Intrahepatic cholangiography by ERCP using Caerulein injection or with changing of position were studied in 14 cases of hepatoma or cholangioma, 14 caces of metastatic liver cancer and 15 cases of liver cirrhosis. 1) Visualization of 4th to 6th branches of the intrahepatic bile duct was effective for the diagnosis. 2) As the cholangiographic findings, obstruction, stenosis and distal dilatation were characteristic in hepatoma, cholangioma or metastatic liver cancer. 3) In cirrhosis, tortuosity, caliber irregularity, compression, approximation and rigidity were outstanding findings. 4) There are some limitations of diagnostic ability so far.

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In an attempt to clarify the healing process of gastric ulcer, endoscopic findings were studied with particular reference to staging of ulceration and to classification of healing process from the presumed initiation of healing process. 1) When symptoms disappeared in a short period (within a few days), the healing process presumably started on the day of disappearance of symptoms. 2) Brownish coating due to bleeding disappeared within a week and edematous swelling of the ulcer margin in two weeks. Reddish halo of regenerative mucosa developed from the third week in shallow ulcerations, sixth week in deeper ulcerations and fourth week on the average. 3) Stages of ulcer healing were classified as A1, A2, H1, H2. "A" stands for active and "H" for healing. Al : Marginal swelling was clearly present. Brownish coating was initially present. A2: The stage between Al and H1. H1 : Narrow reddish halo developed. In case of rapidly healing ulcer within three weeks no red halo developed and marked decrease in ulcer size followed this stage was classified into H1. H2: The stage wilh wide reddish halo. The width of halo was more than the half of ulcer radius. 4) Healing process of gastric ulcer was classified into four groups according to duration required until scarring. Group A : Promptly healing group. Scarring occur in one month by shrinking of ulceration. Stage Al and A2 for 10 days, H1 and H2 for five days. Group B : Ordinarily healing group. Scarring in two months. Each of four stages required 15 days. Group C : Slowly healing group. Scarring in four months. Stage Al for 15 days, A2 for one month, Hl for one month and a half and H2 from the third month. Group D : Hardly curable group. Scarring did not yet develop at fourth month. Stage H2 had lasted until redness disappeared at sixth month (stage HO) The depth of ulceration was roentgenologically less than 5mm in groups A and B, and more than 5mm in groups C and D.

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The stomach cancer frequently coexistent with borderline lesions of the gastric mucosa. However, the rate at which a borderline lesion coexists in the stomach with cancer is not necessarily high. This may suggest that a borderline lesion is closely related to the develo-pment of a certain type of stomach cancer. In order to study the relation of the background of the borderline lesions and stomach cancer, 115 cases of endoscopically diagnosed borderline lesions were analyzed and followed up. The stomach cancers newly discovered the observat-ion period were analyzed pathologically and statistically, in which, there were coexistent stomach cancer. The results obtained were following: 1) There were 14 cases (16 lesions) of stomach cancers coexising among 115 cases of borderline lesions (12.2%). They were two cases of Borrman's type I, two cases of Borrmann's type II, four cases of early gastric cancer type IIc ul (-), a case of IIc ul (+), three cases of type I and four cases of type IIa. Histologically, 13 cases were differentiated and three cases were poorly differentiated. 2) Nine cases of stomach cancers were newly discovered out of 101 cases of boderline lesions during following up (for two months as the shortest, 13 years and three months as the longest, or an average of four years). Two cases were omitted from this study because of insufficient informations. The other seven cases comprised a case of Borrmann's type I, a case of early cancer type IIc ul a case of IIc ul (+), three cases of IIa and a case of IIa + IIc. Histologically five lesions were differentiated and two were poorly differentiated. 3) The frequency of newly discovered stomach cancers were nine cases among 101 borderline cases. This was significantly greater than the expected value obtained by correcting the age from the general population during the same period (p<0.01). These findings may indicate that the borderline lesion of the stomach is closely related to the development of differentiated stomach cancer without ulcer active change, and it may be said that the patient with a borderline lesion belongs to the high risk group for stomach cancer.

