In the 18 years period from 1958 to 1975, 34 liver hemangioma cases (21; male, 13; female) were found by peritoneoscopy out of 1, 892 patients of liver diseases (1, 468; male, 424; female) in our hospital. The frequency of occurrence of liver hemangioma was higher in the female than in the male. On age distibution, the peak occurrence was in the 4 th to 5 th decade. Size of hemangioma ranged from rice to man's head in size. All of 5 cases with large hemangioma were female, and remaining 29 cases had hemangioma smaller hen's egg in size. In 26 out of 34 cases hemangioma was located on the left side of the Cantlie's line. Selective coeliac an giography and peritoneoscopy were useful for the diagnosis of liver hemangioma. In Japanese literatures in the 60 years period from 1915 to 1975, 184 cases of liver hemangioma were reported. Our 34 cases were compared with the 184 cases and foreign country cases. Our cases were consistent in the sex and age distibution with the Japanese and foreign reports. The location of liver hemangioma of our cases was not in accord with the 184 cases but in accord with the foreign reports.

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Esophageal manometric studies were carried out using an endoscope, which is useful for diagnosis and patho physiology in esophageal disorders. Esophageal peristalsis was measured by means of a direct transducer (Figure 1). Lower esophageal sphincter pressure (LESP) was measured by a rapid pullthrough technique with a PE catheter of 1.7 mm in internal diame ter constantly infused with water at a rate of 2.0 ml/min.. A forward-viewing fiberscope was introduced into the esophagus only with surface anesthesia of pharynx. After introduction of an endoscope, esophageal peristalsis were elicited by the stimulus of air which was sent by a simplified constant pressure device (Machida) connected with an air inlet of the endoscope and measured by a direct transducer inserted through a channel orifice of the endoscope (Figure 2). For measurement of LESP, a tip of the endoscope was placed at about 5 cm proximal to the gastroesophageal mucosal junction and a manometric tube was inserted in a similar way. Manometric study of esophageal peristalsis was per. formed on 98 subjects which consisted of 5 groups as shown in Table 1. Esophageal peristaltic waves were successfully recorded in all cases of group A (control subjects) at the part of 10 cm proximal from the gastroesophageal junction. Mean frequency, amplitnde, andduration of the peristaltic wave were 4.6±0.9 number/min., 37.8±15.6 cm H2O, 1.9±0.8 second respectively. In group B (PSS), frequency and amplitude of the peristaltic wave were significantly lower than those of control subjects (P<0.001, Figure 14), (P<0.05, Figure 15), and 18 of 35 cases showed aperistalsis, 7 cases showed weakness of the peristaltic wave. The detection rate of esophageal changes in PSS was 71.4% by the manometric method in comparison with 57.1% by only radiography (Table 2). In the other groups, 2 cases of dermatomyositis, 3 cases of achalasia, 1 case of esophageal carcinoma, and another of gastric polyp (72 year old, female) showed abnormalities of the peristaltic waves. The LESP was measured in 23 control subjects, 12 patients with PSS, 6 patients with hiatal hernia, and 3 patients with achalasia, the mean LESP were 16.3±5.8, 7.8±4.3, 8.7±6.5, 26.2±6.3 mm Hg respectively. The LESP in PSS was significantly lower than that of control subjects (P<0.001, Figure 20).

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Endoscopic papillotomy is one of the great advances in recent years in the fields of the endoscopy. We have been attempted the examination of the biliary duct by inserting the fiberscope through the incized papilla into the common bile duct after endoscopic papillotomy. Recently we have succeeded in making the peroral fibercholedochoscope by courtesy of Machida Co. Ltd…In this method, we use the choledochoscope with the sliding tube, which is so-called direct method. The sliding tube has no optical system and its bending angle of the tip are 150°in up, 120°in down, and 90°in right and left directions. The length of the soft tube is 1100 mm with an inside diameter of 7 mm and an outside diameter of 13 mm. Choledochoscope is a front-view fiderscope, its bending angle of the tip is 150°in only one direction (up). The length of the soft tube is 1400 mm with a diameter of 6 mm. It is equipped with inflation, water feeding, suction devices and a large channel of 2.4 mm. This procedure has been performed in 21 patients. We investigated the rate of insertion to the duodenal second portion and front view of the duodenal papilla. As the result, we considered that this scope had still some points for improvement. This work was supported in part by a Grant-in-Aid for Cancer Reseach (52-24) from the Ministry of Health and Welfare.

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Endoscopic Retrograde Panereatocholangiography (ER CP) has gained popularity for direct cholangiography. In this paper the laparoscopic cholangiography which was performed to the patients whose gallbladder was not visualized by ERCP was evaluated. ERC was carried out to 123 patients. In 88 patients whose bile ducts were sufficiently opacif ied by ERC, 27 (30.70) shows no visualization of gallbladder. Among the patiens whose gallbladder was not visualized by ERC, abnormality of the gallbladder, for example cholecystoli-thiasis or atrophic cholecystitis, was comf irmed by operation and laparoscopy in 95.90. Combied examination of ERC and laparoscopic cholangiography was performed to the 20 patients, who had nonvisualized gallbladder or nonopacification of the bile duct by ERC. By combined examination, correct diagnosis was obtained in 90%. There was no serious side effects of the laparoscopic choiangiography in our hospital. When there is nonvisualization of the gallbladder by ERC, combined examination of ERC and laparoscopic cholangiography is valuable method for the accurate preoperative diagnosis.

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In stead of color slide method we have employed color print recording method using the Machida and Olympus endoscopes. Our new device is that the endoscope is coupled with the camera, Olympus OM-II, by each abaptor and enlarging lens. Horikomi Photorecorser DH-I is one of the most excellent data camera apparatuses, which is fixed to the back side of the camera, Olympus OM-II. We use a roll of negative 35 mm film, ASA 400 for color print. By this method we have taken several sheets of color photographs (or color prints) for every examination where the patient's name date and place of the lesion are marked. We have attached these color prints on the report paper. Regarding the color print the advantage is that the doctor can observe the picture without a projector in contrast to the color slide.

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