(1) Clinical and pathological findings were studied in 56 cases of cerebral embolism among 1, 029 patients admitted to the Second Medical Department, Tokyo University Hospital from 1941 to 1957.
(2) No sexual difference was found (male 30, female 26),
(3) The nature of the underlying heart diseases were as follows; mitral stenosis, mitral stenosis and insufficiency, combined valvular disease, sclerotic and hypertensive heart disease, congenital heart disease, S.B.E., and so on.
(4) Thirty per cents of 56 cases had multiple embolic episodes. Interval between each episode was within 6 months in about one half of the cases.
(5) It was demonstrated that atrial fibrillation was the very important factor as the cause of emboli, and digitalis therapy, congestive failure or size of the heart were not related to the occurrence of cerebral emboli.
(6) Paralysis was the most frequent neurological symptom. No dominant laterality was found. Recoveries from paralysis were complete or moderate in 74%.
(7) Recovery from mental deterioration was seen in 79%, one half of which restored the consciousness in 24 hours.
(8) Many cerebral embolic episodes occurred in valvular heart disease with intracardiac thrombus. On the other hand, many cases of S.B.E. without intracardiac thrombus developed cerebral emboli.
(9) The lesions of basal ganglia and internal capsule were found to be most frequent, and the area of middle cerebral artery was involved far more frequently than the other area.

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During the year of 1949 till 1957, a total of 199 attacks in 184 cases of rheumatic fever in children were observed at the Pediatric Clinic of Tokyo University Hospital. It appeared that recent increase of rheumatic patients was observed in Japan. According to the statistical analysis of the disease, it occurred particularly in March, April and October, November and December. The first attack was most common between the age of 5 and 12, and 80% of the total cases were fallen in this age group.
Carditis was observed in 54.7%, and polyarthritis in 82.3% of the total cases. As to the minor manifestations, high fever was found in 69.1% and in-creased erythrocyte sedimentation rate in 90.9%. Among the cases of rheumaticcarditis, 19% of the cases showed an insidious or latent onset. Even in such cases, elevated antistreptolysin-O titer and increased erythrocyte sedimentation rate were found. Such a form of carditis was considered to have a great clinical significance because of its high incidence of residual cardiac damage.
A total of 83 cases of rheumatic fever was observed for more than 1 year without prophylactic measures for the recurrence of rheumatic fever. Among these, 14 cases (16.9%) died in the observation period. All these cases had carditis at their first attack. Recurrence rate during observation period was 22.6%, and one half of the recurrences occurred within the first year after the initial attack.
Importance of an early diagnosis of the disease and a prompt therapy was emphasized.

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Gorrelations of the metabolic state of human heart to EGG and to Xray findings were studied and discussed.
There was a significant decrease in myocardial citrate extraction and a tendency of disturbed lactate and pyruvate metabolism in the cases with ST-T changes. In many cases with ST-T abnormalities, myocardial oxygen extraction coefficient was increased.
QTc correlated, in general, with oxygen extraction coefficient. The magni-tude of G in frontal plane showed slight but significant negative correlation with oxygen extraction coefficient.
Oxygen extraction coefficient increased distinctly with the enlargement of the heart in cases with valvular disease, while it was not so apparent in patients with hypertensive and/or sclerotic heart disease without failure.
In cases with cardiac enlargement due to valvular disease of the heart, ST-T abnormalities, increase in QTc and reduction of the magnitude of G were frequently observed.

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To investigate the physiological role of the sympathetic innervation of the carotid sinus, an attempt was made to find whether denervation sensitization of the carotid sinus would occur 2 weeks after the resection of the sympathetic nerve supply or not. The changes in sensitivity to noradrenaline weree examined by injecting 5-25 gamma of noradrenaline directly into the adventitia of the denervated carotid sinus. The resulting fall in blood pressure and the changes in the carotid occlusion reflexes were compared with those following the injection of the same dose of noradrenaline into the adventitia of the innervated side.
The responses to 5-50 gamma of noradrenaline injected directly into the adventitia of the carotid sinus area were variable in normal pentobarbital anesthetized dogs, and the doses less than 20 gamma of noradrenaline did not show the systemic hypotension and the depression of the carotid sinus reflexes in these dogs.
In the cervical-sympathectomized dogs, 5-25 gamma of noradrenaline applied locally on the denervated side induced the typical blood pressure fall and the depression of the carotid occlusion reflexes in almost all the experiments, while these typical responses were not found by the application of noradrenaline to the innervated carotid sinus.
Angiotensin did not show such responses by the local application to the denervated carotid sinus.
Thus, evidence of supersensitivity was obtained by the local application of 5-25 gamma of noradrenaline to the denervated carotid sinus area. The sympathetic innervation of the carotid sinus seemed to be significant.

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(1) In electropolarogram of the rabbit brain, spontaneous fluctuations were obtained at each time directly after insertion of the platinum electrode ; having a frequency of 2 components ; a rapid one of 5 to 15 cycles per minute, and a slow one of 1/2 to 1 cycle per minute.
(2) When two EPGs were recorded simultaneously from two different areas of the brain, both fluctuations were independent from each other. The EPGs from brain and ear-lobe also have different rhythms from each other, whereas both ear-lobes showed a synchronous fluctuation.
(3) The factors responsible for these fluctuation were analysed in some detail, and it was revealed that the mechanism was highly complicated one. It was proved that at least two factors were operative ; active and passive one. The active one is nervous in origin, so the extirpation of the superior cervical ganglion or ganglion blocking agent had a synchronizing effect on the rhythms of each one of the brain EPGs as well as the rhythm of ear-lobe EPG. The passive factor may be hemodynamic in origin, and this expressed itself in the synchronized waves of brain EPG after the extirpation of the symapthetic ganglion, and also disclosed itself in synchronity with the respiration under the nembutal anesthesia or during Biot's respiration.
(4) It is possible that there still exist other factors related to this problem but still unknown from the present study.

