Formerly ulcerative colitis was known as a rare disease in Japan. However, the number of patients with this disease has been increasing rapidly in the decade from 1965 to 1974, and its incidence increased almost 10 times during the past 10 years. The most vulnerable ages for the onset of the disease are between 20 to 24 years and the onset age of female is 5 years older than that of male. The higher incidences of the disease are seen in urban districts including large cities with more than one million of population. As an important background factor to account for the rapid increase of the disease, it is suggested that the life-environment of the Japanese people has been westernized, especially the change of dietary habit depending on meat.
Although the etiology of the disease can not be established, various theories are proposed. At present, the autoimmune theory is the main focus for the etiology. According to this theory, the antibody-dependent cell-mediated cytotoxicity (ADCC) with the anticolon antibody mainly causes destruction of the colonic mucosa. Moreover, the involvement of the mechanisms of immediated hypersensitivity and the immune complex have also been indicated. As causes of disruption of the immune system, abnormality of the function of the thymus associated with the germinal center and the spindle cell hyperplasia has been postulated, which is being used for the treatment of the disease. Furthermore, HLA is being studied as a possible immunohereditary background. On the other hand, those who support the bacterial theory are looking into changes in the intestinal flora and the intestinal lymphnode, though no causative organisms have so far been detected. The relationship between abnormal immunity and bacterial infection is being analyzed at the same time.
For the treatment, salazosulfapyridine and adrenocorticosteroid hormone are mainly used, but the administration of these drugs has still many problems, making the therapy of the disease difficult. Therefore, development of a new therapy based on etiological and pathologic findings should be established.
As the number of patients with this disease increases, the prolonged cases might develop colon cancer. In fact, this is already a big problem in the western countries, it is considered necessary also in Japan to set up immediately measures of prevention, early diagnosis and treatment for the development of cancer based on new findings about the mechanism of onset of cancer.

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Acute hemorrhagic colitis developing after the administration of oral synthetic penicillin has been paid attention as antibiotic-induced colitis in Japan. The authors have experienced 29 cases since 1977. Antibiotics causing this disease were ABPC in 20 cases, AMPC in 2, ACPC in 1, SBPC in 1, CEX in 3, LM in 1, etc. These drugs were administered orally for a short period of 1-5 days. The onset of the disease was characterized by abdominal pain, diarrhea developing relatively suddenly followed a little later by tomato juice-like bloody diarrhea. Light fever was observed in 14 cases (48%).
The location of inflammatory lesion was confirmed by emergency endoscopy in 14 cases, It was found more proximal to the descending colon in 8 cases, and more proximal to the sigmoid in 6 cases. Mucosal edema and bleeding were also observed. In addition to this, longitudinal linear redness and narrowing of the lumen caused by dark red swelling of mucosa were observed in approximately 70% of the cases.
Histologically, hemorrhage into lamina propria mucosae was prominent, inflammatory cell infiltration was relatively mild and eosinophilic infiltration was marked.
Neither ulcer formation nor pseudomembranous plaque were observed. In order to investigate the cause of the colitis, authors performed a quantitative analysis of aerobic and anaerobic bacterial flora in 12 cases. The total number of bacteria in 1 g of bloody feces was decreased to log 7-9 cells and the value of log (anaerobic bacterial number per gram / aerobic bacterial number per gram) was less than 1.1 in most cases which was generally about 2 in healthy adults.
Klebsiella oxytoca was observed in 9 cases (75%), the number of which was log 2.75-9.30/g, and clostridin difficile was not detected at all in any case.
The clinical and endoscopic pictures of the present disease was very similar to that of transient type of ischemic colitis, and it was concluded that the cause of antibiotics-induced hemorrhagic colitis might be different from that of pseudomembranous colitis.

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A study of 177 cases of adenoma and early cancer in the colon resected under colono-scopy was done and the following results were obtained.
Approximately 12 percent of the cases were those of early cancer in the colon.
Higher risk of developing cancer was found in patients with larger adenoma and female patients. In addition, adenoma located in the right and sigmoid colon had higher poten-tiality for malignancy than the one in the rectum.
Thirty-three per cent of the cases had anothar adenoma or cancer. These results suggested that further investigation of the entire colon should be done when adenoma was detected in the recto-sigmoid area.

