This review of clinical preanesthetic assessment of surgical patient was designed to help not only the anesthesiologist but also all medical colleagues.
Today, many kinds of assessment technique for all organ are available, but often neglected. The present papar is a discussion of some of practical point which should be done as a preanestheticassessment of respiratory, cardiac, liver and kidney functions.Practical points of preanestheticevaluation are includ:
(1) family history, past history and present history.
(2) physical examination.
(3) laboratory tests.
Laboratory test should include:
(1) blood: type, WR, WBC, RBC, Hb, Hct, Platlet, bleeding time, clotting time and HBantigen and antibody.
(2) urine: urine volume/day, SG, protein and glucose.
(3) blood chemistry: serum glucose, TP, A/G, BUN, Na, K, Cl, SGOT, SGPT, LDH, BSP, Al-P and CPK.
(4) lung function test: VC, V_T, FEV₁ RR and blood gas if necessary.
(5) chest X-ray.
(6) ECG.
It should be emphasized that a precise assessment of all organ function is not alway possiblebecause of the uncertainties of intra-anesthetic management as a result of unanticipated surgicalproblems that may adversely affect all organ functions.

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The in vitro blast transformation response of lymphocytes to mitogens (PHA, Con A and LPS) and changes in the T and B cells proportion were investigated in the time course of theguinea pig pregnancy. The effects of pregnant guinea pig serum in mitogen-stimulated normalguinea pig lymphocyte cultures w ere also studied.
The result obtained are as follows:
1) The responses of the peripheral lymphocytes in the spleen and lymph nodes of theguinea pig to PHA and Con A were remarkably enhancing at the early and middle stages ofpregnancy, but they were remarkably decreasing at the end stage and delivery.
2) The numbers of RRBC -and EAC-rosette forming cells in the spleen and lymph nodesat the pregnancy of guinea pig were counted.The T cell proportion in the spleen and lymphnodes showed a tendency to decrease during the pregnancy and to decrease remarkably at thedelivery.The B cell proportion did not show such a change as in the spleen and lymph nodes.
3) It was shown by the measurement of ³H-thymidine incorporation that the guinea pigsera of the early and middle stage in the pregnancy remarkably inhibited the response of thenormal guinea pig lymphocyte to Con A.

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Recently, macrophages requirement for immune responses in guinea pig has been studied. The macrophage-lymphocyte interaction and the change of intracellular cAMP levels of thesecells on immune response has been reported. However, the details of this mechanisms are notyet clarified.
The changes of intracellular cAMP levels of lymphocytes subpopulation especially T cellsof the guinea pig were measured after addition of isoproterenol and theophyllin. Furthermore, at the same time, the effect of macrophages upon T cell cAMP levels were studied.The resultsobtained were as follows.
1) The cAMP levels of the T cells purified from the lymph node cell suspension by passingthrough glass wool column and nylon wool column did not change by the addition of isoproterenolor theophyllin.
2) If purified T cell population were initially interacted with macrophages, the cAMPlevels of the cell population were observed to be increased by the addition of isoproterenol ortheophyllin.
3) From this experiment it was clarified that the interaction between T cells and macrophageswas necessary for the increase of intracellular cAMP in T cells.However, further investigationis necessary whether it may depend on the direct contact of T cells with macrophagesor on some factor (s) released from macrophages to T cells after interaction between these cells.

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Vitamin E is well recognized to act as a very versatile reagent for facilitating fertilization. Recently, particular attention has been focussed on the fact that Vitamin deficient subjects maydisplay changes quite similar to those described in cases of aged subjects.
From this view-point the author has investigated the testis and skeletal muscles of Vitamin E deficient rats and aged group, and has compared their histo-pathological changes.
In the testicular tissue, the decrease of spermatocyte, sperm, and number of Leydig cells Were observed the hyalinosis of the basal lamina of seminiferous tubules Was very striking. Moreover, proliferation of multinuclear giant cells which might be derived from spermatocytesand reserved Sertori cells were not unfrequently observed.It is noteworthy that hyaline degenerationof the basal lamina of tubules in the aged group constitute one of the conspicuousfeatures.
In the m. gastrocnemius of experimental rats, uneven atrophic and degenerative changeswere observed associated with occasional floccular degeneration, increase of number of nuclei, non-reactive necrotic change, and proliferation of reticulin fibers. The muscular degenerationand atrophy are justifiable as the process resembling the dystrophic changes of the muscle, andobviously different from the neurogenic atrophy of the muscle which is documented as the groupatrophy of muscles.
There are many similarities between Vitamin E deficiency changes and that of aging. Vitamin E is regarded as an anti-oxidative agent, and its deficiency may lead to peroxidation of thecytomembrane which eventually may cause extensive degenerative changes of the cell.
From the above, the author has concluded that further detailed investigation of the biologicalaction of Vitamin E on various tissue injury and aging, may provide a clue to the understandingof the phenomenon of aging.

