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Background and Methods. Eight patients thought to have primary early gastric lymphoma are studied to evaluate the usefulness of endoscopic mucosal resection for the diagnosis of reactive lymphoid hyperplasia (RLH) or malignant lymphoma. Results. In these patients, conventional endoscopic forceps biopsy did not provide a definite histologic diagnosis. Endoscopic ultrasonography (EUS) demonstrated that the disease was limited to the mucosa and the sub-mucosa in all patients, without any paragastric lymph node involvement, so endoscopic mucosal resection was performed to obtain specimens large enough to include the submucosa. As a result, primary early gastric lymphoma was diagnosed in five patients, for whom subsequent gastrectomy confirmed the diagnosis. Conclusions. The authors recommend that endoscopic mucosal resection be performed in patients thought to have primary early gastric lymphoma and for whom a definite diagnosis can not be made by conventional endoscopic forceps biopsy. Cancer 1993; 17:1207-13.

More than 85% of patients with T1 colorectal cancer have no lymph node metastasis and can be cured by endoscopic resection. To avoid unnecessary surgery after complete endoscopic resection, accurate histologic methods for evaluating resected specimens are needed to discriminate those at high risk for lymph node metastasis. A retrospective multi-institutional, cross-sectional study of 806 T1 colorectal cancer patients was conducted. A budding/sprouting score was incorporated for predicting lymph node metastasis in addition to other parameters, including the depth of submucosal invasion, histologic grade, and lymphovascular invasion. Lymph node metastasis was detected in 97 patients. Independent predictors of lymph node metastasis by multivariate analysis were depth of submucosal invasion ≥1000 μm (odds ratio (95% confidence interval)=5.56 (2.14–19.10)) and high-grade budding/sprouting (3.14 (1.91–5.21)). Among lesions with a depth of submucosal invasion ≥1000 μm, lymph node metastasis was detected in 59 (29%) of 207 patients with high-grade budding/sprouting, and in 34 (9%) of 396 with low-grade budding/sprouting. Lymph node metastasis was detected in only 4 (2%) of 203 lesions with a depth of submucosal invasion <1000 μm. Of these four tumors, three invaded lymphatic and/or venous vessels. Thus, the risk for lymph node metastasis can be classified into three groups: high risk with a depth of submucosal invasion ≥1000 μm and high-grade budding/sprouting, intermediate-risk with a depth of submucosal invasion ≥1000 μm and low-grade budding/sprouting, and low-risk with a depth of submucosal invasion <1000 μm. These findings revealed that a depth of submucosal invasion ≥1000 μm and high-grade budding/sprouting are powerful predictive parameters for lymph node metastasis in T1 colorectal cancer. This three-tier risk classification system will facilitate the decision for additional major surgery for T1 colorectal cancer patients after successful endoscopic treatment.

The purpose of this study was to clarify the clinicopathological characteristics of autoimmune pancreatitis (AIP) in Japanese patients with inflammatory bowel disease (IBD).

Rho kinase (ROCK) is involved in various physiological functions, including cell motility, vasoconstriction, and neurite extension. Although a functional role of ROCK in nociception in the central nervous tissue has been reported in neuropathy, the peripheral function of this protein in hyperalgesia is not known. In this study, antinociceptive effects of AS1892802 [1-[(1S)-2-hydroxy-1-phenylethyl]-3-[4-(pyridin-4-yl)phenyl]urea], a novel and highly selective ROCK inhibitor, were investigated in two rat models of arthritis. Orally administered AS1892802 exhibited potent antinociceptive effect in both an adjuvant-induced arthritis (AIA) model (inflammatory arthritis model) and a monoiodoacetate-induced arthritis (MIA) model (noninflammatory arthritis model), with an ED(50) of 0.15 mg/kg (MIA model). Fasudil, a ROCK inhibitor, and tramadol were also effective in both models; however, diclofenac was effective only in the AIA model. The onset of antinociceptive effect of AS1892802 was as fast as those of tramadol and diclofenac. AS1892802 did not induce gastric irritation or abnormal behavior. Because AS1892802 rarely penetrates the central nervous tissue and is also effective by intra-articular administration, it seemed to function peripherally. These results suggest that AS1892802 has an attractive analgesic profile for the treatment of severe osteoarthritis pain.

