As endoscopic images involve shading (unevenness of lighting), shading correction (SC) is essential to their effective image processing. SC was studied in endoscopic images of experimental models, the liver surface and the gastrointestinal tract. They were obtained with a color video camera through a peritoneoscope or with an electronic endoscope. For SC, a certain shading master (SM) is necessary representing only shading of the original image (OI). SM was made by blurring each RGB component image of 01 by repeating a smoothing filter (size 15 x 15) 20 times. We divided each OI component by each SM and adjusted the lightness to that of the average of the appropriately lighted area of OI. Shading and color corrected images (SCCI) were reconstructed from RGB component images. The corrected images were almost even in lightness and appeared natural in color. SCCI were useful for the subsequent image processing, especially for binarization. For automatic SCCI, the lightness was adjusted by using the mean plus one standard deviation of the lightness of the whole OI instead of the average of the appropriately lighted area of OI, which presents also color correction good enough for practical use.

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C. C. D. (Charge Coupled Device) put in the tip of the videoendoscope is sensitive to infrared rays. Utilizing this characteristc, the authors have developed the infrared video-endoscope. It is desingned to observe the upper G. I. tract with the infrared rays through the abdominal wall radiated from the outside of the body. We have applied this videoendo-scope to clinical cases to study its usefullness for diagnostics. The subjects of this study included 5 cases of gastric ulcer, 2 cases of gastric cancer, 7 cases of atrophic gastritis, and erosive gastritis, 2 cases of duodenal ulcer and 10 other cases. The observation of inside the stomach by this apparatus revealed the followings. The picture of most part of anterior wall is obtained as satisfactory as expected in most cases. In some part of anterior wall, picture is not so well as in the other parts. The picture of posterior wall is not so well as that of anterior wall because posterior wall is lit up indirectly, through anterior wall, by the infrared rays. It means that it is difficult to observe posterior wall and to acquire the findings by this method. But it would be possible to observe the posterior wall better by increasing the volume of infrared rays and some other method. In anterior wall neither fine appearance of the mucosa nor superficial vessels are seen although superficial vessels are done clearly in normal cases and atrophic gastritis cases by visible rays examination. Large vessels in deeper layer are seen clearly and branches of them are also observed in details. In gastric cancer cases, pooling of the blood is seen around the wall of cancer crater. In gastric ulcer cases, it is possible to observe the vessels in the deeper layer surround-ing the scar area, but it is not seen in the center of ulcer scar itself. Applying this infrared observation using prototype of infrared videoendoscope, the information regarding deeper layer of gastric wall, especially that of vessels, are consid-ered to be informative. The authors are planning to develop new method in order to compare the picture of this apparatus with that of infrared videoendoscope which lights up inside the stomach. The comparison will bring the findings of the deeper layers' vessels which are not seen by the observation under visible rays. The further study is also planning for the progress for diagnostics by infrared video-endoscope.

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Sixty-one early cancers of the large intestine were studied in order to know the developmental process of colorectal cancers. The distributions of early cancers of large intestine were compared with those of 640 adenomas and 378 advanced cancers. Early cancers were deviled into two groups accord-ing to their size above 10mm and 10mm or less. Early cancers sized 10mm or less were accompanied less frequently with adenomatous element in histology than larger lesions above 10mm in size. Grossly, 91% of small lesions showed flat or sessile in shape on endoscopy. Distributions of those small early cancers of large intestine were more similar to those of advanced cancers than those of large early cancers. Early cancers above l0mm in size distributed similarly to those of the large size adenomas above 10mm in diameter. Sessile small cancers investigated in this study are speculated to be lesions which cancerated in their early stage because of their histological features. We think that process of early cancerization is main route which progresses to the advanced cancer because of their similar distributions in the large intestine.

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Ninety cases of Mallory-Weiss syndrome (M-W syndrome) were analyzed on their clinical features. As the inducing factors of M-W syndrome, alcohol intake was 40.0% and endoscopy was 13.3%. The tears were almost located in the cardia, in which about a half of the tears were found on the lesser curvature. The number of the tears ranged from one to four and 71.2% had a single tear. Accompanied lesions of the upper gastrointestinal tract, such as erosive gastritis or gastric ulcer were recognized in over a half of the cases. Most of the tears healed within 3 weeks. The average period of healing was 9.1 days in the linear tears and 18.7 days in the spindle-shaped tears. Six cases required blood transfusion and/or endoscopic hemostatic procedures. Five of them occured after alcohol intake and one during endoscopic examination. Several spindle-shaped tears were mainly observed near the lesser curvature of esophago-cardiac junction or cardia in most of these cases. Endoscopic hemostatic procedure was performed to 4 cases in which vessels with massive bleeding were exposed. Among them, local injection of Aethoxysklerol® was done in 3 cases, and it was very successful. Only one case was operated (1.1%). In this case, the first endoscopic examination revealed some linear tears without bleeding, but massive re-bleeding occured and local injection of absolute ethanol was not effective. Most cases of M-W syndrome improved rapidly, but some cases in which massive bleeding could not be controlled, especially in patients with liver cirrhosis. So it is considered that early diagnosis and endoscopic hemostatic procedures are very important.