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Recently, we experienced three cases of gastric cancer, in which the first biopsy was negative. This experience made us to study the rate of false negative biopsy. The rate of correct diagnosis at the first gastric biopsy was 94.8 percent among 364 cases of gastric cancer and false negative results were 5.2 percent. The rate of false negative biopsy was 3.7 percent in early cancer and 5.8 percent in advanced cancer. Among advanced cancers with negative biopsy Borrmann's type 4 were most frequent and Borrm ann's type 3 came next. The causes of negative biopsy were con jected either submucosal infiltration of the cancer or technical errors. Importance of repetition of biopsy and following up of the case should be emphasized.

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X-ray and endoscopical examinations of small intestine, and colonof iberscopy were performed on 8 cases of Diphyllobothriasis. Diphyllbothrium latum in the small intestine (especially distal part of the worm) was clearly demonstrated by x-ray examination, but it was necessary to compress a part of small intestine at least during 10 seconds. By this compression techneque, we have showed the location of scolox of this worm at the middle part of the jejunum in two cases. After studying the length of proglottid in X-ray films it was revealed that this worm lived in the human small intestine in shorter condition than that was regarded before. (The length of the worm became about three times longer when it died.) Endoscopical observation of the jejunum have been done as far as about 50-60cm beyond the duodenojejunal angle, but we could not observe the worm in all cases. While, in one case, the worm was clearly observed by colonof iberscopy along the sigmoid and descending colon, and this worm was easily identified as Diphyllobothrium latum endoscopicaly through careful observation of its proglottid. Biopsy specimens from small intestine of the patients of this disease showed no partic-ular histological finding.

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Twenty-eight patients (11 males and 17 females), who were clinically suspected to have cholecysto-pancreatic diseases, underwent both the B. T. PABA test, a new pancreatic exocrine function test, and the endoscopic retrograde cholangio-pancreatography (ERCP). The abnormalities of the main pancreatic duct and its branches in ERCP were classified as "normal", "slightly abnormal", "moderately abnormal" and "severely abnormal". In the B. T. PABA test, more than 70% of PABA excretion rate was used as a "normal" value. Seven out of 13 patients with abnormal pancreatic duct in ERCP showed abnormal values in PABA excretion. Only two out of 15 patients with normal pancreatic duct in ERCP showed abnormal values in the B. T. PABA test. Statistically significant difference in the B. T. PABA test was observed between the two groups with "normal" and "abnormal" pancreatic duct and branches. This result showed that there was high correlation between the B. T. PABA test and the findings of pancreatic duct in ERCP, Although, this could be inferable from the results that the pancreozymin-secretin test was correlative with the ERCP and a signi-ficant difference was observed between the B. T. PABA test and the pancreozymin-secretin test, our paper may be the first report about the correlation between the B. T. PABA test and the ERCP.

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Endoscopic magnifying observation method of the gastrointestinal mucosa has been developed and widely applied in recent years. However, observation of the individual small intestine was not easy because of difficulties in an endoscopic insertion technique into the small intestine which is the most distant portion both from the mouth and anus. A newly developed magnifying enteroscope, type SIF-M, was deviced by Olympus Optical Co.. Its close-up observation enables us to magnify the mucosa ten times larger, so that the minute villi may be clearly inspected. According to the rope-way technique, SIF-M or CF-HM (a magnifying colonoscope) was introduced into the small intestine per anally. SIF-M was used for the observation of the whole parts of the small intestine and CF-HM, for the ileum. After the usual observation, l Oml of 0.1 % methylene blue solution was directly sprayed on the mucosa. Villi were stained quickly and inspected clearly by the magnifying scope. Normal mucosa showed finger-shaped villi and their arrangement was regular. On the other hand, the mucosa of inflammatory bowel disease showed irregularly shaped villi and their arrangement was irregular or sporadic. It was emphasized that the endoscopic magnifying observation of the individulal villi will be useful not only for the correct diagnosis of the small intestine but also for the approach to the path-physiological aspect of the small intestine.