Central adenosine A(2A) receptor is a promising target for drugs to treat Parkinson's disease (PD), and the central blockade of adenosine A(1) receptor improves cognitive function. In the present study, we investigated the effect of a novel adenosine A(1) and A(2A) dual antagonist, 5-[5-amino-3-(4-fluorophenyl) pyrazin-2-yl]-1-isopropylpyridine-2(1H)-one (ASP5854), in animal models of PD and cognition. The binding affinities of ASP5854 for human A(1) and A(2A) receptors were 9.03 and 1.76 nM, respectively, with higher specificity and no species differences. ASP5854 also showed antagonistic action on A(1) and A(2A) agonist-induced increases of intracellular Ca(2+) concentration. ASP5854 ameliorated A(2A) agonist 2-[p-(2-carboxyethyl) phenethylamino]-5'-N-ethylcarboxamidoadenosine (CGS21680)- and haloperidol-induced catalepsy in mice, with the minimum effective doses of 0.32 and 0.1 mg/kg, respectively, and it also improved haloperidol-induced catalepsy in rats at doses higher than 0.1 mg/kg. In unilateral 6-hydroxydopamine-lesioned rats, ASP5854 significantly potentiated l-dihydroxyphenylalanine (l-DOPA)-induced rotational behavior at doses higher than 0.032 mg/kg. ASP5854 also significantly restored the striatal dopamine content reduced by 1-metyl-4-phenyl-1,2,3,6-tetrahydropyridine treatment in mice at doses higher than 0.1 mg/kg. Furthermore, in the rat passive avoidance test, ASP5854 significantly reversed the scopolamine-induced memory deficits, whereas the specific adenosine A(2A) antagonist 8-((E)-2-(3,4-dimethoxyphenyl)ethenyl)-1,3-diethyl-7-methyl-3,7-dihydro-1H-purine-2,6-dione (KW-6002; istradefylline) did not. Scopolamine- or 5H-dibenzo[a,d]cyclohepten-5,10-imine (dizocilpine maleate) (MK-801)-induced impairment of spontaneous alternation in the mouse Y-maze test was ameliorated by ASP5854, whereas KW-6002 did not exert improvement at therapeutically relevant dosages. These results demonstrate that the novel, selective, and orally active dual adenosine A(1) and A(2A) receptors antagonist ASP5854 improves motor impairments, is neuroprotective via A(2A) antagonism, and also enhances cognitive function through A(1) antagonism.

Peroxisome proliferator-activated receptors (PPARs) are members of the nuclear receptor superfamily and function as ligand-modulated transcription factors that regulate gene expression in many important biological processes. The PPARdelta subtype has the highest expression in the brain and is postulated to play a major role in neuronal cell function; however, the precise physiological roles of this receptor remain to be elucidated. Herein, we show that the high-affinity PPARdelta agonists L-165041 [4-[3-(4-acetyl-3-hydroxy-2-propylphenoxy)-propoxyl]phenoxy]-acetic acid] and GW501516 [2-methyl4-((4-methyl-2-(4-trifluoromethylphenyl)-1,3-triazol-5-yl)-methylsulfanyl)phenoxy acetic acid] protect against cytotoxin-induced SH-SY5Y cell injury in vitro and both ischemic brain injury and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) neurotoxicity in vivo. In the SH-SY5Y studies, treatment with L-165041 or GW501516 significantly and concentration-dependently attenuated cell death following thapsigargin, 1-methyl-4-phenylpyridinium, or staurosporine exposure, with the extent of damage correlated with the level of caspase-3 inhibition. In the transient (90 min) middle cerebral artery occlusion model of ischemic brain injury in rats, i.c.v. infusion of L-165041 or GW501516 significantly attenuated the ischemic brain damage measured 24 h after reperfusion. Moreover, the PPARdelta agonists also significantly attenuated MPTP-induced depletion of striatal dopamine and related metabolite contents in mouse brain. These results demonstrate that subtype-selective PPARdelta agonists possess antiapoptotic properties in vitro, which may underlie their potential neuroprotective potential in in vivo experimental models of cerebral ischemia and Parkinson's disease (PD). These findings suggest that PPARdelta agonists could be useful tools for understanding the role of PPARdelta in other neurodegenerative disorders, as well as attractive therapeutic candidates for stroke and neurodegenerative diseases such as PD.

