Diseases of the rectum necessitating rectal amputation with permanent colostomy have been increasing in Japan. In fact, this tendency is also remarkable in the authors' depart-ment of surgery.
From 1964 to 1976, among 170 cases of rectal cancer, 80 underwent the Miles opera-tion, whih accompanied many disadvantages of colostomy. In the authors' department, most of the patients with colostomy have been trained to control fecal evacuation by colostomy irrigation.
In this study, 21 males and 13 males managing their colostomics by irrigation were examined by interview and questionaire.
As for the frequency of irrigation, 19 patients do it every day, 10 on alternative day and 5 on every third day. Most irrigators take an hour or less to irrigate. No severe com-plications such as perforation has occured.
Colonofiberscopic and histrogical findings revealed no romarkable differences in the mucosa of the remaning colon between 17 irrigators and 5 non-irrigators.

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Reviewing the current understanding the lateral lymphatics of the rectum and clinical attitude of treatment for the lateral lymphatic spread of rectal cancer, we have to say that the poor recognition of the lateral lymphatic spread of rectal cancer has been still present since the Miles' operation was generally used for rectal cancer.
We tried to disclose the correct anatomical situation of the lateral lymphatics of the rectum and clinical significance of that lymphatics, for the treatment of rectal cancer, dis-secting some autopsy materials and cadavers and reviewing the operative materials. We would like to stress here that the misunderstanding of the lateral lymphatic pathway should be corrected immediately and the commpete dissection of the lateral lymphatics should be generally adopted for low-lying rectal cancers.

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Twenty patients who complaiend of proctalgia of unknown origin were proctologically examined and the following facts were recognized.
1) In all cases, tenderness on the wall of ischiorectal space was discovered by digital examination.
2) In 65% of the cases, backache was complained of and the past history revealed trauma and distorsion of lumbosacral region.
The author suspects that the cause of proctalgia is traumatic stimulus of lumbosacral nerve.
Therapeutically, pudendal nerve block with bupivacaine hydrochloride was performed in severe cases and indomethasin suppository was applicated in other cases.

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In the literatures, the term "anal canal" has often been used without clear definition causing much confusion among the leaders.
There are two "anal canal", one is surgical anal canal ranging from anal verge to the upper edge of levator muscle and the other is anatomical anal canal ranging from anal verge to dentate line. The former may be called sphincteric anal canal and the latter anodermal anal canal.
The progress of colopctology is now requiring. clear definition of the anal canal and the committee of rules for the management of colonic cancer specimen defined "anal canal" as surgical anal canal.
For thr the practice of anorectal lesions however, both of them are eqivalently important; surgical anal canal is concerned with the anatomy, function and measurent of sphincteric muscles, the extent of fisulas and sphincter-preserving operation of rectal cancer etc. On the other hand, anatomical anal canal is concerned with the development, diagnosis and treatment of various anal lesions etc.
It is therefore desirable to observe and describe every anal or rectal lesions in connection with 3 the landmarks of anal verge, dentate line and upper edge of levator. However, observation and description of the lesions are liable to be done only with one of the landmarks, because each of them is perceived by the different sensation of tactile, anoscopic and visual sensation respectively. In a case of rectal cancer for example, the location is described with the distance from anal verge at tke time of preoperative endoscopic examination. At operation, the location is scrutinized as the distance from the upper edge of levator for the persuit of preserving sphincters. In the resected specimen, the location is measured as the distance from dentate line.
The above description shows the importance of understanding, mesasurement and standard figures of both surgical and anatomical anal canal.
Measurement of both values were performed by us with 140 male and 32 female Japanese adults who received health check. Both values were measued as follows; the posterior aspect of the anus was opend and visualized with Strange's anoscope. The top of a metallic sound was rectangularly twisted and fooked on the upper edge of levator mid-posteriorly. Two tiny rubber rings were threaded to the sound and each of them was shifted according to the level of dentate line and anal verge.
The results are shown in the following table.
Surg. Anal Canal
Anat. Anal Canal
Male
3.2cm
1.8cm
Female
2.9cm
1.7cm
At the time of presentation, those vlaues will be discussed also in connection with corpulence ane histology.

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For the investigation of pathophysiology in the oligoganglionosis of colon, the experimental destruction of Auerbach's plexus by temporary hypoxia was induced in dogs.
Compared the EMG of the oligoganglionic segments with normal EMG which was classified into five basic patterns by ourselves, the frequent appearance of spike bursts was characteristic, suggesting the role of Auerbach's plexus as inhibitor against the electric activity of the colon. This spike burst was inhibited by β stimulator and accelerated by β blocking agent.
By X-Ray examination, this oligoganglionic segment has shown no narrowing as like as Hirschsprung's disease but some degree of disturbed bowel movement.

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