The studies were performed on 21 cases of lymphoid hyperplasia (LH) and 40 cases of malignant lymphoma of the stomach for the purpose of macroscopical diagnosis, especially early diagnosis of malignant lymphoma. LH and early malignant lymphoma were classified into following 5 types and 6 types respectively. LH : Multiple Ulcero-erosive Type, Depress-ed Early Cancer-like Type, Saucer-like Ulcer Type, Submncosal Tumor Type and Swelling Fold Type. Early malignant lymphoma: Multiple Ulcero-erosive Type, Depressed Early Cancer-like Type, Saucer-like Ulcer Type, Elevation Type, Swelling Fold Type and Flat Type. When relationship among LH and early malignant lymphoma was taken into con-sideration, the metioned classification was established. And it is useful for preoperative diagnosis of these lesions. Retrospective studies were also done on the followed-up 10 cases (LH 3 cases and ma-lignant lymphoma 7 cases). The first radiological and endoscopic findings revealed multiple ulcers and erosions in all cases. Recurrent remission and relaps of multiple ulcers and ero-sions were observed in a period of one or two years. But, 5 cases of malignant lymphoma (Multiple Ulcero-erosive Type) changed to advanced type soon after. The incipient findings of malignant lymphoma are difficult to be differentiated from those of Multiple Ulcero-erosive Type of LH. Therefore, both of them were compared. The following findings suggest LH : dotted ulcers and erosions, depressions of form from stellate to round, and slight granulation arround depressions. On the other hand, malignant lymphoma may reveal following findings; Many of depressions are accompanied by circ-umscribed elevation, and the hole of lesion becomes swollen. The lesions cannot be diag-nosed by only one of these findings. Therefore, we should take all these findings and frequent biopsy into consideration in diagnosis of LH and malignant lymphoma.

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With the widespread use of endoscopic gastric biopsy and cytology under direct vision in the diagnosis of gastric cancer, early gastric cancers are recognized with increasing frequency. Although a large variety of diagnostic methods and tools are available, a correct diagnosis was difficult when cancer lesions are grossly flat. From 1959 to 1979, early gastric cancers of type IIb were found in 92 patients (103 lesions) in our clinic. In the present paper, the diagnostic acurracy of the routine examinations combined with biopsy and cytology was compared with that of the Congo red-methylene blue test developed in our clinic. By routine endoscopic examinations, a correct diagnosis was provided in only 18.2-0 of the typical IIb lesions. IIb lesions of 10mm or more in diameter were correctly diagnosed, but a diagnosis was difficult when IIb lesions were less than 10mm. But the Congo red-methylene blue test raised the diagnostic rate of IIb lesions. By this test, typical IIb lesions of less than 10mm conld be correctly diagnosed. IIb lesions were chiefly observed as areas where Congo red and methylene blue became white.

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Portal pressure depends not only on resistance to portal flow but also on the volume of splanchnic blood snpply into the portal system from the gastrointestinal tract, pancreas, and spleen. In the cirrhotic patients an abnormal hemodynamic situation exists and it is reasonably expected that this would predispose the mucous membrane of the stomach to peptic ulceration or erosion and this would have also serious implications in massive hemorrhage. In the present study, gastric blood flow data in the upper body of the normal control subjects and the patients with esophageal varices were obtained by the H2 gas clearance method using fiberoptic endoscope. In 23 control subjects, blood flow in the upper body was 62.4 ± 13.5 ml/min/100g, whereas that of the 33 esophageal varices patients was 89.4 ± 28.9 ml/min/100g and significant difference was present between them (p<0.001). And also blood flow of the patients with gastric mucosal redness was greater than that of the patients without it (100.9±26.7 vs. 77.2±26.8 ml/mm/10g). The present data suggest that in the patients with esophageal varices, hyperdynamic circulatnon exists despite the presence of portal outflow resistance.

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This study was undertaken to prove the relationship between the lack of staining with Lugol's solution and tissue glycogen level of esophageal carcinomas. Biopsy specimens from 20 cases of esophageal carcinomas were observed by PAS stain and electron microscope, and the determination of glycogen content was done by anthrone method. The results were compared with those of the normal epithelium. The normal esophageal epithelia were more deeply stained than the cancerous ones in PAS. All of the cancerous esophageal epithelia were weakly stained in PAS. Electron-microscopically we could observe many glycogen granules in the cytoplasm of the superficial portion of the normal squamous cell, but a small amount of glycogen gran-ules in the cytoplasm of the cancer cell. Glycogen cotent of the cancerous esophageal epithelium (m ±S. E.: 0.28 ± 0.04 g/tissue 100g) was statistically lower than that of the normal esophageal epithelium (m ±S. E.: 1.35 ±0.12 g/tissue 100g) (p<O.01). We proved that the stainlessness of esophageal carcinoma with Lugol staining method was low in glycogen content biochemically, and highly evaluated its usefullness for the di-agnosis.

