A 57-year-old man with a spinal cord injury to the lumbar region（L1）underwent a colostomy in order to ease bowel care and prevent fecal contamination of decubitus ulcers. Pre-and post-colostomy conditions were compared with regard to defecation,food intake,daily activities and decubitus ulcer infections and healing. We also reviewed whether changes following the colostomy contributed to a better lifestyle.
　We found that,following the colostomy,the time and effort required to defecate were significantly reduced for this patient. Food intake increased and resulted in a weight gain of 2kg. In addition,the patient no longer feared the possibility of fecal incontinence and thus gained confidence and freedom both physically and mentally,leading to a more comfortable lifestyle. Decubitus ulcers were easier to treat,but did not heal as a direct result of the colostomy.
　From this case we conclude that a colostomy can improve the quality of life for some patients with spinal cord injuries.

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　Patients undergoing or about to undergo a colostomy are subject to various anxieties and shifts in their psychological state. Thus,although it is difficult to evaluate patients anxieties exactly,it is of prime importance to treat such patients perioperative psychological disorders with a view to furthering their future quality of life（QOL）.
　We used Spielberger's State-Trait Anxiety Inventory （STAI） to assess the anxieties and the psychological condition of six patients undergoing colostomy. The STAI scale makes it possible to qualify vague anxiety in such patients so that we can decide to start individual nursing for each stoma rehabilitation.
　The anxiety scale plays an important part in evaluating the psychological condition of patients undergoing colostomies.

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　The purpose of this clinical report is to assess the cost performance of the pouch drainage method in comparison with the gauge dressings method,involving frequent changes of dressings,in jejuno-cutaneous fistula management. We treated a jejuno-cutaneous fistula with severe skin erosion around the fistula with FOY（gavexate mesilate）ointment and gauze dressings；however,there was no improvement. Therefore,the better to manage the skin lesion,pouch drainage was tried with Surgidrain Open-Top A-M（Alcare Co.,Ltd.）together with some other devices,and after ten days the erosion improved.
　We calculated the total equipment cost and the daily cost of the fistula management for both the gauze dressing and the pouch drainage methods,and also the frequency of equipment exchange for both methods of fistula management.
　1. The total cost of the dressings for the fistula management
　　Gauze dressings　¥58,963
　　Pouch drainage　¥26,050
　2. The frequency of changes of dressings for the fistula management
　　Gauze dressings　3.1 times/day
　　Pouch drainage（before skin irritation improvement）
　　0.7 -1.8 times/day
　　（after skin irritation improvement）
　　0.2 times/day
　3. The daily costs of the fistula management
　　Gauze dressings　 ¥2,746/day
　　Pouch drainage（before skin irritation improvement）
　　¥1,280-¥1,686/day
　　（after skin irritation improvement）
　　¥484/day
　In conclusion it is clear that the advantages of pouch drainage in fistula management include：（1）an improvement in skin irritation,（2）no need for frequent dressings exchanges,（3）lower cost in comparison with gauze dresssings.

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　Colostomies were performed under laparoscopic control on three patients. In this paper,our experience using laparoscopy in colostomies is evaluated and the usefulness of laparoscopy for colostomies is discussed. The advantages of laparoscopy for colostomy are：firstly,it enables us by means of a small puncture wound to observe the whole intraperitoneal space,secondly,the most suitable point at which the colon can be brought out through the most abdominal wall,and finally,it makes care of stomas easier because there will be no other wound around the stomas.
　The results obtained from such surgical experiences may suggest that the use of laparoscopy in constructing colostomies should be adovocated in some cases.

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　Six of 12 patients who had undergone a total colectomy with a temporary ileostomy between 1988 and 1993,received a special diet we had contrived,while the other 6 did not. The bulk and consistency of stool between the two groups at the early postoperative stage were compared. In the patients on the special diet,discharge from the ileostomy was less bulky,and its consistency changed much earlier from being sludgy（unformed）to being soft（semiformed）. As a result,closure of the ileostomy was achieved much earlier in the patients put on the regimen. The special dietary regimen we designed will offer an earlier recovery from a total colectomy combined with a diverting ileostomy.

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　This report concerns a patient with recurrent and massive hemorrhaging from colostomy due to cirrhosis and hepatocellular carcinoma. Of the treatments used,sclerotherapy was the most effective and decisive. Complete cessation of bleeding was achieved by using soft appliances which could protect the mucocutaneous region around the varices,and by instruction about management of the bleeding and colostomy care in the patient daily life. With the decrease in the amount of bleeding,the worries and distress gradually diminished. Essential care for hemorrhagic varices consists of（1）a reduction in the venous pressure of varices,（2）the protection of the mucocutaneous region around the stoma,and（3）instruction on the management of the bleeding from the stoma and underlying diseases.

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　We have been educated the colostoma care by lecture and/or technical teaching at the bed side. In this study,we have evaluated our instruction for young nurses how to fit medical instrument of colostoma for quality of patients.
　We discovered that the experience for the judgement and the observation in stoma care is not sufficient for some young nurses because of their different cituation of skilled chance.
　Therefore,we newly developed instructional manual using photographs and brief explanations,and is thought to be very useful for nursing education of the colostoma care.

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