Thirty-four cases of small colorectal cancers (CRC) less than 2cm in diameter, invading into or beyond the proper muscle layer, were analyzed. As compared with the CRC over 2cm, small CRC were more frequent in females as well as the older age group, and in the sigmoid colon. Among the small CRC, 68% were well differentiated adenocarcinoma. Nodal metastasis were seen in 29% of the cases, and 9% had synchronous hepatic metastasis. According to the Shimoda's classification, small CRC were classified as Polypoid Growth type (PG) and Non-polypoid Growth type (NPG). Only three cases were classified as PG, and they showed neither nodal nor hepatic metastasis. On the other hand, NPG showed nodal metastasis (32%), and hepatic metastasis (10%). NPG was further classified as ulcerated type and submucosal tumor (SMT) type. Of six cases of the SMT type, five had nodal metastasis, two had hepatic metastasis, and two died of recurrence. We may underestimate the depth of invasion of small CRC, especially that of the SMT type. We should be aware of the existence of the small advanced CRC with an SMT-like appearance and with poor prognosis.

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Immunologial staining of p53 and bcl- 2 was carried out in patients with : incipient adenoma, 81 ; submucosal carcinoma, 20 ; and heterochronic adenoma occurring after colorectal cancer resection, 99. p53 staining was positive in 2 % of patients with incipient adenoma and mild dysplasia ; there was a positive correlation between ratio and the grade of atypism. After colorectal resection, p53 staining was positive in 28 % of patients with adenoma and mild dysplasia. bcl- 2 staining was positive in 50 % of patients with adenoma and mild dysplasia after resection, a significantly higher positive ratio than the 28 % in patients with incipient adenoma of similar grade of atypism. In patients with heterochronic adenoma after resection, bcl- 2 positive adenoma occurred in 35.4±25.7 months ; this was significantly shorter than the 48.4±36.4 months in bcl- 2 negative adenoma patients. The shortest time for p53/bcl- 2 positive adenoma occurreace was 32.9±22.0 months. Since heterochronic adenoma after resection had increased bcl- 2 and p53 gene protein, it is considered that the genetical grade of malignancy may be accelerate and the malignancy potential may be high in patients with adenomas after colorectal cancer resection.

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In order to more fully understand the morphological chracteristics and the process of morphologic changes of villous adenoma of the large intestine, the vascular structure images of eleven surgical resection specimens were microangiographically studied. Macroscopically, villous adenomas were pedunculated polyps and nodular conglomerate-like lesions. Pedunculated villous adenomas had numerous large stalk vessels, suggesting abundant blood flow. By imaging the nodular conglomerate-like lesions composed of a conglomerate of polyps with stalk vessels, destruction/deciduation and ulceration of individual polyps were found. Vascular structures similar to the mucosa of normal colon were found at the periphery of polyps. In lesions with cancer invaded to the proper muscle layer, scattered ulcerations due to the destruction of polyps were also observed, corresponding to a Dukes B lesion. Invasive carcinomas were characterized by the basic vascular patterns of villous adenoma. Protuberant villous adenocarcinoma showed vascular structures similar to pedunculated polyp. Ulcerative villous adenocarcinoma had polypoid remnants with a vi llous component at the periphery of the tumor. Stalk invasion seems to play an important role in ulceration.
The above findigs are considered very important additional information regarding the development of villous ademoma, as well as for endoscopic treatment or local excision for the prevention of hemorrhagic comlications of incomlete removal of adenoma.

