The patients underwent eradicative endoscopic ligation of untreated esophaeal varices employing 40 O-rings per case on the average. Eradicative endoscopic variceal ligation is the treatment of routine choice in our department as the alternative to sclerotherapy. The treatment-related change in hemodynamics in these patients was investigated by percutaneous transhepatic portgraphy (PTP). Pre-treatment PTP revealed images of the regions ranging from the left gastric vein (alone or together with the posterior gastric vein) hepatofugally via the cardiac venous plexus and Sudare like vein to the esophageal varices or paraesophageal vein. After the treatment, endoscopic findings in all cases turned to F₀, RC (-) and images of cardiac venous plexus decreased, and images of the Sudare like vein and the esophageal varices or paraesophageal vein were scarcely seen in PTP. Thus, the bloodstream from the portal vein not so much reached into the esophageal varices after the ligation, a hemodynamic change assuring the effectiveness of the treatment.

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In order to clarify the diagnostic limitation for the extent of cancer cell infiltration in depressed early gastric cancer, 21 cases of early depressed gastric cancer on lesser curvature of gastric body were studied using electronic endoscopy. The endoscopically suspicious gastric cancer area of each case was marked off from surrounded normal mucosa with metal clips to be compared with immediate pathological diagnosis in resected specimen. Then, the inconsistency between endoscopic and pathological diagnosis was evaluated. Endoscopic diagnosis of cancer area in 12 (57%) cases corresponded to those of pathological findings, but not in 9 (43%) cases. The predominant gross type in correctly diagnosed cases was IIc (75%), and in incorrectly diagnosed cases was IIb (56%). Endoscopic features, such as discoloration, abnormal pattern of gastric area, disappearance of vascular pattern and well-defined depressed margin from surrounded mucosa were seen in correctly diagnosed cases. These 4 endoscopic features were less seen in the incorrectly diagnosed cases. Pathologically all layer mucosal infiltration with undifferentiated adenocarcinoma was observed in 7 of 12 correctly diagnosed cases (58%) and 4 of 9 incorrectly diagnosed cases (44%). Middle mucosal layer infiltration was noticed in 3 of 12 correct cases (25%) and 4 of 9 incorrect cases (44%). These results suggested that there was the limitation of present electronic endoscopic diagnosis for the extent of infiltration in depressed early gastric cancer, even if we made a careful examination with 4 diagnostic features mentioned everywhere. However, if discoloration and disappearance of vascular pattern could be seen in the IIb cases with middle layer infiltration of undifferentiated adenocarcinoma by image processing, accuracy of diagnosis might be improved. Therefore, the further development of new image processing electronic endoscopy is required in the future.

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A 38-year-old female was admitted for the further evaluation of elevated lesions of the stomach. Gastroscopy revealed multiple small elevated lesions of the gastric body, which were diagnosed as carcinoid tumors on histologic examination of biopsy specimens. Hypergastremia (1048 pg/dl), iron deficiency anemia and positive parietal cell antibody were identified, whereas urine 5-HIAA, serum serotonin and histamine levels were within normal limits. Total gastrectomy was performed. Histological examination disclosed multiple endocrine cell micronests and approximately 90 carcinoid tumors up to 0.5 cm in diameter in atrophic fundic gland mucosa.

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Calcified gastric cancer detected by X ray examination is rare. We report a case of calcified gastric cancer on the plain abdominal X ray and CT. The patient was a 88-year-old man with diabetes mellitus. Upper gastrointestinal series in a check up revealed an elevated lesion of the stomach for which he was hospitalized. Endoscopic examination showed a hemispherical elevated lesion with thick white coats and marginal depression on the lesser curvature of the gastric body and histological study of biopsy specimens disclosed signet ring cell carcinoma. Calcification was not visible on admission but appeared in the thickened wall of the stomach on CT 12 months later. In spite of chemotherapy increase of calciffication in the gastric wall during cancer growth was observed on CT, plain X ray also showed small stippled calcification on the 26th months after admission. He died of carcinomatous peritonitis 28 months after admission. At autopsy longitudinal cross section of the stomach showed whitish calcification in the tumor. Histological study disclosed mucinous adenocarcinoma with calcified deposits.

