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PCPS (peroral cholangio-pancreatoscopy), a modality of mother and baby scope systems, was very useful for the diagnoses of bile duct tumors. The endoscopical findings and pathological findings obtained on the biopsy specimen collected under the direct view were valuable. For the diagnosis of pancreatic diseases, PMPS (peroral micro-pancreatoscopy), in which ultrathin quartz fibers are used for the baby scope, was useful. By this method, we could observe the inside of the pancreatic duct through an untreated normal papilla. This is very helpful for endoscopical diagnosis of small pancreatic cancers. EUS (endoscopic ultrasonography) was also a useful method for the diagnosis of small pancreatic cancers. EUS could draw the three layers of the common bile duct and gall bladder walls, and could distinguish a cholesterol polyp from a non-cholesterolic one. Combined application of these methods will aid in the discovery of early stages of cancers in the bilio-pancreatic system.

To evaluate myocardial tissue changes using two-dimensional (2D) echocardiography, several approaches were attempted. 1. Quantitative evaluation of the myocardial echo intensity by computerized image processing in patients with old anteroseptal myocardial infarction: 2D echocardiograms of the parasternal long-axis view were converted to digital images to measure the echo intensity of the regions of interest (ROI) placed in the interventricular septum (IVS), the left ventricular posterior wall (LVPW), the left ventricular cavity, and the pericardium. The mean value of the echo intensity was compared with that of the pericardium (maximum echo intensity) and of the left ventricular cavity as the minimum. In 12 normal subjects, the relative echo intensity of the IVS was 0.40 +/- 0.05 (mean +/- SE), whereas it was 0.71 +/- 0.06 in 11 patients with old MI (p less than 0.001). Color display facilitated the visual recognition of the numerical differences in echo intensities. 2. Evaluation of the myocardial echo intensity in acute phase of myocardial infarction: In nine normal elderly persons, the relative echo intensity of IVS was 0.29 +/- 0.14, and there was no significant change in the early stage (three to seven days) of acute infarction (0.31 +/- 0.14). Two weeks later, however, a significant increase was noted (0.61 +/- 0.10) (p less than 0.01), probably due to an increase in collagen fibers. 3. Changes of the myocardial echo intensity in acute myocardial ischemia: Two-dimensional echocardiograms were recorded in nine open-chest dogs using 3 and 5 MHz transducers before and 10 min, 1 hr, 3 hrs, and 6 hrs after coronary artery ligation. With the 5 MHz transducer, the echo intensity of the ischemic myocardium was decreased after 10 min and was remarkable after 1 hr (0.24 +/- 0.08), and restored in six hrs. These changes could not be detected using the 3 MHz transducer. 4. An in vitro study for assessment of ultrasonic attenuation in the canine infarcted myocardium: The frequency dependency of ultrasonic attenuation of the resected canine myocardium in the frequency region of 2 MHz to 7 MHz was estimated one and two weeks after coronary artery ligation. The distributions of attenuation characteristics were nearly consistent with those of collagen contents determined histologically. In conclusion, we demonstrated that acute and chronic ischemia of the myocardium influences the transmission and reflection of ultrasound. By applying this property, ultrasonic tissue characterization may become a useful tool for detecting myocardial ischemia in the near future.

To assess myocardial tissue changes by two-dimensional echocardiography, quantitative evaluation and color display of the echo intensity were attempted using computerized image processing. The materials consisted of 11 patients with old anteroseptal myocardial infarction one year or more after the onset (OMI), and 12 normal subjects. Two-dimensional echocardiograms in the parasternal long-axis view were obtained using a commercially-available phased-array sector scanner. Scanner receiver settings including sensitivity-time control were maintained constant in all subjects. Images were recorded on the U-matic tape using a video tape recorder, then stop-frame end-diastolic images were converted to digital images. To measure echo intensity, regions of interest (ROI) were placed in the interventricular septum (IVS), the left ventricular posterior wall (LVPW), the left ventricular cavity, and the pericardium. The mean value of the echo intensities was determined for each ROI. Then, the relative echo intensity of the IVS or LVPW was calculated using the mean value of the pericardium as the maximum echo intensity, and the mean value of the left ventricular cavity as the minimum echo intensity. In normal subjects, the relative echo intensity of the IVS was 0.40 +/- 0.05 (mean +/- SE) and that of the LVPW was 0.31 +/- 0.02. By contrast, in patients with OMI, there was a significant increase (p less than 0.001) in the relative echo intensity of the IVS (0.71 +/- 0.06). The relative echo intensity of the LVPW was less than normal, but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate tissue changes, we studied myocardial texture using two-dimensional echocardiographic images. We investigated 19 normal subjects, 28 patients with left ventricular hypertrophy, and 12 patients with old anteroseptal myocardial infarction of longer than one year duration. Using 2.5, 3.5, and 5.0 MHz transducers, two-dimensional echocardiograms in the parasternal long-axis view were obtained, and the textures of the interventricular septal images were classified in three types; type I, with a nearly uniformly speckled or echolucent appearances; type II, with multiple, discrete, small (2 to 4 mm) highly refractile echoes; type III, with larger highly refractile echoes (greater than 4 mm) appearing as a cluster of broad patches or band-like echoes. Normal subjects belonged to the type I texture, while many with left ventricular hypertrophy belonged to the type II category. Type III was often observed in patients with old anteroseptal infarction. Using a transducer of higher frequency, there tended to be a shift from type II to I or type III to II. In phantom experiments using carbolandam granules instead of the myocardium, the echocardiographic texture became rough when the phantom was farther from the transducer or the transducer was of low frequency. We suggest that the texture in two-dimensional images may reflect myocardial tissue changes, when other factors including the apparatus and technique remain stable.

