It is important that a peritoneoscope ensures any physician to operate easily and take sharp photographs. We have developed a new system for peritoneoscopy in collaboration with the Olympus Optical Co. and report here clinical experience with this system. This is the first time that an (automatic exposure) camera with the automatic flash volume con-trol system is applied to the rigid scope. The system consists of a light quide type scope, a 16mm automatic exposure camera adapter with an automatic winder and an extracorporeal light source equipped with a flash facility (Table 1, 2, Fig. 1 and 2). The scope optics provide improved resolution minimizing curvature of field, and opti-mum light distribution ensures virtually uniform illumination throughout the visual field. As this light source incorporates a high-output flash tube, bright images can be obtained despite the light quide type illumination. This system automatically offers clear photographs irrespective of the distance to the object (Fig. 6, 7, 9, and 11). By using 35mm manual exposure camera with focusing adapter, images 24-31mm in diameter can be produced (Fig. 8, 10 and 12). We feel that this new system proved easier to operate and safer than the conventional equipment, and will be useful for the diagnosis of the liver diseases and other intraperitoneal lesions.

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Of 272 cases of liver cirrhosis, the diagnosis of which had been established by peritoneoscopy between 1964 and 1978, a retrospective study primarily of peritoneoscopic pictures was performed in 181 cases whose survival or death was ascertained. Their survival rates were computed by the life table method. The ultimate purpose of the present study was to know whether or not the morphological features of the cirrhotic liver might provide prognos-tic information. The results obtained are briefly described, as follows: 1) The 1-year, 3-year, 5-year, 10-year and 14-year survival rates of the 181 cases were 90%, 69%, 55%, 32% and 25%, respectively. There were no significant differences in those survival rates between the male and female groups. By age calssification, the younger group of patients of less than 40 years of age showed quite an excellent prognosis. 2) The 5-year and 10-year rates of the enlarged right lobular type were as high as 63% and 60%, respectively. The corresponding figures of the atrophic right lobular type were 36% and 13%, respectively, which were significantly low compared with those of the former type (p<0.01). 3) The 5-year and 10-year rates of the small nodular type were 70% and 49%, respec-tively, while those of the medium to large nodular type were 39% and 19%, respectively. A significant difference was present between the two types (p<0.01). 4) The 5-year rate of the narrow stromal type and that of the broad/mixed stromal type were 63% and 440, respectively. There also existed a significant difference between the two (p<0.05). 5) Liver cirrhosis cases possessing the extremely enlarged spleen as observed peritoneoscopically gave such a low 5-year rate as 21%. 6) In liver cirrhosis of the atrophic right lobular, large nodular or broad stromal type, the risk was fairly high of death occurring from hepatocellular failure within 5 years. 7) Of liver cirrhosis cases of the broad stromal type, hepato-cellular carcinoma compli-casion was developed only 1 case within 5 years. The above findings suggest that a peritoneoscopic examination of the liver is of great value for knowing the prognosis of liver cirrhosis.

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In 37 cases of chronic pancreatitis, endoscopic retrograde pancrentogram (E. P. G) was studied in relation to duration of the symptoms. The association of pancreatolithiasis, diabetes mellitus and liver damage was also cosid-ered. Most of E . P . G . findings widely accepted as diagnostil of this disease, e.g. "Irregu-lar branches" "Rosary" and "Obstructive" changes of the main duct didn't change all though the clinical caurce. They may, therefore, indicate the final stage of the changes. On the other hand, "Simple dilation" appeared in the very, early stage of the disease, and "Stens-sis" was sean in the relatively early plase. These two findings changed to other stable E . P. G. Patterns with lapse of time staging of this disease by E. P. G. Findings may be possible, but requires further investigation.

