We examined 472 patients of the hookworm disease who consulted our clinic in 1951-'55 and 54 patients in 1946-'48 comparing with symptoms after the World War. After World War II, subjective symptoms which were caused by unwell nourishment, for example tiredness, fatigue and emaciation, were recognized at the high percentage. Slightly fever (above 37°C) were seen in 31.7%. Many cases complained pain upon the pressure on 3cm right lower part of navel. The liver enlargement were seen in 32.6% and the urobilinogen reaction of the urine were positive in 23.3%. Some patients revealed positive liver function test, especially C. C. F. were found sensitively. Many cases showed hypochromic microcytic anemia and each values and indexes were paralled with the degree of the anemia. Many cases showed eosinophilia in blood and the number of eosinophylic leucocytes related to the degree of the anemia. When the grade of anemia were severe, the eosinophylic leucocyte increased. But in some cases of severe anemia missed the eosinophylic leucocyte. Plasma protein decreased in many cases of the patients. We recognized various symptoms, anemia, enlargement of the liver and disturbance of liver function in 63 cases of hookworm carrier. Considering the above finding, it seems necessary to treat the carriers of hookworm as the patient of hookworm disease.
To keep a good rest is considered as essential in the treatment of diseases which may cause renal damages, but the reason why the rest is so important is not clarified yet. In the present studies, the effects of standing and exercise on renal blood flow (RBF), glomerular filtration rate (GFR), filtration fraction (FF) and sodium, potassium and protein excretions were examined by clearance methods, in 6 normals and 34 patients with essential hypertension, cardiac and renal diseases. In both standing and exercise, RBF, GFR and sodium excretions were observed to have a tendency to decrease, and FF to increase in many cases, however the decreases of RBF, GFR and sodium excretions were greater in exercise than in standing generally. And these decreases were severe in patients with renal diseases, while the changes of RBF and GFR were slight or insignificant in normals. These changes of renal functions in standing and exercise are similar to the effects of adrenalin, and the possibility that the sympathetic nervous regulations participate in the effects of these conditions on renal haemodynamics was discussed. After exercise, RBF and GFR were restored to the former levels within 30 minutes in most cases, although the recoveries were delayed to some extent in patients with renal diseases and essential hypertension. No correlations were found between the original level of RBF and its decrease in these conditions. The effects of standing and exercise on proteinuria were observed to have no definite tendency, and the author could not find any correlation between the protein content of urine and the changes of RBF and GFR. In patients with orthostatic proteinuria, the decrease of RBF while standing were very severe and continued for a long period, and it is presumed that the decrease of RBF may play the important role as one of causative factors in the mechanism of the proteinuria in this disease.
The coronary sinus catheterization was carried out on ninetyeight human subjects, including twenty-two normal subjects, fourty patients with cardiac failure, thirteen patients with coronary sclerosis, six cases of hypertension, six cases of anemia, ten patients with hyperthyroidism, and one patient with beri-beri. In these subjects, the myocardial lactate metabolism was investigated in the recumbent rest, in the exercise test, and in the 10% oxygen hypoxia test, as well as during the intravenous administration of Lanatoside C or Vitamin B1. The results thus obtained were as follows. 1. In the healthy individuals with the mean arterial lactate concentration of 7.79±1.30mg per dl the coronary venous lactate concentration averaged 3.80±0.60mg per dl, the coronary arterio-venous lactate difference 3.99±0.79mg per dl, and the myocardial lactate O2 extraction ratio 30.5±6.4 per cent. The relationship of the coronary arterio-venous lactate difference (ΔL) plotted against arterial lactate concentration (La) follows the next formula, and the rising arterial lactate concentration upon the exercise test resulted in increased coronary arterio-venous lactate difference according to the same formula. La=0.116 ΔL2+0.608 ΔL+3.15 Consequently, in this report, the problems of the myocardial lactate extraction were discussed on the basis of the myocardial lactate extraction coefficient ratio (ΔL/ΔLn):ΔLn is the normal value of the coronary arterio-venous lactate difference, corresponding to a particular arterial lactate level in the formula. In the resting state as well as upon the exercise test, the increases in the arterial lactate concentration were accompanied with a rise in the myocardial lactate O2 extraction ratio, and at the arterial lactate concentration of 30mg per dl the ratio reached approximately to 90 per cent. 2. In the moderate and severe cardiac failure the coronary venous lactate concentration was significantly elevated, and in the severe cardiac failure both the coronary arterio-venous lactate difference and the myocardial lactate O2 extraction ratio were significantly reduced. In cardiac failure as well as in coronary sclerosis or hypertension, the myocardial lactate extraction was significantly lowered, resulting in lowered myocardial lactate O2 extraction ratio as compared with that of the normal at a comparable arterial level. It was noteworthy that in cardiac failure these decreases were in parallel with the grade of its severity. In addition, the decreases in these heart diseases became more evident by the exercise test and the hypoxia test. The data described above suggests that the myocardial lactate metabolic abnormality is not due to the secondary effect of the cardiac failure but precedes it. 3. In the cases of thyrotoxicosis and anemia the coronary venous lactate concentration was significantly elevated, and both the coronary arterio-venous lactate difference and the myocardial lactate extraction were significantly lowered. One patient with beri-beri showed also a remarkable reduction in the myocardial lactate extraction. Additionally, in thyrotoxicosis the myocardial lactate O2 extraction ratio was significantly lowered, and in severe anemia and in beri-beri the ratios were lowered as compared with that of the normal at the same arterial level. Moreovere, these abnormalities became conspicuous by the exercise test. 4. After the administration of Lanatoside C to the cases of cardiac failure the myocardial lactate extraction was significantly improved in contrast with the control patients. 5. The myocardial lactate usage was determined in eight healthy individuals and nineteen patients with heart diseases. The normal value was distributed widely between 0.47 and 3.75mg per dl per 100 grams per minute (Mean value:1.88±0.88).
