Studies published in the past 10 years suggest that group A streptococcal infections are frequent in the Orient and lead to a high incidence of rheumatic fever (RF) and rheumatic heart disease (RHD). In the present study, streptococcal infections were found to be more prevalent in Japan and Taiwan, whereas RF and RHD were more common and severe in the Philippines, Thailand, and Indonesia, particularly among the socioeconomically less privileged populations. The pattern of childhood RF varied: Carditis was the most common manifestation, occurring in 57% to 94% of the patients; polyarthritis was generally atypical and less common in the tropics; chorea minor and erythema marginatum were much more common in Japan, less common in Taiwan and rare in the tropics. RF recurrences were quite common and led to the development of new carditis, and deterioration or persistence of the preexisting heart disease. The 5 year mortality rates differed greatly, ranging from zero to 42%.
There was disappearance of the heart murmur in 16.5% to 37.5% of patients. Such apparent recovery was related to adherence to chemoprophylaxis. The major risk factors adversely affecting survival were the severity of carditis, inadequacy of medical service, noncompliance to chemoprophylaxis, RF recurrence, poor socioeconomic status, and high prevalence of group A streptococci. It is concluded that there is no uniform "Orientaltype" of natural history of RF and RHD. The natural history varies greatly among countries as is true in other parts of the world.

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In 12 patients with acute myocardial infarction the hemodynamic effects of a single intravenous injection of 30mg of pentazocine were investigated. The administration of pentazocine resulted in no significant hemodynamic changes. In particular, there was no increase in peripheral vascular resistance and no evidence of decreased left ventricular function or respiratory depression. In the occasional patients who demonstrated an elevation of pulmonary arterial pressure, it was probably due to a direct effect of the drug on the pulmonary vasculature.

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Twelve patients with ischemic heart disease were investigated by right and left heart catheterisation. All patients were studied at rest and during exercise, both before and after administration of β-blocker propranolol, Inderal (ICI). Left ventricular function decreased after administration of propranolol, but these changes were significant only during exercise. Contractility was depressed after administration of propranolol already at rest. On the other hand, left ventricular filling pressure decreased after administration of propranolol. Our results show the poor reliability of the evaluation of the left ventricular function based solely on the left ventricular filling pressure.

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The effects of intravenous lidocaine on the refractory periods of the atrium, AV node and right ventricular myocardium were studied using His bundle recordings and the extrastimulus technique with and without atrial and ventricular pacing. The drug was administered in an intravenous bolus dose of 1mg/Kg followed by an infusion of 100micrograms/Kg/min. The AH, HV intervals and resting sinus cycle length as well as functional and effective refractory periods of atrium, AV node and right ventricle were measured before and 5min afrer bolus injection of lidocaine. Neither of the refractory periods nor AH and HV intervals changed significantly following administration of lidocaine. The result of this first study in children is in agreement with previous reports of the effects of lidocaine on the cardiac conduction system in adults.

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Simultaneous echoand phonocardiographic studies were performed in 17 patients with normally functioning Lillehei-Kaster (LK) tilting disc prosthesis in the aortic position. The LK aortic valve prosthesis was well recorded by echocardiography with a disc excursion of 14 to 25mm and very fast opening and closing velocities, too rapid for quantitative assessment. On phonocardiography the opening click of the prosthesis was only rarely observed (2 out of 17 cases), while the closing sound was consistently present in all patients, occurring within 5msec of the point of complete closure of aortic disc prosthesis by echocardiography.
Systolic time intervals (STI) measured by combined echoand phonocardiography were similar to the predicted values in 15 patients who had no evidence of residual cardiac dysfunction. In the remaining 2 patients, one or more components of the STI differed by more than 2 standard deviations from the predicted values, and in these there were associated findings to explain the discrepancies.
This study illustrates the echoand phonocardiographic features of the normally functioning LK aortic valve prosthesis. In addition, precise measurements of the isometric contraction and relaxation periods as well as standard systolic time intervals are possible with these techni-ques.

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Right ventricular wall motion was readily accessible for echocardiographic recording along the right sternal border in 27 pediatric patients (age: 24hrs-12yrs). Right ventricular epicardial and endocardial wall motion could be recorded only at the right sternal border in 10 of these patients, emphasizing the need for a new, alternative examination site.
Calculated measurements of right ventricular wall thickness recorded from both right and left sternal borders (7pts) were similar (range of diff.=0-0.6mm; mean of dill.=0.26mm). Autopsy confirmation of right ventricular wall thickness was obtained in 2 patients.Epicardial motion could not be identified at the left sternal border in 10 patients. In these patients, right ventricular wall thickness was estimated by measuring from the inner chest wall to the endocardium. These measurements were compared to right ventricular wall thickness obtained from the right sternal border. Wall thickness obtained from the left sternal border was significantly underestimated in the absence of a definite epicardial interface (range of diff.=0.2-2.6mm; mean of diff.=1.3mm).
We conclude that the right sternal border is a useful examination site when studies from the left sternal border are technically inadequate for evaluation. Measurement of right ventricular wall thickness should not be attempted unless both epicardial and endocardial interfaces are recorded simultaneously.

