In order to make a correct assessment of gastric secretion and to evaluate the defensive and aggressive factors of stomach in peptic ulcer diseases, we performed an endoscopic gastric analysis by the pan-endoscope. Gastric juice was collected every 10 minutes, before and after the stimulation of tetragastrin (4μg/kg). The endoscopic gastric analysis was performed in 49 subjects, 19 cases of gastric ulcer, 14 cases of duodenal ulcer, 8 cases of gastro-duodenal ulcer and 8 cases of hospital control. By six biopsy specimens simultaneously obtained, the atrophic border was decided, and classified into C₁, C₂, O₁ and O₂. Macromolecular glycoproteins (Fr. I hexose) in both the collected gastric juice and biopsy specimen from the antral mucosa were extracted, fractionated on Bio-Gel A-1.5m column chromatography, and analysed by the phenol sulfuric acid method. BAO decreased in the order of C₁, C₂, O₁ and O₂. There was a linear correlation between BAC and the concentration of Fr. I hexose in basal secretion (r=-0.609, p<0.01). Fr. I hexose of biopsy specimen in gastric ulcer patients was 7.8±0.6μg/mg and 10.9±0.8μg/mg in duodenal ulcer patients. There was a significant difference (p<0.01) between them. We also found a linear correlation between BPO and Fr. I hexose in biopsy specimen (r=0.443, p<0.01). Thus, we can perform the study of gastric function including defensive and aggressive factors by the endoscopic gastric analysis, as well as simultaneous morphological examination of the stomach.

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The scarred liver is defined as having broad scar formation on the liver surface. Present report is a study of clinical manifestation of cases with this disorder. The subjects were 30 cases which were found out of 2, 000 cases of laparoscopy. There were 22 males and 8 females. The scarred liver were classified into true scarred liver, macronodular scarred liver (so-called "potato liver"), mixed type scarred liver (with liver cirrhosis) and mixed type macronodular scarred liver (with liver cirrhosis); the number of each type were 5, 2, 6 and 17 cases respectively. Underlying etiological factors were nonA nonB virus infection (18 cases), alcoholic (7 cases), autoimmune (4 cases) and extrahepatic portal-venous obstruction (1 case). Rate of the scarred liver appeared in each etiologic group were; 21.2% (4 cases out of 14) in autoimmune, 4.3% (7 cases out of 160) in alcoholic and 2.2% (18 cases out of 820) in nonAnonB virus. Only two cases of the true scarred liver or macronodular scarred liver had apparent past history of acute liver damage and the rest of these groups did not show the evidence that they developed from severe hepatic necrosis. Cases of mixed type scarred liver had the history indicating an acute exacerbation of chronic liver damage in the course. Site of the scars or nodules on the surface of the liver was studied. The liver was divided into 9 areas by portal tracts according to the Couinaud's classification. Flat and massive scar formation are predominant observed in the medio-imferior (57%) and anteroinferior (43%) portions of the right lobe and latero-inferior (37%) portion of the left lobe, whereas cleft-like scar formations are mainly seen at the Cantlie's line and borderlines of hepatic areas (47%). Large nodules are located in the antero-inferior (57%) and antero-superior (27%) portions of the right lobe. These results suggest that formation of the scarred liver have not necessarily specified etiology, manifest clinical history of hepatic necrosis, nor common hemodynamic factors.

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Forty-seven juvenile polyps (43 patients) were polypectomized in 1971-1985. Clinicopathoilogical study was performed in the patients with juvenile polyp. In our study it was found that adult patients with juvenile polyp are not so rare. The cause of juvenile polyp is not certain. The histological classification has not been established. According to Morson, it was described as hamartoma. Horrilleno, Roth, Patrick and Franzin considered that the cause of juvenile polyp was colonic inflammation in their articles. In this study, two peaks of age distribution curve were noted; the one less than 10, the other 30-39. (Figure 1) This result is the same as that in Roth's series. (Figure 7) The colonic complications were checked up in 43 patients with juvenile polyp. Inflammatry polyps and colitis were found in 7 patients. These patients were all adults, and encountered in children under 10 years of age, no colonic complications were (Table 1). A solitary juvenile polyp with carcinoma in situ (Figure 6), two cases with ulcerative colitis (Figure 5) and one with multiple juvenile polyps were found in this study. Juvenile polyps in adults are closely correlated with inflammatory process (Figure 10).

