A recurrence pattern of linear ulcer scars of the stomach was analyzed on the basis of the endoscopic follow-up stuties of the scars. One hundred and nine patients with linear scars were followed up every 4 to 6 mouths for 10 years from 1967 to 1976 at the Second Department of Internal Medicine of Fukushima Medical College. An assumption of prognosis of the linear ulcer scars was proposed on the basis of the following results. 1. The location of the linear ulcer scars was restricted to the gastric angle and its adjacent area. 2. There were 96 patients with recurrence and 13 patients without recurrence of ulcer, a recurrent. 3. Ulcer was not observed in the same area as the preexisting one. The recurrence patterns ulcers were divided into 4 types; A, B, C, and D, according to correlation of location between a recurrent ulcer and prexisting ulcer scar (Table 1) . 4. The recurrence pattern tends to be similar to that of a preexisting ulcer scar (Table 4) . 5. A close correlation between a recurrence pattern and the length of a scar was observed(Table 2 and Figure 12). 6. Hypothetical diagram of the course of a linear ulcer was proposed on the basis of length of a scar and an ulcer recurrence pattern (Figure 14). 7. Therefore, a prognosis of a liner ulcer could be assumed from a recurrence pattern and length of a scar (Table 6).

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The technical problmes of colonoscopy has been improved significantly. However, there still remains a serious problem how to relieve the distress of the patient during colonoscopic examination. In our institution, 30% N₂O analgesia was performed in 166 cases of colonoscopic examination. It was sufficiently of f ecive in 133 cases (78.9%) of total examines with a prominent sedative and a mild analgetic effect. Our questionnaire about the premeditation in colonoscopy and usefulness of 30% N₂O analgesia to several institutions in our country showed that few institutions used sedatives or analgesics as the premeditation and N₂O analgetic method was not considered at all for fear of making the patients unconsciousness or insensibility. But actually its rapid effective-ness, good recovery from analgetic condition, no side effect and easy managenent are greatly helpful in reliaving the distress of the patient during colonoscopic examination.

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The number of parietal cells was estimated through endoscopic biopsy specimens taken from the upper greater curvature of the residual stomach with or without a stomal ulcer. A partially modified Hoshiko's method was used for the calculation of parietal cells. There was an apparent difference in the number of parietal cells depending on the association of ulcers. The calculated number of parietal cells in cases with stomal ulcer remained in the level of those in normal, not-operated stomach. On the contrary, the number of parietal cells in residual stomach without ulcer was significantly low. If the corrected number of parietal cell (length of parietal cell number of parietal cell) is used this difference becomes more apparent. MAO was measured and compared to the number of parietal cells. There was not a significant difference statistically between those two groups, though there was a tendency that the decrease of parietal cell function was less prominent in cases with on stomal ulcer.

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The experimental study on the acute toxicity of methylene blue was done for the purpose of comfirming the safety of endoscopic dying. Previous papers reported that the methylene blue showed no significant side effect without direct toxic effect on nerve fibers in cases of intrathecal instillation, and was considered safe enough for oral administration. This study was attempted to know the influence of methylene blue to the liver and kidney. Wister rats, weighing 150 gr. each, were given 10, 50 or 100mg/kg of methylene blue I.P. or P.O.. Twenty four hours after administration, the rats were killed. The blood samples were measured for GPT, ALP and total bilirubin, and the liver and kidney were examined histologically. Some of the rate, mainly in the large dosage groups, showed the slightly elevated GPT level, spotty necrosis of the liver cell, and slight damage of the glomeruli and tubules in the kidney. These results may suggest a possibility of side effects caused by oral administration of methylene blue in a large dose.

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Endoscopic retrograde cholangio-pancreatography (ERCP) and pancreozymin secretin test (P-S test) were performed in 90 patients with chronic pancreatitis and ERCP findings were compared with values of P-S test for the study of correlation between these two exami-nations, and discussions were made on diagnostic evaluation of ERCP in chronic pancreatitis. Cases studied include histologically diagnosed cases, chronic calcifying pancreatitis, cases showing abnormal P-S test and cases of suspected chronic pancreatitis with upper abdominal discomforts and elevated serum or urinary amylase. 47 out of 54 cases with definite chronic pancreatitis showed abnormal P-S test and, on the other hand, ERCP revealed abnormalities in all of these cases. Statistical study indicated that the values in P-S test were well correlated with ERCP findings in grade of their ab-normalities. However, the discrepancy between ERCP findings and P-S test values was observed in nine cases. Four were cases of biliary tract diseases with or without gall stones. One was of unknown etiology and the rest four cases had chronic calcifying pancreatitis, in which stones were located mainly in large pancreatic duct.

