下壁側壁梗塞に合併し,手術により救命し得た仮性心室瘤の1例を,本邦17例の文献的考察を加えて報告する.症例:52歳,男.咳嗽,動悸,息切れを主訴として入院.入院時,心拍数112/分の頻拍,および両肺に湿性ラ音を聴取.胸部X線写真上心胸郭比70%の心拡大を,また,心電図II,III,aVF,V6に異常q 波, I, II, III, aV_L , aV_F, V₄, V₅, V₆に陰性T波を認め,下壁側壁梗塞に伴う,うっ血性心不全あるいは心筋梗塞後症候群に伴う,心嚢液貯留が疑われたが,断層心エコー図にて左室後側壁下方に収縮期に拡大する巨大な円形のエコーフリースペースがあり,心筋梗塞に合併した仮性心室瘤が強く疑われた.左室造影にて,左室腔と交通した左室腔とは別の腔が証明され,また冠状動脈造影上,左回旋枝本幹に完全閉塞を認め,下壁側壁梗塞に合併した仮性心室瘤と診断し,入院後早期に,瘤切除,破裂口閉鎖術を施行した.切除された瘤壁は,心筋組織および心外膜成分を含まず,組織学的に仮性心室瘤と診断された. 術後経過は順調で, 現在, 社会復帰している.なお,本邦における仮性心室瘤18例のうち,非手術例は殆ど死亡しているのに対し,手術例の予後は良く,特に近年は,心エコー法,心臓核医学検査等の非観血的検査により生前診断がなされ,手術により救命される例が増加している.

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It is a well known fact that Cholinesterase (ChE) is important in acetylcholine cycle.
Moreover, it has been assumed that uterine contraction might be related to ChE activity in myometrium. ChE activities of rat myometrium were observed in sexual cycle, various stages of pregnancy and puerperium by Hesterin-Miyazaki method. The effects of castration, administration of sexual hormones and contraction induced by various substances were investigated on ChE activities of non-pregnant, dregnant and puerperal myometrium.
The administrated sexual hormones were various estrogens and progestins.
Oxytocin, Methylergometrine tartrate and Acetylcholine chloride were used for inducing the contraction of rat uterus.
ChE activities of serum and placenta were simultaneously measured.
The obtained results were as follows :
1) ChE activities in myometrium decreased in estrus and after castration, and increased in diestrus.
However, ChE activities in serum were high in estrus and low in diestrus.
2) ChE activity in myometrium showed a rapid decrease up to the 14th day of pregnancy, and very slowly decreased from the 14 day through labor. Then, ChE activity was recovered to the value in non-gravid period 3 to 6 days after delivery.
ChE activity in antiplacental site of myometrium was higher than in placental site.
ChE activity in placenta was higher in late pregnancy than in mid pregnancy.
ChE activity in serum increased during pregnancy but its deviation range was rather large. Then, this activity in serum gradually decreased during puerperium and became lower on the 6th day post partum than in non-gravid period.
3) Effects of estrogens and progestins on ChE activities in pregnant myometrium were nct remarkable.
ChE activities in placenta and serum were also unchanged by estrogens and progestins.
4) ChE activities in puerperal myometrium were diminished by the administration of estradiol benzoate (1 mg or 100μg), estrone (1 mg or 100μg) or estriol (1 mg) for 6 days, but not changed by the administration of 10μg of these estrogens or 100μg of estriol.
On the other hand, ChE activities of puerperal myometrium were slightly diminished by the administration of progestins (1 mg). ChE activities of serum in puerperium became high, as in pregnancy, after the administration of 1 mg of estrogens for 6 days.
5) ChE activity was slightly low after the administration of oxytocin, but no effect of it was found in vitro. Methylergometrine tartrate and acetylcholine chloride had no remarkable effects on ChE activities in myometrium. ChE activities in serum and placenta were almost unchanged after administration of oxytocin, methylergometrine tartrate and acetylcholine chloride.
6) ChE activities were low in myometrium and placenta of uterine horn with dead fetus.

