One hundred seventeen cases of early gastric cancer were experienced in our department during 9 years period from 1968 to 1976. The gland area where the cancer developped was examined by means of endoscopical procedure and the congo-red method. The correlaions of early gastric cancer and its located gland were as follows. 1) Seventy-six percent of 117 cases with early gastric cancer were seen in pyloric gland area, 15, 4% in glandular border area, and 3.6% in fundic gland area. 2) Endoscopic atrophic border shifted from C-I type to O-III type according as aging. 3) In terms of macroscopical classification, 92, 70 of 41 cases with elevated type were differentiated adeno-carcinoma and mostly located in pyloric gland area. However, in 76 cases of depressed type, no such characteristics were observed. 4) Histologically, all of 10 cases in fundic gland area showed undifferentiated type of early gastric cancer, while in pyloric gland area 73 out of 89 cases were differentiated type. Fifteen out of 18 cases in glandular border area showed undifferentiated type.

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On 100 biopsy specimens obtained endoscopcallly the distribution of mucopolysaccharide in the duodenal mucosa and the mucus layer covering on the surface of the mucosa, its biochemical analysis histoimmunological analysis, and mechanism of its secretion were researched. The results are as follows: 1) The mucous substance could be observed endo-scopicaly by spreading 0.2% Azure A. 2) The duodenal mucosa was rich with the PAS-positive substance, as well as the gastric mucosa, and acidic mucopolysaccharide of the Alcian bluepositive was more in the former. The covering mucous layer of the duodenum was composed of a double layer construction of the PAS-positive layer and the Alcian blue-positives, but it was thinner than the gastric one. In the duodenal crypt, Alcian blue-positive (acid mucopolysaccharide) was more rich than in the stomach. 3) According to 3H-glucose and 35SO4 autoradiography, acidic and neutral mucopolysaccharides were observed in the cylindrical epithelial cells in which the presence of mucopolysaccharide had not been proved histochemically. Thus, the cylindrical epithelil cell group appeared to be the cell group secreting the PAS-positive substance in the mucus layer covering on the duodenal mucosa. Brunner's glands were similar : many goblet cells in the crypt were Alcian blue-positive, and the Alcian blue-positive substance in the mucus layer appeared to be mostly derived from the goblet cells. 4) Hexosamine was examined for observing the change of mucopolysaccharide in the intestinal mucosa and antral mucosa of the stomach. Muco-Polysaccharide level of normal antral mucosa were 2.114 mg/g and normal duo-denal mucosa were 1.994 mg/g. 5) Considering that secretory component (sc) in the digestive tract was glycoprotein, we discussed in the each stage immunohistologically about variation of the distri-bution of sc, and s-IgA. IgAcontaining cells were proved to increase, and sc decrease in the active stage ulcer. As to the variation of the mucus substance in the duo-denal ulcer, the content in the mucosa and the covering mucus layer will be further pursued in the aspects of various factors, the mucus barrier and secretory immuno-globulin will have to be disscussed in the future.

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For the purpose of the possible diagnosis of hepatic lesion from the intrahepatic bile duct findings, we performed intrahepatic cholangiography by EPCG using caerulein or changing position. As the pathological findings of the intrahepatic dile duct, displacement, stenosis, occlusion or dilatation of the peripheral branch due to the influences of the tumor were visualized. But when the tumor was small, or when peripheral branches of the bile duct were not visualized, satistactory result was not obtained. Therefore, still we have to make an effort to visualize the small branches in order to establish the accurate diagnosis of hepatic lesions using endoscopy.

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It is well known that elderly people may develope complications during esophago-gastro-duodenoscopic examination. Therefore, electrocardiograms were recorded in 80 elderly patients before gastroscopy. Surprinsingly, their electrocardiographic findings showed abnormalities, in over 80% of all examined cases. Thus, electrocardiograms were recorded in 20 elderly patients before and during gastroscopy, and comparisons were made. In all the patients examined, the pulse rate increased through gastroscopic examinations. Electrocardiographically, ST-T changes during gastro-scopy were noted in 8 patients and atrial premature beat developed in one patient. As the conclusion, it is seemed to be important that cardiovascular examination should be carried out in elderly oeoole before eastroscopv to prevent accidents.

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Crohn's disease with a wide involvement of the colon is one of rare diseases in Japan. The patient was a 27-years-old man whose chief com-plaints were external fistulae of the bowel and diarrhea with weight loss on re-admission on May 1975. Appen-dectomy was experienced four years previously in his history. Barium enema showed a diffuse involvement of the colon over the entire length, associated with shortening and rigidity, but the terminal ileum was not involved. Cobblestone appearance in the right side of the colon and linear confluent ulcerations in the left side of the transverse segment as well as the descending segment were observed. At that time, the tentative radiological interpretation was made as ulcerative colitis, with requirement of further studies to establish the diagnosis. Colonofiberscopy revealed no abnormalities in the rectum but multiple longitudinal ulcers of various size in the sigmoid and the descending colon. The mucosa surrounding these ulcers were almost normal in the lower sigmoid, whereas it was irregularly nodular, edematous above that level, showing cobblestoning in the descending colon. Biopsies disclosed non-specific chronic inflammatory changes of the bowel wall except for one place where inconspicious granulomatous foci were found. Thus the case had preoperatively been diagnosed as Crohn's disease on clinical, endoscopic and microscopic grounds and a subtotal colectomy with ileorectal anasto-mosis ensued. Grossly the resected colon was consistent in findings with those of radiology and endoscopy. The significant histologic description was the presence of non-caseating granulomas, fissures, the transmural inflammation and lymphocytic aggregation, which is attributable to Crohn's disease. In this case, although there was preoperative difficulty in differentiating Crohn's disease from ulcerative colitis even on radiograms, the review of X-ray films has con-firmed Crohn's desease in the entire colon.

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As an initial symptom or chief complaint of early gastric cancer, epigastralgia, gastric stozziness, abdominal dis-tension, weightloss or nausea are fairly common. But hematemesis is very rare. About two hundred cases of early gastric cancer were detected in our clinic so far, and only three cases with initial symptom of hematemesis were encountered, which will be described in this paper. The cases are as follows: (1) A 40-year-old woman ; Ulcer lesion at the posterior wall of the body was diagnosed of IIc+(III), and was suspected to have the course of malignant cycle. (2) A 63-year-old man with the inducement of heavy drinking; A pedunculated polyp at the greater curvature of the body was diagnosed of polyp carcinoma. (3) A 63-year-old man with the inducement of an-algesics; A polypoid lesion at the greater curvature of the antrum was diagnosed of IIa+IIc macroscopically. Analysis was made on the relationship between hemate-mesis and macroscopical classification of the early gastric cancer and the localization of the lesion.

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