Remodelling Olympus GIF-D₂, a magnif ing scope have been manufactured for trial. This instrument have a object lens of long focal distance and 50-degree angle of orthoptic viewing. An object is continuously magnified, as the scope approach it. The maximal magnif ing power, which is gained when tip of scope sticks to objects, is fifteen times. Magnif ing views through the scope are similler to those through dissecting microscope with equal magnifications. Target biopsies can be accurately done with the scope, even at the time of close-up observation. This scope would be available for precise examinations, as well as for primary examinations of upper gastroint-estinal tract. In order to prevent hilights and to clear minute findings through magnifing scope, dye scattering method was appried. In this studies gastric mucosa, intestinal metaplasia and various lesions of the stomach were observed. In f undic area, regularly arranged, round or oval papillae were seen and capillary vessels were also seen after dye solution washed out. In pyloric mucosa, the papillae were slender in shape and irregular in size and arrangement. Intestinalized gastric mucosa were observed after staining by methylene blue, according to our in vivo staining method. In this lesions, four types were classified from staining patterns, from type "a" to "d". Staining became more remarkable alphabetically, and tye "d" was similler to villi of the duodenum. In other gastric lesions, changes of papillae, capil-lary vessels and other minute findings were exaggra-ted. Differentiation of benign and malignant lesions has become more easy and more accurate.

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Gastric peristalsis and pyloric movement were observed by the gastric fibrescope GTF in 54 subjects either with normal gastric mucosa or mild to moderate atrophic gastritis. In a few instances, simultane-ous serial radiographs were also taken for comparison. The activity of gastric peristalsis was classified into the following 5 grades and their relation to pyloric movement was studied: Grade I Absence of peristalsis A. With patulous pylorus seen as a dark round hole; most common. B. With completely closed pylorus seen as a pinpoint; infrequent. C. With slight pyloric movement; extremely rare. Strong asterisklike contraction is never seen. Grade. II Mild peristalsis A. A round peristaltic wave is formed in the antrum, advancing slowly toward and disappearing immediately proximal to the pylorus (Fig.1-A). B. A non-propulsive contractile ring occurs and disappears repeatedly immediately proximal to the pylorus (Fig. 1-B). Grade III Moderate peristalsis Peristaltic wave is formed in the proximal antrum and advances distally, when the pylorus is open (Fig. 2-a); when the wave reaches the segment immedi-ately proximal to the pylorus, the pylorus starts closing, peristaltic wave contracts strongly to form a ring with radiating folds in the pyloric region (Fig. 2-b). The ring becomes more constrictive, and reaches the pylorus(Fig. 2-c). A complex, asterisklike contraction involving the pylorus is then formed and protrudes (Fig.2-d). Constriction dissolves from the centre enabling a glimpse of the closed pylorus (Fig. 2-e, f), followed by opening of the pylorus (Fig. 2-g) Grade IV Vigorous peristalsis The peristaltic wave is more marked and deeper, and moves with stronger antral constriction. The proximal side is elevated and longitudinal folds are seen over the surface of the wave (Fig. 3-a). With its distal movement luminal constriction and longit-udinal folds become more marked, to completely occlude the lumen (Fig. 3-b). When the peristaltic movement is vigorous, this constriction occurs con-siderably proximal to the pylorus, and the more active the peristalsis, the more proximally the constriction starts. The contraction ring protrudes proximally and the mucosa swells up through its centre and seemingly migrates centrif ugally (Fig. 3-c). Occasionally, duodenal juice regurgitates through it. The constriction dissolves gradually and the closed pylorus becomes visible through its opening (Fig. 3-d). The peripyloric area then becomes flattened usually with a shallow contraction ring remaining(Fig.3-e). Grade VV Markedly vigorous peristalsis The peristaltic wave is more prominent and stron-gly constricts the lumen already near the pars angularis with strong contraction of the entire antrum, but this type is extremely rare. Radiologically, when the peristaltic wave reaches, the proximal loop of circular muscle, a special muscular structure of the antrum, the onward movement is aborted, and the circular muscle loop contracts accompanying shortening of the lesser curve, followed by contractile movemnet of the whole prepyloric segment, a gastric emptying movement called "antral systol". The luminal constriction resembling the pylorus, as mentioned in Grade IV peristalsis, was considered by Schindler to be the pylorus itself or its vicinity, but, as it occurs considerably proximal to the pylorus, it cannot be the pylorus itself. While Fukuchi regarded it as representing the antral systol, , the swelling up of the mucosa through the constri-ction suggests a constant onward movement of peri-staltic wave, and may require an explanation diffe-rent from the so-called antral systol. The pyloric movement was usually associated with gastric peristalsis; in the absence of peristalsis or in the case of weak peristalsis, the pylorus was usually patulous. Occasionally, however, pyloric movement, though mild, was observed independent of peristalsis, suggesting some autonomy under certain circumstances. The peristalti

