In this study,the external environment of the ostomate is thought to consist of three components：physiological,social,and intellectual. The physiological environment was defined as that pertaining to the appropriateness of the positioning of the stoma. It is thought,therefore,that preoperative skin marking should be performed for ensuring proper placement of the stoma and convenient self-care by ostomates. Social environment could be improved by the development of stoma care items which are better suited to the special needs of these patients. It was further concluded that difficulties relating to the third component may best be resolved through strategies including education and practical guidance. Factors relating to the internal environment of the ostomate involve personal cleanliness and daily living habits.

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　We developed a new instrument for measuring the quality of life in colorectal cancer patients after their operation. Factor analysis indentified five factors. Internal consistency measured by Cronbach's alpha coefficient was 0.86. Next we standardized the outcome in 89 patients,and classified that into three degrees；low,fair,and high quality of life. Although the patients with colostomy have a lower quality of life in most factors than others,they have a higher quality of life（though not significantly higher）in the factor of satisfaction for defecation and urination at 3 months after the operation.

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　A pressure ulcer at the sacral area often shows a cavity under the skin known as a pocket. The treatment for the pressure ulcer with a pocket is very difficult. At first we tried to treat them in accordance with wound healing principles but then,we established particular treatment methods.
　First the wound was debrided and then covered with healthy granulation tissue. Using a hydrocolloid dressing directly adhering to both sides pocket surface was made. The histological examination of the adhered area showed poor vascularization,and was very fragile with less fibroblast containing granulation tissue. The adhesion,when being kept quiet,soon became stronger. If it is difficult to keep the wound quiet or if the wound is diagnosed as infected,the pocket must be opened as soon as possible.
　At all events it is essential to keep the wound in a moist environment and to avoid using antiseptics on it.

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　Although the majority of skin barriers consists of more than two kinds of hydrophilic polymers,the skin protecting function of each polymer is not fully clarified. Firstly,testing of the patches on normal human skin was conducted using test samples consisting of a single hydrophilic polymer to analyze each skin protecting function.
　Secondly,patch testing on normal human skin was conducted using two samples of test skin barrier in order to analyze the skin protecting function of each. Both consisted of combinations of hydrophilic polymers intended for actual use in skin barriers.
Results：
1）The natural skin surface relief was preserved best in the sample group with Karaya gum,and well preserved with Citrus pectin. In the sample with CMC the relief pattern was highly broken.
2）The relief pattern was better preserved int he Karaya gum with Citrus pectin composition than in Karaya gum with CMC composition.

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　Performing a temporary ileostomy without careful planning or peristomal skin management will upset the usual life of the patients and impose on them a psychological burden. We hare had experience of 6 cases of patients who recovered from peristomal skin trouble by means of a suitable selection of prosthetic appliances and predictive skin care. These cases suggest it is very important to consider the following：
1. Even with the emergenct cases we have to mark the stomal site before the operation.
2. The height of the stoma should be more than 1 cm in order to further peristomal skin management.
3. We have to have a firm understanding of the social background of the patients and the of their ability to manage their stomata by themselves.

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　We had a patient who suffered from continuous bladder bleeding due to invasive prostatic cancer. Though he was managed with bilateral ureterocutaneostomy,percutaneous cystostomy and continuous saline irrigation,obstruction by blood clots caused a marked leakage around the cystostomy catheter. The patient complained of discomfort,anxiety,insomnia and coniact dermatitis around the cystostomy. We applied a "Nipple pouch",a stoma pouch combined with a nipple around the cystostomy catheter. It proved useful and could catch all the leakage around the catheter and provide relief from his problems including the skin trouble.

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　A 78-year-old woman underwent right hemicolectomy along with the resection of a large part of the small intestine,and was provided with a jejunal fistula because of obstruction of the superior mesenteric artery due to advanced pancreatic cancer.
　In this case,expulsion of 800 ml/day of stimulative intraintestinal liquid caused severe erosion of the area surrounding the subsided jejunal fistula.
　In spite of frequent changes of gauze dressings（3 times a day）,the skin problem grew worse and she complained of severe pain,itching,and insomnia. After use of the pouch drainage technique,using an open-top Surgedrain（Alcare Co.,Ltd.）,and administration of a hydrophobic skin protector,UniSalve（United,Inc.）,skin damage improved,and treatment was repeated once every 4-5 days.
　Appropriate management of jejunal fistula is necessary for improving the daily lives of patients and for reducing the workload of nursing staff.

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　All ostomates hope to lead everyday lives free from unpleasant smells. There is a method using the above-mentioned carrot powder which destroys the bad smell from stomal discharges.
　The carrot leaf powder was prescribed as the deodorant to one hundred patients with colostoma over a period of 2 weeks. In 75％ of them the bad smell more or less ceased after 7 days of treatment and in 2 weeks the number had grown to 85％ in all. The 19％ of cases that reported a good response at the end of the first week had experienced a further improvement by the end of the second week. The 38％ of cases that did not seem to respond to treatment during the first week,improved somewhat during the second week.
　Thus taking carrot leaf powder provides some improvement in the quality of ostomates'life.

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　The development of improved stoma appliances underlies recent progress in stoma rehabilitation. However the glut in the numbers of appliances has confused many nurses new to stoma rehabilitation. Therefore,we tried to select stoma appliances by using a personal computer（PC）.
Materials and methods：The PC is a Macintosh Power Book 170,and the OS is Kanji Talk 7.0. Application soft is "File Maker Pro." Information concerning the appliances was keyed in from the book "A List of Main Appliances for Stoma in Japan",edited by the Japan stoma rehabilitation training committee in 1992. We used a check list covering various stoma situations to search out answers for nurses new to stoma rehabilitation. Then we selected some appliances by using the PC.
Conclusions'：477 intestinal stoma appliances were input. Although it was possible to select some kinds of appliances,the input information for the appliances was not enough；more information concerning stoma appliances is needed.

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　In stomal care,patch testing is employed both for skin tests and for selecting equipment. A new sheet for the patch test（P-test）was developed by the author and the usefulness of this test was evaluated in the present study.
　The study was conducted on 40 ostomy patients,and the value of the P-test was assessed by 25 medical care professionals（physicians,enterostomal therapists,and nurses）at different institutions. The results of their evaluation were as follows：100％ noted stable application,78％ mentioned the absence of incompatibility,93％ found that application could be clearly assessed while 88％ of the subjects hoped to use the tests again,and 85％ rated it as useful. These findings confirmed the value of the P-tets.

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