We investigated tumor necrosis factor (TNF) production by peripheral monocytes obtained from 50 normal subjects and 28 patients with inflammatory bowel disease (IBD). Monocytes incubated with lipopolysaccharide (LPS) or phytohemagglutinin (PHA) for 20 h. TNF production and its release into the supernatant was analyzed by bioassay against L929 cells. Levels of TNF production by peripheral monocytes derived from normal subjects and patients with ulcerative colitis and Crohn's disease were 130±70U/ml, 1086±682 U/ml and 1035±682 U/ml, respectively, An elevated level of TNF production was thus demonstrated, which was thought to be due to increased LPS uptake. Positive rates of moncytes labelled with FITC-conjugated LPS were significantly higher in patients than in healthy controls. On the other hand, when the monocytes were treated with salazopirin and its metabolites (5-aminosalicylic acid and sulphapiridine) plus steroid, the level of TNF production was markedly suppressed. These results suggest an important role of TNF in the pathogenesis of IBD.

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Urodynamic studies were conducted to determine the incidence of bladder dysfunction after surgery for rectal cancer.
First, as basic studies, 1) the nerves responsible for bladder function were examined using the pelvis of a cadaver, and 2) postoperative bladder dysfunction was studied clinically. As a result, differences were noted in the type and degree of neurologic injury depending on the operative technique and extent of dissection. Postoperative bladder dysfunction had a higher rate of occurrence when wider dissection was performed.
Urodynamic studies were conducted in 70 patients after surgery for rectal cancer, and the following results were obtained.
1. By cystometry, decreased uresiesthesis and reduction of bladder compliance were observed, whereas UCPP disclosed a decrease in pressure with in the urethra and shortening of the posterior urethra.
2. Retrograde cystography demonstrated irregularities of the bladder wall, widening of the internal urethral orifice, and vesicoureteral reflux.
These findings were more frequent in patients who underwent wider dissection. The irregularities of the bladder were associated with a decrease in bladder compliance, and the widening of the urethral orifice was associated with shortening of the posterior urethra.

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The prognostic value of histological type of the cancer and the degree of cellullar stromal reaction were analysed in 111 cases of curatively resected rectal cancer. The author classified histological type as follows : 1) homogeneously well differentiated type (well₁), 2) well differentiated type with less differentiated at the invading margin (well₂), 3) moderately differentiated type, 4) poorly differentiated type, 5) mucinous type.
The results obtained were as follows :
1) The less differentiated types showed the higher incidence of lymph node metastasis. The rate of lymph node metastasis in well₂ was higher than wells by 40% difference.
2) The survival rate was significantly higher in the type wells than in well₂.
3) The less differentiated rectal cancers showed the poorer cellular stomal reaction.
4) The degree of cellular stromal reaction correlated directly with the survival rate and inversely with the incidence of lymph node metastasis.
5) The multi-variate analysis yielded that the depth of invasion contributes most to the prognosis, then histological type, cellular stromal reaction, lyph node metastasis and venous invasion in the order described.
It was concluded that the prognosis of rectal cancer might be better predicted by the two factors, histological type and cellular stromal reaction, in combination with the current pathological staging based on depth o invasion and lymph node metastasis.

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The aim of this study was to evaluate the preoperative efficacy of arteriography in determining the extent of the field of dissection of lymphatics in surgery for rectal cancer.
The studied angiograms were 52 postoperative microarteriograms and 233 preoperative inferior mesenteric arteriograms.
The results were as follows ;
1) It was possible to diagnose the horizontal spread of cancers by differentiating the first branches of the superior rectal arteries and by interpreting the direct findings of tumor feeding arteries and circumferential indirect findings.
2) A close corelation was found between the extramural local spread of the tumor (S-max) and the extramural length of visualized arterial abnormalities (L-max). An L-max value of less than 10 mm was found to indicate no invasion to adjacent organs, more than we should counter to be with invasions.
3) The relationships between middle rectal arteries (MRA) and the main tumors were classified into four categories. Applying this categorization, there was a high incidence of metastasis to the lateral lymph nodes if the tumors were fed from the MRA, wheseas in contrast, there were no cases of metastasis if the MRA were distant from the main tumor and not involved with feeding.

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The labeling index, or the fraction of tumor cells in the S-phase of the cell cycle, was determined in 41 colorectal carcinomas and 3 cell lines of cultured colorectal carcinomas, by DNA flow cytometry using anti-bromodeoxyuridine monoclonal antibody. The labeling index was significantly higher in tumor cells than in normal colonic epithelial cells. The index in tumors invading into, but not through muscularis was lower than the index in tumors invading through subserosal layer. The index did not differ between 25 diploid tumors and 16 aneuploid tumors. The labeling index thus determined appears to be an independent prognostic variable for colorectal carcinomas.

