The effect of per-operative combined therapy with radiation as its main component was evaluated by surgical specimen in 173 cases of esophageal cancer from 1969 to 1982. The main points of the present investigation were: a) establishment of criteria to judge the effects of combined therapy; b) correlation between the histological features and the criteria established; and c) evaluation of the predictive effects of the combined therapy through endoscopical findings. According to the judgment criteria, the effect was classified in 4 types: complete response, partial response, minor improvement and no improvement. A significant correlation was found between the histological features and the pre-established criteria. Moreover, taking into account the changes of the endoscopic findings due to combined therapy, it was found that the most appropriate time to judge its effects were between two or three days before the operation. In order to estimate the predictable effect of the pre-operative combined therapy we considered the three following items related to the main tumor: a) the configuration of the elevation; b) the exposure of the cancerous region after using lugol solution; and c) the configuration of the oral side of the tumor. The first 2 items were subdivided in 4 types; and the third one in 3 types. For each case, the sum of the above mentioned items was used as the index of evaluation of the effect. According to the pre-operative combined therapy which was used, the indices found for effects EF₁, EF₂ and EF₃ were : -0.180±0.303, -0.010±0.291 and 0.183±0.142, respectively. A good correlation was found between this index of evaluation and the recent clinical cases.

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In our analysis of the diagnostic result of ERIC in intrahepatic stone, it revealed that 74 among 93 patients with intrahepatic stone were correctly diagnosed by ERIC. On the other hand, 6 among 232 patients of non-intrahepatic stone were incorrectly diagnosed as intrahepatic stone by ERIC. As a result, the diagnostic sensitivity, specificity and accuracy of ERIC in intrahepatic stone were assessed to be 79.6%, 97.4% and 92.3% respectively. The ERIC would clearly show out the entire biliary tract, local stenosis, and location and size of stone. Preoperatively, it is one of the most useful and effective methods in accurate diagnosis on both intrahepatic stone and its associated abnormalities of biliary tree. Comparing the sensitivity, specificity and accuracy among ERIC, IVRC and US, we find that: (a) both sensitivity and accuracy are the best in US, (b) the specificity shows no significant difference among ERIC, IVRC and US. Although US is the most sensitive diagnostic procedure for intrahepatic stone, the local stenosis of bile duct and spetial relationship between stone and entire biliary tree are unable to be clearly demonstrated by US. Therefore, preoperatively, a direct cholangiography by ERIC or PTC is further necessary for obtaining a better surgical result. IVRC is also effective in diagnosis of intrahepatic stone. However, because of having two dis-advantages of limited anatomic resolution and non-efficiency in detecting extrahepatic stone, the usefulness of IVRC in common practice has largely been reduced.

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The morphological classification of Peyer's patch, as reported in part, consists of "Lymph Follicle Type (LF type)" and "Lymphocyte Aggregation Type (LA type)" from macroscopic, stereoscopic and histological examination in autoptic cases, and from endo-scopic examination, "Border Type (B type)" was settled as a transition type between LF and LA type. In the present report, a clinico-statistical study of Peyer's patch was performed in normal terminal ileum of 100 endoscopic cases and 48 autoptic cases (the same cases as reported in part 1). Incidence, sex and age distribution of the individual type of Peyer's patches were studied. The results obtained were as follows. 1. Peyer's patch was observed in almost all cases, and LA type was higher than LF type in incidence and B type was the lowest (Table 1, 5). 2. The incidence and the incidence by type of Peyer's patch, and the mean age of Peyer's patch-present cases had no difference between male and female (Table 2, 4, 6, 8-a). 3. Age distribution of LF type Peyer's patches was the highest in teens, then de-creased with increasing age. That of LA type Peyer's patches was high in newborns, the lowest in teens, then increased with increasing age. B type Peyer's patches were rarely distributed in younger and older age groups (Table 3, 4, 7, 8-a, 8-b). 4. It is assumed that LA type Peyer's patch in newborns is immature in function as Gut-Associated Lymphatic Tissue (GALT), and matures to LF type. After the puberty, LF type Peyer's patch seems to take atrophic changes and transform to LA type through B type with increasing age.

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We have attempted precutting procedure by means of the tip of usual papillotome when a selective cannulation to the common bile duct failed, however, the results was not satisfactory. Therefore, we made a needle type device (needle knife), recently. A cutting procedure by the needle knife has been performed at a point in the center of top of the oral elevation of major papilla. This method was successfully applied in 24 patients out of 25 patients. Indications were as follows ; impacted stones, Billroth II resected stomach, diagnostic EST and selective ERC. Complications were encountered in 12%, one perforation and two pan-creatitis, which seemed more frequent than those by the normal papillotome group (8.7%, 38 out of 436 cases), but not significant statistically. This method provides a safe precutting techinque at EST and an useful method to obtain ERC when conventional cannulation failed.

