We studied on the criteria for the judgement on whether gastric carcinoma is positive or not at the margin of the endoscopically resected specimen. Fifty five surgically resected gastric mucosal carcinomas which are histlogically differentiated do not have an ulcer in the lesion, and the maximam diameter is less than 2cm, are investigated. By tracing the contour of them, "Protrudent width" defined by us was measured. In the case that the resected specimen is investigated by dividing into stepwise sections of 2mm in width, the criteria for carcinoma being negative at the margin are as follows: 1) sections at both edges do not contain carcinoma, 2) the length of a section needs more than the width of carcinoma in the next section when the width of carcinoma in the next section is larger than that in a given section, and 3) all sections need to have non-cancerous mucosa at the both edges that the length is defined as "Protrudent width". "Protrudent width" is 1.4 mm in cases of well differentiated tubular adenocarcinama, and 2mm in cases of moderately differentiated tubular adenocarcinoma.

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The usefulness of a new system of endoscopic ultrasonography, Fujinon Sonoprobe System SP101 with a miniature probe scanner of 20MHz, was investigated in diagnosing gastric cancer invasion. The system is used in conjunction with the forceps channel valve of most video endoscopes. On 38 cases with gastric cancer examined, image of lamina muscularis mucosae (mm) was obtained in only 4 cases (19%) as a clear layer structure in early gastric cancer. Diagnosis of depth invasion was difficult in 8 cases (21%). Half of the lesions located at the lesser carvature near the angulus of the stomach. In the meantime, a precise diagnosis of depth invasion was possible in 76% of early gastric cancer, except for 8 cases cited above. The detailed interpretation, on the other hand, was difficult in advanced cancer because of extensive attenuation. To cover the lesser penetra-tion and limited size of imaging field, the combined use of lower frequency mechanical radial scanner will be effective.

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We investigated the respiratory function of mitochondria isolated from gastric fundic mucosa of rabbit under irradiation of low intensity 514.5 nm light. Visible argon laser with the power of 200 mW was irradiated to the mitochondrial susupension of 2ml in volume. Restipatory function was measured by Clark-type electrode and temperature was also measured. We found that the mitochondrial respiratory function was enhanced by argon laser irradiation even taking account of its temperature elevation effect. Mitochondoria contains a lot of chromophore, such as cytochorom C which is sensitive for green light. Therefore, it is thought that green light irradiation affects certain enzyme of mitochondria. Our results may suggest the possible kintics for cell-photo-stimulation by low-intensity light irradiation.

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Carcinoma of the gall bladder are divided into 4 types based on the ERCP findings of 86 cases. The relationship between each types and diagnostic evaluation, survival rate and histology are investigated in this paper. Accurate diagnosis before operation is 40.7% in total and 88% in type 2 (non-visualization of the gall bladder with oval compression of the liver hilus), 72.2% in type 4 (filling defects in the gall bladder), respectively. Originated cancer is not diagnostic in type 1 (cancer invaded into the common bile duct). Differenciation between benign disease is also impossible in type 3 on ERCP. Cases of type 3 and type 4 shows longer survival rate than those of type 1 and type 2. Resectability was the highest in type 3 and the lowest in type 2. According to the agreement of Japanese Society of Biliary Surgery, 25 cases (100%) of type 1 and 7 cases (87.5%) of type 2 showed stage IV. On the other hand, 8 cases (66.7%) of type 3 and 8 cases (66.7%) of type 4 showed stage I or II. Four cases of early stage cancer of the gall bladder are found in type 3 and type 4 cases. Histologically, tubular adenocarcinoma is frequently observed, especially in type 3 and type 4 cases. Papillary adenocarcinoma is found only in type 3 and type 4 cases. In conclusion, classification of carcinoma of the gall bladder on ERCP would be usefull for suggesting survival, resectability and histology.