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A basic study was carried out with Cyanoacrylate (ethyl-α-cyanoacrylate) which is used as a tissue adhesive agent, in order to evaluate clinical application as a sclerosing agent. When it was injected into a vessel of rabbit's ear, rapid coagulation was observed producing localized acute inflammation, but neither deciduation of intravascular endothelial cells nor thrombosis was induced. When it was injected submucosa of esophagus and stomach of the dogs, similar changes were induced. When Cyanoacrylate alone was used clinically, varices was not improved. It seemed difficult that single use of Cyanoacrylate improve varices. Therefore, simulataneous administration of Cyanoacrylate and Etanolamine Oleate seemed to be indicated. Since Cyanoacrylate polymerizes Eth-anolamine Oleate in the puncture needle in an instant when the later is injected following the injection of the former, it is important that Ethanolamine Oleate be washed away thoroughly with 5% glucose after injection. Considering the properties of Cyanoacrylate, it should be used for such purposes as hematemesis in the event of esophageal varix rupture, or as prevention of bleeding upon removal of the puncture needle.

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Omeprazole (20mg/day, after breakfast) were administered to six patients with active gastric ulcer, who were endoscopically followed up every two weeks as a rule. The protrusion of the base of the ulcer were found in four of these patients (Table 1). The incidence of the protrusion during the administration of omeprazole might be higher than that with H2 receptor antagonist. With the object of elucidating the high incidence of the protrusion, the 24 hours intragastric pH monitoring, the time course measurement of plasma gastrin levels and the biopsies from the protrusion were performed. In all of five patients who were performed pH monitoring under the administration of omeprazole, the holding time over pH 3 were 100% and the 24 hours mean pH were about seven. On the other hand, among the H2 receptor antagonist (Ranitidine) administered cases, the holding time over pH 3 were about 50% and the 24 hours mean pH were about four (Table 2). There was no statistical difference between the plasma gastrin level and the protrusion of the ulcer base as the result of the time course measurement on one or two weeks during the administration of omeprazole (Figure 7). Histologically, the protrusion was mainly constituted of the granulation tissue and was not due to the epithelial hyperplasia. Namely, the protrusion might result from the proliferation of the granulation tissue after vanishing of peptic action of gastric juice by omeprazole and not from trophic action to the mucosa by secondary hypergastrinemia.

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From 1971 to 1987, 231 cases of typical acute gastric mucosal lesions (AGML) were treated in Kitasato University Hospital. A clinical and endoscopic analysis of AGML were made, and the results were as follows : (1) The main causes of AGML were drugs (37.7%), emotional stress (24.3%), surgical stress (4.3%) and cerebral disease (5.2%). While in 51 cases there was no inducing factor for AGML. (2) The lesions were most frequently seen in the antrum (43.3%), and 31.2% of the patients were in the upper part of the body. But most of the upper-gastrointestinal tracts were affected widely. (3) Drug induced AGML were found equally in the antrum and upper-body, and AGML induced by emotional stress were located in the antrum. (4) AGML in the antrum were 100 out of 231 cases, and were more frequently sees in younger age. They were consits of acute multiple ulcers and acute erosive gastritis. Lesions of the patients with critical illness were mainly acute erosive gastritis. (5) Acute multiple ulcers in the antrum were seen in 36 cases, out of which 10 cases were drug-induced, 13 cases were induced by emotinal stress, 13 cases were of unknown origin. Acute multiple ulcers healed rapidly and recurrence of ulcers was not seen for more than 3 years in 23 cases.

