A sensitive and specific radioimmunoassay for the determination of plasma angiotensin II was developed by using the antisera against synthetic angiotensin II in combination with labeled angiotensin II. This assay employs an acetone extraction procedure and detects as little as 0.8 pg per tube of angiotensin II. The mean (±S.E.) plasma angiotensin II concentration in 19 normal subjects was 14.4 ± 1.8 pg/ml in a state of overnight fasting and recumbency. In 13 normal subjects, in whom 40 mg of furosemide was injected intravenously, plasma angiotensin II concentration before and after 30 and 120 minutes in an upright position was 14.6 ± 2.2, 56.6 ± 5.7 and 74.3 ± 9.0 pg/ml, respectively. In 6 normal subjects, and infusion of isotonic saline, angiotensin II concentration reduced from 14.1 ± 3.7 to 9.2 ±1.7 pg/ml. Thus, it was ascertained that the simplified radioimmunoassay method reported here using an acetone-petroleum ether extraction method was specific and highly sensitive.

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For the purpose of unraveling the relations between disturbances in microcirculation and deposition of lipids in the aortic wall, 9 rabbits were fed a 1% cholesterol and 5% coconut oil at intervals up to 16 weeks, and 4 rabbits were used as controls. After microangiography of vasa vasorum, the same specimens were studied histochemically. The distribution of vasa vasorum became poorer on sacrifice by microangiography. However, it could not be thought that disturbances in vasa vasorum was a cause in the early deposition of lipids, because lesions were histologically mild in the greater parts of vasa vasorum. The sites of predilection for the vascular lesions were initially the branching part, and then the thoracic aorta. Thickness and numbers of the elastic lamina in the media decreased straightly in the distal direction, and the degree of intimal thickening and accumulation of lipids were parallel with the degree of the medial thickness. The intimal cells tended to be arranged radially with wide intercellular spaces in the cross section, suggesting the convenience for the passage of fluids. From the above facts, it may be reasonable to presume that the difference in severity of disturbances of microcirculation resulted in the difference in the site of predilection.

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Histopathology, distribution and incidence of vascular changes were studied in tissues obtained at autopsy on thirty-seven children. Elastic and musculoelastic arteries showed a high incidence of arteritic changes, however the degree of the lesions was in general mild to moderate with the exception of the iliac artery, which revealed severe changes and a necrotizing panarteritis which was often accompanied with an aneurysm formation. A high incidence of arteritic changes, of which main histological feature was necrotizing panarteritis, was seen in extravisceral middle sized arteries. The coronary artery in particular was involved in each case and most had an accompanying aneurysm, some of which had ruptured. Intravisceral small sized arteries showed a relatively low incidence of arteritic changes and the degree of inflammation was in general mild. Phlebitis was present in over half the number of patients. The degree of lesions was mild in the small veins and mild to moderate in the large veins. Vascular lesions in Kawasaki disease should be termed systemic vasculitis rather than a systemic arteritis. There was a correlation between the caliber of involved vessels and the degree of vascular lesions. According to the histopathology, distribution and incidence of angitis, Kawasaki disease does resemble infantile periarteritis nodosa with the exception of the different manner of the coronary and iliac involvement.

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The simultaneous correction of tetralogy of Fallot and an aneurysm of the coronary artery due to mucocutaneous lymph node syndrome (MCLS) in a 4-year-old boy was successfully performed. Of the four aneurysms found on the coronary angiogram at the age of six months, the smaller three regressed spontaneously leaving slight dilatation and thickening of the arterial wall during the 4-year follow-up period. However, the largest one in the right coronary artery, which remained almost the same size, showed marked stagnation of blood in the aneurysm with the possibility of thrombosis and resultant myocardial infarction. At operation, there was a large aneurysm in the right coronary artery, 9 mm in width and 18 mm in length. The wall of the aneurysm was very thick and tightly adherent to the myocardium. The aneurysm as resected and an aorto-coronary bypass graft was fashioned from a saphenous vein taken from the patient's mother, since an autogenous vein was not available. A ventricular septal defect was closed and pulmonary stenosis was relieved without any difficulty. Postoperative cardiac catheterization and coronary angiography four weeks after the operation revealed satisfactory correction of the tetralogy of Fallot and a patent aorto-coronary vein graft. Several problems regarding surgical treatment of coronary artery aneurysm due to MCSL are discussed.

