肺癌症例の増加に伴って手術症例も増し,その成績も年々向上しつつある現況であるが,なお早期での手術症例数は必ずしも多いとはいえず,高齢者(70歳以上)手術や皿期以上の進行肺癌例の手術ことに癌浸潤のある周囲組織・臓器を同時に合併切除する拡大手術がむしろ増加しているのも現況である.
ここでは過去約20年間に教室で取扱った1300例以上の手術症例を主として,その外科治療成績を検討しながら現在の肺癌の外科療法について紹介した.早期の肺癌では5年生存率が75%以上の成績がえられ,ほぼ完全に治癒しうるともいえるが,進行肺癌では拡大手術を行って手術の根治性を高めようと努めても,また,外科療法に化学療法,照射療法,免疫療法などを組合せた多角的集学的治療を行っても,なお充分な治療成績を挙げるに至ってはいない.
このような肺癌治療の現在の成績を考慮しながら,将来の展望にっいても若干言及した.

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Organ transplantation is recently drawing public attention. Working in a facility where many brain dead cases occur, we cannot be indifferent to organ transplantation. Our center began to provide kidneys obtained just after brain de ad patient heart stoppage in May 1988. We have provided the kidneys from nine brain dead patients in the period from May 1988 to September 1989. In the present paper, we report problems found in the nine cases and discuss the present status and future of renal transplantation.
Both hemodialysis and renal transplantation are believed to be equally essential for treatment of chronic renal failure. In Japan, however, the proportion of renal transplantation in the treatment of chronic renal failure is much lower than that of many foreign countries. In addition, kidneys provided by dead donors account for only 30% of total kidneys used in transplantation.
Renal transplantation is a radical treatment form for chronic renal failure. We believe that the promotion of renal transplantation, transplantation using kidneys provided by dead donors in particular, will be a great boon for patientswith renal failure.

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Hyperasialoglycoproteinemia is observed in galactosamine-treated rats. I studied the effects of galactosamine on biosynthesis and secretion of rat plasma glycoproteins in order to obtein the information on mechanism of hyperasialoglycoproteinemia. The administration of a large amount of galactosamine to rats resulted in marked elevation of values of GOT, GPT and serum asialoglycoproteins, and decrease of serum total protein and hepatic asialoglycoprotein receptor. The amount and rate of incorporation of leucine and mannose into plasmatransferin and total protein were inhibited by 85^-90% on first and third day after galactosamine injection. Amino acid incorporation into these proteins returned to normal on fifth days, in contrast, mannose incorporation remained 50% reduction of normal on fifth day. The ratio of high mannose type to compley type in carbohydrate chains of plasma glycoproteins of normal rats and those on fifth day after injection was 94.5: 5.5 and 97.5: 2.5, respectively. The ratio of N-acetylglucosamine tosialic acid of the former was as same asthat of the latter.
From these results, I concluded as follows.
1. Most of biosynthesis and secretio n of plasma glycoproteins stopped on first and third day after galactosamine injection.
2. On fifth day, partia l glycosylated plasma glycoproteins were observed in the circulatin, but their carbohydrate chains were processed normally.
Therefore, pathogenesis of hyperasialoglycopro teinemia in galactosamine hepatitis was not secretion of plasma glycoproteins with abnormal carbohydrate chains but decrease of asialoglycoprotein receptor in liver.

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Glucose metabolism in patients with chronic liver disease was examined through the kinetics of insulin (IRI), glucagon (IRG) and somatostatin (SRIF) during a 75g oral glucouse tolerance test (OGTT)
The following results were obtained:
1) Chronic liver diseases were frequ ently associated with impaired glucouse tolerance; it was seen in 88% of the liver cirrhosis (LC) group,75% of the chronic active hepatitis (CAH) group and 42% of the chronic inactive hepatitis (CIH) group; parti c u larly,44% of the LC patients exhibited a diabetic-type curve.
2) As to the hormones involved in chronic liver diseas e, delayed overresponse of IRI was observed in all groups, which was most prominently in the LC group. IRG suppress i o n by glucouse administration was reduced in all groups; the LC patients show e d delayed overresponse, and the chronic hepatitis patients a slight overresponse. Of S RIF, delayed overresponse was noted in the LC patients and a slight overresponse i n the chronic hepatitis patients. The increase in SRIF was less than that in IRI or IR G. However, thease three hormones increased with the progression of disease; t h e highest levels were seen in LC, fllowed by CAH and CIH.
3) As to the IRI/IRG (I/G) molar ratio, IRG initially pred ominated in the LC group, but IRI was always high in the CAH and CIH groups. As to the IRI/SRIF (I/S) mo l a r ratio, SRIF was initially predominant in all groups, especially in the LC group. By glucouse tolerability, JIG and I/S molar ratios of the diabetic type were simillar t o those of LC.
4) As to co rreration between each of these hormones and liver function parameters reflecting liver reserve capacity, significant correlations (p<0.01) were obserbed between IRI and Alb., between IRG and ICG-R15, Alb. or E/T, and betwe e n SRIF and ICG-R₁₅, Alb., ChE or BCAA/AAA in the LC group. SRIF correlated with a greater number of parameters than did IRI or IRG.
These resuluts verify that chronic liver disease accom pany hypersomatostatinemia as well as hyperinsulinemia and hyperglucagonemia. Hyperinsulinemia seems attributable to reduced hepatic insulin degradation, excessive secretion of insulin from pancreatic B cells and lowered sensitivity of insulin in the target organs. Hyperglucagonemia seems due to hypersecretion of glucagon from pancreatic A cells and reduced degradation of injured hepatic cells. Hypersomatostatinemia, insofar as can be concluded from the data in this study, is most likely to result from a decrease of degradation of injured hepatic cells, although there is the possibility that it may arise from excessive release of somatostatin from pancreatic D cells or the involvements of hyperinsulinemia and hyperglucagonemia.

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Dibutyryl cyclic-AMP (DBc-AMP), one of the cyclic-AMP analogs, reportedly passes through cell membranes comparatively easily and directly, without β-receptor intervention, and has a physiological activity similar to that of cyclic-AMP. DBc-AMP is regarded as useful for the metabolic improvement of energy because it has the effect of increasing glucose metabolism, in such processes as glycogenolysis, glycolysis and insulin secretion.

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With the wide use of diphenylhydantoin (DPH) for controlling convulsive disorders, associated side effects have been observed. We presented a case of 57-year old woman who developed severe anemia due to pure red cell aplasia after repeated injections of DPH for controlling her status epilepticus following head trauma. It is reported that anemia improves after discontinuation of DPH. In our case, however, patient's anemia was persistent because of secondary renal dysfunction in spite of stopping of DPH. Our experience taught us that DPH was neither indicated nor adequate for controlling seizures or status epilepticus.

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