剖検標本手術標本を用い大腸粘膜微細模様の基礎的検討を行い,X線検査,内視鏡検査および直視下生検により,微細模様像の臨床診断的意義について検討した.　大腸粘膜の肉眼的微細模様は有溝型,部分的有溝型,無溝型に分類可能で,その出現頻度は手術例では89%が有溝型,部分的有溝型7%,無溝型4%であったが,剖検例では84%が無溝型であった.　粘膜の高さが500μ以上であれば肉眼的に溝を認め,500μ以下に萎縮すると溝は消失する.又萎縮傾向を認めるものに炎症所見を認めた.　大腸粘膜微細模様の描出能はX線検査では75%,通常内視鏡検査では51%,色素内視鏡検査では100%であった.　生検所見を点数評価基準によって整理し,正常型,中間型,炎症型の3型に分類した.生検正常型の71%はX線的にも正常と判定できたが,生検炎症型の64%しか異常を指摘できなかった.一方色素内視鏡検査では生検正常型の83%に正常模様を認め,炎症型の93%に異常を認め,粘膜様像を十分現し組織学的変化を示現できた.

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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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胃潰瘍と十二指腸潰瘍とが共存する例について,X線検査例と内視鏡検査例とに分けて検討した.共存例は,全潰瘍に対して,X線例では,9.4%,内視鏡例では,13.1%に発生した.性別は,5:1で男性に多く,40代がもっとも多い.初回検査時の集計では,胃・十二指腸潰瘍いずれもopenのものが,X線例,内視鏡例ともにもっとも多い.経過観察例では,十二指腸潰瘍の方が,胃潰瘍より治癒の方向に進みやすい.狭窄が,共存潰瘍発生のもっとも主要な原因であるとは断定できない.共存例における萎縮性胃炎は,胃潰瘍,十二二指腸潰瘍いずれもscarの例にもっとも多い.内視鏡診断における潰瘍存在部位は,胃角部・十二指腸球部前壁の組み合せがもっとも多い.

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内視鏡的直視下電気凝固法を上部消化管出血29例に施行し,全例・救急止血に成功した.これらの成績により,本法の施行にあたっては,年齢,病巣局所の出血状況,全身的な合併症の有無などの因子はその適応上,余り問題にならないことが判明した.また本法による救急止血後の治療は既に提唱して来た内視鏡検査による厳重な監視体制と一定の手術適応基準により行った.その結果,重篤な全身性疾患のため,あえて内科的治療にとどまらざるを得なかった大量出血の5例のうち,2例に再出血死を,3例に永久止血を認めた.また少量出血の18例と外科的治療を行った大量出血の6例についてはその治療の経過において再出血は認めず,且つ安全に外科的治療を行うことが出来た.さらに本法の施行中に大出血を招来したが,本法による再止血に成功した2例を除き,重篤な偶発症は経験しなかった.

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53歳の男性で,経年的胃集検の所見からその発育経過を明らかにすることの出来た胃平滑筋肉腫の1例を報告する.すなわち730日の観察期間に径2.6cmから5.5cmへと発育したもので,そのdoubling time,組織の核分剖数等の点から他の報告例と対比し若干の考察を加えた.　また本例はBorrmann3型の胃癌を独立病変として合併しており,その点も加えると,きわめてまれな症例と考えられる.

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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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