The cases of rectal carcinoid reported in Japan have shown a significant increase in recent years, and total numbers of cases recorded in the literature until 1976 were 65. Average age of the patients was 48 years, and the overall percentages were 61% in males and 39% in females. The primary tumors were usually found 4 to 6 cm above the anal ring as a single submucosal nodule with yellowish color, but there was no constant laterality in their localization. The majority of the tumors were below 2 cm in diameter, and the simple local excision was performed. The cases reported had nonspecific rectal symptoms of bleeding and pain, and only two cases were accompanied by carcinoid syndrome. The metastasis into local lymph nodes or liver was observed in 11 cases including one with a primary tumor below 2 cm in diameter. The rectal carcinoids regardless of their size proliferated in lamina propria mucosae, and often invaded submucosa beyond muscularis mucosae. The muscular invasion and lymph node metastasis were more pronounced in the cases with the lesion more 2 cm, in whom the radical operation including an abdominoperineal excision of rectum was undertaken as adequate therapy.
A primary carcinoid tumor of rectum can be correctly diagnosed by characteristic histologic patterns such as the formation of ribbon or rosette and sclerosing pattern compres-sed by dense connective stroma. It was found that the rectal carcinoid belongs to the family of slightly argyrophilic carcinoid by Grimelius' silver nitrate stain. In all of the cases examined by electron microscope, neoplastic cells contained abundant round secretory granules measuring 200 nm on average in diameter.

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Electron microscopic analysis of paranasal, bronchial, gastric, appendiceal and rectal carcinods indicated that tumor cells of all cases contained specific endocrine type secretory granules and showed either the presence of absence of acinar or tubular differentiation.
Besides the pleomorphism of appendiceal carcinoid granules, the size of spherical secretory granules in other cases varied to the limited extent from one case to another and from one cell to another. While EM survey is one of the most useful tool for the diagnostic confirmation of carcinoid tumor, combined inmunohistochemical, endocinological and boichemical examinations of boigenic substances such as amines and polypeptide hormones may be essential for the elucidation of functional and histogenetic aspects of this tumor type. The new concept of carcinoid as tumor of neural crest origin may not be in accordance with some findings of reported cases.

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We examined twenty-four carcinoid tumors of the rectum in twenty-one patients on the histological and histochemical viewpoint. Four of 21 tumors were microcarcinoids incidentally found in the surgical specimens of the rectum resected for familial adenomatosis coli with carcinoma. Twenty-one carcinoids were made up mostly of anastomosing trabecular and ribbonlike structures, partly added by more various structures, and in only three small solid nests or short trabeculae predominated.
All of 21 carcinoids examined histochemically were positive for the silver impregnation on specific secretory granules, that is, 19 tumors for the argyrophil reaction by Grimelius method and 2 for the argentaffin reaction by Fontana method. There were PAS positive granules in the tumor cells in all of 16 tumors examined and alcian blue positive mucus of epithelial type in a few foci in two of 20 tumors examined.
Four microcarcinoids were composed uniformly of nonargentaffin, argyrophil cells sho-wing a trabecular pattern and located in the deep mucosa above the muscularis mucosae. A 0.3 mm microcarcinoid as limited to the deep mucosa, but two 0.7 mm and one 0.8 mm microcarcinoids indicated an early minimal invasion of the submucosa just below the muscularis mucosae. Rectal carcinoids measuring 5 mm and above grew mainly in the submucosa forming a well-circumscribed tumor mass.
Contrary to the former reports, the present results suggest that nearly all of the rectal carcinoids are reactive and positive for silver impregnation on specific secretory granules especially for argyrophil cells by Grimelius method like the foregut-derived carcinoids. Most of the rectal cercinoids seem to be derived from argyrophil cells found in the basiglandular area of the rectal tubules, occasionally accompanying a few mucous cells by divergent differentiation of primitive tumor cells.

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Eight patients with carcinoid tumors of the rectum, were observed in our clinic. The two cases manifested the clinically malignant courses. The one was dead of wide spread metastasis to liver, ten months after anterior resection for 7 cm×5 cm sized carcinoid tumor of the upper rectum, the another is alived with hepatic metastasis, in ten months after pull-through methode operation for the invasive type of tumor sized to walnut. In these cases, histochemical reaction of the tumor cells is positive to Grimelius stain but not to Masson-Fontana stain, while electron micrograph shows secretory granules in the cytoplasm.