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The mucus secretion during the process of duodenal ulcer healing have been investigat-ed and the following results were obtained. It was found that the formation of the mucus barrier occured during the process of the ulcer healing at an earlier stage than that usually described. Already at the latter half of the active stage histochemical study by Alcianblue-PAS Staining, showed irregular PAS-positive staining in the surrounding part of the ulcer and the complete staining at the healing stage. In addition, autoradiography with ³H-glucose and ³⁵SO₄ revealed that these isotopes were incorporated mainly into the cells of the surrounding part or the mucus layer of the ulcer at the active stage, and the incorporations enhanced prominently at the healing stage. These results suggest that the formation of mucus barrier following mucus secretion initiates from the latter half of the active stage, at an earlier stage than that reported pre-viously. Importance of mucus barrier in the mechanism of the ulcer healing was suggested

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Parenchymogram visualized by Endoscopic Retrograde Pancreatic Parenchymography (ERPP) and ERCP was studied. The results were as follows; 1) Thirty of 91 cases had a pancreatic disease such as pancreatic cancer, chronic pan-creatitis, agenesis of the dorsal pancreas and so on. In most cases, we could not easily dif-ferentiate pancreatic cancer from other pancreatic diseases by the parenchymogram alone. 2) Comparing the findings of the parenchymogram of pancreatic cancer with the his-topathological findings of the resected specimen of the same case, we found that we could not decide evidence of pancreatic cancer and extension of invasion of pancreatic cancer by the parenchymogram alone. 3) Concerning serum amylase after ERPP, there were almost no changes in cases with pancreatic diseases such as pancreatic cancer or chronic pancreatitis, while there were re-markable changes in a half of the cases without pancreatic diseases. 4) Reading of the branches of the pancreatic duct was very useful in the differential diagnosis of pancreatic diseases. Therefore, we pointed out the necessity of visualization of the branches of the pancretic duct in ERCP.

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Among 82 gastric adenomas in 71 patients who were followed-up, biologic and patho-logic mitotic cell counting was performed in 31 lesions of 31 patients. The lesions were divided into 3 groups: Group a) 9 lesions transforming to malignancy, Group b) 12 lesions showing histological changes in atypism, and Group c) 10 lesions remaining unchanged hist-opathologically. The changes of each lesion were studied in 2 areas of the superficial layer (dysplastic layer) and the deeper layer (non-dysplastic layer). Furthermore, popula-tions of the Paneth cells, goblet cells and brush border distribution were assessed; and the following results were obtained 1) The average number of biologic mitotic cells of the superficial layer in the moderate dysplasia (Group III) at the initial examination was 6.4 cells/mm², and it showed a tend-ency to increase as the degree of atypism increased: 26.5 cells/mm² in severe dysplasia (Group IV) and 39.4 cells/mm² in focal cancer (Group V). However, no significant dif-ference of mitotic cells among them were encountered in the deeper layer. 2) In the lesions which showed histological changes in atypism, Paneth cells, goblet cells and brush border distribution showed an decrease in population or disappearance as the lesions showed an increase in cellular atypia. 3) There are no significant difference of mitotic cells between the initial (4.4 cells/ mm²) and the last examination (5.1 cells/mm²) in the 10 lesions which remained unchanged. 4) Two lesions (22.2%) with moderate dysplasia (mean 0.8 cells/mm²), all lesions with severe dysplasia (mean 3.1 cells/mm²) and all lesions with cancer (mean 5.6 cells/mm²) had cells with pathologic mitosis in the group showing malignant transformation. 5) In relation between numerical distributions of biologic and pathologic mitotic cells and population of Paneth cells, goblet cells and brush border in 5 classified histological groups, Group I and II were similar in histological features, while Group III was different from Group I, II and IV. It was suggested that Group IV showed histological features sim-ilar to Group V rather than Group III.