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Bladder disturbance in female which is considered to have developed under influence of imbalance of sex hormone is not infrequently encountered in daily practice. It may be adequately called “endocrine cystopathy in female”. However, little is known about this trouble.
To reveal how the symptoms of this disease develope, function test of the autonomic nervous system and cystometric examination were carried out in patients with this disease, and experimental study was also made on the cholinesterase (ChE) and monoamineoxidase (MAO) activities in the urinary bladder of the female mature albino rats treated with various kinds of sex hormone.
1) The function of the autonomic nervous system in patients with female endocrine cystopathy was. abnormal in majority of the cases.
2) Of this dysfunction of the autonomic nervous system in this disease, it was characteristic that hypertonicity of parasympathetic nerve was mostly observed in the younger group of patients, and hypertonicity of the sympathetic nerve in the older one.
3) The function of the autonomic nervous system which had been abnormal before treatment of this disease was completely normalized in a large number of cases when the symptoms were dramatically improved by the sex hormone therapy. From this fact, it is presumed that dysfunction of the autonomic nervous system in this disease plays an important role in development of bladder symptoms under influence of imbalance of sex hormones.
4) Intravesical pressure was determined in patients with this disease. The urinary bladder of the younger group of patients was hyperesensitive and hypertonic, and that of the older group of patients. contrarily showed a tendency of reduced tonicity.
5) Variation of the ChE activity was examined biochemically in the uriary bladder of the female mature albino rats after administration of sex hormone. The ChE activity was lowered by short-term administration of a large dose of follicular hormone, and contrarily it was markedly elevated by long-term administration of a small dose of the same hormone.
6) In addition, variation of the ChE activity was histochemically observed in the urinary bladder albino rats treated in the same manner. Findings almost corresponded to the results obtained in the biochemical study. In other words, a marked rise of the ChE activity was demonstrated mainly in the muscular layer of the cervical and trigonal area of the urinary bladder in the group treated with a small dose of follicular hormone for a long time.
7) The MAO activity was examined histochemically in the female mature albino rats treated with various kinds of sex hormones. It increased in the group given the long-term administration of a small dose of androgen as compared with that in the control.
From these results of the clinical and experimental study, it seems most probably that dysfunction of the autonomic nervous system mediates between theimbalance of sex hormones and the development of bladder symptoms in “female endocrine cystopathy”.

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In order to asses the cardiac function of ischemic heart disease, 31 patients (6 stable angina and 25 old myocardial infarction) without overt heart failure were studied. Pulmonary artery diastolic pressure (PADP), mean right atrial pressure (mRAP) and cardiac index (CI) were measured by SWAN GANZ catheter prior to infusion (control) and at every 100 ml infusion of 6 % hydroxyethyl starch (infusion rate was 20 ml/min. ). Slope of cardiac function curve was calculated from maximum change of CI divided by PADP. We terminated the infusion when the PADP rearched 18 mmHg or the total infusion volume of 400 ml. The patients in this study were subdivided into 5 groups according to the ECG findings and clinical features in acute phase.
Group I consists of 6 patients with stable angina. Control PADP was 6.5 ± 2.1 mmHg mean ± 1SD), mRAP was 1.8 ± 1.0 mmHg and CI was 3.58 ± 0.54 L/min/m². Group II consists of 9 patients with /inferior myocardial infarction. Control PADP was 6.5 ± 2.1, mRAP was 1.3 ± 0.9 and CI was 3.15 ± 0.46. Group 3 consists of 5 patients with anteroseptal myocardial infarction. Control PADP was 9.6 ± 2.1, mRAP was 2.8 ± 1.9 and CI was 3.25+ 0.55. Group IV consists of 6 patients of myocardial infarction with previous history of myocardial infarc tion. Control PADP was 10.2 ± 4.3, mRAP was 1.2 ± 1.6 and CI was 2.97 ± 0.87. Group V consists of 5 patients with right ventricular infarction. Control PADP was 8.0 ± 4.1, mRAP was 3.8 ± 1.6 and Cl was 2.96 ± 0.87. Control PADP and CI were normal in all groups there were no significant differences between earch groups. Group V showed significantly higher mRAP than other groups. Although the patients in group I showed significant increase in PADP (2.7± 1.0 ), mRAP (0.8 ± 0.4) and CI (0.22 ± 0.13) from control, these changes were smaller than other groups. Group 11 showed significant increase in PADP (7.8 ± 2.0), mRAP (1.9 ± 1.2)and Cl (0.95 ± 0.37) from control. Group II showed significant increase in PADP (8.4 ± 2.7), mRAP (1.6 ± 1.5) and Cl (0.47 ± 0.33) from control. Group IV showed significant increase in PADP (10.0 ± 3.8), mRAP (3.0+1.3) and CI (0.45+0.34) from control. One patient in group III and four patients in group N, the PADP increased over 18 mmHg and CI decreased at this higher pressure. The slope of cardiac function curve of group III (0.06+0.04) and group IV (0.07 ± 0.07) were significantly smaller than group II (0.13+0.06). Group V showed significant increase in PADP (5.2± 1.6) and mRAP (3.6± 1.7), but there was no significant increase in CI (0.28+0.36). The change of mRAP from control in this group was significantly larger than other groups.
Hemodynamics being identical among the 5 groups (mRAP in group V was higher than other groups but was in normal range), the cardiac function and reserve could not be assesed prior to volume expansion. Our findings by volume expansion suggests: 1) In group I cardiac reserve was maintained by the neuro-humoral regulatory mechanisms.2) Regulatory mechanism to preload augumentation is fairly well reserved in group II, but compromised in group III and was severly compromised in group IV.4)In group V right ventricular failure which was suggested in control became overt after volume expansion.
Volume loading test is a interesting test to understand the natural history and pathologic phisiology of ischemic heart disease.

