The influence of the acid-secreting area on healing and recurrence of duodenal ulcers and age-related changes of the acid-secreting area in patients with duodenal ulcers were investigated by the endoscopic Congo red test developed in our clinic. Duodenal ulcers were more often associated with a large acid-secreting area than normal subjects and patients with gastric ulcer. Results indicated a close correlation between healing and recurrence of duodenal ulcers and the extent of the acid-secreting area. When the acid-secreting area was large, the ulcers failed to heal completely and recurrence was more commonly seen. On the contrary, when the acid-secreting area was small, the ulcers tended to heal rapidly and not to recur. Thirty two normal subjects, 42 patients with duodenal ulcer and 69 patients with gastric ulcer were followed-up by this test. The observation period ranged from 1 to 12 years. Shrinkage of the acid-secreting area was observed in 18.8% of normal subjects and in 31.9% of patients with gastric ulcer. But in 97.6% of patients with duodenal ulcer, the extensive acid-secreting area persisted irrespective of aging. In conclusion, duodenal ulcers were often associated with a large acid-secreting area and the extensive acid-secreting area of duodenal ulcer patients persisted irrespective of aging. The extent of the acid-secreting area was related to the healing and recurrence of duodenal ulcer.

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291 cases with liver diseases were studied with peritoneoscopy and liver scintigraphy. Twenty-two cases (7.6%) out of 291, on which peritoneoscopy and liver scintigraphy were performed, were proved to have diaphragmatic grooves of the liver. The rate of occur-rance was higher in females (14.1%) than in males (5.5%). As ages were older the frequencies became higher. Highest frequencies (30.1%) were seen in patients in their seventies. As regards liver diseases, the coexistence of acute hepatitis (5.2%) and chronic hepatitis (1.6%) was low, but that of liver cirrhosis (18.2%) and fatty liver (16.7%) was high. Usually diaphragmatic grooves have no clinical significance, but are often evidenced by a horizontal corded defect along the side of the liver hilum on the liver scintigram. Peritoneoscopy is important for the establishment of a correct diagnosis.

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The effect of glucagon on the upper gastrointestinal motility was investigated by acetaminophen absorption method and by endoscopic procedure. Gastric emptying was quantitatively measured by measurement of serum acetaminophen concentration 30 min after starting a test meal. Intramuscular administration of 1 U. S. P. unit of glucagon caused a significant decrease in the serum acetaminophen level in comparison to that of control group. This indicates that glucagon delayed gastric emptying significantly. However, there was no difference between the effect of 1 U. S. P. unit of glucagon and 4 mg of butropium bromide. Gastric peristalsis was endoscopically judged by the classification of Niwa. Endoscopic examinations showed that glucagon significantly inhibited gastric peristalsis and that inhibitory effect of 1 U. S. P. unit of glucagon and 4 mg of butropium bromide on the gastric peristalsis were equally effective. No patients reported any side effect after administration of 1 U. S. P. unit of glucagon. Therefore, in view of its effectiveness and lack of adverse effects, glucagon is a useful alternative for premedication of upper gastrointestinal endoscopy.

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Laparoscopy was carried out in 62 patients with upper GI malignancies. Final diagnoses of 62 patients were early gastric cancer ; 9, advanced gastric cancer ; 43, leiomyo-sarcoma of the stomach ; 6, malignant lymphoma of the stomach ; 2 and leiomyosarcoma of jejunum ; 2. 8 cases of gastric cancer located mainly on the posterior wall were impossible to observe. 2 cases of gastric sarcoma were also impossible to observe because of endogastric growth. Laparoscopic serosal findings of 33 cases of gastric cancer which were located within observable areas by laparoscopy was compared with the depth of invasion in the operative specimen. Seven of 8 cases of early cancer had normal serosa. But vascularization or a white tumor on the serosa was detected by laparoscopy in all cases of advanced cancer. Of 41 cases of gastric cancer in which surgery was performed, findings of laparoscopy and laparotomy were compared as to infiltration to the neighbouring structures, distant metastasis and enlargement of perigastric nodes. The results of laparoscopy were good for sites where observation is easy, such as the omentum, peritoneum and liver. But the detection of the pancreatic infiltration and lymph nodes involvement was inadequate. In the inoperable cases, most of cases were confirmed to show extensive infiltration and metastasis by laparoscopy. In 8 leimyosarcomas which had not been diagnosed by endoscopy, 7 cases were observed by laparoscopy. The characteristic findings in six of 7 cases were extraluminal growth, reddish brown, smooth surface and vascucularization. Histological diagnosis was established in three of 7 cases by laparoscopic biopsy. We evaluated that although laparoscopy has anatomical restrictions in the range of obser-vation, it has the following advantages, so that it should be positively performed for selected cases. Information concerning the depth of invasion of carcinoma is obtainable. II The extension degree to the neighbouring structures and metastasis are observed. III The clinical diagnosis is obtained by laparoscopy and biopsy, especially in extraluminal GI tumors.

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The author developed one man method simply performing total colonoscopy without premedication, fluoroscopy, an assistant and a splinting device. In 660 consecutive colonoscopic examinations during one year and three months period from June 1981 to September 1982, a mean time of colonoscopy reaching the cecum was 6 minutes and 57 seconds and the success rate was 96.8 per cent. However, no colonoscopic examination had been done to completely visualize the whole colon, because there existed some blind areas in all cases and residual colonic contents disturbing adequate observation in 37.7 per cent of the cases. Successive performance of total colonoscopy and barium enema on the same day had been attempted as detailed examination in solving these problems and the diagnostic results had been extremely improved as this combination became routine. The author emphasized that an effort should be made to aim at "perfect colonoscopy" which is able to screen the whole colon without any blind spots, and not only technical progress but also a new device of colonoscope with improved instrumental ability are urgently required for this purpose.

