The purposes of preoperative irradiation in cancer of the rectum is the suppression of metastasis, reduction of the lesion, prevention of recurrence and improvement of operability. Therefore, the present study was undertaken to examine precisely the effects of preoperative irradiation by means of endoscopy and histologic examination of biopsy and resected material. Endoscopically, the most important effects of preoperative irradiation included improvement of hemorrhagic lesions and flattening of the lesion. In resected material, flattening and regression of the tumor, and also histological regression and destruction of the lesion were confirmed while reduction in tumor size as a result of interstitial fibrous growth was also observed. Findings suggestive of improvement were first seen around 3, 000 rads, and all the findings above were seen at 4, 000 rads both endoscopically and histologically. According to the Takizawa pathological classification, an increase in X₂ was seen from 3, 000 rads, but there was only one case of X₃, at 6, 000 rads. Therefore both endoscopic and histological findings suggest that the most appropriate irradiation dosage in order to increase operability in cancer of the rectum is between 3, 000 and 6, 000 rads.

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A new surgical apparatus was devised in our institute which is applied for quick anastomosis of the colon and the rectum in Welch type operation.
This device consists of two rows of stainless-steel staples, two grips and a clamp.
Twelve mongrel dogs weighing 8.5 to 28 kg were operated using this apparatus by the method of abdomino-proctosigmoidectomy with preservation of the anal sphincter.
After operation, anastomotic junction was examined endoscopically, radiologically and histologically.
These examinations revealed that the junction had no stenosis, no leakage and little inflammatory changes in the operated twelve cases.
From this experiment we conclude that this new instrument could be used for clinical cases with much advantage.

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One hundred and ninety six cases with cancer of the colon and rectum who had recieved curative resection were classified according to the stage classification which was settled by Japanese Research Society for Cancer of Colon and Rectum. The relative survival rate was calculated and the long term prognosis was evaluated in each stage. The following result was obtained: Cancer of the colon and rectum is considered to be a curable disease, if it is discovered and resected at the stage I in which the cancerous proliferation is limited to the proper muscle layer without any metastasis.

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The first case is a 32-year-old female who visited our hospital complainig of genital bleeding. Though laparotomy was performed under the diagnosis of myoma of the cervix in our gynecological department, there was a tumor at the anterior wall of the rectum. As it looked submucosal tumor of the rectum, partial resection of the rectum was performed. The tumor was hard and measured 2×1×0.8 cm. Histopathological examination revealed it was endometroisis. The second case is a 46-year-old female who visited our hospital complaining of abdominal tumor. Total hysterectomy and bilateral salpingooophorectomy were performed in the gynecological department, and the tumor of the sigmoid colon, which seemed carcinoma was found.
Sigmoidectomy was performed under the diagnosis of submucosal tumor of the sigmoid colon after barium enema and proctoscopic examination. The tumor was measured 4×2 cm. Histopathological examination revealed it was endometriosis.
It is difficult to distinguish between carcinoma and endometriosis of the colon except on histological grounds though the chances of making correct diagnosis are enhanced if the symptoms occur or are increased during menstruation. The necessity of operative biopsy should be persisted.
The treatment should be determined carefully by reference to the age of the patient and the severity of the symptoms.

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Ischaemic colitis is a well recognized entity which results from sudden occulusion of a main trunk or a branch of a mesentric artery or from hypoxia with non-occulusive mesenteric arterial disease. Although ischaemic colitis is not rare in the older age groups with episodes of ischaemia involving the heart or brain, its endoscopic findings are rarely reported.
A 54 year old male complaining of dull left hypochondrial pain, was examined using a colonoscope. Endoscopic appearances such as longitudinal ulcers without cobble-stone appearance, stricture of the canal of splenic flexure, diffuse capillary dilatation and congestion etc. were different from other specific or non-specific inflammatory bowel diseases.
Endoscopic diagnosis of ischaemic colitis is not so easy, because its endoscopic findings are not uniform according to its stage or severity. Therefore, more description of the cases in each stage and severity will be necessary to make more effective differential diagnosis of ischaemic colitis.

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Remarks are first made on various items necessary for surgery of cancer of the large bowel. Detection of early cancer is only around 10% in the case of cancer in the large bowel. But recent progress in diagnosis especially of endoscopic biopsy, has revealed that majority of cancer in the large bowel originates from adenoma. Further, most of the early cancer take polypoid appearance and can now be cured easily by endoscopic polypectomy.
In the surgery of colon cancer, it has become relatively easy to carry out wide resection of the colon and complete dissection of the lymph nodes. The rate of curative operation is as high as 80 %, and non-touch isolation technique (Turnbull) is also carried out to prevent hematogenic spread of cancer cells. For reconstruction of the intestine, end-to-end anasto-mosis is employed exclusively.
For cancer in the lower rectum, abdomino-perineal amputation is used. For the prevention of local recurrence, which occurs in a relatively large number, wide removal of the rectum and anus, and complete dissection of regional lymph nodes are being carried out in recent years. Although it is somewhat complex, dissection of lymph nodes along the internal iliac vessels should not be overlooked. In spite of extended surgical technique, operative wound undergoes rapid primary healing.
For cancer in the upper rectum, sphincter-peserving operation is carried out. This operation has become safe by the progress in surgical technique, and radicality can be fully satisfied. In cancer of the upper rectum, the low anterior resection is better. If the lower margin of the tumor is a little low and within 4-5 cm above the dentate line, the pull-through operation will be indicated. This sphincter-preserving technique is now used in 40 % of operated rectal cancer cases together with progress in the diagnosis of rectal cancer.
Thus, the treatment of rectal cancer is being developed, with prevention of local recurrence by extended surgery in cancer of the lower rectum and by preservation of anal functions without loss of radicality in cancer of the upper rectum.
Majority of cancer of the large bowel are localized type, the rate of metastasis to lymph nodes is low, and the end results are generally favorable. Five-year survival rates in cases undergoing curative operation have been 69% for colon carcinoma and 58% for rectal carcinoma.

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On the treatment of hemorrhoids, conserative procedure is basically preferable. Longstanding prolapsed internal hemorrhoids, however, should be treated surgically because the condition of its vessel wall has irreversibly changed.
For thrombosed prolapsed inrernal hemorrhoids, surgical treatment is preferable a few days later when the acute sign and symptom have decreased. Although most of them are treated conservatively at our hospital, we have not encountered the recurrences.
On the surgical treatment, circumferential removal of hemorrhoidal zone such as Whitehead's operation should not be recommended because of not only its anatomical and physical unreasonableness but also its several postoperative anal disturbances.
Concerning the surgical operation for hemorrhoids, we might say "too much is worse than too little" than "too much is as bad as too little".
Most important thing is the preservation of anal function. "Ligation and excision procedure" is removal of main three or four hemorrhoids with ligation of roots of their hemorrhoidal arteries along the longitudinal axis of the anal canal. This method is, simple and most of hemorrhoids are completely cured without any post-operative anal disturbance.

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There is wide variation in the treatment of the anal fistula, but it should be not only curative but produce minimal disturbance of the anal function.
Apart from the usual fistula, there are fistulas occuring in patients with Crohn's disease and ulcerative colitis.
Five of seven patients with Crohn's disease and seven of seventy three with ulcerative colitis treated in the recent four years were accompanied with some anorectal fistula or abscess.
Less aggressive treatment is indicated for fistulas in these cases.

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