One hundred and seventy one benign lesions of gastric mucosa were studied under the dissecting microscope with the technique as described in the previous report. A total of 171 cases inclusive of 44 with adenomatous polyp, 5 with atypical epithelium, and 122 with benign ulcer were studied : India ink was infused in 2, 1, and 9 respectively. 1) Adenomatous polyps were divided into three groups on the basis of the appearance of the gland. openings: (I) Pattern represented by isolated elliptical and long slit-like gland openings. The distribution is regular. (II) Pattern represented by round gland opening with sparce distribution. (III) Surface structure represented by a congregation of villous projections. Fine capillaries showed highly dense distribution below the epithelium. The capillaries were not distinct despite intense injection in the fresh specimen. 2) Surface structure of atypical epithelium showed uniform distribution of mainly short slit-like gland openings. Capillaries ran between two gland openings, and showed slightly irregular reticulate pattern. The irregularity in caliber, form, and distribution of capillaries was less prominent than adenocarcinoma, but more prominent than fundic gland area. 3) Capillaries in the base of benign ulcer were too fine to be distinctly visualized. Regenerative epithelium taking a palisade-like appearance was seen at the margin of benign ulcer in the healing stage. Capillaries of regenerative epithelium showed vinelike appearance, and were so densely distributed that each vessels couldn't be identified in the fresh specimen.

View full abstract

Melanosis coil is a disease with black or brown pigmentation of colon mucosa. Since there is scarcely unevenness of the mucosa and neither sclerosis by xray is impossible. Diagnosis is possible only by endoscopy. As melanosis coli is not a surgical disease, we did not know the distribution and the grade of pigmentation accurately. However, with the fibercolonoscope (FCS), we are able to study the condition in more detail. In our institute, we have experienced 58 cases of melanosis coli among 1071 cases of f ibercolonoscopy from June 1969 to May 1974 (5years). The incidence of melanosis coli is 5.4% (58/1071), including 3.5% of endoscopic finding (37/1071), and 9.4% of biopsy finding (58/615). Among these 58 cases of melanosis coli, there are 29 males and 29 females, but the ratio of percent are 4.6 males and 6.5 females. The age ranges from 18 to 85 years, average is 53 years. Endoscopy revealed gray-black, black-brown, yellow-brown or mild brown color. These changes were distributed in the rectum and sigmoid colon in 33 among 37 cases (89.2%). The other distribution of the pigmentation was in 2 cases all over the colon, in 2 cases from rectum to transverse colon and in 5 cases to descending colon. The pigmentation was mostt intense in the rectum and lower part of sigmoid colon and less towards the oral sides. In the upper part of the sigmoid and descending colon, any such change was not scarcely. Pigmentation was relatively homogeneous in some cases and marked difference in density was noted even at the same site in others. Histologically, pigment is seen in the cytoplasm of phagocytic mononuclear cells of the stroma or tunica propria of the mucosa. Histochemical studies of biopsied specimens revealed the pigmention to be due to melanin-like substance. In these 58 cases, we found 15 cases of colonic polyp or polyps, 12 cases of colonic cancer, 4 cases of irradiation colitis, 3 cases of colonic diverticulosis, one case of ulceratives colitis, 5 cases of hemorrhoids, 4 cases of cancer of the cervix, one case of stomach cancer etc. 42 among 58 cases (72.4%) of melanosis coli have the history of prolonged use of laxative of anthracene or anthraquinone series from one month to 38 years. Among 8 cases without history of using the laxative of anthracene groups, we found 4 cases of colonic cancer and one case of cervical cancer. Conclusion : 58 cases of melanosis coli among 1071 cases of f ibercolonoscopy were found during past 4 years. Endoscopically the most characteristic finding is the localization of pigmention at the rectosigmoid area. The pigment was identified as melanin-like substance. It is noteworthy polyp or cancer of colon were noted in 22 of 58 cases (38%).

View full abstract

During the past one year, 110 operative and postoperative choledochcscopy by using improved choledochofiberscope were performed in 43 cases who underwent duct exploration. At the same time, selective cholangiogram obtained with insertion of a thin teflon tube selectively under visual control into desired portion of the biliary tract, has been employed as an adjunct to the conventional roentgenological examination. This selective cholangiography enabled to clarify abnormalities in the selected ducts, with complete filling of contrast material. In this paper, the improved choledochofiberscope MODEL IV which has been developed in our department was introduced and importance of selective cholangiography adjunctively to endoscopic examination was strongly emphasized to overcome pitfalls of conventional roentgenological examination.

View full abstract

From 1972, the endoscopic observation of the small intestine have been done using the S. I. F. (Olympus) by ordinary method. Nowadays, the duodeno-jejunal junction can be observed easily in almost cases. But with this method, we can not observe the lower part of the jejunum. So, we use the rope way method with the per anal endoscopic tecqnic which have been reported by Dr. H. Hiratsuka. By Combination with these methods, we can observe and take out biopsy specimen from the mucosa of the not only ileum but also through out small intestine. Apparently, the mucosa of the upper small intestine differ from the lower one-in the crescentric folds, the color of the mucosa and the pattern of blood vessels. We suspect that these differences are correspond to the varieties of its function. By the way, the mucosa of the lower part of the small intestine, especially the end of the ileum resembles the large bowel. The dye scattering method can help us to observe the villi on the surface of the mucosa. In normal case, the villous pattern of small intestine is quite regular in shape and its arrangement. We enphasize that it is very important to observe the surface villous pattern of the intestinal mucosa for the purpose of studying on its disease.

View full abstract

From 1969 to the present, one thousand and sixx hunded colonoscopies were done. Irregular configurations of the colonoscope were investigated in 1400 examinations which the early 200 examinations in our series were eliminated because of our technical difficulties. They were seen mainly in the sigmoid or transverse colon ; frequency was calculated by dividing the number of irregular configurations by the total number that the colonoscope had passed through the above mentioned segments. In the sigmoid it was 8.2% (75/914), in the transverse colon 16.7% (115/690) and all together 11.8%. Irregular configurations of the sigmoid seemed to appear more frequently than those of the transverse colon, reason probably being that many efforts were made to remove the irregularity in the early portionn of the colonoscopic examination. In the sigmoid, double a-loops appeared most frequently; i.e. onethird of the times; it was followed by the reverse α-loop irregularity: i.e. 30.7 %. Remaining irregular configurations in the sigmoid were as follows; counter α-loop, double reverse α-loops, .A-loop, and complex knots. In the transverse colon, the γ-loop had the highest frequency; i. e. 65.2%. Such a high frequency of the γ-loop is apparently the result of less multiplicity in the irregular configuration of the colonoscope in the transverse colon. Sometimes artificial γ-loop formation is possible; in that instance the frequency will be 7.8% which is almost equivalent to that in the sigmoid, if the number of γ-loop deducted from them. Remaining irregular configurations in the transverse colon were as follows; left-flexure loop, reverse γ-loop, right flexure loop, and bilateral flexure loops. To remove them in the sigmoid was possible in almost all examinations, but it seemed to be further more difficult in the transverse colon, especially for the loops which were located over the right-sided colon. Even though disadvantages due to irregular configurations of the colonoscope have been described in a previous paper, the examiner has to decide in each case whether or not the irregularities would be able to be removed. Much additional information concerning the position of the colonoscope can be given by fluoroscopic assistance. So minimum use of fluoroscopy is recommended because of its effects on the human body and on the glassf fibers respectively.

View full abstract