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A 49-Year-old male admitted to our Hospital on March 13, 1995 with a complaint of hematoemesis. Endoscopic examination revealed four gastric ulcers and one of them had a naked vessel observed in the center of an ulcer, so that hypertonic epinephrine-saline injection was performed. Projecting bleeding occurred during the endoscopic hemostatic treatment. Transcatheter arterial embolization was immediately performed and hemostatis was once controlled. But bleeding recurred and then transcatheter arterial embolization was repeated. But bleeding was occurred again and, therefore, we did an emergenct operation. The resected specimen showed edematous mucosa and ulcers. Histopathological examination of the resected specimen revealed dilated and tortuous arteries and veins in the gastric mucosa. Endoscopic hemostatic treatment might not be enough for some cases of the gastric arteriovenous malformation.

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Three cases of duodenal gangliocytic paraganglioma experienced during last 10 years at our hospital were evaluated from the clinical aspect with addtional review of the literature. This neurogenic tumor is extremely rare. However, it arises from the second portin of the duodenum, especially in the vicinity of the papilla of Vater in the majority of cases. A peticular shape consisted of uneven and nodular submucosal tumor with erosion and ulcer on the surface make the diagnosis of this tumor easy. This tumor should be surgically operated in the earlier stage from the viewpoints of accompanying bleeding from the tumor, pancreatitis, obstructive jaundice and regional lymph nodes metastasis in some cases.

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Sixty-two-year-old asymptomatic male was pointed out positive stool occult blood at medical screening test and admitted to our hospital for further evaluation of the colon. On endoscopic examination, IIa+IIc like lesion, 2.0X2.0 cm in diameter was demonstrated at the transverse colon and histology of biopsy spesimens taken from the lesion revealed well differented adenocarcinoma. Partial resection of the transeverse colon was performed on surgery. Components of adenoma, adenocarcinoma in adenoma and carcinoid were histologically shown in the IIa+IIc like lesion. Coexistence of adenoma, adenocarcinoma and carcinoid in a same lesion of the transverse colon is extremely rare on the literature.

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A 63-year-old woman took further examination because of constipation in our hospital. Brium-enema and colonoscopy revealed a semipedunculated polyp with whitish color and smooth surface in the rectum. A polyp was resected by endoscopic polypectomy and diagnosed as angiomyolipoma histologically, which was consisted of three different components in the submucosa : blood vessels, smooth muscle bundles and adipose tissue. Angiomyolipoma is a benign hamartoma which usually occurs in the kidney with tuberous sclerosis. To our knowledge, this is only the fifth colonic angiomyolipoma without tuberous sclerosis reported in the international literature.

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The patient is a 60-year-old woman. She originally had a tendency toward constipation. She was admitted to our hospital because of abdominal pain and diarrhea, and diagnosed with transient ischemic colitis in the descending colon. Eight months later, she had similar symptoms, and was hospitalized at another institution, and the same diagnosis as shown above was made. One month after that, the same symptoms occurred, and the endoscopy at our hospital resulted in the same diagnosis. Thereafter, the patient's bowel movement was managed with administration of a laxative, and no relapse was observed during the past two years. As regards ischemic colitis with two episodes of relapse, there have been reported only five cases including the above case. Thus, our above case is considered to be a valuable one. Therefore, a report is made on it.

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A 51-years-old woman was admitted to our hospital with complaints of dyspnea, diarrhea and abdominal fullness. In spite of the administration of several kinds of antibiotics, such as imipenem/cilastatin and ceftazidime, diarrhea and pyrexia continued. Small amount of ascites as well as massive right pleural effusion were observed in chest X-p and abdominal CT. Sigmoidoscopic examination revealed multiple yellow-white, hemispherically protuberated pseudomembranes in the mucosa of rectum, and the culture of stool showed positive for Clostridium difficile toxin. The diagnosis of pseudomem-branous colitis was made on the basis of these findings. Administration of vancomycin led to the immediate improvement of all symptoms, including pleural effusion and ascites. This is a very rare case of pseudomembranous colitis associated with ascites and massive pleural effusion.

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After endoscopic ligation to stop bleeding from esophageal varices, new hemorrhage from ulcers at the site of ligation reccurred in 2 cases. Octreotide-somatostatin analogue, diminished bleeding effectively. There was no adverse effect of infusing octreotide. Octreotide may have some benefits in achieving the control of variceal bleeding.

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