Clinicopathologic evaluation of the trend toward histologically poor differentiation with submucosal invasion in superficial early colorectal adenocarcinomas

We examined differences in the degree of differentiation in intramucosal and submucosal areas of involvement in early colorectal adenocarcinomas of 131 patients and compared these findings with tumor morphology. In addition, K-ras and p53 protein expression was determined in cases where poorly differentiated adenocarcinoma was detected in the submucosa. We identified 6 patients with both intramucosal differentiated (well-to-moderately differentiated) adenocarcinoma and submucosal poorly differentiated adenocarcinoma (MwSp). The morphological tumor type was superficial in all MwSp cases. The observed MwSp adenocarcinomas had a significantly higher frequency of lymphatic invasion than the more common superficial type of adenocarcinoma. Genetic analysis of these MwSp lesions was carried out using the polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) method to detect the presence of K-ras codon 12 point mutations, and an immunologic staining technique was used to identify the presence of p53 protein overexpression. The K-ras mutation rate was 33.3%, and the p53 overexpression rate was 66.7% for the MwSp adenocarcinomas. Our findings suggest that the rapidly reduced histologic differentiation observed in some of these superficial colorectal adenocarcinomas may play a role in their higher degree of invasiveness.

[Post-genome challenges against inflammatory bowel diseases]

Advancement of genome analysis might give great impact to the treatment of inflammatory bowel diseases(IBD). IBD patients are treated by sulfadrugs, steroids and anti-immune drugs. For difficult cases, leukocytapheresis, beclomethasone dipropionate, anti-TNF therapy, anti-LTB4 therapy and other new methods are applied. Developing epoch-making drugs will be achieved by finding new molecular targets. Histologic identification of dysplasia is important in the surveillance of long-standing ulcerative colitis. The molecular diagnosis is required for the distinction of dysplasia from the regenerative inflammatory changes. P53 immunostaining have been proved useful. Various molecular targets will be taken into discussion as additional procedures. Recent genome analysis have revealed some genetic factors contribute to pathogenesis of IBD, which are HLA, IL4, MUC3, IBD1 locus, IBD2 locus and so on. More information about genes concerning IBD will be provided by analyzing dense SNP map using DNA tip. They will open the way to the tailored therapy.

[Medical therapy in ulcerative colitis]

Salazosulfapyridine(SASP) and 5-aminosalicyclic acid(5-ASA) are useful in the therapy of mildly to moderately active ulcerative colitis. 5-ASA lacks sulfa moiety of SASP and is associated with a decreased incidence of side effects. In patients with moderate or severe ulcerative colitis, glucocorticoids which may be given in conjunction with SASP or 5-ASA are beneficial in producing remission. Proctitis or left-sided colitis is effectively treated with glucocorticoid enemas. If symptoms are refractory to outpatient management, the patient should be hospitalized and given initial therapy with glucocorticoids. Total colectomy(ileo-anal anastomosis; IAA et al) must be considered for acutely ill patients not responding to intensive medical therapy. Early surgical consultation is necessary in severely ill patients.

[The study of genetic changes in colorectal cancer accompanied with ulcerative colitis]

The usefulness of gene information was studied when used in conjunction with a morphological diagnosis of either dysplasia or carcinoma that later develops into ulcerative colitis (UC). The cases investigated consisted of those operated on for UC with carcinoma complications and those operated on for UC over 7 years previously without carcinoma complications. Ras and DCC were examined for the presence of any point mutations in codon 12 and polymorphism in codon 201 using the PCR-RFLP method, while p53 was also studied immunohistologically. A mutation in ras was found in 25% of the UC-IV cases and also in 17% of the UC-III cases, while no mutation at all was found in the UC-I and UC-II cases. p53 showed a high rate of positivity in the UC-IV and UC-III cases with carcinoma complications, while it was negative in all cases in the control group cases. Gly in DCC codon 201 was also found in many cases including the control group. This study demonstrated that a gene aberration can thus influence the pathophysiology and cancerization of UC and therefore the p53 findings were thus considered to be useful in the morphological diagnosis of dysplasia and carcinoma.

