In the resting state of 6 cases of hyperthyroidism and 2 cases of anemia, and before and after infusion of 6% PVP 5 ml./Kg. body weight in 3 normal and 3 hypertensive cases, the left ventricular performance was studied by the transseptal left heart catheterization using radioisotope dilution method and compared with those of normal and low output failure. Thus following results were obtained;
In hyperthyroidism, with the increase of heart rate, stroke volume was increased, which may be caused by the acceleration of left ventricular function shown by the change of CSR and MSER, and by the increase of blood inflow shown by increase of LVEDV.
The high output state in induced hypervolemia is due to the increase of blood inflow, but the left ventricular function is rather depressed.
In conclusion, thyrotoxic heart is not only accelerated by thyroid hor-mone but also overloaded by increased venous return.

View full abstract

Pyridinolcarbamate; Anginin (B23) is a venous bradykinin antagonist, which antagonizes competitively and reversibly the venoconstrictive effect of bradykinin and its active homologues. This compound has also been shown to antagonize the congestion, exudation and hemorrhage induced by brady-kinin and its active homologues and to remove the edematous change from experimental atheroma and to promote the normal fibrous healing of atheroma.
This compound has also exhibited clinically a beneficial effect in the atherosclerotic diseases of the brain and the heart, however, the evaluation of the effectiveness of this kind of drug in these morbid conditions had to depend upon rather the indirect evidences. In order to see directly the effect of pyridinolcarbamate on the arterial lesion the atherosclerosis of extremities seems much more suitable. The authors have first attempted this compound in the treatment of atherosclerotic occlusion in lower extremities of 2 hos-pitalized patients; 33 years old and 57 years old men.
The first patient aged 33 years suffered from a marked cyanosis of his right foot with a history of 6 months and the pulsations of right popliteal, posterior tibial and dorsal pedal arteries were completely absent and arterio-graphy revealed the complete obstruction of popliteal artery immediately above the knee joint. Pyridinolcarbamate was given 1Gm. daily and on the 3rd day of the medication the cyanosis disappeared dramatically and the intermittent claudication exhibited a slight improvement. On the 14th day of the medication the right dorsal pedal pulsation was recognized and on the 15th day the pulsation became visible through the skin and at the same time the pulsation of right popliteal artery began to be recognized. The volume of pulsation increased gradually but relatively rapidly and concomi-tantly with the remarkable improvement of intermittent claudication and on the 25th day of the treatment there was no differnce of skin temperature be-tween right and left foot and the pulsation exhibited almost normal volume in dorsal pedal artery. On the 26th day the pulsation of his right posterior tibial artery also reappeared. Under the medication of this compound no relapse and no untoward effects of the drug have been noted for 3 months period of the observation.
The second case aged 57 years suffered from intermittent claudication and the absence of the pulsation of bilateral popliteal, dorsal pedal and pos-terior tibial arteries and the arteriography revealed the occlusion of the middle part of the right femoral artery.
The treatment with pyridinolcarbamate for 2 weeks in a daily dose of one Gm. induced a slight improvement of intermittent claudication and on the end of third week a marked improvement was noted and at the same time the pulsation of his right dorsal pedal artery reappeared. His inter-mittent claudication exhibited a marked improvement concomitantly with the appearance of his dorsal pedal artery. A definite shortening in crest time in plethysmogram was noted in the bilateral second toes on the 130th day of the treatment. Thereafter his condition has been continuously good and he had no relapse and no untoward effects of the drug during the whole observation period of 5 months.
The effect of pyridinolcarbamate seems to originate from the improve-ment of atheromatous changes by the compound in these patients.

View full abstract

(1) Pressor responses to norepinephrine, synthetic angiotensin II and hog renin in rats were compared before and after isovolemic transfusion of human plasma. After transfusion of plasmas from normal subjects and a hypertensive patient with normal renal function, the pressor response to hog renin in the assay rat somewhat decreased with comparable decrease of responsiveness to norepinephrine. With plasma from a normotensive patient with azotemia, the response to renin remained unchanged with decreased responsiveness to norepinephrine and angiotensin II. Of 7 studies with plasmas from 5 hypertensive patients with terminal uremia, 4 revealed aug-mented responses to hog renin in spite of decreased sensitivity to norepine-phrine in all the 4 and angiotensin II in 2 of them.
(2) The amounts of angiotensin formed during incubation of a fixed dose of hog renin and an excess of renin-substrate in the presence of plasmas from uremic and/or hypertensive patients were compared with those of simultaneous incubation in the presence of normal human plasmas. In-cubation with neutral mixtures resulted in significantly greater yields of angio-tensin in 6 studies with plasmas from 4 hypertensive uremic patients as com-pared to those with control plasmas. Incubation with acidified mixtures caused formation of angiotensin in significantly greater amounts in 2 studies. Incubation studies with plasmas from a hypertensive patient without renal failure and a normotensive patient with impaired renal function revealed no significant difference between yields of angiotensin with patients' plasmas and those with control plasmas.
(3) The results suggest that the activity of a given dose of renin may be greater in the presence of plasma from a patient with terminal uremia and hypertension than in the presence of plasma from a normal man. The observed phenomena are quite similar with those known to occur with plasma from renoprival animals.

