The purpose of this study is to demonstrate the morphologic findings of the chronic cor pulmonale relating with the clinical findings of the right ventricular strain due to advancement of pulmonary affection.
Anatomic findings of heart ventricles, including the size of myocardial fibers, were observed comparing with the retrospective findings of the chest x-ray film, electrocardiogram and phonocardiogram in fifty-seven cases of pulmonary tuberculosis, clinical course of which were well described. Obtained results are as follows.
1. In the cases of which weight ratio of right ventricle to left ventricle plus septum were ≥0.50, the right ventricular strains on the E. C. G. and the P. C. G. have continued for more than one year. In majority cases of this group, percent vital capacity were less than 30% at two years before death.
2. In the cases of which weight ratio were less than 0.49, the clinical findings of the right ventricular strain were found not or minimal in its degree and short in its continuation.
3. In majority cases of the advanced pulmonary tuberculosis, the heart ventricles, especially left ventricle, were atrophic.
4. From the aboves, the pathologic findings of the chronic cor pulmonale should be definited not only the findings of the right ventricular hypertrophy, but also the right pattern of the heart ventricles, such as the weight ratio of ventricles is more than 0.50.
5. The myocardial fibers in the right ventricles in “chronic cor pulmonale” were increased in length and were enlarged in cross sectional area for the fibers in the left ventricles.
6. In the chronic cor pulmonale, the length of the myocardial fibers in the left ventricles were also increased, but their cross sectional area were changed not significantly.

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Recently cardiopulmonary failure due to respiratory and/or pulmonary circulatory dysfunction has been increased and is becoming a major problem as cause of death in the patients with pulmonary tuberculosis.
It is, therefore, important to detect and prevent them as early as possible prior to its occurrence.
The electrocardiogram and vectorcardiogram has been used for diagnosis of right heart overloading due to pulmonary circulatory dysfunction.
There has been a few reports on vectorcardiography in chronic lung disease, but systemic study of the P-vector loop in pulmonary tuberculosis is few as the P loop recorded with ordinary method is relatively small and merged in the initial and terminal portion of the QRS and STT loop.
Then, the P-vector loop recorded with electrical dissection method in 160 patients with pulmonary tuberculosis was analyzed and compared with pulmonary function, type of the disease and pulmonary blood flow, to discuss if it is possible to foreknow the presence of pulmonary circulatory dysfunction due to ventilatory dysfunction.
The results are as follows:
1) Right axis deviation of frontal maximal P-vector was noticed according as the advancement of the disease and in the group of low FEV_1.0%, and the decrease of cardiac index was significantly correlated with verticalization of frontal maximal P-vector. QRS loop often showed the findings of right heart overloading in the cases with frontal maximal P-vector had over +90°right axis deviation.
2) Magnitude of maximal P-vector was increased concurrently with advancement of the disease though no relationship was noticed between the magnitude of maximal P-vector and ventilatory dysfunction.
3) The tendency was observed that figure of eight of P loop was increased accordingas the advancement of the disease.
From the results it was considered that P loop was related closely to the type of the disease, ventilatory dysfunction, right heart overloading and blood flow of the lungs. Therefore, analysis of P-vector loop is quite useful to diagnose the presence of pulmonary circulatory disturbance in patients with pulmonary disease.

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Six cases of esophagobronchial fistula with pulmonary suppuration were reported.
Clinical diagnosis was given based on the patient's history and esophagography. The common complaints were choking when swallowing liquid. The authors placed their emphasis upon making careful history-taking and X-ray examination if the patient is accompanied by the history of recurrent or chronic pneumonitis.
All six cases were successfully recovered after surgery.
It is difficult to determine whether the fistula is congenital or acquired origin. Surgical and pathological diagnosis is recommended. Four cases presented in this paper were congenital, one case was supposedly congenital, and the remaining on was assumed to have had developed from esophageal diverticulum.

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