In this report we evaluated the clinical pictures, the findings of the hypotonic duodenogram ahd the endoscopic findings of eight patients with carcinoma of the duodenal papilla and the ampulla. The diagnosis was made preoperatively and curable operation was performed in all eight patients. As a result of this investigation, following conclusions were obtained.1) All patients were above fifty years old.2) Among initial clinical signs, the jaundice was noted most frequently. It was seen progressively or intermittently. Among laboratory data, the elevation of the serum slkaline phosphatase activity was most characteristic, which was not always proportional to the degree of jaundice. It was found in all eight natients.3) Radiologically and endoscopically, carcinoma of the duodenal papilla and the ampulla were classified into following three grouns.(i) Type I is a case, in which the malignant lesion was limited at the only main papilla. Its surface was irregularly granular, accompanied by some erosions and hemorrhages. (2 of 8 cases)(ii) Type II is a case, in which the longitudinal fold was markedly swollen. Its surface was generally smooth. (4 of 8 cases)(iii) Type III is a case, in which the main papilla and the longitudinal fold were almost normal radiologically and endoscopically. But the endoscopic pancreatocholangiography revealed the filling defect at the end of the pancreatic duct and the common bile duct.4) The biopsy was done at the main papilla in 7 of 8 patients. Two of them were positive in malignancy. On the other hand, the cytological examination of the pancreatic juice and the bile was done in 5 of 8 patients. It revealed positive malignancy in all 5 patients. From this investigation we can say that the duodenof iberscope, the endoscopic pancreatocholangiography and the cytological examination of the pancreatic juice and the bile, collected after the cannulaion of the tef lone tube into the orifice of the duodenal papilla, are the most effective to make the diagnosis of carcinoma of the duodenal papilla and the ampulla.

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Tere are many reports of the disease produced by infection with Strongyloides stercoralis. In these reports. various clinical features including symptoms, laboratory findings or certain specific findings in roentgenological examination of the gastrointestinal tract are described.But none of these have mentioned the findings of the endoscopic observation of duodenum and jejunum. Recently we experienced 4 cases of severe infection with Strongyloides stercoralis. Duodenofiberscopic examination by using FGDS (Machida) revealed serious duodenitis and jejunitis in all of the cases. Mucosal edema, whitish discoloration and turbidity of the mucosa with much of dirty mucus were noticed instead of normal velvety mucosal pattern. In some cases, ulceration or erosions with occaional bleeding were present. Especially in one of the cases, operated on the stomach by means of Billroth-II because of the duodenal ulcer, many shallow ulcers with slight stenosis were displayed in the jejunum. Bringing the f iberscope to the mucosa disclosed that tips of the many of the villi became thickened and club-shaped in all of the cases. These findings were very similar to macroscopic findings of the small intestine in the autopsy cases. Endoscopic biopsy of the jejunal mucosa in the gastrectomized case revealed severe infestation with many larvae as well as adult worms. These findings disappeared in a short period after taking a vermif uge, Thiabendazol. The features revealed by duodenof iberscopic examinations in 4 cases of serious strongyloidiasis are very interesting with regards to the diagnostics of small intestine by use of endoscope. We expect that in the near future it will become possible to observe endos-copically and take biopsy specimens under direct vision throughout the entire small intestine.

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Two gastric cancer lesions were found in the stomach of 67 years old woman. One lesion was adenocarcinoma tubulare II b type limited in the mucosal layer of the posterior wall on the prepyloric area. The other lesion was undifferentiated gastric cancer localized in the submucosal layer of the posterior wall on antrum.We suspected that the latter originated from aberrant pancreas in the submucosal layer.

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A case of carcinoid tumor of the stomach, which was observed in such a young boy 15 years of age, is reported. The patient was admitted to the 1st Division of Internal Medicine, with the chief complaints of faintness or transiently lost vision sensation on standing-up and heaviness of the left flank, that have appeared on and off without noticeable cause until 3 July, 1971 when he saw us for the first time since he was 10 years old, although not always but very frequently. He has had no remarkable past illness, but was mentally and physically retarded to such a degree that he was unable to start walking by himself. Meanwhile, ever since he was 5 years old, the flushing of the face has been noticed already, but no other signs of carcinoid syndrome were seen. At the time of his admission, the thin patient was found to have hypochromic anemia, which was treated by iroh therapy with success, without any other abnormalities on biochemical, urine and feces examinations. Radiologic as well as endoscopic (gastrocamera with fiberscope) examination revealed that there was a semicubic tumor covered with normal gastric mucous membrane but with bridging folds at the antrum of the posterior wall, indicative of submucous tumor of the stomach. So the tumor was immediately operated on. The resected stomach showed that the tumor in question was a submucous tumor of the stomach, 22×15×12 cm in size, elastic hard in consistency, cubic in shape, and the cut surface of the tumor was yellowish-white, partly brown, in color. Histology of the tumor pointed to carcinoid tumor of the stomach, argentaf f inity of which was, however, found negative by Masson-Fontana staining. Seven months after the operation, the patient remains quite normal. It should be noted for reference that his serum serotonin level and urinary 5-HIAA excretions as measured after the gastric resection were 67-143, μg/1 and 6.0 mg/day. respectively.

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