[Vitamin K deficiency syndrome caused by antituberculous agents]

Vitamin K deficiency caused by antituberculous agents was examined in clinical patients and in experimental rats. When antituberculous agents given to the patients who had only total elental diet because of small intestinal dysfunction, a marked increase in plasma PIVKA-II and a decrease in thrombo-test value were observed. These changes were quickly normalized by administration of vitamin K, despite of succeeding or stopping of antituberculous agents. In rat experiments, effects of four agents (ethambutol, isoniazid, paraaminosalicylate, and rifampicin) on prothrombin time were studied. Among these agents, only rifampicin prolonged prothrombin time. This prolongation depended on drug doses and duration of administration. In addition to this hypoprothrombinemia, an increase in plasma PIVKA-II was also observed, and these changes were normalized within 24 hours of vitamin K administration. These data suggest that rifampicin inhibits vitamin K epoxide reductase interfering re-use of vitamin K and caused vitamin K deficiency in patients with total elental diet.

Differential expression of platelet-derived endothelial cell growth factor (thymidine phosphorylase) in nonpolypoid and polypoid lesions of the colon

To clarify the relationship between angiogenesis and the early development of colon cancer, expression of platelet-derived endothelial cell growth factor (PD-ECGF), a known angiogenic and endothelial cell chemotactic factor, was examined in 119 human colon premalignant adenomas and colon carcinomas. Localization of PD-ECGF was assessed by immunocytochemistry in 70 nonpolypoid growth (NPG) lesions that represented 29 carcinomas (NPG carcinomas) and 41 adenomas (NPG adenomas) and 49 polypoid growth (PC) lesions that included 15 carcinomas (PG carcinomas) and 34 adenomas (PC adenomas). Simultaneously, the expression of tranforming growth factor alpha (TGF alpha) and epidermal growth factor receptor (EGFR) were examined in serial sections from these lesions. Twenty (68.9%) of 29 NPC carcinomas and 20 (48.7%) of 41 NPC adenomas exhibited positive staining for PD-ECGF, whereas 15 (100%) of 15 PG carcinomas and 27 (79.4%) of 34 PG adenomas expressed PD-ECGF. There was a statistically significant difference in the frequency of PD-ECGF expression between NPG adenomas and PG adenomas (p<0.01). In addition, the incidence of PD-ECGF expression was higher in PG carcinomas than in NPG carcinomas (p<0.05). Positive staining for TGF alpha and EGFR was detected in 14 (48.2%) and 10 (34.5%) of 29 NPG carcinomas, respectively, whereas, 17 (41.5%) and 13 (31.7%) of 41 NPG adenomas expressed TGF alpha and EGFR, respectively. A significant trend for coexpression of PD-ECGF and TGF alpha was detected in either NPG adenomas (p<0.05) or PG adenomas (p<0.01). These data demonstrate that PD-ECGF may be involved in the early stages of colon cancer development during the adenoma-carcinoma transition and additionally that angiogenesis which may be induced by PD-ECGF and/or TGF alpha could play an important role of colon cancer development.

Colonoscopic diagnosis of dysplasia and early cancer in longstanding colitis

Five colitic cancers were detected among 40 patients with longstanding total colitis. The colitic cancers did not show the common polypoid or ulcerated appearance in the early stage, often being flat or plaque-like. It was not easy to detect these lesions endoscopically, and it was often impossible to do so radiologically. The flat or plaque-like early cancers were often surrounded by granular and/or red mucosa. We believed that the colonoscopic detection of this colitic cancer and dysplasia was difficult because: (1) the morphology of the lesions was difficult to determine, (2) the background mucosa was not normal. When the lesions were small, it was more difficult to detect them on the colitic mucosa than on the normal mucosa. The contrast between the lesion and the background mucosa was not clear in the latter condition. In surveillance colonoscopy (using a TV colonoscope) for longstanding ulcerative colitis, careful scrutiny throughout the large intestine is required to detect colitic cancers and dysplasia at an early state.

