There were 342 SCI patients surveyed through a nationwide questionnaire on bowel management. Of the 201（57.8％）respondants,only three cases of C₆ SCI had undergone elective colostomies in our clinic. To assess the differences in bowel care before and after surgery,we interviewed these 3 cases,one man and two women. A total of 3 colostomies were done for the following reasons：fecal contamination of a decubitus ulcer and prolapse of the rectum in one case,and incovenience of bowel self-care in all three. Follow-up time ranged from one to four years. Bowel care ranged from 1 to 6 hours each time,once or twice times a week preoperatively,was reduced to 40-60 minutes each time,3-7 times per week postoperatively. Abdominal pain,distention,anorexia,fecal leakage and emotional stress also duninished. All cases were comfortable with the postoperative bowel self-care which required no additional aid or medication.
　We conclude that colostomies conducted in C₆ SCI patients makes bowel self-care considerably more convenient and improves the quality of life as well.

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　This 78-year-old woman had a retracted colostomy on top of a large peristomal hernia. She could neither see the stoma when standing nor be fitted with any available stoma apparatus. She required manual defecation daily by herself and had lost hope for the future. To improve her Quality of Life（QOL）we undertook an operation in which the stoma was resited and the hernia was reconstructed using Marlex mesh. Her new stoma proved very functional and she regained hopef or her life. However,she died suddenly from aspiration pneumonia on the 58th postoperative day.

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　In this study,we evaluated the clinical practicality and safety of a KARAYA sheet（Biohesive K-1）as a primary surgical wound dressing. In 30 patients who underwent abdominal surgery the operation wound was sutured with Biohesive K-1（BHK-1）on the first postoperative day and removed on the 7th postoperative day. When BHK-1 was removed,complications of the skin,reactions of the patients and convenience of the sheet were evaluated. Bacterial contamination was examined by a stamp culture method. No skin complications were noted and small skin eruptions or itching feeling was less than 10％. In all patients,the surgical wounds were completely protected from bacterial contamination. We concluded that BHK-1 was a very practical and safe surgical wound dressing.

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　This study investigated the psychological influences and problems for ostomates by comparatively examining their awareness of whether or not they have cancer. Patients（n=131）who had colostomies following the treatment of rectal cancer and are also members of an ostomates' association in Ishikawa prefecture,responded to the State-Trait Anxiety Inventory（STAI）and the Rosenburg Self-Esteem Scale（RSE）by mail. The results of this study showed that ostomates who know they have cancer suffer more significantly from anxiety than those who do not know. The self-esteem scores for ostomates who were aware of their cancer rose significantly,and the postoperative period became longer. In light of these findings,we conclude that ostomates who know they have cancer need more psychological support in the early postoperative period than presently provided. We also conclude that it is necessary to incorporate a long-term psychological support system into the nursing care system.

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　Skin surface pH value was measured using a HORIBA pH meter（H7MV）and microelectrode（6210-06T）. Normal controls for pH value were distributed from 3.8 to 6.4. Mean pH was　4.8 to 0.8. Four kinds of skin barriers exhibited a buffer effect raising pH value to nearly 5.0. Immediately after the skin was washed with soap,pH value reached 6.2. After washing with UNIWASH,however,pH value reached 5.4.
　The pH value of peristomal skin was 6.7. This shows that peristomal skin is easily affected by dermatitis.

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　Very few cases of defecation dysfunction after anterior resection for rectal cancer have been seen. During the past 10 years our hospital has treated only seven patients （7/277=2.5％）suffering for several months from frequent bowel movement and dermititis around the anus. These difficulties restricted patients' daily routines and social lives. Patients were treated using irrigation therapy. Warm water（800 to 1000ml）was injected slowly into the anus. Within one hour bowel movement usually occurred. Irrigation therapy reduced the frequency of bowel movement from 12.5 times to 3.6 times per day.
　Dermititis and pain disappeared. Irrigation clearly is useful for improving the quality of life of these patients.

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　In ileostomy patients,who underwent emergency operations due to surgical complications,stoma care may be limited because of inadequate preparation preoperatively. To clarify the problems of ileostomy care under such conditions,we analyzed pre-and postoperative stoma care in 8 patients. Patients who preoperatively had the stoma site marked by informed consent experienced less skin and stoma site complications and achieved independent stoma care sooner than other patients. Skin trouble could be attributed to stomal deformity and massive exdate from the drain. In the early postoperative stages,the use of a surgidrain-open-top was effective for collecting watery discharges. We conclude that informed consent and stoma site markings should be done preoperatively,and that it is necessary to select and adjust various stoma devices in each patient.

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　We have successfuly treated ulcers,abscesses and fistulas around the Ileostoma using the following methods：povidone iodine treatments；skin washing；antibiotics；artificial skin applications（Debrisan）；salve applications；and a low-fixing stoma-pouch for postoperative MRSA colitis following colon cancer-induced ulcerative colotis surgery.

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　We reviewed ostomy visitor（OV）volunteer activities at ostomy associations in Western countries and conducted a survey among Japanese medical personnel regarding the introduction of OV activities to Japan. Our aim was to show that there is a need for OV activities among Japanese ostomates.
　Charts were used to explain the framework for the system as proposed by the Japan Ostomy Association,Inc.,which requires four basic roles for ostomy visitors and principles for response in order to adequately introduce OV activities.
　The scope of these operations and the committee responsible for implementing the activities were also discussed. For establishing OV activities in Japan,support,understanding and guidance of qualified medical personnel and existing of well trained ostomy visitors are indispensable.

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　Follow-up ostomy services for 175 outpatients in Japan were investigated by questionnaires and some published materials.
1）Many outpatient clinics have been estabilshed in big cities.
2）A lot of clinics are managed by large national or public hospitals.
3）Most stoma cilnics are conducted one to four times monthly.
4）In many clinics,ostomates are treated and educated not only by doctors but also by nurses.
5）In many cases,ostomates with stomas of the gastointestinal tract as well as those with stomas of the urinary tract are examined in the same cilnic.
6）Adolescent and geriatric ostomates and pediatric patients are also given instructions in identical clinics.
7）Ostomates have post-hospital follow-up exams at stoma clinics in other hospitals.

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