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The aim of this study was to elucidate the characteristics of liver surface in patients with C type acute hepatitis resulting in chronicity. Laparoscopic features of the liver surface in 14 patients with C type was retrospectively studied and compared with those in 23 patients with B type trasient acute hepatitis. In addition, the relationship between endoscopic findings and microscopic findings were also investigated. In the C type patients, vascular proliferation, periportal reddish marking and many small depressions were significantly dominant compared with the B type patients. Regarding the correlation between laparoscopic and histologic findings, periportal reddish marking was well corre-sponding to piecemeal necrosis, while relation between many small depressions and focal necrosis was not so significant. Furtheremore, similar comparison of the above-mentioned features needs to be studied between the patients with C type acute hepatitis resulting in chronicity and patients with C type transient acute hepatitis.

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A 53-year-old man was visited to our hospital complaining of hematemesis. A semipedunculated polyp was found in the lower esophagus by endoscopic examination. The surface of the polyp was smooth and partly erosive. The polyp was resected by endoscopic polypectomy, which measured 9×9×6mm in size. The histological examination showed that the tumor originated from muscularis mucosae and infiltrated to the submucosa. The tumor cells consisted of an admixture of epithelioid-like cells and spindle shaped cells. The tumor cells were positive for actin immunostaining. Based on these histological findings, this tumor diagnosed as leiomyoblastoma. As for the leiomyoblastoma of the esophagus, only 9 cases have been reported in the literature.

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A 75-year-old man was admitted to Fujieda-city Shida General Hospital for a thorough examination of the esophagus. Double contrast radiography showed an elevated lesion with a niche in the middle esophagus. The endoscopic examination also revealed an elevated lesion with a central depression and white coats. Histological examination of biopsied specimen revealed epithelioid cell granulomas and leukocyte infiltration, but no findings of malignancy. The culture of samples obtained by brushing and gastric juice for Mycobacterium tuberculosis was positive. The esophageal lesion almost disappeared after 3 months of anti-tuberculosis medication. Esophageal tuberculosis is a rare disease, and only 32 patients including the present case have been reported in Japan. Although the diagnosis of the disorder is generally difficult, a culture of the esophageal tissue by brushing is useful for detecting Mycobacterium tuberculosis, and ultrasonography also helps its diagnosis.

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A 67-year-old man was admitted to our hospital for further examination of gastric mass lesion detected at another hospital. Gastric fluoroscopy and gastric endoscopy showed a large elevated lesion on the greater curvature of the upper body of the stomach. Endoscopic ultrasonography (EUS) revealed a sharply bordered hypoechoic tumor measuring 28×14mm in diameter with a heterogenous internal structure, extending mainly within the 3rd layer of the gastric wall. Proximal gastrectomy was performed. Histology confirmed that the tumor consisted of carcinoid tissue extending mainly within the submucosal layer. EUS was a useful method to evaluate location and extension of the tumor in the gastric wall. We have also made a short review of the literature concerning gastric carcinoid of the elevated type.

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A 48-year-old male complaining of chest pain was hospitalized without abnormalities of the circulation and respiratory systems. Upper gastrointestinal series and upper GI endoscopy revealed a shallow ulcer in the anterior wall of the angulus and irregular and nodular mucosa in the greater curvature of the antrum. It was diagnosed as plasmacytoma of the stomach by biopsy. Peripheral blood count and bone marrow findings were normal. Subtotal gastrectomy was performed. Histopathological findings of the resected stomach demonstrated that tumor invaded to the submucosal layer and showed IgG k type by immuno staining.