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The author determined the Serum cholinesterase (SChE) activity by the use of Acholest method which may readily be done during the surgical procedures to investigated its clinical significance and arrived at the followihg conclusion.
1. Reduced SChE activity was recognized in 26 (32.5 %) of 80 cases who were operated upon for general surgical diseases. The incidence of the reduction in this esterase activity was found to be higher in cases of gastric cancer and those with impaired liver function, being 56.2 and 61.5 % respectively. As to the relationship between liver function tests and SChE activity, 70 % of cases with normal A/G ratio showed normal SChE activity, while the activity was found normal in a half, decreased in the other half of cases with renuced A/G ratio ; the zinc sulfate test (Kunkel) revealed that the greater the value of this test, the more becomes the number of cases showing decreased SChE activity, a reduced SChE activity was also seen in 17 % of cases of negative CCF test and in more than 50 % of positive cases. Otherwise, no distinct correlatit n was noticeable between liver function tests and SChE level.
2. Halothane and methoxyflurane, at ordinary concentrations used in anesthesia, were found not to affect the SChE activity.
3. Succinylcholine chloride (S. c. c.) as well as d-Tubocurarine (dTc), among muscle relaxants, also was found not to exert any significant influence upon the SChE activity.
Hexafluorenium apparently lowered the SChE activity, its duration of action being prolonged particularly in cases showing reduced SChE activity preoperatively.
4. As the criterion for the evaluation of the duration of the neuromuscular blocking action of S. c. c., the conventionally employed apnea period is not always suited. In contnast to this, a method devised by the author in which the plamter flexion of toes induced by electrical stimulation of the tibial nerve was measured by means of a strain gauge. The method was demonstrated to give much more correct results.
5. In 8 of 33 cases of cardiac surgery, reduced SChE activity was seen, and this incidence is substantially the same as that for general surgical patients with normal liver function.
In cases of general cardiac surgery done without the use of artificial heart & lung, no particular alterations in the SChE activity were noten during and after the operation probably because only young patients about 20 in age were employed, while in those undergoing open-heart surgery by the use of artificial heart & lung there was a declining tendency of the SChE activity noted due to the use of this apparatus.
In cases of heart operation conducted with the use of artificial heart & lung under hypothermia, the SChE activity was found to be lowered by hypothermia of below 34°C, especially below 30°C. This reduction in the esterase activity occurred more frequently and definitely in cases with a low Acholest value preoperatively than in those with nomal Acholest value.
Reduced or greatly reduced SChE activity during a period from 1 to 4 hours following operation may thus be of help in the assessment of prognosis in patients who are oberated upon with the use of artificial heart & lung, whereas such a reduction in this enzymatic activity occurring during and just after the operation is not necessarily indicative of poor prognosis.

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