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1) The incidence of clinical symptoms were as follows : abdominal pain 82%, fever or nausea 35%, jaundice 24% and abdominal mass 12%. The incidence of fever was higher than that of jaundice or abdominal mass. Laboratory studies of blood were normal in one-half of the cases. 2) They were divided into two types, cystic dilatation type in 6 cases and cylindrical dila-tation type in 7 cases following ERCP. Extrahepatic type in 7 cases having no intrahe paticductal dilatation and intra-and extrahepatic type in 6 cases having both intra and extra he paticductal dilatation were recognized. 3) The mode of pancreatico-biliary anastomosis were classified into two types, one is pancreatic duct flowing into common bile duct in 3 cases and the other was common bile duct flowing into pancreatic duct in 13 cases. Anomalous pancreatico-biliary tract anastomosis were recognized in all 16 cases. 4) The maximum diameter of the extrahepatic bile duct co-related to the degree of the terminal choledochal stenosis. 5) A case of idiopathic choledochus dilatation associated with cancer of the liver and two cases accompanied by pancreatolithiasis were observed in the present series.

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The authors experienced twenty cases of acute duodenal ulcers mainly found on urgent endoscopy in the past five years. Clinical and endoscopic studies of these ulcers obtained the following results; 1) There were seven patients (35.0%) who had some inducements. The patients included nineteen males and a female ranging from twenty-nine to seventy-eight in age. 2) The onset of acute duodenal ulcer was sudden. 3) The patients presented with severe clinical symptoms which were severe abdominal pain, hematemesis and melena. 4) Endoscopically, acute duodenal ulcers were characterized by wide, superficial and shallow features. The depth was considered as so-called Ul-II. 5) Location of these ulcers was the same as that of chronic duodenal ulcers. 6) Most of these ulcers healed within two to three weeks. As the etiology of acute duodenal ulcers has not been known, it is difficult to investigate the pathogenesis. However, it is suggested that the disturbance of regional blood flow due to ischemia in the duodenal bulb might be related to the pathogenesis of these ulcers.

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In order to study the physiological function of the large and small intestines, a new f iberoptic endoscopy had been developed by us and named, as "Multipurpose Ileocaecoscopy (MIS) ". This scope has the multipurpose channel, which is 5 mm in diameter and twice wider than that of the ordinary colonoscopy. Through the channel of the MIS, it is possible to measure the intraluminal pressure and to take the electromyogram of the whole large intestine and the intubation and indwelling of tef lon tube in the terminal ileum could be carried out successfully. Then a trial was made to insert the tube into the terminal ileum by using prevailing Olympus CF-LB3 instead of MIS. This intubation technique is a modification of cardiac catheterization. Through the channel of CF-LB3 a guide wire is positioned in the terminal ileum. Subsequently only CF-LB3 is pulled out leaving the guide wire in position. Along the guide wire a tef lon tube can be placed in the ileum. Then by pulling out the guide wire the one end of the various tubes in size can be left in the terminal ileum. By this indwelling tube method, it was possible to measure the intraluminal pressure of the whole colon by a pressure transducer. The intraluminal pressure was measured by the transducer method in patients with acute terminal ileitis, diverticular disease of the colon and irritable colon syndrome. The indwelling tube method also provided well double contrast roentgenograms of the intrapelvic ileum to terminal ileum, where, without this method, barium in the sigmoid colon usually interferes with the detection.

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This paper reports two cases of columnar lined esophagus successfully diagnosed by X-ray examination and endoscopy with biopsy. A special reference to the association of ref lux esophagitis is added. Case 1 was an 80-year-old female. She had a sliding hiatal hernia and stricture at the lower part of mid-esophagus. An endoscopic diagnosis of columnar lined esophagus was confirmed by biopsy which showed columnar epithelia with goblet cell and reflux esophagitis in slight degree. Case 2 was a 55-year-old male. Endoscopy revealed severe reflux esophagitis with erosion after total gastrectomy The biopsy specimen from the esophagus showed columnar epithelia similar to those in the small intestine. Both cases had reflux esophatitis as mentioned above and may suggest some relationship between the appearance of columnar epithelium in the esophagus and reflux esophagitis, though the severity of esophagitis was not necessarilly correlated to the extent of columnar lined esophagus.