Abstract

ABSTRACTCharacterising the mechanisms of cell death following focal cerebral ischaemia has been hampered by a lack of an in vitro assay emulating both the apoptotic and necrotic features observed in vivo. The present study systematically characterised oxygen-glucose-deprivation (OGD) in primary rat cortical neurones to establish a reproducible model with components of both cell-death endpoints. OGD induced a time-dependent reduction in cell viability, with 80% cell death occurring 24 h after 3 h exposure to 0% O2and 0.5 mM glucose. Indicative of a necrotic component to OGD-induced cell death, N-methyl-D-aspartate (NMDA) receptor inhibition with MK-801 attenuated neuronal loss by 60%. The lack of protection by the caspase inhibitors DEVD-CHO and z-VAD-fmk suggested that under these conditions neurones did not die by an apoptotic mechanism. Moderating the severity of the insult by decreasing OGD exposure to 60 min did not reduce the amount of necrosis, but did induce a small degree of apoptosis (a slight reduction in cell death was observed in the presence of 10 μM DEVD-CHO). In separate experiments purported to enhance the apoptotic component, cells were gradually deprived of O2, exposed to 4% O2(as opposed to 0%) during the OGD period, or maintained in serum-containing media throughout. While NMDA receptor antagonism significantly reduced cortical cell death under all conditions, a caspase-inhibitor sensitive component of cell death was not uncovered. These studies suggest that OGD of cultured cortical cells models the excitotoxic, but not the apoptotic component of cell death observed in vivo.

Adenosine A1receptors in the brain are believed to play an important role in brain functioning. We have discovered a novel adenosine A1receptor antagonist, FR194921 (2-(1-methyl-4-piperidinyl)-6-(2-phenylpyrazolo[1,5-a]pyridin-3-yl)-3(2H)-pyridazinone), and characterized the pharmacological activity in the present study. FR194921 showed potent and selective affinity for the adenosine A1receptor without affinity for A2Aand A3receptors and did not show any species differences in binding affinity profile among human, rat, and mouse. Pharmacokinetic study in rats revealed that FR194921 was orally active and highly brain penetrable. Oral administration of FR194921 dose-dependently ameliorated the hypolocomotion induced by the A1receptor agonist N6-cyclopentyladenosine in rats, indicating this compound exerts A1-antagonistic action in vivo. In the passive avoidance test, scopolamine (1 mg/kg)-induced memory deficits were significantly ameliorated by FR194921 (0.32, 1 mg/kg). In two animal models of anxiety, the social interaction test and elevated plus maze, FR194921 showed specific anxiolytic activity without significantly influencing general behavior. In contrast, FR194921 did not show antidepressant activity even at a dose of 32 mg/kg in the rat forced swimming test. These results indicate that the novel, potent, and selective adenosine A1receptor antagonist FR194921 exerts both cognitive-enhancing and anxiolytic activity, suggesting the therapeutic potential of this compound for dementia and anxiety disorders.

Background:The color change observed endoscopically in early gastric cancer is thought to correlate with vascular density and architecture. This study investigated the endoscopic microvascular architecture in intramucosal gastric carcinoma in vivo. Methods:Intramucosal gastric carcinomas without ulceration in 27 patients were studied by using a new magnifying upper endoscope with attention to microvascular findings. The carcinomas were divided into two major types histologically: differentiated (18) and undifferentiated (9). Results:A regular subepithelial capillary network was demonstrated in noncancerous mucosa. The appearance of the carcinomas differed depending on histologic differentiation. With all of the differentiated carcinomas, there was a well-demarcated area where the regular capillary pattern of noncancerous mucosa had disappeared and irregular microvessels were proliferating. In contrast, with undifferentiated carcinomas there was only an ill-defined area with disappearance or a reduction in the density of capillaries in the noncancerous mucosa. Conclusions:Magnified endoscopic observation of microvessels may be of assistance in the identification of intramucosal gastric carcinomas that exhibit only subtle changes in color and shape at standard endoscopy.

