The surface pH of the gastric mucosa which were measured at 12 points in each subject by the microglass pH-electrode on a gastroendoscope, were compared with the histologic findings and the gastric secreting function on 32 cases of the duodenal and the gastric ulcer. The surface pH of the gastric mucosa in the cases with duodenal ulcer was high in the pyloric gland area and low in the fundal gland area with a boundary at 4.0. The surface pH of the gastric mucosa in the cases with gastric ulcer was higher than 4.0 in the pyloric gland area and the f undal gland area with the atrophic changes, but lower than 4.0 in the normal fundal gland area. The patterns of the distribution of the surface pH of the gastric mucosa were clssified into the following four types. Type 1 : pH were below 4.0 in the antrum, the angle and the body. Type 2 : pH were below 4.0 in the angle and the body, and was above 4.0 in the antrum. Type 3 : pH was below 4.0 in the body, and were above 4.0 in the antrum and the angle. Type 4 : pH were above 4.0 in the antrum, the angle and the body. The position of the atrophic border could be estimated from the pattern of the gastric mucosa. The secreting function of the gastric acid did not vary in Type 1 and 2, but diminished in Type 3 and 4, more pronounced in the latter. The pattern of the pH of the gastric mucosa was well correlated with the location of the gastric ulcer. The cases with the duodenal ulcer were included in Types 1, 2 and 3. The cases with the gastric ulcer in the antrum were included in Types 2 and 3, and these in the angle were included in Types 2, 3 and 4. The cases with the gastric ulcer in the body were included in Type 4.

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A new panendscope FG-QBR (Fujinon) with convertible roofprism which makes a wide range observation from forward to side view was developed. With the aid of bending action to four directions, it has great powers of observation even in the narrow upper gastrointestinal tract. This instrument is also effective in such treatment as irrigation, aspiration, dye-scattering and biopsy with a forceps opening. Since June 1975, using this FG-QBR, the diagnosis has been done in emergency endoscopy as well as in routine endoscopy at The First Department of Internal Medicine and Department of Traumatology, Osaka University Medical School. Since 1977, a new FG-QBR was avairable for us after a few times revision. The experiences of endoscopy with this new FG-QBR has been increased as many as 200 times until December 1977. The pathological changes, such as, esophageal varices, gastric cancer, duodenal ulcer and so on, were found in endoscopy with this instrument. Ruptured varices, hemor-rhagic gastritis and bleeding ulcers were also found in emergency endoscopy. The additional pathological lesions in other organs of the upper gastrointestinal tract were found in 33 cases (170), which added the accuracy of the diagnosis. So, the usef ullness of this panviewfiberscope FG-QBR has been confirmed in our experiences.

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Among 140 cases of depressed type of early cancers, 131 were II cs and II c+IIIs, of which II cs were 55 consisting of 28 m and 27 sm lesions, whereas II c+ IIIs were 76-34 m and 42 sm lesions. Data from these cases were reevaluated. No relationship was noted between the depth of invasion and age or sex. In regard to the size of II c, sm group was approximately 3 times as large as m group, whereas in the II c+ III group, sm lesions averaged 1.5 times as large as m group. The so-called “stiffness”, by which we mean poor distensibility or mobility as observed by endoscopy, was more frequently noted in sm group. “Stiffness seems to represent fibrosis and cancer tissue in the submucosa. The characteristic features of the converging folds, namely sudden interruption, irregular thinning, clubbing, and fusion, are not indicative of m or sm. What we call “the clarity grade of II c, by which is meant the percentage of the length of macroscopically identifiable II c border compared with the total length of IIc border-line, was larger in the sm group than in m group. In conclusion, the conventional criteria of depth diagnosis are not very reliable and further study is desired to establish the new criteria.

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Thirty-four patients were monitored by electrocardiogrphy before, during and after colonscopy. These patients included 8 elderly people (older than 60 years old) and 6 patients with cardiovascular disease.Although 27 out of 34 patients were pointed out electrocadiographic abnormalities during colonscopy, these abnormalities were not so serious, such as sinus tachy-cardia (47.1%), sinus bradycardia (2.9%), ST-segment depression (9.8%), and axis deviation (35.3%). As the conclusion, it seemed that dehydration by dietregulation for colonoscopic examination and administration of laxative might be main cause of ECG-abnormalities. Therefore, this examination should be carried out carefully in elderly examinee in whom the complication of ischemic heart diseases are higher in incidence.

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Manipulation of a colonscope is sometimes very difficult when there exists a marked loop formation in the sigmoid colon. In order to keep the sigmoid colon in a straight position, a sliding tube made of plastics was devised by Makiishi et al. The sliding tube has been widely used in colonoscopy to straighten the loop of the sigmoid colon and advance the scope to the ileocecal area more quickly and easily. However, some disadvantages have been found in using the present sliding tube. There is some difficulty in handling the colonoscope attached to the sliding tube, being restricted by the length of the colonscope. For the purpose of covering the demerits of the conventional instrument, a new sliding tube (slit sliding tube) has been devised. The slit sliding tube is made up of three parts ; an inner tube, an outer tube and a fixing screw. Prior to insertion of the colonoscope, outer tube and the fixing screw are attached to the scope and are placed near the handle. With the contraction of the elastic outer tube to approximately 10cm of length, the colonoscope is employed in the usual manner. When the tip of the scope reachs the splenic flexure of the colon and the sigmoidal loop is let down, the inner tube is attached to the scope and then the three parts of the apparatus are joined together in a short time. Then the sliding tube is inserted safely into the middle or upper parts of the descending colon as the same manner as the conventional sliding tube. Thus, the slit sliding tube makes it more easy to keep the sigmoid colon in a straight position. By using the slit sliding tube, the scope is restricted only by the length of the outer tube (about 10cm). Therefore, the slit sliding tube is also used by a short length colonoscope as well as a long one. Especially, by using this slit sliding tube with CF-130 (Olympus), a pan-colonscope, colonscopic examination of the ileocecal area is more easily and perfectly performed.