Multiple abdominal telangiectases and lymphangiectases. A limited form of Osler-Weber-Rendu disease?

We describe a 23-year-old man with protein-losing enteropathy, iron deficiency anemia, and recurrent gastrointestinal bleeding. The patient eventually developed disseminated intravascular coagulation, portal vein thrombosis, and extensive small bowel infarction. The autopsy showed multiple telangiectases in the intestines, mesentery, liver, gallbladder, renal pelves, and diaphragm. In addition, lymphangiectases were found in the retroperitoneal space, intestines, and liver. These lesions appeared to have been the cause of the gastrointestinal bleeding and the protein-losing enteropathy. The case most likely represents Osler-Weber-Rendu disease without the usual manifestations in the skin and oral-nasal cavities.

Expression of p53 protein related to human papillomavirus and DNA ploidy in superficial esophageal carcinoma

We examined the p53 protein and human papilloma virus (HPV) by immunohistochemistry and DNA ploidy by cytofluorometry in paraffin-embedded esophageal carcinoma tissue specimens. Sixty-one patients with superficial esophageal carcinoma were operated on between 1983 and 1991 without any prior treatment. Immunostaining of the anti-p53 protein antibody (CM1) was positive in 32 carcinomas (52%). Patients with p53-positive tumors had a poorer outcome than those with p53-negative tumors (P < 0.05). In addition, patients with p53-positive tumors did not have any characteristic site of relapse. Only 5 of the 61 patients (8.2%) had HPV-positive tumors. One of these 5 carcinomas expressed both p53 protein and HPV. Three patients with HPV-positive tumors which had invaded the submucosal layer died of relapse. A determination of DNA ploidy revealed 30 patients with aneuploid tumors, 13 with polyploid tumors and 18 with diploid tumors. The outcome of the patients with aneuploid tumors was worse than that of the patients with diploid tumor (P < 0.05). p53 protein expression was not associated with DNA ploidy; however, the 16 patients who had both p53-positive and aneuploid tumors had a worse prognosis than patients with p53-negative and aneuploid tumors (P < 0.01). These findings suggest that p53 protein expression in conjunction with DNA ploidy may be a useful indicator in evaluating the prognosis of patients with superficial esophageal carcinoma.

Minute flat depressed neoplastic lesions of the colon detected by contrast chromoscopy using an indigo carmine capsule

Thirty-seven diminutive flat depressed neoplastic lesions of the colon, smaller than 5 mm, were detected by contrast chromoscopy using an indigo carmine capsule and subsequently removed by endoscopic mucosal resection. We investigated the endoscopic, macroscopic, and histologic characteristics of these lesions and also evaluated the usefulness of chromoscopy and the magnifying endoscope for detecting this type of lesion. The lesions were classified into two types according to the measured height of the histologic sections: 28 lesions were truly flat depressed and the remaining 9 lesions were flat elevated. Of the 37 lesions, 18 were adenomas with mild atypia, 14 with moderate atypia, and 5 with severe atypia. The flat depressed lesions included 12 with mild atypia, 11 with moderate atypia, and 5 with severe atypia. No invasive carcinoma was present in either type, and no adenoma with severe atypia was identified in any of the flat elevated lesions. The overall rate of severe atypia was 13.5%; the rate of severe atypia for the flat depressed type was 17.9%, which is approximately 14-fold greater than that of ordinary diminutive polypoid adenomas (1.3%). The detection of these lesions was facilitated by the use of indigo carmine dye, which clearly demonstrated the mucosal irregularities. The frequency of detection of these lesions was increased four to five times with a magnifying endoscope, as occurred in nearly 10% of all of the patients examined. These data suggest that the finding of endoscopically minute flat depressed neoplastic lesions is not at all uncommon when examination is meticulously performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative clinicopathological and immunohistochemical study of ras and p53 in flat and polypoid type colorectal tumours