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Four hundred preparations of lumbar arteries from fifty fetuses (6-10m.) were macroscopically studied. In order to investigate the origin, course and branching of the vessels, corrosioncasting method with synthetic rubber was used.
The main findings are as follows:
1) More than half of the 1st and 2nd lumbar arteries arise from abdominal aortae about atthe level of the middle part of each vertebral body. Most of the 3rd lumbar arteries arise atthe level of cranial part of the 3rd vertebral body and most of the 4th at the level of the 3rdlumbar intervertebral space.
2) In the 1st and 2nd lumbar arteries, more than 70% of the right side arteries arise higherthan the left side.
3) In 11.1% of the cases, the both side arteries form the common trunks.
4) Most of the upper (1st and 2nd) lumbar arteries pass along the antero-lateral surfaceof the vertebral body horizontally, while most cases of the lower (3rd and 4th) lumbar arteriespass downwards.
5) Of the stems, proximal to the primary divesion, which have 6 to 16 small branches, islonger the right side than left side in more than 80% of the cases.
6) In 51% of the cases, the spinal branches arise from the proximal site, in 24% from thesite and in 25% from the distal site of the primary division of the stem, respectively.
7) The width of the ramus ventralis is equal to the ramus dorsalis in more than 79% ofthe cases.

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As a method of searching the pathosis of gastrointestinal mucosa, the electrical potential difference (hereinafter referred to as PD) was measured inductively in the upper gastrointestinal tract and the lower colon and from which some views were obtained at the same time. In this study, the probe electrode was attached to the gastrointestinal mucosa under direct vision by way of endoscope, which enabled this method to be put into practice and the reference electrode was placed on the small papula previously injected intradermally with physiological saline.
The PD of the gastrointestinal mucosa of the normal group by this method was -23. 2±9. 4mV in the esophagus, -30. 5±7. 9mV in the greater curvature of the gastric body, -24. 6±7. 4 mV in the greater curvature of the pyloric antrum, -3.3+1. 8mV in the duodenal bulb, and -34. 5±7. 1mV in the lower colon. It was noted that, with significant decrease in primary aldosteronism after enucleation of adrenal adenoma and with remarkable decrease in ulcerative colitis in the aggravating period, the PD was reversed to the electrically positive side. It was indicated that the PD was the lowest in the crater and also low in the infiltrative region of carcinoma of the colon. In the continuous PD record of gastric ulcer and gastric carcinoma, a similar pattern was observed, in which the PD in the infiltrative region of gastric carcinoma indicated a low value. In this manner, there is a fluctuation of the PD according to each disease, which will be useful in aid of the clinical diagnosis. Further, although there was no macroscopic change under the influence of mucosal injury factors (Aspirin, Alcohol) on gastric mucosa, the PD decreased rapidly and remarkably. Thus, it is considered that the PD may become a sensitive indicator of mucosal injury.

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A local injection therapy of Bleomycin has been performed to the 24 brain tumors as a supplementary therapy. Then its effects and pathological findings are reported. In the cases ended up with subtotal or partial removal, On-unaya's device was detained in the tumor bed or cyst, and the specific abovementioned therapy was started on the 7th day when the postoperative condition was stabilized.
On an averege from 0.1mg/kg to 0.2mg/kg of Bleomycin was injected by percutaneous puncture into its reservoir every other day. To the malignant gliomas, Co⁵⁰ irradiation and vaccination (SSM) were used together with this therapy. In 4 of 5 craniopharyngioma and one recurrent oligodendroglioma, the remarkable clinical effects have been obtained. But only one case of paracellal meningioma was not showed on clinical effects.As for intraventricle tumors, Bleomycin was injected through the V-A shunt valve, but the therapy was not successful and the patients died after the recurrence.
On the other hand, most of the patients with the malignant gliomas died due to their recurrences about one year or so in spite of temporary clinical improvements.But each case of reticulum cell sarcoma and medulloblastoma survived longer.From the 13 autopsied cases of malignant gliomas, the similar pathological findings were obtained around the tumor bed. On the macroscopical findings, hemorrhagic infarction is shown from the convexity to the depth of the white matter, and in the deeper part, the tumor tissues were actively increasing. On the microscopical findings of necrotic tissues, there are hyaline fibrous membrane, fibrin, severe coagulation necrosis of tumor cells with hemorrhage, increasing capillary vessels, and infiltrating lymphocytes and granulocytes.
Consequently, the scintillation scanning of Bleomycin labeled Co⁵⁷ was utilized to study the state of widespreading and invading in the three patients of glioblastoma along with the same injection method. Bleomycin labeled Co⁵⁷ was still stated into the tumor bed at the 8th day after the injection.
In the pathological and radiological findings, it was estimated that the tumor cells were almost necrosed tissues by the injected Bleomycin in the easy stage, but in due time, the fibrous tissues were formed.
For this reason, the Bleomycin was not enable to invade into the deep tumor cells, and the efficacy could not be exhibited enough.
In conclusion, I realize that the subtotal removal must be performed on gliomas before introducing this local injection therapy, because I could have Bleomycin invade into the rest of tumor cells.

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