity. MDF activity of shock peak D samples was determined under the controlled assay condition, and shown to be markedly increased in parallel with progression of shock states. MDF isolated from shock plasma was found to be filtrable, soluble in aqueous media, recovered in the chromatographic fraction of molecular weight range between 800 and 1000, heat stable (i.e. 56 C, 30 min), and to give a positive ninhydrin test. The amino acid analysis of MDF after hydrolysis in 6 N HCl and using an amino acid analyzer, revealed the molecular species composed of alanine, aspartic acid, glutamic acid, glycine, iso-leucine, leucine, serine, threonine, and valine indicating it to be nona- or octapeptide without sulfur-linkage. The observed lysosome abnormalities and ischemic cellular injuries in the pancreas were consistent with the view that the primary site of MDF production is the ischemic viscera, particularly pancreas in which intracellular acidosis causes activation of lysosomal acid proteases to catalyze the degradation of substrate proteins to the peptide. The data presented do suggest MDF may be an important determinant in impairment of myocardial performance during cardiogenic shock, presumably affecting on contractility of the viable non-infarcted portion of the heart muscle.

View full abstract