The neonatal changes of digoxin-like immunoreactive substance (DLIS) in the sera from 15 preterm and 7 term infants, the immunological specificity of DLIS, and the relationship between DLIS levels and sodium excretion from the kidney were observed. The natriuretic activity of DLIS extract prepared from cord blood of healthy full-term infants by acetone-HCl extraction and a gel column was also examined by the rat renal artery perfusion method and the following results were obtained.
(1) The immunological specificity and accuracy of the detection of DLIS was confirmed by a sample dilution test, a recovery test for standard digoxin, and an absorption test with antidigoxin antiserum.
(2) The gestational age was smaller, the serum DLIS level was higher and there was a negative correlation between peak DLIS and gestational age (r=-0.73, P<0.001).
(3) Serum DLIS levels and fractional sodium excretion (FENa). There was a statistically significant positive correlation between (r=0.35, P<0.05).
(4) The injection of DLIS extracts into renal arteries of rats increased urinary sodium excretion to levels two or three times higher than that of the pre-infusion period (P<0.05).
These findings led to the conclusion that DLIS might be one of the natriuretic substances in the neonatal period.

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Plasma levels of atrial natriuretic peptide (ANP) were determined in eight patients with cardiac impairment after open heart surgery. Catheters were placed in the coronary sinus and exteriorized through the subclavian vein in seven patients during the surgery. After the operation, a Swan-Ganz catheter was inserted, and one catheter each was placed in the peripheral artery and urinary bladder. Right atrial pressure (RAP) and pulmonary artery wedge pressure (PAWP) were measured at 10 : 00 p.m. on the day of the operation and at 10 : 00 a.m. on the following day. When measurements of atrial pressure were performed, blood was obtained for determinations of plasma level of ANP, plasma renin activity (PRA) and plasma aldosterone concentration (PAC). Urine was collected from 0 : 00 a.m. after the operation for 10 hours, and parameters of renal function were measured, including creatinine clearance (Ccr), free water clearance (FWC) and fractional excretion of sodium (FENa).
Plasma concentrations of ANP correlated significantly (p<0.05) with PAWP, but not with RAP, PRA, PAC, Ccr, FWC or FENa. There was a significant (r=0.82, p<0.05) correlation between ANP levels in coronary sinus and peripheral artery the former was four times higher (p<0.05) than the latter.
These findings suggest an important role of left atrial pressure in the release of ANP in patients with cardiac impairment due to open heart surgery. The high concentration of ANP in coronary sinus in the present study supports the consideration that ANP synthesized in the atria enters into circulation through the coronary sinus.

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Ventricular septal defect (VSD), which is one of the most common cardiac malformations, sometimes leads to aortic regurgitation (AR). In this study, several conditions related to occurrence of AR were analyzed on the basis of 184 operated cases.
1) VSD was divided into the following three types ;
supracrystal type without (Ia) and with clonal muscular rim (Ib), and membranous type (II), which accounted for 26%, 6% and 68% of cases, respectively.
2) The frequency of abnormal aortic cusps in each of the three types was 67%, 18% and 6%, respectively, and there was a significant difference between types Ia and II (p < 0.01).
3) According to the cumulative curve of the occurrence of abnormal aortic cusps and AR, the 50th percentile for the former was 10 years of age, that for the later 13 years.
4) There was no relationship between the frequency of abnormal aortic cusps and the size of VSD.
5) Spontaneous closure of VSD was thought to occur in many cases between 6 and 15 years of age.
6) Concerning the operative indications for VSD Ia, the following conclusions were obtained : i) Cases with AR should undergo the radical operation regardless of stage or age. ii) In cases without AR, patients over 10 years old should undergo the operation.
However, operation for patients under 10 years old should be decided with reference to the progression of cusp abnormality and the occurrence of spontaneous closure.

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During the past four years, nine patients with liver cell carcinoma have been treated at first Department of Surgery, Gunma University and its related hospitals. Out of nine patients, seven patients had liver cirrhosis, one had chronic hepatitis and the other with a normal liver served as a control. The dynamic changes in 25 indices of liver function were investigated in the five patients who were treated at Gunma University. On the preoperative examinations, extreme abnormalities in the results of ICG-Rmax, OGTT, LAP and GTP tests were observed, particularly in those who died. Among the results of postoperative examinations, remarkable abnormalities were observed in T-Bi, TTT, ZTT, Ch-E, A/G, Plt and total cholesterol in the cases with liver cell carcinoma combined with liver cirrhosis.
It is felt that a more effective method to measure the total liver function change should be developed.

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Protein-free cell culture was performed on Dunn's osteosarcoma (clone-14). The number of viable cells of clone-14 decreased linearly in the logarithmic scale. L-glutamine, glucose and folinic acid suppressed the decrease in cell number. Alkaline phosphatase activity of the medium increased with the addition of glucose and folinic acid. An increase in the specific activity of the enzyme with the addition of glucose and folinic acid was demonstrated by measuring the protein concentration of the media. In comparison, L-glutamine suppressed the increase in protein concentration and alkaline phosphatase activity of the media. These data indicate that these substances change the metabolism of the osteosarcoma clone.

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Of 116 patients with primary carcinoma of the esophagus admitted to Second Department of Surgery, Gunma University Hospital, during the period from 1969 to 1986, 79 patients (68.1%) underwent subtotal esophagectomy with an operative mortality of 12.6%. The cumulative 5-year survival rate of the resected cases was 30%.
The average survival period of the non-resected cases was 5.2 months. Patients with small carcinoma, i.e., less than 4 cm in length, had the most favorable prognosis, showing a 5-year cumulative survival rate of 61.5%.

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Between January 1982 and June 1986, 32 patients with primary hepatic tumors were seen in the First Department of Surgery, Gunma University School of Medicine. Twenty-seven had hepatocellular carcinoma, one cholangiocellular carcinoma and four hepatoblastoma. Ages ranged from 2 months to 76 years, with an average of 52.7 years. The male to female ratio was 26/6. Twenty-one patients (78%) had cirrhosis, and HBs-antigen was positive in four (15%). Serum α-fetoprotein level was positive in 25 patients (92%). Of the 32 cases, one was treated with trisegmentectomy, five cases with lobectomy, two with subsegmentectomy and one with wedge resection. Among nine patients who underwent hepatic resection, seven patients are still alive. One of 27 cases of hepatocellular carcinoma survived 2 years and 8 months after hepatic lobectomy. The 1-, 2-and 3-year survival rates were 66%, 50% and 50%, respectively.
From our clinical study, it was concluded that early detection and complete removal of tumor are essential to improve the prognosis of primary hepatic tumors.

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