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Acording to the statistics of mortality in Japan, the number of patients with cob-rectal cancers have been increasing. It is possible that the mortality of cob-rectal cancer will exceed that of gastric cancer by the year 2000 As regards the histological development of cob-rectal cancer, adenoma-cancer sequence is postulated. Therefore, early detection and treatment of adenoma as a precancerous state is very important. Moreover, many cases of so-called focal cancer can be completely cured by mere polypectomy. On the basis of these facts, endoscopic polypectomy, which is more easier than surgery, has rapidly been used for cob-rectal neoplastic polyps in Japan. Authors experienced 60 cases (a total of 96 lesions) of cob-rectal neoplastic polyp from 1976 to 1981.
Results of the analysis of these cases were as follows: (1) As regards the location of the polyp, most cases were found in the sigmoid colon (38.5%). Fourteen of 96 lesions (14.6%). showed false negative findings on the films of Barium enema. Therefore, endo-scopy should at least be used up to the level of sigmoid colon concomitant with Barium enema. (2) Sessile polyp became more creased at its base, more atypical and more reddened as they grew larger. On the other hand, some of the larger pedunculated polyp unexpectedly showed less atypical pattern. (3) 10.4% of the polypectomied lesions were unable to retrieve. (4) Fourteen cases (15 lesions) of early cancers were endosopically polypectomied. Four of these 14 cases underwent surgical operation, too. (5) On polypectomy for polyps of larger than 1 cm in size, authors have been injecting Indian ink into the cob-rectal wall as far as possible, so that the surgeon can easily find the operation site later when it is necessary, and endoscopist can easily do follow-up endoscopy. (6) Half of the patients with early cancer had another neoplastic legion in the colon or rectum, so it is important to closely examine these patients with neoplastic polyps before polypectomy, and follow them periodically after polypectomy, since they seem a high risk gronp. (7) No complications have been observed so far.

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Twenty cases of primary colorectal cancer associated with gastric cancer synchronously or metachronously were operated in our hospital from 1954 to 1982. The average age of these patients was 62.6 years old and 9 cases were male. In the period from 1974 to 1982, a series of 373 patients with colorectal cancer were treated, while 777 patients with gastric cancer were treated. The incidence of colorectal cancer associated with gastric cancer was 4.0% in colorectal series, and 1.9% in gastric series respectively.
Seven of 20 patients had synchronous cancer. In 3 cases, colorectal cancer was found first and gastric cancer was diagnosed later by preoperative examination. On the contrary, in 3 cases of gastric cancer, colorectal cancer was found at the time of operation.
Thirteen of 20 patients had metachronous cancer. Seven patients were treated due to colorectal cancer initially, 6 patients were treated due to gastric cancer initially. The average interval between the first and the second primary cancer was 7 years and 5 months from the first colorectal cancer to the second gastric cancer, and 3 years from gastric can-cer to colorectal cancer. About half of the gastric cancer was early gastric cancer while in colorectal cancer, there was only one case of early cancer.

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Seven patients with advanced or recurrent colorectal cancer were treated by pelvic exen-teration for; 5 were in rectum, 1 was in the sigma and the other one was a recurrence of the rectal cancer. The patients age ranged from 38 to 75, and 6 were male and 1 was female.
Dysuria was the most prominent symptom in 6 cases, anal bleeding in 5, difficulty in defecation in 2, and perineal pain in 1 case. For the change of the urinary tract, ileal conduit was made for all patients.
Lymphadenectomy was perforamed, starting in the area around the aorta and inferior vena cava below the inferior mesenteric artery, then continuing to the external and internal iliac vessels and the presacral tissues and the obturator fossae. Lymphnode metastasis in the rectal cancer was found in ni in 1, in n2 in 3, and in n3 in 1 case, but there was no case of no. One patient has been surviving for 6 years and 5 months, and one for 2 years and 3 months, and other one for 11 months, but all the other patients died between 6 and 18 months. The symptoms including pain, fecal odor, and rectal bleeding were palliated in all patients.
Complete clearance of advanced colorectal cancer by pelvic exentration is indicated after proper selection of the patients.

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The results of sphincter-preserving method for the rectal carcinoma was evaluated and the cases of the post-operative local reccurence were analyzed.
A total of 216 cases were operated during these 7 years at Osaka National Hospital.One hundred and seventy-eight (82.8%) of these 216 cases were completely cured by resection. Ninety-five cases, or 45.7 per cent of the resected rectal carcinomas underwent sphincter preserving operations. They were 76 cases of anterior resection, 11 pull-through operations and 8 local excisions.
Local reccurences were observed in 4 cases after the curative resection, and they were 3 cases of the anterior resection and 1 of the local excision. The second laparotomy were done in 3 cases of 4 local reccurence cases, and all of them had complete cure by resection. The surgical implantation of the viable cancer cells to the suture-line and the residue of the invisible cancer tissue were assumed as the probable causes of the local reccurence after the anterior resection of the rectal carcinomas.