Mutations in oncogenes and tumour suppressor genes may have an important oncogenic role. Although flat type tumours have been frequently detected in recent years, ras and p53 expressions have not been studied in these tumours. Using a monoclonal and polyclonal antibody to the ras p21 and p53 product, paraffin wax embedded sections of 98 colorectal tumours (43 cases of the flat type colorectal tumour and 55 cases of polypoid type tumour) were stained using the immunoperoxidase technique. Staining was evaluated by light microscopic examination. Positive staining rate of ras p21 for the flat type was 0%; for the polypoid type, it was 60% in cancer with submucosal invasion, 82% in adenoma with high grade dysplasia, and 0% in adenoma with low grade dysplasia. The positive staining rate of p53 for the flat type was 50% in submucosal cancer, 9% in adenoma with high grade dysplasia, and 0% in adenoma with low grade dysplasia. For the polypoid type, it was 40% in submucosal cancer, 12% in adenoma with high grade dysplasia, and 0% in adenoma with low grade dysplasia. The intermediate staining rate of p53 in the polypoid type was 20% in submucosal cancer and 41% in adenoma with high grade dysplasia. It was seen that p53 was commonly expressed in both flat and polypoid lesions, p21 was not expressed in flat lesions, whereas it was commonly expressed in polypoid neoplasms. In the flat type cancer, a genetic change different from that of the polypoid type cancer is suggested.

Non-involvement of ras mutations in flat colorectal adenomas and carcinomas

Ras gene mutations occur relatively early during colorectal tumor development and have been observed in 40-50% of malignant colorectal tumors. Advances in endoscopic techniques have made it possible to detect small, flat colorectal tumors that could not be detected by standard examinations. To determine whether ras gene mutations are also involved in the genesis of small, flat colorectal tumors, we examined ras point mutations in 34 cases of small polypoid or flat elevated colorectal tumors (32 adenomas, 2 carcinomas) and in 26 cases of small, flat colorectal tumors (13 adenomas, 13 carcinomas) by means of the polymerase chain reaction (PCR) and dot-blot hybridization. Ras gene point mutations were observed in 16 of the 34 tumors of the former type (47%), but in none of the 26 tumors of the latter type, even though the grade of dysplasia was severe in the flat tumors. Our results suggest that different genetic pathways for tumor progression may exist for polypoid and for flat colorectal carcinomas.

Prevalence of primary sclerosing cholangitis and other liver diseases in Japanese patients with chronic ulcerative colitis

An association between primary sclerosing cholangitis (PSC) and chronic ulcerative colitis (CUC) is well known in Western countries, but there have been no reports on this association in Japan. We reviewed 163 consecutive CUC patients (91 males and 72 females) diagnosed from 1984 to 1990 at Tokyo Women's Medical College. Abnormal liver function tests were found in 42 patients with CUC (25.8%), but chronic liver disease was only diagnosed in seven patients (4.3%). Among these seven patients, there were four with PSC, one with small-duct PSC, one with transfusion-associated chronic hepatitis and one with Type B liver cirrhosis. No relationship was found between the documented colonic manifestations of CUC and the presence of PSC. The four PSC patients did not have a longer history of CUC at the time of diagnosis of PSC than CUC patients without PSC. At the time of PSC diagnosis, two patients were asymptomatic, one presented with right upper quadrant pain, and the other had fatigue. Three patients were diagnosed as having CUC before the onset of PSC (range 2-13 years), and the other patient had both diseases simultaneously. All four had a good prognosis. Thus PSC was the most common chronic liver disease associated with CUC in our series, and it was present in all our CUC patients with alkaline phosphatase levels exceeding twice the upper limit of normal and mild transaminase elevation.