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A high power up to 35 times magnifying colonoscope (CF-HM) has recently been de-vised and we have had an oppotunity to use this apparatus. We have performed 277 mag-nifying colonoscopic examinations in 207 cases during the past one year from July 1979 to June 1980. Among all cases investigated, we found 102 colon polyps in 65 cases. Through the intensive magnifying colonoscopic study and stereomicroscopic observation on the polypecto-mized materials, we classified adenoma into 5 types from the view point of minute surface structure. Type I is circular type, Type II is tubular type, Type III is grooved type, Type IV is gyral type and Type V is irregular type. Most of tubular adenomas were classified into the type I, II and III and we found a mixed type in 21% of tubular adenoma. All tubulo-villous adenomas were classified into type IV. The lesions classified to type V were regarded as carcinoma in adenoma. The adenomas with malignant potential were more frequently observed in type III and type IV than type I and II. More surface lobulations were seen in larger adenomas. Carcinoma in adenoma showed charactaristic findings, name-ly, irregularly distributed small pits, many irregular lobulations and disapperance of normal mucosal pattern. From the findings mentioned above, it was concluded that magnifying colonoscopy was a valuable method for evaluation of polyps and for early diagnosis of car-cinoma of the large intestine.

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Getting the world modernized and complicated, irritable colon syndrome (=irritable bawel syndrome, I. B. S.) has increased in incidence. We have been studying pathophysiology of IBS by mean of the simultaneous measnre-ment of colonic motility at many positions using an endoscopic method. This study was designed to correlate abdominal pain, one of the chief symptoms of IBS and intraluminal pressure patterns, especially quantity of motility and patterns of waves. As the results, elevation of motility index and abnormal fast wave with about 6 cycles were observed at the site of abdominal pain. This tendency had no relationship with the clinical type of IBS and other symptoms. The motility index and type of waves differed considecably in the distal and proximal colon on the same patient, which suggested that intraluminal pressure patterns should be observed at as many points as possible.

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The gastro-duodenal epitheliar border was examined in 100 cases by using small caliber panendoscope by means of retrof lexion in the bulb and methylene blue spraying method. The border was divided grossly into two types, as follows: Type I in which the border located just on the pyloric ring, and Type II in which it was seen in the bulb. Type II was subclassified into a and b. Type ha showed very poor border methylene, blue, while Type IIb had very clear demarcation between gastric and duodenal epithelim. The frequen-cy was 18.0% (Type I), 24.0% (Type IIa) and 58.0% (Type IIb). The cases with closed type of atrophic border in the stomach showed Type IIb domi-nantly, with getting open type, Type IIb shifted to Type ha and finally Type I. The IIb type border was most commonly seen in the cases without intestinal metaplasia in antrum, on the contrary in the cases with maked intestinal metaplasia, Type I was domi-nantly seen followed by Type IIa. On analysing the distance between epitheliar border and the center of ulcer in 22 duo-denal ulcers, it was revealed that the duodenal ulcer appeared closely to the border, 91.0% of which located within the distance of 10mm from the border and its average distance was 7.3mm.

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Sjögren's syndrome (SjS) is known as a systemic disease which is accompanied by vari-ous collagen diseases, malignant lymphoma or sarcoidosis. This case of SjS was complicated with IIc type of early gastric cancer and portal liver cirrhosis. The early gastric cancer was inoperable due to the decompensatory liver cirrhosis and within 3 years the former advanced to Borrmann's type 4 scirrhous carcinoma, of which the patient died. " The complication of gastric carcinoma with SjS is very rare. Since the first case re-ported by Thomas in 1973, only 2 cases including this one have been reported in Japan. This case is the first report on the complication of SjS with liver cirrhosis and gastric cancer. The autopsy also revealed the complication of fibrosis of thyroid and interstitial pneumonia.

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A 67-year-old asymptomatic male was f onnd to have a gastric ulcer by mass screening for gastric cancer. Upper GI series and endoscopy revealed an irregular ulcer with mucosal converging folds on the posterior wall of the middle body of the stomach (Figure 1, 2a, 2b). The circumference of the ulcer was well-defined, but there was a small protuberance with bleeding on the greater curvature aspect of the ulcer. Total gastrectomy was performed, because biopsy specimens of the protuberance showed a cancer cells. Pathological examination of the resected stomach revealed early gastric can-cer (IIc) and heterotopic glandular structures (Figure 4, 5). Those glandular structures showed multiple cysts of various sizes (less than 3mm), and appered diffusely in the submu-cosal layer. On the other hand, the mucous membrane showed remarkable intestinal meta-plasia and pseudopyloric metaplasia. The small glandular structures showing pseudopyloric metaplasia penetrated through the muscularis mucosae into the submucosa (Figure 8). The cysts were filled with mucus, which was throught to be retention cysts.