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One hundred and eighty patients with duodenal ulcer were operated during 11 years from 1971 to 1981. Three different types of procedure were performed for these 180 patients Vagotomy-drainage for 67 patients, gastrectomy only for 57 patients and vagotomy-an-trectomy for 56 patients.
The average length of hospitalization in patients undergoing vagotomy-drainage was 43 days, and this was significantly shorter than 52 days for patients undergoing gastrectomy (P<0.05). The average time required for vagotomy-drainage operation was 137 minutes and this was significantly shorter than 154 minutes required for vagotomy-antrectomy. There were no statistically significant differences as to the degree of intraoperative bleeding among three groups.
The technique of vagotomy-drainage reduced BAO by a mean of 85.6% and this was significantly lower than the other two procedures (P<0.05). This technique also had a mean of 84.9% reduction for MAO and a mean of 83.4% reduction for PAO and, the dif-ferences were significantly lower compared with vagotomy-antrectomy.
Postoperative complication was seen in 22.3% of patients undergoing vagotomy-drainage. There were no statistically significant differences in postoperative complications among three procedures, but postoperative bleeding and pancreatitis occurred frequently following the technique of vagotomy-drainage.
The rate of recurrence following the technique of vagotomy-drainage was as high as 10.4%, but this did not have statistically significant differences at P=0.05 level compared with the other two procedures. Dumping symptoms were noted in 13.2% after vagotomy-drainage and no statistical differences were found among all three surgical procedures.
After vagotomy-drainage, 81.5% of patients had a good and excellent clinical results (Visick grade I + II). but the difference did not reach statistical significance.
We concluded that the procedure of vagotomy with drainage for an duodenal ulcer could be performed with safety in most patients and was an effective operation as resective surgery. But vagotomist should master accurate techniques of vagotomy and learn accurate vagal anatomy.

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Selective proximal vagotomy (SPY) was applied to 64 patients with duodenal ulcer dur-ing the past 6 years. Their ages ranged from 19 to 73, and there were 53 male and 11 female patients. Sixty cases followed-up for more than 6 months were evaluated; 30 patie-nts underwent SPY, 7 SPY plus resection of ulcer and 23 SPY plus pyloroplasty (of these 15 Judd pyloroplasty and 8 Finney pyloroplasty). There were no operative deaths and postoperative complications showed that bleeding occurred in 1 case, a minor wound infection in 1, and an abnormal liver function test in 1.
The mean reduction rate of basal acid output was 78.1±14.1 and that of peak acid output was 83.3±11.1. Within 1 year after SPY with or without pyloroplasty, symptoms including belching (27.3%), epigastric fullness (27.3%), and dumping (5.5%) developed. One year after the operations, the incidence and severity of these symptoms decreased ; belching (20.8%), epigastric fullness (18.8%) and dumping (2.1%). The overall clinical evaluations showed that 94.6% of the patients had Yisick I and II, 3.6% Yisick III, 1.8%Visick IV. Only one patient developed recurrent ulceration.
Thus, SPY is generally suitable for duodenal ulcer without causing serious side effects, although long-term follow-up studies are required to determine the reduction rate of acid output and the recurrence rate of ulcer.

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In May 1981, a 14-year-old boy was admitted to our hospital with the clinical diagnosis of intussusception of the ileo-cecal region. The tentative diagnosis at the operation was the tumor of the terminal ileum. The histological diagnosis was malignant lymphoma. After admission, barium enema and colon fiberscopy revealed small lymphoid polyposis extending throughout the colon. This small lymphoid polyposis resembled “Multiple Lymphomatous Polyposis of the Gastrointestinal Tract”(M.L.P.)originally reported by Comes in 1960. The first report of the disease in Japan was by Narui and Nakamura in 1979, a case of benign M.L.P. Although it is not yet certain that our case is an another case of M.L.P., we think it worthwhile to report our case resembling the M.L.P.. So far, there has been no evidence for recurrence for a year and three months following the operation. We would like to follow-up this patient and make a final diagnosis.

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A 57-year-old female was admitted to the hospital 5 years after cholecystectomy with the chief complaints of abdominal pain and nausea.
Upper gastrointestinal series showed a smooth filling defect in the descending limb portion of the duodenum. Upper GI scope's diagnosis was duodenal polyp. The patient underwent re-operation. The duodenum was opened and the orifice of the common duct was covered by a small tense cyst. The cyst was punctured and full of bile. The diagnosis of choledochocele was made and the duodenal luminal portion of the cyst was excised. The patient was kept under observation for one year. She had no recurrence of pain or nausea.
Choledochocele is a very rare disease. There was only 4 cases in Japanese literatures.