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Peritoneoscopic findings of 22 HBV carriers, who had become asymptomatically seroconverted to anti-HBe, were compared with those of 14 HBeAg positive asymptomatic carriers. Adhesions between the liver and its neighbouring organs were observed in 1 (7.1%) HBeAg positive patient and in 10 (45.5%) anti-HBe positive ones. Depressions, expressed as the sign of lobular necrosis, were observed in 1(7.1%) patient in the former and in 12 (54.5%) patients in the latter, Whitish markings, the sign of inflammation and fibrosis, were observed in 13 (92.9%) and 22 cases (100%) respectively. Whitish marking, depression and adhesion, which were considered to be morphological changes of the liver surface seen after hepatitis, were observed more frequently in anti-HBe positive patients than in HBeAg positive ones, and the difference was statistically significant. Our findings appear to support morphologically the presence of hepatitis during seroconversion of the patients, who had no history of active liver disease. We also examined the state of HBV DNA in the liver of 5 patients and found integrated HBV DNA (random integration) in all 3 anti-HBe positive patients. We considered this to be the sign of past HBV carrier state.

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The authors studied macroscopic features of colectomized specimens and preoperative endoscopic appearance associated with early cancer and/or dysplasia in 4 cases with long-standing colitis. The cases consisted of 2 patients with ulcerative colitis, 1 with intestinal tuberculosis and 1 with Crohn's disease. There were 4 early cancers (3 mucosal and 1 submucosal cancer), 1 advanced cancer and 6 dysplastic lesions in the colectomized specimens. Macroscopic appearance of 3 mucosal cancers was flat (two lesions) and slightly depressed (one lesion). Submucosal cancer was a sessile polypoid mass. Of 6 dysplasitic lesions, 4 were even mucosa, 1 was granular mucosa and 3 were slightly elevated lesions. Dysplastic lesions tended to be lower in height than early cancers. Colonoscopic diagnosis could be made for flat tumors and some dysplastic lesions such as even mucosa accompanied with redness or granular mucosa. These fine lesions appeared more clearly using color corrector treatment of videoscopic image and dyecontrast method with indigocarmine. Early colitic cancer is characterized by the flat tumor surrounded by even red mucosa or granular mucosa which is different from healed mucosa.

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Fifty-two early colorectal cancers and 578 adenomas removed by polypectomy were investigated with reference to their sizes, locations and gross appearances. Three hundred twenty-two advanced cancers were also investigated with reference to their locations. The following results were obtained. (1) Early cancers were most frequently seen in the sigmoid colon. (2) Pedunculated early cancers were most frequently seen in the sigmoid colon in contrast to the subpedunculated type. (3) Similarly, pedunculated type of adenomas over 6 mm in diameter were distributed most frequently in the sigmoid colon. (4) Advanced cancers were most frequently seen in the rectum. Pedunculated type of early cancer of the large intestine seems to need longer time to develop to advanced cancer than subpedunculated type of early cancer. If all types of early cancers progress to advanced cancer equally, more numerous advanced cancers must be found in the sigmoid colon. This slow progression of pedunculated type of early cancers can explain opposite distributions of early and advanced colorectal cancers.

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A case of drug-induced esophagitis caused by an ascorbic acid tablet is reported. To our knowledge, this is the first report of esophagitis induced by ascorbic acid tablet in Japan. The patient, a 45-year-old female, took a Vit. C tablet without water just before going to sleep. In the next morning, she came to us because of the onset of pharyngeal discomfort. At endoscopic examination, a circumferential and diffuse thin white coat was found 15cm long in the upper esophagus. Biopsy specimen taken from the lesion showed degeneration of squamous epithelial layer and edema suggested by spaces among cells. And micro-abscess was shown in the more degenerated lesion. She was treated with sodium alginate and her symptom disappeared 3 days later. 10 days later, no abnormal lesion was found by endoscopic examination. The size of Vit. C tablet in this case was 19.3 × 8.1 × 7.6 mm, the pH was 2.42 and the Vit. C content was 995.6 mg. We considered that the drug caused esophageal mucosal injury for its large size and very low pH in this case.

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A case of multiple lymphomatous polyposis is reported. The patient was 57-year-old female who developed loss of weight in January, 1987 and entered to our hospital in April at the same year. She had an episode of RLH diagnosed by local doctor 4 years previously. Physical examination on admission revealed a solitary lymph node swelling on the back of neck. Upper G-I x-ray examination demonstrated thickened mucosal folds in the stomach and duodenal bulb and white-colored, small to flat semioval multiple polypoid lesions from the 2nd portion of the duodenum to the transverse colon. Otherwise, lip-like masses were sporadically observed in the jejunum and ileum. Biopsies from the lesions demonstrated B -cell type malignant lymphoma classified as diffuse medium sized cell type (LSG), or small cleaved cell type (WF). The diagnosis of multiple lymphomatous polyposis was confirmed. The lesions excluding ileum were almost completely diminished by the chemotherapy mainly with VEPA. In addition, 18 cases of multiple lymphomatous polyposis reported in Japan were briefly reviewed.

