We previously investigated the effects of sodium ferrous citrate (SFC) on neutrophils in vitro and revealed that SFC inhibits neutrophil functions such as oxygen radical production and chemotaxis. In this study, we evaluated the anti-inflammatory effect of SFC using a dextran sulfate sodium (DSS) -induced rat colitis model. DSS solution (5%) was given ad libitum for 10 days to rats (DSS group). SFC (2mg/body) was given per os to SFC+DSS group rats for 3 days before the DSS administration and for 10 days accompanied with DSS solution. Leukocyte count was markedly increased in DSS rats and the increase was significantly suppressed in SFC rats. The length of colon was shortened in DSS rats, but the change was suppressed in SFC rats. The erosion area was significantly smaller in SFC rats compared with that of DSS rats. These findings indicate that SFC has a potential to exert anti-inflammatory actions on a DSS-induced rat colitis model.

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We investigated the significance of intraoperative peritoneal lavage cytology (CY) in 868 patients with colorectal cancer. According to the classification by the depth of invasion, carcinomas of m, sm and mp had negative CY, and carcinomas of se, a2, si and ai had positive CY more frequently than those of ss and a1. The rate of positive CY increased as peritoneal dissemination and lymph node metastasis became severer. With reference to histological type, CY was predominantly positive in poorly-differentiated carcinomas. The cumulative 5-year survival rate was significantly poorer in patients with positive CY than those with negative CY. Based on multivariate analysis, CY proved to be a significant covariate associated with survival. When the survival rate was compared with the results of CY and the presence or absence of peritoneal dissemination (P), the survival rate was significantly higher in patients with negative CY irrespective of the presence of P. In patients with cur A and B, peritoneal recurrence was less in patients with a negative CY irrespective of the presence of P. The above results suggest that patients with highly advanced carcinomas predominantly have positive CY and that CY is one of important prognostic factor.

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There have been two hypotheses concerning the histogenesis of colorectal carcinoma : adenoma-carcinoma sequence and de novo carcinogenesis. Although the importance of K-ras mutation has been accepted regarding carcinogenesis, few studies have looked at the correlation between K-ras mutation and the feature of atypical glands demonstrated in epithelial tumors that arise in the colorectal epithelium. In partricular, it remains obscure how K-ras mutation influcences phenotypical characteristics of an epithelial tumor, e.g. tubular, villous, and others. The present study describes the incidence and variety of K-ras mutation in each independent histological component comprising epithelial neoplastic lesions of the large intestine of less than 10mm diameter. As the result, it was extensively rare for a small lesion entirely composed of villous component obtained from any groups of lesions to show the highest incidence of K-ras mutation. Then, a tubular component generally indicated lower incidence, but those obtained from the groups having an area of villous components were high. Accordingly, K-ras mutation may advance the phenoconversion from tubular to villous configuration in colorectal lesions of epithelial neoplasia.

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Background : It is not unreasonable to assume that the risk of post-polypectomy hemorrhage is correlated with supplying artery diameter. The aims of this study were to analyze the correlation between morphological parameters and supplying artery diameter in pedunculated colorectal polyps.
Method : A total of 47 pedunculated colorectal polyps in surgical specimens of colorectal cancer (adenoma, 40 ; carcinoma in adenoma, 4 ; hyperplastic polyp, 3) were used. Histological pictures of the sliced specimens stained with H&E were transferred to a personal computer for the morphological parameters and supplying artery diameter.
Results : The polyp head was 5.9±2.8mm and 4.8±1.9mm in vertical and horizontal diameter, respectively. The polyp stalk was 2.0±0.5mm and 5.8±3.2mm in diameter and length, respectively. The mean supplying artery diameter was 95.7±33.0μm. The artery diameter was found to be significantly correlated with the stalk diameter (r=0.36, p<0.0001), but less correlated with the head diameter (r=0.24, p>0.05).
Conclusion : the risk of post-polypectomy hemorrhage was considered to increase with stalk diameter. When polypectomy is performed for polyps with larger stalk diameter, squeezing of the stalk by a clip or snare device may be of prophylactic value for post-polypectomy hemorrhage.

