Endoscopical and histopathological study had been done to 1556 cases of endoscopically proved duodenal bulbar ulcer. 233 cases had been observed to have "Shimofuri" lesion which reveals pepper-and-salt appearance of fundamentally mucosal hyperemia and tiny whitish mucus coating (to be abbreviated to Shimof uri). The result were : 1) Endoscopic manifestations of Shimofuri was characterized by tiny whitish mucus coating with mucosal hyperemia. 2) The distribution chart of age group on duodenal ulcer cases in which Shimofuri was observed showed the highest in twenties (30.9%). 3) Shimof uri was always coexisted with duodenal ulcer and was observed on 15% of bulbar ulcer cases. 4) 91.7% of Shimofuri was found in the vicinity of an ulcer and 8.3% on the remote site of an ulcer. 5) Histopathological study of Shimofuri showed non-specific inflammatory reaction on mucosa accompanied by erosive lesion. Clinical study was also done on our follow-up cases of 108 Shimofuri in 277 bulbar ulcer (follow-up duration from 3 months to 9 years and 5 months) that showed: 1) Shimofuri was observed in comparatively incipient course of duodenal ulcer and then one disappeared shortly where another repeated frequent appearances. The form of its appearance was in various ways. 2) The healing rate of duodenal ulcer within 3 months and the recurrent rate of duodenal ulcer within 1 year made no difference between the group of Shimofuri cases and that of non-Shimofuri cases. But the duration of sickness on Shimofuri cases tended to extend over a long time. 3) 12 long term follow-up cases more than 4 years were studied only to gain an interesting result, that is, the appearance of Shimofuri decreased after 4 years' duration and in 8 cases Shimof uri did not appear for more than 4 years since the last Shimof uri had been observed. 4) It is considerable that the function, especially the relation with the gastric secretory function, should be made much of to trace the appearance of Shimofuri to its origin here-after.

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In our routine rectisigmoidoscopic examination, minute mucosal disorders have been noticed not rarely in the rectum by means of the dye-endoscopy. These were classified into 4 types; Type 1, varioliformed mucosal elevations with erosion on each top; type 2, disordered mucosa showing an irregular mucosal net-work pattern, type 3, sporadic small mucosal depressions; type 4, variformed low mucosal protrusions. Although it may be speculated that these disorders might be caused from proctitis due to infections or acute inflammatory diseases, it is difficult to study the pathogenesis retrospectively. So, the fol-low-up stusy of 3 cases of aphthoid colitis and a case of pseudomembranous colitis have been made prospectively. Type 1 was seen in the acute stage of aphtoid colitis, which became smaller and lower a week, later and then, type 3 was seen a month later. Biopsy specimens taken from the type 1 disorders which were seen a week later, showed lympho-follicular proliferation in the submncosa. These changes, however, were not observed in the type 3. On the other hand, mucosal disorders of type 4 were seen continuously for 6 months in a case of pseudomembranous colitis. Biopsy specimens also showed lymphofollicular proliferation in the submucosa. Magnifying observation by using CF-HM was a useful method to observe the details of the disordered mucosal surface. For the study of the pathogenesis of these disorders, it is necessary to continue the follw-up study of other kinds of proctitis.

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It is recognized that the atrophic border is significant in the study of gastric ulcer. Tits time, we studied the atrophic border of the stomach in 744 cases by means of the endoscopic congo-red method. 287 cases arte with gastric ulcers and 455 cases had not ulcers or other lesion, although they usually exhibited gastritis. Additionally, we studied the relationship between the atrophic border and initial gastric ulcer (by endoscopic exam-ination and anamnesis), and we also studied its relationship to recurrent gastric ulcer. Of the 287 cases of gastric ulcer, our study showed that 131 were of the initial type. 98 out of the 131 cases (74.8%) were ulcers which existed near the atrophic border (near ulcers). Ulcer which existed more than 2 cm away from the atrophic border (distant ulcers) were found in 27 cases (20.6%). Ulcers on the f undic gland area (fundic ulcer) were found in 6 cases (4.6%). There were 156 cases of recurrent ulcer of which 87 were near ulcer (55.8%), 61 were distant ulcers (39.1%) and 8 were f undic ulcer (5.1%).