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Two cases of duodenal carcinoid were presented. Case 1: A 47-year-old woman entered Yamada hospital with the chief complaint of epigastralgia. Physical examination revealed epigastric tenderness. Although serum serotonin and urine 5-HIAA were normal, serum gastrin were elevated. A gastrointestinal series and endoscopic finding showed small polypoid lesion in the duodenal bulb. Strip biopsy were performed and biopsy specimen proved carcinoid cells. The tumor, measuring 4×7×7mm in size, was removed by surgical operation. The tumor was located at the duodenal submucosa. Gastrin were not proved in the tumor and serum gastrin after operation were still high. Case 2 : A-73-year-old woman who hoped gastrointestinal examination consulted a doctor although she had no gastrointestinal symptome. Physical examination revealed almost no abnormality. Endoscopic examination showed semi-pedunculated polyp in the duodenal bulb. The tumor, measuring 5×10mm in size, was removed by endoscopic polypectomy. The tumor was located at the duodenal lamina propria. The histological patterns of the both tumor were those of classical pattern of carcinoid tumor, composing of small uniforms with trabecular and pseudorozett structures. Car-cinoid cells were stained by the Glimelius method. Approximately 145 cases of duodenal carcinoid tumors have been reported in Japan, but 24 of them had been diagnosed definitely with endoscopic biopsy, polypectomy or strip biopsy. Gastric carcinoid tumors with hypergastrinemia were often reported, but reports of duodenal carcinoid tumor associated with hypergastrinemia were only 6 cases including our case. All of them except one case were not shown gastrin in the duodenal tumors. However our case showed atrophic gastritis on the biopsy speciemen. It is suggested that duodenal carcinoid tumor with hypergastrinemia were accompanied with type A chronic gastritis. We discussed indication of polypectomy of duodenal carcinoids.

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A 53 year-old female patient, was admitted to our hospital for the evaluation of severe anemia. After admission, she passed tarry stools. X-ray and endoscopic examination showed an elevated lesion with deep central ulceration its on the anal side of the SDA. The mucous membrane on the foot of the lesion looked normal.These findings strongly suggested leiomyosarcoma. Histological findings of biopsy specimens taken from the surface of the ulceration showed proliferative growth of spindle cells which seemed to originate from the submucosal stromal cells. She was treated surgically by pancreatico-duodenectomy, and the resected specimen looked like a Borrmann type Z tumor, 35×35×10mm in size, in the second portion of the duodenum. Histologically, it revealed Antoni's type A and B schwannoma, and S-100 proteins were stained positively in cytoplasms on immunoperoxidase staining. Moreover, it showed many mitoses and inva-sive growth toward the serous membrane, so it was finally diagnosed as malignant schwannoma of the duodenum. Schwannoma of the duodenum is very rare, and only 15 cases have been reported so far in Japan. The authors discussed the clinical characteristics of duodenal schwannoma based on the 16 cases, including our case and 15 documented cases.

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A 70-year-old man was followed up at our out-patient clinic after radiation therapy for his lung cancer. He complained of abdominal pain and nausea in Sept. 1987. Colonofiberscopic examination showed erosion surrounded by red halo from the descending colon to the rectum. Examination of feces aspirated on colonoscopy revealed Blastocystis hominis. Blastocystis hominis was classified as yeast genus before, but recently it has been reclassified as a protozoan parasite. Its pathogenicity to lower digestive tract may depend upon its number in fecal specimen. Metronidazole is most widely used for the treatment. This is a first case described about colonofiberscopic findings of the colitis due to Blastocystis hominis in Japan.

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There are only 79 case reports of angiodysplasia (arteriovenous malfomation, heman-gioma) of the colon in Japan.But this disease of the colon maybe recognized with increasing frequency as a cause of lower intestinal bleeding in the elderly, because of the pathogenesis. We experienced a case of a 60-year old woman with rheumatic heart valvular disease. She had recurrent episodes of gastrointestinal bleeding of l0-year duration and repeated conventional studies were normal and the bleeding origin was unexplained. In our hospital, angiography showed two vascular ectasias in the descending colon and colonoscopy showed two angiodysplasias in the same place of the colon, one was a small blue varix-like lesion, the other was a large teleangiectasia. The pathogenesis of angiodysplasia was thought to be associated with aging degenera-tive lesion. On the basis of these hypothesis, the vascular ectasia shoud be considered as the cause of gastrointestinal bleeding in an elderly person, if conventional studies fail to reveal any lesions.