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Laparoscopic appearance were studied in correlation to histological finding and clinical features in 20 cases with drug induced hypersensitive liver injury. We classfied into green liver and white one according to surface color of the liver. The surface of green liver showed smooth, and liver biopsy specimen appeared acute drug induced liver injury, combined type. Serum A1-p levels were significantly higher in green liver than in white one. The surface of white liver showed five types such as smooth (4 cases), groove like depression (2 cases), groove like depression+flat wavy deformity (1 case) and potato liver (1 case). Liver biopsy specimen of groove like depression appeared acute hepatocellular type. Liver biopsy specimen of groove like depression+flat wavy deformity, large regener-ative nodule and potato liver appeared chronic drug induced liver injury, hepatocellular type. In two cases multinucleated giant cells were seen around zonal liver cell necrosis. Severe liver cell necrosis was observed in two cases, who were detected serum autoantibodies. It suggests that the progress in some of the drug induced hypersensitive liver injury may involve an autoimmune mechanism.

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15, 487 upper gastrointestinal endoscopic examinations were performed in 6, 529 patients. Of the patients 36 lesions (32 patients) were histologically diagnosed as gastric atypical epithelium by the endoscopic biopsied specimens. The changes of endoscopic finding in 13 lesions (11 patients) with a follow-up period from 3 months to 3 years were compared with those in 13 lesions (12 patients) more than 3 years. There were some changes on the surface and shape in the more than 3 years' group but no evidence of remarkable changes in the less than 3 years' group. No remarkable change of color is seen in the both groups (Table 1). Spontaneous detachment was found in one patient of the less than 3 years' group. Figure 1 showed an endoscopic view of this case. Histological changes of the biopsied specimens revealed neither evidence of remarkable changes nor malignant transformation in both groups of 12 lesions (10 patients) of the less than 3 years' group and 8 lesions of the (7 patients) more than 3 years' group (Table 2). In this study, we suspected that gastric atypical epithelium showed relatively slow growth and had the low malignant potential.

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Scanning-electron microscopy using a chemical-digestion method after mechanical stripping of liver capsule helps to observe three-dimentional subcapsular microstructures. Lobular parenchyma was covered with a thin membrane of connective tissue. A subcap-sular terminal portal venule and terminal hepatic arteriole were observed to along with interlobular connective tissue. In the central part of the lobule, some of the sinusoids were exposed to the subcapsular space from the parenchyma, gathered centripetally and drained into the central vein. A case of fatty liver was presented and it is demonstrated that these subcapsular microstructures correspond to the lobular markings of the liver surface which are observed by magnifying peritoneoscopy.

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We devised a very thin colonofiberscope "COL-MS" (Fujinon) for trial of which an outer diameter was 9.5 mm, for the purpose of relieving pain of patients acompanied by colonofiberscopy, and also investigated clinical availability of the COL-MS on total colonoscopy. We could reach the cecum in 63 of 65 patients (97%). and the average time was 10.4 minutes. In our questionnaire after total colonoscopy, we obtained results that 17 patients (26%) had no pain and 42 (65%) had slight pain. There was no patient who had severe pain due to colonoscopy. In conclusion, we demonstrated that COL-MS was a very useful instrument for total colonoscopy.

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A 74-year-old man presenting with diarrhea of 2 weeks duration visited our clinic and received upper GI endoscopy for screening. Endoscopic examination revealed a slightly elevated lesion on the posterior wall of the lower esophagus, locating about 30 cm from incisors. The lesion was discolored with a wall defined margin. And showed no stain with Lugol'solution scattering method. Biopsy specimens revealed cellular and structural atypia of the epithelium which were difficult to differentiate between dysplasia and cancer. Histology after operation showed moderate dysplasia of the esophageal mucosa. Localized severe dysplasia 3 mm insize was found in the lesion, 10×10 mm in size.

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A fifty-year-old man visited the outpatient clinic of our hospital with a chief complaint of epigastric discomfort. The first upper GI examination showed a round undulated tumor 3.5cm in diameter covered with normal gastric mucosa in the supraangular region of the stomach. The tumor was elastic soft on pressing by a biopsy forceps. The biopsy specimen showed the normal gastric mucosa with no eosinophilic infiltration. A diagnosis of a submucosal tumor of the stomach was made and he was followed at three months interval. The second radiological and endoscopic examination were carried out eighteen months later. The tumor completely disappeared, and no evidence of the tumor were seen. This tumor seems to be classified as socalled vanishing tumor of the stomach of undetermined origin.

