To investigate possible carcinogenesis of phenols, fecal phenols were measured in patients with colo-rectal carcinoma using gas chromatography and bacterial productive pathway of phenols was studied. Fecal phenol was detected in 11 out of 30 patients with rectal carcinoma and fecal p-cresol was detected in 8 out of 8 in colonic carcinoma, 28 out of 30 in rectal carcinoma. Detection rate was significantly high compared to healthy controls (p<0.01). Fecal concentration of p-cresol was 150±170 micro gm/gm in colonic carcinoma, 170±190 micro gm/gm in rectal carcinoma (40±50 micro gm/gm in healthy controls) and that of phenol was 10±20 micro gm/gm in rectal carcinoma (not detected in healthy controls). And there were no statistical significance between patients with colo-rectal carcinoma and healthy controls.
In the study of bacterial productive pathway of phenols, phenol was produced by aerobes, such as Enterobacteriaceae, Streptococcus but p-cresol was produced mainly by anaerobes such as Bacteroidaceae. Among phenols, p-cresol might be related as one of carcinogenetic substances in colo-rectal carcinoma.

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Functional evaluation for defecation after rectal excision with coloanal anastomosis was done in eleven patients (mean age 58 years, male 8 ; female 3) and compared with 50 patients after usual low anterior resection.
Immediately following surgery frequent bowel movements and soiling were observed in all patients. These symptoms improved with time and most patients could enjoy almost normal daily life by the twelfth postoperative month.
One month after both operation, anal canal resting pressure and maximum squeeze pressure were significantly reduced and rectoanal inhibitory reflex was absent. One year after surgery, anal canal resting pressure and maximum squeeze pressure were as same as those after usual low anteriar resection preserving anal canal.
Although anorectal function was slightly worse in total than after usual low anterior resection, no patient was incapacitated by poor bowel function. Coloanal anastomosis is an efficacious alternative operation for a cevtain number of carcinoma of midrectum to preserve anal continence.

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Preoperative transrectal ultrasonography was performed in 56 patients with rectal cancer. Pararectal lymph node metastasis was positive in 28 patients and swelling of pararectal nodes was detected in 15 of them (54%). In 28 node negative patients, swelling of pararectal nodes was detected in 4 patients (14%). Seven hundred and ninty one pararectal lymph nodes were obtained from 56 operative specimens and 108 of them were involved, and 20% (22/108) of involved nodes and 0.7% (5/683) of non-metastatic nodes were detected (p<0.01). All of detected nodes were larger than 4mm in diameter, but detected ultrasonographical pattern was similar in involved node and non-metastatic nodes. In all the detected metastatic nodes the cancerous tissue occupied more than 50% of the mass of each node. An experiment using spherical and flat agar mass as model of lymph node revealed the spherical mass was more easily to be detected ultrasonographically. Lymph node in which cancerous tissue occupied more than 50% of each node showed spherical swelling. Spherical enlargement was thought to be most important in detection of lymph node by ultrasonography, irrespective of the presence or absence of metastasis.

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Immunoperoxidase staining for CEA was performed in 33 colorectal cancers, 10 lymphnodes metastases and 17 liver metastases. One polyclonal and seven monoclonal antibodies against CEA (1A4, 1B2, 2C3, 4H11, 5H7, 6C7, 7D1) were used in this study.
The results were as follows :
1) All the primary lesions and metastases were positive for polyclonal and five monoclonal antibodies.
2) Using 1A4, 10 of primary lesions, 2 of lymphnodes metastases (each of primary lesion was negative) and 10 of liver metastases (6 of primary lesions were negative) were not stained.
3) Using 4H11, 9 of primary lesions, 2 of lymphnodes metastases (each of primary lesion was negative) and 7 of liver metastases (3 of primary lesions were negative) were not stained.
4) The sites of staining with CEA antibodies were similar in each of primary lesions and lymphnodes metastases, but there were difference between the primary lesions and their liver metastases in 9 of 17 patients.
These results concerning CEA suggest that cancer cells in liver metastases could aquire different biological characters from cancer cells of the primary lesion.

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Lymphatic drainage from the rectum was studied in 13 cases by the double isotope transport method using ^99mTc-sulfur colloid and ¹¹¹In-colloid, following their submucosal injection into the rectum on the day before operation. Surgically dissected lymph nodes were classified into the following groups : Group 1 of the upward route, made up of the para-rectal nodes, superior rectal nodes and inferior mesenteric nodes ; Group 2 of the lateral pelvic route, consisting of the common iliac nodes, internal iliac nodes and external iliac nodes, and Group 3, comprising the para-aortic nodes. The nodes were individually assayed for the uptake of radioactivity by a well-type scintiration counter.
The study revealed that upward route from the rectum would be the main lymphatic stream : that the lateral pelvic route would be another important route for lymph node metastasis, and that there would be other routes to para-aortic nodes other than the upward lymphatic drainage : the inter-aorticovenous, preaortic and left lateroaortic nodes would also be the key to successful lymph node dissection.

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We evaluated the clinicopathological features and prognosis of eight local recurrence cases of rectal cancer after curative operation (in 40 case). The mean duration until recurrence was 22 months, and the rate of recurrence by site was 18.8% for Rs, 20.0% for Ra, and 22.2% for Rb. High recurrence rates were seen in 46.7% for the maximum tumor diameter of 6.0cm or above and 50.0% for 2/3 of the circumference or above (p<0.05). The deeper the tumor invaded, the higher the rate of recurrence. The recurrence was as high as 36.4% for ly (+). High recurrence rates were seen for Dukes B and C ; recurrence was seen in 6.9% for the absolute curative resection group and in 54.5% for the relative resection group (p<0.01). Only three cases (37.5%) could be re-operated on for local recurrence. The five-year survival was 74.1% for the absolute curative resection group and 59.6% for the relative curative resection group. On the basis of the above finding, it is considered that the ly factor is involved in the local recurrence of rectal cancer and that it is required to remove lymph nodes extensively and completely.

