Meterial and methods: During a period of 7 years, 4706 gastroscopic examinations were performed by the author at the Institute of Gastroenterology, Tokyo Women's Medical College. Among them, 413 patients were diagnosed as gastric xanthoma (8.7%). This is ao report of the endoscopic characteristics and the studies of associated gastritis and further investigation by endoscopic dyeing with methylenn blue and congo red, scanning electron microscopy, histochemical analysis of gastric xanthoma in addition to histopathological examination. Endoscopic examination: The incidence of gastric xanthoma was higher in female than in male in each age group: The incidence increased when they got loder. Many patients had only single xanthoma in the stomach. No correlation between gastric xanthoma and serum cholesterol was found. The gastric xanthoma was most frequently seen at the prepyloric region. It represented 38% of the cases. About 15% of cases were located at gastric body and gatsric angle. The shape of xanthoma varied; some are plateau-like elevation, some are flat. The surface of the xanthoma were similar to the gastric areola. The relation of gastric gland and xanthoma was investigated by the method of endoscopic dyeing with Congo red. All of the gastric xanthomas were located within the territory of the pyloric glands. It indicates close association of xanthoma with atrophic gastritis. The coexistence of intestinal metaplsia in gastric xanthoma was investigated by endoscopic dyeing with Methylene blue and histoachemical examination. Methylene blue was present around the epitelial cells in about 64%, while, positive staining by alkaline phosphatase was noted up to 80%. Scanning electron microscopic observation: The tissue taken during biopsy was investigated by scanning electron microscope The xanthoma appeared countless thick microvilli under scanning electronmicroscopy. Each of the microvillus represented opening of paneth cells and absorpt ive cells. Histop athologica observation: Intestinal metaplasia was present on the surface of gastric xanthoma in 44%. Biochemical analysis and biochemical examination: The lipid content was analysed by gas chromatography in xanthomas. Freecholesterol and triglycerides were all present, but all cholesterol was not esterified.

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The diagnosis of duodenal ulcer become more easily because that is possible for observasion the doudenal bulb sufficiently after the development of duodenal fiberscopy. Untill now duodenal ulcer is diagnosed by radiography, the demonstration of the existense of the ulcer is undoubtful but the character of ulcer especially the decision of healing finding, in another words diagnosis of scar of the ulcer is not enough only by radiography. For precisely demonstration the finding of the duodenal ulcer, I collect 257 cases of active duodenal ulcer (63 cases in gastric mass survey and 194 cases in Nihon University Hospital). 336 cases of scar of duodenal ulcer (135 cases in gastric mass survey and 261 cases in the Nihon University Hospital) for 1, 970-1, 973. The conclusion will be illustrated as follow: 1. Scar of duodenal ulcer is two times more than active duodenal ulcer in gastric mass survey. 2. Scar of duodenal ulcer diagnosed by radiography is 62.9% in coincident with duodenal fiberscopic examination. 3. For the heightening of the diagnostic rate of scar in radiography it is better in pron, Fowler's position, 20°-40° right anterior. 4. Criteria for radiographic diagnosing a scar of duodenal ulcer: a) Convergency b) Difference of density c) Deformity d) Niche with blunt edge is easily disappeared by strong compression method 5. Scar stage was demonstrated at first time examination its recurrent rate is slightly higher than active duodenal ulcer but recurrent rate of asymptomatic duodenal ulcer is lower.

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Case: 70 years old female. She had been cholecystectomized because of the gallbladder stone 12 years ago. Since 6 years before the admission in our clinic, she had been suffered from upper abdominal discomforts and right hypochondralgia. On admission, there was no abnomality in the laboratory findings. Plane film of the abdomen revealed the pneumobilia. Upper GI series showed reflux of barium meal from the internal midportion of the duodenum to the common bile duct. Drip infusion cholangiography was negative. Endoscopic observation of the duodenum and ERCP were performed. There found parapapillary choledochoduodenal fistula about 1cm oral from the crif ice of the major papilla. The cannula was inserted through both fistula and the orifice of the major papilla to the common bile duct, and the visualization of the biliary tract by 50% Urografine revealed no stone. It was considered that her symptome was caused by reflux cholangitis. In order to make fistula larger and to make reflux contents in the common bile duct flow rapidly and easily into the duodenum, endoscopic electrosurgical sphincterotomy was tried. From the orifice of the papilla to the fistula, special designed cutting knife was inserted and a current for cutting was applied using Olympus PSD. Endoscopic sphincterotomy was performed safely and successfully. By this method, narrow distal segment extending from the orifice of the papilla to the fistula was cut down and the orifice of the fistula was opened widely. After this procedure, reflux contents flowed out easily into the duodenum, and her symptome disappeared completely. It was considered that the endoscopic electrosurgical sphincterotomy was useful to cure reflux cholangitis caused by the parapapillar choledochoduodenal fistula.

