Relevant to the cause of the acute myocardial infarction, the theoretical assumption whether coronary thrombosis or coronary spasms will play more important factors offers much debate nowadays. The matter has been a subject of vigorous investigation in our laboratory and noteworthy results have been obtained to support coronary functional derangementas one of the most important causative factors of the myocardial infarction. Based on these observations, the author made an investigation to elucidate the above-mentioned subject, utilizing autopsy subjects which suffered from non-thrombotic, non-occlusive myocardial infarctions and related coronary impaired heart diseases.
Twenty five cases of non-thrombotic, non-occlusive myocardial infarctions and four cases of related coronary impaired diseases were studied. Moreover, one hundred and twenty cases of heart with coronary thrombosis served as a control. The most common site of thrombosis formation is assumed to be the point 2.5 cm from the origin of the coronary orifice and the site was excised at 3 mm interval.
Several sections were cut and embedded in paraffin.
Approximately ten sections were cut and stained routinely with HE, Azan and PAM stainings. Representative sections were also processed for a transmission electron microscopic investigation. The results obtained were as follows :
1) The morphological study of the non-thrombotic, non-occlusive myocardial infarction disclosed a frequent occurence of the mechanical destruction of the vascular wall as well as the imbibition of the serous component in the mural layer which could be justifiable as pre-thrombotic lesion of the coronary arteries.
2) The above-mentioned change disclosed various alterations based on the extent of coronary atherosclerosis and the amount and degree of the imbibed serous component. They were categorized as slightly destructive, collagenous network formative, serous component imbibitive, intimal thickening with mural hemorrhage and destructive types with atheroma.
Moreover, occlusion by soft atheroma was confirmed and might be subclassified as one of the variants of the destructive type with atheroma.
The last type was encountered in patients who received cardiac massage at the terminalstage and intensification of mechanical destruction due to manipulation should be taken into consideration.
3) The above-mentioned acute changes may result from a rapid increase of intra-luminal pressure which cause marked coronary circulatory derangement. However, this fails to give adequate explanation for the interpretation of the most common occurrence of pre-thrombotic lesion which frequently observed at 2.5 cm from the orifice.
The common occurrence of this pre-thrombotic lesion was confirmed with the cine-angiography of the patients suffering from the angina pectoris which revealed persisting spastic change at that site. In this context, it is worthwhile to consider the concept of coronary post-spastic failed and good reflow to give adequate explanation for it. The concept was initially proposed by Sheehan and Davis in the renal arterial trees based on observation of the blood flow after release from the renal arterial ligation.
4) This proposal is obviously substantiated by the acute circulatory disturbance, which is manifested by the cytoplasmolytic edematous lesion in the medial smooth muscle cells and the persisting ischemic change of the arteriolo-small arterial trees.
5) Occasional aggregates of the coagulative necrotic foci in relatively broad range were noted in the non-thrombotic, non-occlusive acute myocardial infarction. In other instances, necrotic foci were surrounded by far advanced degenerative regions.
6) The cases which had related coronary impaired heart diseases revealed similar changes to a lesser extent.

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1) Effects of electrical stimulation of the brain stem upon hippocampal and neocortical EEGs of the normal rabbit were studied in the acute experiment.
2) Low frequency stimulation (2 or 5/s) of the brain stem produced EEG spikes in both hippocampi with suppression of theta waves when the background EEG exhibited slow theta waves (3-4/s) in the hippocampus and occasional spindle bursts in the neocortex. The neocortical EEG showed no changes during the stimulation.
3) The most effective sites were examined and proved to be nucleus raphe centralis superior and nucleus raphe magnus.
4) Outside the raphe nuclei there existed the sites where the stimulation could produce no such effects regardless of the state of the brain.

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The mucosa of the respiratory tract, if desquamated by injury or infection, regenerates rapidly. The purpose of the present study is to demonstrate the morphological process of early stage respiratory mucosal regeneration in rats.
The tracheal mucosa of 54 adult rats of both sexes was removed by curetting through tracheostoma. Each time, from 1 hour to 12 hours after curetting, specimens were collected from the injured area of the trachea of 4 rats for TEM and SEM study. In addition, vascular network casts for SEM were made each time by infusion with artificial resin through the aortic arch of 2 rats.
1) As early as 2 hours after curetting, the surviving epithelial cells (mainly the basal cells) began to migrate from the wound margin. This migration was still continuing 12 hours after curetting, although no increase in mitosis was found yet in the surviving epithelial cells.
2) Also beginning one hour and 30 minutes after curetting, the injured blood vessels formed terminal "blind" branch vessels (mainly capillaries and veins). Four hours and 30 minutes after curetting, many bud-like processes were observed at the floor and margin of the curetted wound. Six hours after curetting, these processes grew into "blind" branch capillaries, and areas of these capillaries anastmosed with the neighboring capillaries or veins. Twelve hours after curetting, new vascular networks were formed in the areas of the new vessels (mainly capillaries and veins), but the arrangement of vessels was irregular. No increase of mitosis was found in the lamina propria and submucosal layer within 12 hours after curetting.