Background.The purpose of this study was to elucidate the role of adenoma in the early stage of colorectal cancer development, we focused on the clinicopathologic relationship between adenoma with low-grade dysplasia (ALGD), adenoma with high-grade dysplasia (AHGD), and cancer that invades the submucosa in the colorectum. Methods.We clinicopathologically examined a total of 553 adenomas and 58 cancers that invaded the submucosa. The tissues were excised from 479 patients who underwent total colonoscopy. Results.The percentage of ALGD was 79.9% in the proximal colon, 70.5% in the distal colon, and 48.3% in the rectum, respectively. The percentages of AHGD and cancer were 14.5% and 5.6% in the proximal colon, 21.3% and 8.2% in the distal colon, and 35.4% and 16.3% in the rectum, respectively. In contrast with the distribution of ALGD, the distribution of both AHGD and cancer shifted from the proximal to the distal site, with a statistical significance (P< .01). When the distribution of adenoma was compared according to tumor size, both large- and small-sized AHGD showed a similar cancer distribution, however, both large- and small-sized ALGD showed different distributions. Conclusion.An important role of AHGD for cancer development in the colorectum may relate to the similar distribution between AHGD and cancer; however, the different distributions observed between ALGD, AHGD, and cancer suggested that ALGD has only a slight association with the development of cancer. (Surgery 2002;131:S105-8.)

Since superficial tumors have been found, their peculiar pathologic features have evoked questions concerning their biologic behavior, their natural history. The aim of the present study was to elucidate the natural history of colorectal cancers (CRCs) including superficial cancers, using a retrospective radiologic method. Forty nine cancers that had had initial configurations of early cancer seen by previous radiography and that were examined pathologically were the subject of the present study. Growth speeds [doubling time (DT) calculation] and configurational changes at the various stages (invasion depth) were compared between polypoid growth (PG) and nonpolypoid growth (NPG). Growth speeds of mucosal cancer and submucosal cancer were also compared. The results showed that early CRC grows slowly (DT 31.2 months) when the cancer is limited to the mucosa. However, as tumors grow down to the submucosa, their growth speed accelerates (DT 25.8 months). The DT of these early cancers were longer than that of advanced cancers. The pathologic growth pattern (NPG or PG) of the CRCs did not affect the tumor growth speed. In respect to tumor configuration, when the tumor is limited to the submucosa the antecedent growth pattern may be easily deduced. It seems difficult, however, to know the initial growth patterns in advanced cancers because cancers with polyloid growth frequently change to a nonpolypoid growth pattern when in advanced stages. Among 32 advanced cancers, only 6 (19%) derived from IIc/IIc+IIa cancer. The most common (more than 70%) origin of advanced cancer seems to be IIa, Is, and Isp lesions. These results suggest that NPG cancers or superficial depressed cancers are not the main origins of advanced cancers, and that these cancer do not show extraordinarily rapid growth.

We encountered 15 patients with colonic polyps showing histologic features that did not belong to any of the known categories. All polyps were elongated and drumstickshaped, with lengths of 12 to 160 (mean, 29 mm) mm. Histologically, the polyps were covered with normal mucosa and consisted of edematous, loose, fibrous, connective tissues and dense, fibrous submucosal layers, often showing dilation of blood vessels and lymphatics. Although the mechanism of generation of such polyps remains unknown, their elongation may be caused by intestinal motion. Because this kind of polyp has not been described previously outside Japan, we here introduce a new type of polyp, which we have proposed calling the colonic muco-submucosal elongated polyp.

Abstract: This study was conducted to evaluate lymph node metastasis as a key prognostic factor in esophageal cancer. Metastatic lesions in lymph nodes were grouped by histological morphology as intracapsular or extracapsular, and the significance of lymph node metastasis was evaluated by relating metastatic lesions to clinical pathologic factors and patient prognosis. In our hospital, 46 of 81 patients who underwent resection of esophageal cancer developed lymph node metastasis. These 46 patients were enrolled in a study analyzing the relationship between the metastatic mode and the clinicopathological factors. The frequency of extracapsular metastasis was significantly high in patients with a profound depth of cancer, three or more metastases, distant metastasis (n3 and n4), or severe lymphatic invasion. The prognosis was significantly worse in patients with extracapsular metastasis, and this tendency was also seen even in patients with three or more metastases, limited metastasis (n1 and n2), or mild lymphatic invasion (ly0 and ly1). These findings suggest that the metastatic mode reflects the degree of esophageal cancer progression and is an important prognostic factor.