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We report two cases of adult T cell leukemia (ATL) invading the stomach wall. Case 1: A 52-year-old man born in Okayama prefecture was hospitalized because of epigastralgia. Endoscopic examination revealed erosions with erythema on the anterior wall of the fornix. The biopsy specimen showed diffuse infiltration of the abnormal lymphocytes with convoluted or lobulated nuclei to the mucosa. Immunohistochemical studies showed that they had T cell surface markers. HTLV-1 antibody titer was elevated to 1: 4, 096 and he was diagnosed as having ATL. Fifteen days later, a second endoscopic examination was performed. It revealed new fine granular lesions on the greater curvature of the stomach. Histological examination of the biopsy specimen of these lesions showed the same cellular infiltration. The erosions on the anterior wall got worse with marked erythema and petechiae. He was treated by VEPA chemotherapy, and improvement of the gastric lesions with ATL cells infiltration was observed on the subsequent endoscopic examinations. Case 2 : A 44-year-old man born Kagoshima prefecture attended our hospital because of generalized skin eruptions wihout itching. A hemogram showed that the white blood cell count was 5, 700/mm3 with 10% abnormal lymphocytes. He was admitted and diagnosed as having ATL because HTLV-1 proviral DNA was detected from biopsy specimens of the skin eruptions by Southern blot analysis. Endoscopic examination was performed to investigate dysphagia. It revealed verrucous lesions in the antrum, a huge mass with a giant ulcer in the lower body, and giant folds with erosions in the upper body of the stomach. Histologically, infiltration of ATL cells was found in all of these lesions. This is a rare case where a variety of forms of infiltration of ATL cells were observed at the same time.

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A 68-year-old female farmer was admitted to our hospital because of severe right lower abdominal pain with vomiting. Physical examination disclosed that moderate tenderness was elicited in the right lower abdomen. The white blood cell count was 8, 300 without eosinophilia. Stool specimen gave a negative test for occult blood nor parasite eggs. Colonoscopy showed several whipworms in the ascending colon ; all of them were endoscopically removed. Her clinical symptom was ameliorated on the next day. The patient was given mebendazole 100mg twice daily for 3 days. One month after completion of therapy, the feces were repeatedly examined for ova by MGL method, but no eggs were detectable.

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A 70-year-old man was referred to our hospital because of epigastralgia. The endoscopic study and the x-ray examination with contrast medium of upper gastrointesti-nal tract showed an active ulcer on the posteroinferior wall of the duodenal bulb. Tow weeks later, a thin hairy fissure arose from the bottom of the bulbar ulcer toward the antrum was found at the second x-ray examination. Two more weeks later, the fissure extended toward the antrum at the third x-ray examination, but the endoscopy did not show the fistula in the peripyloric region. Four months later from the initial examination, it was observed by x-ray examination that duodeno-gastric fistula was completed. The endoscopic study also found an pseudopyloric canal on the greater curvature of the of antrum. Therefore, it was clear that the double pylorus was appeared secondary to the duodenal bulbar ulcer in the case. It has remained in the same condition for more than 3 years. We reported a case especially of penetrating process in detail observed by endos-copy and roentogenography and studied the clinical course of acquired double pylorus of previously reported cases in Japan.

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A 84-year-old female (A) and 61-year-old male (B) with no abdominal symptoms were admitted to our hospital suffering from pneumonia and diabetes mellitus, respectively. In the ileocecal region of each patient a painless large egg-sized tumor was palpable. Colonoscopy, ultrasonography and computed tomography suggested the tumors to be appendiceal mucoceles. A fistula was made endoscopically between the cecal wall and the tumor capsule in both cases by cauterizing with microwave. In the case A, a colonoscope was inserted through the fistula and biopsies were obtained from the inner wall of the tumor capsule. In the case B, tissue specimens were also obtained successfully from the mucocele wall by blind endoscopic biopsy because the caliber of the fistula was not so large enough as to insert the colonoscope into the tumor lumen. On the biopsy specimens both lesions were revealed histologically to be appendiceal mucinous cystadenoma. Both patients had a good clinical course without any complications such as perforation or bleeding at the sites of fistulation and biopsy. It is occasionally difficult to differentiate mucinous cystadenoma from mucinous cystadenocarcinoma by imaging examination. The biopsy technique tried on our cases may, therefore, be appreciated as an usefull tool for correct diagnosis of appendiceal mucocele and for deciding the way of surgery.

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A 68-year-old male was ref f erect to our hospital in July 1991 because of diarrhea. Barium enema study and colonoscopic examination revealed multiple polypoid lesions in the entire colon. Upper G-I series and endoscopic examinations revealed multiple polypoid lesions extending from stomach to ileum. On admission peripheral lymph nodes were palpable in neck, axilla and inguinal region. Histological study of biopsy specimens taken from the cervical lymph node and the gastrointestinal lesions demonstrated B-cell type malignant lymphoma with deffuse medium sized cells. A diagnosis of multiple lymphomatous polyposis was made from these findings. A chemotherapy of ABEP was started since 4 courses of CHOP treatment were not effective. We also reviewed, 29 cases of multiple lymphomatous polyposis reported in Japan.