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The clinical efficacy of Proctosedyl suppositories, a form of conservative therapy for acute hemorrhoidal attacks, was evaluated by the single-blind method with placebo. A total of 60 patients (Proctosedyl: 30 cases, 14 males, 16 females ; placebo: 30 cases, 21 males, 9 females), mainly afflicted with internal hemorrhoids, participated. Progress was observed over a period of 2 weeks. Efficacy was assessed by determination of the point decrease ratio, based on the judgement standards of Tab. 5. The clinical efficacy of Proctosedyl was evaluated to be remarkable in 6 cases (20.0%), effective in 17 cases (56.7%), ineffective in 7 cases (23.3%); placebo was remarkably effective in 0 cases (0%), effective in 4 cases (13.3%) and ineffective in 26 cases (86.7%). Proctosedyl ameliorated pain (spontaneous and defecation), hemorrhage, and swelling, both subjetive and objective symptoms, although hemorrhoidal size was not reduced. The only side effects were the feeling of a foreign body inside the anus (Proctosedyl) 1 case, placebo 1 case) and the desire to defecate following insertion (Proctosedyl 1 case).

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Prolonged healing of anorectal open wound results mainly from 4 kind of causes being described below.
1) Neglecting cardinal principle of anorectal surgery
2) Inadequate control of post operative bowel movement
3) Inproper after care Further there exist in fact a few cases of prolonged wound healing, which cause is quite unknown.

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We obserbed whethere an nodular lymyhoid hyperplasia has a conection with an edematous enterocolitis or not. At the surgical clinic, an edematous lision of the intestine has a fundamental disfunction, espesialy, in the ileitis, postoperative adhesive enteropathy, nodular lymphoidhyperplasia of the ileum, and peritonitis. It is our concerning point that an edematous lision occures after hyperplasia of the lymphoid tissue in the submucosa of the intestine. We treated to treat with a gammaglobulin were be in good condition.

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A case of mucocele of the appendix complicated with intussusception was reported. A 62-year-old female was transferred from a hospital to our department with a chief complain of pains in the lumbal region. Colonofiberscopy at the third day after the admission and Ba enema examination at the fourth day were performed. These examinations revealed that the intussusception had occured in the right-sided colon. After these examinations a complete reduction without operation was obtained.
At the 12th day, we found a well-defined tumor in the caecum after the Ba enema study and by following that with endoscopy a reddish tumor was observed at the orifice of the appendix.
Biopsy specimens obtained from the tumor were negative for malignancy. Operation was performed under the diagnosis of benign appendical tumor. The resected appendix was felt like sausage and formed an abscess. This was diagnosed as mucocele of the appendix after the histopathological study.
There are no reports of endoscopy done in intussusception in our knowledge, thus making this case be the first one in the world. The endoscopy in intussusception is not always dangerous and often indicated for a correct diagnosis:

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The fine distribution of the intra-mural lymphatic vessels of the rectum and anal canal was investigated, besides the conventional method of puncture injection of dye fluid, by a new method to visualize the lymphatics with inttraarterial injection of AgNO₃ mixed with India ink and moreover, by a method to detect the lymphatics with EM and the obtained results are as follows.
(1) All the submucous lymph vessels above the level of ca 2 mm below the mucocutaneous junction have valves which are directed upwards.
(2)It is believed in general that the mucocutaneous junction is the dentate line. But according to the author's histological studies the mucocutaneous junction does not correspond to the dentate line.
(3)It is said that injections of dye fluid above the dentate line do not descend below this line and injections into the wall of the pecten are limited sharply at the dentate line. However, according to the author's investigations, injections of dye fluid into the pecten fill the lymphatics freely across the dentate line, while injections above this line fill the lymphatics of the pecten to a limited extent. The author made clear this phenomena from the histological point of view.
(4)Electron microscopic observations of the lymph vessels in the rectum and anal canal revealed no particular difference in the fine structure from that of the lymphatics in the other parts of the body.

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Preliminary observations indicated that the scanning electron microscope was useful to compare the mucosal surface appearances of the normal large intestine with ulcerative colitis.
The samples observed in this series were 22 resected specimen of normal large intestine, 2 resected specimen and 7 biopsied specimen of ulcerative colitis patients.
The excised samples were washed with saline solution and fixed with 4% formaldehyde and 1.2% glutaraldehyde. Then they were cut by razor, and dehydrated by 30-100% alcohol using critical point drying method.
Following above treatment, deposition of the cabon and gold was performed.
Observation of the samples was performed with Hitachi H.H.S.-2R, M.S.M.-400, and S.-500.
Regular crypts, tall villis, regular furrows and microvillis were observed on the surface of the normal large intestine.
In chronic ulcerative colitis, irregular crypts, short villis, short and irregular microvillis and abundant mucus were observed.

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