Abstract: The subjects in this study consisted of 40 preoperative untreated esophageal squamous cell carcinoma patients. While p53 did not significantly correlate with the clinicopathological factors, E-cadherin significantly correlated with lymphatic invasion, vascular invasion, the depth of invasion, the degree of lymph node metastasis, the histological stage, and the number of lymph node metastases. Epidermal growth factor receptor (EGFR) significantly correlated with age, the depth of invasion, and the number of lymph node metastases. The 5-year cumulative survival rate was 45.7% in the p53-positive cases and 61.9% in the p53-negative cases, with no significant difference, and 87.8% in the E-cadherinpositive cases and 19.1% in the-negative cases, and the difference was significnat. The prognosis was significantly poor in EGFR-positive subjects: the 5-year survival rate was 38.6% in EGFR-positive cases and 68% in-negative cases. The 5-year survival rate in E-cadherin-negative, EGFR-positive cases was 0%, while it was 91.7% in the reverse pattern, and this difference was significant. These findings suggest that both E-cadherin and EGFR are important prognostic factors, and a more precise prognosis can thus be obtained by combining them. Such a combined technique may be very useful as an indicator for grading the biological malignancy of esophageal cancer.

Forty cases of nongangrenous ischemic colitis were studied to find the different clinical features between stricturing form and transient form. Clinical and laboratory findings were compared between two groups, 15 cases of stricturing form and 25 of transient form, which were diagnosed by follow-up barium enema radiography. The following four items, of the nine studied, were significantly different between the two groups; namely, patients of stricturing form were older in age, had longer time intervals from the onset of disease to disappearance of subjective symptoms and to normalization of white blood cell count and/or erythrocyte sedimentation rate, and showed an increase in l-h erythrocyte sedimentation rate on day 5 or earlier of the disease. Our observations indicate that the age and l-h erythrocyte sedimentation rate might be useful indicators to differentiate the stricturing and transient forms early after the onset of the disease.

A series of 1,630 patients with gastric cancer was reviewed with special reference to their ages. The overall resectability rate was 84.6%. With increasing age, there was also an increase in: the male-to-female ratio, the frequency of tumors located in the distal third of the stomach, and the degree of differentiation of the carcinoma (p<0.01). There was no age-related association to: tumor size, early gastric cancer of 30–40%, macroscopic classification, histological staging, or symptomatology. The 5-year survival rates did not differ significantly among the various age groups. From 1980 to 1984, clinical characteristics were evaluated in 58 patients under 40 years of age and in 39 patients 80 years of age and older. Preexisting medical illnesses and postoperative complications were more frequent in the aged group; however, there were no operative deaths in either group. In conclusion, although there are several distinct properties depending on the age of the patients, very elderly as well as young patients can be successfully treated.

Two patients with primary malignant lymphoma underwent spontaneous regression. One was a 40-year-old woman with a large ulcerating tumor on the greater curvature of the gastric antrum. This tumor shrank spontaneously, leaving only a small shallow ulcer. The resected specimen showed a minute focus of malignant lymphoma in the ulcer base. The other was a 73-year-old man who had a tumor with central ulceration on the posterior wall of the gastric antrum. Endoscopic biopsy revealed a malignant lymphoma. This tumor disappeared 60 days later. The patient refused surgery and remains well with no evidence of recurrent disease at this writing, 44 months later. Although there have been several case reports of spontaneous regression, partial or complete, of gastric malignant lymphoma, our cases seem to be the ones best proven.

A bronchogenic cyst was found in the abdomen, in the retroperitoneum adjacent to the superior pancreatic body. The cyst was unilocular and contained about 100 ml pale yellow mucinous fluid. Microscopic examination revealed a pseudostratified columnar ciliated or cuboidal epithelium, seromucous glands, smooth muscle and cartilage, the distinctive features of bronchogenic cysts. This aberrant location of the cyst is explicable if abnormal buds of the tracheobronchial tree are pinched off and migrate into the abdomen in an early embryonic stage before the canal linking the abdominal with the thoracic cavity is closed by fusion of the future components of the diaphragm.