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The response of limb blood flow to cold stimulus was determined by venous occlusion technique in 30 healthy subjects. The stress was applied by immersing one hand into icefloating water for 35sec, and the blood flow was measured serially in the contralateral upper limb. The change of blood flow at the 15th sec of stress was the largest among the intermittent measurements, and decreased by 48±8% of the control value. A significant rise in plasma dopaminebetahydroxylase was found in response to the same stress. This simple cold stress test may be used to evaluate the function of the reflex arc involved in reflex vasoconstriction.A significantly diminished vasoconstriction was observed in 12 uremic patients with a concomitantly smaller rise of plasma dopaminebetahydroxylase activity in the test.

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The relation of plasma dopamine β-hydroxylase (DBH) activity to age was examined in normotensive and hypertensive subjects.Plasma DBH activity was the highest in the group of 25-34 years, and gradually decreased with age. Plasma DBH activity was higher in the hypertensives than in the normotensives in all age groups, and the difference was significant between the groups of 45-54 and 55-64 years.Plasma DBH activity was increased in labile hypertension.
Plasma DBH activity was higher in the group of essential hypertension with normal renal function than in that with reduced renal function. It was lower in the severe hypertensives than in the mild cases. Plasma DBH activity was also decreased in the hypertensive patients with cerebrovascular disorders.
Plasma DBH activity was lower in the hypertensive patients with renal parenchymal diseases than those of essential hypertension with normal renal function. Plasma DBH activity was also decreased in primary aldosteronism, while it was increased in pheochromocytoma.
These observations suggest that measurement of plasma DBH activity may be valuable in the differentiation of essential hypertension from the secondary forms of hypertension, and the evaluation of the hypertensive processes. To evaluate plasma DBH activity, it is important to consider its agerelated changes.

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Effects of various stimuli on plasma dopamine β-hydroxylase (DBH) activity were studied in the patients with essential hypertension in relation to the age and the hypertension severity. Twenty minutesstanding, treadmill exercise, low sodium diet for 3 days and 2 hoursstanding were used as the sympathetic stimuli.
The increase in plasma DBH activity by 20 minutesstanding and by treadmill exercise was small, and no significant difference was found in relation to the age and the hypertension severity index.
While, by low sodium diet for 3 days, the increase in plasma DBH activity was significantly higher in the hypertensives aged 20-39 than in those aged 40-59 (p<0.01) and above 60 (p<0.05).
The increase in plasma DBH activity by the stimulus was also significantly higher in the mild hypertensives than in the moderate (p<0.05) and the severe hypertensives (p<0.01).
By low sodium diet and 2 hoursstanding, the increase in plasma DBH activity was significantly higher in the hypertensives aged 20-39 than in those aged 40-59 (p<0.05). The increase in plasma DBH activity by the stimuli was also significantly higher in the mild hypertensives than in the moderate hypertensives (p<0.01). The increase in plasma DBH activity in the high renin group was significantly higher than that in the low renin hypertensives (p<0.05), though there was no significant difference in the basal plasma DBH activity. The increase in plasma DBH activity in the hypertensives with a fall of mean blood pressure of more than 10mm Hg by low sodium diet for 3 days was significantly higher than in those without significant blood pressure fall (p<0.05).
Plasma DBH activity was more markedly increased by treadmill exercise in the hypertensives with positive ECG responses than in the normotensives with negative ECG responses to exercise (p<0.05).
Significant correlation was found between plasma DBH activity and serum catecholamine in the mild and the moderate hypertensives (p<0.05).
These results suggest that the sympathetic nerve activity might play a role in the pathogenesis of hypertension in the early stage of essential hypertension and measurement of the responses of plasma DBH activity to low sodium diet for 3 days is one of the valuable indicators of the sympathetic nerve activity in the hypertensive patients.

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The present study is focused on spectrum analysis as a useful method of processing the PCG in order to obtain the frequency spectral distribution of normal heart sounds.
Thirty normal subjects aged from 17 to 34 were studied. PCG was recorded on the fourth intercostal space at the left sternal border using a sound level meter coupled with a standard 6ml cavity. The microphone had a linear response from 0.2 to 8, 000Hz. The signal was filtered with the standard B network according to the ANSI specifications and was registered on a four track FM tape recorder. A four channel analyzer with a microprocessor for off-line elaborations was used with 10KHz sampling frequency. The PCG signal was triggered by a QRS detector on the R wave of the simultaneously recorded ECG. Fast Fourier transform was performed employing either a four channel analyzer with a microprocessor, or an A/D converter with a computer. Finally the results of the analysis were statistically elaborated.
The described procedures permit to obtain a direct and exact tracing of the acoustic features of the heart, thus representing an attempt to come closer to the standardization and automatic analysis of the phonocardiographic technique.