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The anal fistulas situated anteriorly in the female has been notorious for its liability to postoperative sphincteric insufficiency caused by the thin and coarse formation of the sphincters in this area. Forty six cases of them were analysed here to illustrate the characteristics (excluded are cases with Crohn's disease). The age distribution shows the peak is at thirties. As for the types, simple, low intersphincteric fistula is predominant, although there are a few complicated cases such as a high, high and low intersphincteric fistula, an ischiorectal and a pelvirectal fistula case. There is no extremely complicated case nor a case with perforation to the vagina. The length of ailment ranges from fairly short time of days to long time of years. The operational methods are open in 24% and sphincter-preserving in 76%. Our method of sphincter-preserving consists of coring out with complete preservation of the sphincters. The incidence of postoperative complication is minimal, the term of hospitalization is 25days in average and the term of complete healing is within 40days in most cases. The recurrence was observed in 6, all of which are reoperated and healed well except one case. The other characteristic is existence of cases with the primary opening between the dentate line and anal verge, of which macroscopic and microscopic pathology are reported.

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When laminin, a constituent of the basement membrane, was used for the judgement of venous invasion in colorectal cancers, good results were obtained.
The rate of cancers positive for venous invasion was high with 77.9%. In laminin stain, veins in tissues of cancer and the capillaries were also stained distinctly. The relation between venous invasion disclosed by laminin stain and liver metastasis was examined.
In the site of venous invasion the findings around the cancer were noteworthy. The number of involved veins was not related with the rate of liver metastasis. With the size of involved veins the rate of liver metastasis was high in veins below 50μm in diameter as well as in vessels above 200μm in diameter, the venules were considered to be related also well with liver metastasis.
Thus, laminin stain was considered to be useful for judging venous invasion of cancers.

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In this study the absorption, the excretion, the antitumor effect and the inhibitory effect of water-soluble fraction (LEM) prepared from culture medium of Lentinus edodes mycelia against colonic tumors induced by azoxymethane (AOM) in rats were revealed. LEM was excreted in the urine soon after intravenous administration and absorbed from the intestinal mucosa after enteral administration. LEM suppressed the growth of AH60C implanted subcutaneously in rats and BAMC-1 in mice. LEM normalized the NK cell-mediated cytotoxicity of spleen cells in AH60C-bearing rats. In vivo LEM augmented the NK cell-mediated cytotoxicity in normal mice, but didn't in vitro.
LEM inhibited the number of colonic tumors induced by AOM especially at the distal colon but didn't significantly suppress the growth of tumor. LEM was more effective on the enteral administration than the intraperitoneal route.
LEM normalized the changes of serum protein in rats treated with AOM.
It was suggested that the anti-tumor effect of LEM was host-dependent and that LEM could be used for prevention of human colonic carcinoma.

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A 22-year-old male with Crohn's disease associated with campylobacter jejuni infection during the relapse, is reported. In 1986 (20-year-old), he was diagnosed as Crohn's disease because of inflammatory mass and cobblestone appearance at ileo-cecal region and multiple longitudinal ulcers in the small intestine. Salazopyrin was given and his clinical course had been uneventful. In January, 1988 he developed bloody diarrhea and abdominal pain and was admitted to our department on February 24. Bloody diarrhea was about 17 times a day. Sigmoidoscopy revealed multiple discrete ulcers and bleeding. Serum total protein and albumin were 4.0 and 1.4g/dl respectively. Intravenous steroid regimen with TPN was started. Campylobacter jejuni was detected by stool culture on admission and erythromycin was given. One week later, stool culture for campylobacter jejuni was negative. Symptoms subsided gradually and bowel movements decreased to 2 times a day on the 14th hospital day. This is the first case in which campylobacter jejuni detected from the stool was described in Crohn's disease in Japan. The significance of campylobacter jejuni infection in Crohn's disease was discussed.

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In order to know the distribution of colorectal diseases in patients who have anal disorders, such as hemorrhoid, fistula, abscess and anal ulcer, we analyzed the data obtained from the 3193 patients. Abnormal findings were observed in 123 patients (3.85%) : 17 advanced carcinomas (0.53%), 4 early carcinomas (0.13%), 95 colon polyps (adenoma or hyperplastic) (2.97%), 1 carcinoid tumor (0.03%), 6 ulcerative colitis·proctitis (0.19%), 0 Crohn's disease (0%). The most frequently involved area was rectal colon (42.7%), followed by sigmoid colon (41.9%), descendng colon, transverse colon, ascending and caecum in decreasing order. The rate of rectal cancer over 50's was 1.04%.

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A total of 23691 patients were screened with sigmoid fiberscopy at the human Dock. From these subjects, 14 cases of rectal carcinoid were found, with the incidence of 0.06%. Nine cases were male and 5 cases were female, but there was no difference between male and female on incidence rate.
All the 14 tumors located within 10cm from anal verge and were less than 10mm in diameter. According to Soga's classification, histological type was type A in 4, type B in 4, and type E in 6 cases. Over 4 years the median period of follow up observation, there was no local reccurence and distant metastasis in 9 cases treated by endoscopic polypectomy only.

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Button colopexy was carried out effectively on two patient with prominent colostomy prolapse. The fixation of prolapse loop is performed through the abdominal skin and the colonic lumen using buttons and the non-absorbable suture.
The procedure is easily effective and applicable even to the very poor risk patients without laparotomy and resection of colon.

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