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Two cases of colorectal cancer and dysplasia associated with ulcerative colitis preoperatively diagnosed by endoscopy were reported. Case 1 A 23-year-old female who had been suffering from ulcerative colitis for 9 years visited our hospital with abdominal pain and vomiting. Endoscopy disclosed a protruding lesion in the descending colon and many granular lesions from the sigmoid colon to the descending colon. Histologically, the protruding lesion measuring 28 mm in size was adenocarcinoma located within propria muscle and the granular lesions were compatible with high-grade dysplasia. Another advanced cancer with invasion to serosa was found in the cecum. Seven months before surgery, the lesion in the descending colon was only about 15 mm in diameter when she was seen at another hospital. It is suggested that cancer growth in this condition is relatively fast. Case 2 A 52-year-old male, whose onset of ulcerative colitis was uncertain, came to the hospital with hematochezia and abdominal pain. Endoscopy showed stricture in the rectum and an irregular elevated lesion only recognized with dye endoscopy using indigocarmine. Histological examination of the resected specimen revealed advanced cancer located in the stricture with dysplasia surrounding the lesion. It is considered that dye endoscopy is particularly useful for detection of dysplasia.

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A 24-year-old male was admitted to our hospital with massive lower gastrointestinal (GI) hemorrhage. Urgent colonoscopic examination showed marked varices extended from the upper rectum to the terminal ileum except the mid-transverse colon.In the ascending colon, blood was oozing from the mucosa. Endoscopic and double contrast X-ray examinations of the upper and lower GI tracts revealed no other potential sources for blood loss. Selective mesenteric arteriography and portography via superior mesenteric artery demonstrated absence of abnormal arterio-venous communication and portal occulusion. Abdominal computed tomography scan and ultrasonography obtained no findings suggestive of portal hypertension. In addition to the above findings, (associated) other no diseases led us to a diagnosis of lower GI varices, originating probably from vascular abnormality.

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A 63-year-old woman visited to hospital complaining of discomfort of the right upper abdomen. Both ultrasonography and CT scanning showed gall stones and dilated common bile duct. ERCP revealed multiple small filling defects in the lower part of the common bile duct and endoscopic ultrasonography detected a protruding tumor in the common bile duct just above the papilla of Vater. Intraoperative cholaongioscopy revealed multiple choles-terosis of the common bile duct. Cholesterosis should be also taken into account when small mass lesions exist in the lower segment of the common bile duct.

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Percutaneous ethanol injection under laparoscopy was conducted for 5 patients with hepatocellular carcinoma and 1 patient with suspicious lesion, and concomitantly laparoscopic magnification was used to observe in detail the morphological changes of the tumor, 99.5% ethanol was injected at a dose of 2.5 cc to 25cc for 3 patients with hepatocellular carcinoma, the laparoscopy was performed before and after the ethanol injection. Follow-ing the injection, tumor were markedly changed to the flat figure form and yellowish-white color from white. Tumor vascularization decreased disappeared. Thus, percutanous ethanol injection under laparoscopy could be safe and effective on the basis of gross observation, and it was considered to be useful for treatment of hepatocellular carcinoma on the liver surface.

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A 69-year-old male was admitted to our hospital complaining of jaundice. CT and US didn't demonstrate an evident mass in the pancreatic head, but PTC showed complete obstruction of the lower part of the common bile duct. ERP demonstrated the different calibers of the main pancreatic duct, 2 cm in length from the major papilla and there were no lateral side branches along the dilated distal duct in the range of 4.5 cm from the stricture. A tumor found in the dorsal portion of the resected pancreatic head was 2.5 cm in size. Histological examination revealed tubular adenocarcinoma extended continuously in the distal pancreatic duct in the range of 4.5 cm from the tumor.

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