Present study reports the histological and endoscopic characteristics of 81 minute cancers of the stomach. The minute cancer was defined as that within 1 cm in diameter. The results were : 1) The majority of the minute gastric cancers were histologically of differentiated adenocarcinoma and the invasions were limited within the mucosal layer. 2) 42 lesions were diagnosed preoperatively. About one half of them were detected their presence by X-ray examination, on the other hand, approximately 90 % were correctly diagnosed by endoscopy. 3) The limit of size in the endoscopic detection of minute gastric cancers appeared to be around 4 mm in diameter. The cancers larger than 6 mm in diameter were successfully detected in most of the cases preoperatively. 4) The endoscopic characteristics of minute gastric cancers were studied, deviding 11 a and If c into 4 types respectively, and II b into 2 types. 5) Biopsy played the most important role in the diagnosis of minute gastric cancers. A correct aiming of the first biopsy was essential.

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The potential of YAG laser coagulator (MediLas, MBB) for endoscopic control of bleeding was investigated experimentally using a flexible fiberoptic laser transmission system. The depth of penetration of the laser beam into tissues was also studied. Results: 1) The radiation to the normal gastric mucosa resulted in a grayish discoloration surrounded by a reddish halo and regional edema. An ulceration ensued, which healed within 3 to 4 weeks. 2) There was no penetration into the serosa even when the radiations were repeated eight times with a power output of 45w for 3 seconds each, or three times with 65W for 3 seconds. 3) An artificial gastric bleeding by repeated endoscopic biopsies could be coagulated within 7.4 seconds with 45w, or within 5.5 seconds with 60W. Neither 20W nor 30W was sufficient to attain coagulation. Our study may show that at least 45W will be necessary to stop bleeding. 4) Arterial bleedings were produced by a surgical removal of a small part of the gastric mucosa. The rate of bleeding was 6.1 ml/min on an average. These bleedings could be coagulated by laser radiation with 40W for 18.0 seconds or with 50W for 15.7 seconds as a mean. 5) A bleeding from a mesenteric artery as large as 1 mm in diameter could be coagulated by YAG-laser. The hemostatic efficiency was closely related to the blood volume and the velocity of the flow in the bleeding arteries. 6) A radiation with 45W for 3 seconds caused a photocoagulative effect to a depth of 5 mm in the liver, 5 mm in the kidney and 2 mm in the spleen.

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Gastrointestinal endoscopy was performed to 30 pediatric patients between the ages of 6 months and 14 years of age. Forty eight upper gastrointestinal endoscopical examination were performed to 22 patients between 1 year and 14 years of age. Nine lower gastrointesti-nal endoscopical examinations were performed to 8 cases between the ages of 6 months and 14 years of age. Of 22 cases wifh upper gastrointestinal sereis, 5 had duodenal ulcer, 3 had foreign bodies, 2 had congenital esophageal stricture and 1 had gastric ulcer. Endoscopic removal of foreign bodies successfully perfomed to all of the three cases. All of them were coins; one was in the esophagus and others were in the stomach. Stomach foreign bodies were removed endoscopically because they were failed progression through the gastroinetstinal tract dispite of following up for 5 days and 12 days respectively. Of 8 cases with lower gastrointestinal sereis, a case had ulcerative colitis and one had juvenile polyp. Endoscopic polypectomy was successfully performed to the cases of juvenile polyp by so-called "intraoperative endoscopy". Six cases under the age of ten were examined under general anesthesia and others received only local (pharyngeal) anesthesia in upper gastrointestinal sereis. Only 1 year old in f ant received general anesthesia and others received no anesthesia in lower gastrointestinal sereis. As to the instrument the thinnest fiberscope, Olympus GIF-P, (connecting part: 9 mm in diameter, bending part: 8.8 mm in diameter, bending angle : up 180° and down 60°, right and left 100°) were used in the most procedures (70%) of upper gastrointestinal sereis. Machida Romanoscopy (∅20 mm) and Olympus Colonofiberscope (∅13.6 mm) were used in 66 % and 22 % of lower gastrointinal sereis. No complication was observed in these sereis. It is concluded that gastrointestinal endoscopy is useful for the diagnosis and treatment to the pediatric patients with gastrointesti-nal disease as to the adult patients and can be performed safely under general anesthesia if necessary.