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Behaviors of the antral mucosa correlating to the course of gastric ulcer were studied on 2713 GTF films and 445 photographs of resected stomachs. In this study, antral lesions were classified into antral edema, hemorrhagic spot, and gastritis verrucosa. The antral edema includes simple edema and edema associated with erosions localized at the antral mucosa. The hemorrhagic spot was defined as spot-like lesions spreading on the antral mucosa. The antral edema was found more frequently in the stomachs with ulcer than in the stomachs without it. The hemorrhagic spot was rarely observed in non-ulcerated stomach but sometimes followed by development of gastric ulcer. An analysis was attempted in the correlation between the course of gastric ulcer and the antral lesions, and revealed that antral edema and gastritis verrucosa were observed more frequently in the groups of ulcer which healed spending over six months and of recurrent ulcer than in the group of ulcer which healed within six months. Gastritis verrucosa was found in 5.6% of the stom-achs resected for gastric ulcer and in the same frequency of the stomachs with ulcer which was treated medically and followed by endoscopy. From the results above mentioned it can be concluded that appearance of the antral lesions in the course of gastric ulcer may signify hardness of prompt cure of the ulcer.

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A 83 year old male was admitted with general fatigue and itching for a few months. Skin changes of verrcous protrusions were noted in the face, neck, hands, foot and body surface, as. well as hyperpigmentation in the perineum and mamillar regions. The lips, tongue and oral mucosa were also involved with papillomatosus thickening. Barium meal study showed numerous granular shadows throughout the esophageal surface. Endoscapi-cally, esophageal mucosa appeared thickened and finely granulated throughout the esophagus. These lesions were not found beyond the esophago-gastric mucosal junction. Endoscopical biopsy of the esophageal mucosa revealed squamous epithelial papillo matosis. Transitional cell carcinoma of the right renal pelvix was confirmed by retrograde pye-lography and a diagnosis for malignant acanthosis nigricans associated with renal pelvix cancer was established. The patient died of pulmonaly complication due to metastasis to the both lungs. Esophageal disorders such as diffuse granular protrusions seen in this old man is ex-tremely rare and shoud be differentiated from esophageal moniliasis, esophageal leukoplakia and a similar type of esophagitis.

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Two cases of malignant change of gastric polyp which had been followed up by X-ray, endoscopy, and biopsy were reported.Case I The first roentgenologic and endoscopic examination revealed a pedunculated gastric polyp on the greater curvature of the antrum, which was diagnosed as benign polyp by biopsy. One year later, the second X-ray and endoscopy demonstrated the same finding as before. Seven years later, the pedunculated polyp changed to flat polyp in shape and was diagnosed as adenocarcinoma by biopsy. Gross specimen of the resected stomach showed a IIa + IIc type early gastric cancer. This fact suggested that marked changes seen between the endoscopic appearance and the resected stomach may had been induced by endoscopic biopsy. Histological diagnosis was papillary adenocarcinoma with invasion m. Case II X-ray and endoscopic examination showed a pedunculated gastric polyp on the greater curvature of the corpus of remnant stomach. Biopsy specimen taken at that time revealed benign polyp which was diagnosed as malignancy one year after the initial examination. Five years after, the resected stomach showed a pedunculated polyp, 22 ×11× 23mm in three dimensions.

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We experienced a case of endometriosis of the sigmoid colon. A 50 year-old female was admitted to our hospital with chief complaints of constipation and lower abdominal pain. Barium enema revealed a smooth stenosis without a niche nor filling defect in the sigmoid colon. A colonoscopic view of the identical region revealed a smooth elevated lesion covered with normal mucosa, and a narrowed lumen of the area. Partial colectomy and total extirpation of the uterus and the adnexa were performed. Histologically endometrial tissues were found in the muscular layer of the sigmoid lesion. The literatures were reviewed and clinical features, diagnosis and therapy of endometriosis of the colon were discussed.