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The clinical features of 106 patients with colorectal cancers associated with other primary malignancies were investigated in this study in order to select patients of high risk for multiple primary malignancies and to improve the therapeutic results after early detection and early treatment thereof. Clinical factors were compared between colorectal cancers with and without other primary malignancies, and between synchronous and metachronous multiple cancers. Though some clinical factors, such as sex ratio, age at diagnosis of colorectal cancer, and family history of cancer, are different between them, no clinical factors were obtained which were useful to select patients of high risk for multiple primary malignancies. The analysis with regard to the site of other primary malignancies revealed that the stomach was the most frequent site of other malignancies, and suggested that patients who had received radiation therapy for cervical cancer had high risk for the development of rectal cancer. The prognosis of patients depended on a cancer of advanced stage and the second cancer in synchronous and metachronous cancer, respectively. It is important to carry out careful examintion and follow up for detection of synchronous or metachronous cancer to improve the therapeutic results.

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IBS is a prevalent, functiononal disease of the intestines which is diagnosed by the symptoms and the physical and some instrumental examinations such as endoscopy and roentgenography. However, all of these examinations are performed for exclusive diagnosis distinguishing it from other organic diseases as colon cancer, polyp, inflammatory bowel diseases, etc.
Positive diagnosis has been accomplished by measurement of intraluminal pressure and electromyography, but those measurements have been performed only for scientific interest to clarify the pathophysiology of the syndrome.
To obtain a simple and clear mean of positive diagnosis of the syndrome, we devised a method to visualize the configurement of the whole colon with a small amount of orally taken barium.
Each configuration thus obtained in a film is measured to determine the diameters dividing the whole colon and rectum into 16 parts.
Seventy-four IBS patients are divided into 3 subgroups of constipation (n =27), diarrhea (n =20) and alternative types (n =27) respectively and the characteristics of intestinal configuration were analyzed and compared with each other and the control group (n =27), and the results were as follows.
1. In the control group, the diameter is the widest in the cecum, becoming gradually narrower thereafter and the narrowest at the upper part of the descending colon. Thereafter, it again widens to about the same size as the cecum.
2. In the constipation type, although the basic pattern is the same as the control group, when compared with the control, the right half of the colon is wider in diameter, and on the contrary the left half of the colon is narrower and the narrowest at the sigmoid and the rectum.
3. In the diarrhea type, although the basic pattern is the same as the control, when compared with the control, it is narrower in the right half of the colon and wider in the left half of the colon.
4. In the alternative type, the characteristics are in-between the above 2 types.
This analytical method of visual configulation of the colon with contrast media is useful for diagnosis of IBS, differential diagnosis of the 3 subgroups, recognition of improvement or exacerbation, effect of the various therapeutic methods, etc.

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To evaluate the importance of colonic mucus, changes of the gastrointestinal mucosal levels of hexosamine, which indicate content of mucus in the gastrointestinal mucosa, were determined after applying stress to dogs. The dogs, which were applied stress for 2 weeks, were examined in this study. Teprenone, an agent that facilitates mucus synthesis and secretion in the colon, was administered orally to the dogs to analyze the changes of the mucosal hexosamine content.
Applied stress induced a decrease in the content of mucous glycoprotein and tended to produce a mucosal lesion in the colon.
The results of this study suggested that Teprenone can increase the content of mucous glycoprotein in the colon and facilitate the healing of a stress ulcer.

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This is a report about a case of stricture type ischemic colitis, which was followed up by colorectal endoscopy and external ultrasonography (US).
A 60-year-old man was admitted to our hospital because of left lower abdominal pain and bloody stool. US revealed a thick colon wall. It was observed as a low-eche layer between the mucosa and submucosa caused by inflammation. The degree of endoscopic findings corresponded to the degree of wall thickening more than to blood chemical findings (CRP or WBC).
US is a safe and useful method for the treatment of ischemic colitis.

