Three hundred and sixty-five biopsies under direct vision, using a fibergastroscope, were performed on 339 patients with gastric cancer from 1966 to 1975. Diagnostic accuracy improved with an increased in the number of biopsy specimens and reached 100% when 6 or more biopsy specimens were obtained. Positive specimens were obtained with 48.5% of the biopsied tissue from the center of the lesion (A), 52.2% from the inner margin of the lesion (B1), 19.6% from the outer margin of the lesion (B2), and 1.6% from the area around the lesion (C). The combined result of the biopsies from A and B1 was highly positive in 49 out of 51 cases (96.1%). Diagnostic accuracy of the early cancer reached 96.9%. This was significantly higher than that of advanced cancer (80.3%). False negative biopsies were found in 51 (16.3%) of the 313 patients who were gastrectomized and diagnosed by histological examinations. Twenty-three of the 27 patients, who were diagnosed as benign either by x-ray or endoscopic examination, and 4 of the 5 patients who were diagnosed as benign under both examinations, were found to have positive results by biopsy. Positive biopsy examination was particularly helpful with patients showing on inconclusive or benign diagnosis by x-ray and/or endoscopic examinations.

Mortality due to acute cholangitis (AC) has been tremendously reduced by the advent of endoscopic sphincterotomy (EST). This study investigates whether EST is really a curative procedure for the treatment of AC, or not. Diagnosis of AC, in 159 out of 1,061 cases in which EST was performed, had been made by infected bile which was recognized as green or pyobile collected during ERCP. Emergency drainage by EST was performed immediately after AC was diagnosed. The causes of AC were attributable to benign diseases in 128 cases (80.5%) and malignant diseases in the remaining 31 cases. Clinical symptoms included abdominal pain, fever, and obstructive jaundice, but Charcot's triad was noticed in 66 cases (43.3%) and Reynolds pentad in only 7 cases (4.6%). As to the relation between clinical symptoms and properties of bile, pyobile was more likely to be recognized in patients with severe symptoms. Four patients treated at our hospital died of AC (2.5%). All were over 80 years old, and their conditions were already complicated by disseminating intravascular coagulation (DIC) syndrome. Compared with the results obtained in patients treated with percutaneous transhepatic biliary drainage (PTBD), the resulting mortality rate was less. Therefore, we feel the best approach for treating AC, which progresses to acute obstructive suppurative cholangitis (AOSC) in the final stage of the disease, is to diagnose early, by ERCP, and to promptly obtain decompression by subsequent EST, or to perform radical surgery.

Peripheral lymphocyte counts, T-cell and B-cell populations, DNCB skin reactions, Mantoux reactions, mitogenic transformation using PHA, and determination of serum phenytoin concentration were carried out in 45 children with severe handicaps. Twenty two of these patients were receiving phenytoin treatment. When compared with control subjects, the skin reactions were significantly depressed in the handicapped children, amongst whom those treated with phenytoin had more impaired reactions than those who were untreated. No significant relationship between the results of the skin reactions and the other parameters was found.

We reviewed 11 patients with esophageal mucosal carcinoma in various aspects to improve the early diagnosis of the disease. Eighteen lesions measuring 0.5 to 5.0 cm were confirmed histologically in the 11 cases. Histologically 10 of the 18 lesions were carcinomas in situ (ep cancer), and the other 8 lesions were carcinomas confined to the mucosa other than ep cancer (mm cancer); all 18 lesions were squamous cell carcinomas. Six (85.7%) of the seven mm cancers showed abnormal radiographic findings regardless of the size. Similarly these findings were noted on four of five (80%) ep carcinomas 2 cm or larger in size. All 15 lesions diagnosed before operation showed abnormal findings on conventional endoscopy regardless of the size and depth of transmural invasion. Morphologic change was observed in 9 lesions (53.3%), while 13 (86.7%) showed color change; most of the lesions (80%) were manifested as redness. Dyeing of the resected specimen with Lugol solution (Katayama Chemical Industries, Osaka, Japan) showed all 18 cancerous lesions as unstained areas. Among the 18 lesions, two lesions were unstained areas, which agreed with the areas determined histologically. An additional lesion was visible with dye endoscopy as an unstained area but it was not visible with radiography or conventional endoscopy. Dye endoscopy using Lugol solution is very important because it allows detection and evaluation of the extent of esophageal mucosal cancer.

Gastrointestinal: Rectal polyp associated with schistosomiasisA Japanese man, aged 64 years, was investigated by colonoscopy because of a positive fecal occult blood test. Colonoscopy revealed a sessile polyp, about 2 cm in diameter, in the rectum. The appearance of the polyp after spraying the region with indigo carmine is shown in Fig. 1. As the polyp was thought to be an adenoma, the polyp was removed by endoscopic mucosal resection. Histological evaluation revealed a hyperplastic polyp and calcified Schistosoma eggs in the submucosa (Fig. 2).Schistosomes are tropical parasites that are thought to infect at least 200 million people worldwide. The major human parasites are Schistosoma hematobium , S. mansoni and S. japonicum . S. hematobium is endemic in several countries in Africa while S. mansoni is endemic in Africa and Central and South America. S. japonicum is largely restricted to East Asia but is now rare in Japan. The location of adult worms in the human host is partly determined by parasite species. For example, the preferred site for S. hematobium is vesical veins while the preferred sites for S. mansoni and S. japonica are the superior and inferior mesenteric veins. Adult worms of S. japonicum survive for approximately 5 years and produce up to 3000 eggs per day. At least half of these eggs pass through the intestinal wall and are discharged in feces. The remainder lodge in the intestinal wall or go back to the liver via the portal vein. These eggs elicit a chronic inflammatory response that includes granulomas and large numbers of eosinophils. Common clinical manifestations include hepatomegaly and various manifestations of portal hypertension. It is unclear whether intestinal schistosomiasis predisposes to colorectal polyps but S. japonica eggs were found in the base of the polyp in the above case.