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Recently a high power magnifying colonoscope (CF-HM) was devised, which made it possible to observe fine structure of the colonic mucosa. We have an opportunity to use this new colonoscope. We carried out magnifying studies in 72 cases (9ltimes) during nine months since December 1978. Its specification is as follows: magnifying power is 35 times in the maximum, the effective length is 1420mm which is sufficient to observe the ileocecal portion. The image is good enough to get accurate diagnosis. We can easily recognize "units" and pits composing intestinal areas instead of "fine network pattern." The magnifying view of inflammatory disorders are well corresponded to histological classification. A minute polyp or "a bud of polyp" was also found out in three cases by this magnifying colonoscop in comination with ordinary observation.

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Gastrointestinal fiber scopes after endoscopy were found to be contaminated with a considerable high number of bacteria at four endoscopy departments in Osaka. Each instrument after endoscopy demonstrated Bacteria up to 10 to 10 in number. And number of of bacteria on the fiber scope after conventional cleaning was 10 to 10. This increased up to 108 during one night at the room temperature. Above results may show inef f ectireness of conventional way of deacling instruments. We recommend a method of disinf ectin using 2 % glutaraldehyde (Sterihyde). It was simple and reliable. By this treatment, number of bacteria on the instruments decreased to 10 on each scope. The residual glutaraldehyde on the colono- and bronchof iberscope was 2.lmg and 0.02mg respectively, within a safe level for human body. We also propose criteria for disinfection of fiber endoscopes. That is: number of bacteria on a scope after disinfection should be lower than 10 and no Pseudomonas aeruginosa or Escherichia coli should be detected. Instead of the test for HBs Ag, occult blood test should be negative.

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"Eight points" methods of gastric biopsy under direct vision had been performed in 353 subjects living in Chokai Village, Akita prefecture. From the histological point of view, the authors devised "Metaplasia Index" that express the grade of intestinal metaplasia. The "Metaplasia index" is very suitable for evaluation of the development of intestinal metaplasia of the stomach and we reached 90% of agreement for persons who were per-formed repeated gastric biopsies at one or two years interval. Sexual difference of the grade of intestinal metaplasia obtained by the metaplasia index was well fit to the previous reports, but it was more severe in the male than in the female. The grade of the intestinal metaplasia of the stomach gets severe with age, but by our observation, it takes a favorable turn after 50 years of age in the male. There are many back ground factors of this situation and we would suggest the possibility of the intestinal mepaplasia to be reversible. Histologically, it was diagnosed as polyp cancer with invasion m.

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This is a case report of adenoma of Brunner's gland in the duodenal bulb. A 37 years old male admitted to Tokuyama Chuo Hospital with chief complaints of tarry stool and anemia. Upper GI series revealed a polypoid lesion with stalk in the duodenal bulb. Endoscopic polypectomy was performed and the polyp was successfully removed without any accidental complication. The resected polyp was 27mm×22mm×22mm in size. Histologically it was diagnosed to be adenoma of Brunner's glands.

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A case of the tuberculosis of the colon roentgenologically similiar to the ulcerative colitis was reported. A 53-year-old man was admitted to our hospital because of a weight loss and muco-bloody stools. Roentogenologically, the lesion was continuous, and ulcer formation and many inf lam-matory polyps were diffusely found from the descending colon to the cecum. But, a skipped lesion was seen at the S-D junctional area and the mucosa between ulcers appeared intact. Edoscopically, relatively deep, circular ulcers exsisted at the S-D junctional area and inflam-matory polyps were scattered. Granuloma with caseous necrosis was not obtained by biopsy and tubercle bacillus culture from feces were ineffective. But, the tubercle bacilli were cultured by biopsy speeimen from the bottom of the ulcer. Finally, it is concluded that the tubercle bacillus culture by biopsy is effective for the definite diagnosis of tuberculosis of the colon.

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