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We report laparoscopic findings of two cases with rare abdominal tumors. The 1st case was 76-year-old male with chief complaints of slight fever and left hypochondralgia. His laboratory data on admission showed remarkable inflammatory state. He was found to have a retroperitoneal tumor by imaging diagnosis (ultrasonography, abdominal computed tomography and angiography etc.). His laparoscopic findings showed parieto-visceral metastasis with yellow-whitish nodules and a large greyish tumor without capsule, partially covered with thick visceral peritoneum. The specimens from these nodules corresponded to malignant fibrous histiocytoma microscopically and electron-microscopically. The 2nd case was 71-year-old female with high fever. Her laboratory data on admission showed remarkable inflammation state too. She was suspected of hepatoma by imaging examinations. On laparoscopy, yellow-whitish irregular flat tumors were seen on the hepatic surface and parieto-visceral peritoneum. She was laparoscopically diagnosed of peritoneal malignant mesothelioma with liver metastasis. It was proven by biopsy from these tumors. Laparoscopy was the best examination in the diagnosis of these two cases.

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A 55-year-old man with chronic hepatitis was referred to our hospital for investigation of the gastric extramural tumor which had been incidentally detected in a local hospital during peritoneoscopical examination. Sonography showed small hypoechoic mass lesion containing a echogenic spot, at the anterior wall of the stomach. Biopsy specimen of this mass lesion obtained under second peritoneoscopical examination showed round and spindle cells with large nuclei and nucleoli. Other examinations, such as upper GI X-ray, abdominal CT scan or abdominal angiography showed no abnormality, and no malignant cells could be obtained by needle biopsy under gastrofiberscopy. Subtotal gastrectomy was performed in the clinical diagnosis of gastric myogenic or neurogenic malignancy. Surgical findings revealed extramural tumor at the gastric anterior wall, measuring 1.6×0.8×0.8 cm in diameter, and final diagnosis of leiomyoblastoma was histologically established. The size of this tumor was the smallest among gastric extramural leiomyoblastoma reported in Japan. Finally, we reviewed reported 209 cases of gastric leiomyoblastoma of Japan and stressed that, in the light of opportunity to detect by ultrasonography or peritoneoscopy such small gastrointestinal tumors, particular attention must be paid also to the gastrointestinal region during ultrasonographic or peritoneoscopic examination.

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A case of primary biliary cirrhosis (PBC) is reported in a 51-year-old woman. She was admitted to the hospital for jaundice. On the first examination, remarkable hepatos-plenomegaly (Figure 1) and enlarged thyroid gland were noted. Laboratory investigation revealed hepatic dysfunction and positive serologic tests for the antibodies against mitochondria and thyroid microsome. So she was diagnosed to have PBC accompanied with chronic thyroiditis. One year after the onset of jaundice, endoscopic study disclosed multiple esophgeal varices which were likely to rupture (Figure 2). Then esophgeal transection and splenectomy were performed under the diagnosis of PBC with portal hypertension. Histologic findings of the biopsied specimens of the liver were consistent with the diagnosis (Figures 3 and 4). After the surgery, esophageal varices disappeared completely (Figure 5) and she has been in good condition for more than two years. It is very rare that a patient with symptomatic PBC becomes asymptomatic after any treatment.

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A case of solitary small intestinal lipoma is described. A 66-year-old woman presented with nausea, vomiting, abdominal pain and massive melena. Barium follow through study showed a smooth, oval filling defect in the jejunum at 25 cm. beyond the ligament of Treitz (Figure 1). The fiberoptic examination of the jejunum revealed a pedunculated submucosal tumor with a superficial hemorrhagic erosion (Figure 2). Superior mesenteric arteriogram showed slightly increased vascularity surrounding the tumor, which was fed by its jejunal branch (Figure 3). At operation, approximately 7 cm. of the jejunum had intussuscepted distally with a soft mass forming the leading head of the intussusception. Pathological examination revealed a submucosal lipoma of the jejunum, measuring 3.5×2.0×2.0 cm., associated with multiple hemorrhagic erosions (Figure 4, 5 and 6). Benign small intestinal tumors are very uncommon. Reports presenting endoscopic and angiographic features of intestinal lipomas are extremely rare. A brief review of symptoms, complications, radiographic diagnosis and endoscopic features of small intestinal lipomas is given.

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A 67-year-old male, who was operated upon for carcinoma of the stomach 6 years ago and for carcinoma of the sigmoid colon 1 year ago, underwent colonoscopy, which revealed a semipedunculated polyp in the distal ileum in a distance of approximately 10 cm from the ileocecal valve. The surface structure of the polyp was the same as the surrounding normal mucosa. Endoscopic polypectomy was performed, and the retrieved material, measuring 10×6×6mm was histologically diagnosed as cavernous lymphangioma. Lymphangioma is a nonepithelial benign neoplasm, and is rarely encountered in the small intestine. This case is the first one in the reported lymphangioma that has ever been treated by endoscopic polypectomy.