Expression of oncogene products and growth factors in early gallbladder cancer, advanced gallbladder cancer, and chronic cholecystitis

The expression of oncogene products and growth factors (epidermal growth factor, transforming growth factor-beta, erbB-2, ras p 21, and c-myc) in gallbladder cancer and chronic cholecystitis was measured by immunohistochemical staining on paraffin-embedded serial sections. Expression of these products was graded according to staining intensity in an area of positively stained cells. This study reports the detection of oncogene products and growth factors in cholecystitis as well as in early and late gallbladder cancer. The multiexpression of oncogene products and growth factors was greater for both gallbladder cancer groups as compared with the cholecystitis group. The percentage of epidermal growth factor positivity diminished with increased proportion of interstitial tissue and, conversely, the percentage of transforming growth factor positivity increased with increased proportion of interstitial tissue. The proportion of ras positivity was significantly greater in both early and advanced cholecystic cancer as compared with cholecystitis, but also was considerable even for cholecystitis. These results suggest that various oncogenes may have significant roles in gallbladder cancer and that collagen synthesis is reduced by epidermal growth factor and enhanced by transforming growth factor-beta.

Extensive varices of ileocecum. Report of a case

A man was admitted to our hospital because of intestinal reddish bleeding. Colonic varices were found at the cecum by colonoscopy. Angiography of the superior mesenteric artery showed that blood vessels were scant from the end of the ileum to the ascending colon. An operative view revealed the varices, but there was no trace of the ileocecal vein. This case, presenting a deficit of the ileocecal vein, indicated that the blood flow could not return via the ileocecal vein, and therefore there was an outflow through the varices to the surrounding intestine or abdominal veins. Such a case is probably unrepresented in the literature because it was caused by the total deficiency of the ileocecal vein and it was in the right colon.

Significance of serum sialic acid in patients with Crohn's disease

Serum sialic acid was measured to evaluate the activity of Crohn's disease. The sialic acid levels of patients with Crohn's disease in remission (CRP 0.0 mg/dl) were significantly higher than those of healthy subjects and postoperative patients with Crohn's disease. In patients in remission, serum sialic acid was significantly correlated with hemoglobin, hematocrit, platelet, and rapid turnover protein. Correlations with platelet, retinol-binding protein, and prealbumin were especially strong. From these findings, it was concluded that serum sialic acid level provides a useful index of the activity of Crohn's disease.

Immunohistochemical study of epidermal growth factor and transforming growth factor-beta in the penetrating type of early gastric cancer

We report that the penetrating type of early gastric cancer (PEN) is a specific type of early gastric cancer and that the poorly differentiated PEN type could be considered an initial lesion of linitis plastica-type cancer. We performed an immunohistochemical study to clarify the role of growth factors (epidermal growth factor [EGF] and transforming growth factor-beta [TGF-beta]) in the PEN type of early gastric cancer. The results indicated that the PEN type of early gastric cancer has a high growth capacity. Moreover, it was suggested that EGF was involved in its specific infiltrative growth and that both EGF and TGF-beta were involved in its specific scirrhous growth. From these findings, it was assumed that the immunohistochemical staining of EGF and TGF-beta in endoscopic biopsy specimens was useful for the diagnosis of the PEN type of gastric cancer and also for the diagnosis of the initial lesion of linitis plastica-type gastric cancer.

Endoscopic mucosectomy for early gastric cancer using modified strip biopsy

We present a modification of strip biopsy (SB), one of the endoscopic treatment modalities for early gastric cancer. Using a side-viewing endoscope and a special electrocautery snare, we treated 6 patients with early carcinoma of the intestinal type with this modified strip biopsy (MSB). All tumors could be completely resected and 5 patients were not operated on: All 5 remained tumor-free at follow-up of at least one year. These results compared favorably with a historical control group of 17 patients with early gastric cancer treated with conventional strip biopsy. We therefore recommend applying our new method of MSB especially in the intestinal type of early gastric carcinoma; these preliminary data however, need confirmation in larger trials.