The hepatic blood flow (EHBF) and the oxygen consumption of the liver(splanchnic O2 consumption) were estimated and calculated by the hepatic venous catheterization on normal fifteen healthy persons and twenty-three patients without liver disease in resting and fasting state. (1) The EHBF was 870 (700-1140) cc/min./M2 in fifteen healthy persons, 830 (670-1140) cc/min./M2 in twelve patients with chronic gastritis and peptic ulcer, and 880 (775-1040) cc/min./M2 in three patients with bronchial asthma and pulmonary diseases. The average EHBF of these thirty cases without liver disease was 855 cc/min./M2. (2) In four patients with diabetes mellitus the EHBF was slightly decreased, and in four cases with essential hypertension the EHBF was moderately decreased. (3) In healthy persons and the patients without liver disease, approximately 24% of the basal cardiac output passes through the hepatic circuit. (4) The average hepatic arteriovenous oxygen difference was 4.86 Vol.% in ten cases, and the average hepatic (splanchnic) oxygen consumption was 40.7 cc/min./M2 in nine cases. (5) The validity of the BSP method in the estimation of the hepatic blood flow was discussed.
On' twenty-nine patients, fifteen with liver cirrhosis, seven with epidemic hepatitis and seven with carcinoma of the liver, the hepatic blood flow was estimated by the hepatic venous catheterization. In fourteen of them, the hepatic arterio-venous oxygen difference was determined and splanchnic oxygen consumption was calculated. (1) In the patients with liver cirrhosis, the EHBF was generally decreased (565cc/min./M2). However, in the cases with hepatic enlargement and slight fibrosis observed peritoneoscopically the EHBF was normal or slightly decreased (830-940cc/min./M2), on the other hand in the cases with distinguished liver atrophy the EHBF was highly decreased (155-500 cc/min./M2). In the former, the prognosis was relatively good. (2) In the patients with epidemic hepatitis, the EHBF was 745 (480-1310) cc/min./M2, and in those with carcinoma of the liver was 630 (310-955) cc/min./M2. (3) The hepatic arterio-venous oxygen difference was 5.38 (2.36-6.90) Vol.% in the patients with liver cirrhosis, and 5.02 (2.11-7.85) Vol.% in epidmic hepatitis. These difference was smaller than that of the healthy persons and the cases without liver disease. Calculated splanchnic oxygen consumption was 24.8 (10.0-45.2) cc/min./M2 in liver cirrhosis and 35.3 (18.1-60.5) cc/min./M2 in epidemic hepatits, both having been less than that in control persons. (4) On the basis of the studies described on first report and here, the effect of upright standing, diet, blood transfusion and various drugs on the EHBF was examined and discussed.
Six cases of leukemia were treated with an anti-leukemic substance, 6-mercaptopurine (“Mern”). In two cases of chronic myelogenous type and one case of chronic lymphatic type remarkable hematological and clinical improvement were observed. It was moderately effective in one case of subacute or acute myelogenous type but ineffective in one case of subacute or acute monocytic type. 6-mercaptopurine was practically as effective as the ordinal anti-leukemic substance. And there observed nothing of side effect especially on erythrocyte and thrombocyte, that is a remarkable good point of 6-mercaptopurine.