Hemagglutination of formalin preserved human group O erythrocytes treated with tannic acid and sensitized with streptokinase-steptodornase (Varidase) were devised by us and investigated in 183 sera of patients suffering from rheumatic fever, acute glomerulonephritis, scarlet fever and chronic tonsillitis etc. High titers were often observed in these poststreptococcal sequelae and titers were commonly low in apparently healthy persons. The titers of the hemagglutination (anti-SK-SD) correlated with that of Todd units of antistreptolysin O, but usually higher than the latter.
It may be useful as one of the serological reactions for the supporting evidence of preceding streptococcal infection in guidance for the diagnosis of rheumatic fever.

View full abstract

The point of maximum intensity (PMI) of the aortic diastolic murmur was analyzed in 801 cases of aortic insufficiency (AI) of various etiology, and unusual location including the "right-sided" murmur was investigated.
Though the PMI was widely distributed, a great majority of cases had the PMI along the left sternal border irrespective of the etiology concerned. Particularly, the 3rd and the 4th left sternal border (3L and 4L) were the main places where the murmur was best audible and this was observed in 598 out of 801 cases (74.5%). Mid-sternal portion (3M) was the secondary place and 99 cases (12.5%) had the PMI here.
Rather infrequent PMI was along the right sternal border (58 cases ; 7.1%) and around the cardiac apex (21 cases ; 2.5%). The other PMI was exceptional.
The "right-sided" AI murmur was observed predominantly in syphilitic case (27 out of 58 cases ; 47%). However, almost all of the other etiological entity could have the PMI along the right sternal border even in a few cases of rheumatic etiology. Moreover, the syphilitic cases did not always have the PMI along the right sternal border, and it was located on the left side in about a half of cases.
The "right-sided" AI murmur was usually loud enough to permit the wide transmission of the murmur over the precordium. The PMI was located more frequently in the classical aortic area (the 2nd right sternal border ; 2R: 36 cases ; 61%) rather than in the 3rd right sternal border (3R: 18 cases ; 28%), and it was located even in the 1st right sternal border (1R: one case). The cases with the PMI in the upper right sternal border (1R and 2R) usually had louder murmur in 3R than in 3L, but the exception was observed in some cases (4 cases ; 11%). Therefore, the concept of the "right-sided" AI murmur was revised to include all of the cases which have the PMI along the right sternal border irrespective of the interspaces questioned.
Roentgenograms revealed the dilatation of the ascending aorta and the rightward displacement of the aortic root in all cases with the "right-sided" murmur. However, in cases with the PMI in 2R the elongation of the aorta predominated, whereas the rightward displacement of the aortic root was dominantly observed in cases with the PMI in 3R. The height of the diaphragm was the one of the accessory factors influencing the site of the PMI. In addition, all cases with the "right-sided" murmur had marked left ventricular enlargement, which also contributed to the rightward shift of the PMI. The conclusion was made that these roent-genographic abnormalities have the primary importance to the "right-sided" murmur rather than the etiology concerned.
Because of the lack of the exact auscultatory and phonocardiographic description, aortic insufficiency associated with aortitis syndrome in the Orient was analyzed and discussed in detail.

View full abstract

It is enunciated that the Lutembacher syndrome can be approved of not only the atrial septal defect associated with the mitral stenosis but the mitral stenosis with secondary occurred or enlarged interatrial communication due to the left atrial hypertension. Moreover, the mechanism of the continuous murmurs occasionally heard at the lower sternal border is discussed from the present case and cases collected from the literatures. Successful surgical treatment of a patient with the Lutembacher syndrome in the above-mentioned concept is presented.

View full abstract

Twenty-two cases with renovascular hypertension were studied to assess the diagnostic value as well as the limitation of abdominal murmurs. Control group which has no stenotic lesion in arteriography showed the abdominal murmur in 34 out of 48 cases, but the murmur was localized over the pulsated abdominal aorta and characterized by the low to medium pitch and short decrescendo following aortic distension sound ("accidental" murmur). The murmur was intensified by amyl nitrite inhalation or by isoproterenol administration, and abolished by methoxamine. The abdominal murmur of renovascular hypertension, on the contrary, had the maximum audibility over the affected artery and high-pitched and long continued in character (occupied all systole, transsystolic or continuous) ("organic" murmur). The intensity of the murmur is not differential clue between these 2 murmurs. The murmur of renal artery stenosis with significant hypertension was attenuated by amyl nitrite inhalation. Overall diagnostic accuracy of renovascular hypertension by phonoarteriography was only 64%, and the limitation of simple auscultation and also of phonoarteriography was demonstrated and the reason was discussed. Despite of the limitation, the phonoarteriography had the merit to discriminate the accidental murmur from the organic murmur and to evaluate the post-operative cases. Because of the definite association of the organic murmur and the stenosis of either the aorta or the main branch, it was concluded that the presence of the "organic" murmur is absolutely indicative of aortography and selective arteriography.

