1. On endoscopical observation of the prognosis, variolif orm erosions, characterized by a swollen bulging border with central defect, are classified as disappearing type (gastritis erosiva) and continuous type (gastritis verrucosa). 2. The duration, in disappearing types, usually did not exceed three months. While continuous types persisted longer for forty-five months as the longest time. 3. Endoscopical features ; (a) Disappearing type. The swollen border protrudes less and gradually and its central defect is shallow and wide compaired with the bulging border. (b) Continuous type. The swollen border protrudes sharply, relatively high. Its central defect is small and sharply. bordered. 4. Seasonal appearance : The onset of disappearing types is most frequent on April and October. While continuous types appear every season, though it has peak in October. 5. Age and Incidence; Disappearing types are most often at 30-39 years old, while continuous at 40-49. G. With the advancement of age, the region where both types appear spreads upward like atrophic pattern in gastric mucosae. 7. Endoscopically, continuous types may be classified four types-Type (a)(variolif orm), Type (b) (polypoid), Type (c) (meanderling) and Type (d) (sausage-like). Type (c) and (d) though they are few, have to be differentially diagnosed from early gastric cancer as II a+II c or I type. 8. Bioptical and histological findings ; (a) Gastritis verrucosa at the pyloric glands region-Pyloric gland hyperplasia is predominant and, at the bottom of the erosions, indifferent cell metaplasia is found. (b) Gastritis verrucosa at the body glands region-Foveolar hyperplasia is predominant and sometimes one may find f oveolar irregular erlongation and cystic formation. (c) Disappearing type (gastritis erosiva) -Inflammatoty cellular infiltration with some foveolar hyperplasia is predominant. 9. The difference of the gastric secretory function between those two types by the standard histalog test (Histalog lmg/kg or 50mg). (I) Compared with transient types and persistent types appeared in the same region of the stomach, the former shows higher average than the latter in basal secretion (BSVR, BAO) and stimulated secretion (SVR, AO). (II) Persistent types (gastritis verrucosa)……(1) Persistent types localized in pyloric region show higher average than those spreading to fundic region in both basal secretion and stimulated one. (2) Persistent types with central depression show higher level than those without central depression in basal secretion and stimulated one. Then we can say as follows : persistent types with central depression is in active stage and those with none is in inactive stage. (III) Transient types (gastritis erosiva)… In the same cases, stimulated secretion at the appearing phase of gastritis erosiva is nearly the same as at the disappearing phase. On the other hand, basal secretion (BSVR, BAO) at the appearing phase shows remarkably high level but at the disappearing phase extremely low. So we can guess that transient types are acute phase of gastritis with variolif orm erosions from the gastric secretory study. This fact was confirmed by histological study of gastric mucosa obtained under direct visual biopsy and resected stomach.

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We applicated dye scattering method of methylene blue solution in 31 cases, indigocarmine one in 19 cases and Lugol's one in 124 cases, to the esophagoscopy for the description of fine uneveness of the esophageal epithelium and the supplemental endoscopic diagnosis of esophageal diseases. The obtained results were as follows; 1) By means of scattering the blue dye solution to the esophageal epithelium, we could clearly observed fine granular changes of esophageal epithelium in 16 cases (84.2%) among 19 scattered ones, and we could easily diagnose granular lesions, leucoplakia and II c type lesion of minute cancer with the aid of biopsy examination. Furthermore, this method clarified transparent blood vessels of submucosal layer through the epithelium in almost cases, esophagogastric junction in 7 cases and linear redness of epithelium in 5 cases. 2) We confirmed that Lugol's solution dyes the esophageal epithelium to brown and silk crape formed epithelium, from the results of animal experiments and microscopic investigation of frozen biopsy materials taken from the stained esophageal epithelium. 3) Whitisch granula and leucoplakia were dyed in black brown by this method, by which we could observe more clearly whitisch granula of the esophagus in 68 cases (74.7%) among 91 scattered ones than routine endoscopy. 4) Lugol's solution could not dye the cancerous lesion and esophagitis, but they could be more clearly observed in 27 cases (79.4%) among 34 scattered ones. 5) We could clearly observed the esophagogastric junction in 61 cases (62.9%) among 97 scattered ones of Lugol's solution. 6) From these results, we concluded that the dye scattering method for esophagoscopy is useful for supplemental diagnosis of esophageal diseases by reason of the clarification of minute depressed or elevated findings of esophageal epithelium.

