Using a multi-filter system phonocardiograph, 200 phonocardiograms of the normal Japanese were analysed, showing the ranges and the variations with age, and refering to some peculiar features in the Japanese.
(1) Among 3 phases of both heart sounds, the 2nd phases had the longest duration in adolescence and became shorter particularly in the aged, corresponding to their snappy heart sounds. The 3rd phase of the 1st heart sound in the aged prolonged and/or increased by sclerotic process in the aorta.
(2) The splitting of the 1st heart sound was rather physiologicalphenomenon and was found in 68% of cases, with an interval of 0.030 sec. on the average between 2 components.
(3) The splitting of the 2nd heart sound was also physiologic, particularly in younger persons, and the over-all average interval between 2 components was 0.032 sec. The narrow splitting was also seen even during expiration in most cases with the splitting.
(4) The Q-I interval was 0.050 sec. on the average and had a trend to increase with the age up to 20 years old.
(5) The physiologic Hegglin's syndrome was sometimes seen in the normal subjects (1.5%).
6) The 1st heart sound was loudest at the apex in most cases, and the 2nd heart sound was commonly louder than the 1st heart sound even at this area (69% of total). Concerning the loudness of the 1st heart sound, both the absolute intensity estimated by the calibration method and the relative one determined by the comparison to the 2nd heart sound at the same area were so influenced by the P-R interval that the shorter this interval, the louder both intensities. This relationship was remarkable even in a comparison of the different subjects who had various intensities and P-R intervals.
(7) Though the 2nd heart sound was usually loudest at the pulmonic area, it showed the maximal intensity at the lower sternal border or even at the apex, particularly in the older age group. The 2nd heart sound was rarely maximal in intensity at the aortic area, and in comparison of the basal 2nd heart sounds, the one at the pulmonic area was usually louder than that at the aortic area even in a half of the older groups. These findings may suggest that the aortic component of the 2nd heart sound, aside from the diminution of the absolute intensity in the aged, is well transmitted to the pulmonic area as well as downward to the apex.

View full abstract

Follow-up study of renal blood flow in patients with essential hypertension was made in 61 cases under natural course (Group I) and in 66 cases under continuous antihypertensive treatment (Group II).
(1) The survey of renal blood flow changes in patients under natural course (Group I) revealed that: i) the average control renal blood flow of 661ml./min. with a range of 102 to 1, 350ml./min. decreased to 506ml./min. with a range of 35 to 1, 330ml./min. (24% decrease on an average), after averaged 35 months of follow-up period with a range of 7 months to 8 years; ii) a significant "decrease" in follow-up renal blood flow (more than 20% decrease of the control value) was found in 31 (51%) of 61 cases, "no change" in 26 (42%) and an "increase" in 4 (7%).
(2) The survey in Group I was analysed in relation to various factors including sex, age, retinal finding, values of renal blood flow and blood pressure, and period of follow-up time. The conclusions which were drawn from the results of the analyses were: i) the initial severities of retinal finding, renal blood flow, and blood pressure may not always be indicative of the degree of succeeding renal blood flow changes; ii) reduction of renal blood flow mainly reflects the preceding blood pressure; iii) succeeding renal blood flow change is closely related with succeedingly sustained blood pressure level; iv) the effect of perisistent elevation of blood pressure is aggravated in advanced age.
(3) From the comparative study of the results in Group II with those in Group I, practical conclusion was drawn that the same degree of renal blood flow change may be expected from succeeding low level of blood pressure irrespective of its spontaneous or therapy induced nature.
(4) The survey of consecutive renal blood flow changes in Group II revealed a "decrease" in 29%, "no change" in 49%, and an "increase" in 22% of 144 determinations, indicating a distinct difference from the survey in Group I, especially in less than 3 years of follow-up observations.
(5) Discussions were made on the observations of prognostic pattern of renal blood flow under natural course and on the comparative analyses with the survey of renal blood flow change under continuous antihypertensive treatment.

View full abstract

Analysis of radioactive colloidal gold uptake rate in the liver, which has a clinical significance as an indicator of liver blood flow, has been performed by the aid of electronic digital computer. It has been demonstrated that after adequate programming of computer well correlated values with manual calculation could be obtained by electronic computer at high speed.
Then the inadequacy of the usual measurement time in cases with liver cirrhosis was discussed. It has been shown that the measurement has to be continued up to 90min. or more in these cases. To overcome this disadvantage, especially in severe cases, new analysing process by the skillful aid of computer was proposed.
The principal advantages of the application of electronic computer, high speed calculation with relatively high accuracy, were illustrated in the pilot study by telephone communication between R.I. laboratory and Computer Center.
The usefulness of this method in clinical medicine was discussed.