[The way of submucosal invasion of superficial sm cancers]

Nineteen superficial sm cancers were studied as for their way of submucosal invasion. The materials were obtained either by colonoscopic polypectomy or by surgical operation. The following were concluded: 1. The ways of submucosal invasion can be classified into three. There is a special type of superficial early cancer which penetrate the mucosal muscle at one point and reaches the deeper layer linearly or show expansive growth at the submucosal layer. 2. The speed of submucosal invasion is either earlier (at the size around 5 mm), or slower (over 15 mm). 3. There are no significant difference in the way of submucosal invasion between IIa and IIc subclasses of superficial early cancers. That is one supporting evidence that there is no fundamental difference among subclasses of shapes of superficial early cancers. 4. One reason why the diagnosis of superficial cancers is difficult is that not a few superficial cancers undergo early morphological change (to sessile form) due to massive submucosal invasion.

Endoscopic appearance of the colon and small intestine of a patient with hemorrhagic enteric graft-vs.-host disease

Endoscopic appearance of the gastrointestinal tract of a patient with severe hemorrhagic enteric graft-vs.-host disease (GVHD) is presented. A 29-year-old man with chronic myelogenous leukemia suffered from severe enteric GVHD after allogeneic bone marrow transplantation. Endoscopy showed hemorrhagic ulceration of the upper jejunum, terminal ileum, and colon at the onset of melena. Sections of biopsies were compatible with acute GVHD. Repeat endoscopy showed gradual healing of the lesions after steroid pulse and antilymphocyte globulin therapy, but the patient died of cytomegalovirus pneumonitis 14 months later. Autopsy revealed submucosal fibrosis of the small intestine and colon.

[Precancerous lesions of the colon and rectum]

Adenomatous polyp, adenomatosis coli and dysplasia in the inflammatory bowel disease are noted as precancerous lesions. 1) Adenomatous polyps are easily found by colonoscopy as protruded lesions and diagnosed by histopathological study. 2) Adenomatosis coli is easily diagnosed by barium enema and colonoscopy. Adenomatosis coli is accompanied with cancer frequently. As soon as adenomatosis coli is detected, we recommend surgery. IRA (total colectomy and ileorectal anastomosis) is mainly undertaken for adenomatosis coli. But when there are many adenomas in the rectum, we recommend IAA (total colectomy, rectal mucosectomy and ileo-anal anastomosis). 3) Diagnosis and therapy of dysplasia accompanied with the inflammatory bowel disease (ulcerative colitis, tuberculosis, Crohn's disease) remain unclear. There is a deep relationship between cancer and dysplasia and inflammation.

Follow-up after polypectomy of colorectal adenomas. The importance of total colonoscopy

Five hundred eighty-two patients with colorectal adenomas or early cancers were polypectomized from 1974 to 1985. In 100 patients, total colonoscopy was performed more than twice after the initial polypectomies. These patients were divided into three groups: group A patients underwent total colonoscopy at 1-year intervals; group B patients underwent total colonoscopy at 2-year intervals, group C patients underwent total colonoscopy at 3-year or more than 3-year intervals. The frequency and location of newly developed adenomas were investigated. The detection rate for new adenomas was 13% in group A and 50% in group B; thus, there was a significant difference between group A and group B (P less than 0.01). The transverse colon is the only segment where the topological proportion of newly developed adenomas increased in comparison with that of index adenomas (P less than 0.05). The detection rate for new adenomas was significantly higher in patients who had carcinoma in situ at the time of initial polypectomy (P less than 0.05). Questionnaires about colonoscopy and colonic adenomas were therefore mailed to the patients who were lost to follow-up after the polypectomy.

[Endoscopic diagnosis of early colon cancer]

Early colon cancer are divided into pedunculated (with constriction) group and broad-based (without stalk) group. The former is more of ten diagnosed, particularly in the earlier cancers (m cancer). However, the possibility that broad-based group may be missed during the endoscopic examination cannot be neglected. Colonoscopy should be performed with scrupulous care not to miss small broad-based lesions. They are frequent in the rectum and the right-sided colon. Flat or depressed type of early cancers have come to be diagnosed owing to the effort of colonoscopist and the improvement of the scope. Particularly, the introduction of TV scopes into the field of colonoscopy has accelerate the trend.