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A patient with situs inversus visceralis totalis, and choledocholithiasis underwent ERCP and EPT which resulted in evacuation of a stone in the common bile duct into the duo-denum. The patient, a 53 year-old female, had a history of cholecystectomy for cholelithiasis 6 years ago. She developed an episode of severe epigastralgia, nausea and vomiting in Des, 1977, and then she was admitted to another hospital and received some medications with relief of symptoms. She had again an episode of similar symptoms in June, 1978, and at that time upper GIS revealed pneumobilia, regurgitation of contrast medium into the bile duct and choledo-cholithasis. Consequently she was tranferred to our hospital for the purpose of EPT. After admission, She underwent ERCP and EPT. These procedures were done as follows; the patient being placed on rt-side lying position, endoscope was inserted into the duodenal second portion twisted inversely. Two choledochoduodenal fistulas were observed on the inner posterior wall of the duode-nal bulb. Subsequently the papilla of Vater was easily observed, and ERCP (especially ERC) was easily done. Finaly EPT was successfully done with stone evacuation by basket catheter. Her clinical course after EPT is smooth without any surgical intervention so far.

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A 46-year-old male, who had been diagnosed as periarteritis nodosa (P. N.) by biopsy of skin lesions and treated with a steroid (betamethasone 4.5 mg/day) orally, was admitted to our hospital with a complaint of sudden severe epigastric pain. The stomach, at that time, endoscopically showed multiple and irregular-shaped ulcers with white coat and coagula in the body and anglus, surrounded by mucosal thickening and hyperemia, and forming belt like-shaped ulcers as a whole from the body to the antrum on the posterior wall. Edematous and reddened changes of the mucosa in the antrum were observed. Biopsy revealed severe acute inf lamatory changes in the ulcers and detected numerous Candida albicans from white coats, but not from the mucosa. X-ray examination, ten days after admission, showed two, irregular and belt like-shaped ulcers developing along the lesser curvature of body the greater curvature of the antruim on the posterior wall. Neither aneurysm nor obstruction of gastcic vessels was proved angiographically. Using anti-ulcer drugs and decreasing dosage of steroids, the ulcers have changed to linear scars and healed in two months. This case is interesting because of these varied findings in the stomach. The authors discussed the pathogenesis as follows, 1) These changes in the stomach were mainly based on ischemia of the gastric wall due to P. N. 2) In addition, steroid therapy and invasion of Candida albicans played an important role in the pathogenesis.

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This paper presents clinical and endoscopical features of 9 patiens with drug associated colitis. All of the patients were female and they were between 29 and 64 years of age. Anti-bacterial agents used were LCM, TC, CET, PA, CEX and ABPC. These drugs were pre-scribed for reasons of following conditions; prophylactically after opertion (4 cases), otitis media (2 cases), upper respiratory infection (3 cases) . The risk of developing colitis for an individual receiving antibacterial agent does not appear to be dose-dependent nor to be related to the route of administration. The most common symptoms were diarrhea, abdominal pain and fever. The interval from initiation of antibiotic therapy to the onset of diarrhea was from 2 to 15 days. All of the patients got well both clinically and colonoscopically by 11-- 49 days after the onset of diarrhea. No patient had spontaneous relapse of colitis any more. Pathogenic bacteria were not noticed in spite of repeated stool culture of all cases. Case (3) and (A) had positive lymphocyte stimulation test. Colonoscopy was the most useful examination in evaluating the disease. Two cases had pseudomembraneous colitis, and the others had a colitis with mucosal redness, erosion, edema and bleeding. The finding of pseudomembranes seemed to indicate a worse outcome. Generally speaking, patients receiving antibacterial agent should be carefully checked for the development of diarrhea. If diarrhea developes, a colonoscopic examination should be performed promptly. Once colitis is found, the antibacterial agent should be immediately discontinued. An energetic supportive therapy should be done especially in case of pseudo-membraneous colitis.

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