In order to clarify the natural history of gastric carcinoma I made an analysis of prospec-tive or retrospective follow-up cases in 34 gastric carcinoma patients(early:11 cases, advanced:21 cases), including scirrhous carcinoma in 9 patients. In this paper the relation tocancer histology and growth pattern was mainly discussed and we came to the following conclusions:(1)11 of 14 cases with differentiated carcinoma(tubl, tub2)showed slow growing patterns and the period from early cancer to advanced cancer was 4 to 6 years(mean doubling time, DT:12.5 months). Nevertheless, three cases showing penetrating cancer tended to progress rapidly within a short period of one or two years. These cases are considered to be high for biological malignancies. (2) Regarding the natural history of 15 undifferentiated adenocarcinoma patients, we classified into three types;(1)slow growing carcinoma accoinpanied by malignant cycles in even advanced ulcerative cancer, (2) rapidly growing carcinoma with solid and medullary perrern(mean DT:3.7 months), very often leading to complications such as liver metastasis, and (3) scirrhous type carcinoma(diffusely penetrating car cinoma. (3) As for scirrhous carcinoma in our 9 cases we pointed out primary lesions in fundicgland area by endoscopical film review, and observation periods were 12-40 months(average 20 months). Taking this evidence into consideration, the focus should be directed to early diagnosis and the management for gastric carcinoma. As next approach of translational research we made multiparametric in situ mRNAhybridization(ISH)analysis for gastric biopsies to lymphatic invasion and vascular invasion inpatients with gastric carcinoma. We determined the level of metastasis-related genes that regulate different steps in the process of metastasis;EGFR, bFGF, VEGF, Type IV Collaginase(MMP-2)and E-cadherin. Our results showed that higher expression of type IV collaginase andreduced expression of E-cadherin significantly were correlated to lymphatic invasion, and higher expression of Type IV collaginase and VEGF were significantly correlated with vascular invasion. These data suggests that our ISH method for gastric biopsy specimens will be useful to predict metastatic potential and recurrence of gastric cancer. In conclusion we should perform a strategic research aiming the development of clinically truely effective molecular targeted drugs as well as molecular diagnosis of cancer.

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To determine whether postendoscopic acute gastric mucosal lesion (PE-AGML) caused by Helicobacter pylori (H. pylori), biopsy specimens taken from 12 patients with PE-AGML before onset and from 36 patients after onset of PE-AGML were examined histologically with HE staining, Giemsa staining and immunostaining. The detection rate of H. pylori showed significantly high in post-onset cases compared with pre-onset cases (69% vs 25%, p=0.018). The shorter interval between onset of symptoms and biopsy, the greater H. pylori density on biopsy specimens was shown (p<0.01). Neutrophil infiltration rate showed also high in post-onset cases compared with pre onset cases (92% vs 25%, p<0.0001). The shorter the interval between onset of symptoms and biopsy, the greater neutrophil activity on biopsy specimens was shown (p<0.01). Gastric mucosal atrophy was observed in 25% of the biopsy specimens taken from preonset patients and 6% of the post-onset and 10.3% of all specimens. And intestinal metaplasia was seen in 33% and 3% of these cases, respectively, and 10.4% of all specimens. These observations strongly suggested that most cases of PE-AGML were not infected with H. pylori before onset. From these results, author propose that most cases of PE-AGML is caused by acute infection with H. pylori.

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A 52-year-old man was admitted to our hospital in order to have endoscopic mucosal resection (EMR) for colorectal polyps. He underwent upper gastrointestinal endoscopy because of epigastric pain. Endoscopic picture showed a reddish depressed lesion, 10mm in size, in the distal esophagus adjacent to the esophagogastric junction (EGJ). This lesion was biopsied and pathologically diagnosed as adenocarcinona. EMR was performed for this lesion. Histological examination revealed moderately differentiated tubular adenocarcinoma, involving the lamina propria mucosae (m₃), lymphatic permeation (ly₁), and no venous permeation (v₀). As lymphatic permeation was detected, esophagectomy was performed. On histological examination of the surgically resected specimen, carcinoma cells were limited to the mucosal layer, however, there was no metastasis to the lymph nodes. Early mucosal adenocarcinoma in the distal esophagus adjacent to the EGJ is vary rare. It was presumed that adenocarcinoma developed from cardiac glands in the mucosa of EGJ zone.

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The patient, a 72-year-old woman, was pointed out elevated lesion with ulceration at the upper body of the stomach and admitted to our hospital. No malignancy was shown on the endoscopical biopsy. However, operation was performed because macroscopically, the lesion was not negrected malignancy. Histological study revealed granuration with hyperhyalinization and increase of the collagen fiber in the submucosal layer. The cause of the lesion is unknown, but was considered that it might have been related to a long-term taking of the histamin-2 blocker and anti-ulcer drugs.

