A new classification of skin barriers which are made of various components is proposed. The main points of this classification system is as follows：
　1. Skin barriers are divided into two basic types,according to their chemical construction,i.e. gel type which is composed of a hydrophilic polymer alone and polymer blend type which is made of hydrophilic polymer and hydrophobic polymer.
　2. Hydrophilic polymer used in the polymer blend type are classified into 5 groups,i.e. Karaya gum,Karaya gum/pectin,CMC/Karaya gum,CMC/Pectin,and CMC,and hydrophobic polymers,into 3 groups of PIB,PIB/SIS and SIS. Into all hydrophilic-hydrophobic group combinations,the polymer blend type is subdivided.
This system of classification can be anticipated to discriminate components and properties of different skin barriers and thus prove of better clinical use.

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　This paper deals with the historical changes and the results of the stoma clinic in Osaka National Hospital. During these 9 years,1338 patients in total visited the stoma clinic. The substances performed at the clinic were the ordinary follow up in 51％,the direction of pouch in 16％,the skin trouble care in 11％,the guidance of irrigation therapy in 8％ and so on.
　The stoma clinic in Osaka National Hospital has two characteristcs. The first is that the stoma clinic is functioning as one of a service of colo-proctology division,and the second is that nurses take a leading in management of the stoma clinic. In conclusion,it is necessary to deeper further understanding of the persons concerned in stoma clinic to improve it.

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　Sixteen（16）ostomates（58～81 years old）were interviewed to confirm their needs for their apparatus.
　They complains mainly 7 problems and some problems such as the skin trouble,unstability of the apparatus defies solution especially for the elderly patients.
　The result of this study seem to indicate that some non-adhesive type appliances as a device would be useful for the elderly ostomates.

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　Urine acidification by cranberry juice was studied in urostoma group（10 patients）and normal group（10 cases）. Urine pH was measured before drinking 100％ cranberry juice and two hour later. In normal group urine pH was significantly lowered（p<0. 05 by paired t-test）from 6. 0±0. 73 to 5. 66±0. 43（mean±SD）. In urostoma group urine pH 7. 45±1. 23,which was higher than normal group,was significantly lowered（p<0. 001）to 6 .84 ±1 32.
　There was no significance in the degree of acidification between two groups. This study disclosed that 100％ cranberry juice,even a low volume （100 ml）,can lower urine pH for two hours. And we reported one case which might indicate long-term effect on urine acidification by drinking 150 ml cranberry juice every day. It was discussed if cranberry juice is useful for stoma care.

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　Unwritten hardships of enterostomates and methods of improvement were reported based on my personal experience as a colostornate for full one year and an ileostomate for successive seven years.
　Complete elimination of the hardships could only be achieved by diagnosis of rectal malignancy in the very early stage of the disease followed by an anus preserving operations now available and advancing remarkably. Leading propagation for the self recognition of the very early clinical signs,i.e. transient but intermittent colic abdominal pain and association of increased mucinous material with bowel movement,should be promoted by every medical professionals.
　Because of the incidence of Miles'type operation associated with permanent enterostoma formation does not show significant decrease by now in my departrnent of surgery,and as we all know any effort for the "ugly" stomal care ends up in vain and causing everlasting hardships,I have been emphasizing the important role of the nervous system preserving technique and the "beautiful" stoma formation to my colleague colorectal surgeons and teaching my students.
　Regarding to the appliances for these inavoidablc ostomates,there are several huge manufacturing companies in the adva.ilced world. They are producing many different types of unique appliances and numerous series of combination. It must be a fortunate stage of advance,but for average ostomates too much selection means less personal adaptibility and causing some isolated patients fixing on their self-rightous methods of stomal care. To assist those patients,advanced knowledge on the appliances, those are neither controlled nor contributed by big companies,are essential for medical professionals including surgeons,nurses and of caurse enterostoma therapists. I emphasize we should never forget the most important role of adhesive material called "skin barrier",that connect the appliance on to the skin around the stoma,is protection against any damage of the skin.
　Finally,based on my personal experience as a GI surgeon for more than 30 years and a patient with stoma,I have reported on sequential change of mental and psychological states of ostomates along with the change of medical care for rectal malignancies,and requested thoughtful and very kind collaboration of professionals with ostomatcs suffering from unwritten hardships.