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The linear arrayed ultrasonic fiberendoscope developed by cooperation of Machida Seisakusho Company and Toshiba Medical Company has been being improved gradually. The fourth experimental equipment is being tring at present. We investigated its useful-ness in diagnosis of a disease in the epigastric region and carried out the examination in a total number of 50 cases from June, 1981 to December, 1982. The technique is considered to have reached nearly the level of practical use with developement of the fourth equip-ment. In the present paper, the usefulness of the linear arrayed ultrasonic fiberendoscope is stressed on the results is the cases examined with this equipment. In addition, we developed a rubber balloon which is attached around the probe and have used it in 30 cases since July, 1982 with very good results. Thus, the usefulness of the balloon is reported together. Tumors were revealed easily and the depth and area of the tumor intf filtration could be diagnosed in esophagus and stomach cancers. The technique was useful for grasping the whole condition of a submucosal tumor and for its differential diagnosis by difference in inner echo in the esophagus and the stomach. A clear image was obtained without being affected by the abdominal wall and gas in the digestive tract in diseases of the pancreas. The linear arrayed ultrasonic fiberendoscope is being expected to be used for examination of lesions in the upper digestive tract and diseases of the pancreas in the future.

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A-69-year old man was admitted to our hospital because of dysphagia. X-ray findings of upper G. I. tract and endoscopic pictures revealed a flat elevated tumor on the superior duodenal flexure. Biopsy was carried out twice, revealing borderline feature and no definite diagnosis of malignancy was established until the operation. By examining the resected specimen histologically, carcinoma in situ, well differentiated adenocarcinoma, was found. As the patient was poor risk because of the two previous resections of the lung and liver impairement, local excision was done, however, the patient expired at 61st postoperative day, because of the complication of lung and liver failure. Reviewing the literatures, this case is the 22nd. reported one (except periampullary carcinoma) of early duodenal cancers in Japan. Among the 22 reported cases, this case is considered to be a rare case of a flat elevated type of early supraduodenal cancer, so far reviewed.

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A 44-year-old female was admitted with a chief complaint of melena. An emergency endoscopy with the Olympus GIF-P2 was performed after admission. No abnormality was noted in the esophagus and the stomach. A small amount of blood was found in the duodenal bulb. Duodenoscopy with Olympus JFB-3 revealed a duodenal polyp with bleeding in the second portion. Endoscopic polypectomy was performed without any camplications. The resected polyp was 20 x 15 x 10 mm in size and proved to be adenomatous polyp histologically.

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A 56 year-old man who had a mucous bloody stool when he took the field to Taiwan and in 1953 and 1955 after returning to Japan, and since then he has never been abroad, was presented. In September 1980, the patient visited our Department asking for medical advice about mucous bloody stool. A colography showed a deformity of the cecum, and colonoscopic pictures showed on irregular ulcer with white coat in the cecum near the orifice of the appendix. A microscopic picture of biopsy specimen from the lesion showed a mass of Entamoeba histolytica in granulated tissue of the ulcer. For the past ten Years in Japan, 81 cases of amebiasis have been reported. 64 of the 81 cases had a lesion in the large intestine, and only 5 of 48 cases excluding 16 cases with insufficient information were had a lesion in the ileocecal region. In the 5 cases, our case was only one that could be diagnosed by endoscopy.

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This paper reports a case with superficial elevated carcinoma of the rectum, which was treated with the Argon Laser Photo-chemotherapy with Hematoporphyrin Delivatives (HpD). A small protruded mass with central depression was found at the anterior aspect of the distal rectum. Biopsy revealed well differentiated adenocarcinoma and the laser treatment was carried out because of having asymptomatic myocardial infarction and an unfavorable position of the lesion for the endoscopic polypectomy. At 72 hours after the injection of 3.0 mg/Kg HpD, the laser beam with a wave length of 514.5 nm, 0.4 watts of power, was irradiated to the neoplasm for approximately 25 minutes. Tumor regression was observed rapidly on the lesion with tissue necrosis within first 24 hours, and the laser-induced ulceration was clearly demarcated from the normal surrounding mucosa. The lcer-healing was achieved at 6 weeks later, and remained cancer cells were not detected on repeated biopsy examinations. No paticular side effect including the light sensitivity was observed during a course of the treatment. Because of applying the selective effects of HpD retained in the neoplastic cells, the new procedure could be safely available in patients with so called 'high risk' for the surgical intervension.

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A 45-years-old female was admitted to our department of surgery with anal bleeding. Barium enema examination revealed a polypoid figure, approximately 1 cm in diameter, in sigmoid colon. A semipedunculated polyp, type III of Yamada's classification was detected at 28 cm from anus by colonoscopy. The surface of the polyp head showed white coat and the rest cherry-red colour. Biopsy revealed a benign polyp . Endoscopic polypectomy was carried out and the polyp was removed without any accidental complications. The resected polyp measured 4×3×3 mm, which was histologically diagnosed as cavernous hemangioma. The world literature has reported 272 cases of hemangioma in the gastrointestinal tract. Nearly half the total cases was present in the large intestine, but the cavernous hemangioma of simple polypoid type based on the Gentry's classification is rare in the gastrointestinal tract. The cardinal sign is rectal bleeding. Abdominal pain, diarrhea, constipation, anemia and melena are also frequently mentioned. It is more incidental from the second to fourth decades of life and is more frequent in male than female, In this case the endoscopic polypectomy was the procedure which made diagnosis and treatment at the same time.

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