It is obvious that in the field of surgery the management before and after operation has a grest influence on the survival of the patient. As a step in such management the acid-base bal ance is considered to have a great bearing on the homeostasis of the body. In view of this, the author measured the humoral pH of the patients for the period of one week before and after operation with Astrup's microequipment to determine various values of the acid-bese balance. Simultaneously, measurements were taken of the circulating blood volume and Ht values of the same individuals, and in some cases the contents of Na, K, CI, lactate and pyruvate in their serum and urine were estimated.
As a result it was found that even in the case of acid-base imbalance postoperative metabolic acidosis has an important role in it. Especially low pH was observed in the cases of advanced age of 60 years, requiring more than 6 hours for operation of malignancy, and needing blood transfusion of over 1, 000 cc, that is, the greater was the surgical intervention, the more severe was postoperative metabolic acidosis. The circulating blood volume decreased immediately after operation, and taking a course similar to the change in the acid-base balance, it returned to the preoperative level in one week. Ht value also served as a good criterion for the circu lating blood volume. while the blood Na level declined after operation, the potassium and chl oride levels showed no appreciable change. Lactate and pyruvate increased immmediately after operation, but they returned to the preoperative level within 3 days.
Judging from these results, Lactate-Ringer solution was beter than 5% glucose solution for the transfusion during operation, especial effective was Lactate-Ringer solusion at pH 8.0 for the prevention of postoperative metabolic acidosis. In addition, from standpoint of mainten anee of the circulating blood volume, D40 Lactate-Ringer solution (Lactate-Ringer solution supplemented with low molecular Dextran) proved to be effective.
For the treatment of this metabolic acidosis THAM (Trishydroxy-methylaminomethane) was effective as reported by various authors. The metabolic acidosis in 2 or 3 days was not so severe as to require any correction.

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We have studied 65 patients, who were treated with Bleomycin in this hospital, with regard to the pulmonary disorders induced by Bleomycin, and obtained the following results. Their early diagnosis and prevention were also discussed.
1) Pulmonary disorders, as side effects of Bleomycin, were recorded in 8 out of 65 cases (12%). They developed in the relatively old patients. The patients under 49 years old had no pulmonary disorders. There was no strict correlation between the development of side effects and the drug dose or the duration of administration.
2) The patients frequently had the subjective symptoms such as cough, sputum, and dyspnea. As for humoral factors, α₁-acid glycoprotein and fibrinogen tended to show their high levels. Roentgenographically, the six cases revealed mainly funicular or patchy shadows in the lung field and the two, mainly fibrous reticular shadows.
3) Two of the patients with pulmonary disorders had previous lung diseases. The pulmonary disorders developed more frequently in the cases where the other anticancer drugs were used before and after the administration of Bleomycin. The disorders tended to appear frequently in the cases of malignant lymphoma.
4) The results shown above indicate that administration of Bleomycin requires careful consideration of its indication. It may be better to perform periobically chest roentgenography or pulmonary function test. When the development of pulmonary symptoms are detected, administration of Bleomycin should be discontinued immediately. Furthermore, it may be desirable to use, if possible, the fibroblast inhibiting agents together with Bleomycin.

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We have succeeded in inducing pulmonary disorders in mice and rabbits by administering Bleomycin. The following conclusions were obtained from microscopic and electronmicroscopic observation.
1) Pulmonary disorders could be induced in two different species of animals, mice and rabbits. The histological changes consisted of hypertrophy of the alveolar septum, precipitation of fibrin, proliferating tendency of the bronchiolar epithelium, and septal interstitial cellular infiltration. These changes were found to be localized initially under the pleura and appeared to proceed diffusely into the deep region of the lung.
2) The present findings suggested, as for the mechanism for development of pulmonary disorders, that Bleomycin gives vascular endothelial cells direct damages which increase the permeability of the blood vessels. Then the alveolar space and interstice begin to contain the protein-rich exsudate owing to the increased vascular permeability. Disturbance of absorption would cause fibrotic changes. Additional bacterial infection would sometimes further increase vascular permeability and make the histological pictures appear to be more complicated.

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We have used fibroblast-inhibiting agents, chloroquine and prednisolone, together with Bleomycin to prevent pulmonary disorders induced by Bleomycin in mice, and have obtained the following satisfactory results.
In the group to which eitheer of the fibroblast-inhibiting agents was administered together with Bleomycin, as compared with the control group to which Bleomycin alone was adminstered, hypertrophy of the alveolar septum, emergence of foamy cells and cellular infiltration were slight with no atypical proliferation of the bronchiolar epithelium, and the pulmonary structures were well maintained. As for the mechanism of such inhibition by chloroquine or prednisolone, their antiinflammatory effect around the pulmonary vascular endothelum or fibroblast-inhibiting action would be considered to be important. Further studies may be needed to clarify this point.

