The clinical significance of the possible factors which may affect the cardiac function and prognosis of the patients with acute myocardial infarction were evaluated in 112 patients with this disease. Patients were subdivided into 4 groups according to the levels of pulmonary capillary wedge pressure (PCWP) and left ventricular stroke work index (SWI): Group I (52 patients) PCWP<18 mmHg, SWI&ges;30 g·m/m²; Group II (18 patients) PCWP&ges;18 mmHg, SWI&ges;30 g·m/m²; Group III (15 patients) PCWP<18 mmHg, SWI<30 g·m/m² ; Group IV (27 patients) PCWP&ges;18 mmHg, SWI<30 g·m/m² . Immediate mortality rate (4 weeks after the onset of myocardial infarction) was 17.0% in all patients and Group IV had the highest mortality rate (48. 1%), in contrast to the lowest mortality rate (3.8%) in Group I. The episodes of previous myocardial infarction were noted more frequently in Group IV (74.1%) than in Groups I (7.7%) and II (11.1%) (p<0.001). Mean age in Group IV (68.0 :!: 5.2 (SE) years) was also significantly higher than those of the remaining 3 groups (p<0.001). In 55 patients without previous myocardial infarction, mean infarct size estimated from total released creatine phosphokinase (CPK) (CPK) in Group IV was largest among the 4 groups, although it was similar to that in Group II: 919.070.0 (SE) IU/ml in Group I, 1470.0126.0 in Group II, 958.0107.0 in Group III and 1493.0145.0 in Group IV. The number of involved coronary arteries differed significantly between Groups I and IV: in Group I involved coronary artery (75% narrowing) was absent or one at most, while in Group IV all 9 patients had at least one coronary lesion and 3 of 9 had triple vessel disease. In this study no significant difference was observed between the incidence of anterior and inferior myocardial infarctions in Groups I, III and IV. Thus, we conclude that age, previous myocardial infarction, infarct size and the number of involved coronary arteries may determine the cardiac function in acute phase of myocardial infarction and hence, immediate mortality of this disease.

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Plasma renin activity (PRA) was serially determined 0, 15, 30, 60 and 120 min following administration of furosemide in a dose of 40 mg intravenously (i.v.) and 80 mg orally (p.o.) at a one week interval in 10 healthy men. Following i.v. furosemide administration, PRA increased rapidly and reached a plateau level of 6.1±1.0 ng/ml/h (222±44% of the control), at 15 min and remained at about the same level throughout the remaining period of the study. In contrast, PRA increased progressively to a maximum level of 5.5±0.7 ng/ml/h (285±53% of the control), 120 min after p.o. furosemide. In case of p.o. furosemide, the increase in PRA was dependent on the doses used per body weight, and was significantly correlated with the cumulative sodium excretion by itself, or the cumulative sodium excretion adjusted by either the leanness index or the body surface area. Such relationships were not apparent after i.v. furosemide. These findings suggest that the response of renin release to furosemide in healthy men differs with the routes of administration and renin release with p.o. furosemide may be largely due to a net sodium loss, while mechanism(s) other than sodium loss may be involved in the early hypersecretion of renin with i.v. administration of furosemide.

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A pharmacological study on myocardial oxygen consumption was carried out in open-chest dogs using an arterio-venous oxygen difference analyzer. The continuous monitoring of the oxygen difference showed that the peak changes in coronary blood flow did not coincide with the greatest change in myocardial oxygen consumption. Perhexiline, 0.3-3 mg/kg intravenously, increased coronary blood flow and decreased myocardial oxygen consumption, dose-dependently . Perhexiline decreased aortic and systemic blood pressures and left ventricular work except for lower doses of perhexiline which slightly increased cardiac output and ventricular work. Over-all mechanical efficiency of the left ventricle was increased with perhexiline, while the efficiency was decreased around the peak effect of larger doses of the drug on systemic blood pressure and coronary artery. Verapamil, 0.03-0.3 mg/kg, showed essentially the same effects as perhexiline with ten-fold potency superior to perhexiline. Glyceryl trinitrate showed inconsistent effects on coronary flow and myocardial oxygen consumption, and it decreased cardiac work and mechanical efficiency of the left ventricle .

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Alterations in the concentration of plasma dehydroepiandrosterone sulfate (DHEA-S) and cortisol in patients with essential hypertension (EH) were investigated. The subjects were 25 patients with EH: 7 of low plasma renin activity (PRA) group, 10 of normal PRA group and 8 of high PRA group; 7 normal subjects were used as the controls. Plasma DHEA-S and cortisol were measured before and after the following tests: (1) circadian rhythm (6:00, 16:00 and 24:00), (2) furosemide (0.7 mg/kg) test, (3) ACTH (12.5 IU/4 hr) infusion test, (4) dexamethasone (1.0 mg) test, (5) furosemide (0.7 mg/kg) test under dexamethasone (1.0 mg) treatment, (6) metopirone (1.5 g) test, (7) angiotensin II (8 ng/kg/min, 30 min) infusion test and (8) saline (1000 ml/hr) test. The alterations of the endogenous ACTH-adrenal hormone system as well as the renin-angiotensin-aldosterone system induced by these tests did not cause significant changes in plasma levels of DHEA-S in the 3 groups with EH. However, significant enhancement of plasma DHEA-S was observed after both the administration of exogenous ACTH and angiotensin II. It is considered that the responsiveness of DHEA-S to ACTH may increase in the low and normal PRA groups and that the responsiveness of DHEA-S to angiotensin II may increase in the high PRA group. Based on these results, it is suggested that plasma DHEA-S hardly or only partially participates as a causal factor of EH.

