One of severe side effects of nonsteroidal anti-inflammatory drugs (NSAIDs) is gastroduodenal mucosal damage. Cyclooxygenase is one of molecular targets of NSAIDs, and one of the isozymes, COX-2 is reported to be highly expressed in inflammatory tissues. As a candidate of the most safe and effective anti-inflammatory drug, COX-2 specific inhibitors have been developed. On the other hand, it is also reported that COX-2 is upregulated in cancer tissues and NSAIDs affects biology of many kinds of cancer. Therefore, to investigate possible indication of NSAIDs and COX-2 specific inhibitors in anti-cancer therapy, a lot of researches have been under way.

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The patient was a 61-year old man. He was admitted to our hospital due to two early carcinomas (0-IIc) of the esophagus. One located in the posterior wall, 33∼38cm distal to his incisor, and the other in the anterior wall, 33∼35cm distal. At first, we performed endoscopic mucosal resection (EMR) of posterior lesion, because we prevent esophageal stricture. Three months later, we performed EMR of another one. Thereafter he did not develop esophageal stricture. We performed EMR in two stages for double early carcinoma located in the same level of esophagus, without esophageal stricture.

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We reported a rare case of primary malignant lymphoma of the esophagus without extraesophageal involvement. A 69-year-old woman was admitted to our hospital because of dysphagia. An upper gastrointestinal series showed several longitudinal giant folds from the upper to the lower portion of the esophagus. Endoscopic view of the esophagus showed the giant mucosal folds with smooth mucosal surface. EUS showed a hypoechogenic thickening of the third layer along the whole length of the esophagus. The internal echo pattern is slightly irregular. Endoscopic mucosal resection (EMR) was performed. Biopsy specimen taken from the ulcer after EMR showed a diffuse medium-sized B-cell lymphoma. Chemotherapy was performed with modified CHOP (cyclophosphamide, vindesine, pirarubicin, prednisolone). A follow-up barium study and endoscopy showed regression of the esophageal mass after chemotherapy.

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50 year old man with abnormality in medical upper GI examination came to our hospital. 5 cm sized large tumor shaped like "kagamimoti" was found in the anterior wall of the stomach. The upper lesion of the tumor consisted of epitheliogenic mass rode on the lower lesion looked like submucosal tumor. Distal gastrectomy was performed. The tumor was mucinouscarcinoma which invaded to musclaris propria. Well differentiated adenocarcinoma was exposed in central portion of the tumor and massive mucine produced by carcinoma pushed up mucosa from submucosa in the periphery of the tumor.

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A 67-year-old female visited at our hospital with the chief complaints of dizziness and general malaise from three days before. She had never been noticed melena due to old fashioned lavatory at her house. On admission, laboratory tests showed 5.3g/dl of Hb and she fainted at a shock state after abdominal computed tomography. Digital examination of her rectum showed bloody stool. Therefore an emergent upper gastrointestinal endoscopy was done. Endoscopy revealed oozing bleeding from the small diverticulum in a large diverticulum in the third portion of the duodenum, and the hemorrhage was successfully treated with suture of the orfice of the small diverticulum by endoscopic clipping. Although hemorrhagic duodenal diverticulae are rare, their hemostasis were difficult and surgery should be often applied. Endoscopic clipping like as closing the orfice of the diverticulum must be an easy and effective procedure for hemorrhagic duodenal diverticulum.

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A 70-year-old woman who had been hospitalized repeatedly due to pneumonia caused by bronchiectasis for 26 years was admitted to our hospital in January 1997 because of diarrhea and legedema. Colonoscopy indicated redness and granular mucosa with a simple ulcer. Mucosal biopsies revealed diffuse deposition of amyloid in small blood vessels of the lamina propria mucosae. This amyloid protein was identified as AA amyloid, which was suggestive of reactive AA amyloidosis in association with bronchiectasis. Clinical improvement was remark-ably obtained after IVH and dimethyl sulfoxide (DMSO) administration.

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We present an unusual case of Richter's hernia of the small bowel through the port site following removal of drains after laparoscopic procedures. A 52-year-old woman who was found to have early cancer of the sigmoid colon, was admitted to our hospital. She underwent a laparoscopic-assisted anterior resection for early stage cancer. After the operation, her postoperative course was uneventful. However, after removing the drains, she started to complain of a symptom because of small bowel obstruction. Abdominal X-ray demonstrated dilated small bowel loops. Richter's hernia of the small bowel through the port site used as the insertion route for the drains was diagnosed by intestinal contrast study using long tube and computed tomography of the abdomen. Reoperation was performed. Her postreoperative course was uneventful. Computed tomography of the abdomen is useful for the diagnosis of this rare Richter's hernia after laparoscopic procedures. It's thought that it's necessary to consider some idea to prevent such incisional hernia. (i. e., Smaller trocar insertion site (<10mm) should be utilized as the insertion route for drains. To suture the fascia of trocar site completely, then the insertion route for drains should be separated from the insertion route for trocar as “Z” tract entrance).

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A 28-year-old woman was admitted to our hospital complained with abdominal fullness. She was also complicated with general fatigue and pedal edema. Her liver function test was abnormal and several imagings were performed. Hepatomegaly, esophageal varices, gatric varices and a small amount of ascites were detected. However, diagnosis was not confirmed. The peritoneoscopy showed a bluish-purple liver surface, whitish lymphatic cysts and collateral veins. Then, liver biopsy revealed congestive liver cirrhosis. Budd-Chiari syndrome (BCS) was strongly suspected. Hepatic venography and inferior versa cavography revealed stenosis and obstruction of the hepatic veins and the inferior vena cava. A diagnosis of BCS was confirmed. Percutaneous transluminal angioplasty (PTA) was performed as a treatment. After that, her liver function and general condition were improved. Esophageal varices and ascites had disappeared. Although the advanced fibrosis of the liver was present, portal hypertension seemed to be diminished.

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