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In order to elaborate on a difference between the idiopathic proctitis and the proctitis and/or proctosigmoiditis accompanying common cold-like symptoms, we have compared with 23 cases of the former and 10 cases of the latter, both of which were found by routine procto-sigmoidscopic examination in our department of medicine for the past 15 months. The result were as follows (1) Only endoscopic examination with biopsy for the rectum could make diagnosis for proctitis. None of other diagnostic procedures including clinical symptoms, labolatory data and X-ray findings failed to reveal the diagnosis of proctitis. We have used the Olympus CF-MB2 routinely. (2) All of the 10 cases of proctitis and/or procto-sigmoiditis accompanying common cold-like symptoms were encountered during a period from December 1977 to March 1978 when the influenza due to Hongkong A-type virus prevailed concomitantly around the city. Therefore we have speculated that the proctitis and/or proctosigmoidi+is accompanying common cold-like symptoms might be caused by viral infection, although no definite proof for that was available so far. (3) In spite of the above observations we could not distinguish the difference among ulcerative colitis, idiopathic proctitis and the possible viral procto-sigmoiditis either by endoscopic or histological examinations as well as by X-ray examination. In Summary, we feel strongly the necessity to follow up those cases similar to ours, particularly using further diagnostic aid including immunological and virological techniques.

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A 40 year-old potatory man was admitted to the Osaka City University Hospital on March, 31, 1977 complainixng of dyspnea and cough. His present illness began 11 months before admission, when he noticed dyspnea, ascites and edema. He was treated in the other hospital as pancreatic pleural effusion and pancreatic ascites. Chest X-ray examination revealed a great amounnt of effusion in the right pleural cavity. Thoracentesis yielded 1200 ml of serous effusion with an amylase value of 184500 international unit/1 with a protein value of 3.6 g/dl, whereas the serum amylase was 790 international unit/1. An upper gastrointestinal barium study including hypotonic duodenography was normal. Seventy days after admission the patient underwent an endoscopic retrograde cholangio-pancreatography. It revealed a main pancreatic duct and branches with a stenosis in the midpancreas with a dilatation and tortuousness of the duct. An additional finding was found that it communicated by way of a sinus tract through the aortic hiatus into the pleural space.

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A case with type IIa of colonic tubular adenoma, 32×18mm in size was reported. A 62-year-old man who has been suffered from lumbago for three months was admitted at the Aichi Cancer Center Hospital in Dec. 1977. Barium enema and colonofiberscopic examination revealed a large flat elevation with a central depression in the sigmoid colon and then a colonic carcinoma was suspected. The gross appearance of the resected specimen, however, showed only a flat elevation without an ulceration although a slight depression was thought to be present preoperati-vely. It was, therefore, difficult to classify the lesion into the type IIa or type IIa + IIc. Histological diagnosis of the resected specimen was a tubular adenoma with moderate atypia.Maruyama reported that a colonic elevation with central depression was carcinoma without exception. The literatures regarding sessile elevated lesions in the large intestine were reviewed. The elevated lesions that we had experienced by colonofiberscopy from July 1975 to Dec. 1977 were discussed.

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A 13-year-old girl was admitted to our hospital in March, 1976, with a complaint of bloody stool of 3 months duration. X-ray examination showed a tumor-shadow with slight stenosis in the sigmoid colon, which was suspected submucosal tumor. Endoscopic examination showed carcinoma of infiltrating-ulcer type and biopsy revealed poorly differentiated adenocarcinoma. At the time of operation peritoneal dissemination and metastasis to the left ovarium were already observed. Macroscopical and histological findings showed moderately differentiated adenocarcinoma of infiltrating-ulcer type. And she died 3.5 months after surgery. A review of the literature on primary carcinoma of the colon in persons under 20 years of age enabled us to find a total of 30 cases, including our case, from 1935 to 1977in Japan (excluded the cases of familial polyposis and the autopsy cases). The commonest initial symptom was abdominal pain and it was fornd over 80%. The mean duration of symptoms was 4 months. For the preoperative diagnosis of 28 cases, 16(57%) were intestinal obstruction and only 6, colonic carcinoma. The age distribution of 30 cases were 10 to 19 years old. Boys predominated, 23 of 30 cases being boys. 12 (40%) of 30 cases were located in the transverse colon. Over 50% of these carcinomas were mucinous or signetring cell carcinoma. Carcinoma of the colon should not be excluded as a clinical diagnosis in young persons only on the basis of age. Barium enema x-rays and endoscopic examinations should be performed more frequently on young persons who have abdominal pain or vague abdominal symptoms persisting more than several weeks.

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