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　The incidence of stomatal haemorrhage,a complication of ostomy,is relatively low and serene cases are quite rare. This paper describes a case of stomatal haemorrhage which became severe as it recurred. We could save the patients life and ultimately achieve a recovery,but not without great difficulties in local care due to persistent stomatal haemorrhage and resulting disorders of the stomatal mucosa and adjacent skin. Additional difficulties were encountered in care at home and rehabilitation efforts since this patient was aged and ilved alone with his aged spouse.
　This paper describes the local care made for the treatment of stomatal haemorrhage in this case and discusses its causes,and recommended remedial actions. It is necessary to develop special programs in medical care and welfare services which can provide for aged ostomates who have to be cared at home.

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　We report our experience in managing a patient with multiple enterocutaneous fistulas from the small intestine that developed after gastric resection for cancer. The care for this patient was made difficult by copicious fistulous drainage,the fact that the openings of the fistulas situated below the skin level,and the fact that the origins of the fistulas from the bowel tract were not easy to be located. First,the eroded skin was protected from the discharge by the use of CMC skin protectant and by collecting the entire output of the fistulas into a large disposable plastic pouch glued around the fistulous orifices. Second,the sizes of the fistulous tracts and the levels of intestinal openings were clarified by fistulograms,then smaller tracts were obliterated by applying several kinds of skin protectants over their external openings. This simplified the tracts of drainage. Such measures facilitated the healing of wound and the fistulas finally closed.

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　A 65 year old woman,had uterus cancer at age 38,with radiation therapy. A year later lower bowelcomplications necessitated a loop stoma. When seen at the Stoma Clinic peristomal skin had a severe ulcer,large amount of watery stool and unhealthy condition. NURSING PLAN：1）Prevent skin infection 2）Promote wound healing 3）Avoid skin damage when pouching. POUCHING：1）Ulcer covered with Remidarm（sterile wound dressing） 2）Pospack B（clear open end pouch）applied. This method was successful. Patient could change her pouch and was discharged. She has visited the stoma clinic and is now able to take care of herself and is enjoying a better life.

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　Patients who undergo subtotal colectomy and ileo-rectal anastomosis without ileostomy for ulcerative colitis have many problems such as frequent diarrhea,dermatitis around anus,pain and mental depression.
　In order to care these patients,pre-and post-operative care program that included patient education,perianal skin care and control was made by experience. And this program improved these patient's problems.

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　In a case of Crohn's disease with intractable ulceration around the ileostoma who undergone subtotal colectomy,the relationship among ulceration period,general condition and Crohn's disease activity was studied.
　The results suggest that the ulcerntion around the ileostoma was influenced not only by leak of feces,but also by nutritional condition and Crohn's disease activity.
　To prevent the ulceration,good management or the general condition of the patient is necessary along with pertinent caring ileostoma.

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　We studied 18 patients with ureterocutaneostomy. Stomal stenosis was detected in 11 patients. There was a tendency to stomal stenosis in the case performed radiation,diabetic patient or obesity patient. Also,there was a tendency to stomal stenosis in normal ureter rather than hydroureter. We deviced new ureteral stent,which can be retained by ‘pig tail’ tip in the renal pelvis and met good results of management and prevention for stomal stenosis with it.

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　The management of the ileostomy is generally tluought to be difficult to control. We,therefore investigated the early management（post-OP within 2 weeks）of the diverting loop ileostomy in our ward. Twenty three patients with adenomatosis coli and ulcerative colitis who have under gone diverting loop lieostomy between 1989 and 1990 were included in this study. They were checked following 4 points.（1）The amount of discharge from the ileostorny,（2）The appearance of the stoma itself,（3）The state of appliance,（4）The peristomal skin irritation.
　Pospack K was selected for appliance during the skin. Daily exchange of the appliance enabled to check such complications of ileostomy as edema,bleeding,necrosis,recession and so on. After the ileal discharge began,usually on 3 post-op. day,Hollister two-piece appliance was selected because it was durable,easy to apply and to check the stoma. Every two days exchange of the appliance not only had the advantage of preventing the skin troubles around the stoma,but also raised the interest for the stoma of the patient himself. By doing so,the self care of the ileostomy could progress smoothly and every patient mastered it within two weeks.
　Finally,our care-program for 2 weeks after making temporary loop ileostomy was shown.