Crohn's disease in the esophagus--report of a case

A case of esophageal Crohn's disease is described. Crohn's lesion was observed in the lower esophagus, and sarcoid-like granulomas were found in the biopsied specimen. A clinical consideration of this phenomenon is presented.

Esophageal lesions in intestinal Behçet's disease

Esophageal lesions are rarely seen in patients with intestinal Behçet's disease. Three patients with esophageal lesions (dissection of esophageal mucosa, esophageal ulcer, esophageal varices) were observed among 15 patients with intestinal Behçet's disease or non-specific simple ulcer (1974-1984). Two-thirds of these fifteen patients had fully developed or suspected Behçet's disease, and one-third had no symptoms typical of Behçet's disease. They are classified as non-specific simple ulcer. The average age of the 15 patients was 43 years, all patients but one were male. The recurrence rate after surgical treatment was 70%, that of medical treatment was 90%.

Localized colitis cystica profunda of the sigmoid colon

Localized colitis cystica profunda (CCP) is a rare condition found in the rectum. Localized CCP of 70-year-old man was found in the sigmoid colon, it was accompanied by a cancer in the ascending colon and an adenomatous polyp with focal malignancy in the sigmoid colon. Colonoscopically, the tumor appeared like a submucosal tumor.

Polypectomy of a large juvenile polyp in the ascending colon

A large juvenile polyp in the ascending colon of a 5-year-old boy was successfully polypectomized . The boy often had rectal bleeding, and anemia was known. Transection was necessary to prevent bleeding and anemia.

Changes in dietary fiber intake among Japanese in the 20th century: a relationship to the prevalence of diverticular disease

In view of the fact that Japanese dietary patterns have been undergoing rapid "Westernization," in part characterized by decrease in fiber, we assessed dietary and crude fiber content in the Japanese diet using food consumption tables for the period from 1911 to 1980, and studied the trend in the reported prevalence of diverticular disease of the colon. Fiber content declined in diphasic pattern: the first decline, which probably had started in the late 19th century, progressed until the Second World War. Although records during the war period were unavailable, the high fiber content of the Japanese diet in the period immediately after the war reflects the tendency to supplement rice with more fiber-rich cereals, and to increase the amount of rice through reduced polishing during the war time. The second decline in fiber content in the Japanese diet, which started in the 1950s and progressed throughout the period of "high economic growth," was mainly due to the decrease in cereal consumption. The changes in crude fiber content in the Japanese diet after the Second World War resemble the pattern of rapid decline noted in the United States during the 1930s to the 1950s. The prevalence of diverticular disease in both countries also shows sudden steep upward turns during the period between 1930 and 1950 in the United States and the late 1970s in Japan, suggesting the presence of threshold level(s) of fiber intake for the effective prevention of diverticular disease. The prevalence of diverticular disease is still relatively low in Japan. However, if the current dietary trend continues, it may rise to a level currently found in the "Western" countries in the coming few decades.

Peutz-Jeghers polyp with several foci of glandular dysplasia: report of a case

A case of Peutz-Jeghers syndrome in which one colonic polyp showed many foci of glandular dysplasia is reported. Peutz-Jeghers polyps are considered to be hamartomatous, and their malignant potential has been considered doubtful. This case is valuable because foci of glandular dysplasia existed within hyperplastic glands. Glands of Peutz-Jeghers polyps are proliferative in nature, and therefore it is not surprising that there are areas of glandular dysplasia and of cancerous change.

Pediatric colonoscopy

With the improvement of instruments, colonoscopy has become applicable also for children. During the past 10 years, pediatric colonoscopies were performed 83 times on 45 infants and children. The value and indications in pediatric colonoscopy are described here. Pediatric colonoscopy is a very significant complement to the conventional clinical and radiologic examinations.