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Relationship between the expansion of atrophic gastritis in the cardiac portion of the stomach and the extent of cardiac glands was studied in 38 cases with closed Type I and II of cardiac Congo-red pattern classified by Suzuki et al by means of endoscopic Congo-red test and histological analysis of biopsy specimens taken from some points close to esophago-gastric junction on the lesser curvature. Histological findings showed a good correlation with Congo-red test. “Non-discolored area” of Congo-red characterized by the absence of acid secretion consisted mainly of atrophy of the fundic glands and it increased with age, namely from Type I to Type II. This finding supported an established theory that atrophic gastritis in the cardiac portion spread to the lower. The incidence of cardiac glands found in biopsy specimens taken from the site most close to esophago-gastric junction in Type II (50%) was significantly higher than that in Type I (13.3%). And it was very interesting to recognize cardiac glands in 22.2% of biopsy specimens from Congo-red border in Type II. These results may indicate the fact that an area of cardiac glands is expanded in the process of the development of atrophy of fundic glands in the cardiac portion.

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Gastric lesions seemingly resulting from indomethacin suppositories were endoscopically examind. The following results were obtained :1) The gastric lesions occurred more commonly among aged people; 68 years in avalage (4 men and 2 women). 2) On the amalysis of underlying diseases there were articular rheumatism in 2 patients, lower back pain in 2 patients, and fever due to common cold in 2 patients.3) The main complaint was hematoemesis in all the patients, 2 of whom also had sever epigastric pain. 4) The gastric lesions occurre at the earliest within 10 hours after the insertion of a suppository, but they usually occurred 2 or 3 days later. The dosage was 50mg to 350 mg.5) The gastric lesions were gastric ulcers and were endoscopically characterized by ovoid, irregular, and band-like structures, The site of occurrence was the horn or the body of the stomach. Because they were cured within one to three months after conser-vative treatment, they seemed to be acute gastric ulcers. The role of prostaglandin at the barrier of the gastric mucosa has been focussed on recently. It is believed that non steroidal antiinflammatory agents inhibit the production of prostaglandin and subsequently disturb the gastric mucosa. Therefore, it seems that when indomethacin suppositories are used, prostaglandin plays a role in the occurrence of gastric ulcers. The relations between indomethacin suppositories and prostaglandin will be focussed on when the occurrence of gastric ulcers due to a drug is clarified.

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60cases with filling defects on the liver scintigrams were studied with peritoneoscopy. 17 cases (28.3%) were proved to have space occupping masses in the liver in accordancewith filling defects on the liver scintigrams. But, 37 cases(61.7%) could not been foundany space occupping masses in the liver, as it were, false positive(Table 1). The causes for false positive diagnoses were:(1)the gall bladder fossa and portahepatis (15 cases);(2) atrophy of the liver (7 cases); (3) liver cirrhosis (6 cases); (4)adhesion of the urdersurface of the liver(3 cases);(5)extrinsic pressure defects of tumor(2cases);(6)intrahepatic biliary duct dilatation(2 cases);(7)malformation of the liver(1case);(8)radiation induced hepatic injury(1 case)(Table 2). The instructive 6 caseswith false positive hepatic scans were reported(Fivure 1-14). Since a filling defect on the liver scintigram may appear in a variety of clinical condi-tions, peritoneoscopy is important for the establishment of a correct diagnosis.

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We investigated early stage of intestinal metaplasia by analysis of C-I type (Kimura, Takemoto classification) gastric mucosa. From its distribution, histology, enzyme activity (ALP, LAP), and autoradiographic study (H-thymidine), we clarified the pathophisiologic state of early stage of intestinal metaplasia. In many cases (88%), the distribution of early stage of intestinal metaplasia located only in the prepyloric region. And in some cased (12%) scattered in the antrum. From the histological and enzymological points of view, almost all cases are of an incomplete type of intestinal metaplasia (ALP-, LAP-), and all cases were short of the Paneth cell. According to the autoradiographic study (H-thymidine), we recognized enlargement of the generative cell zone and there was little difference between atrophic gastritis and early stage of intestinal metaplasia in labelling index (L. I.).