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A 62-year-old male patient has suffered from soiling for 9 months. Slight haemorroids were initially treated by medicine and the frequency of soiling decreased. However, soiling persisted about twice per day thereafter. Anorectal manometric study revealed a decrease of maximum resting pressure and squeeze pressure, but anal canal length, anorectal reflex and anal canal rhythmic wave were normal. Conservative therapy with stool bulking agent did not improve the soiling. The defecation state was recorded by the patient, and the result suggested a relationship between the frequency of soiling and the psychological factor. Sulpirid was initially used but did not improved the symptom. Valproate sodium, which had been reported to be useful to improve anal canal resting pressure, did not improve the soiling either. Diazepam was finally administered to the patient, and the soiling disappeared completely. The mechanism of the action is undetermined. However, direct stimulation to γ-aminobutyric acid (GABA) receptor of internal sphincter muscle and/or muscle relaxing action may be a mechanism of the action.

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An 18-year-old man was admitted to our hospital because of lower abdominal pain and bloody stool several times a day. Specific past history of illness was not found although slight constipation was observed in the past. The patient did not suffer from collagen disease, and antibiotics were not orally administered before the onset. Thumb printing pattern was detected by a barium enema from the sigmoid to the left transverse colon. The edematous redness was found in the above regions by colonoscopy, and ischemic colitis was diagnosed by biopsy. This patient was discharged after 12 days undergoing conservative therapy. It has been conventionally considered that ischemic colitis occurs more frequently in the aged or patients with basal diseases, but this time, a rare juvenile case without basal disease was experienced, and its pathological causes was reported.

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The percentage of tumor involved area of unresectable hepatic metastasis was measured from colorectal cancer which received intra-arterial chemotherapy and its correlation with prognosis was studied. The subjects were 20 cases who underwent intra-arterial chemotherapy. The percentage of tumor involved area (PTIA) was measured by the following formula ; The PTIA=ΣS′/ΣS with S′ as the tumor area on the CT and S as the liver area on the CT. When the area from CT images was measured, all images of CT slice were inputted into a personal computer through an image scanner, and both liver and tumor area in each slice were measured. The PTIA ranged from 1.2% to 31.3%. The average was 7.31±6.93%. The percentage was not more than 15% in 18 cases, from not less than 15% to not more than 25% in 1 case, and not less than 25% in 1 case. As for the correlation between the PTIA and prognosis, a statistically significant reverse correlation was found in all 20 cases (r=-0.460, p<0.05). Even in 18 cases of not more than 15% which account for the majority, a statistically significant reverse correlation was found (r=-0.499, p<0.05). Therefore, PTIA may reflect the prognosis of cases with unresectable hepatic metastasis from colorectal cancer.

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The outcome of maintenance therapy in Crohn's disease was studied retrospectively on sixty patients with quiescent Crohn's disease. There were 39 males and 21 females. There were 11 cases of colitis, 20 cases of ileitis, and 29 cases of ileocolitis. Maintenance therapy was given as dietary, drug, or combined therapy. The follow-up period was from 214 days to 3365 days (mean follow-up period : 2873 days). No significant differences in the cumulative remission rate was found between males and females. The complication of a lesion (colitis, ileitis, or ileocolitis) did not affect the cumulative remission rate. Patients with previous complication showed a reduced cumulative remission rate as compared to the patients without previous complication. Significant difference was not noted among the maintenance therapies, however, combined therapy tended to be more effective than other maintenance therapies on patients with ileocolitis.

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Contribution of clinicopathologic variables, DNA ploidy, and DNA index to hematogenous distant metastasis after curative resection of rectal cancer was evaluated in 112 patients who had undergone curative resection (Cur A) of rectal cancer. Hematogenous distant metastases developed in 33 organs in 31 patients. Sites of metastases were : liver in 13, lung in 15, bone in 2, and brain in 3 patients. A univariate analysis revealed that the depth of tumor penetration (p<0.01), lymph node involvement (p<0.01), venous permeation of tumor cells (p<0.01), and clinical stage of the disease (p<0.01) contributed significantly to the development of hematogenous distant metastases after curative resection of rectal cancer. However, a multivariate analysis revealed that venous permeation of tumor cells (p<0.01) and lymph node involvement (p<0.05) were significant independent high-risk factors for the development of hematogenous distant metastases after curative resection of rectal cancer.

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