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　In Japan,for fear of recurrence of caccr or because of using anti-neoplastic drugs,physicians sometimes react negatively to colonic ostomates becoming mothers. There are few reports of deliveries with a colostomy. We have an experience of a 28-year-old woman who successfully delivered a child after colostomy. When she was 20 years old she underwent Miles'operation because of rectal cancer. She had been taking 5FU at least 100 mg/day for 6 years. When she was refered to our hospital,no recurrence was detected and we stopped the medication. After one year,she became pregnant and delivered a healthy baby girl by cesarian section. In her course her stoma was extended by 61％ with recovery to the former size after the delivery. We also reviewed 8 Japanese ostomate cases who delivered children.

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　There has been a recent marked increase in interest in stoma rehabilitation. While considerable time has been spent on the technical aspects of these rehabilitation the social problems have not yet been fully solved.
　Medical social workers（MSW）are specialists in the field of social problems. However,the actual condition of contribution of the MSW has been uncertain,A questionnaire to survey MSW's work was used. This survey was mailed to members of the Research Society of Tokai for Stoma Rehabilitation. The questionnaire were returned from 101 members that were consisted of 47 physicians,50 nurses and 4 MSWs. Of 101,52 members answered that MSW have not worked in their hospital. Solving the social problems were main reason why the members introduced their patients to MSW. The majority of the mambers were needed MSW when patients agreed with becoming ostomates. It maybe concluded that MSW has the important position in the stoma rehabilitation.

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　Fifty three cases,27 ulcerative colitis and 26 familial polyposis,with ileo-anal anastomosis（IAA）were investigated for the actual patient's condition concerning of the frequency of daily stooling and fecal soiling,an experience of soreness,the self care and prevention method of the perianal skin integrity by use of our checkrist.
　Frequency of the perianal skin soreness was a marked reduction from 79％ to 22％ at 7th POD and 6 month after surgery.
　Between two different diseases,colitis and polyposis,a significant difference of a frequency of the fecal soiling and soreness was observed immediately after surgery.
　The grade of the severity classification of the perianal soreness was designed to make skin care plan using of an objective findings could be given from the record of clinical card.
　The aim of this study is to provide easier and safer support for appropriate self care of the patient by use of our new plan of the skin care system based on our classification concerning the perianal skin soreness.

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　A case of an ostomale,a female aged 34,after Miles operation for rectal cancer who was delivered of a baby by Caesarean operation is reported and ostornates in Japan are clinically reviewed in terms of deilvery.
1）In Japan,there liave been 8 reported cases of ostomates,including the present case,who went through their pregnancy and delivery after the operation.
2）The underlying diseases are benign in 4 cases and malignant in the remaining 4 cases.
3）All malignant cases were delivered of a baby by Caesarean section,but the section does not appear to be necessary.
4）In our present case,the stoma was not deformed and the irrigation was able to continue durmg pregnancy without trouble.
5）It seems that patients after Miles operation should be avoid pregnancy for 5 years at least.

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　In order to establish ostomy visiting in Japan,several conditions have to be met. Prior to starting the program,institution must have：A）A correct understanding of function and limitation of visiting. B）A good preparation for any inconvenience that possibly will be caused by ostomy visiting.
　On the other hand,the ostomy visitors have to satisfy next two factors. A）They must be sufficiently educated by ostomy visitor training program. B）They must understand that visiting is done only under direction of "ostomy visitor's association".
　Ostomy visiting program will be able to function affectively in our country,provided these four requirements are satisfied.

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