Abstract: A 47 year old man had a ten year history of intestinal bleeding due to arteriovenous malformation of the distal ileum. Selective angiography is the most reliable technique for the diagnosis of the lesion and a correct diagnosis was not made until the selective superior mesenteric arteriography was done after repetitive laparotomy and intestinal resection. Transcatheter embolization was transiently successful. This case seemed to belong to type 2 according to Moore’s classification and was probably of congenital origin.

Five hundred ninety-two patients with early gastric cancer underwent surgical resection from 1970 to 1986 in our hospital, and 13 died from a recurrence of their disease. A careful analysis of these 13 patients suggests that carcinomas which invaded to the submucosa tend to recur more often than those confined to the mucosa. Well differentiated and papillary adenocarcinomas characterized by protruded or elevated lesions tend to recur earlier than poorly differentiated or signet-ring cell carcinomas characterized by depressed or excavated lesions. However, both types recurred from hematogenous metastases, with the liver being the most common site. Therefore, the macroscopic and histological features presently used to characterize early gastric cancer do not provide sufficient information to accurately predict which patients are at most risk for recurrence.

Abstract: A polypoid pseudosarcoma of the anal canal in a 45-year-old woman was surgically treated. Morphologic characteristics of the tumor were essentially identical with those in hitherto-described pseudosarcomas of the esophagus, larynx, fauces, or oral cavity. Histologic features of the tumor support the presumption of epithelial origin of the sarcoma-like element on the basis of the presence of a clearly epithelial element in the sarcoma-like areas, justifying the term “pseudosarcomatous carcinoma,” instead of “pseudosarcoma.” This is the first report of this tumor type detected in the anal canal.

Typical Turcot's syndrome is characterized by the association of a brain glioma together with multiple colonic polyposis, in which the number of polypoid lesions is small and the association of colonic cancer occurs at a younger age than in familial adenomatous polyposis. We describe a family in which both the father and his son presented with typical Turcot's syndrome without parental consanguinity. This is the first report of a family that is considered to follow an autosomal dominant inheritance. After reviewing 25 documented cases in which the average age of death was 20.3 years old, it was learned that the major cause of death was brain tumor (76 percent) and the minor cause was colon cancer (16 percent). Patients were very young and, therefore, unlikely to have produced a child before their death. These facts seem to support the theory that Turcot's syndrome is an autosomal dominant disorder.

In order to study the natural history of fundic gland polyposis, 23 patients with familial adenomatosis coli/Gardner's syndrome were examined over a follow-up period ranging from 17 mo to 13 yr (average 6 yr). Examinations included gastric radiography and endoscopy with biopsy. Fundic gland polyps were found in 10 individuals. The size and number of polyps varied considerably. During the follow-up period, there was an increase in number or size of polyps, or both, in 5 patients (aged 8–27 yr), a decrease or disappearance in 2 patients (aged 36 and 41 yr), an initial decrease or disappearance followed by a late-occurring increase in 2 patients (aged 28 and 35 yr), and a new appearance in 1 patient (aged 23 yr). In addition, malignant or adenomatous changes of fundic gland polyps were not observed in any patient. Therefore, fundic gland polyposis in patients with familial adenomatosis coli/Gardner's syndrome may appear as early as 8 yr of age. In some patients there is a gradual increase in number and size of polyps, whereas in others, polyp proliferation ceases and polyps may even decrease in number and size. Our findings indicate that the fundic gland polyposis does not require prophylactic surgery and that careful periodic follow-up should suffice.

Abstract: A 52‐year‐old male was admitted to our hospital complaining of crampy abdominal pain of sudden onset, followed by bloody diarrhea. He had been prescribed cefteram pivoxil for gingivitis three days before the onset. A total colonoscopic examination on admission revealed several shallow longitudinal ulcers and erosions, with erythematous, edematous mucosa and luminal narrowing from the sigmoid to the descending colon. Barium enema showed luminal narrowing and thumbprinting in the same region. Fecal culture for Clostridium difficile (C. difficile) on admission was positive and the D‐1 toxin of C. difficile was strongly positive in stool. Two days after admission, the stool was negative for the D‐1 toxin. Biopsies taken from lesions revealed a desquamation of the surface epithelium and some crypt degeneration, abundant fibrinous exudates in the lamina propria, and mild neutrophilic infiltration. Colonic lesions had resolved by seven days after admission. This case suggests that colitis with ischemic changes may result from antibiotic‐associated overgrowth of C. difficile producing the D‐1 toxin during antibiotic treatment.

