The changes of cardiac function induced by upper gastrointestinal endoscopic examination, were studied employing electrocardiography (ECG) and ultrasound-cardiography (UCG) in 14 high-age patients. Both were recorded before, during and after endoscopic examination, and at the same times blood pressure were also measured. ECG could be recorded in all of the patients, but UCG could not be recorded in 3 patients because of emphysema or funnel chest. In all of the patients examined, heart rate, blood pressure and cardiac output increased during examination and decreased after examination. ST segment depression in ECG were observed in 8(57%) out of 14 patients. In one case, serious arrythmia which was short run typed ventricular premature beats. was found during and after examination. Rate-corrected pre-ejection period (PEPc) prolonged in all of the patients during examination. After examination, PEPc prolongation due to impaired cardiac function was recognized in 4 patinets. Rate-corrected ejection time (ETc) changed in various ways in each patients. PEP/ET prolonged in all of the patients during examination, and still prolonged after examination in 4 patients of whose PEPc prolonged. Ultimately it was proved that endoscopic examination effected considerably on cardiovascular system. Consequently it should be emphasized that cardiovascular changes at the time of endoscopic examination should be taken care especially in old-aged patients, even after finishing the examination, and continuous observation of the conditions of patients examined be essentially necessary.

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The YAG laser (MBB Co., West Germany) was used for treatment of protruded ealry gastric cancers, gastric polyps and phytobezoar as clinical application in addition to ordinary use as photocoagulator. In protruded early cancer of the stomach, 2 cases of I type and one case of IIa-type were treated with the YAG laser resulting in eradicating the lesions . The clinical course of these patients was uvenentf ul and no recurrences of the lesions have been observed. For protruded early cancer of the stomach in patients to whom surgical treatment is contraindicated, the YAG laser treatment is available on the basis of its safety and simplicity. The YAG laser treatment was done in 3 cases of gastric polyps of Type II according to Yamada's classification and proved difficult to use an electric sector. one procedure of the treatment was sufficient to eradicate a lesion in these cases. YAG laser treatment is available for cases in which hemorrage and perforation might be caused by polypectomy. YAG laser treatment was attempted in a case of phytobezor. This treatment will be applied as one of the non-surgical treatments for phytobezoar in the future although investigation in more cases is needed.

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One of the troublesome problems in treating patients with a peptic ulcer is when we should stop the administration of antiulcer drugs, for it is still debatable which finding may signify complete healing of an ulcer though many authors have discussed this problem. In our previous study on fluorescence endoscopy for the active gastric or duodenal ulcers, the amout of fluorescence mainly reflected local mucosal blood flow and a decrease of fluorescence at the margin of an ulcer strongly suggested the hardness of healing. In order to apply this method for the estimation of the complete healing of an ulcer, patients with a gastric or a duodenal ulcer scar were investigated in this paper. Materials and methods: The method of fluorescence endoscepy was previously reported by the author, as an modification of original Katsu's method. The amount of f lurescence was measured using a light sensor (cadmium sulfate, Cds) on the films which were taken endoscopically about five seconds after the appearance of the fluorescent light on the scarring mucosa (Fs) and surrounding intact mucosa (Fi) (Fig. 1, 3). Fs/Fi ratio was called "healing index" since it may indicate maturity of scarring tissue . Materials were three canines with gastriculcer induced by acetic acid, 14 patients with a gastric ulcer scar (18 cases with red scar and two cases with white scar) and eight patients with a duodenal ulcer scar (ten with scar I and two with scar II). Results: 1) Experimental study; Healing indeces were low in the first and second week of scarring period, but later increased rapidly and became close to the value of 1.0 (Fig. 4). 2) Clinical study; Majority (16 of 18 cases) of gastric red scar showed healing indeces lower than 0. 8, on the other hand, in two cases with white gastric scars the indeces were higher than 0.8. Four cases with a long-standing ulcer scar showed low healing indeces continusly, and one of them relapsed two months later (Fig. 7, 8). In cases of duodenal ulcer scar, the indeces were higher than those in cases of gastric ulcer scars (Fig.6). From these results, it is suggested that the healing index may well indicate the grade of regeneration in the scarring tissue, and that the probability of recurrence would be higher when the value remains low for a long time.

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In order to simplify the procedure and to improve visuality in cholangiography we devised a new model of a duodenof iberscope by making the visual direction of the Olympus JF-B3 15 degrees backward. By applying the new model to examination for 51 patients with a suspicion of the pancreas or biliary tract of diseases, we could cannulate a tube through the new fiberscope at a rate of 98%, a rate of visualization was 87% in selective retrograde cholangiography, and 97% in selective retrograde pancreatography, respectively. Although we could not obtain a signiticant increase in the success rate of cholangiography, we could observe vater's Ampulla more clearly from downward under good visual control of the cannule than by using the original JF-B3. However, it may be necessary to add a further ability to the new scope to cover a forward view in addition to a backward view so that it can be used for routine examination of the upper digestive tract by making insertion of the scope easier.