View full abstract

(1) Unilateral pulmonary artery or vein was distended by a balloon in closed and open chest anesthetized dogs. A part of the experiments was per-formed under perfusion of unilateral lung in situ. Persistent elevation in the pulmonary arterial pressure is always observed during distension of unilateral pulmonary artery as well as a pulmonary vein. Transient fall in the femoral arterial pressure is often observed at the initial stage. Following it, persistent slight decrease during the distension and rebounded rise after release of the distension are sometimes observed.
(2) The increase in the mean pulmonary arterial pressure correlated with degree of distension of the pulmonary vascular wall. The maximal change in the mean pulmonary arterial pressure is about 6mm. Hg or about 37% increase in arterial distension and about 3mm. Hg or about 22% increase in venous distension. The fall in the femoral arterial pressure correlates with changes in the intraluminal pressure of the inflated balloon. The maximal change of the transient hypotension is about 6% decrease in arterial distension and about 19% decrease in venous distension. The maximal change of the following persistent hypotension is about 3% decrease in arterial distension and about 12% decrease in venous distension. The cardiac output shows about 9% reduction.
(3) The pulmonary hypertension is concluded to be due to pulmonary vasoconstriction elicited by stimulation of stretch receptors in the pulmonary artery and vein. Participation of the vagal and sympathetic pathways is not proved. The changes in the femoral arterial pressure are also concluded to be due to both decrease in vascular tone and decrease of the cardiac output.

View full abstract

From the experiment on the rat heart slices the following results were obtained.
(1) About 25 per cent of RNA ribose were synthesized via the oxidative pentose pathway and approximately 75 per cent via the non-oxidative one in normal ventricular myocardium. This ratio is same as that of liver.
(2) The synthesis of RNA ribose via the oxidative pentose pathway appeared suppressed in hypertrophied myocardial slices.
(3) Despite an increase in RNA content of hypertrophied myocardium, the function i.e. the incorporation rate (C¹⁴-RNA/RNA content) were apparently decreased.
(4) As for the relationship between DNA and the oxidative pentose pathway, no relation could be found. Moreover, there was no change in the incorporation rate of DNA in hypertrophied myocardium employed in this study.

View full abstract

Pulsus alternans involving the right side of the heart was studied in 5 patients. Four of 5 patients had mitral stenosis with severe pulmonary hypertension and the other had postpartum myocardial disease with clinical signs indicating both left and right heart failure. It was concluded that pulsus alternans in the pulmonary circulation was elicited in close connection with severe right ventricular strain or failure.
Premature beat of ventricular origin was one of the most important trigger mechanism initiating pulsus alternans. Contrary to the previous opinion in the literature pulsus alternans following premature beats could persist for a rather long time, at least in the presence of pulmonary hyperten-sion. Pulsus alternans was induced in a patient by exercise as the pulmonary hypertension was exaggerated.
Alternation of the right ventricular diastolic and right atrial pressures was found in 2 patients in addition to that of the right ventricular systolic pressure. However, it could not be considered that the atrial or right ventri-cular diastolic alternation played an important role in the genesis of pulsus alternans in the pulmonary circulation.

View full abstract

Potassium chloride in a dose of 3 to 5Gm. was administered orally in 11 normal subjects and 49 patients with ventricular hypertrophy, bundle branch block or myocardial infarction. The resulting electrocardiographic changes were examined with the mean QRS, T and the ventricular gradient (G) vec-tors. Frank's lead system was used for analysis.
After potassium administration, the QRS vector was decreased in mag-nitude in one third of the cases, but the grade of this change was not marked in most of them. The G vector increased its magnitude with relatively small change in its direction in most of the cases. Changes in the T vector occurred according to the relative orientation of the original QRS and T vectors. In some cases, however, the G vector changed its direction slightly anteriorly.
Discussions were made on the practical value of the procedure and on the mechanisms of the observed changes.

View full abstract

An etiologic and patho-anatomical survey was carried on 128 autopsied cases of infarction collected from 10 districts in Japan. Myocardial infarction was observed more frequently in male than in female, and there was a tendency to younger age in male compared with that in female.
Massive type infarct was experienced in 83 cases (64.9%), and the infarct due to coronary arterial thrombosis was seen in 71 cases (56.4%). The commonest area of infarct was antero-septal or posterior wall of left ventricle.
Thrombi were observed more frequently in cases of the massive than in the scattered one.
The clinically typical cases of acute myocardial infarction were experienced mainly in massive type. On the contrary, atypical cases without anginal attack were frequently observed in scattered type. Patients with massive type infarction died sooner (within 6 months to 1 year) than the scattered one.
This report may provide a basic statistics for understanding pathoanatomy and clinical findings of myocardial infarction and for the applicability of anticoagulant therapy for myocardial infarction.

View full abstract

A case of cystic pheochromocytoma with paroxysmal hypertension was described in details. We observed that T waves in the lead II, III and aVF were significantly elevated, and the enlarged T loops on vectorcardiogram were more displaced to the left and downward than that before the attack and the QRS-T angle was markedly widened during the attacks. The mechanism for these changes was discussed.

View full abstract