(1) By investigating many autopsy cases, it was found that the incidence of combination of the pulmonary edema was high in the cases with central nervous system diseases, particularly in the cases having localized foci in the vicinity of the internal capsule, the lentiform nucleus and the third ventricle.
(2) From the histological viewpoint, an attempt was made to classify the clinical cases of postoperative acute pulmonary edema into 3 groups: (1) that occurring after a brain operation or brain trauma, (2) that occurring after a cardiopulmonary operation of cases with pulmonary circulatory disturbances, (3) that occurring after an abdominal operation of cases with metabolic disorders. It is worthy of note that the incidence of the postoperative pulmonary edema was significantly high after brain surgery.
(3) In the examination of the pulmonary vascular innervation, the reflex pathway has been clarified and the 2 centers were assumed to be in the reflex arc of the innervation of the pulmonary vessels. The higher center of the reflex arc ascending through the vagus nerve was in the nuclei of the preoptic areas, while the lower center of the reflex arc ascending through the sympathetic or sinus nerve was in the medulla. The authors have also confirmed that the site of cerebral damage in the clinical cases of pulmonary edema, occurring after a brain operation or a brain trauma, had a close relation to either the higher or the lower center of the pulmonary vascular innervation or the both.
(4) The authors have succeeded in the experimental production of the characteristic pulmonary edema of cerebral origin by a complete destruction of the bilateral preoptic areas. Pathophysiology concerning the experimentally produced pulmonary edema has been studied in detail.
(5) Based on the results of both clinical and experimental studies, the pathogenesis of the clinical pulmonary edema occurring after a brain operation or a brain trauma was assumed to be as follows. The operation or trauma was directly responsible for the development of pulmonary hypertension, the prolongation of pulmonary circulation time, and the increase in the permeability of the pulmonary capillaries. At the same time, the operation or the trauma directly caused the changes in renal or hepatic circulation and endocrine regulation, inducing anuria, disturbance of water and electrolytes balances. The combination of these factors accelerated a selective pulmonary edema of an acute type.

View full abstract

Asthmatic-bronchitis, presumably due to air pollution, has been a major cause of sickness among U.S. Forces personnel in the Tokyo-Yokohama area. The most prominent symptoms are nocturnal cough, wheezing, and shortness of breath. The disease seems to differ from typical bronchial asthma in the following ways: (1) Onset in early adult life. (2) Absence of allergy history. (3) Persistent shortness of breath between attacks. (4) Persistent abnormal pulmonary function tests between attacks. (5) Resistance to treatment early in the course of the disease. (6) No improvement of pulmonary function studies after Intermittent Positive Pressure Breathing (IPPB) using Isuprel or epinephrine. Perhaps most characteristic of this disease is the marked subsidence of symptoms when the patient leaves the Kanto Plain. Treatment has been outlined with special emphasis on bronchodilators, hydration, and liquefaction of bronchial secretions. Steroids are used in the seriously ill patient, but they do not completely relieve him of exertional dyspnea. Patients with marked shortness of breath with air flow obstruction by pulmonary function studies and with frequent occurrence of coughing and wheezing, should not be maintained on long-term steroids but should move out of the Kanto Plain. A simple test would be to have the patient go for a few days out of the Kanto Plain and see if he gets relief of his symptoms. If he does get relief, then he should consider moving. It is reasonable to assume that, with increasing industrialization in the Kanto Plain and accompanying increased air pollution, the incidence rate of this disease will increase. With increased smog in other areas of the world, it may be that this disease will be found elsewhere.

View full abstract

From the experimental results it was concluded that SVC-RPA sideto-end anastomosis was safer than end-to-end anastomosis, and that the proximal superior vena cava should be ligated or constricted in order to keep SVC pressure under 200mm.H2O since a definite correlation was found between the occurrence of postoperative chylothorax and an elevated SVC pressure.
Application of SVC-RPA side-to-end anastomosis to a total of 4 patients, including 2 patients with tricuspid atresia, one with single ventricle and another with pentalogy of Fallot, were made and excellent improvements were obtained in 3 cases. An early postoperative death was attributed to the mechanical failure of a respirator in one case.

View full abstract

(1) Synthetic galactose disulfate and glucose monosulfate exhibited a trend to inhibit hyperlipemia and atherosclerosis in cholesterol-fed rabbits by long term administration.
(2) Calcium salt of carrageenin showed experimentally similar inhibitory effects on atheromatous damages in rabbits due to hypercholesteremia, to sodium salt of carrageenin.
(3) Starch sulfate, a synthetic sulfated polysaccharide, decreased remarkably serum lipids and inhibited the development of atherosclerosis in cholesterol-fed rabbits.
(4) These sulfated saccharides failed to show their anticoagulant activities at least at the dosage used in these experiments.