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As gastric sarcoma responds well to chemotherapy or radiotherapy and its postoperative prognosis is relatively fair, its correct preoperative diagnosis is imperative. Endoscopic diagnosis of gastric sarcoma, however, still remains extremely difficult. Solid foundation for endoscopic diagnosis is provided by a close study of gross appearance. Since the cases of gastric sarcoma an institute can experience are limited, it would be of importance to describe precisely the gross appearance of resected specimens of gastric sarcoma, to which we had an access.Materials and Methods Gastric sarcoma in the surgical materials resected at the University of Tokyo Hospital during the period from January 1960 to June 197 were studied with reference to the incidence, location within the stomach and gross findings of the mucosal aspect, particularly of ulcerative lesions in reticulum cell sarcoma, with the aid of their gross photographs and histological specimens.Results and Discussion Twenty-seven cases of gastric sarcoma including 20 cases of malignant lymphoma and 7 cases of leiomyo-sarcoma were found in 3327 stomachs resected during the above-mentioned period, comprising 0.8 % of all the gastrectomy cases. The incidence of sarcoma in all the gastric malignancies was 1.3% during the last six and a half years. The ratio of malignant lymphoma to leiomyosarcoma was 3; 1. Those results coincide with the hitherto published reports. Malignant lymphoma encountered was only reticulum cell sarcoma; lymphosarcoma and Hodgkin's disease were not included. The predominance of reticulum cell sarcoma consistent with the other Japanese reports is in contrast with that of lymphosarcoma among the Caucasians, which is said to represent a racial difference.1. Reticulum cell sarcoma The age and sex distribution showed the mean age of 45.5 years, with the range of the 3rd to 7th decade, without sex preference. Location of the lesions showed that 16 of 19 cases involved the pars angularis or distal to it, which is in accordance with many reports (Nakamura, Palmer, Thorbjornarson et al, Joseph & Lattes) . Size of 29 lesions in 19 cases ranged from 0.7cm to 15 cm in greater diametre with the mean ±S.D, being 5.9±4.8cm Gross classification was made according to the degree of protrusion or depression of the tumour from the mucosal surface of the uninvolved area into the following three : ulcerative, diffuse infiltration and tumour formation types. Of 19 cases, 14 were classified as ulcerative type, of which 5 had multiple ulcerations ;1 case was of diffuse infiltration type featured by diffuse mural thickening and the other 4 cases were of tumour formation type. It should be noted that the ulcerative lesions in the cases with multiple ulcerations were not necessarily of sarcomatous nature ; in a case with 5 ulcerations, status post gastric irradiation, 4 lesions were free of sarcomatous involvement. Three of 4 cases of tumour formation type had multilobated fungating tumours ; each lobe or nodule was rounded, partitioned by deep sulci ; the overlying mucosa was generally smooth with lustre, partially with haemorrhage and adherance of necrotic materials. Such a shape has never been encountered in the other diseases, except probably in some of Palmer's collected cases of other sarcomas. The other cases of tumour formation type had a single Borrmann 1 type mass with a wide, shallow ulceration at the top. No case with the shape of the so-called submucosal tumour was seen in this series, though rarely reported in the literature and included in our unresected, autopsy cases. The depth of involvement was intramucosal in 1 case, submucosal in 3, both of which gave rise to the apperance mimicking early gastric carcinoma the involvement down to the muscularis propria was seen in 5 cases, subserosal in 5, serosal in 4. The primary focus of malignant lymphoma has been believed to be the lymphoid tissue in the submucosa, but Snoddy also reported a case o

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Seventy-two benign ulcerative lesions of the resected stomach were studied under the dissecting microscope. The appearance of the regenerative mucosa was com-pared in normally healing and slow healing ulcers. Usual healing course of a gastric ulcer : Four stages can be recognized in a gastric ulcer which heals com-pletely by the end of 3-months of medical treatment. Stage I : Initial stage. One layer of the regenerative epithelium at the margins. Stage II : Regenerative mucosa with a palisade-like appearance at the margins.Stage III : Red scar with a palisade-like appearance, Stage IV ; Red and white scar with a cobblestone appearance. Gastric ulcer showing protracted healing was deviled into three groups under the dissecting microscope. Group I : Small, shallow and irregular ulcer surro-unded by the regenerative mucosa with pale red, regular cobblestone appearance. Group II : Small, deep and irregular ulcer surroun-ded by the regenerative mucosa with red, irregular and uneven cobblestone appearance. Group III : Large and irregular ulcer surrounded by small multiple erosions and by the regenerative mucosa similar to group II The above classification can be applied to gastros-copic studies in clinical practice. Benign gastric ulcer without exacerbation follows either a normal healing course or a course of Group I. When an ulceration exacerbates during the protra-cted healing course of Group I, it takes the appeara-nce of Group III which in turn changes into that of Group II when a healing process occurrs. These three groups are closely related and interchangeable, and a slow healing ulcer is supposed to shift from one to another in a cycle.