The authors have been treating early gastric carcinoma endoscopically by high-frequency-current polypectomy since 1976, by microwave coagulation since 1982, and by laser coagulation since 1983. In order to achieve absolute curability of early carcinoma, we recommend that polypectomy be performed first, whenever possible. The reason for this is that the resected polypectomised tissue enables a decision to be made as to whether further treatment is necessary, after histopathological examination of the specimen. Otherwise, cases in which snaring is impossible, such as flat or depressed carcinomas of markedly small or large size, should be treated by microwave and/or laser coagulation. In total, we have experienced 92 lesions (83 cases) of early gastric carcinoma treated by all of above 3 methods, and we currently have 5 cases showing more than 5-year survival. Among these, type II a early carcinomas less than 10mm in diameter accounted for the majority; on the other hand, there were 11 type II c cases, also with tumors less than 10mm in diameter. Referring to our surgical data, type II c (without ulcer nor lymph node metastases) less than 5mm in size is limited to the mucosa in 100% of cases, and of 6-10mm in size in 85%. We therefore propose that type II c tumors less than 10mm in size should be treated endoscopically, as well as type II a tumors of the same size. In order to determine the depth of carcinomatous invasion, endoscopic ultrasonography (EUS) is effective. The diagnostic accuracy for Ul(-) early carcinoma is almost 100%, but for Ul(+) cases EUS is not so accurate. Further studies and improvements of EUS are thus needed.

To assess myocardial tissue changes, the distribution of echo intensities of two-dimensional echocardiograms was analyzed using a histogram. The materials were obtained from six normal subjects (N), 29 patients with left ventricular hypertrophy (LVH), and 12 patients one year or more after the onset of anteroseptal myocardial infarction (MI). A transducer with a central frequency of 2.3 MHz was used. Scanner receiver settings, including sensitivity-time control, were kept constant for all subjects. The parasternal long-axis image was digitized and computer-processed. The region of interest was located within the interventricular septum. The mean echo intensity and its distribution were studied. The shape of the histogram was evaluated for skewness and kurtosis. Relative echo intensity: N = 0.23 +/- 0.07 (mean +/- SD) less than LVH = 0.58 +/- 0.18 less than MI = 1.07 +/- 0.25 (p less than 0.01). Skewness: N = 1.58 +/- 0.63 greater than LVH = 0.60 +/- 0.61 greater than MI = -0.14 +/- 0.43 (p less than 0.01). Kurtosis: N = 18.0 +/- 7.3 greater than LVH = 10.5 +/- 3.3 greater than MI = 7.7 +/- 0.9 (p less than 0.01). These differences may closely relate to an increase in collagen fiber content. Consequently, analysis of the myocardial echo intensity distribution, in addition to mean echo intensities, may become a clinically useful approach for identifying myocardial tissue changes.

We carried out through questionnaires the second survey on the epidemiology and the clinical features of chronic pancreatitis in Hokkaido district. Chronic pancreatitis was diagnosed in 258 patients in 19 hospitals during the period April 1977 to December 1984. The ratio of male cases to females was 2.7:1.0 and the average age was 53.9. Alcoholic abuse, observed in 55% of the patients, was a main causative factor. A half of the patients was diagnosed on the basis of pancreatogram and/or image of the pancreas (ultrasonogram and computed tomogram). The incidence of chronic pancreatitis in the second survey was about fourfold over that diagnosed during the period January 1970 to March 1977 in the first survey. Such an increasing number of the patients with chronic pancreatitis in Hokkaido district was considered to be resulted from the difference between two surveys in epidemiological aspects and diagnostic criteria. The proportion of female patients and alcoholic patients was calculated to be increasing. The frequency of the patients diagnosed in a relatively early stage was supposed to be also increasing, because in the second survey a new item (pancreatogram, ultrasonogram and computed tomogram) was added to the diagnostic criteria (histological evidence, pancreatic calcification and definitive disturbance of exocrine pancreatic function) in the first survey. Based on whether alcoholic abuse was causative factor or not, the patients were divided into two groups and the clinical manifestations of both groups were compared.(ABSTRACT TRUNCATED AT 250 WORDS)