View full abstract

(1) Vectorcardiographic tracings were taken by 4 different lead systems, viz., Cube system by Grishman, Equilateral tetrahedron system by Wilson, Orthogonal lead systems by Frank and by Schmitt in 17 normal subjects, 36 cases with coronary sclerosis and 20 cases with valvular heart disease. The direction of the inscription of QRS-loop, the direction of the half area vector and the maximal amplitude of X, Y and Z components of the loop were examined.
(2) Very similar tracings can be obtained by Frank and Schmitt lead systems in most cases.
(3) In normal subjects, agreement of the 4 lead systems was satisfactory, but in patients with coronary sclerosis and valvular disease, these 4 lead systems could not be considered interchangeable.
(4) Compared with orthogonal system by Frank or Schmitt, Z component in Grishman's system is smaller and Y component in Wilson's system is larger.

View full abstract

Macroscopical and microscopical examination of 117 unselected autopsied hearts revealed various degrees of pathological parietal endocardial thickening in 74% of them. The physiological thickening of the normal parietal endocardium was determined as 20μ at the outflow tract and papillary muscles of the left ventricle, as 10μ at the inflow tract of the left ventricle, the outflow tract and papillary muscles of the right ventricle, as 7μ at the inflow tract of the right ventricle, as 300μ at the posterior wall of the left atrium and as 100μ at the posterior wall of the right atrium. The parietal endocardium had a tendency to increase its thickness with age.A new classification of the pathological thickening of parietal endocardium which was made on the morphological and causal-genetic basis was proposed:
A. Morphological classification.
1. structureless fibrosis.
2, fibroelstosis.
3. thickening of subendothelial layer.
4. thickening of all of the 5 layers.
5. thickening of subendocardial layer.
6. (false thickening.)
B. Causal-genetic classification.
I. thrombogenic type.
II. hypertrophic and/or hyperplastic type.
III. exudative, edematous or deposited type.
IV. congenital type.
The correlation between these 2 types of classification revealed the following evidences:
(1) The endocardial fibrosis resulted from mechanical stimulation of the blood stream consisted of the jet lesion and the friction zone. The former was divided into 2 types and was commonly of thrombogenic origin. The impact of strong jet stream with vertical direction to the wall caused the structureless endocardial scar. On the other hand, the impact of jet stream with oblique direction caused the endocardial pocket or subendothelial fibrosis. The friction zone preserved all of the 5 layers of endocardium, but they were markedly hypertrophied and hyperplastic (Elastomyofibrosis). The pathogenesis of the friction zone was concerned with friction effect ofthe blood stream directed parallel to the wall and was related strictly with the persistent hypertension.
(2) The endocardial change due to general metabolic disturbance, exhibited the subendocardial edema or fibrosis (endocardosis), and the degree of this change correlated with the lowering of serum albumin level.
(3) The endocardial fibrosis due to endocarditis showed various histological types, and was mainly circumscribed fibrosis. Subendothelial fibrosis, subendocardial fibrosis or structureless fibrosis were frequently observed. They showed characteristically the irregular arrangement of collagen fibers with chronic inflammatory process.
(4) The myocardial infarction was frequently accompanied with the structureless endocardial scar (reparative fibrosis).
(5) The acquired endocardial fibroelastosis was developed from the fibrosis which lost the primary structure under a certain condition that consisted of mechanical distention and sufficiently long clinical course of more than 6 months.
(6) There was apparent relationship between the grade of endocardial thickening and that of myocardial fibrosis.
(7) The geographical distribution of the endocardial thickening showed commonly the preponderance at the outflow tract of both ventricles. However, some of the endocardosis had a tendency to be preponderant to the inflow tract of both ventricles.
(8) Increase in the heart weight, the grade of cardiac dilatation and the grade of coronary sclerosis was incompatible with the normal endocardium, if they increased more than a certain limit.

View full abstract

(1) A 64-year-old woman with primary carcinoma of the right lung presenting superior vena caval syndrome was discussed.
(2) The syndrome was caused by the tumor thrombus hanging into the right atrial and ventricular cavity from the superior vena cava through continuous infiltrative growth from the primary lesion.
(3) A tumor thrombus was also seen to pass through the right pulmonary vein into the left atrial chamber in a similar manner.

View full abstract

A 30-year-old male, an autopsied case of endomyocardial fibrosis was reported. The patient died about 4 months after the onset of symptoms due to a progressive cardiac failure complicating infarctions in the right lung. The autopsy findings of the heart revealed; a marked dilatation of all chambers, an intensive endocardial fibrosis of inflow tract with mural thrombi in the left ventricle and right atrium, fibrosis of inner half layer of myocardium beneath the endocardial fibrosis, etc. There were no congenital anomalies, valvular changes, coronary sclerosis, or pericarditis, etc. No signs of inflammation were detected in the endocardium, myocardium or blood vessels.
This case is the first report of endomyocardial fibrosis in Japan.

View full abstract