The structural organization of the epithelium at the middle part of human anal sinus was studied with electron microscope. The observed area is the portion covered by the stratified squamouns epithelium, stratified cuboidal or columnar epithelium, simple cuboidal epithelium and pseudostratified columnar epithelium. In the region covered by stratified squanous epithelium, the epithelial cells are similar to the cells of the transitional skin in human anal canal, but its cytoplasm contain well developed organelles. Especially glycogen granules and Odland bodies appear in the cells of granular layer and the upper part of spinous layer. In granular layer, two kinds of keratohyalin granules, round and irregular, are observed. In the surface layer, keratinization does not always progress uniformly. In the regions devoid of stratified squamous epithelium, most of differentiated cells contain a variable number of secretory granules in the supranuclear portion, but basal cells and some of cells in the surface layer do not have such granules. Their granules are considered to be produced from Golgi apparatus and they contain PAS-positive material. Of free surface of the cells in these area, there are found a few irregula short microvilli. They are coveredd filamentous or particular surface coat. Endocrine cells are generally columar in shape and are scattered among the other epithelial cells. These are usually in direct contact with the basement membrane and the apex of cells almost do not reach to the free border. Endocrine cells appear in the region devoid of stratified squamous epithelium and they have no relation to the crypt or gland. Abundant round granules with variable electron density, measuring about 130-150 mμ in dia-meter, are located in the infranuclear portion of the cell. Wandering cells are found among the epithelial cells in the observed area.
A case of reticulum cell sarcoma of the rectum encountered in our department was reported. Only a very few cases have been reported in the world literature. Patient was a 63-year-old male, complaining of anal bleeding. An elastic firm ulcerated tumor was found at the anal canal, part of which was bulging through the anus. Digital and anoscopic examination revealed the upper border of the tumor was approximately 7 cm from the dentate line. Biopsy revealed that the tumor was reticulum cell sarcoma. Fluoroscopical examination was carried out, to rule out the multi-centric lesions. Radical operation, synchronous combined abdominoperineal excision of rectum was performed including the dissection of inguinal and para-ortic lymphnodes. Resected specimen was also probed to be a primary reticulum cell sarcoma of the rectum. Chemotherapy (1400 mg of Cytoxan and 7 mg of Vincristine) was given postoperatively. The patient is in good health as of 6 months after the surgery.
Thirty cases of rectal procidentia underwent various operative procedures were reported. The incidence rose to a peak in the third decade in both sexes but there was another peak in the seventh decade in the female. In contrast to the fact that the disease is more prone to occur in the female in Europe and America, there were more male patients in our series as in most of the Japanese reports. There was an unusual case, a 16-year-old male patient, who had procidentia with particular form of rectial adenomata in association with. abundant retcal secretion resulting in hypoproteinemia and hypopotassenemia, which disappeared after pull-through resection of the rectum. The commonest antecedant etiologic condition was costipation. Electro-myographic study was carried out to verify the dysfunction of the pelvic floor in cases of the rectall prolapse. The dysfunctioning pelvic floor is an important precipitating condition, if not a primary etiology, in developing and accelerating the prolapse. Of manifold therapeutic procedures, Roscoe-Graham's operation was most effective to, prevent recurrence. The Gant-Miwa plication method with Thiersch wire was proved to be a simple but effective procedure and worthy of trial.
1. A case of Peutz-Jeghers Syndrome has been described, in which colonic polyposis and pigmentation of lisp, buccal mucosa and soles were observed. No family history of abnormal pigmentation or significant gastro-intestinal symptom was obtained. Polyps were excised and in two of them malignant changer were observed histologically. 2. This syndrome is important surgically, because it produces acute abdomen and melena; and malignant changes of polyposis may be present. 3. For diagnosis of this syndrome, observation of its course, early diagnosis of its malignant changes, endoscopy, especially fiber-scopy is important. 4. Diagnosis of this syndrome is better preferably limited to the cases with definite presence of the trias.
The Number of out-patients having gastric symptoms has in recent years remarkably increased. Many of them, though free from pathological findings when examined by upper 'G-I X-ray series including the biliary tract and by gastrofiberscope, were found, on illness, to have abnormal habit of defecation, full sensation of the lower abdomen, or other various :subjective symptoms all of long duration. A total of 1335 such cases have been subjected to barium enema examination of the colon (Aoyama's method). With the exception of 27 cases having organic diseases of the colon, organic in the narrow sense of the word such as its tumors. 1308 cases were further investigated. As a result, a close correlation has been found between the X-ray findings such as abnormal location, course and so-called membraneous lifting-up of the colon, together withits traction or stenosis due to mesocolitis, and the patient's subjective symptoms and defecation habits. Based on this study, the authors attempted to designate those symptoms and radiological sighs, including kinking of the splenic flexure or the descending colon, the socalled detour sign, cicatric mesocolitis of the splenic flexure or cicatric mesosigmoiditis, as"colon syndrome" for the purpose of differentiatiating it from the" irritable colon." One of the authors, Hayashida, attempted to remedy this syndrome by surgical intervention: one stage modification of abnormal course kinking, cicatrices and so no of the colon together with left hemi-colectomy. In 150 cases thus treated, 84.9 percent have been free from any subjective symptoms six months after operation.