The function of pyloric sphincter is controversial. Therefore, the gastro-duodenal junction was investigated by manometry under endoscopical observation. Pyloric pressure was measured before and after intravenous secretin administration (2U/kg bolusly) in 17 normal subjects, and in 12 gastric ulcer, 11 duodenal ulcer, and 21 progressive systemic sclerosis (PSS) patients. Gastro-duodenal motility was compared with 17 normal subjects and 13 patients with PSS. Pyloric pressure and gastro-duodenal motility were recorded endoscopically with 3 polyvinyl open tipped catheter, perf used with water using an Arndorfer constant infusion pump, giving an infusion rate of 0.6ml/min. through each catheter. A forward-viewing 2 channel fiberscope was introduced into the gastric antrum only with surface anesthesia of pharynx (Figure 3). After introduction of an endoscope, basal pyloric pressure was measured by a station pull-through technique using a sensor catheter for resting pressure (Figure 2), inserted through a channel orifice of the endoscope. Next, motility of gastric antrum, duodenal bulb and descending duodenum were recorded for about 5 minutes using a sensor catheter for contractile activity (Figure 2). And then, secretin was administrated and pyloric pressure was measured again. In normal subjects, pyloric pressure significantly increased to 14.7±1.5 mmHg (mean±SE) from its basal level, 5.5±1.5 mmHg, manometrically (P<0.001). Endoscopically, the pyloric ring became smaller and closed inspite of antral relaxation (Figure 10). In the patients with duodenal ulcer, pyloric responses were similar to normal subjects. But in the patients with gastric ulcer and PSS, pyloric pressure did not increase significantly from its basal level (Table 1). In some cases with gastric ulcer and PSS, endoscopy showed that the pyloric rings were open and pyloric pressures were 0 mmHg in the resting state. And after administration of secretin, the pyloric rings became a little smaller but did not close completely and pyloric pressures were 0 mmHg too. These studies determined that pylorus possesed independent sphincteric properties in manometry and by simultaneous endoscopic observation, and suggested pyloric sphincter dysfunction in patients with gastric ulcer and PSS. Between normal subjects and PSS patients, mean frequency, duration and amplitude of each motor activities of each positions (gastric antrum, duodenal bulb and descending duodenum) had no significant differences (Table 2).

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Gastro-duodenal epitheliar border was observed in 46 cases by using small caliber panendoscope (GIF-P₂), with which retro-flexion in the bulb and methylene blue spraying were available. The border was identified in 30 cases, of which 83.3% located in the bulb and the remains were just on the pyroric ring. In the cases which showed the border on the ring, the type of atrophic border in the stomach was "open type", and also intestinal metaplasia (elevated type) was seen in two out of five cases. The portion of poor stainability was shown in a few cases at the transitional zone of tlai border. This finding may be due to the possible presence of the intermediate zone, inflammation or intestinal metaplasia, although not yet proved.

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Changes of hepatic surface in various stages of Wilson's disease were discussed by peritoneoscopic examinations in 3 patients with Wilson's disease including cases of the sibling. Comparative studies were made on clinical and histological progress in the disease. Clinical and histological stages of these 3 patients were determined according to Deiss et all and Anderson et al. respectively. In the first case, 8 years old male with clinical stage 1, (hepatic copper accumulation), and precirrhotic stage histologically, peritoneoscopy showed yellowish and smooth liver surface similar to that of fatty liver. Biopsy specimen of the liver revealed typical fatty degeneration. The second case, 13 years old male and elder brother of case 1, with clinical stage JIB to III, (hepatic failure to cerebral copper accumulation), and partially arrested stage histologically, peritoneoscopy showed maculonodular postnecrotic liver cirrhosis. In the third case, 18 years old female, was in the clinical stage IIA to JIB, (hemolytic anemia to hepatic failure), and in the active stage histologically. Blue nodules, which were considered to be specific to Wilson's disease were found by peritoneoscopy. In these cases, peritoneoscopic findings correlated well to histological changes in progress of Wilson's disease.

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This report presented a case of early esophageal cancer of polypoid type which is attempted to study the relationship between Lugol staining method and staining of an esophageal epithelium. A 63-year-old woman was seen at our hospital complaining of obstructive sensation on swallowing. Esophagogram and esophagofiberscopy revealed a polypoid type of tumor in the part of Im (the middle thoracic esophagus) on the posterior wall. Biopsy specimens of non-stained area (cancer) or stained area (normal esophageal epithelium) after spraying Lugol's solution were used for this study. Histochemically the cytoplasm of the superficial portion of normal squamous cell contained much PAS positive substance, compared with that of cancer cell. Electoron microscopic findings indicated that there were many glycogen granules in the cytoplasm of the superficial portion of normal squamous cell, but there were no glycogen granules in the cytoplasm of cancer cell. We measured the glycogen content by Anthrone method and the results were as f ollowes : The glycogen content of cancer epithelium indicated 0.16g/tissue 100g, and that of normal esophageal epithelium indicated 1.71g/tissue 100g. The glycogen content of cancer epithelium was about one tenth that of normal esophageal epithelium.