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A 56-year-old man was admitted to the hospital because of abdominal distension, nausea, vomiting and diarrhea. During the three months before admission he lost 10 kg in weight.
Physical examination on admission showed markedly distended abdomen with a fluid wave, but no hepatic enlargement. Analysis of the ascitic fluid showed that it was transudate, with no evidence of malignancy or infection. An upper gastrointestinal with smallbowel study revealed marked dilatation of the jejunum. The final diagnosis was not made. He had persistent diarrhea and vomiting, and his condition gradually deteriorated.
An autopsy revealed marked fibrous contraction with stenosis of the small intestine at the region of about 170 cm distal from the fossa of Treitz.
Microscopically the most prominent feature was intense thrombophlebitis of the superior mesenteric vein and the portal vein.
On the basis of these results, the stenosis of the bowel was considerted to be due to infarction of the small intestinal veins resulting from thrombophlebitis.

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A case of diffusely infiltrating type of primary carcinoma of the sigmoid colon seen in a 47-year-old man was reported.
He complained of a 2 months-history of increasing abdominal pain and small stool in size. Barium enema study showed a narrowing segment involving the sigmoid colon. Colonofiberscopy demonstrated the finding of cobble stone change and endoscopic biopsy revealed poorly differentiated adenocarcinoma. Non-curative colectomy was performed, because of metastasis of para-aortic lymph nodes. Resected specimen showed stenosing lesion of 13 cm in length, with marked thickning of the wall of the sigmoid colon. The mucosal surface was granular with superficial ulceration. On microscopic examination the tumor was basically consistent with the findings of poorly differentiated adenocarcinoma mixed with signet ring cells, and was invaded with marked lymphangiosis carcinomatosa.
Forty eight cases of diffusely infiltating or so-called linitis plastica type of primary carcinoma of the colon and rectum were reported in Japanese literatures and the clinicopa-thological features were reviewed.

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A case of anisakiasis resulting in ileus was reported. The patient was a 41-year-old male, who liked to eat raw fish. On the day of hospitalization, he still complained of nausea, vomiting and abdominal fullness. After 3 days of intubation of a long tube, these symptoms and signs of ileus disappeared successfully. The correct diagnosis was not made un tila granulomatous mass situated in 80 cm from the terminal ileum was resected. The larvae appeared to burrow into the wall of the ileum to produce an eosinophilic phlegmonous mass. Therapeutic methods were discussed in the text.

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Purpose: Intestinal flora at the time of diarrhea and after recovery from diarrhea were investigated in order to understand the symptom of diarrhea in infants, since it is quite often encountered in routine prediatric clinic.
Subjects: The subjects were 25 infants with the age of 3 years or younger (group A: five boys and four girls under 6 months of age, group B: four boys and five girls fromsix months to under one year of age, and group C: three boys and four girls from 1 to three years of age). All of these were outpatients or hospitalized because of diarrhea.
Methods: The feces of the infants were collected in an anaerobic vessel, kept at 4°C and sent to the laboratory. Anaerobic and aerobic cultures were performed as soon as possible.
Results: The bacterial counts measured in the feces were expressed as the logarithmic values of the bacterial counts per gram of feces. The total counts were 9-11 in both the diarrheal stools in the acute period and the feces in the recovery period after treatment, and the contents of aerobic bacteria were low, i.e. 2-3 columns or more. Among the anaerobic bacteria, the focus was on bacilli in particular and changes were observed in bif idobacterium, lactobacillus and bacteroides. Bifidobacterium showed values of 3.5 in group A, 1 in group B and 1.8 in group C in the acute period and 5.1 in group A, 6.7 in group B and 5 in group C in the recovery period after treatment. The bif idobacterium increased as the properties of the feces improved. In the case of lactobacillus, the values were 1.8, 4.4 and 2.8 in the acute period and 4, 6.7 and 4.8 in the recovery period after treatment in groups A, B and C respectively. The numbers also increased as the prop-erties of the feces improved. However, bacteroides showed values of 9.6, 9.7 and 9.6 in the acute period and 9.7, 10.3 and 9.4 in the recovery period, respectively. The values tended to remain constant with no relation to the properties of the feces. In the group in which pantethine was administered, the bif idobacterium tended to increase more rapidly and the recovery from diarrhea was more rapid than in the non-administered group.
Discussion : The fecal flora in cases of infantile diarrhea showed decrease in bifid-obacterium and lactobacillus in the acute period, but these bacteria tended to increase as the fecal properties improved. However, the number of bacteroides remained constant, no matter what the fecal properties were. In the group in which pantethine was admin-istered, an increase in propagation of bifidobacterium showed the efficacy of this drug in the recovery from diarrhea.

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