Numerical aberrations of chromosomes # 11 and #17 were evaluated in 22 colorectal carcinomas using endoscopic biopsy specimens by fluorescence in situ hybridization (FISH) with repetitive satellite DNA probes. The patients who were admitted to our hospital for. surgical treatment included 7 women and 15 men. The mean age of onset was 67.6 years old (range, 33 to 83) . FISH revealed numerical aberrations in 10 out of 20 (50%) on chromosome 11, and 15 out of 22 (68%) on chromosome 17. There were monosomy 11 in 3, trisomy 11 in 7, monosomy17in 1, trisomy 17 in 10, and tetrasomy 17 in 4. Although there. was no particular relationship between the numerical chromosome instability of #11 and clinicopathologic parameters of colorectal carcinomas, that of #17 was significantly higher in patients with lymph node metastasis (34.0±8.2%VS42.0±10.3%, p<0.05) .These results suggested that numerical chromosome instability of #17 may be a marker of lymph node metastasis of colorectal carcinomas, and FISH using endoscopic biopsy specimens was a useful technique for preoperative detection of numerical chromosome aberrations.

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The aikm of this study was to analyze the Helicobacter pylori(Hp)infection in the cardia. According to our protocol, four biopsy specimens were obtained from the antrum, the lower body, the upper body, and the cardia on the greater curvature using different forceps. Each specimens were streak on the selective medium. Age distribution of Hp positive patients in all 4 biopsy sites had a peak in forties, and uneven Hp distribution on gastric mucosa increased with age. Negative rates of each biopsy site in Hp positive patients were 28% in th eantrum and the cardia, and 11% in the lower and upper body. There were 15 Hp positive patients sequentially positive from the antrum to the oral side, 13 patients from the cardia to the anal side. There were 21 patients of Hp intermittently positive among 4 biopsy sites. In five of them Hp was positive in the cardia and the antrum, in 16 of them in the lower and upper body. It was considered that the first Hp infection of the stomach should occur not only in the antrum but also in the cardia. Most of patients with duodenal ulcer were Hp positive in all 4 biopsy sites, and a lot of parients with gastric ulcer were Hp positive in the fundic gland area of the stomach. There was no correlation between Hp distribution on gastric mucosa and the positive rate and the level of HplgG antibody.

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We succeeded in inserting a microscanner into the gallbladder during transpapillarybilliary sonography (TPBS) in four cases. The wall of the gallbladder was shown mainlyas two layers, i. e., an inner hypoechoic layer and an outer hyperechoic layer, and focallyas three layers, i. e., hyper-, hypo-and hyperechoic layers.To clarify the appropriate distance and angle between the microscanner and themucosa of the gallbladder in transpapillary cholecysto-sonography (TPCCS), we scanned12fresh surgical materials with a microscanner in a physiological saline bath. The bestimage was obtained at a distance of 2.5-5.0mm and an angle of 0-20 degrees. Structural analysis was mostly possible if the distance and angle were less than 10 mrnand 40 degrees, respectively.

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Biliary metallic stems are thought to offer improved long-term palliation of malignantbiliary strictures. We experienced 32 patients with unresectable malignant biliary stricturetreated with a metallic stmt. Seventeen Strecker stentsTM, 14 WallstentsTM and one ZstentTM were applied, and were implanted via an endoscopic route in 22 patients andtranshepatic route in 10 patients. Their long-term results were evaluated in comparisonwith those of cases of ERBD (105 patients)and cases of surgical operation (23 patients withadvanced pancreatic cancer). The scents were successfully implanted in all patientswithout any complications. Stent clogging occurred in g of 32(28%)patients. One patientdied of massive bleeding due to cholangio-duodenal fistula formation about 3 months afterplacement of a metallic stent. Eighteen patients(56%)died within a mean of 162 days and4(16%)are still alive for a mean of 168 days without stent clogging. The stent patency ofrnetallic stent, a mean of 157 days in 21 patients, was significantly longer than that ofplastic stent, a mean of 68 days in 23 patients. There was no significant difference insurvival rates arnong two surgical procedures(pancreato-duodenectomy:n=12, bypassoperation:n=11)and metallic stenting(n=11)in advanced pancreatic cancer.

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The purpose of this study are the evaluation of imaging ability of the main pancreaticduct, the lumens surrounding the pancreas, pancreatic cystic and solid lesions in t:heihtraductal ultrasound (IDUS) .
The subj ects were pancreatic diseases (2 cancer, 13 mucin-producing tumor (3 mainduct type and 10 branch type, 1islet cell tumor, 8chronic pancreatitis, 2focal pancreatitisand 2 pancreatolithiasis)practiced by IDUS at a frequency of 30 MHz (CVIS Inc.) and 20MHz (ALOKA Co. Ltd.) . IDUS was performed at one endoscopic examination in all cases, We examined the imaging limit of.the IDUS at a frequency of 30 MHz and 20 MHz aboutthe main pancreatic duct (MPD), intraductal tumor, pancreatic solid and cystic tumor, pancreatic parenchyma in the inflammatory diseases and the lumens (veins and th.e bileduct)surrounding the pancreas.
The MPD were imaged as three layers in 23 of 28 cases by IDUS at a frequency of 30MHz and one high layer in 15 of 28 cases at 20 MHz. In the rnain duct type mucirproducing tumor, the intraductal tumor could be imaged less than 10 rnm at a diarneter by the IDUS at 30 MHz and more than 10 mm at a diameter by the IDUS at 20 MHz in detail.The tumor size imaged by IDUS at 20 MHz was less than 30 rnm at a diameter in the cysticlesions and less than 20 mm at a diarneter in the solid lesions. The adequate frequency of IDUS was 20 MHz in the evaluation of the pancreatic parenchyma of chronic pancreatitisand pancreatolithiasis. In focal pancreatitis, the periductal fibrosis could not be imaged by IDUS at 20 MHz, but could be demonstrated by IDUS at 30 MHz in detail. IDUS at 20 MHO could image whole cross section of the splenic vein, the portal vein and supramesenteric vein in all cases. The adequate frequency was 20 MHO for the imaging oflesions in the head and uncinate process of the pancreas and in the body and tail of theDancreas with dilated mairl Dancreatic duct.
In conclusion, we provided a basic idea for interpreting IDUS images. The adequatefrequency should be selected for the proper diagnosis of pancreatic diseases in IDUS.

