In the past, there was no good method to evaluate the human colic motility. In this study, it was attempted to evaluate colicmotility by extrasomatic ultrasonography. In a healthy group, the crescentic folds in the colon from the cecum to the descending colon were observed at about 2.5 cm intervsal. The crescentic folds could not migrate, and they had their positions in the colon independent of time. Active peristalsis contractions were observed only from the cecum to the ascending colon. Migration of the large intestinal contents was observed, but there was no active peristalsis contraction in the other parts of the colon. From the transverse colon to the descending colon, one unit was composed of two or three segments of the colon divided by the crescentic folds, and the contents of the unit would migrate to the anal side of the colon depending on the pressure caused by the ascending colon. On the other hand, the crescentic folds and the haustra were not clearly observed in the constipation cases. There was no reaction to neostigmine in those cases.
Therefore, tension of the crescentic folds and haustra strongly involved the migration of this intestinal content.

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Clinicopathological features of 38 mutinous carcinoma cases of the large intestine were compared with those of 533 cases of well or moderately differentiated adenocarcinoma as a control. Mucinous carcinoma had a greater likelihood of occurrence in young people, in the right colon (p< 0.05), and in the anal canal (p< 0.05), macroscopic type 5 (p< 0.05), large tumor size (p<0.05), deep invasion through the bowel wall (p<0.05), and high grade lymphatic vessel invasion (p<0.05) than the control. Five-year survival rate of mucinous carcinoma (44 %) was lower, but not significantly, than that of the control (53%) ; the survival rate after curative resection of mucinous carcinoma (62 %) did not differ from that of the control (65 %). Seventeen cases of poorly differentiared mucinous carcinoma (PMC) showed a greater likelihood of macroscopic type 3 or 4 (p<0.1), deep invasion through the bowel wall (p<0.1), high grade lymph node metastasis (p < 0.l) and lymphatic vessel invasion (p<0.05), and advanced histological stage (p<0.05) than 15 cases of well differentiated mucinous carcinoma (WMC). With the HID-AB staining method, 64.3 % of PMC showed the sialomucin-predominant type and 30.8 % of WMC showed the same (p<0.1).

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To disclose the existing state of treatments and results of symchronous hepatic metatases from colorectal cancer, a multiinstitutional questionnaire study was conducted. Hepatic resection was the most effective treatment for all stages of metastatic tumors, especially for the H₁ stage. Hepatic arterial infusion therapy was the second most effective treatment for the H₂ and H₃ stages. By multivariate analysis, size of tumors greater than 5cm was a predictor for the Hi and H₃ stage, and the number of lesions for the Hi stage. Based on the results of this study, a continuous study on colorectal liver metastases on a nationwide basis is considered to be necessary in the future.

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Among a wide variety of integrins, many β1 subunits are thought to act as receptors of extracellular matrix proteins in epithelial cells and to play important roles in infiltration and metastasis of colorectal cancer. In the present study, serum j31 integrin levels were preoperatively measured in 86 patients with colorectal cancer, and immunohistological staining of this integrin was also performed on 63 of these patients, in order to assess the biological malignancy of colorectal cancer. The serum integrin level was found to decrease as the cancer depth (p=0.0024), lymph node metastasis (p=0.0415), lymph duct invasion (p0.0002), and clinical stage (p=0.0142) progressed. In integrin staining, a lower stainability was observed as the cancer depth (p=0.0021), lymph node metastasis (p=0.0001), lymph duct invasion (p=0.0003), clinical stage (p=0.0001), and venous invasion (p=0.0266) progressed. These results indicated that measurement of the serum level of the adhesion molecule β1 integrin and its immunohistological staining are useful for the evaluation of the biological malignancy of colorectal cancer.

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A 49-year-old male underwent surveillance colonoscopy after surgery of sigmoid colon carcinoma. A sessile polyp measuring 20 mm was resected by endoscopic mucosal resection. Microsatellite instability (MSI) of these tumors (sigmid colon carinoma : primary, early cecal signet-ring cell carcinoma : secondary) was analysed. Both tumors showed MSI in 4-5 out of 6 microsatellite loci. Among the 22 reported cases of signet-ring cell carcinoma in early stages, 8 were cases of multiple colorectal carcinoma. In consideration of the MSI status of this case, signet-ring cell carcinomas in early stages were considered to have a tendency to develop in multiple colorectal carcinoma cases.

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An 85-year-old bedridden female had been suffering from constipation with fecal incontinence, and was referred to our hospital because of bloody stool and rectal ulcer in May, 1994. She had past illness including uterine cancer, diabetes mellitus, congestive heart failure due to atrial fibrillation, and recent right hemiplegia due to cerebral infarction. Colonoscopic examination revealed a sharply-demarcated giant, shallow ulcer occupying the posterior half of the circumference of the rectum, but the colon was otherwise normal. Histologically, the biopsy specimens showed nonspecific severe chronic active inflammation without granulomas or fibromuscular obliteration. Based on the diagnosis of stercoral ulcer, her bowel habit had been controlled conservatively, and the ulcer temporarily healed in 3 months. In spite of good bowel habit, however, the rectal ulcer recurred at the same site in March, 1995, and did not heal. She died from heart failure in August, 1997.
A rare case of rectal stercoral ulcer, in which the first temporal healing had been followed by a subsequent long-standing course of the open ulcer was reported. In the present case, the intractability of the ulcer was assumed to be due to advanced age associated with severe heart and vascular disorders.