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A comparative study between 22 cases of antibiotic-associated hemorrhagic colitis and 11 cases of ischemic colitis was performed by means of endoscopic and histological findings. Age of the patients ranged from 4 to 55 (mean, 29.3) in antibiotic-associated hemorrhagic colitis and from 22 to 84 (mean, 60.5) in ischemic colitis, respectively. Symptomatically, abdominal pain and bloody diarrhea were seen in all cases of both diseases. Colonoscopy with simultaneous biopsy was performed within 72 hours after the onset. From an endoscopic point of view, hemorrhagic changes were observed in both groups. In cases of ischemic colitis, necrotic changes were additionally found in 9 of 11 cases (82%). Histologically, biopsy specimens from antibiotic-associated hemorrhagic colitis showed hemorrhage of different degrees in the lamina propria in all cases. On the other hand, necrotic changes were characteristically seen in biopsy specimens from ischemic colitis in 9 of 11 cases (82%). As the result, different pathogenesis is suggested between them. In ischemic colitis, mucosal necrosis develops due to occlusion or spasm of colonic blood vessels. In antibiotic-associated hemorrhagic colitis, intramucosal hemorrhage is probably caused by capillary damage in the lamina propria of colonic mucosa, although its detailed mechanism remains unknown.

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The authors present six cases of gastric adenocarcinoma in patients under the age of 30. They draw attention to the problem, pointing out that carcinoma of the stomach should be considered even in young patients presenting with upper abdominal distress.

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Adequate cleansing of endoscopes is desirable to prevent infection related to endo-scopic examination. A bacteriological study on disinfectious effect of endoscopes was done in comparison between washing-sterilization method with EW-10 and our original hand-washing method (Aichi Cancer Center Hospital method). Instruments tested included the Olympus GIF-XP10 and JF-10 (waterproof scopes). The materials were obtained by flushing lOml of nonbacteriostatic sterile saline through a biopsy channel and collecting the effluent from the distal end of the scopes and one ml of tenfold diluted materials was then incubated into GAM agar culture at 37°C for 48 hours. The organisms found in the bacterial culture were streptococci, veillonella, bacter-oides, pseudomonas, neisseria, candida, etc. In the washing and sterilizing course of EW-10, cleanser, running water and 2% glutaraldehyde solution were used in this order for a total of 22 minutes. On the other hand, Aichi Cancer Center method, i. e. hand washing with running tap water, cleanser, water, 2% glutaraldehyde solution, water, 70% ethelalcohol in this order usually took two to three minutes. This study showed that the washing-sterilizing course of EW-10 had an excellent disinfectious effect equally with GIF-XP10 and JF-10 instruments. However, our original method (ACCH method) would be reasonable in saving time and expense, since it had almost the same disinfectious effect as that by the washing-sterilizing course of EW-10 with GIF-XP1o instruments.

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We recently encountered an interesting patient in whom linear erosions on longitudinal linear redness were observed in the stomach at endoscopy (Figure 1). As the redness was supposed to be accompanied by acute gastric mucosal lesion (AGML), we termed the redness "Red Line" (R-L), and studied its clinical significance. We collected cases with R-L on endoscopic films retrospectively. As the clarity of R-L was varied, it was graded as shown in Table 1, Figure 2 and 3. Various clinical aspects were searched in the charts of patients with discrete R-L which is more than grade II. There were 307 cases with discrete R-L and its incidence was about 9% as shown in Table 2. There was a preponderance in the 3rd to 5th decades (Figure 4). The distribution rate of discrete R-L in the stomach was 31% in the antrum and 72% in the body (Table 3). The associated disorders of the gastrointestinal tract were shown in Table 4 and those other than the GI tract inTable 5. The patients with diseases which could explain their clinical complaints as active peptic ulcer, gastric cancer, cholelithiasis etc were excluded. Hence, 203 cases entered into a further study. The symptoms of the 203 cases were shown in Table 6. There were 45 symptom free cases (22.2%). Figure 5 shows the cumulative per cent of improved patients. Within 2 months from the onset, 96.2% of symptoms improved. As shown in Figure 6, even though the interval from the onset to endoscopy was short, a great deal of R-L was clearly identified. Two cases were presented in Figure 7 and 8. In endoscopic appearance, R-L is similar to "comb redness" or the other term of "Kammrotung". The latter has been considered to be a sign of chronic superficial gastritis. In the present study, however, it is likely that a great deal of R-L appeared and may subside in close relation to the clinical course of AGML. Therefore, R-L is supposed to be one of endoscopic signs of AGML.

