The clinical and pathological significance of fine network pattern of colonic mucosa was investigated according to the findings of macroscopic and histologic appearance of autopsy or operated specimens, and of the representation of radiographic and endoscopic examination, and of biopsy specimens. 1) The colonic mucosal pattern (fine network pattern) was macroscopically classified into three types i) diffusely grooved pattern ii) partially grooved pattern iii) grooveless pattern. In 45 operated specimens, 40 cases (89%) were of the grooved type, 3 cases (7%) were of the partially grooved type andonly 2 cases (4%) were of the grooveless type. On the other hand, 26 specimens out of 31 autopsy cases were not recognized fine network pattern on the surface of colonic mucosa macroscopically. 2) Concerning with the relationship between the thickness of mucosa and fine network pattern, grooved mucosa was more than 500μm and grooveless mucosa was less than 500μm in mucosal thickness. Desquamation of the epithelium made fine network pattern, disappear. From the histological study of 31 operated specimens, the inflammation of colonic mucosa was seen in only one case out of 26 cases of the diffusely grooved type and 2 cases out of 3 of the partially grooved type showed mucosal inflammation at the grooveless area. also, in both cases of two grooveless types, inflammation of the mucosa was recognized histologically 3) Fine network pattern of colonic mucoas was represented radiographically in 43 cases (75%) out of 57 cases, and in 29 cases (57%) by routine endoscopic examination and in all the cases (100%) by the method of dye-scattering endoscopy. Radiographic and endoscopic appearance of fine network pattern of nomal mucosa was composed of regularly arranged innominate grooves and showed minute areas. 4) 43 cases were classifed into three groups by histologic score of biopsy specimens, that is, 24 cases of the normal group, 5 cases of the intermediate group and 14 cases of the inflammatory group. 17 cases (71%) out of 24 cases of the normal group could be judged as normal radiographically but only 9 cases (64%) out of 14 cases inflammatory group could be pointed out as abnormal radiographically. On the other hand mucosal fine network pattern was efficiently demostrated by dye-scattering endoscopy, and endoscopic findings by this procedure suggested the histological changes of the mucosa. Namely, 20 cases (83%) out of 24 cases of the histologically normal group showed normal fine network pattern by dye-scattering endoscopy, and 13 cases (93%) out of 14 cases of inflammatory group showedab normal fine network pattern, Biopsy specimens taken from the irregularly arranged network area, varioliform-protuberance, minute mucosal protrusion and mucosal defect gave inflammatory signs histopathologically.

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Two types of sliding tube was devised to protect the pharyngoesophageal mucous membrane from some injuries during sofisticated endoscopic procedures.(1) Sliding tube for ERCP; The pharyngo-esophageal mucosal injury which may develope sore throat is the major trouble in endoscopic procedures such as ERCP or EPT especially in patients who have some anatomic abnormalities in the duodenum. because it may take time to examine these patients. This type of sliding tube is used for the protection of the pharyngo-esophageal mucous membrane during ERCP or EPT.(2) Sliding tube for urgent endoscopy; The endoscopic procedures are the indispensable means under urgent situations like upper gastrointestinal bleeding. Repeat insertion of various type of fiberscope into the esophagus, stomach and duodenum is necessary both for making diagnosis and for therapeutic measures like gastrolavage and hemostasis by electrocoagulation. This type of sliding tube is of great value in terms of exchanging a few types of fiberscope during a variety of endoscopic procedures for the purpose of making diagnosis and therapeutic approaches. A sliding tube for ERCP is a vinyl tube of which diameter 1.2cm (inside) and 1.4cm (outside) and is consisted of tube and mouth piece. A sliding tube for urgent endoscopy is diameter 1.6cm (inside) and 1.8cm (outside) and its material and structure as ERCP. We have obtained some satisfactory results byusing two types of sliding tube during ERCP and urgent endoscopy.

