To evaluate the detectability of a miniature endoscopic ultrasonic probe (mini-EUS probe) in diagnosis of the invasivity of the superficial esophageal cancer, the pre-operative ultrasound studies by the mini-EUS probe were compared with the histological studies on resected specimens in a series of fifteen cases of the O-IIc type superficial esophageal cancer. From the analysis of the results, the author proposed the new criteria of ultrasonographic diagnosis as follows: (1) Type T (-): Tumorous echo cannot be detected clearly by the mini-EUS probe when the esophageal mucosa is adequately streched by de-aerated water. This type is considered to be m1-m2 superficial cancer. (2) Type T (+): If the lesion is detected as an abnormal ultrasonogenic structure when the esophageal mucosa is adequately streched, the invasivity is considered to be deeper than m 3 superficial cancer. (3) Type T (+) P: If the lesion is detected as a protruded echogenic structure when the esophageal wall is contracted, it suggests that the depth of the invasion is m3-sm1 superficial cancer. (4) Type T (+) F: If the lesion is detected as a rigid flat structure in contracted esophagus, sm2-sm3 invasion is highly suspected. In order to evaluate the efficacy of new diagnostic criteria, the author examined another series including sixteen cases of O-IIc type superficial esophageal cancer by mini-EUS. Microscopic study proved that the accurate diagnostic ratio was 87.5% (14/16). It is concluded that this new diagnostic criteria by the mini-EUS is useful in diagnosis of invasivity of the O-IIc type superficial esophageal cancer.

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Using a high resolution annular array ultrasonic probe, we analyzed the coherence between the muscularis mucosa and a fine high echoic layer (2b layer) scanned near the base of the second hypoechoic layer. The object used in this analysis are 16 specimens of gastric cancer after formalin fixation. In 3 of the 16 specimens, the muscularis mucosa was found to consist of 2 layers, outer longitudinal and inner circular. In other three cases, loose connective tissues were found between the proper gastric gland and muscularis mucosa. The histological distance between the bottom line of the proper gastric gland and muscularis mucosa averaged 0.317±0.012 mm and the ultrasonic distance between 2b and third hyperechoic layers averaged 0.378±0.007 mm. Statistically there was no difference. The coefficient of the correlation is 0.703 ; thus the correlation is significant. The fine high echoic layer scanned near the base of the second hypoechoic layer is thought to be the boundary line echo between the proper gastric gland and tissue on the serosal side.

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A 31 year-old man was admitted to our hospital for severe abdominal pain. A chest X-ray film revealed free air shadows at the bilateral subphrenic spaces. He was diagnosed as having perf orative peritonitis. The symptoms were improved by conservative therapy. A month later, upper gastrointestinal endoscopy was revealed a gastric ulcer in the upper body of the stomach. Cancer cells were collected by biopsy. Operation was performed with the diagnosis of perforated gastric cancer. During operation, schirrhous carcinoma with penetration to the liver was seen in the body of the stomach. Total gastrectomy with pancreatosplenectomy and lateral segmentectomy of the liver was performed. Histologically, poorly differentiated adenocarcinoma was revealed invading the serosa. No lymph node involvement was noted. The patient received chemotherapy, but died 8 months after the operation.

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A 42 year-old male patient was admitted to our hospital because of the further examination for hypoproteinemia. Huge gastric folds were observed on radiological and endoscopic studies and protein loss from gastric mucosa was demonstrated by scintigram using ^99mTc-DTPA-HSA. Hence, he was diagnosed as Ménétrier's disease. Initially, colonization of Helicobacter pylori (Hp) was detected by cultures of his gastric mucosa. He was treated by a proton pump inhibitor (administered dosages of omeprazole were 40mg/day and 20mg/day for 2 weeks). The endoscopic findings and hypoproteinemia improved and f oveoler hyperplasia disappeared histologically without eradication of Hp, suggesting that eradication of Hp was not always needed on treatment of Ménétrier's disease.

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Cytomegalovirus enteritis in a healthy subject with no particular background was experienced. This case was a 35-year-old man. He consulted our clinic due to lower abdominal pain, watery diarrhea and bloody stools. By endoscopic exmination of the lower part of the digestive tract, red dish erosions were found in the ileal end. A biopsy specimen collected there showed intranuclear inclusion bodies and was stained positive with anticytomegalovirus antibody. Infection with cytomegalovirus (CMV) has been attracting attention as complication easily occurring during chemotherapy for malignant diseases, after organ transplantation, and the case of acquired immunodeficency syndrome (AIDS). Recently, however, the occurrence of this disease in healhy subjects has been reported. We report our experience of a case of CMV enteritis which was the 8th case in Japan since 1990. Our patient's course was uneventful with out treatment and he returned to his normal level of activity soon. But in other cases, prognoses were usually poor. CMV enteritis occurs in healthy subjects on occasion, the diagnosis may be delayed at the time of onset, and serious systemic CMV infection may occur in many cases. Therefore, this disease should be taken into account in diffrential diagnosis of enteritis with unknown cause.