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Relation between the location of gastric ulcer and the fundal gastritis was examined by the endoscopic Congo red test. On the basis of the extent of f undal gastritis, gastric ulcers were classified into two groups, i.e., 1) those associated with slight or no fundal gastritis, and 2) those associated with moderate or severe fundal gast-ritis. In each group, distance between the gastric ulcer and acid-secreting boundary, histological mucosal type around ulcer and healing of ulcer were studied, and obtained the following results. 1. Gastric ulcer associated with slight or no fundal gastritis occured frequently in the angle and the antrum, or in the pyloric gland area adjacent to the fundic gland area. About the half of those associated with slight or no gastritis failed to heal within 3 months after the beginning of the medical treatment. On the contrary, gastric ulcer associated with moderate or severe fundal gastritis was located mostly in the gastric body, or in an area altered by severe fundal gastritis far from the acid-secreting mucosa. Complete healing was observed in 55.4% of the cases with moderate or severe fundal gastritis. 2. Occurrence of the gastric ulcer associated with slight or no fundal gastritis could be explained by Oi's dual cotrol theory on the pathogenesis of ulcer, but that of cases with moderate or severe gastritis could not. 3. This classification of gastric ulcer based on the extent of fundal gastritis is useful not only for the clarification of the pathophysiology of gastric ulcer, but also for the establishment of the guideline of medical treatment of gastric ulcer.

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Gastric ulcers have been thought to occur only in the pyloric gland area. However, endoscopic examinations, using the Congo red test, revealed that 18 ulcers (7.8%) were surrounded by an acid-secreting area and so were, in the fundic gland area. Histological examination of specimens obtained by gastrectomy also showed that 5 lesions (4.4%) were localized in the fundic gland area. Ulcers in the f undic gland area occurred most frequently in the angle and lower gastric body, adjacent to the acid secreting boundary. These ulcers were associated with little or no fundal gastritis, while ulcers in the pyloric gland area were usually associated with moderate or severe fundal gastritis. Repair of ulcers surrounded by normal fundic mucosa was complete although these ulcers were similar in depth to ulcers located in the pyloric gland area. No recurrence of these ulcers was seen in a 1-year endoscopic follow-up period.

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Acute gastroduodenal ulcer found in cerebral damage, known as Cushing's ulcer, is one of the important prognostic complications, because gastrointestinal bleeding is frequently occurred. However, there are few reports on gastrointestinal complications in head injury. The authors studied on factors affecting gastrointestinal bleeding in 433 patients with head injury admitted to Osaka University Hospital from 1967 to 1973. The results are as follows: 1. Gastrointestinal bleeding was occurred in 72 of 433 patients with head injury (17%). 2. Gastrointestinal bleeding was related to the severity and type of head injury, the shock state, the oxygen concentration in arterial blood and the administration of glucocorticoid. 3. Gastrointestinal bleeding was occurred within two days after the trauma in 28 of 72 patients (39%), and within one week in 80%. 4. There was a definite relationship between the degree of gastrointestinal bleeding and the severity of head injury. All of nine patients with massive hemorrhage, who required blood transfusion over 1000ml, belonged to the severest head injury group, and were complicated with sepsis, shock or uremic state. 5. In 64 cases gastrointestinal bleeding could be controlled by conventional medical treatment. In the remaining eight cases, only one patient with duodenal ulcer was survived by emergency operation.

