Although Japan was much behind the western countries in the stoma-rehabilitation it has been making rapid progress in these ten years. And it has become one of the most developed countries in the world. The progress is due to the seminars every 6 months for stoma-rehabilitation, which has been supported by the Japan Society of Colo-proctology.
Stoma-rehabilitation in our country does not depend on the enterostomal therapist(ET), but on the closed co-work of the nurses and the doctors. Surgical methods have been improved to prevent from postoperative complications by making a bud stoma through the extra-peritonealroute at the marking site.
Advancement of the urostoma-care has contributed to the total pelvic exenteration for the locally invasive rectal cancer. Coloproctology can not be developed without enough understanding about the stoma-rehabilitation.

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Multi-step carcinogenesis of colorectal cancer Y. Nakamura Department of Biochemistry, Cancer Institute
Transformation of a normal cell to a malignant cell is caused by an accumulation of genetic alterations in oncogenes and tumor suppressor genes. In colorectal tumor, five genes associated with development and/or progression of adenomas and carcinomas were discovered and the role of each gene during carcinogenesis has been suggested. The APC (adenomatous polyposis coli) gene, which is isolated as a responsible gene for familial polyposis coli (FAP), is frequently mutated in sporadic form of colorectal tumors and is considered to be important for an adenoma formation. A point mutation of the ras oncogene is associated with the second step. A somatic mutation of the p53 gene or MCC (mutated in colorectal carcinoma) gene in addition to these mutations, transforms a benign tumor cell to a malignant tumor cell. Inactivation of the DCC gene may associate with progression of tumors and increase a chance to cause metastasis to other organs.

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As the development of effective antibiotics and synthetic drugs has almost eradicated many fatal infectious diseases, the most pressing problems in modern medicine are diseases which are closely related to functional and cellular degeneration and involve constitutional factors. Accordingly, in the treatment of these diseases, a therapeutic approach which recognizes individual differences and changes biological response through changes of cell function or properties is needed. For these reasons, Kampo drugs are frequently used in the treatment of intestinal diseases and post-operative hepatic injury, and for improvement of general patient condition after operation. In this presentation, I would like to report the treatment of intestinal diseases with combination of Western and Kampo medicine and to present the characteristics of Kampo drug and their differences from Western drugs.

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