It was about 1965 when sphincter-preserving operation represented by Parks' and Goligher's methods were introduced to Japan. Although the methods were imitated at the first stage, they were reformed in several stages because Parks' method has the shortcoming of a internal sphincter defect. The reforms were. published by us in Jap. J. Soc. Col. Proct. and their summaries are as follows ; 1st stage coring-out of all the fistulous tract and excision of internal sphincter (Parks' method), 2nd stage coring-out of all the fistulous tract and. covering of the primary opening with slided skin graft, 3rd stage coring-out of all the tract from 3 ways of internal, intersphincteric and outer routes, 4th stage coring-out of all the tract and closure of the primary opening with semi-closing method of ligation & excision.
For the past 3 years, however, we are practicing the following method and getting good results which consists of those 4 procedures as 1 coring-out of the fistulous tract is started bilaterally form the outer and the inner openings and the preparations communicated at the site of primary abscess, 2 L&E-like drainage wound made at the site of primary opening at and.around the anus, 3 excision of neighboring lesions, 4 closure of the primary opening wound with Dexon after the removal of tension around the site with preparation of surrounding tissues.
The characteristics of this operation are considered that 1 all the fistulous tract is ex-cised, 2 the drainage of internal and external wounds is made effective toward the outside and 3 the internal opening is closed without tension.
This kind of operation was performed for 98 patients in these 3 years and the result is good without remarkable complications. The average days for the complete cure is 27 days and the recurrence was observed in 2 cases among 98 (2.0%). The operation has few drawbacks and is one of the recommendable proceduers for the treatment of low-lying fistulas.

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Electromanometric, electromyographic and histopathologic studies on free, autologous graft of gracilis mucle were carried out in dogs. For the experiments, 39 mongrel dogs were used; anal sphincter was totally removed in 15 dogs (S₀), partially excised in 12 dogs (S_1/2) and untouched in 12 dogs (S₁). Free, autologous gracilis muscle was transplanted in 29 dogs; 9 of S₀ group, 8 of S_1/2 group and all the S₁ group. In 14 out of 29 dogs, denervation of gracilis muscle was carried out 2 weeks prior to grafting. Electromnometric studies disclosed that grafting of free, autologous gracilis muscle significantly increased anal canal pressure of S_1/2 group at one month, elongated high pressure zone of S₁ group at 3 and 6 months after grafting, but was not effective to maintain resting pressure of anorectum in S₀ group. Electromyographic studies carried out 6 months after grafting disclosed that 20 out of 28 grafts showed spontaneous activity electromyographically, but only 2 showed spikes coordinating rectal stimulation. Histopathologically, only 5 out of 28 dogs showed grafted muscle remaining more than 40%. Denervation done 2 weeks prior to grafting had no effects on electromanometrical, electromyographical and histopathological findings.

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In Japan, ulcerative colitis (UC) complicating colorectal cancer is not as common as in United States and Europe, and so far only 25 cases have been reported in the Japanese literature. It is suggested that patients with UC also have an increased risk of developing carcinoma of the bile duct, but UC complicating colorectal cancer and bile duct carcinoma seems to be a very rare association. This paper presents a rare case of long-standing UC complicating rectal cancer and bile duct carcinoma.
A 68-year-old man with a history of diarrhea over the previous 27 years was admitted with jaundice, epigastric discomfort and hepatomegaly. He had undergone cholecystectomy at another hospital 10 months before admission, but no gallstones had been detected. Physical examination revealed hepatomegaly and a sessile rectal mass on digital investigation. Laboratory studies showed slight liver dydfunction (T-Bil. 1.9 mg/dl, Al-p 430 IU/ml, GPT 77IU/ml) and a positive occult blood test for stools. Barium enema and colonoscopic findings showed very mild active ulcerative colitis with total colon involvement and a flat elevated lesion of the rectum. Biopsy histology confirmed a diagnosis of mild active UC with dysplasia and well-differentiated adenocarcinoma.
Percutaneous transhepatic cholaniography demonstrated a dilated intrahepatic bile duct with filling defect, suggesting a diagnosis of intrahepatic stones. Right hepatic lobe'ctomy and transanal local excision of the rectal tumor were performed. Histological findings revealed papillotubular adenocarcinoma of the intrahepatic bile duct with pericholangitis and a welldifferentiated adenocarcinoma of the rectum, 1.5×1.0 cm in diameter, with marked inflammatory cell infiltration. The patient died of recurrence of bile duct cancer three years after discharge. Cases of UC complicating colorectal cancer and bile duct carcinoma reported in Japan were also reviewed.

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Three cases of anorectal malignant mealnoma were reported. There were difficulties in making correct preoperative diagnosis. In two of the three cases malignant melanoma was not suspected from the findings of digital examination or proctoscopy. Of the two cases in which preoperative biopsy was taken, one was reported as signet ring cell carcinoma and the other as poorly differentiated adenocarcinoma, showing the difficulty in histological diagnosis of biopsy specimen. In all of those three cases rectal excision (Miles'. operation) was performed. In none of those cases dissection of the inguinal lymphnodes was performed. In two cases adjuvant immuno-chemotherapy using OK- 432 and DTIC, ACNU, Vincristine (DAV therapy) was performed, which was not effective. In the other case BCG therapy was performed which was not effective as well. All the three cases died with wide spread lympatic and blood born metastasis from 8 to 29 months after the initial operation. Reviewing the 126 reported cases in Japan, at present, Miles' operation with adjuvant DAV therapy was considered to be a standard treatment for this disease.

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Sixty three permanent colostomates of Tokyo Goryokai were selected at random to test the effects of lotion containing squalane, liquid triglyceride and guaiazulene.
The lotion was used for 3 weeks, and discussed with the effects on peristomal dermatitis, skin irritation, skin moisture and adhesion of appliance.
Among 22 cases which had severe peristomal dermatitis, 15 cases showed clinical recovery, 4 cases showed no response, 3 cases showed slight skin irritation due to excessive application of the lotion and subsequent leakage.
The skin which has been dried up during a long period of time after surgery is moisturized using the lotion which effected better adhesion of appliance.

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