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During the past eleven years, we have come across in our hospital 17 cases of erosions of duodenal second portion among 4334 cases of routine duodenal examination. The following results were obtained : 1) There were most frequently found in male (76%), and in patients whose age ranged 40 to 60 years, (50 years on the average). 2) Clinically, abdominal pain was the most frequent symptom. In some cases we found hematemesis and melena. 3) Endoscopically, patchy erosions were the most common type of lesions. There was correlation to a certain degree between histopathological and endoscopic features of duodenal erosions. 4) Patients with erosions of the second portion sometimes have ulcers or erosions in other gastrointestinal regions, however conversely, erosions of the second portion were not frequently found in the same patients with duodenal bulb ulcers. 5) All of 17 cases had certain associated diseases. Liver diseases, particularly liver cirrhosis was seen in high incidence. The degree of erosions tended to well correlate to the gravity of associated liver diseases. Other associated diseases such as diabetes mellitus, chronic renal failure, cholecystitis, cerebral infarction, progressive systemic sclerosis and Crohn's disease were also seen in patients with erosions of duodenal second portion. In addition, the use of steroidal and non steroidal antiinflammatory drugs should be emphasized as one of the causes that precipitates the formation of erosions in duodenal second portion.

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This report is on two cases of small esophageal leiomyoma removed by endoscopic polypectomy. The first case was a 34-year-old male complaining of dysphagia. Endoscopic examination revealed a polypoid lesion of Yamada-typeII covered with normal esophageal mucosa near the E-C junction. Endoscopic polypectomy without using electrocoagulation was performed. The tumor was measured 7 × 7 × 5mm in size. Histological diagnosis was a leiomyoma. The second case was a 56-year-old male without any complaint. Endoscopic examination revealed a movable polyp of Yamada-typeI at the upper esophagus. The polypectomised lesion was measured 10 × 5 × 5mm in size. Histological diagnosis was also a leiomyoma. Thirty-seven polypectomised cases of esophageal leiomyoma have been reported since 1974 in Japan. Bigger leiomyoma (≥ 10mm in diameter) of them tended to be Yamada-typeIII or IV of macroscopic classification, and smaller one (< 10mm) to be Yamada-typeI or II. For small esophageal leiomyoma we recommend the polypectomy without electrocoagulation in order to prevent deeper mucosal defect and to make correct pathological diagnosis.

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This case report describes two patients of papilloma of the esophagus and a review of Japanese literatures. Case 1. A 78-year-old male was admitted to our hospital on January 25th, 1983, complaining epigastric discomfort. On gastrointestinal roentgenogram and endoscopic examination, a protruded lesion was recognized in the middle esophagus (Figure 1, 2, 3). Polypectomy was performed for the lesion (Figure 4). Histological finding disclosed papilloma (Figure 5). Case 2. A 41-year-old male was admitted to our hospital on August 8th, 1983. On gastrointestinal roentgenogram and endoscopic examination, a protruded lesion was recognized in the lower esophagus (Figure 6, 7). Polypectomy was performed to the lesion (Figure 8). Histological finding disclosed papilloma (Figure 9). Both cases were associated with dudenal ulcer.

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A 72-year-old male came to our hospital complaining of epigastric pain. The first endoscopic examination showed gastric ulcer on the lesser curvature of the prepyloric region. Four years later at the second endoscopic examination, this lesion was found to become deeper and larger. Three weeks later at the third endoscopic examination, this lesion was found to develope the double pylorus. A diagnosis of double pylorus was established by passing of endoscope through the pseudpyloric ring into the duodenum. X -ray examination of the upper gastrointestinal tract also revealed a gastroduodenal fistula communicating between the lesser curvature of the prepyloric region and the duodenal bulb. This case was considered as an acquired type of double pylorus due to penetration of the prepyloric ulcer to the duodenal bulb. In addition, we reviewed 36 cases of double pylorus reported in the literature in Japan.

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A 82-year-old female with melanosis duodeni was described. Normal duodenal bulb developed leopard-skin appearance for one year. Light microscopic studies showed that the pigment resides mostly in macrophages in the lamina propria of duodenal villi, but rarely extracellularly. Electron microscopic study revealed pleomorphic pigment granules in the lysosomes of macrophages. Histochemically, the pigment stained positively with Masson-Fontana stain and was bleached by hydrogen peroxide. Staining for iron by Prussian blue reaction and by the Turnbull blue reaction were negative. Electron-probe X-ray analytical findings demonstrated the presence of iron, sulfur and traces of calcium in pigment granules, and the atomic ratio of Fe : S was 1 : 1. On the basis of these findings we have concluded that the pigment is an iron-sulfur protein, but not FeS itself nor melanin. From the fact of this case and seven all cases reported in the literature we agree that the Fe in this pigment is derived from gastric bleeding. This case and three cases in the literature are associated with medications that contain a benzene ring, and its contribution is speculated.

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A 56-year-old man was admitted to our hospital complaining of periumbilicalgia and palpable mass at the right lower quadrant. X-ray studied of the colon demonstrated a filling defect at the ileocecal valve area. Flexible fiberoptic colonoscopy revealed the tumor as a sessile, semispherical polypoid lesion with normal colonic mucosa. Surgical findings revealed that the tumor existed in the ileocecal resion and partial ileostomy with end to end anastomosis was carried out. This tumor was a pedunculated and which was located in the submucosal space of the colon. The cut surface was homogenous and yellowish, measering 5.0 × 4.5 × 4.0 cm. Histological findings showed the submucosal lipoma of the ileocecal valve.

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