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The effect of hypofibrinogenemia with batroxobin on proliferative glomerular lesions of Masugi nephritis was examined in the rat. Batroxobin-treated rats had a relatively low level of plasma fibrinogen and a reduction in glomerular fibrin deposition. Mean nuclear counts in the outer cortical glomeruli were less in the batroxobin-treated group than in the untreated group on the 7th day. However, the difference in the overall severity of the glomerular histologic lesions between the two groups was not significant. Continual injections of the same dosage of batroxobin failed to maintain hypofibrinogenemia, possibly due to the antibody formation. These results suggest that relatively low plasma levels of fibrinogen are obviously not effective enough to prevent the development of the proliferative lesions in rat Masugi nephritis.

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Anatomically corrected malposition of the great arteries (ACM) is an extremely uncommon cardiac disease in which the great arteries arise from their appropriate ventricles despite abnormal spatial interrelations. Two patients with this malformation underwent successful surgical intervention for their associated anomalies. One was of situs solitus, d-loop and l-malposition and the other of situs inversus, l-loop and d-malposition of the great arteries. Fifty-three cases with accurate anatomical description were collected from the literature, and anatomical characteristics and associated anomalies were investigated. From the standpoint of anatomy and hemodynamics, we considered that ACM should be classified into atrioventricular concordant ACM, atrioventricular discordant ACM and ACM with situs ambiguus. Heart position and conus were variable. Dextrocardia and mesocardia were frequent. Bilateral conus was characteristic in concordant ACM, and subpulmonary conus was prominent in discordant ACM. The hypoplasia of the right heart and juxtaposition of the atrial appendages were in high incidence in cases of ACM. Surgical intervention was also discussed.

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The current status of the stroke problem in Japan was reviewed with reference to the magnitude, secular trends, the mode of diagnosis and treatment, preventive aspects and development of community stroke registers.

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Cerebrovascular disease is the most predominant cause of death in Korean adult population. The incidence of cerebral hemorrhage is a little higher than cerebral infarction and prognosis of cerebral hemorrhage is very poor as compared with cerebral infarction. As a risk factor hypertension plays the most important role not only in cerebral hemorrhage but also in cerebral infarction, and serum lipids have less important roles in Korean stroke patients. However, serum triglyceride has close relationship with high incidence of stroke complication in hypertension. Plasma renin activity does not seem to play any important role as a risk factor in Korean stroke patients.

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Stroke is now the third major cause of death in Hong Kong and its incidence is continuing to rise. Disagreement exists regarding the incidence of the various subtypes of stroke, with the university unit figures showing in 100 consecutive cases, 41% infarcts, 7% possibly embolic, 6% transient ischemic attack, 8% definite aneurysm and 38% cerebral hemorrhage. Hypertension, diabetes mellitus, arrhythmia and valvular disease are the commonest identifiable risk factors. Public awareness and better utilization of resources already available remain fundamental to the control of stroke in Hong Kong.

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Cerebrovascular diseases rank now as the fifth leading cause of mortality in the Philippines. Statistical data on stroke is still very meager. With the present on-going study on hypertension and stroke, the epidemiological status of cerebrovascular diseases will improve. Based on the data collected by the author, cerebral infarct is the most common type of cerebrovascular disease; hypertension is the leading predisposing factor for stroke in the Philippines; and the other risk factors are cardiac abnormalities, diabetes, hypertriglyceridemia and hypercholesterolemia.

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This preliminary report of clinical data on cerebrovascular disease (CVD) was based on the retrospective study of 2, 092 cases who were admitted to 15 hospitals consisting of 13 provincial hospitals and 2 municipal hospitals in Indonesia in 1980. Although it cannot present the actual prevalence of the disease, it would be hoped that it might introduce the general performance of the CVD problem in our country. The common diagnosis were cerebral thrombosis and intracerebral hemorrhage. Hypertension is the most important risk factor. The management of CVD must be directed not only towards the prevention of death, but also towards how to prevent stroke before its occurrence. For those directions, further investigation and evaluation should be done more precisely.

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The recent development of health care system, particularly for control of stroke and cardiovascular disease in Japan was briefly reviewed. Vital statistics in Japan and our own epidemiological study showed that incidence of death due to cerebral hemorrhage was decreased. However, incidence of death due to cerebral infarction in Japan was not substantially reduced, though our epidemiological study showed some reduction. From the etiological view point, cerebral hemorrhage was considered to be caused by hypertensive small vessel disease inside of the brain and cerebral infarction to occur in close association with atherosclerosis in the cerebral arteries or sometimes in the neck arteries. It was clearly shown by our study that atherosclerotic lesions were definitely accentuated by presence of hypertension. Among the possible risk factors for cardiovascular diseases, hypertension was found to be the only factor, which significantly contributed to the development of both types of stroke and was controllable by our hands. The problems of community-based hypertension control program were discussed.

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