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A 65-year-old man was found to have a linear ulcer on the anglus of the stomach by a routine X-ray study in 1968. X-ray study has been performed several times scince 1968 and disclosed a linear ulcer on the anglus with a tabacco-pouching deformity and this deformity was progressive, but no evidence of malignancy was noted on X-ray picture performed in 1980. Gastrocamera study has performed 6 times in 13 years. A peptic ulcer was sometimes observed in the middle of the scar without malignant findings. Gastrofiberscopy performed in 1980 revealed a depressed lesion on the anterior aspect of the scar, and the biopsy speci-mens were classified into group V. The surgically resected specimen showed a linear ulcer scar, 6cm in length and a IIc type depressed lesion, 3 × 3.5cm in diameter, on the anterior edge of the scar. Histopathologically, the scar was ulcus-IV scar, pnd the IIc type lesion was diagnosed as moderately differentiated tubular adenocarcinoma (m), and apart from this lesion a min-ute IIc, well differentiated tubular adenocarcinoma (m), was also found on the lessure cur-vature on the scar. These were thought to be multicentric in nature.

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A 75 years old man was admitted to Nagoya University Hospital with chief complaints of anorexia and soft stool in April 1978, when hyperpigmentation of the extremities and deformity of finger nails were observed. The laboratory examination revealed hypoprotein-emia, electrolyte-inbalance and elevated plasma protein loss rate (RISA). Roentgenographic and endoscopic examinations revealed diffuse polyposis in all parts of GI tract except for esophagus Histologically, colonic polyp showed a cystic dilatation of glands and edema-tous stroma with slight cell infiltration. Soon after admission, clinical symptoms were improved by administration of predoni-solon, so the patient was followed-up with maintenance dose of predonisolon. GI tract ex-amination performed 18 months later revealed remarkable decrease of the number of poly-posis in both stomach and colon. Recently, the number of reported cases of Cronkhite-Canada syndrome has been increas-ing, but there has been relatively few cases which are characterized by decrease of the num-ber of GI tract polyposis. However the etiology of this syndrome is unknown, this case has given us some suggestions about etiology of GI tract polyposis in this syndrome.

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A new camera with OLYMPUS RECORDATA BACK 2 was devised in order to rec-ord accurately each part of colon and to distinguish multiple polyps of protruded lesions in the colon. We designated this colonofiberscopy as Recordata-CF (RCF). Sixty one patients with colon lesions were examined 73 times using this new camera along with the usual Non-Recordata camera. A possibility of identification of each part of colon was studied using Non-RCF, 1396 pictures which could be examined in 59 cases, 71 times of colonofiberscopy. In 506 (36.2%) of 1396 pictures, location was not identified. They were mostly polyp (s) & polyposis, carrinoma and ulcerative colitis, which were higher percentage than normal colon in unidentified pictures. The reason why location of the lesions was not identified was mostly due to taking the picture at close-up position for the sake of focusing on the lesions. We compared the pictures taken by RCF and Non-RCF in multiple colonic protruded lesions with 48 numbers. We could distinguish 35(72.9%) polypoid lesions by RCF, but only 28 (58.3%) lesions by Non-RCF. Now further improvement on this devised camera was made in attaching electric calcu-lating machine instead of OLYMPUS RECORDATA BACK 2.

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A 6-month clinical trial of STM-V, a new gastrof iberscope of wide-algle side-view type developed recently by Fuji-Optical Co., Ltd., demonstrated a salient usefulness of the device. This instrument, having a working length of 1, 110mm, was found to permit observation and photography of the interior of the duodenal bulb, if indicated. Provided with an in-genious angle mechanism with a resultant wide twist angle, STM-V permitted us to make observation, photography and biopsy of the posterior wall of the gastric body with ease which often wave proven unsuccessful with conventionally used side-view type fiberscopes. Further, with the device which endures a visual field of as wide as 105°, intragastric orien-tation was simple and easy, a whole weiw of the interior of the stomach was easyly obtain-ed and observation of the esophagus was feasible. The scope, being well insulated electrical-ly, was useful for not only diagnostic but also treatment purposes, such as polypectomy, removal of foreign bodies, electrical cauterization and electorocoagulation.

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