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Analysis of 92 Cases. Gastrointestinal bleeding is thought to be the most common lifethreatening complication after thermal injury. The authors examined the relationship bet-ween thermal injury and gastrointerstinal bleeding in 92 patients admitted to Osaka University Hospital during six years from 1968 to 1973. 1. Gastrointestinal bleeding was found in 34 out of 92 burned patients (37.0%). The frequency was much higher than that in patients with head injury (79 in 491 cases, 16.1%) and in patients with other trauma (11 in 115cases, 9.6%) admitted at the same period. 2. The frequency of gastrointestinal bleeding in burned patients increased with extension of burn size, complication of sepsis or acidosis. 3. No relationship was found between gastrointe-stinal bleeding and the administration of corticoste-roids. 4. Gastrointestinal bleeding occurred within two days after thermal injury in 22 out of 34 cases(64.7 %), Only two patients (5.8%) complicated gastroi-ntestinal bleeding after one week. 5. Below 80% in burn size, the mortality rate was 80.8% in patients with gastrointestinal bleeding. In patients without gastrointestinal bleeding, howe-ver, it was 20.0%. These findings may indicate that gastrointestinal bleeding is an important factor which influences the prognosis of burned patients.

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It is well known that acute gastroduodenal lesion is the most common and serious complication after thermal injury. However, little has been demonstrated what kind of lesion occur in the early stage after thermal injury. To this purpose, early and serial endoscopic examinations of the stomach and duodenum were performed in 11 burned patients admitted to Osaka University Hospital. Among 11 patients, four cases were male and seven were female. Ages ranged from nine to 83 years. Burn size varied from 23 to 70 per cent of total body surface (average burn size, 43.5 per cent of body surface). Mortality within the study population was 81.8 per cent. Endoscopic examination was performed within a week after the onset of gastrointestinal bleeding, and it was done within 48 hours in four cases. Endoscopic examinations showed hemorrhagic erosion in seven patients, duodenal ulcer in one and no remarkable change in three. Gastric ulcer was not found in the present study, It was interested that hemorrhagic erosion was localized in the body of the stomach. There was a close relationship between the severity of the lesions and that of gastrointestinal bleeding.

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Up to date, with remarkable advances of colonofiberscopy, we have been able to observe endoscopically almost all parts of colonic mucosa. Furthermore, for observing minute changes of colonic mucosa, several new approaches have been tried, as one of which, we have already applied the dye scattering method in colonof iberscopy. As the another new approach, we have made a special type of colonof iberscope, type CF-MB-M (Olympus), by which we can easily magnify the colonic mucosa and observe its close-up picture. The new fiberscope is 1110mm in its length and 14mm in diameter of its flexible portion, and its optical apparatus comes close to 5 mm from the colonic mucosa. This fiberscope has been applied to 51 cases in our clinic, and the results obtained were as follows; 1) By means of this f iberscope, the minute findings of the colonic mucosa was more clearly observed than usual. 2) Furthermore, with aids of methylene blue dye scattering method, the endoscopical and/or clinical stages were easily classified in 22 cases of ulcerative colitis. Especially, we could easily differenciate the quiescent stage of this disease from the normal colonic mucosa by observing the minute abnormal surface appearances, such as minute obscure depression or disorder of mucosal structures.

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