Analyses were made of 52 phonocardiograms recorded in 42 cases of hyperthyroidism using a multi-filter system phonocardiograph and a dynamic microphone.
(1) The first heart sound was accentuated, but the Q-I interval fell within the normal range in all cases.
(2) The Q-II interval was shortened out of proportion to the heart rate. The second heart sound frequently splitted and the pulmonic component of the second heart sound was accentuated.
(3) The third heart sound was accentuated. The fourth heart sound had a trend of accentuation, but it was inaudible except in 3 cases with presystolic click.
(4) A systolic murmur was found in all cases. It was an early peaked ejection systolic murmur in graphic configuration irrespective of the area of maximal intensity.
(5) A mid-diastolic murmur of the Carey Coombs type was disclosed at the apex in 7 cases, of which one had a concomitant right-sided Carey Coombs murmur on the left lower sternal border.
(6) The above-mentioned phonocardiographic findings and their significances were discussed, especially in relation to clinical severity of hyperthyroidism.
The mid-diastolic murmur may be considered to be due not only to absolutely increased flow load, but to relatively increased overloading on the damaged heart, which was clinically suggested from the enlargedheart and electrocardiographic changes. The differentiation from mitral stenosis was easily made by the following observations; the normal Q-I interval, the reduced mechanical systolic period, the absence of openning snap, the Carey Coombs type of the diastolic murmur and the response of the heart sounds and murmurs to antithyroid drug.

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Thirty-six patients with chronic pulmonary emphysema have been investigated by pulmonary function tests, and followed up for 5 to 8 years, and the results were as follows.
(1) Seven cases died within 2 years and 9 within 3 to 5 years, 7 died from cor pulmonale.
(2) In the patients with vital capacity of less than 65 per cent of predicted or with maximal breathing capacity of less than 40 per cent of predicted, the largest number of deaths occurred within 5 years, but considerable number of survivals were also noticed. The relationship of the residual volume as a percentage of the total lung capacity to prognosis was not evident.
(3) All the patients with the arterial oxygen saturation of lower than 87 per cent or with the arterial carbon dioxide tension of higher than 55mm.Hg died within 5 years, although considerable number of deaths occurred not only in patients with subnormal values but also in those with normal values of both tests. But the survivals over 5 years were noticed only in patients with the arterial oxygen saturation above 87 per cent or carbon dioxide tension below 55mm. Hg.
(4) All the patients with mean pulmonary arterial pressure of higher than 30mm.Hg or total pulmonary resistance of higher than 500 dynes sec. cm.^-5 died within 5 years. On the other hand, the survivals over 5 years appeared in patients with the former lower than 30mm.Hg or the latter lower than 500 dynes sec. cm.^-5 The relationship of the pulmonary blood flow to prognosis was not evident.
(5) The prognostic significance of the pulmonary function tests has been discussed and it was suggested that the arterial carbon dioxide tension in combination with the maximal breathing capacity was a useful guide to the prognosis.

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(1) On 232 consecutive cases in the Department of Medicine, Tokyo University Hospital, including 8 cases of myocardial infarction, atherosclerotic index was estimated by the method of Gore and Tejada.
(2) The mean value of the indices in each decade did not show clear sex differences and were fairly similar with the results in Sapporo and Fukuoka, reported by Gore et al.
(3) Relationship between atherosclerotic index and hypertension was statistically significant in younger age group under 50. Family history of cardiac diseases, neoplasm and liver cirrhosis had no clear relationships to atherosclerotic index.

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An attemt was made to observe the influence of phosphorus metabolism on the kidney function through clinical and experimental works.
(1) ATP gave a rise of the renal clearance, especially dominant of PAH clearance, in the normal rabbits kidney.
(2) We observed the effect of ATP, vitamin B1 and co-carboxylase on PSP test in kidney diseases. ATP improved PSP in the group suffering moderately, but not in the group seriously disturbed. When the kidney function was within normal limits, there were almost the same numbers of improved and constant rate of PSP excretion by ATP. Co-carboxylase effected on the improvement of PSP better than vitamin B1, and these effects were almost similar to that of ATP.
(3) Inorganic phosphorus and Δ10P were measured for 120 min. after ATP administration to rats which were treated by potassium chromate leading to slightly or seriously disturbed kidney. In serious cases was noted low inorganic phosphorus, whereas Δ10P showed the highest rate in mild cases, but did not increase so much or did a slow return to the beginning rate in serious cases.
(4) Blood pyruvic acid and α-ketoglutaric acid in the kidney disease showed a rise suggesting the disturbance of their utility. ATP, vitamin B1 and co-carboxylase made an improvement of these rates, especially vitamin B1 and co-carboxylase did a remarkable influence. However there was no definite difference of the effect between vitamin B1 and co-carboxylase.
(5) The improvement of the kidney function by the activation of the glucose metabolism by ATP or co-carboxylase was most marked in moderately advanced kidney diseases. PSP test was revealed to indicate without any difficulty the reaction ability to the metabolism of the renal vessels and the tubules. Phosphate bound substances were suggested to play an important role in improving the kidney function by producing high energy phosphate bound substances, activation of phosphorilation as well as causing the smooth TCA cycle.