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Thirty-seven year-old man with Behcet's disease was investigated by a colonoscopy due to the lower abdominal pain in May 1998. When the ascending colon was observed, he suddenly complained severe abdominal pain. At that time, reddish longitudinal discoloration of the colonic mucosa was found from the hepatic flexure to the mid-transverse colon. On the next day, the reddish mucosa changed to severe erosions and edematous area. Abdominal pain dissapeared in a few days. The colonoscopy done after 20 days showed linear ulcerations at the same sites of the colonic mucosa. This is a rare and interesting case with a ischemic colitis of which colonic mucosal morphological changes were se-quentially observed from its superearly stage.

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The patient was 25-year-old woman who had suffered from opened femoral supracon-dylar fracture and acute subdural hematoma due to her traffic injury. She had been confined in a bed-ridden condition. Suddenly, she had bloody stool without pain. Colonoscopy revealed acute hemorrhagic rectal ulcer (AHRU) with the irregular, geographical and approximately half circumferential features in the lower rectum on the dentate line. It was considered that one of the causes of AHRU was the reduction of rectal mucosal blood flow due to the long bed-ridden condition. Changing the position in bed was effective on treatment and we could not recognize her bloody stool any more.

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A 56-year-old man was referred to colonoscopy because of lower abdominal pain. The magnifying colonoscopic examination revealed a type 0'-IIc+Is rectal tumor, 11.8×8.2×3.4 mm in size, showing IIIs pit with amorphism at the depressed (IIc) area and IV pit without amorphism at the protruded (Is) area. Endoscopic mucosal resection was performed, and histological examination revealed well differentiated adenocarcinoma (high and low grade) with minimal submucosal invasion at the IIc area, and tubular adenoma at the Is area. Immunohistochemical study showed that diffuse to focally aggregated staining for p53 at the IIc area and few positive cells at the Is area. Ki-67 positive cells were distributed throughout the whole part of the tubules of adenomatous part (Is) and high grade carcinoma (IIc), but they were confined to the only mucosal upper part at low grade carcinoma (IIc). No K-ras colon 12 mutation was detected within both areas by PCR-RFLP method. The histogenesis and morphogenesis of this tumor were discussed.

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A 24-year-old female, who had been followed up due to liver cirrhosis and atypical hepatocellular carcinoma at a hospital, was admitted to our hospital, complaining of hepatosplenomegaly and right upper abdominal pain. Ultrasonography, CT and MRI images revealed multiple SOLs without enhancement throughout both lobes of the liver, but deffinite diagnosis could not be done. With laparoscopic examination, these tumors were yellow-white and firm to hard. The main tumors of 3 to 4 cm in diameter were located along the anterior surface of the liver. Fine vessels were developping around the main tumor. The histological findings taken from the tumor disclosed spindle-shaped tumor cells scattering in f ibromyxoid stroma. These tumor cells were invading into hepatic sinusoids and showed positive staining for factor VIII-related antigen immunohistochemically, suggesting that this case is compatible with epithelioid hemangioendothelioma (EHE) of the liver. She underwent systemic IL-2 administration but it was not effective on the tumor. Although she is alive ten years later from diagnosis, tumors are expanding throughout the liver, presenting diffuse type of EHE.

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A 77-year-old woman was admitted with a complaint of hematemesis. Endoscopic findings of the stomach showed a submucosal tumor-like lesion with blood coagula on the greater curvature of the antrum. Heater probe coagulation resulted in hematostasis, and ERCP revealed the obstruction of the cystic duct, but the gallbladder could not be visualized. The orifice of the fistula was found endoscopically on the 19th day after the hemostatic procedure. We suspected a cholecysto-gastric fistula by endoscopic fistulography. Histological studies of the biopsy specimen obtained from the fistula revealed adenocarcinoma. A surgical operation showed a carcinoma of the gallbladder with cholecysto-gastric fistula. There are 40 cases of cholecysto-gastric fistula in the Japanese literature. This case is the first to caused by carcinoma of the gallbladder.

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Now, the incidence of colon polyps or colon cancer in our country are increasing because of changing our dietary habit into European and American styles. We often found a lot of polyps with general use of immunochemical fecal occult blood test. Now, we can not perform multiple polypectomies with one observation. We have to take out the endoscopy for collection of the resected lesion. We have to insert the endoscope for consecutive polypectomies. We thought of a method which perform polypectomies of the plural lesions and collect the material in one observation. Then, we catched the resected lesions with a clip tied with thimn thread, we examined polypectomies. We could immediately examine next polypectomies without retrieving resected materials. We could retrieve all the lesions with plural lines at the same time when we took out the endoscopy. We think that we may shorten the time of examination and patient's pain by our method.

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