View full abstract

Propranolol, diphenylhydantoin and tetrodotoxin showed inhibitory or removal effects on fibrillation induced in isolated rabbit atrial muscle strip. Depending upon methods of induction of fibrillation, effects of these drugs were different. The mode of their action seemed to be due to following electrical natures of each drug in its effective dose.
Diphenylhydantoin decreased rate of rise and amplitude of the action potential of dog ventricular fibers and rabbit atrial fibers, which was also a cause of prolongation of conduction time. Duration of action potential was slightly prolonged in an effective low concentration. In contrast propranolol showed a relatively little effect on these items, but depressed ectopic spontaneous activity. Tetrodotoxin had both effects more markedly.

View full abstract

The influence of the rate of change of intraventricular pressure, the aortic diastolic pressure, and the heart rate on the isovolumetric contraction interval was examined in dogs under a variety of hemodynamic states. The experimental conditions included alteration of the contractile state of the ventricle, its preload, and its afterload. Analysis of the data indicated that the isovolumetric contraction interval is inversely related to the maximum rate of intraventricular pressure change, is directly related to the aortic diastolic pressure and is independent of the heart rate. A reliable correlation was found between the ICT interval and the ratio of aortic diastolic pressure to the pressure derivative. This correlation was not altered by the experimental conditions imposed.

View full abstract

To investigate the effect of blood pressure itself on lipid accumulation in the aortic wall, we have studied the effect of "short-term" (about 2 weeks) hypertension on the uptake of cholesterol-4-C¹⁴ by the aortic wall in normo-cholesterolemic female rats. Renal hypertension was produced by partial constriction of a left renal artery. The uptake of C¹⁴-cholesterol by the aortic wall of the rat was expressed in terms of the total and the specific activity of cholesterol and the ratio of the total activity of cholesterol in the aortic wall to the specific activity of cholesterol in the serum. The results indicate that cholesterol uptake by the aortic wall was not accelerated by the existence of hypertension. These results are discussed with respect to the effect of hypertension itself on atherogenesis.

View full abstract

With constriction of left renal arteries of 193 rats in different degrees and either extirpation or infarction of right kindeys, four different elevation patterns of blood pressure were followed.
(1) Macro- and microscopically, these rats developed 6 different cerebrovascular lesions as follows; single massive cerebral hemorrhage, multiple punctate hemorrhage, microscopic hemorrhage, fibrinoid necrosis, cerebral softening and plasmatic imbibition.
(2) Rats which developed single massive hemorrhage died unexpectedly in the early stage of experiment with moderate degree of constriction, while those which developed multiple punctate hemorrhage became temporarily hyperirritable.
(3) Single massive hemorrhage, multiple punctate hemorrhage and fibrinoid necrosis were found almost exclusively in the cerebral cortical area, while 30-40% of microscopic hemorrhage, cerebral softening and plasmatic imbibition were also found in the basal ganglia.
(4) Loosely constricted groups with low rate of increase and also low maximum of blood pressure showed high incidences of microscopic hemorrhage, plasmatic imbibition and cerebral softening and none of macroscopic hemorrhage or fibrinoid necrosis. Moderately constricted groups with both a high rate of increase and also a high maximum of blood pressure developed more single massive cerebral hemorrhage than multiple punctate hemorrhage and fibrinoid necrosis and cerebral softening in about half of the cases but few of microscopic hemorrhage and plasmatic imbibition. Severely constricted groups and group of contralateral renal infarc-tion caused more multiple punctate hemorrhage than single massive hemorrhage and the latter of which showed fibrinoid necrosis, cerebral softening and microscopic hemorrhage in about half of the cases.
(5) Microscopic hemorrhage and plasmatic imbibition were maximal in appearances at the moderate degree of hypertension and subsided abruptly later on, while cerebral softening and multiple punctate hemorrhage were the more frequent as the blood pressure rose higher. Fibrinoid necrosis and single massive hemorrhage showed their peak appearances around the time when the rate of increase of blood pressure was maximal.
In summary, there are three types of cerebral hemorrhage in Goldblatt type hypertensive rats and they seemed to be pathogenetically different each other.

View full abstract

(1) In 1, 244 patients with various congenital heart disease, 12 cases of coronary sinus rhythm were recognized.
(2) Four cases were found in 33 patients with persistent left superior vena cava, and 6 cases were encountered in 9 patients with absence of the inferior vena cava.
(3) The intimate correlation between coronary sinus rhythm and these systemic venous anomalies was emphasized.

View full abstract

Marfan's syndrome itself is not a very uncommon disease. However, when it is associated with subacute bacterial endocarditis or the W.P.W. syndrome, its scarity seems to be worthy of notice. As far as we know, there have been only a few cases of Marfan's syndrome with subacute bacterial endocarditis and none with the W.P.W. syndrome.
Two cases of Marfan's syndrome respectively associated with subacute bacterial endocarditis and the W.P.W. syndrome were presented.
Congenital septal defects were demonstrated in one of these cases. The combination of Marfan's syndrome with congenital septal defect or the W.P.W. syndrome seems to be coincidental to each other.

View full abstract

A 70-year-old female with small ventricular septal defect complicated with subacute bacterial endocarditis was presented. The rare longevity and a pathogenesis of subacute bacterial endocarditis were discussed with special reference to hemodynamic stress by a rapid shunting jet stream passing through the small defect.

View full abstract