Abstract: Endoscopy and biopsy of the terminal ileum were performed in 18 patients with familial adenomatosis coli/Gardner's syndrome. All had undergone total colectomy with ileoproctostomy 7 to 249 months (average, 79.7 months) before the study. In all of these patients, endoscopic studies revealed multiple or innumerable small (less than 4 mm in diameter) polypoid lesions, all recognizable, as whitish, sessile elevations. Histologic findings of the biopsy specimens from the polypoid lesions showed tubular adenoma, with or without lymphoid hyperplasia, in nine (50 percent), but only lymphoid hyperplasia in the other nine patients. Colonic metaplasia was present in the adjacent ileal mucosa in 3 patients with ileal adenomas. The incidence (83 percent) of ileal adenomas detected 113 to 249 months after colectomy was higher than that (33 percent) found 7 to 90 months after surgery. In view of these results, endoscopy and biopsy of the terminal ileum, as well as the retained rectum, should be done periodically for postcolectomy patients with this disease

Abstract: This report describes a case of right-sided ulcerative colitis in which multiple shallow ulcers and erosion with symmetric luminal stenosis were distributed segmentally from the ascending colon to the cecum, with a skip lesion composed of superficial erosions in the right half of the transverse colon. Both the rectum and the left colon were spared at the time of onset. Biopsies taken from the lesions showed non-specific inflammation, while those from the rectum and sigmoid colon showed no abnormal findings. A 5-year follow-up study was made based on radiography and endoscopy. Other inflammatory bowel diseases, such as Crohn's disease, tuberculosis, Yersinosis, Behet's disease, and ischemic colitis were all ruled out, based on the macroscopic and microscopic findings as well as the clinical course. To our knowledge, this is the first report of right-sided ulcerative colitis that has been followed for a long period.

Abstract: A case is reported of carcinomain situ of the vermiform appendix associated with adenomatosis of the colon. Histologic examination revealed the presence of tubulovillous adenocarcinoma in an adenoma. Other lesions associated with this neoplasm were multiple adenomatous polyps in the colon and duodenum and two fibromas in the neck. Since the vermiform appendix is a part of the large intestine, it should be expected that careful examination may reveal the adenomatous involvement and may lead to the discovery of carcinomain situ.

We treated two patients with familial polyposis coli (FPC) who were found to have multiple adenomas in the ileostomy stoma, five and seven years after colectomy, respectively. These adenomas were dense and 3 to 10 mm in diameter. The adjacent ileal mucosa showed a colonic metaplasia. Ileal adenomas detected using intraoperative intestinal endoscopy at the time of colectomy were less than 2 mm in diameter and sparse in density. These findings suggest that ileal adenomas occurring after colectomy for FPC tend to increase in size and number and to resemble colonic adenomas.

Aim: Endoscopic color change of early gastric cancer was suggested to be correlated with mucosal vascularity. Using a hemoglobin index (IHb = 32 X log2 Vr/Vg) calculated from electronic endoscopic data, we investigated the mucosal hemoglobin volume and distribution of early gastric cancer. Methods: 47 intramucosal gastric carcinomas (29 differentiated carcinomas (DC) and 18 undifferentiated carcinomas (UC)) were studied. The IHb values of each of the picture elements of the linear region of interest (ROI), which was set on both cancerous and non-cancerous areas in the electronic endoscopic image, were determined. The mean IHb values of the cancerous lesion (IHb-C) and the non-cancerous mucosa (IHb-N) were calculated. The ratio of IHb-C to IHb-N was calculated and compared between the DC and UC groups. The pattern of distribution of mucosal hemoglobin was categorized, according to the wave form of the hemoglobin distribution curve on the linear ROI. Results: The median ratio of IHb-C and IHb-N in the DC was higher than that in the UC (1.21±0.082 (95 % confidence interval), 0.83±0.032, P < 0.001). The DC demonstrated three major patterns of hemoglobin distribution (i.e. mountainous, spicular and small wave-like patterns), while in the UC, the hemoglobin distribution curve showed a decreased or disappearing wave form, compared with that of non-cancerous mucosa. Conclusions: IHb could be one of the most useful markers to quantize the degree of color change in endoscopic images.