View full abstract

(1) The effect of bilateral internal mammary artery ligation on coronary disease was discussed and the simplicity and the largely beneficial results were emphasized.
(2) The ECG changes in 26 cases of coronary insufficiency and myocardial infarction placed under this surgical procedure were studied and a slight improvement was observed.
(3) Those cases showing marked sclerotic changes in the mammary arteries during the operation did not show any improvements.

View full abstract

Fibrillations in cardiac muscle, vascular muscle and striated muscle were studied from the point of view of membrane potential, especially ordinary action potential and interaction potential.
(1) Ventricular muscle fiber of frog in hypertonic solution showed hump-formation in depolarization phase and electrical alternans.
(2) Intracellular action potential in muscle fiber of Bulbus arteriosus of toad in Ringer's solution exhibited various types of interaction potential.
(3) Electrical activity of frog striated muscle in Ca-deficient solution revealed interesting properties of interaction potential.

View full abstract

(1) Synthetic glucosamine sulfate exhibited experimentally suppressing effects on hyperlipemia and atheromatous changes in rabbits induced by long term administration of cholesterol, as judged by biochemical determination of serum lipid patterns and by macro-and microscopic observations of the aorta.
(2) Sulfated glucuronic acid likewise inhibited the increase in serum lipids induced by cholesterol feeding, with a trend to inhibit atherosclerosis.
(3) No anticoagulant activity was shown with the both materials as far as at the doses used here.

View full abstract

The role of neural factors in experimental renal hypertension was studied from the points of peripheral vascular reactivity, function of baroceptors and sympathetic activity in renal hypertensive dogs and the isolated smooth muscle strips of hypertensive rats.
(1) The hypotensive responses to pentobarbital was more marked and continued longer in chronic renal hypertensive dogs than the controls.
(2) The pressor responses to noradrenaline was remarkably augmented in renal hypertensive dogs, while the changes in those to angiotensin and Pitressin were not so marked.
(3) The threshold for adrenaline or noradrenaline of isolated smooth muscle strips of intestine, rectum and uterus of rats was lower in hypertensive rats than in the operated normotensive and control groups. But the threshold for angiotensin and acetylcholine was rather higher in the hypertensive group.
(4) The sensitivity of baroceptors examined by using the isolated perfusion method was unchanged and the baroceptors were resetted to the higher blood pressure level in chronic renal hypertension.
(5) The influence of sympathetic innervation on carotid sinus activity was not different between the normotensive and renal hypertensive dogs.
(6) The depressor responses to the sufficient amounts of ganglioplegics were not significantly changed in hypertensive dogs compared with the normotensives.
(7) After the extensive sympathectomy the direct blood pressure fall was not significantly different between the normotensive and renal hypertensive dogs and the final blood pressure level was higher in renal hypertension than the control level.
(8) The urinary excretion of adrenaline and noradrenaline was not significantly changed in chronic renal hypertensive dogs except the slight increase in the stage of blood pressure rising.
Thus, increased sensitivity of peripheral blood vessels to noradrenaline was demonstrated in vivo and in vitro experiments in hypertensive animals. The baroceptors were resetted to the higher blood pressure level, and their sensitivity itself remained unchanged in renal hypertension. The sympathetic overactivity was not recognized in hypertension. Therefore, only the increased sensitivity of peripheral vessels to noradrenaline contributes to a part of the pressor mechanism in renal hypertension, while the baroceptors and sympathetic activities are passively adjusted to the higher blood pressure levels in hypertension.

View full abstract

Asthmatic attacks were induced in 11 asthmatics by the inhalation of the antigenic extracts. The electrocardiograms were obtained before, during and after the attacks for comparison. The significant changes during the asthmatic attack were as follows: (1) taller and more peaked P-waves in leads II, III and aVF, and the shifting of the mean vector of P-waves on the frontal plane towards the right; (2) generalized low amplitude of QRS-complexes, especially marked in left precordial leads and shifting of the mean vector of QRS-complexes on the frontal plane towards the right; (3) respiratory changes in QRS-amplitude which was lower during the inspiratory phase and taller during the expiratory phase; (4) clockwise rotation of the heart along the longitudinal axis. The above findings were observed in all cases and could be explained by the hyperinflation of the lung and "strain" of the right side of the heart by the increased pulmonary artery pressure, which was observed during cardiac catheterization.
Ectopic beats were observed in 2 cases among 11, while the air way obstrution was becoming progressively severe, but disappeared after the air way obstruction reached a maximum. From the present study, it was also believed that there seemed to be no direct cardiac danger of the provocative study by the inhalation of the antigenic extracts.

View full abstract

Three cases of the aortic arch syndrome with cardiomegaly and aortic calcification as cardinal symptoms were reported. Fifteen necropsy cases of pulseless disease in Japan were reviewed chiefly about heart involvement, sites of lesion in vascular system and etiological consideration.
These reported cases suggest that there is a heart lesion produced by the same cause as the generalized idiopathic arteritis.

View full abstract