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The present study has been conducted by gaschromatography to determine the compositions of total plasma fatty acid in liver diseases. The subjects studied comprised 73 cases of various liver diseases, 10 cases of diabetes mellitus and 10 normal persons. The results obtained by this study are summarized as follows:
1. The compositions of total plasma fatty acid in the cases with jaundice were almost similar to those without jaundice; namely, an increase in palmitate, palmitoleate and oleate, and a decrease in linoleate.
2. The level of palmitoleate increased remarkably in all liver diseases, although it remained unchanged in diabetes mellitus. It is interest that an increased level of palmitoleate related to the extent of liver injuries, such as acute stadium of acute hepatitis> obstructive jaundice> active form of chronic hepatitis> fatty liver> convalescent stadium of acute hepatitis> inactive form of chronic hepatitis> Gilbert's disease. The increases in the palmitoleate was found in liver cirrhosis in order of cases with normal Glucose Tolerance Test (GTT), those showing abnormal GTT and those comlicated with primary diabetes. In contrast with cirrhosis, palmitoleate levels in active form of chronic hepatitis without diabetes mellitus could not be distinguishable from that with diabetes mellitus.
Liver diseases as well as severe diabetes mellitus showed an increase in palmitate and oleate and a decrease in linoleate and L/O ratio.
The decreased levels of arachidonate in acute hepatitis, and their increases in chronic hepatitis and fatty liver appeared to be characteristic. No change was found, however, in mild diabetes mellitus.
3. The increased levels of palmitoleate was found in the acute hepatitis of which liver function was normalized, but still remained abnormally high even when liver function test became complitely normal. However, some acute hepatitis showing abnormal liver function test and most of chronic hepatitis always showed abnormally high level of palmitoleate through the courses. In the biliary cirrhosis due to choledocus carcinoma, palmitoleate increased remarkably as the liver function grew worse.
4. Palmitate and linoleate had the positive and negative correlation, respectively, to serum total lipid in the cases without jaundice.
5. The high concentration of total lipid in serum was observed in acute hepatitis, obstructive jaundice, liver cirrhosis complicated with primary diabetes and sever diabetes.
6. Cholestyramine was given in 4 cases of jaundice, but no change in the compositions of total plasma fatty acid occurred.
7. Any detectable alteration in both the fatty acid synthesis and its oxidation using liver tissues obtained by needle biopsy from 7 cases without jaundice was not found.

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Gaschromatographic observatons of the quantities and the compositions of fatty acids in liver tissues were carried out of rats injured by carbon tetrachloride after feeding on free fat diet to investigate the effects of ethyl-linoleate administration with and without 29.6% γ-linolenate on injured liver.
The results were as follows:
1. Arachidonate in phospholipid fraction of the control group increased two days after linoleate or γ-linolenate administrations. After eleven days this increased level of arachidonate was corresponded to two and three times of the control value respectively. Whereas in the carbon tetrachloride injected rats no increased synthesis of arachidonate could be observed two days after that treatment. Two fold increased synthesis of arachidonate was found, however, eleven days after the carbon tetrachloride treatment in the group with the linoleate or the γ-linolenate, and there were no differences in the both groups.
2. Palmitoleate and oleate in triglyceride fraction and cholesterolester fraction increased markedly at the regenerating stage in injured livers rather than the sever damaged stage. Other endogenous fatty acids as well as these fatty acids decreased below 50% by administration of these highly unsaturated fatty acids.
3. Fatty acid in phospholipid fraction was found to be about equal quantity in each group. On the other hand, in unsaturated fatty acids treated group, palmitoleate and oleate decreased with the simultaneous increase of linoleate and arachidonate.
4. Fatty acid in tryglyceride fraction, fatty acid in cholesterolester fraction and total fatty acid increased more remarked in the carbon tetrachloride treated group. These levels were decreased, however, 50% by the administration of highly unsaturated fatty acids, and such administration markedly inhibited the increase of these fatty acids.
5. From these findings the preventive effects of linoleate and γ-linolenate on carbon tetrachloride induced fatty liver might be explained as that the intrahepatic increase of administrated these fatty acids depressed the inflow of FFA into the liver tissues from peripheral fat tissues and the sequential synthesis of arachidonate accelerated the synthesis and secretion of lipoproteins.

