In order to elucidate natural history of the development of human colonic carcinoma, endoscopic and pathologic studies were performed on the colonic tumors induced by intrarectal administration of N-methyl-N-nitrosourea to the experimental rats. The following results were obtained. 1) Four-hundred seventy-four tumors induced in this experiment consisted of those of 160 small or flat elevation type (33.7%), 189 sessile polypoid type (39.9%), 71 pedunculated type (15.0%), 44 central depression type (9.3%) and 10 unusual type (2.1%). Gross appearance of most of those tumors was similar to that of early colonic carcinoma in human. 2) Incidence of the tumor-bearing rats was not different between male and female. However, ratio of number of tumor per one rat of male and female was approximately 2 :1. 3) Histologically, 431 colonic neoplasmas consisted of 32 adenomas (7.4%), 327 polypoid carcinomas (75.9%) and 72 carcinomas coexisted with adenomas (16.7%). Seven out of 72 carcinomas coexisted with adenomas resembled so-called carcinoma in adenoma in human. 4) Both size of the tumor and grade of the carcinomatous invasion were not related to interval since occurrence of the tumor. 5) Pedunculated type of the colonic carcinoma transformed to sessile polypoid type of the colonic carcinoma by carcinomatous invasion into the stalk. 6) As the morphogenesis of the colonic ulcerative advanced carcinoma, three different developmental courses were confirmed ; a) ulceration due to carcinomatous invasion into the stalk of the pedunculated type of carcinoma, b) ulcer formation of the sessile polypoid type of carcinoma and c) development of the tiny ulcerative type of carcinoma since initial stage. 7) Although the incidence of the tiny ulcerative type of carcinoma was low, grade of the malignancy was high. This finding suggested that the tiny ulcerative type of carcinoma might play an important role in the development of ulcerative advanced carcinoma. 8) The diffuse infiltrative and constrictive type of colonic carcinoma developed as the non-polypoid type since the initial stage.

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Recently, we have developed the marker disk method to measure gastric ulcer area endscopically. The aberration ratio of this method was measured in 5 volunteers' stomachs and revealed as 3.12±1.96%. This data indicated that the marker disk method was reliable and would be useful in determining the precise gastric ulcer area endoscopically. In the present study, we have compared reduction rates of ulcer areas in various treatments for gastric ulcer. Results were as follows: 1. In cases of inpatients, the average of ulcer areas was reduced to 29% of initial ulcer size after 2 weeks of treatment. In contrast, the average of ulcer areas was reduced to only 49% of initial ulcer size in outpatient after the same period. The patients who received treatment in inpatient showed significantly quicker reduction of ulcer area when compared to that of outpatients especially at the early stage of the treatment. 2. Among outpatients and inpatients, the patients who were treated with H₂ blocker showed quickest reduction of ulcer area. 3. The H₂ blocker treatment in outpatient was similarly effective to conventional therapies without H₂ blocker in inpatient. 4. It is well known that low dose of antacid has no effect for ulcer hesling. Although, in this study, in inpatients who received treatment with low dose antacid, the average of ulcer areas was reduced to 24% of initial ulcer size after 2 weeks. It seemed that the hospitalization and bed rest were most effective factors for reduction of ulcer area. From these results, it was confirmed that the spontaneous healing of gastric ulcer was strong and therefore should be considered when evaluating of the effect of medication for an ulcer.

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Endoscopic findings of 147 gastric cancers smaller than 10mm in longest diameter in 133 patients were investigated, and diagnostic accuracy of routine endoscopic examination were compared with endoscopic Congo red-methylene blue test developed in our clinic. A correct preoperative diagnosis of cancers smaller than 10mm in diameter was made in 42.2% of the lesions by routine endoscopic examination, especially in types of ha, IIb, and IIc without converging folds, the diagnostic rate being very low. To make a correct diagnosis of these cancers, it is necessary to observe the entire surface of the gastric mucosa under optimal condition and subsequently obtain biopsy specimens from the target lesions. The endoscopic Congo red-methylene blue test raised the diagnostic rate to 83.8% of cancers smaller than 10mm in diameter. In this test, cancers were seen as areas where the dyes were bleached to white, so that this test is very useful to diagnose such lesions in which visual signs of maligmancy are indistinct or absent.