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Depth diagnosis of gastric cancer is of importance, since it directly relates to the prog-nosis. This paper is to report our study in this regard in protruding types of gastric cancer, mainly by means of endoscopy. For the past 13 years, 690 resections were carried out for gastric cancers consisting of 510 advanced and 180 early cancers. Of which 14 lesions were Borrmann I (Borr. 1) and 53 were early cancers of protruding types, all protruding types totalling 67 lesions which were analysed in this study. Protruding types tended to be found in the aged male averaging 60 years. Histologically, most of them were of well differentiated types even in Borr. I cases, but undifferentiated types were also encountered. The sizes of the bases of I and ha averaged 7.7 and 6.2 cm² respectively in m lesions, whereas they were 28.8 and 33.7 cm² in sm cases. In Borr. I cases, the sizes averaged 42.3 cm² The sizes of the lesions thus showed a close correlation to the depth of invasion. Supposing the bases of lesions were round in shape, the diameters could be calculated as 3 cm in m cases of I and ha, 6 cm in sm and 7 cm in Borr. I. The marginal lines in front view of the lesions were somewhat irregular in sm lesions compared with m. It was also noted that the surface of sm lesions showed more irregularity with frequent depressions on top attached with white exsudative fur. These findings were more remarkable in Borr. I.

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Among 3, 141 cases of endoscopic examinations experienced in the past 5 years at Kyoto National Hospital, 2, 340 cases with abnormal changed were studied clinically and histopa-thologically. The results were as follows : 1) Thirteen percent of all the gastric lesions were seen in the antrum. 4.4 % of all the benign ulcers, 18.2 % of all the gastric cancers and 72.1 % of all the gastric polyps were in the antrum. 2) Of all the lesions in the antrum, 35.6 % were cancers, 35.0 % were polyps and 18.8 % were benign ulcers. 3) The ratio of benign and malignant ulcerative lesions was 2 : 3 in the antrum. 4) In the antrum, 35.7 % of benign ulcers were multiple, whereas in the other part of the stomach it was only 10.1 %. 5) The ages of the highest frequency were their thirties in benign multiple ulcers, fifties and sixties in benign single ulcers and advanced cancers, respectively. 6) Eighty percent of patients with benign ulcer complained abdominal pain as an initial symptom. 25 % of patients with early gastric carcinoma had no complaint. 7) Fifty-six percent of benign multiple ulcers were diagnosed erroneously as malignat at the first X-ray examination, but the diagnoses made by gastroscopies were correctin 83.3 %. 8) All of 9 cases with benign single ulcer had complicated systemic diseases. This may indicate that the systemic disorders per se or administered drugs for them related to the pathogenesis of the antral single ulcers. 9) By taking biopsies from the definite four points, the distribution of intestinal metaplasia was classified into five types. 93% of benign antral ulcers developed in cases of "non-metaplastic" type. Malignant ulcers in the antrum seemed to be closely related to intestinal metaplasia. 10) Ten cases of resected specimens with benign ulcers were histologically examined. Two cases of single ulcer showed the histological features compatible to the "channel ulcer". Six cases of multiple ulcers in the antrum showed characteristic findings of the acute ulcer.

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We devised a gauge for measuring hardness of the liver (Fig. 2, 3) which can indicate hardness of the liver with numerical values. As this gauge can pass through an outer cannula of a Vim-Silverman needle, we can easily use this gauge at peritoneoscopic exam-ination. Handling of this gauge, as shown in Fig. 4, is so easy that we can read the value in a few minutes. As a pilot lamp is put on immediately after the tip of this gauge touches the liver surface, we can measure hardness of the liver in a constant condition. The hardness of the liver measured by this gauge correlated well with peritoneoscopic findings (Fig. 18) and histologic findings (Fig. 19). In general, the value of hardness of the liver becomes lower as lobular distortion progresses. The lowest value was shown in liver cirrhosis. As mentioned above, this gauge was very useful to measure hardness of the liver and to study pathophysiology of diseases of the liver.