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Platelet lipid peroxides were determined according to the method of Sato and Takamatsu in 37 patients with cerebral vascular disease (25 patients with infarction, 12 patients with hemorrhage) within 14 days after the episode. Platelet aggregation were also measured in some patients. In addition, serum total cholesterol, phospholipid, triglyceride and HDL cholesterol were measured. Results were compared to those obtained from 72 age-matched healthy subjects.
Platelet lipid peroxides tended to increase with the age up to the 5th decade, Platelet lipid peroxides significantly increased in patients with cerebral infarction as compared to healthy subjects. There was observed no difference in platelet lipid peroxides between patients with cerebral hemorrhage and healthy subjects. In healthy subjects, platelet lipid peroxides positively correlated with serum triglyceride level and atherogenic index. However, the correlation was not observed in patients with cerebral infarction or hemorrhage. Platelet aggregation by epinephrine and ADP was higher in patients with cerebral infarction as compared with healthy subjects. But, there was no difference in platelet aggregation between patients with cerebral hemorrhage and healthy subjects.
The results suggest that platelet lipid peroxidation is enhanced in patients with cerebral infarction. This may contribute to thrombus formation in this form of cerebrovascular accident.

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Eosinophils were collected from the peripheral blood of a patient with a eosinophilic granuloma of soft tissue, so called Kimura's disease, and purified by the density gradient method using Percoll. These eosinophils were then incubated with different concentrations of calcium ionophore A23187, and then both the ultrastructural changes in the cells and peroxidase release from them were examined.
Under an electron microscope, marked granule-lysis and dilatations of the perinuclear spaces and endoplasmic reticula were noted. Through the connection of the intracellular tubular structures with the dilated perinuclear spaces and reticula, or by direct diffusion in the endoplasm, extracellular release of the granule content was observed. In accordance with these morphological responses, peroxidase, a major granule content, was released into the incubation medium. These responses of the eosinophils were dose-dependent on the A23187 and calcium ion in the incubation medium, and were inhibited by pretreatment of the cells with a calcium antagonist, TMB-8.
During the process of the peroxidase release, the intracellular c-AMP level decreased, but the intracellular c-GMP level did not change. Pretreatment of the cells with theophylline, however, inhibited this decrease in c-AMP level but not the peroxidase release.
In summary, the present results indicate that calcium ionophore A23187 induces the extracellular secretion of the granule contents of eosinophils through the dilated endoplasmic reticulum and perinuclear space in a calcium-dependent, but c-AMP and c-GMP independent, manner.

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Effects of water soluble iodinated contrast media on microvascular circulation system were examined in the rat mesenterium and liver. The contrast media used in the present study were 32% Ioxaglate (IG), which was recently developed as a low osmolality contrast medium, 76% Meglumine sodium amidotrizoate (MSA) and 65% Meglumine amidotrizoate (MA), both of which have been conventionally used. The videographic analysis of the rat mesenterium microcirculation and the measurements of local blood flow in the liver using the hydrogen clearance method were performed after the injection of these three kinds of contrast media.
1. The results of the videographic analysis were as follows :
1) Various kinds of phenomena indicating impairment of the microvascular circulation were observed, such as the rolling of the white blood cell, white thrombus, flying thrombus, blood sludge and stasis, after the injection of the contrast media.
2) The rolling phenomenon of the white blood cell and the flying thrombus were seen even with a low dose of the contrast media. The white thrombus, once formed, showed a tendency to grow. The blood sludge and stasis sometimes appeared after the administration of 6 ml/kg or more of the contrast media.
3) The degree of the impairment in the microvascular circulation was scored. The MSA showed the highest scores and the MA, then the IG followed. The scores positively correlated with the osmolalities and with the administered doses of the contrast media.
2. Changes in the local blood flow in the liver were as follows :
1) Transient increases were noted in the early phase after the injection, which were linearly proportional to the osmolalities of the contrast media.
2) Local blood flow tended to decrease 5 minutes after the injection of the conventional contrast media (the late phase) when 8 ml/kg was given. The decrease observed after the MSA injection was statistically significant (p<0.01).
3) These decreases in the local blood flow in the liver correlated with the scored degree of the impairment of the microvascular circulation in the mesenterium by the videographic analysis. Considered from the standpoint of microvascular circulation, the above findings suggest that it is necessary to keep the administration dose of the contrast medium at the lowest level, and that there are less side effects in the use of IG, which is a new low osmolality contrast medium.