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Peritoneoscopy and liver biopsy were carried out in 259 patients suffering from various liver diseases. Forty-four cases were acute hepatitis, 17lcases were chronic hepatitis, (inactive form 28, active form 122 and active form with bridging formation 21), and 44 cases were hepatic cirrhosis. The histological features were compared with macroscopic findings of peritoneoscopy and laboratory data including S-GOT, serum albumin, serum γ-globulin, cholinesterase, ICG disappearance rate, and 45 min BSP retention rate. Kalk's classification and Shimada's code criteria were employed for evaluation of the macroscopic findings. In the group of enlarged white liver, serum γ-globulin level and BSP retention rate were valuable to differentiate between acute hepatitis and chronic hepatitis. In the group of patchy nodular liver and early nodular liver, ICG disappearance rate appeared to correlate well with the existence of bridging formation which means clinically to be at the precirrhotic stage. Since the peritoneoscopic examination and liver biopsy were not always performed in all patients with liver diseases, predication from the laboratory data alone was required in such cases. Therefore, a scoring method using S-GOT, serum albumin, serum γ-globulin, ICG and BSP was designed. This method revealed that chronic active and inactive forms of hepatitis were able to differentiate each other clearly. In addition, we found that incidence of rheumatoid factor and HB, Ag in chronic active form were more frequent than in inactive one.

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Recently many cases of cancer of pancreato-biliary tree have been found according to progress of new techniques, for example, ERCP, or PTC and so on. Especially cancer of duodenal papailla seems to have the best resectability and the best prognosis, though there is a problem of finding the disease in early stage. In 21 cases of cancer of duodenal papilla in our clinic, analysis was made on the findings of hypotonic duodenography, cholangiography, and duodenal endoscopy and these cases were classified into three type; swelling type, nodular type, and infiltrating type by endoscopic findings. Retrospective comparative studies were made on the accuracy of diagnosis by these three examinations and also on the probability to diagnose the infiltrating degree of cancer before the operation by judging from some characteristic findings. Endoscopy gave the most accurate diagnosis of this disease and endoscopic classification tend to relate to infiltrating degree of cancer of duodenal papilla.

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The definite diagnosis of the colonic tuberculosis by biopsy have been considered to be difficult until today. In 6 (85.7%) of 7 cases without antituberculous therapy, tubercle bacilli were cultured from biopsy specimens. There was no relation between cultivated results and shape of unlcers, i. e. size or depth. It is considered that tuberle bacilli always exist on the bottom of active ulcers of and that culture of tubercle is more effective than histological examination for the definite diagnosis of the colonic tuberculosis. It has become clear that cases without typical "scarred area with discoloration" exist on the follow-up radiological studies of non-operated cases of colonic tuberculosis, definitely diagnosed. We could classify X-ray patterns of colonic tuberculosis into 3 groups in the investigation of these atypical cases.

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In the past, removal of foreign bodies from the esophagus was done with relative ease, while most foreign bodies in the stomach not passing spontaneously required surgical remoal. Recently, removal of such foreign bodies has been facilitated with the use of the f iberendoscope. In two patients, foreign bodies were successfully removed from the stomach utilizing an Olympus f ibre-endoscope, particulary now that grasping forceps and trapping snares are available. Removed foreign bodies were a lipstick and a room key lodged in the stomach. In both cases of intragastric foreign bodies, the procedure was well tolerated, laparotomy avoided and the patients were discharged from hospital.

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The prevalence of parasites has decreased remarkably due to an improvement of public health, but in some cases parasite infection causes abdominal symptoms. So it is necessary to recall parasitic infection when diagnostic screening of abdominal symptoms is made. Some cases that ascaris lumbilicoides or anisakis parasited in the digestive tract were captured by the f iberscope are reported but Necator americanus is too small to be found by X-ray series and is easily overlooked during endoscopic examination. Here two such cases of Necator americanus infection were reported. The patients came to the hospial with chief complaint of epigastric pain. ERCP was intended to be performed in order to diagnose pancreatitis or not. On that occasion Necator americanus (red in color) were found moving near the duodenal papilla and they were captured using biopsy forceps. One patient was found to have chronic pancreatitis but the other had no leision and the both have enjoyed their life since the insecticide was prescribed.

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Localized complications in colonof iberscopy, such as bleeding, perforation, etc, have been well recognized. Recently, we had a rare case of portal venous gas that occured during intra operative colonoscopy. A 27-year-old female with a three year history of ulcerative colitis was admitted to Wakayama Medical College Hospital complaining of abdominal pain, bloody stool and fever of one month duration. She underwent medical therapy consisting of antibiotics, corticosteroid and salicylazosuf apyrindine for five weeks. Following these treatments she was taken to surgery. Under general anesthesia laparotomy was performed and colonof iberscope (Olympus, type TCF) was inserted to clarify the extension of the lesion. Suddenly numberless air bubbles were noticed in all inferior mesenteric venous system. These bubbles appeared to originate from the distended colon and collect toward the portal vein. Her blood pressure dropped to 70/40. She recovered herself under the pertinent treatment by the anesthetist. Fifteen minutes after this happening, the operation proceeded. She had subtotal colectomy and ileorectal anastomsis. Her postoperative course was eventful, and complicated by anastomotic leakage, but she recovered and was discharged on her 139 postoperative day. The etiology of portal venous gas in this case was discussed.

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