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Endoscopic direct and indirect methylene blue (MB) staining methods were done in 53 subjects aged 21-77 years, and the ability of making a diagnosis was compared on each method. Both indirect MB staining method and dyeing method using MB by Suzuki et al. were done in 9 cases of gastric cancer and 19 cases of gastric polyp within a week. The staining area and the grade in these lesions were compared on both method. Staining with indirect MB method was done twice in 44 cases within a month and the reproducibility of staining was evaluated. The following results were obtained; 1) The indirect MB staining method is superior on making an accurate endoscopic evaluation of the degree and the extent of intestinal metaplasia, and its reproducibility is good. Moreover, this method is simpler than a direct MB staining method. 2) There is no difference between indirect MB staining method and dyeing method in making a diagnosis of gastric cancer. The indirect MB staining method is superior to the dyeing method in the diagnosis of protruded lesions of the stomach.

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The patient was a 48-year-old multipara. when she had a hysterectomy for the diag-nosis of uterine myoma in June 1976, the diagnosis of hydatidif orm mole was made by histological examination and anticacer drug was given. In February 1978, she visited our hospital with a complaint of right hypochondralgia. Laboratory data showed a positive test for human chorionic gonadotropin. Radiographic examination revealed metastatic lesions in lungs and liver. An upper gastrointestinal series and endoscopic examination demonstrated a submucosal tumor on the greater curvature of the antrum, which was diagnosed gastric metastasis of the chorioepithelioma by histological examination of biopsied specinen. Methotrexate re-markably decreased the size of gastric metastatic lesion. It is well known that chorioepithelioma metastasizes hematogenously in the early stage. However, only seven cases with metastasis of chorioepithelioma in stomach has been re-ported previously in Japan. In addition, all previous cases were found at gastrectomy or autopsy. As far as we reviewed, our patient is the first case whose diagnosis was made by endoscopic gastric biopsy.

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Swallowing of foreign badies is a common problem. Most of them spontaneously pass through the entire gastrointestinal tract without causing symptoms. The potential hazards of impaction, obstruction, and perforation may lead the physician to remove a foreigh body. This has been generally performed through a regid endoscope in the field of oto-rhino-laryngo-pharyngology or at surgery. Fiberoptic endoscopic extraction of foreign bodies from the gastointestinal tract has been repeatedly reported. This report describes the re-moval of an unusual foreign body with the f iberoptic endoscope and a polypectomy snare. A 22-year-old female visited our outpatient clinic complaining that she had swallowed a toothbrush 48 days ago when brushing her coated tongue. Plain films of the abdomen immediately taken showed bristles of the toothbrush in the duodenal bulb. Endoscopy with the Olympus GIF-D₃ was performed. The bristles were identified in the duodenal bulb and the whole body of the toothbrush in the second portion of the du-odenum. Whth the use of a polypectomy snare, the bristles were easily caught and the toothbrush was removed through the stomach and esophagus. GIF-D₃ was again intro-duced but no serious wounds or pathological lesions were seen. She recovered une-ventfully.

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A case of multilocular liver echinococcosis is reported. A 58 year old male was in-fected with echinococcus in the northern Kurile islands (Shumushu Is.) at the end of the World War 11(1943. 1 9 4 5). His chief complaints were occasional jaundice, hepatomegaly, and expectoration of bitter bile-stained sputum due to a secondary hepato-pulmonaly fistula, a very rare compli-cation of this disease, which was found in only 3 (1.5%) of 194 cases of multilocular liver echinococcosis in Hokkaido. In this case it needed about 33-35 years after infection until these complaints have appeared. Roentogenograms of the chest and the abdomen disclosed multiple calcified lesions in the lungs and the liver. Immunodiagnostic tests of echinococcus (CFT, IHA, I.E) were all positive and the haemogram showed a high eosinophil count of 30%. ERCP also revealed a stricture of the common bile duct and dilated intrahepatic bile ducts which run upside-down. To our Knowledge, this seems the first ERCP of multilo-cular liver echinococcosis. Biopsy under direct vision of laparoscope was performed from ash-colored, very hard tumor under the right lobe of the liver. The specimen showed cysts with thick chitin membranes characteristic of this disease. Operation for the hepato-pulmonary fistula was successful and surgical biopsy specimen also showed multilocular liver echinococcosis.

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