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A retrospective study was conducted on 154 colon cancer patients who underwent curative resection between 1971 and 1983. Nineteen clinicopathologic variables were evaluated for their prognostic significance using Hayashi's discriminant analysis by qualitative data. The most important indicators of cancer recurrence were : level of positive nodes, presence of bowel obstruction or perforation, venous invasion and depth of tumor penetration. The importance of each factor varied according to failure patterns as follows : (a) level of positive nodes, presence of bowel obstruction or perforation and venous invasion-for distant metastasis ; (b) presence of bowel obstruction or perforation and depth of tumor penetration-for peritoneal dissemination ; (c) level of positive nodes-for locoregional failure. The correlation ratio of discrimination was highest in the case of distant metastasis and lowest in the case of peritoneal dissemination. Discrimination of recurrence was achieved with an 86% success rate by combining 7 important factors. Using this discriminant procedure, 7 out of 9 cases of recurrence following curative resection after 1983 were successfully determined to be in the high-risk group for treatment failure. It is concluded that multivariate analysis is useful for evaluating the prognostic importance of various indicators, and also for predicting cancer recurrence.

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We carried out a clinicopathologic study of backwash ileitis in ulcerative colitis, chiefly in our own patients. Backwash ileitis was defined as ulcerative colitin (UC) -like inflammation extending beyond the ileocecal valve and spreading homogeneously and diffusely over the ileum. In our department, backwash ileitis was detected in 13 of 45 patients who underwent detailed examination of the ileocecal region, among 60 UC patients who had undergone resection by the end of 1987. Grossly, the affected ileum showed continuous erythema, erosion and ulceration, and, in remission, looked like tenned leather with loss of circular folds. Histologically, inflammation, which was evaluated as mild, moderate or severe, was mild in 7 patients, moderate in 4 and severe in 2. Microscopy revealed that inflammation was not always continuous but sometimes took the form of a skip lesion. The lesion extended over a distance of 9.8cm on average, 29cm at the longest, from the ileocecal valve. There was a significant correlation between backwash ileitis and pestoperative enteritis (p<0.001). This indicated the importance of adequate resection of the ileum in cases of UC accompanied by backwash ileitis and surveillance of postoperative enteritis.

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Since mteronidazole has been found to be effective in cases o Crohn's disease, we evaluated its efficacy in the treatment of intractable ulcerative colitis.
Seven patients with ulcerative colitis received 0.5-1.0g metronidazole daily for more than 3 months. Three cases were the chronic persistent type, and 4 cases had more than 6 months active duration after recent relapse. Three cases were diagnosed as the total colitis type, 2 as left-sided colitis type, and 2 as proctitis type. All patients had received salicylazosulfapyridine and corticosteroids, but the disease was in the active symptomatic phase. Therapeutic effect was evaluated in terms of clinical symptoms, blood inflammatory reaction and endoscopic findings.
A marked effect was obtained in 5 cases, a slight effect in 1 cases, and no effect in 1 cases. Metronidazole tended to be effective for patients with a long active disease duration and no severe symptoms, resistant to corticosteroid therapy. We have reported because it is significant that a proportion of cases of intractable ulcerative colitis responded favorably to metronidazole.

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It is very rare to encounter two different malignant tumors in the same organ, in this case the rectum. A 69-year-old woman was admitted to our hospital because of rectal bleeding. Barium enema and colon fiberscopffc examination revealed a sessile white polypoid tumor on the posterior wall 3cm above the dentate line, and pigmentation around the anal canal. Abdominoperineal rectal resection (Mile's operation) was performed. Histopathological and immunohistological examinations of the resected specimen revealed double tumor, one being malignant lymphoma, diffuse B-cell, large cell κ type, and the other malignant melanoma small cell type.

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Use of a skin flap applied to a case of deformed colostomy. Stoma site marking had been performed as usual, but this became bent downwards after the first operation. The colostomy site was depressed because of shortening of the extraperineal colon related to the thickness of abdominal subcutaneous fat. A skin flap was designed to reform these deformities, and skin excision and lipectomy around the colostomy were added.
Thus the skin flap may not be raised due to the skin condition, the circumference of the stoma and the degree of its deformity. However, the technique of using a local skin flap as in this case is easy and noninvasive. The use of skin flaps and other techniques by plastic surgeons are useful procedures for cases of deformed stoma.