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A diagnostic method of endoscopic toluidine blue dye-spraying technique was studied. Administration of toluidine blue did not show any toxity. When 0.05% toluidine blue solution was sprayed on the stomach, gastric mucous membrane with intestinal metaplasia showed metachromatic staining about 2 minutes after spraying. The toluidine blue dye-spraying technique did not need washing by water after spraying. The rate of correct diagnosis by toluidine blue dye-spraying technique was 77.8%. False positive cases were 22. 2%. Histological examination showed that most of metachromasia originated from staining of intracellular mucin in goblet cells by the dye absorbed in gastric mucous membrane with intestinal metaplasia. It turned out that intracellular mucin in goblet cells was mainly consisted of chondroitin sulfate B and C. This was confirmed by the histo-chemical and test tube methods using chondroitinase. Intestinal metaplasia was classified into 8 types by the toluidine blue dye-spraying technique.

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Mucosal blood flow of the large intestine of 32 cases of ulcerative colitis and 7 normal subjects was measured by hydrogen clearance method. Mean mucosal blood flow of the active phase of ulcerative colitis was 56.86±14.87ml/min/100g. The value was signifi-cantly larger (p<0.005) than those of the quiescent phase of ulcerative colitis (36.34±4. 82ml/min/100g) or normal subjects (34.91±2.33ml/min/100g). In severe colitis, mucosal blood flow increased more than the moderate or mild cases. However, there were no significant correlations between mucosal blood flow and the location of the inflammatory bowel process or length of the diseased period.

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We clinically studied five cases with non-icteric primary biliary cirrhosis (PBC). All patients were female and the mean age was fifty. Concerning laboratory findings of liver function, the serum level elevation of GOT and GPT was moderate, that of biliary tract enzymes ; Al-p, LAP and r-GTP remarkable and that of total cholesterol and IgM in various degrees. The above-mentioned pattern of liver function test continued long. Some kind of autoantibodies were detected in all cases. In five cases with PBC we performed a laparoscopy at non-icteric stage and noticed that reddish patches were seen in all cases and cholestatic findings could not be seen on the liver surface. Reddish patches were irregularshaped and distributed unevenly in comparison with red spots which are recognized in some of chronic active hepatitis. Under long-term observation of the liver function, the level of serum GOT and GPT is more stable in non-icteric PBC than chronic active hepatitis with red spots. Therefore, we think that we can distinguish non-icteric PBC from chronic active hepatitis with red spots by laparoscopy and follow-up of the liver function.

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Endoscopic YAG laser treatment was attempted in 25 cases of gastric tumor. The effect of laser treatment was histologically confirmed after surgical resection in 10 cases of early gastric carcinoma, a case of borderline lesion complicating ha and a case of Borrmann 3 type advanced cancer. Nine lesions of early gastric carcinoma (IIc, 7 lesions : I, 1 lesion and ha, 1 lesion), a case of malignant lymphoma of the stomach, borderline lesion, Borrmann 3 type advanced cancer, gastric polyposis, and two cases of submucosal tumor were under follow up after laser treatment. Biopsies taken from the scars on several occasions did not show malignant cells in 7 lesions of early gastric carcinoma and malignant lymphoma. Tumors disappeared in cases of borderline lesion and submucosal tumor. No serious complications were noted. The endoscopic laser treatment was effective for patients with localized gastric carcinoma, borderline lesion and other benign protruded lesion.

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We performed endoscopic examinations of small intestine using a panendoscope (GIF-P₃, Olympus). The detail of the technique are similar to those which were reported by Hiratsuka. The endoscope was inserted through the mouth via an intestinal string. Ten cases underwent this examination. In all cases, endoscope reached to the distal ileum in short time without severe complications, and biopsy was also done. Compared to the method that other authors described, our method can be performed in many clinics, because no special instruments are needed. We hope that enteroscopic examination will be done more easily and frequently by this method.