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A 56-year-old male presented with a gradual onset of in epigastrium three months prior to admission, and a mass in the -neck two weeks prior to admission. Physical examination revealed swelling of a left supraclavicular lymphnode on admission. Laboratory data showed anemia, hypo proteinemia and obstructive liver dysfunction. Biopsy specimens of a left supraculavicular lymphnode revealed metastasized poorly differentiated adenocarcinoma. On upper GI series narrowing and rigidity of the gastric antrum was seen. Numerous fine white nodular lesions scattered in the mucous membrane mainly of the gastric body were seen through gastroscope, which were adenocarcinoma in biopsy. Under the diagnosis of gastric cancer, he was treated with anticancer chemotherapy. Bilateral chylothorax developed later and he died on the 72th hospital day. Autopsy revealed an irregular erosion in the gastric antrum and numerous fine nodular lesions in the gastric body. Proliferation of fiberous tissues of the submucosal layer was not remarkable in a cut surface of the specimen. Histological findings showed undifferentiated adenocarcinoma mainly involving the submucosal layer of the stomach, where tumor embolizm and proliferation in lymph and blood vessels were remarkable.

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Under the development of fiberscope and its increased usefullness of urgent endoscopy, we can observe many acute gastric lesions. The relationship between its inducements and endoscopic findings is difficult to clarify. And peculiar course and form of acute gastric lesions have been reported. We observed submucosal tumor like lesion at the greater curvature of gastric corpus in a 48 Y. O. man who ate Sashimi and 7 hours later complaint epigastralgia nausea and vomiting. After 10 days, the tumor like lesion had been disappered like vanishing tumor.

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A 77-year-old woman visited our hospital with lower abdominal pain . Barium enema study showed a smooth, spheroid and small-fingerhead sized polypoid shadow in the sigmoid colon (Figure 1). Colonoscopy revealed a smooth, soft and yellowish polypoid lesion about 10cm from anal ring (Figure 2). Biopsy specimens showed normal colonic mucosa, and the diagnostic impression on this tumor was most likely a submucosal one. As the tumor was pedunculated and readily snared, endoscopical polypectomy was performed. The removed tumor measuring 1.3×0.8×0.7cm had a smooth, soft and elastic consistency. The pathological diagnosis was a submucosal lipoma of the sigmoid colon (Figure 3, 4). Lipoma of the large intestine has been considered a relatively rare entity in Japan, but as such reports have recently increased, we could collect 77 cases throughout Japan. Nineteen cases were observed endoscopically (Table 2) and endoscopical polypectomy was performed in 6 cases (Table 3). If a lesion is pedunculated and snaring is feasible, the endoscopic removal may be very useful for the diagnosis and treatment of lipoma.

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This is a case report of lymphadenitis tuberculose associated with intestinal lymphangiectasia. The patient is a 33-year-old female who was admitted to the 2nd Department of Internal Medicine, Osaka Medical College because of intermittent general fatigue and edema in the lower extrimities for 3 years. Past history revealed lymphadenitis tuberculosa colli and hepatitis at the ages of 12 and 29, respectively. Laboratory findings on admission revealed as follows; RBC 3.54M/mm³, Hb. 9.8g/dl, WBC 2500/mm³, T. P. 5.0g/dl, Alb. 53.9%, ¹³¹I-PVP test 5.4%. Plain film of the abdomen showed diffuse positive shadows along lumbar paravertebral area suggesting calcified lymph nodes due to previous tuberculosis. Hypotonic duodenography showed thickening of valvulae conniventes associated with excessive secretions. Numerous, whitish spots were found by small intestinal fiberscopic examination. Photomicrograph of peroral duodenal biopsy specimen showed marked dilated lacteals in the slightly clubbed villus, which was compatible with histologic findings seen in intestinal lymphangiectasia.

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A 47-year-old man was administered 3 mg/day of colchicine because of his steroid resistent uveitis. After five days he suffered from watery diarrhea on which antidiarrheic had no effect. Duodenofiberscopy using Olympus GIF-D₃ was performed and showed cluster of white villi and sparse scattered duodenal white spot in the second portion of the duodenum (Figure 4). Magnifying endoscopy with 0.5% methylene blue revealed mild atrophy of the intestinal villi (Figure 4). Crypts were also observed from the biopsied specimens under dissecting microscope (Figure 6) and scanning electron microscope (Figure 7). Furthermore biopsy specimens were also. taken from the duodenum three hours after oral administration of 20 ml of olive oil for electron microscopic study. This revealed characteristic vesicles containing fat droplets which were considered Goldi vesicles or lysosomes in the absorptive cells and we could not find chylomicrons in the intercellular spaces (Figure 9). This finding indicates that colchicine is detrimetal to microtubules and finally leads to inhibition of chylomicron's release out of the absorptive cells. This phenomenon was first described by Glickman et al based on experimental study in rats. We also reported in 1977 (Figure 1 & 2). This is the first report in human subject.

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