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It is said that ulcerative colitis is only rerely accompanied by hepatic abscess. We recently experienced a case of hepatic abscess associated with ulcerative colitis, which was cured by puncture drainage under ultrasonography. Details of this case are reported with some comments based on the literature. The patient was a 41-year-old man, who visited our hospital because of hemorrhagic diarrhea. A diagnosis of total ulcerative colitis was obtained from clinical findings and the results of contrast enema and colonoscopy. Although salazopyrin therapy achieved an improvement in the symptoms, fever ocourred soon after. Since laboratory examination revealed hyperleukocytosis and an increase in biliary-system enzymes, abdominal ultrasonography and CT were performed and a diagnosis of hepatic abscess associated with ulcerative colitis was made. Percutaneous transhepatic drainage was performed under ultrasonography, and antibiotics were given. The drainage tube was removed about 2 months later, when fever had been relieved and the abscess had been reduced. The patient was then discharged because remission of ulcerative colitis had also been obtained. This case is now being followed up on an outpatient basis. There has been no relapse to date.

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Cryptococosis is a general term for subacute or chronic infectious disease caused by Cryptococcus neoformans. This disease can affect almost any organ of the body, but more frequently involves the central nervous system and respiratory organs, rarely involving the digestive tract. We report the clinical course of a 66-year-old male patient with mesocolon cryptococcosis. The patient visited the National Ohkura Hospital with a complaint of mass in the right hypogastric region. From the radiological findings, a benign mesenteric tumor was suspected and, accordingly, laparotomy was performed.
The tumor was present in a region between the ascending and transverse mesocolon and was diagnosed pathohistologically as a cyst that had formed due to Cryptococcus. The postoperative course was favorable but the patient died of gastric carcinoma ten years later.
No lesions of cryptococcosis were observed at autopsy.

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We experienced three cases of rectal carcinoid which were resected by endoscopic polypectomy. Patient 1 was a 38-year-old male with a chief complaint of bleeding upon defecation. Patient 2 was a 57-year-old male with a chief complaint of left lower abdominal pain. Patient 3 was a 45-year-old male with occult blood in the stool. In all cases the size of the polyp was between 0.5cm and 1cm and all were located 45cm from the anal verge.
These histological findings were classified as A+B+C (Soga's classification).
In general, the treatment of rectal carcinoid is selected according to tumor size, i.e., ≥ 2cm radical resection ; 2cm1cm, local resection ; 1cm≥ ; endoscopicpolypectomy or fluguration.
We therefore wish to emphasize that a tumor of less than 1cm can be resected by endoscopic polypectomy.

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We carried out a study on the clinical effect of administration of disodium cromoglycate (DSCG), an anti-allergic agent, in cases of ulcerative colitis. The subjects were 19 patients diagnosed as having ulcerative colitis according to their clinical condition, progress, X-ray diagnosis and endoscopic findings. Details of the patients were : male female 12, aged between 13 years and 65 years at first visit, average age 28.3 years ; total colitis type 6, left-sided colitis type 9, proctitis type 4 ; serious cases 2, moderate cases 6, slight cases 11; treated with salazosulfapyridine 3, treated with steroid 1; hospitalization 5, outpatients 14 ; allergic malady in past or family histories 8. After prescribing DSCG 240-600mg orally per day depending on each symptom, we examined the effects according to the symptoms before and after medication, the findings of blood examinations and the endoscopic changes. After two months of DSCG administration, only one case was improved endoscopically, but the symptoms of ulcerative colitis disappeared satisfactorily in 12 cases out of 19. Based on the judgement of treatment effect by Dr. Tsuchiya and others, 14 cases out of 19 were found to be considerably effective and/or effective and only 5 examples were ineffective, Two of the five ineffective cases improved later. In other words, only two cases showed complete ineffectiveness of treatment, and DSCG showed an extremely high utility ratio. It was thus clearly indicated that immediate-type allergy is closely related to the onset of ulcerative colitis. We therefore hope that DSCG which controls the degranulation of mast cells will be widely used as a therapeutic medicine for ulcerative colitis.

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Transrectal ultrasonography was performed on 20 patients for preoperative examination of deep anal fistula and periproctic abscess and the results were evaluated.
The intrinsic muscle, levator ani muscle and internal and external anal sphinctor muscles were shown on the images, and using these findings the sites of lesions were more objectively determined and classified for diagnosis, It became apparent that fistula, which caused so-called rectal stenosis, was often present in the submucosal layer.
Transrectal ultrasonography can be performed with case on patients with deep anal fistula or periproctic abscess with little stress. It is used for aspiration biopsy cytology by ultrasonics in cases of suspected malignant change in the fistula and for reliable incision of periproctic abscess. A objective diagnosis could be made to decide the site of lesions using preoperative Ultrasonography for deep anal fistula and abscess in the rectum and anus.

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