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(1) A series of some bis-quaternary salts containing the bicyclo (2. 2. 2)-octane ring has been found to possess hypotensive effect. The relationship between chemical structure and hypotensive effect of these compounds was investigated.
(2) 2-(3-Dimethylaminopropyl)-3a, 4, 7, 7a-tetrahydroisoindoline dime-thiodide (KK-25-S) has been found to be the appropriate one as a hypotensive agent of this series.
(3) KK-25-S shows specific ganglionic blocking action with a long duration of action.
(4) After oral administration, KK-25-S is relatively well absorbed.
(5) No evidence of chronic toxicity was observed in dogs and monkeys after the oral administration of 5mg./Kg. for a period of 90 days.

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The Pwave in hypertension was studied comparing with that in normal and mitral stenosis.
(1) In various findings of the Pwave, there were significant differences between normal and pathological conditions. Hypertensive cases had inter-mediate changes compared with the other two groups, and these changes were intensified by the elevation in the diastolic blood pressure level.
(2) From the results obtained in these comparison studies, we proposed the 7 electrocardiographic criteria to assess the changes in the Pwave in both hypertensive and mitral stenosis. In hypertensive cases, the incidence of each criterion was increased according to the elevation in the diastolic blood pressure level. Special attention was given to some criteria, namely "relative" left axis deviation of the Pwave, which was characteristic to mitral stenosis and mild hypertension, and the finding that the amplitude of the Pwave in lead V₆ was higher than that in V₅, which indicated the more definite sign of the left atrial overloading and often seen in mitral stenosis and severe hypertension.
(3) The grade of Pwave change gave us the more distinctive differentia-tion of the Pwave between normal and mitral stenosis. In hypertension, this grade was increased with the elevation in the diastolic blood pressure level, and in severe cases, the grade of Pwave change became similar to that seen in mitral stenosis.
(4) On the bases of the observations in the follow-up cases as well as above-mentioned results, we suggested that the change in the Pwave in hypertension was a reflection of the left atrial overloading possibly resulted from the left ventricular one.

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Phonocardiographic study was made in order to display the similarity in the left atrial overloading between hypertension and mitral stenosis which is expressed by the Pwave changes as described in the preceeding paper.
(1) A positive correlation among the diastolic blood pressure level and the grade of accentuation of the atrial sound, determined by our multi-filter system phonocardiograph, was revealed and this relation was also ascertained in the follow-up study as well as in the cold pressor test.
(2) "Q-1" interval in hypertension showed a significant prolongation, and there were definite correlations among this prolongation, the diastolic blood pressure, and the other phonocardiographic and electrocardiographic findings.
(3) The pathophysiological significance of these phonocardiographic and electrocardiographic findings in hypertension was discussed. It was concluded that the accentuation of the atrial sound and the prolongation of the "Q-1" interval, combined with the Pwave changes, should be the reflection of the left atrial overloadiug, therefore, these findings might be one of the objective signs indicating the impending left heart failure in hyper-tensive hearts.

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(1) Measurement of various portions of vector loop obtained from 66 normal subjects and 42 patients with left ventricular hypertrophy was made. Vectorcardiograms were taken by the Frank method and by the Grishman method. In addition to normal values, differential quantitative features between two conditions not reported thus far were endeavoured to be sought.
(2) In general anterior magnitude of initial forces and inferior and an-terior magnitude of body of QRSsÊ loop were smaller in left ventricular hypertrophy than in normal, and width of the body in frontal plane and posterior magnitude of the body were larger in the former than in the latter. These items constitute useful diagnostic differentiation between both conditions because of less overlapping.
(3) The magnitude of the maximal vector of the QRSsÊ loop had tend-ency to be larger in cases with left ventricular hypertrophy than in normal hearts, but the overlapping between both values was too great for a good differential criterion.

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A case of successfully repaired sinus of Valsalva-right ventricular fistula in a young male is presented. Exertional palpitation and dyspnea, slight enlargement of heart, and the continuous machinery murmur maximally heard at the left 3rd intercostal space, were the chief clinical manifestations and signs. Diagnosis was suspected by the right heart catheterization and confirmed with the direct entrance of arterial catheter into the right ventricle from immediately above the aortic valve in retrograde aortography.
Under the total cardiopulmonary bypass, using the pump oxygenator, aneurysm of Valsalva sinus was resected and sutured, and associated high IVSD was also closed. Postoperative course was uneventful.Brief summary of cases of this disease in Japan is also tabulated.

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A case of 64-year-old male, with recurrent episodes of supraventricular tachycardia and progressive congestive heart failure of unknown origin was presented and discussed.
Markedly dilated heart showed diffuse irregular myocardial degeneration and fibrosis, without arteriosclerosis or valvular lesions, and patchy fibro-elastosis of the parietal endocardium at autopsy. The pathogenesis has been discussed and it was assumed that it might be a certain degenerative process of muscle fibres themselves.

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