The carcinoma of the vermiform appendix was classified into three types, carcinoid type, cystic type and colonic type by Uihlein and McDonald in 1943. Today they are known as carcinoid, malignant mucocele and adenocarcinoma of the appendix. And there is a tendency to differentiate the adenocarcinoma (colonic type) as primary adenocarcinoma of the appendix from the other two.
From 1900 to 1970, twenty-five cases of primary adenocarcinoma of the vermiform appendix, (exclusive of 10 cases of malignant mucocele) have been reported in Japan, our case bringing the total 26. The average age these patients was 55 years old with range of sixteen to seventy-seven years. Seventeen of the cases were males and nine were females. The average age and sex distribution are almost same as those seen in English literature.
The patient, a 67 year old, Japanese farmer was diagnosed as acute appendicitis 32 years ago and treated conservatively at that time. Since then he had never had any complaint of abdominal distress before January in 1970, when he felt a distress and noticed a tumor with slight pain at the right lower quadrant. The complaints had continued to his admission in April, 1970. Physical examination, lavoratory findings and X-ray studies suggested the cecal tumor. He was operated in May of this year. The tumor located at the retrocecal region adjacent to the cecum and was 9cm×6 cm×5cm in size. The right hemicolectomy (including about 25 cm of the ileum) and anastomosis between ileum and transverse colon were performed with en-bloc dissection of a part of the psoas major and minor muscles, into which the invasion was suspected. He was discharged in good condition four weeks after the surgery.
Histologically, the tumor is moderately differentiated adenocarinoma producing slight amount of mucin. The appendix was almost destroyed but partly recognized at the central part of the tumor. The cecum was invaded into the serosa, muscular layer and partly muscularis mucsae but not into the mucous membrane. No regional lymph node involvement was seen on microscopic examination of the specimen.
The anthers added the comment on classification, clinical features, treatment and prognosis of primary adenocarcinoma of the vermiform appendix by reviewing the literature of this subject.

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The object of temporary colostomies is diversion of intestinal content from the lesions in lower bowel and they are predisposed to be closed when the primary object is achieved. Their prerequisite threfore, is easiness and safety in the procedures of construction and closure.
For those purposes, loop colostomy is most fitted when the techniques of primary opening, mucocutaneous suturing and mucosal eversion are applied. Instantaneous opening of the stoma immeduately resolves the obstruction in lower bowel and there has not been a case that was complicated with peritonitis or infection of abdominal wall even if the stoma was opened instartly in a patient of bowel obstruction without satisfactory preparation of the bowel.
Owing to mucocutaneous suturing, inflammatory reaction around the stoma is minimized with the result of minimal formation of cicatrical tissues. Therefore, stenosis of the stoma is prevented and on the occasion of closure, the possibility of closing the stoma merely by suturing the opening is increased. However, meticulous separation of adhesion and removal of cicatrices are required.
No serious complications are yet experienced in our 25 cases of temporary colostomies except 2 cases of herniation around the stoma in elderly patients which was corrected operatively with success.

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Gastrointestinal flora was investigated by means of puncture method of alimentary tract during laparotomy of patients with benign and malignant diseases, and also during autopsy of accidental and diseased cadavers. Bacterial study of anal region was also carriedout in healthy adults and patients with anal diseases by means of direct culture.
Most frequently detected microbes in the transverse colon and in the sigmoid colon were E. coli and Bacteroides, and anal flora of healthy adults was similar to those of the colon.
Bacterial flora of the colon were not influenced by gastric acidity or cancer of the stomach.
Aerobic microbes decreased their detection rate after three days successful oral administration of Neomycin or Kanamycin, and reincreased after five days use. However, anaerobic microbes increased their detection rate after three days oral administration of Neomycin and decreased after four to six days use.
Aerobic microbes such as E. coli, Proteus, Klebsiella and Pseudomonas which were detected from subjects after five days administration of such antibiotics showed high resistence to some kinds of drugs.
Therefore, preoperative oral administration of aminoglycoside antibiotics for three days limitted period was considered to be effective as an intestinal antisepsis against aerobic microbes, but was not so effective against anaerobic flora.

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