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A patient, 62 year old male, visited the university hospital with complaint of right hypochondralgia. Physical and labolatory examination disclosed that his abdominal pain was due to acute cholecystitis with gall bladder stone. Besides this, UGI series showed aoval filling defect, 4×3 cm in size, just above the esophago-gastric junction (Figure 1). Endoscocally the tumor located 3 cm above the E-G junction and its surface was smooth except small erosive change at the top (Figure 2&3 in colour). The tumor was endos-copically polypectomized successfuly. The size of the tumor was 4×3×2 cm and histological diagnosis was lipoma of the esophagus (Figure 4&5). This is the first lipoma case of the esophagus to which endoscopic polypectomy was performed and the size is the largest among the cases of esophageal tumor polypectomized endoscopically.

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A case of asymptomatic Caroli's disease was reported. At a mass screening for gastric diseases, a man aged 36 was advised to undergo a thorough check-up because of huge varices in the fundus of stomach. He had no subjective symptoms and had lived in good health. Examination of the stomach by X-ray and endoscopy revealed huge multiple varices in the fundus of stomach. Endoscopic retrograde cholangiogram showed many cystic dilated intrahepatic bile ducts, but extrahepatic bile duct and gall bladder had no abnormalities. Endoscopic retrograde pancreatogram showed normal pancreatic duct. Very hard and fibrous enlarged liver was observed by peritoneoscopy. Biopsy specimen obtained from right lobe of the liver under direct vision of peritoneoscopy showed typical findings of congenital hepatic fibrosis. Echogram of kidney, renoscintigram, Retrograde pyelogram showed the findings of sponge kidney and multiple cysts in both kidneys. Liver function tests showed moderate elevation of AL-P, 1-GTP, and LAP. Slight abnormalities of PSP examination, BSR, serum BUN and creatinine have also been observed. So for as we know, there is no report of asymptomatic Caroli's disease like this case, and we think this case would be very helpful to klow the natural course of this disease. We also discussed about 13 cases of Caroli's disease reported in Japan.

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Only a few workers have so far reported on early cancer of the gastric remnant Reported here is a clinical experience of early gastric cancer I type which the authors discovered in the gastric remnant. The patient is now well 10 years after the second operation. The patient was a 61-year-old male to whom partial gastrectomy had been performed 18 years ago because of advanced cancer of Borrmann's type II at the antral portion of the stomach. Although the patient had been asymptomatic after the first operation, early cancer was detected in the gastric remnant by a screening survey of the stomach. This case may suggest the importance of periodical survey after gastrectomy.

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Most of juvenile polyp of the colon are pedunculated and benign. Endoscopic polypectomy is very useful for the treatment of juvenile polyp, in patients with melena and abdominal pain (Three cases of benign and pedunculated polyps in the sigmoid Endoscopic polypectomy were done the colon fiberscope MB3 and PSD-3 (Olympus)). No critical complications such as bleeding or perforation were encountered after polypectomy.

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During the last 6 months, 94 procedures were examined in 77 patients by means of a newly devised Pentax Flexible Sigmoidofiberscope model FS-34A in our clinic. The insertion tube is so small (11. 5mm in diameter) that the fiberscope can be introduced easily into the large intestine with mild premedication and less discomfort to the patient. In addition to the wide angulation capability and short bending portion, a 95° angle of the visual field makes FS-34A to be an ideal instrument for rapid and accurate observation of the rectosigmoid colon. Although the FS-34A is flexible, ability of its vacuum is enough, its forceps elavation mechanism makes biopsy accurate with enough quantity, and the fiberscope, light source and medical camera provide photography with excellent quality. The FS-34A is excellent for routine endoscopic diagnosis and useful for urgent endos-copy and screening for colon disese.

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