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A 72-year-old female who was treated conservatively by an internist for pain in the right anterior thoracic wall was admitted to our hospital. On a previous fiberscopic exami-ination of the stomach, suspicious malignant lesions in the esophagus were providently dis-covered. On x-ray and endoscopic examinations of the esophagus, irregular and recessed altera-tions of the mucosal layer in the Im region of the esophagus were revealed. These were subsequently documented as squamous cell carcinoma in histology of biopsied specimen. She underwent operative treatment which revealed two recessed lesions in the mucosal layer, 1.6cm×1.5cm in the Im region and 1.2cm x 0.8cm in the Iu region without any metastasis. Microssopically, the depth of. cancerous invasion was sm and m respectively for the above lesions. Based on these findings, this case was considered to be multiple early cancers of the esophagus. Since 1972, when rules for registration of esophageal cancer were established, four cases of multiple early esophageal cancer have so far been reported including this case. Investigation of these cases should provide useful hints for the diagnosis and treatment of esophageal cancers.

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In case of many little polypoid lesions localized in a part of the stomach, we named them as "localized multiple gastric polypoid lesions." These may include multiple early gastric cancer of type II a, localized polyposis and multiple elevated atypiral epithelia. We studied endoscopic differential diagnosis of these gastric lesions as well as verrucous gastritis.

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A 42-year-old married woman was admitted to the hospital for refractory right pleural effusion and ascites of three months duration. Tuberculosis, chronic liver diseases and malignant tumor were ruled out, and clinically Meigs syndrome was highly suspected, but several gynecological examinations revealed no abnormalities. Peritoneoscopic examination showed left ovarial neoplasma which was small egg in size and reddish in color. Therefore bilateral salphingo-oophorectomy was performed. Right pleural effusion and ascites disappeared rapidly several days after surgery and have not recurred. The tumor removed measured 3.2 × 4 × 2cm, consisted of thyroid tissue alone histologically, showed no teratomatous component and represented a pattern of "pure struma ovarii". Including our case, only 15 cases of Meigs syndrome associated with struma ovarii have been reported. Peritoneoscopic examination is useful for diagnosis of this syndrome since it is able to differentiate this syndrome from other diseases.

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It is often difficult to differentiate a stenosis by infected diverticular disease and that by carcinoma. A procedure that von Lohr and Thiede have developed in 1977 can be of great help in making clear, reliable diagnosis. This prevents an overlapping of demonstration at the stenosed segment of the large intestine. An example of our experiences is demostrated.

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A 68-year-old male, who had suffered from hypertension and had the past history of two stroke fits, was admitted to our hospital with complaints of the left lower abdominal pain and melema. On admission, his blood pressure was 210/150mmHg. Leucocytosis, positive CRP, and hypokalemia were found. No pathogenetic bacteria was detected in the feces. ECG showed LVH & strain pattern. Melena disappeared soon after the admission, and abdominal pain subsided in the following days. On the 2nd hospital day, Ba enema examination showed three longitudinal ulcers. Two ulcers were running in parallel from the sigmoid to the lower descending colon, and another longitudinal ulcer was found in the upper descending colon. All accompanied fold convergences and "sacculation". Rectum had no abnormality. One week after, sigmoidoscopic examination revealed longitudinal red scars with fold convergences 30cm away from the anus. None except the nonspecific inflammatory cellular infiltration was proved in the biopsy specimen. 47 days after the onset, the longitudinal scars were still found, but the intestinal deformity couldn't be seen at all. Based on the clinical findings, we considered this case as "a transient type of ischemic colitis".

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Fibergastrointestinal scope FGI-SD (Machida) is now widely used in the routine examination of the esophagus, stomach and duodenal bulb. The diameter of FGI-SD is ex-tremely small, 9.8mm ∅, and its visual direction is forward. The most characteristic of this scope is its wide biopsy channel of 2.6mm∅, which is exactly same as that of the standard fibergastroscope FGS-BL. Because of the wide biopsy channel, FGI-SD is used, not only for the routine check of the upper G-I tract but also for other miscellaneous purposes such as polypectomy, removal of foreign body, electrocautery and electrocoagulation.

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