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A 58-year-old man was referred to our hospital for deformity of gastric angle on upper gastrointestinal series. Endoscopic examination revealed ulcer scar at the gastric angulus and antral gastritis. Biopsy specimen from the antrum showed chronic active gastritis with moderate neutrophil infiltration. Helicobacter heilmannii were detected in the biopsied specimens by McMullen modified stain clearly. Follow-up endoscopic examination after eradication therapy, same as Helicobacter pylori eradication regimen, revealed improvement of the antral gastritis. Biopsy specimen from the antrum showed no active gastritis and no evidence of Helicobacter heilmannii. We report a rare case of Helicobacter heilmannii-associated antral gastritis.

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A 58-year-old Japanese man developed nausea and epigastralgia after a 20-day period following coronary artery bypass grafting (CABG) with the right gastroepiploic artery (RGEA) for triple vessel disease. An upper gastrointestinal endoscopic examination revealed a gastric ulcer coated with white necrotic tissue on the greater curvature of the lower body of the stomach, which was round-shaped, 1 cm in diameter, and also associated by conspicuous fold convergency. The ulcer was successfully treated with cimetidine and teprenon. Although the use of RGEA as a graft in CABG is recognized as a safe and useful treatment as well as the use of internal thoracic arteries, a careful observation should be required for gastrointestinal complication including the formation of gastric ulcer.

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A 69-year-old female suffering from epigastralgia and heart burn visited our hospital in December, 1997. Endoscopic features showed scattered hemorrhagic erosions in the edematous antrum, which were compatible with acute gastric mucosal lesion (AGML). Although the lesions were rapidly disappeared by continuous administration of roxatidine (150mg/day), chief complaints did not disappeared but were repeatedly worsened ; AGML recurred in October, 1996 and in March, 1998 in spite of long term H₂-blocker maintenance therapy. Rapid urease test, serum antibody and histologic examination for Helicobacter pylori (H. pylori) showed positive results. She underwent H. pylori eradication therapy for 3 times after March 1998, and urea breath test, culture and histology were negative for H. pylori until May 1999. AGML has never relapsed after the eradication therapy and repeated endoscopy showed only chronic gastritis with mild mucosal atrophy. Both epigastralgia and heart burn also disappeared. We reported a rare case of AGML with frequent recurrences under maintenance therapy of H₂-blocker, in which eradication therapy for H. pylori was effective.

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A 66-year old man who had bloody stools was referred to our hospital. Colonoscopy revealed a pedunculated polyp with a stalk in the sigmoid colon. The head of the polyp was 20mm in size, soft and looked like a shiitake (mushroom). As the stalk was 10mm thick and 15mm in length, polypectomy was performed. Histological examination of the resected specimen revealed well differentiated adenocarcinoma with slight invasion to the submucosal layer with lymphatic invasion. Therefore, partial sigmoidectomy was performed. Lymph node metastasis was negative and no residual cancer in the resected colon was detected.

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We report a rare case of the malignant lymphoma of terminal ileum found by the colonoscopic retorograde terminal ileography and the biopsy before the surgery. A 53-year-old man visited our hospital for ileocecal pain. Ultrasonographically, we found the tumor and the thickened wall of the terminal ileum. Colonoscopically, we also found the multiple protruded lesion with the focal ulceration on the terminal ileum. At the same time we tried the endoscopical retrograde terminal-ileography, and we found the similer lesions on the terminal ileum. Moreover, we found the other lesions on the oral side of the ileum. Histological findings of the biopsy specimens showed malignant lymphoma (diffuse medium sized cell type). After the Ileocecal resection, chemotheraphy was done. We suggest the importance of observation of terminal ileum and the device of examination following.

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A 51-year-old woman was admitted to the hospital complaining of right lower abdominal pain. Appendectomy was performed with a diagnosis of acute appendicitis. Histologically, well differentiated adenocarcinoma in the appendix was seen. The cancer was limited to the mucosa, but might have invaded the margin. Two months later, it was diagnosed remaining of adenocarcinoma of the vermiform appendix by colon fiberscopy. Ileocecal resection with regional lymph node dissection was performed. We must be careful in treating appendicitis. And we emphasize the importance of pathological examination after appendectomy.

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A 47-year-old woman presented with abdominal pain. Abdominal computed tomography and barium follow-through radiography showed segmental small bowel ischemia of the jejunum, and she was treated conservatively. Endoscopic retrograde cholangiography was perf omed, because her urine amylase, gamma-glutamyl transpeptidase, and alkaline phosphatase were elevated on admission. This examination revealed an intraluminal filling defect in the bile duct. Furthermore, a superior mesenteric arteriogram showed complete extrahepatic portal venous obstruction with collateral vessels near the porta hepatis. These examinations demonstrated portal vein thrombosis developed idiopathically, which led small bowel ischemia and collateral vessels associated with bile duct varices. Bile duct varices are common in patients with extrahepatic portal venous obstructions, whereas patients with no symptoms are recommended to be kept under obsevation, since spontaneous variceal hemorrhage or severe obstructive jaundice needing treatment are extremely rare.

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