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The patient was a 20-year-old male who was prone to natural constipation and who had symptoms agreeable to irritable bowel syndrome since he was about eight years old. He experienced severe abdominal pain about five pm followed by massive stool and then had bloody diarrhea seven or eight times until the next morning. Endoscopic examination immediately after consultation at our hospital revealed circular and longitudinal ulcers developing from the descending colon to the transverse colon. Diagnosis of Ischemic colitis was made. A case of irritable bowel syndrome with ischemic colitis is very rare and this was the third reported case in the world.

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Radiation colitis sometimes shows uncontrollable bleeding. The treatment by 4 percent formalin solution was effective for two cases of radiation-induced hemorrhagic colitis. Case 1 was an 80-year-old female who had cloacogenic carcinoma, poorly-differentiated squamous cell carcinoma type. This was complicated by hemorrhagic proctitis 16 months after radiation therapy. Bleeding could not be controlled by steroid enema and endoscopic laser therapy. Formalin treatment was very effective for hemostasis. Case 2 was 47-year-old female who had breast cancer with multiple bone metastases. This was complicated by hemorrhagic colitis 15 months after radiation therapy of bone metastases of the lumbar spine and the sacrum. Three formalin treatments were needed for hemostasis, however, they were effective. The formalin treatment is a simple, effective and minimally invasive therapy for radiation-induced hemorrhagic colitis of the lower sigmoid colon and the rectum.

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Granular cell tumor is defined as a benign tumor derived from Schwann cells. This tumor develops in any part of the body, but it mostly occurs in tongue and skin. The gastrointestinal tract is an uncommon location for this tumor, especially in large intestine. Granular cell tumor in the anus is extremely rare.
A case of granular cell tumor that occurred in the anal canal was reported. A 50-year-old male visited our hospital complaining of pus discharge from the anus. The diagnosis was fistula-in-ano and was operated on. The fistula was intersphincteric type with a simple low track. A hard nodule, 10.5×5 mm in diameter, with smooth surface was palpable at the dentate line beside the fistula. Following coring out of the fistula, the submucosal nodule was also extirpated.
Histological examination with H·E staining revealed the presence of eosinophilic granules in the cytoplasm, and immunohistochemical studies of the nodule were positive for S-100 protein and neuron-specific enolase. The diagnosis of granular cell tumor was made. Some granular cell tumors are reported to grow up invasively. Adequate local resection including polypectomy is recommended.

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A 53-year-old male visited our hospital for further examination because of positive fecal occult blood. Radiological and endoscopic examinations revealed a submucosal lesion of the rectum. It was considered to be possibly a submucosal tumor, but diagnosis of this lesion by means of endoscopic biopsy was suspected adenocarcinoma. Low anterior resection was performed. The lesion, 1.4 cm in the largest diameter, looked like a submucosal tumor marcroscopically. Pathological examination revealed well differentiated adenocarcinoma with lymphoid stroma and invasion to the submucosal layer. Reports of colorectal cancer with submucosal tumor-like morphology and lymphoid stroma are rare. This was a rare case, and the developement and progression of such tumors were discussed.

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A 45-year-old female visited our hospital complaining of defecation disorders since childhood. Barium enema showed a dilated sigmoid colon and rectum without narrow segment, but a proximal colon of normal diameter. Hirschsprung's disease was excluded by presence of the rectoanal inhibitory reflex, and the diagnosis was of a presumed idiopathic megacolon and megarectum. Daily drug treatment with magnesium sulphate prevented severe constipation for 7 months, although idiopathically the episode of severe pain, constipation, and abdominal distension with dilated colon, suggesting sigmoid volvulus, occurred, and was treated by sigmoidectomy. She has had restored bowel function without using laxatives for over one year since the operation. Sigmoidectomy was a good operation for recovering bowel function.

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Among 648 patients with colorectal cancer, 89 patients with hepatic metastasis (synchronous, 56 ; metachronous, 33) were analyzed regarding their clinicopathological features, therapeutic outcomes and recurrence in the remnant liver after hepatectomy, and the results were as follows :
1)Invasion to the perirectal adipose tissue of the rectum or to the serosal surface of the colon, lymph node metastasis, and lymphatic invasion were all considered to be important risk factors for liver metastasis.
2)The five-year survival rates in patients undergoing resection of either synchronous or metachronous liver metastasis were 36.1 % and 40.1 %, respectively, whereas the prognosis of the patients with liver metastasis who did not undergo surgery was very poor.
3)Recurrent disease was observed in 21 patients after hepatectomy, 14 of which showed recurrent lesions in the residual liver. Re-hepatectomy was performed in 7 patients with remnant liver metastasis, showing good results in the survival period as compared with the non-resected group.
In conclusion, hepatic resection with an adequate surgical margin and postoperative intraarterial chemotherapy for daughter metastasis and occult metastasis was thought to be indispensable for preventing recurrence in the remnant liver. Furthermore, resection of recurrence in the remnant liver should be actively attempted for patients without any recurrent lesions in organs other than the remnant liver.

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