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The aim of this prospective randomized study was to compare the efficacy and acceptability of preoperative mechanical bowel preparation of the colon with polyethylene glycol solution (PEG) and modified Brown's method for 68 patients undergoing elective colon and rectal resection. 33 patients had mechanical bowel preparation with PEG (groupP), and 35 had mechanical bowel preparation by modijied Brown's method (groupB). All patients received no preoperative oral antibiotics for chemical cleaning of the colon. There were no significant difference between the groups with regard to postoperative outcome including delay of bowel movement, period of keeping from diet, hospital stay and the incidence of SSI (16.5% in groupP, 12.1% in gorupB). The evaluation for preparation by surgeons were well acceptable in both group. But judged from the result of questionnaire to the patient asking their evaluation to preparation method and the fact that two of 33 patients in groupP couldn't complete the preparation because of inability to receive full dose of PEG, preoperative technical preparation with Brown's method was preferable with respect to the acceptability for patients. In conclusion, both preoperative mechanical bowel preparation methods proved to be equally effective, so PEG was not indispensable.

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We discuss a case of surgically treated chronic idiopathic pseuodoobstruction (CICP).
A 60-year-old man was admitted to the hospital with complaints of constipation and abdominal fullness. On admission, physical examination disclosed severe abdominal distention, no abdominal tenderness and loss of bowel. Conservative therapy was started, but he developed hypotension, respiratory failure, and hyperventilation. Emergency operation including subtotal colectomy and ileostomy was performed, because the total colon was significantly distended. The post-operative course was good.
CICP is characterized by massive dilatation of the colon without any organic obstruction. In Japan, few reports have been reviewed. The etiology of this disease is unknown and is an isolated condition rather than a part of chronic intestinal tract. Either total or subtotal colectomy is required when conservative management, such as colonic decompression or medical management, fails.

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This is a report of a case study on bowenoid papulosis that shows close resemblance with the symptoms of condyloma acuminatum. The patient was a 34-year-old woman. In August 2002, she had anal intercourse once. Then, in the fall of the same year, a papule started to appear around the anus. Then, the skin lesion enlarged and increased to the extent that made her consult us in January 2003. In the lesion of condyloma we found a dark-brown flat papule. Suspecting bowenoid papulosis, we ordered biopsy. As a result, in situ carcinoma was found, which resembled Bowen's disease that could indicate malignancy. We diagnosed and treated this as bowenoid papulosis. Relapse occurred three times. Each time the lesion was removed and cauterization was applied. The symptoms disappeared, and the treatment was completed in June 2003. The patient had no complaints there after.
Bowenoid papulosis is an STD, carrying the Human Papilloma Virus. Simple examination can lead to a diagnosis of condyloma acuminatum because of the first appearance of the lesion. However, there is an important difference between BP and condyloma acuminatum. BP carries a serious type of HPV, and, over a period of time it can develop malignancy and eventually into a serious case of cervical carcinoma, whereas the latter does not. Therefore, careful observation and follow-up are required.

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We experienced a case of gastrointestinal stromal tumor (GIST) of the anal canal with buttock tumor. A 72-year-old man with the chief complaint of buttock tumor was referred to plastic surgery, and received biopsy suggesting GIST. Buttock tumor was palpated 10 cm in diameter on digital examination. MRI scan revealed a dumbbell shaped giant tumor occupying the lumen of the lower rectum and expanding to the right buttock region. Abdominoperineal resection with V-Y advancement flap was performed. The resected specimen showed submucosal tumor above the dentate line, and subcutaneous tumor out of anus. Histologically the tumor was composed of spindle-shaped cells with an interlacing bundle pattern, and mitotic activity was 2/50 HPF. Immunohistochemically, the tumor was positive for CD34 and KIT protein, and negative for s-100 protein, making this tumor a borderline malignant GIST originating from the anal canal. This case is valuable for studying the pathogenesis and growth mechanism of GIST.

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A 35-year-old woman had been an outpatient in the department of gynecology for the treatment of endometriosis. She had developed constipation before menstruation. She was admitted to the hospital with abdominal distension. Obstruction at the large intestine was determined. Since conservative therapy was not effective, we decided to operate for ileus. We found a mass, the size of a fist, in the rectum, and Hartmann's operation was performed. Pathohistological examination showed rectal endometriosis.
Only 38 reports of ileus caused by endometriosis of the large intestine have been reported in Japan in the past. In the case of a mature woman with a history of endometriosis, this disease should be taken into consideration, and it is necessary to ask about the symptoms of menstruation in detail.

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