General behavior of human serum lipoproteins in Disc type acrylamide gel electrophoresis was investigated. Ways of staining serum lipoproteins suitable for Disc type acrylamide gel electrophoresis were also investigated. The separating gel concentrations allowable for lipoprotein electrophoresis were found to be 3.40% to 4.00%. The optimum concentration seemed to be 3.75% or very close to that. Migration of serum lipoproteins was affected by the buffer strength (concentration) of separating gel solution. A reciprocal relationship was observed between gel buffer strength and the mobility of lipoproteins, especially of alpha-L lipoprotein. Staining of serum lipoproteins was performed in a gel tube by mixing serum samples with a solution of Sudan Black B in ethylene glycol. Sudan Black B solution may be premixed with sample gel solution. Instead of conventional large pore gel solution, a modified sample gel solution composed of sample gel components and Sudan Black B solution was found to be the most suitable for our purposes. Acrylamide gel concentration and the ratio of total volume of ethylene glycol to the total volume of sample gel components were important with respect to sample gel solution and sample gel layer formation. Adequate sample gel concentrations were from 3.2% to 3.6% when the ratio was kept within 0.60 to 0.75. Our results indicate that it may be feasible to develop acrylamide gel Disc electrophoresis for the routine clinical laboratory examination of human serum lipoproteins.

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Electron microscopic observation was made on the renal biopsy specimens of eleven cases of membranous nephropathy. The renal biopsy was performed successively following the course of the disease, and immunoprotein deposits at epithelial side of glomerular basement membrane and transformation of the basement membrane were analyzed in detail, and relations of pathological findings to clinical pictures were investigated. Following results are obtained that in clinically early and active stage, the deposits are homogeneous, compact and electrondense and attached directly to fused foot-process. Projections arising from the basement membrane invade the base of the deposits and partially surround them. In advanced and inactive stage, the deposits become granular and rarefied, and come to be absorbed and organized by fine fibrils originated from the surrounding projections. One layer of new basement membrane comes to be formed at the epithelial side of the deposits. Scarcely seen are the homogeneous, compact and electron-dense deposits attached directly to fused footprocess, which are found in early and active stage. In clinically advanced and still active stage, homogeneous and compact deposits are further seen at the epithelial side of already transformed basement membrane. In conclusion, the continuation of deposition of new immunoprotein at the epithelial side of the basement membrane, and injury and destruction of the basement membrane seem to be correlated to the increase of proteinuria; and the decrease of new deposits and the appearance. of newly formed basement membrane at the epithelial side seem to be correlated to the decrease of proteinuria.

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Concerning the relationship between the disturbance in pulmonary function after open heart surgery and changes in alveolar surface activity, the results of experimental and clinical studies are described. 1. In some patients with cardiac disease, the minimal surface tension was already slightly elevated before surgery. After operation, the markedly high value of 11.0 dynes/cm on the average was temporally obtained. 2. For the determination of surface tension measurement at 37°C is more profitable. 3. After I hour of complete extracorporeal circulation, the surface activity markedly fell, but a considerable decrease was noted even after simple thoracotomy. 4. After 24hours of IPPB, no remarkable change was seen in minimal surface tension. After 48 hours of IPPB, the markedly high value of 13.6 dynes/cm on the average was obtained. 5. The inhalation of lecithin through a nebulizer during IPPB improved the decreased pulmonary compliance and PaO₂ to some extent. 6. By the intravenous drip infusion of CDP-choline from immediately before the operation, throughout the operation to the postoperative period, a marked result on the maintenance of alveolar surface activity was achieved. The mechanism in the development of post-operative pulmonary insufficiency after open heart surgery, the influence of extracorporeal circulation and long term IPPB on pulmonary function, and the essence of preventive measures and postoperative management have been dis-cussed in outline.

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Adrenalectomy was performed on 20 cases diagnosed as primary aldosteronism on account of their complete conformity to Conn's new criteria and the results of clinical and biochemical examinations. Further, renal biopsy was performed on 15 of them. A single adrenocortical adenoma was found by gross observation in 12 out of the 20 cases (60%). Bilateral adrenocortical hyperplasia was found by pathohistological examination in 7 cases (35%) and in the remaining I case (5%) the adrenal cortex had almost normal appearance. Of the 12 macroscopical adenoma cases, by particular observation, 5 had an almost completely capsulated adenoma; abnormal findings of the renal tissue were not detected in these cases and the postoperative blood pressure recovered completely normal level. As to the other cases that had appeared as an adenoma to the naked eye, it was pathohistological, revealed that adenoma-like mass was continuous to the proper cortex to the adrenal and that hyperplasia was also present in the contralateral adrenal cortex, so these cases were regarded as adenomatous hyperplasia. The postoperative blood pressure was not restored to the normal level except in 3 of them, and sclerotic changes were markedly present in the afferent arteries of the kidney. Of the hyperplasia cases, 4 were found to have micronodular hyperplasia with marked sclerotic changes in the interlobular artery of the kidney, and normal blood pressure was not recovered in these cases except one. The remaining 3 were cases of diffuse hyperplasia; in 2 of them the renal arteries were almost normal and blood pressure was restored to the normal level. Pathohistological findings of the adenoma, adenomatous hyperplasia, and hyperplasia suggest the possibility of transition from hyperplasia to adenoma. It is conceivable that the changes in the renal tissue have a significant influence over the postoperative clinical improvement and normalization of blood pressure, and a part of differential diagnosis between primary aldosteronism and idiopathic aldosteronism.

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Presented here is the successfully corrected case of a four-year-old boy with congenital mitral insufficiency and ventricular septal defect associ-ated with pulmonary hypertension. The mechanism combining both lesions and the surgical treatment for mitral insufficiency in childhood are also discussed.

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