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A case of ileo-coecal actinomycosis is described and the cases of intestinal actinomycosis presenting in Japan over the past 10 years are reviewed. A 54-year-old man was admitted to Kawasaki Medical School Hospital in August 28, 1985, complaining of abdominal pain. Palpation of his abdomen revealed tenderness in the lower abdomen and painful firm mass was palpated through the right wall of the rectum. Barium meal examination of the small intestine did not visualized the appendix and the medial side of the coecum and the lateral side of the terminal ileum was compressed in a hemispheric way probably due to an extra colonic mass. Colonofiberscopic examination showed a small red mass in the orf ice of the appendix. At the time of biopsy, the mass and surrounded mucosa about 5 cm in diameter was pulled up. Echography showed the coecal mass compressing the urinary bladder. The coecum including the mass was resected. Resected mass was 2.7×3.3×2.1 cm in size and cut section of the mass showed small abscess. Histological finding showed the sulfur granules in the abscess.

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Recently we experienced a case of ischemic colitis (IC) occurring in a patient receiving long-term hemodialysis (HD). A 27-year-old man who had been receiving HD for about 9 years suddenly developed abdominal pain and bloody stool several hours after receiving HD. The laboratory data at the onset showed leukocytosis, CRP positive and renal function disorder, but the others were within normal range. Barium enema showed a stenotic and irregular lesion near the hepatic flexure of the transverse colon. Colonofiberscopy examined 3 weeks after the onset showed a stenosis with mucosal edema, bleeding, cobblestone like appearance and longitudinal ulcer. The histopathological findings were severe infiltration of polymorphonuclear cells, f ibroblasts, connective tissues and no granuration tissues among them, which meant nonspecific acute inflammation. Concerning the pathogenesis of this case, we considered that decreased renal plasma flow, unbalansed serum electrolyte and disordered autonomic nervous function in chronic renal failure led to hypertension, heart failure, progression of arteriosclerosis and elevation of intraluminal pressure and furthermore transient hypotension and hypovolemia induced by HD were implicated for the development of IC.

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Ureterosigmoidostomy has been used as a means of urinary diversion for benign and malignant disease of the urinary bladder. Recently adenocarcinoma of the colon develop-ing at the site of ureterosigmoid anastomosis has been reported with increasing incidence as a late complication of Ureterosigmoidostomy. The etiology of the malignant change in the colon remains obscure. A 60-year-old man is presented who developed polypoid lesion of the colon one year after ureterosigmoidostomy for bladder tumor. Colonofiberscopy revealed that this polyp occurred at the left ureterosigmoid anastomotic site, which was confirmed by using DIP and PSP reagent during examination. Endoscopic polypectomy with colonof iberscope was carried out. The resected polyp was 2.0×1.0cm in size, and was found to be tubular adenoma, not including carcinoma, histologically. It has been discussed that the colonic adenoma has high possibility of malignant transformation. The rate of malignant change of colonic adenoma has been reported with a range of 1.7-55.0%. Therefore, patients who undergo ureterosigmoidostomy should be followed for the rest of their lives. We recommend surveillance colonof iberscopy, including endoscopic polypectomy, and histological examination at regular intervals for these patients, beginning one year after this surgical procedure.

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Esophageal endoprosthesis under endoscopic guidance was attempted in 11 patients with malignant upper gastrointestinal stricture (6 patients with esophageal cancer and 5 patients with gastric cancer) who were all inoperable because of their age and medical condition. Three types of endoprosthesis tube were used in this study ; Sumitomo- Bakelite tube in 7 patients, Celestin-Pulsion tube in 2 patients and Nipro tube in 2 patients respectively. The technique is as follows ; after local pharyngeal anesthesia and intravenous premedication for sedation a small caliber forward viewing endoscope (Olympus, GIF-XP) equipped with an endoprosthesis tube and a pushing tube is introduced into the esophagus and passed through the esophageal or gastric cardia stricture. And then, the prosthesis tube is placed in the stricture by the pushing tube under endoscopic guidance and fluoroscopic control. In patients with a severe stricture, balloon catheter dilatation of the stricture using the Microvasive Rigif lex Balloon is performed before endoprosthesis. Endoscopic esophageal endoprosthesis was successfully accomplished in all 11 patients without any complications except for one patient with postoperative pleural effusion. These patients had better oral intake of diet just after the procedure. The follow-up period of endoprosthesis in these 11 patients ranged from 8 to 119 days until the patients' death except for one patient who is still alive 40 days after the procedure.. During these periods, all the patients have been free from any stenotic conditions. These results apparently showed that endoscopic esophageal endoprosthesis was a safe and effective procedure for treatment of inoperable malignant strictures of the esophagus or gastric cardia. Although the technique cannot prolong the patients' survival, it can provide more comfortable condition in their limited life (quality of life).

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