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Colonic tumour is a general designation of the colonic lesion featured by its protrusion into the bowel lumen, regardless of its benign or malignant nature ; most of the colonic tumours are the so-called benign polyp, which is said to have a close relation to carcinoma on one hand, and is sometimes most difficult to tell from carcinoma, on the other. The purpose of this paper is to find reliable criteria for differentiation between benign polyp and polypoid carcinoma of the colon.1. Analysis of endoscopic observations The materials are 73 cases with 106 lesions, in total, of endoscopically benign, colonic tumours without ulceration, adherence of blood clot or necrotic material detected by colonic fibrescopy (with CF-SB, CF-MB and CF-LB, Olympus) at the First Department of Internal Medicine, University of Tokyo and at the Department of Medicine, Tokyo Medical College, until May 1972 and at the Medical Department of Luisen Hospital, Aachen, at the Department of Gastroenterology, Leiden University, and at the Department of Medicine, Laennec Hospital Paris from May to August 1970; those casess of the latter 3 institutes are the personal experiences of Niwa, one of the authers. Of the above mentioned lesions, 75 lesions in 61 cases, in which sufficient histological specimens were taken by direct vision biopsy, were selected for the study of relation between size and shape of protrusion, on one hand, and histological diagnosis on the other. The shape of protrusion was classified as sessile, semi-pedunculated and pedunculated: The size was assessed by comparison with the opened biopsy forceps, measuring ca. 5 mm in length, and graded as about 0.5 cm, 1 cm and 2 cm in diametre. The incidence of carcinoma was significantly higher (p<0.01) in the semi-pedunculated tumours (4/31) than in the sessile ones (0/36) ; the differences between pedunculated (1/8) and sessile, and between pedunculated and semi-pedunculated, were insignificant. Comparison between size and incidence of carcinoma revealed a higher incidence in 2.0 cm group (2/8) than in 0.5 cm group (1/44) with some statistical significance (p=0.058), but the differences in the other combinations were insignificant. With the 46 lesions, which were well photographed, surface appearance and colour were studied by the photographs with reference to incidence of malignancy. The incidence of carcinoma was significantly higher (p<0.01), in uneven surface (4/10) than in even surface (1/36) ; the colour of the surface was divided into three categories, id., red, normal and pale, but the difference in carcinoma incidence was insignificant among them.2. Study of surgical materials Hundred and eighty-six colonic tumours seen in the colectomy specimens at the University of Tokyo Hospital from January 1967 to December 1971, and at the National Cancer Centre until November 1971 were studied for the relation of shape and size to histological malignancy. Concerning the shape, incidence of malignancy was significantly higher (p<0.01) in the semi-pedunculated tumours (9/23) than in sessile (11/81) or pedunculated (11/82). Size was closely related to malignancy (p<0.001) . The larger the tumours, the higher the incidence : carcinoma was seen in 1/97 tumours less than 1 cm in diametre, 10/56. 1 to 1.9 cm, and 20/33 larger than 2cm. Expected occurrance rate of carcinoma in each group (with the reliability coefficient of 0.90) was estimated as 0.05 to 4.8% in the tumours less 1 cm in diametre, 10 to 29% in the tumours 1 to 1.9 cm, and 44 to 75% in the tumours larger than 2cm. Summary and Conclusion Ulceration, bleeding, and adherence of necrotic materials over the tumour are generally accepted as suggestive evidences of malignancy. The present study revealed the presence of malignancy even without those findings. Other findings were also found by the present study to suggest malignancy : semi-pedunculated tumour, rough surface and large size were all associated with malignancy. Even with that

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The purpose of this paper is to report our experience of endoscopic papillotomy. This endoscopic papillotomy was first evaluated as to the technical feasibility and safety using 10 dogs. The safety of this new method has been established with the experiment using dogs. Tne first clinical trial in human being was performed in a 65 year-old male. The instnument used was a cutting snare specially designed by us in attempt to avoid postoperative stricture. The snare was introduced into the papilla. Papillotomy was performed with high-frequency way e. No recongnizable hemorrhage occured by this technique. Vital signs were observed after the papillotomy. Serial measurement of SGOT, SGPT, alkaline-phosphatase and serum-amylase was performed. There was no change in vital signs and biochemical data. The papilla was sufficiently wide open to extract biliary stones. Stones was successfully removed and follow-up study revealed no side effect and insufficiency of the sphincteric muscle. We have successed 3 cases of 4 we have done. We believe this will prove to be a very useful technique for removal of residual choledochal stone in certain poor risk patients.