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Various hormones were administered to spontaneously hypertensive (Okamoto and Aoki) and normotensive rats and their blood pressure and body weight were measured.
(1) In spontaneously hypertensive rats vasopressin, pitressin, aldosterone, noradrenaline and diethylstilben had no effect on their blood pressure. Cortisone and thyroid powder accelerated the development of hypertension and enhanced hypertension. DCA enhanced hypertension. Testosterone had a tendency to increase the blood pressure in males, progesterone lowered it in females and estradiol decreased in both males and females.
(2) In normotensive rats ACTH had a slight tendency to increase blood pressure. Cortisone, DCA and thyroid powder developed hypertension. Radiothyroidectomy had a slight tendency to lower blood pressure but they remained within normal range.
(3) Excessive humoral state of thyroid (thyroxin) and adrenal cortical hormones (cortisone and DCA) by their administration developed and enhanced hypertension. If hypertrophy of the pituitary, adrenal and thyroid glands can be regarded as a demonstration of their hyperfunction, it may be concluded that the pituitary secretes excess amount of ACTH and TSH and makes the target organs secrete excess amount of their hormones. In this way the adrenal and thyroid showed hyperfunction, which plays one of the important etiological roles in the development and maintenance of hypertension.
The outline of this study was reported at the symposium of 35th annual meeting of the Japanese Endocrinological Society in 1962 and at the 51st annual meeting of the Japanese Pathological Society in 1962.

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(1) Heart muscle catecholamine content, pseudocholinesterase activity, and glutamic oxaloacetic transaminase and glutamic pyruvic transaminase activities were measured in rats after administration of 3, 5, 3' triiodothyronine and 1-methy 1-2-mercaptoimidazole in order to find further correlations between these and the effects of thyroid hormones. Heart muscle adrenaline content significantly decreased in hyperthyroid group compared with hypothyroid and coutrol group. The significance of this finding in explaining hypersensitivity of adrenaline in hyperthyroidism was discussed. The metabolism of catecholamines in relation to this finding was also discussed.
(2) Pseudocholinesterase activity in the heart muscle significantly increased in hyperthyroid group and decreased in hypothyroid group compared with control group. Its possible significance in thyroid diseases was discussed.
(3) Glutamic oxaloacetic transaminase and glutamic pyruvic transaminase activities in the heart muscle significantly decreased in hyperthyroid as well as hypothyroid group compared with control group. It is likely that muscular involvements in thyroid diseases are significant enough to cause possible liberation of these enzymes.

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(1) Frank lead vectorcardiogram was recorded in 30 normal persons and in 323 cases with hypertension and acquired and congenital heart disease. The T-loop was classified into 8 types according to the directions of inscription in 3 planar projections. Frequently observed types were examined with the direction of the maximal T vector.
(2) In majority of normal cases, the T-loop was inscribed counterclockwise in horizontal and clockwise in sagittal planes.
(3) In left ventricular hypertrophy, abnormal inscription of the T-loop was observed with abnormal rightward and superior deviation of its maximal vector and the T-loop oriented more than 120° in horizontal plane was usually accompanied by abnormal inscription. Percentage of abnormal inscription was higher in cases with cardiac complaints.
(4) In right ventricular hypertrophy, directional change of the T-loop was relatively small but changes in inscription of it were common. The T-loop was always inscribed abnormally in cases with abnormal inscription of the QRS-loop.
(5) The concept of the polar vector was found to be valuable in studying the inscription and the direction of the T-loop. Significance of changes in inscription of the T-loop was discussed.

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A case of inconstant left bundle branch block which appeared during the course of sepsis is reported. The electrocardiogram showed 2:1 intermittent left bundle branch block and then the normal QRS complexes were seen following comparatively shorter R-R intervals among left bundle branch block with atrial fibrillation. The bundle branch block disappeared after alleviation of fever, but the prolonged A-V conduction persisted.

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