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We report a case of Kaposi's sarcoma with colonic involvement. In July 1986, a 68-year-old man was admitted in the Department of Dermatology because of a 15-month history of progressive, painful and purple skin lesions affecting both feet and arms. Accosding to biopsies from his skin, the diagnosis of Kaposi's sarcora was comfirmed. His HTLVIII antigen was serologically negative. After the chemotherapy with Vinblantine and β-interferon for 10 months, he complained of abdominal discomfort and had hemoccult positive in the stool. Colonoscopic examination revealed numerous, reddish and sessile polypoid lesions in the left-sided colon, measuring 0.5 cm to 1.0 cm in diameter. Some polyps had central ulcerations. Barium enema examination also revealed some polypoid lesions at the same portion. Biopsy finding from colonic lesions showed the pathological pattern of Kaposi's sarcoma. Colonoscopic examination and biopsy study are very useful for making the diagnosis of the Kaposi's sarcoma patients with abdominal symptoms.

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This case report describes a 67-year-old man with a leiomyoma of the descending colon. The patient was admitted to hospital to receive a thorough physical checkup in January 1987. Barium enema examination then revealed a spherical polyp about 7mm in diameter in the descending colon. Colonoscopic examination in April 1988 showed a semi-pedunculated polyp covered with almost normal appearing colonic mucosa. At the same time, endoscopic snare polypectomy was performed. The resected tumor was 7×6×4mm in size and was histologically diagnosed as a submucosal leiomyoma. The leiomyoma is rare in colon and rectum as compared to other parts of the gastrointestinal tract. In Japan, about 150 cases of leiomyoma of the colon and rectum have been reported, and endoscopic polypectomy was performed only in the 18 cases, including the present case. The endoscopic polypectomy is thought to be useful for the therapy of small pedunculated or semi-pedunculated colorectal leiomyoma of intracolic type.

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Two cases of malignant villous tumor (carcinoma) were encountered among a total of 163 cases of colorectal cancer which underwent resection at our hospital in the past nine years. Case 1 was a case of villous cancer which developed in the transverse colon. Case 2 had three types of concurrently developed cancer consisting of cancer in a villous adenoma in the ascending colon, a localized Borrmann 2 type adenocarcinoma in the cecum and ha cancer in the sigma. It is widely known that a villous tumor prefers a site locating within 25cm from the anus and that it is rather rare to develop in the oral site of the colon. The histopathological pictures were demonstrably different between the two cases. Case 1 was a malignant villous tumor infiltrating into the tunica musclaris with a pronounced property of low grade malignancy with slow growth in the depth. However, case 2 featured a strong property characterized by cancerous transformation of a villous adenoma. Interesting finding of histopathological pictures as a class of villous tumor have prompted us to present the observations and certain comments from the literature. Furthermore, case 2, with concurrent multiple cancers including cancer in a villous adenoma, was thought to be a relative rarity in that only two cases had been reported in Japan.

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HDTV is new television system, that will replace NTSC television system. It is vertical resolution is 1125. The still pictures of rectal mucosa were able to take by HDTV camera (FOR. A HMC-1000). Rigid proctosigmoidoscopy (Olympus) was used and connected HDTV camera by C-mount adaptor (Olympus). (Figure 2) Charge coupled device (CCD) was used in HMC-1000 camera, HMC-1000 system was showed in Figure 1. Releasing time of the camera is 0.6 sec. The memory was needed 3 megabyte for one color still picture. Fine color still pictures of rectal mucosa had been taken. (Figure 5).

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Endoscopic hemostasis by pure ethanol injection has been shown to be an efficient hemostatic method and is widely used. In the present study, we evaluated the complications of pure ethanol injection method on 127 hemorrhagic gastric ulcer patients treated by the method. Results were as follows ; 1) Ulcers were enlarged following pure ethanol injection in eight cases. Of these, seven ulcers in the body were enlarged along the long axis of the stomach, oral or aborad direction originating from the primary ulcers. One ulcer at the angle was enlarged in the direction perpendicular to the long axis of the stomach. 2) In two patients, the extended area of gastric mucosa turned dark blue immediately after ethanol injection, supposed to be due to gastric mucosal ischemia. 3) In one patient with a prepyloric gastric ulcer, the ulcer was deepened following pure ethanol injection, and the endoscopic examination two months later disclosed the double pylorus. To prevent the complications of pure ethanol injection method, ethanol should not be injected too deeply, and the amount of ethanol injected should be limited as little as possible.

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