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Five cases of kissing ulcers in the body of the stomach, longitudinally linear or long oval in shape, have been reported. These ulcers are noticeble because of their unusal form of ulcer and massive gastrointestinal hemorrhage. Four were male and one was female. The patients were old in age, ranging from fifty eight to seventyseven, average sixty-nine, and were admitted to the hospital because of hematemesis and melena. Shock developed in four of them. Three patients were managed by immediate surgery and postoperative courses were satisfactory. One of two patients, treated medically, died. Two patients had been in definite stressful physical condition, prostatectomy and acute pneumonia, prior to developing hemorrhage and could be regarded as acute stress ulcer. Histological examinations of the resected stomach were performed on four patients and revealed that these ulcers were acute ulcers involving submucosa (Ul II) and were located in the intermediate zone. It would be thought that kissing ulcers in the body of the stomach, longitudinally linear or long oval in shape, is one of the characteristic form of acute ulcer involving acute stress ulcer. On the other hand, the acute symmetric ulceration of the antrum of the stomach, which is longitudinally linear in shape, develops in younger age with severe abdominal pain and is followed by rapid healing, is reported by Takagi et al. Our cases would correspond to those of the body of the stomach. It would be thought that, in spite of their some different clinical features, both groups of characteristic ulcers are essentially same lesions and ulcers of our cases develop in the body because of their high location of the intermediate zone. Our cases resemble, in shape of ulcer, Mallory-Weiss syndrome and shoud be differentiated from the latter. The reported cases of Mallory-Weiss syndrome in Japanese literature were reviewed briefly from the standpoint of acute stress ulcer. Some cases, which would be thought to be acute stress ulcer rather than Mallory-Weiss syndrome, are included in them.

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Two cases of pseudomyxoma peritonei diagnosed by laparoscopy were reported in this paper. The diagnostic usefulness of laparoscopy and the pathogenesis of pseudomyxoma peritonei are also discussed. Case 1 was a 66 year-old male with a large amount of ascites which was thought to be due to peritonitis carcinomatosa or liver cirrhosis. Laparoscopy showed a diffuse involvement of the peritoneal surface covered with many gelatinous nodules. The patient has been asymptomatic only with diuretics for 12 months since discharge from the hospital. Case 2 was a 68 year-old female with right hypochondrial tumor. Massive gelatinous materials in peritoneal cavity were observed by laparoscopy. On laparotomy, mucocele of appendix and metastatic tumor on the surface of omentum were seen, and total excision was perf omed. The patient has been symptom free for 7 years after the surgery. In these two cases, mucin-secreting epitheliums in the gelatinous materials without malignant change were histologically demonstrated. Pseudomyxoma peritonei should be defined to be accumulation of gelatinous materials and the appearance of mucin-secreting epitheruum which occur solely in the peritoneal cavity. It should be, therefore, differentiated from the mucinous adenocarcinoma which shows distant metastases as well as malignant cells in histology. On the other hand, if no epithelial cells are found in mucus, it should be called to be the rupture of a simple mucocele. The epithelial cells disseminated on the peritoneal surface show a marked mucus secretion without malignant alterations in morphology. Pseudomyxoma peritonei takes a progressive and fatal disease process developing the secondary adhesion of intestine or ileus, although it is non metastatic or invasive. For this reason the treatment should be the same as in malignant tumors.

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Carcinoma of the pancreas in young females are relatively rare. A case diagnosed by Endoscopic pancreatocholangiography (EPCG) is presented. Case Report: This 29-year-old woman was admitted to another hospital for an ovarian cyst operation. Histological examination revealed adenocarcinoma, probably from the stomach. She was then sent to our hospital. Upper gastrointestinal series with . barium and GTF study showed an extrinsic compression on the posterior wall of the upper gastric body. On EPCG study, the main pancreatic duct was completely obstructed at the body of the pancreas. At autopsy, a large ductal carcinoma at the body and the tail of the pancreas was found.

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