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We studied combined gastric and duodenal ulcers grouping the cases in radiological and endoscopical diagnosis, and obtained the results below. In the total ulcers, the incidence of the combined ulcer was 9.4% in the cases of radiological diagnosis and 13.1% in the cases of endoscopical diagnosis. The latter was higher than the former. It was considered that the duodenofiberscopy was used in patients who have some abnormal findings in duodenum, pancreas and bile duct radiologically. The number of the male was more than the female. The proportin of the male to the famale was 5 to 1. At the first examination, the one both gastric and duodenal ulcers were fresh was most frequent in the cases of radiological and endoscopical diagnosis. In the cases which were observed the process, as compared with gastric ulcer and duodenal ulcer in combined ulcers, recurrent cases were same numbers, but duodenal ulcers were more in cured cases. The bulbus of duodenum make a stenosis by scarred healing. In duodenal ulcer proceeding cases, the one which has clear stenosis was only one case in the cases of radiological and endoscopical diagnosis. So, the stenosis does not appear to be a major factor in the pathogenesis of combined ulcers. In atrophic gastritis of com-bined ulcers, the one both gastric and duodenal ulcer were scarred was most frequent. In endoscopical diagnosis, the combination of gastric angle and the anterior wall of duodenal bulbus was most frequent. Adding advanced endoscopic examination to X-ray studies, we should examine coexistent ulcers more exactly and should clear the true form more minutely.

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Endoscopic electrocoagulation was performed to 29 patients with bleeding gastrointestinal lesions. Hemostasis was done in all cases. Nineteen cases of gastric ulcer, 3 of gastroduodenal ulcer, 4 of gastric cancer and 3 of duodenal ulcer were successfully electrocoagulated, and two of gastric ulcer rebled. There was no morbidity nor mortality on endoscopic electrocoagulation. This time, usefulness and security of endoscopic electrocoagulation could be evaluated.

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A 53-year-old male with gastric leiomyosarcoma was reported, in which growth process of the tumour was traced by the review of the findings at the annual gastric mass surveys. The tumour grew from 2.6cm to 5.5cm in diametre during the observation period of 730 days. The doubling time was 631 days. Six cases, including the present one, have been reported, in which the growth process of gastric leiomyosarcoma was observed; in the cases with the long doubling time (631 day and 1090 days), no ulceration was found in the lesion, while in the cases with shorter doubling time (40, 175, 410 and 435 days) the lesion was always ulcerated. The present case had, in addition, an independent leison of Borrmann III type gastric carcinoma. Such a case is extremely rare in the literature.

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The patient is a 21-year-old male, who complained of watery diarrhea, lower abdominal pain and fever. Barium enema and colonoscopy revealed ulcers and inflammatory polyps scattered from the sigmoid colon to the transverse colon, so that ulcerative colitis was suspected. He was treated with salazopyrin and steroid, however, there was no improvement. Then medication was changed to anti-tuberculous therapy. The effect was dramatic. His symptoms and sings were relieved within a month. He had bilateral hearing loss due to toxic reaction by streptomycin (SM) two months later. Once SM was stopped, the recurrence occurred. Total colectomy was performed. On the resected specimen, longitudinal ulcers, cobble stone appearance and thickness of wall were seen with several small erosions. Histological study disclosed that transmural inflammatory spreads across all layers of the transverse colon. There were small granulomas without caseation in the submucosal layer. Regional mesentric lymph nodes also revealed similar with infiltration of a few Langhans' giant cells. According to the diagnotic criteria of Crohn's disease propsed by the Japanese Society of Gastroenterology, it is difficult to rule out Crohn's disease, however, the dramatic effect of SM-indicates the possibiliby of the rapentic diagnosis of tuber culosis. Discussion was made shortly in diagnosis and treatment of this rare and tnter-esting case.

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Studies were made on the complication of laparoscopy in our country in the requirement of N World Congress of Gastroenterological Endoscopy. The number of compication from 1969 to 1977 and its items were taken by questionnaire in 114 institutions. The complete replies were filled in 72 institutions (630), and the followings were revealed.(1) Total examinee were 31, 652 cases from 1968 to 1977. (2) The incidence of complication was 0.945%, and death rate by the complications was 0.076% in total examinee. Moreover, the incidence of complication due to laparoscopy was 0.5810, while this due to liver biopsy through laparoscopy was 0.476% in biopsied 24, 358 cases.(3) The items of complication due to laparoscopy were as follows in order of inci-dence; cutaneous emphysema, circulatory insufficiency, infection, puncture of follow viscus, mediastinal emphysema, anaphylaxis, pneumothorax, and omental emphysema. On the other hand, the same study on complication due to liver biopsy was as follows; intraabdominal bleeding, bile peritonitis, pneumothorax, and circu-latory insufficiency.(4) Although the room for laparoscopic examination was also examined, 61 out of 72 institutions had aseptic exclusive room including operation room for laparoscopic examination. However, the remained 11 institutions just used the same room for usual gas-troenterological endoscopy.

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