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Acute gastric lesion in the intracranical disease is well known as Cushing's ulcer. Although there are several reports on clinical features of Cushing's ulcer confirmed by the operation or postmortem examination, little has been shown about early features of acute gastric lesion in head injury. The present study deals with endoscopic observations of acute gastroduodenal lesions seen in 34 cases with head injury.1. Endoscopic findings in 34 cases with head injury showed esophagitis in three cases, acute hemorrhagic gastritis in seven, acute gastric erosion in three, acute gastric ulcer in ten and duodenal ulcer in two. Gastric lesion was found in 80% of patients.2. Acute hemorrhagic gastritis was mainly found in the body of the stomach. Acute gastric ulcer was also seen in the same site and almost all of the lesions were multiple.3. Acute hemorrhagic gastritis was found within one week after head injury. On the contrary, acute gastric ulcer was seen after one week.4. Endoscopic examination revealed acute gastric lesion even in eight of 14 cases in which no gastrointestinal bleeding was occurred.5. The administration of adrenocorticosteroid might affect the occurrence of acute gastric ulcer.

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ERCP has become a routine examination as well as angiography for the diagnosis of biliary and pancreatic disease. Recently, this diagnostic value is more increased by detailed analysis of X-Ray findings. On the other hand, complications of ERCP seem to be increasing due to overdose infusion of contrast medium. Here, we studied about complications of ERCP; 108 cases could be followed up by leukocyte count, serum amylase and fever for one week. This paper is written very important things for complications of ERCP. Our conclusions are as follow:1) Cases having an acinar filling showed hyper amylasemia and prolonged serum amylase value.2) Acute pancreatitis recurs after ERCP.3) Severe jaundice or biliary tract disease having a suppurative cholangitis were aggravated by ERCP.4) Some cases of cholecystitis with gall stone were aggravated by ERCP. Cholecystitis was aggravated by injecting of contrast medium. This study suggests that ERCP is an important examination for diagnosis of biliary and pancreatic disease, but ERCP should be done with great care to avoid its complications.

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An autopsy case was presented in which the supra-am-pullary duodenal carcinoma coexisted with the sigmoid carcinoma and polyp of the descending colon. A 79-year-old male was admitted to the hospital on march 8, 1974 because of coliky pains in the right upper quadrant abdomen. The upper G-I series showed a filling defect in the second portion of the duodenum. Duodenofiberscopic examination demonstrated an irregular ulcer with the stenotic lumen, and biopsy specimen showed adenocarcinoma. But the patient had already been in so serious condition to undergo surgery and was treated conservatively. He died on Nov. 24, 1974. At the postmortem examination, the supra-ampullary adenocarcinoma of the duodenum was of an ulcerated type and encircled the lumen with the length of 3 cm. In addition, there were found both sigmoid adenocarcinoma which was of a polypoid type with a size of 3.3.1.5cm and the pea-sized pedunculated adenomatous polyp about 10cm oral to the part of the sigmoid cancer. In this case, a combination of duodenof iberscopic examination and a selective biopsy proved the most helpful for diagnosis of the duodenal carcinoma. We also reviewed the literature of coexistence of the duodenal ca with the sigmoid ca.

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"Colitis aphtosa", which was first reported by Yoshikawa (1973), is considered to be a new entity of inflammatory colon disease. Its clinical and laboratory findings, especially its endoscopical findings, are different from other specificand non-specific inflammatory colon diseases. Multiple small round erosions, found at the lymphapparatus in the mucosa or the submucosa, is distinguished from other inflammatory colon diseases. Its etiology is, however, not elucidated yet. Recently, we have experienced a case of familiar onset of "colitis aphosa" whic is interest to suggest the etiogy of this disease. A thirty-six year old man was admitted to our hospital, complaining of abdominal pain, slight fever, sence of fullness and anal bleeding. Clinical examinations showed leukocytosis (12100/mm3) and occult blood positive, but no significant bacillus or virus was found out. Endoscopical examination, using colonof iberscope type CF-MB-M (Olympus), revealed multiple small round redness and/or erosion in the rectum. Immediately, colonofiberscopic examination was carried out to his family, and his father (69 year old) and his wife (34 year old) who were boarding with him had similar findings on the rectal mucosa, and they were diagnosed "colitis aphtosa." However, his daughter (9 year old) and son (6 year old) who were boarding with, and his two sisters (47 year old, 42 year old) and one brother (34 year old) who were not boarding with, and his two sisters (47 year old, 42 year old) and one brother (34 year old) who were not boarding with had no positive findings. Therefore, it cann of completely rule out that the etiology of this disease has a posibility of a certain inf ecious disease.

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