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One of common factors of bleeding tendency during and after extracorporeal circulation is due to fibrinolysis. Moreover, it is a well known fact that kinin-system, which is activated by fifibrinolysis, Hageman factor, trypsin and tissue activator, is responsible for pathological changes of hemodynamics in shock, inflammation, pancreatitis etc.
Therefore, it would readily be conceivable that kinin-system was also activated by extracorporeal circulation through the activation of fibrinolysis and Hageman factor, since extracorporeal circulation activates fibrinolysis and Hageman factor.
This study is to report activations of kinin-system in 37 patients who underwent open heart surgery by determing plasma kininogen (kinin precursor).
The results obtained were as follows:
1. Activation of fibrinolysis during and shortly after extracorporeal circulation was observed.
2. Plasma kininogen was markedly reduced during extracorporeal circulation and resumed to normal after extracorporeal circulation, which would be suggestive of release of kinin.
3. AMCHA (50mg/kg) inhibited fibrinolysis due to extracorporeal circulation and fibrinolysis returned to normal 180min. post-operatively.
4. Trasylol of 10, 000units per kilogram was equivalent to AMCHA of 100, 000units for a child and 200, 000units for an abult were often suboptimal.
5. Trasylol was also effective in suppressing occurrence of kinin activation.

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Clinical examinations were performed in 1969 on patients with allergic occupational asthma caused by inhaling the body fluid of sea-squirts attaching to the shell of cultured oyster.
The allergic symptoms caused by inhaling the body fluid of sea-squirts were rhinitis, conjunctivitis, bronchitis and bronchial asthma. The sea-squirt asthma was observed in 43 out of 201 oyster shuckers. Positive skin test was seen in 95.2% of 21 cases with sea-squirt asthma. And Prausnitz-Küstner reaction of the asthma was observed in 10 out of 11 cases. Obstrutive disturbance in lung function tests was shown only in a few cases because examination was performed in resting intervals and the subjects were of old age. It is clear that there is a close relation between basophils and allergic reaction caused by sea-squirt asthma as shown by an increase of basophils in the pre-attack stage of working periods.

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Alkaline phosphatase (ALP), glutamic oxaloacetic trans-aminase (GOT), glutamic pyruvic transaminase (GPT), isocitratedehydrogenase (ICDH), glutamate dehdrogenase (GDH), glucose-6-phosphatase (G-6-Pase) and bilirubin were assayed using the sera obtained from the dogs with bile duct ligation as well as the patients obstructive Jaundice.
The influence of bile acid on enzyme release from the liver tissue was examined. Following Perfusion of the dog liver with a solution containing bile acid, the liver slices were prepared. The sliced materials were incubated into Krebs-Ringer's solution for a certain period, and the enzymatic activities in the medium as well as the oxygen consumption in the slices were measured.
1. The serum bilirubin level started to increase 2 days after the ligature and reached to a maximum level 4 days after the operation, which was followed by gradual decrease.
2. The activities of all the serum engymes estimated in the dog rised 6 to 12 hours before the elevation of serum bilirubin, especially the increase in activities of GDH, ICDH and GOT appeared to be earlier than those in G-6-Pase and GOT. Out of all the engymes mitochondrial GDH and cyto-plasmic GPT showed the most remarkable increase.
3. The histological changes of the ligated liver such as degeneration or necrosis remained to a minimum extent over the period of increase in the serum engyme activities.
4. In the serum obtained from the patients with obstructive jaundice the increase in activities of mitochondrial GDH and microsomal G-6-Pase was prominent.
5. When the liver slices perfused with bile acid solution were incubated into Krebs-Ringer's solution, the release of GDH and G-6-Pase into the medium was accelerated selectively, accompanying the diminished oxygen consumption in the liver tissue. This result seems to suggest that bile acid may influence the elevation of the serum engymes in the case of obstructive jaundice.

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Transaminases GOT, GPT) purified partially from the dog liver were seperately injected into the vein of normal dogs.
Following the injection the engyme levels in the blood and bile were measured.
1. The disappearance of the exogenous serum GOT was more rapid than that of GPT after the administration, and the half-life of GOT in the circulation was estimated to be approximately 6 hours.
2. In the lymphatic fluid the activities of the exogenous GOT and GPT increased immediately after the injection and reached to the similar levels with the serum activities 7 hours after the injection, then both activities decreased in a parallel manner, showing a little higher levels in the lymphatic fluid than those in the bile.
3. In the bile the activities of GOT and GPT elevated very slightly following the injection and GOT appered to be excreated more easily than GPT.

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