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Salicylazosulf apyridine (SASP) in a single dose of Z to 4g was administered to 9 patients with untreated Crohn's disease to evaluate its therapeutic effect. The effect was judged using the criteria compiled by the Investigation and Research Committee for Inflammatory Bowel Disease organized by the Ministry of Health and Welfare. Changes in the X-ray and endoscopic findings were simultaneously investigated. Results showed that the SASP therapy was remarkably effective in 5 but ineffective in 4 of the 9 patients. In one of the 5 cases in which the drug was effective, the lesions disappeared, as shown by X-ray and endoscopic examination, with the use of SASP alone. There was also objective improvement as shown by X-ray and endoscopic examination in the remaining 4 cases, but the lesions still remained. These lesions disappeared after treatment with a combination of SASP and elemental diet. As the cases in which SASP was effective were those with Crohn's disease accompanied by colonic involvement, it is suggested that SASP is effective in cases of Crohn's disease of both the small and large intestine and in Crohn's colitis. Despite the disappearance of the subjective symptoms and normalization of the ESR and CRP values due to SASP therapy, there were many cases with lesions indicated by the X-ray and endoscopic examinations. Combination therapy with elemental diet was thus thought to be desirable in such cases.

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Small early cancers at the esophagogastric junction have been rarely found. Only seven cases have been so far reported in Japan. We herein reported a case of small early cancer at this area. A 63-year-old woman visited to our hospital because of discomfort at swallowing. The initial upper GI series revealed no particular lesions at the esophagogastric Junction, but a small lesion of depressed type carcinoma at this area was found by endoscopy with biopsy. Histologically, the specimen revealed signet-ring cell carcinoma of IIc type (7 X 6mm) showing with the depth of invasion in the submucosa. Early cancer showing this type of histology at this area has never been reported in Japan.

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A 25-year-old man was admitted to Jichi Medical School Hospital, complaining of poor appetite and general fatigue. Laboratory examination on admission showed liver dysfunction and elevation of amylase activity in both serum and urine. When ERCP was performed, a mass protruding into the lumen with a central small depression was found endoscopically in the region of the duodenal papilla. Endoscopic biopsy showed signet-ring cell carcinoma and the tumor was resected surgically, ranging 4 X 2.5 X 0.8cm in size. A central small depression of the tumor connected with the common duct. Age distribution of 413 cases reported on literature during the last ten years was studied. Cases in their twenties as our patient are very rare. Signet-ring cell carcinoma is extremely rare in cases of carcinoma of the duodenal papilla.

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A 42-year-old man with a history of having swallowed a dental instrument was transferred to the surgical service from a physician. Plain x-ray examination of the abdomen showed a foreign body in the left upper quadrant (Figure 2). Endoscopic examina-tion revealed a dental instrument lodging in the transverse colon (Figure 4). The dental instrument was extracted from the transverse colon using fiberoptic colonoscope and polypectomy snare. No complications were observed. Endoscopic removal of foreign bodies from the intestinal tract is a simple, safe and effective method.

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A 71 year-old female was admitted to our hospital because of general malaise. Roentgenogram and endoscopic examinations of the stomach revealed a large lesion like Borrmann-2 type cancer in the antrum. One biopsy specimen obtained from the oral portion of this lesion demonstrated a squamous cell carcinoma and another from the anal portion showed an adenocarcinoma. A subtotal gastrectomy (Billroth-I) and partial transverse colectomy were performed. Macroscopically, the tumor mass with ulceration (14X1cm) occupied the almost whole pyloric region of the stomach except the lesser curvature. Microscopically, the tumor was composed of the squamous cell carcinoma and adenocarcinoma which were separated each other by the connective tissue, thus supporting the diagnosis of the collision cancer. In this case, we examined the surface of the squamous cell carcinoma under the dissecting microscope. Two characteristic findings were obstanned. One finding was the small projections (300-400p in diameter) scattering on the surface of this lesion. Anothor was a clear demarcation between the cancer and the normal gastric mucosa. The histological finding of the projection revealed the squamous cell carcinoma into the lumen. This dissecting microscopic findings suggest the possibility of diagnosis of the squamous cell carcinoma in the stomach by means of magnifying endoscopy. Furthermore, we reviewed 142 reported cases of gastric cancers which have a component of the squamous cell carcinoma.

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The authors experienced a case of double pylorus. The patient is a 60-year-old female. She had been treated with predonisone during 10 years because of rheumatoid arthritis and suffered from recurrent gastric ulcer. An upper gastrointestinal series performed in October 1982 showed a prepyloric ulcer on the lesser curvature. A month later, her upper gastrointestinal series showed a double pyloric channel. So-called U-turn technique with a small-caliber panendoscope in the duodenal cap comfirmed the presence of double pylorus. In the case reported here, the lesion was not evident on an initial X-ray examination, but became obvious later. Therefore, the lesion appears to be acquired.

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