A qualitative analysis of serum lipoproteins in 123 cerebrovascular patients and 138 controls was carried out by a modified polyacrylamide gel disc electrophoresis in order to investigate the contribution of lipoproteins to cerebrovascular disorders. Mid-band lipoproteins were present in 148 of 261 over-all subject .Furthermore, in these subjects with mid-band lipoproteins, higher levels of serum total cholesterol and triglyceride were found when compared to the subjects without mid-band lipoproteins. Mid-band lipoproteins were detected significantly more frequently in patients than in controls .The incidence of mid-band lipoproteins among the patients with cerebral infarction was higher than that among those with hemorrhage, and was higher in the patients with abnormal electrocardiographic findings or impaired renal functions compared to those without them. The incidence of mid-band lipoproteins in patients was not affected by hyperlipidemia. However, in controls, the incidence was higher in hyperlipidemics than in normolipidemics. In normolipidemic subjects, the incidence of mid-band lipoproteins was higher in cerebrovascular patients than in controls, suggesting existence of abnormal lipoprotein metabolsim even in normolipidemic cerebrovascular patients.

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One case of concealed preexcitation and four cases of Wolff-Parkinson-White (WPW) pattern (including one questionable case) n which the electrocardiographic (ECG) manifestations were highly suggestive of the conduction through Mahaim fibers or septal bypass are described. ECGs of Case 1 did not demonstrate preexcitation but showed a peculiar arrhythmia consisting mainly of the sequence of trigeminy and quadrigeminy due to the occurrence of "supraventricular premature beat" which is preceded by inverted P wave and often showed aberrant conduction of right bundle branch block (RBBB) pattern and occasional anterograde conduction failure. Atrial reciprocal rhythm (ARR) related to the presence of concealed bypass which is essentially capable only of retrograde conduction, that is, a concealed preexcitation, was the most likely mechanism. Intermittent conduction through the left-sided Mahaim fibers was the most likely mechanism of aberrant conduction of ventricular reciprocal beat (VRB). Case 2 was type A WPW pattern associated with short PR interval. After daily intravenous drip infusion of digitalis (Cedilanid), which has been generally considered to depress the atrio-ventricular (A-V) conduction and accelerate the anomalous bypass conduction, PR interval gradually prolonged to 0.16 sec, while type A WPW pattern with decreased size of initial delta wave remained. This finding was considered to favor the mechanism of either combination of A-V nodal bypass and left-sided Mahaim fibers or left-sided Mahaim fibers alone rather than left-sided (type A) Kent bundle. Case 3 was believed to be type A WPW pattern due to anomalous conduction through left-sided Mahaim fibers. However, concomitant RBBB could not be wholly excluded in Cases 2 and 3 (particularly, in Case 2). Regarding Case 4, it was impossible to label as type A WPW pattern without the aid of intracardiac recordings and pacing study because such a QRS pattern seems to have been labelled as atypical RBBB. Case 5 was considered to be atypical case associated with normal PR interval. WPW pattern of A-V junctional escape beats was indicative of the conduction through Mahaim fibers or septal bypass.

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The first purpose of this study was to determine which P wave features contain information to distinguish between right atrial pressure overloading (RAPO) and volume overloading (RAVO) and then to lean whether this discrimination can be diagnostically significant. We then attempted, using correlational and multi-variate analytical methods, to extend this diagnostic utilization of the orthogonal P wave to hemodynamic parameters. Forty-nine patients with isolated pulmonary stenosis (PS) or primary pulmonary hypertension (PH), and 44 patients with ostium secundum atrial septal defect (ASD) were used as prototypes for RAPO and RAVO, respectively. In the relationship between 97 computer-measured P wave items and selected hemodynamic variables, "magnitude of maximal P vector in the horizontal plane" showed the highest correlation with right ventricular systolic pressure (sys. RVP) in RAPO (r=0.75) and with the shunt ratio in RAVO (r=0.69), (both significant at p < 0.001). A stepwise multiple regression analysis using several P wave measurements was also attempted to predict the sys. RVP or the shunt ratio. To determine the maximum number of P wave items (singly or in combination) useful in separation of RAPO and RAVO, multi-variate statistical analysis was performed. The chosen combination of azimuth of terminal 30 msec. P vector, angle of maximal P vector in the horizontal plane resulted in correct identification of 78% of RAPO and 77% RAVO. Thus the terminal P wave components representing left atrial activity prove important in differentiating between RAPO and RAVO.

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Electron microscopic studies on the alveolar-capillary barrier were carried out in 13 patients of chronic pulmonary edema and/or congestion resulting from heart disease of various etiologies. The characteristic findings are tremendous proliferation of type II granular pneumocyte and irregular thickening of alveolar epithelial and capillary basement membrane. These ultrastructural changes correlated to the duration of heart failure and mean pulmonary arterial wedge pressure despite of disease groups and the age of the patients. In particular, lamination of capillary basement membrane with fragmentation was more specific finding which was observed only in patients with mean pulmonary arterial wedge pressure above 35 mmHg and duration of heart failure over 6 years. There was no apparent relationship existed between the ultrastructural changes and pulmonary arterial pressure. In addition to these characteristic changes the remaining ultrastructural changes of the alveolar-capillary barrier were difficult to make a correlation to clinical course and cardiopulmonary hemodynamics.

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The pre- and postoperative systolic time intervals, hemodynamics and serum catecholamines were studied in 30 patients with successful myocardial re-vascularization surgery or left ventricular aneurysmectomy and the influence of the surgery on the left ventricular function was evaluated. 1. Significant depression of left ventricular performance was recognized in the group of patients with left ventricular aneurysm as compared to the patients with angina pectoris with or without previous myocardial infarction before the operation. 2. At 2 hours after the operation, significant decrease of ET/PEP, cardiac index and stroke work index and marked elevation of systemic vascular resistance were seen in the group of patients with aortocoronary bypass surgery who had previous myocardial infarction and with left ventricular aneurysmectomy as compared to the group of patients without previous myocardial infarction. 3. At 2 hours after the operation, ET/PEP seemed to reflect the left ventricular stroke work and the depression of the left ventricular function was mainly affected by the elevation of systemic vascular resistance due to the hypersecretion of serum catecholamines. 4. Reduction of systemic vascular resistance by vasodilator brought an improvement of ET/PEP, cardiac index and stroke work index.

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Chemical characteristics of vascular collagen were studied in stroke-prone spontaneously hypertensive rats (SHRSP) which developed cerebrovascular lesions spontaneously in over 90% of the population. Aminoacid analysis of arterial collagen among SHRSP showed no remarkable difference from stroke-resistant SHR (SHRSR) and normotensive Wistar-Kyoto rats (WK). The uronic acid content of the aorta, which elevated with aging, was increased in SHRSR and especially in SHRSP. The hexose content of collagen was also increased in SHRSP characteristically with a concomitant increase in the ratio of the disaccharide unit (glucosyl-galactosyl-hydroxylysine) to the monosaccharide (galactosyl-hydroxylysine). The relative increase in β and γ components was also noted in SHRSP. These structural changes of vascular collagen especially noted in SHRSP may be related to the fragility of arterial wall or to the stroke-proneness.

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