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The effects of different concentrations (10^-8 to 10^-5M) of ouabain on frequencydependent positive inotropy were studied in rabbit papillary muscles. In the absence of ouabain an increase in the frequency of stimulation (from 15/min 30, 60, 90, and 120/min) produced a frequencydependent increase in the contractility in papillary muscles. Ouabain (10^-8M), which did not produce any change in the contractility, also did not produce any change in the frequencydependent increase in the contractility. However, in the presence of 10-1M of ouabain the frequencydependent increases in the contractility were greater than those in the absence of ouabain. At a concentration of 10^-6M of ouabain the frequencydependent inotropic effect was positive only at low frequencies (30, 60/min) whereas at higher frequencies (90, 120/min) the positive effect was transient. In the presence of still higer concentrations (2, 5×10^-6M and 10^-5M) of ouabain the frequencydependent positive inotropy was changed to negative inotropy and this effect was dependent upon the concentrations of ouabain. This ouabaindependent change to negative inotropic effect of frequency increases was not due to the lack of oxygen or energy supply. Also the negative inotropy for the same concentration of ouabain was directly related to the frequency of stimulation. There results indicate that the frequencydependent increase in the cardiac contractility is mediated through an inhibition of the sarcolemmal Mg⁺⁺-dependent, Na⁺-K⁺-ATPase. Preinhibition of this enzyme system abolishes the frequencydependent positive effect and the latter shows an inverse relationship with the degree of preinhibition.

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Fortytwo healthy male albino rabbits weighing around 1Kg were divided into 4 groups. Group I (8)-fed on normal stock diet, Group II (8)-fed on stock diet plus cholesterol (0.5gm in 5ml of olive oil). Group III (15)-received stock diet plus cholesterol plus garlic (0.25gm) juice. Group IV (11)-received stock diet plus cholesterol plus onion (2.5gm) juice. The animals were closely observed and followed for 16 weeks. Approximately every 4 weeks, blood samples were collected for estimation of various parameters (S. cholesterol, S. triglycerides, S. lipoproteins, S. phospolipids, and fibrinolytic activity). At the end of experiment, animals were sacrificed and degree of aortic atherosclerosis was graded (grade 0 to 4) in different groups and compared.
Experimental study revealed that both garlic and onion (garlic more than onion) had significant effect in inhibiting the rise in S. cholesterol, S. triglycerides, S. beta lipoproteins, and S. phospolipids and significant effect in enhancing the fibrinolytic activity. The beta: alpha ratio was altered favourably and the ratio was kept close to normal. As regards the degree of aortic atherosclerosis as seen on post mortem, it was significantly less in garlic and onion group when compared with pure cholesterol group.

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A chronically and transseptally implanted left atrial catheter was utilized to perform repeated cineangiography in the conscious dog. The advantage of this preparation is that catheter placement does not require a thoracotomy. Left ventricular function was compared in the same pentobarbitalanesthetized and conscious dog. Anesthesia significantly depressed myocardial function as was demonstrated by a decrease in ejection fraction and segmental circumferential fiber shortening velocity (VCF) and an increase in enddiastolic volume. In addition, no difference in Vcf occurred between the base and the apex. Since anesthesia produced regional difference in the degree of depression of VCF, we conclude that anesthesia will produce patterns of ventricular contraction which are variable and unpredictable. Consequently, we recommend the use of the conscious dog and this preparation in order to evaluate myocardial function.

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The effect of angiotensinconverting enzyme inhibition on regional blood flow was studied in a total of 21 normotensive Wistar rats fed on either low or high salt diet. A new potent angiotensinconverting enzyme inhibitor (CEI), SQ 14, 225 was administered intravenously in a dose of 2mg/Kg to the conscious animals, and changes in fractional distribution of cardiac output were determined with a microsphere method.
Prior to administration of CEI, there was no significant difference in mean arterial pressure (MAP) or regional blood flow between saltdepleted and saltloaded rats. With CEI, MAP did not change significantly in either group. Fractional distribution of cardiac output increased to the kidneys (p<0.002), and decreased to the stomach, spleen, and skeletal muscle (p<0.02, p<0.002, and p<0.01, respectively) in the saltdepleted group, while a pattern of blood flow distribution was not changed in the saltloaded group.
These results suggest that angiotensin II plays an important role in regulating regional blood flow in saltdepleted conscious animals, but not in saltloaded ones.

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An unusual case of primary angiosarcoma of the left atrium in a heart with chronic rheumatic valvulitis is described. The tumor which was detected at autopsy 2 years after the second valvotomy operation was restricted to the endocardium only and metastasized to the brain.

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A dislodged Pudenz ventriculoatrial shunt catheter removed from the main pulmonary artery by arteriotomy is reported in a 21-yearold man.

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