Xanthoma is a skin disease related to hyperlipemia in most cases. In recent years, however, xanthoma came to be found in the gastric mucosa owing to the advancement of endoscopy. Xanthoma in the gastric mucosa is a greyish yellow, single or multiple, isolated small tumor with the shape of round, oval or irregular and the size of millet to red bean. Xanthoma was noted in 114 cases (0.39 percent) out of 2920 cases in wich picture was taken with a gastrocamera in a period of eight years from January, 1959 to January, 1966. Study was carried out on these subjects. The age ranged from 19 to 89 years and the ratio of the male to the female was 3 :2. The patients over 40 years held 84. l percent. Thus it was more frequently encountered in the aged patients. The number of xanthomas found by means of the gastrocamera in 114 cases was 162, 1. 4 per case. In the excised stomach light yellow xanthomas with a smooth or rough surface, from 1mm to 6mm in diameter were noted. The number of xanthomas found in 29 excised stomachs was 86 in all, 2.9 per case. There were no clinical symptoms characteristic to gastric xanthoma. Serum cholesterol was within the normal limit except for one case complicated with hypertension. In a patient with hyperlipemia and nodular xan-thoma, the gastrocamera examination did not reveal any gastric xanthoma. According to gastric diseases, xanthoma was most frequently noted in gastric polyp holding 43.7 percent, followed by gastric cancer, 13.8 percent, gastric ulcer, 3.8 percent and gastritis, 3.6 percent. The number of xanthomas found in the excised stomach was most mumerons in gastric polyp showing 7.7 per case, followed by gastric cancer, 1.4 per case and gastric ulcer, 1.2 per case. In histological examination, the mucosal epidermis showed a transformation to the intestinal epidermis in many parts and in the proper layer of the mucosa groups of a large number of so-called xanthoma cells with foamy, somewhat bright plasma were noted. It was shown by lipoid staining that xanthoma cell contained fat and lipoid. The findings in the gas chromatographic analysis of the gastric xanthoma tissue practically agreed with those in the chemical analysis of the skin xanthoma tissue. Gastric xanthoma develops locally in the gastric mu-cosa only. It was often found in the excised stomach and suggestive of the pathogenesis.

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1) 548 patients with gastric and duodenal lesions were routinely examined by combined three methods beforee operation, and compared with postoperative histologic diagnosis.2) X-ray diagnosis was correct in 83.3% of gastric cancer and 75.2% of gastric ulcer, and gastrocamera was correct in 92.8% of gastric cancer and 86.5% of gastric ulcer. As generally accepted X-ray exami-nation is just schadow diagnosis, sometimes it may be difficult to differentiate between some kinds of lesions, for instances between duodenal ulcer and periduodenitis, if niche will not be detectable. From this point of view, when ability of fluoros-copat progressed more cases might be diagnosed as doubtful changes on the X-ray film. So these doubtful lesions are to be comfirmed by endoscopy and sometimes by cytology. But it still remains as the most important and reliable method in the field of gastric diagnosis.3) When X-ray examinations find the questionable lesions in the stomach as ulcers or polyps under suspicion of malignant changes, giant rugae gastritis, suspicion of superficial cancer endoscopic examina-tion was especially usefull. And at this time, if exact position of tip of the camera in the stomach is controlled under fluoroscopy, diagnosttc accuracy of the lesions are increased markedly. To decrease the blind zone of the gastrocamera, author tried some new methods. To photograph the posterior wall of the upper body of the stomach, two balloons were attached to the tip of the camera to increase the distances between apparatus and the lesions by inflation of the balloons within the stomach. In another method we changed the tip of the camera into steal, and attracted the tip by strong magnet through abdominal wall. So distance between the lesions and the tip of the camera was enlarged and enabled to look down the posterior wall of the body of the stomach. To get photograph of cardial zone we routinely used bent method.4) As the gastric cytology authors employed chymo-trypsin lavage technique as routine procedure under the control of X-ray. We used new radioopaque hard tubes, and added "UROKOLIN" 5g/dl as the contrast medium to the chymotrypsin fluid. We washed always perticullary doubtful parts of the stomach under fluoroscopic controll and we called this method as selective gastric lavage. According to this new method, we found the fact, that there are so little differences in the diagnostic accuracy between the cancer of antrum, pylorus, body and cardia. We get positive results in over 90% of cancer cases in any parts of the stomach. Then accuracy of the cytologic diagnosis of the stomach lesions was increased so much and false positive case was zero. So these methods have some weakpoints in each other, but when used combined at the same time, it is sure to increase accuracy in the detection of the malignancy of the stomach. Author could correctly diagnosed 99.5% of the stomach cancer with this method.

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Material studied was consist of resected 27 gastric cancers including 21 cases of superficial depressed type of early gastric cancer and 6 cases of moderately advanced gastric cancer which were obtained from the operating rooms of the 1 st Department of Surgery of Showa University. In every case the characteristic gross appearances of superficial depressed type in the resected specimens were evaluated in detail retrospectively concerning the features of the botom and the edge of the depression. Then the discussion was done on diagnostic reliabilities of each characteristic gross features of the depression in making diagnosis by gastrocamera. The following results were obtained:I The following features in gastrocamera make the cancerous depression easily be detected and also the most reliably to be diagnosed. They are also very helpful in differential diagnosis.1. Interruption of the mucosal folds around the depressed lesion.2. Irregularity in shape and indentation in the center of the depressed lesion.II The following findings in gastrocamera are very contributory in making the differential diagnosis, when recognized, however less reliable to detect the depressed type of the early gastric cancer.1. Discolouration in the center of the depress lesion2. Rigidity and gradual slenderness of the mucosal folds toward the depression.3. Elevation around the margin of the depression.

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