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It has been reported that spontaneously diabetic mice, KK mice, have various myocardial lesions resembling those found in human cardiomyopathy.
In order to elucidate the pathogenesis of these abnormalities in KK mice, the hearts from KK mice (ages ranging from 15 to 40 weeks) were examined using light and electron microscopes. And to clarify the effect of calcium antagonists on the myocardial lesions of KK mice, diltiazem was given both in vivo and in vitro.
In vivo, KK mice (ages 7 weeks) were divided into 4 groups, and given as follows :
Group I : saline 0.2-0.3 ml per day,
Group II : diltiazem 100μg/kg per day,
Group III : diltiazem 200μg/kg per day,
Group IV : diltiazem 400μg/kg per day, intraperitoneally for 14 weeks.
In vitro, the isolated hearts from KK mice (ages 22-32 weeks) were perfused with Krebs-Henseleit solution containing 6mM glucose using the modified Langendorff perfusion method, under the following four conditions.
Group I : gassing the perfusate with 95% O₂+5% CO2₂,
Group II : gassing the perfusate with 95% O₂+5% CO₂ adding diltiazem 4mg/L,
Group III : gassing the perfusate with 95% N₂+5% CO₂,
Group IV: gassing the perfusate with 95% N₂+5% CO₂ adding diltiazem 4mg/L.
After administration of diltiazem in vivo and in vitro, a histo-pathological study of the heart was performed. The results obtained as follows:
1) The body weight, blood sugar, and urine sugar increased to a maximum at aged 20 weeks followed by a decline. KK mice aged 20 weeks showed marked hyperglycemia (the average non-fasting blood sugar was 318±71.7 mg/dl), and urine sugar (the positive percentage was 71%).
2) Myocardial degeneration, disorganized arrangement of muscle fibers, interstitial edema, and pericardial calcification were found extensively in KK mice aged 15 weeks or older.
3) The electron microscopic findings of the myocardium in KK mice aged 40 weeks disclosed fragmentation and sparsity of myofibrils, configuration of mitochondria and completely disorganized contractile elements. Indentation of sarcolemma and focal thickening or dispersion of the glycocalyx layer were also noted.
4) After administration of diltiazem in vivo, the ratio between heart weight and body weight of KK mice in group II and group III disclosed that its value was remarkably less than that in group I.
5) The electron microscopic findings of the myocardium from KK mice in group I in vivo showed marked fragmentation and sparsity of myofibrils, indentation of sarcolemma and dispersion of the glycocalyx layer. But the findings of the myocardium from KK mice in group II and group III in vivo had a rather organized myofibril arrangement as well as preserved sarcolemma and glycocalyx layer.
6) The electron microscopic findings of the myocardium from KK mice in group III in vitro (anoxic state) showed marked degeneration of myofibrils and disruption of the glycocalyx layer. But in the findings in group IV (anoxic state with addition of diltiazem 4mg/L), these degeneration and disruption of the glycocalyx were less significant than in group III.
7) KK mice are considered to have the degenerative change in the myocardium due to hereditary or secondary cause, and it is suggested that the myocardium of KK mice have the abnormality of increased permeabilities in the sarcolemma from the present study. And it is demonstrated that calcium antagonist, diltiazem, as a membrane stabilizing agent, has beneficial effects on the myocardial lesions in KK mice.

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Thirty patients with so-called unidentified gastrointestinal syndrome were examined by Maudsley Personality Inventory (MPI) and Galvanic Skin Reflex (GSR). The purpose was to clarify the relationship between psychologic anxiety felt by patients during a fluoroscopic examination and the radiologic shape and function of the GI tract.
The frequency of GSR before examination was either equal to or higher than that after thirty minutes.
The highly frequent GSR group was hypertonic and hyperperistaltic in GI series.
There was no significant relationship between the frequency of GSR and the transit time of the barium meal through the small intestine.
As for MPI, no significant characteristics were demonstrated.
It may be concluded that the patients felt more anxiety before the GI examination than after the examination, and that patients whose X-rays showed a hypertonic stomach or a hyperperistaltic stomach felt more anxiety.

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The correlation between vascular changes and arrhythmia in idiopathic cardiomegaly has been paid a little attention. We have reported a case of familial idiopathic cardiomyopathy, having various ECG abnormalities in many of her family tree. A 59 years old woman had a dyspnea and pointed out cardiomegaly in 1969. She lost consciousness, got hemiplegia and admitted in 1975. The ECG showed atrial standstill, idioventricular rhythm and multifocal VPC's. The congestive heart failure developed and she died of bronchopneumonia. Autopsy findings are as follows; The heart weighed 700g, showing dilatation of four chambers, focal endocardial fibrosis of right ventricle and scattered foci of intramural fibrosis in antero-septal and lateral wall. Extramural coronary arteries were unremarkable. The myocardial cells showed slight hypertrophy and disarray. Small arteries showed peculiar thickening of media and luminal narrowing. The conduction system showed marked atrophy and fibrosis, with a loss of conduction cells more than 70 percent in sinus node and about a half in His bundle. A-V node was well preserved. Posterior ramus of left bundle branch showed marked edema and/or fibrosis in bifurcation. We concluded that specific arterial changes of conduction system in this case might be related to the damage in conducting cells, resulting various ECG abnormalities.

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