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Escape from sodium and potassium retaining actions of aspirin-like drugs used in a patient with Bartter's syndrome. AN analysis was done with regard to the mode of escapes from sodium and potassium retaining actions of aspirin-like drugs in a patient with Bartter's syndrome. In the indomethacin therapy of the syndrome, there was a delay in the initiation of potassium escape as compared to sodium escape, whereas no delay was seen in the ibuprofen therapy. This delay was probably related to the direct or indirect inhibition of sodium-potassium exchange in the distal nephrons. The course of aspirin therapy went midway between the above two. In the spironolactone therapy, the mode of escape was a mirror image of the one in the indomethacin therapy. Also, in a patient with rheumatoid arthritis, but without Bartter's syndrome, the escapes from the effects of indomethacin were seen. In order to understand the effect of these drugs on potassium excretion in Bartter's syndrome, some other intrarenal events, such as the influence on chloride transport in the loop of Henle leading to potassium conservation, may have to be considered.

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This report concerns a 9 years old boy, who had situs solitus and atrioventricular concordance with double outlet left ventricle, pulmonary stenosis, tricuspid stenosis, ventricular septal defect, secundum atrial septal defect and hypoplastic right ventricle. Previous Blalock-Taussig shunt was created at the age of 11 months. Total correction consisted of closure of atrial septal defect and tricuspid valve orifice, and direct anastomosis of right atrial appendage to pulmonary trunk. Though atrial pacing was required for the immediate post operative period, the patient regained sinus rhythm 3 days after operation. He is doing well at present, one year after the operation.

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A case of atrial septal defect with idiopathic thrombocytopenia was successfully operated with the aid of heart-lung machine. The operation was performed under the administration of platelet rich plasma, fresh blood and adrenocorticosteroids before, during and after the operation .With the aid of these treatments, no severe hemorrhagic diasthesis was encountered.

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Cardiac catheterization, angiocardiography and ventricular muscle biopsy were performed in forty patients with idiopathic cardiomyopathy and included 21 cases of hypertrophic cardiomyopathy and 19 cases of congestive cardiomyopathy. 1) Cardiac catheterization revealed normal cardiac index and stroke index in both types, although there was a slight tendency toward decrease in cases of CCM. HCM showed slightly elevated right ventricular end-diastolic pressure and left ventricular end-diastolic pressure with a high incidence of atrial kick. CCM showed an elevated mean pulmonary artery, mean pulmonary wedge and left ventricular end-diastolic pressure. 2) Angiocardiographic findings revealed that in HCM left ventricular end-diastolic volume as well as left ventricular end-systolic volume, ejection fraction, meanVcf and MNSER were within normal range, and left ventricular anterior wall thickness, left ventricular mass and shortening of short axis in systole were increased. in CCM left ventricular end-diastolic volume and end-systolic volume increased, and ejection fraction, meanVcf, MNSER were decreased. The left ventricular anterior wall thickness was normal, and the left ventricular mass was smaller compared to the volume. The shortening of long and short axes in systole was slight. Left ventricular asynergy and mitral regurgitation occurred frequently. Coronary cineangiograms revealed normal patterns in both types. 3) Histological findings revealed hypertrophy of myofibers, degenerative changes, i.e. scarcity of myofibrils, deformity of nucleus and vacuolization of myocardial fibers, and collagen proliferation in both types. 4) No definite relationship was seen between parameters of left ventricular function and the findings of biopsied left ventricular muscle except for increase in wall thickness which might be apparently due to hypertrophy of the myocardial fibers.

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