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A62-Year-old male who was followed at our hospital because of choledocholithiasisand diabetes mellitus. Endoscopic examination of the upper digestive tract showed sight redness in theesophagus in the lower chest. Lugol solution spraying revealed an unstained srea, and thelesion was diagnosed as 0-Ilb. In addition, a flat elevated lesion with small granules was also detected in stomach anddiagnosed as fla of stomach. The EEMR-tube method was performed far the esophageallesion and strip biopsy for the gastric lesion. The histological diagnosis of the esophageal lesion was esophageal cancer:depth, mm;ie(+);Iy0;v0;and margin(-). The gastric lesion was early gastric cancer:Ila type;tubl;depth, mm;Iy0;v0:andmargin(-). There are 13 reported cases of.synchronous esophagea1-gastric double mucosalcancer including ours(16 esophageal lesions and 21 gastric lesions), These cases werereviewed clinicopathologically.

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A67-year-old female was admitted to our hospital due to the multiple metastatic bonetumors. An endoscopic examination for the upper gastrointestinal tract revealed multipleulcerated submucosal tumors all aver the gastric body, especially at the greater curvatureaspect. These features were compatible with those of metastatic gastric tumors. It was not u.ntil the autopsy revealed 4 months later that the primary site was the softtissue in the left femur and pathological diagnosis was made as malignant fibrous histiocytoma (MFH) -storiforrn-pleomorphic type with the metastases to multiple organsincluding the stomach. While MFH is common among the soft tissue tumors in the middle aged patents, 1thas been rarely reported as either the primary or the metastatic site in the alimentary itract.

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We reported here the case of a 46-year old woman with mucosal prolapse syndrome (MPS). She was positive for fecal occult blood test on routine health care check. Radiological and endoscopic examination showed a solitary ulcer with a well-demarcate dedge in the rectum. Biopsy speciment of the ulcer showed fibromusculosis in the rectal mucosa. we observed a U1-II rectal ulcer with swelling of the third layer by endoscopic ultrasonography (EUS). Four months later, the ulcer changed to the scarring stage and a low echoic area in the third layer remained in the ultrasound image. EUS was useful in distinguishing a rectal ulcer from rectal tumor. The ultrasound image of MPS might reveal the useful information With regard to the mechanisms of MPS in the near future.

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The geographic yellowish spots are known to be characteristic colonoscopic findings of chronic schistosomiasis japonica, but have not been always clear. we experienced a chronic schistosomiasis japonica case showing a fine colonoscopic picture by the injection of methylene blue solution into the submucosal layer. A 68 year-old male admitted with complaint of discomfort of perianal region because geographic yellowish spots were observed on colonoscopic exarnination. Biopsy specimen from the yellowish spots showed ova of 5chistosomia japonicum and he was diagnosed as chronic schistosomiasis japonica. Furthermore, by the injection of methylene blue solution into the submucosal layer of the yellowish spots, the yellowish spots were found to be consisted of many, clear and yellowish granules and we could get a fine colonoscopic picture of chronic schistosomiasis japonica.

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Arare case of early ileal cancer discovered during colonoscopy is reported, In a 68-year-old man, irregular nodules through the ileocecal valve were detected during a colonoscopic examination that was performed to monitor recurrence of colonic intramucosalcancer treated by endoscopic mucosal resection. Because this tumor consisted of.irregularnodules with easy bleeding and-broad-based form, it appeared to be a submucosaLlyinvasive cancer. The endoscopic diagnosis was confirmed by histological examination ofbiopsy specimens, which showed a weld-differentiated adenocarcinoma. The tumor (size: 2.8 × 2.3 × 1.6cm), located in the ileum 2 cm proximal to the ileocecal valve, was surgicallyresected. Detailed histological examination of the resected tissue showed that the welldifferentiated adenocarcinoma was located mainly in the mucosal layer with the invasioninto suhmucosal layer at the top of the tumor. No invasion into veins or lymph vessels was observed.
Early ileal cancer has been rarely reported, with only 6 cases in the Japanese and English literatures until Sept, 1994. In the present case, the criteria of colonoscopic examination on an elevated type of early colorectal cancer were useful for evaluating theextent of invasion of the tumor. Since 29-40 % of ileal cancers develop in the ileum within 10cm from the ileocecal valve according to the Japanese literature, observation of theterminal iieum during colonoscopic examination is useful for detecting early ileal cancers.

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A29 year old man was admitted to the Niigata Cancer Center Hospital on March, 1991with complaint of tarry stool. Endoscopic examination revealed edematous enlarged major duodenal papilla withhemorrhage. Abdominal CT scanning and celiac angiography showed tumor at the head ofthe pancreas with multiple liver m6tastasis. Histological exarnination of the specimenstaken on laparotomy for by-pass operation revealed islet cell tumor. Atotal 29.0 grs of streptozocin (1.0grs/w) had been administered. After treatment of streptozocin, the size of parlcreatic turnor was reduced and metastatic liver tumors wereundetectable on CT scanning. Therefore, it is concluded that streptozocin should be triedfor the frantment of islet cell tumor.

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