The extent of the influence of the location of marking on postoperative stomacare,especially on the stability of the apparatus,was compared with various factors presumably influencing stomacare,and the possible optimal location of marking as seen from this viewpoint was examined. Evaluation was made by means of multivariate analysis and mathematical quantification theory Class and Class,using, as indexes,possible peristomatal cutaneous symptoms and early and latter postoperative frequencies of exchange of the apparatus.
　The results revealed that the frequency of exchange depended largely upon the location of marking in both early and latter stages and that a location,i.e.‘1 cm above umbilicus’ , ‘6 cm left side from the median line’ was most superior in keeping the stability of the apparatus in the latter postoperative stage.

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　Quality of life of ostomates is influenced by subsequent complications and care problems resultmg from carelessness at surgery. Obstacles to implanting a stoma at the optimum site are as follows：1) misdiagnosis on spread of the pathology,2) insufficient preoperative information regarding the stale of the colon proximal to the advanced cancer,3) emergency surgery,4) inflammation,5) severe obesity,6) technical error.
　Under the circumstances above,the patients must be treated with great care：1) The optimum site for a stoma has to be established prior to surgery,even in an emergency,whenever the merest possibility exists that a stoma might be necessary. 2) A suitable extent surrounding the optimum site（Fig. 1）and the alternatives proximal to it（Fig. 2）must be observed and marked prior to surgery. A basic misunderstanding on stoma site marking is that a stoma can be implanted at only one point. Stoma site marking consists of locating a suitable area where ostomates can rely on the bag for perfect fitting. 3) Stoma construction should never be considered as an insignificant addendum to removal of the rectum,though it requires no technical difficulty. Bearing the optimum stoma site and the drawing route of colon in mind,the bowel must be divided and implanted straight,but not under tension.

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　Occasionally,we find the patient whose stoma is hard to be cared by oneself at the sitting position because of the hanging upper abdominal wall over the stoma,though the stoma was made at the preoperatively marking site. It has frequently occurred in obese patients or old women with redundant abdominal wall. The lower abdominal wall of the obese patienth angsd own,projectsa tth e sitting position,and the increasing thickness of subcutaneous fatty tissue is also observed. But the colon situated in the abdominal wall as the stoma and the surrounding tissue do not stretch,and the stoma is depressed relatively and covered by the upper abdominal fatty wall.
　In order to prevent this trouble,we prepare the enough length of the colon for the subcutanous part of the colostomy,and we think that the site of the colostomy should be made at the higher level than usual,namely at the level of the navel or slightly at lower level than it.

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　Twenty-six cases of patients in whom synchronous creation of both intestinal and urological stomas have been done（hereafter in short as double stoma patient）were reviewed and evaluated from view point of stoma care. Evaluation were made by scoring to five components as follows; 1）stoma site,2）stomal and peristomal condition,3）distance between two stomas,4）status of scar on midline incision,and 5）complication of stoma. In highly scored patients（excellentg roup）,stoma marking were done in 100％ and in modarately scored patients （fair group）marking rate was 60.7％. On the other hand,marked cases was took 16.7％ of low scored patients（poor group）. Skin irritation by leakage occured highly in poor group,while low in excellent group.
　This analysis led to the conclusion that preoperative stoma site marking was important management in stoma care.

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　The beauty of human body arises from exuberant health. In the present report,the introduction of the physiological action of the skin protecting agents（skin barriers）and their bacteriostatic action on the skin surface will be discussed with reference to the concept of wound healing.
　Since skin barriers have been recently used on the peristomal skin immediately after surgery,few cases of peristomal dermatitis have been experienced. For example,peristomal erosion or ulcer heals with surprising rapidity when the correct use of the skin barriers,due to the effectiveness of these agents against skin problems.
　The keratin layer on the skin surface is a acidic mantle（about pH 5.0）,and this acid membrane protects the living organism from bacteria. The acidity acts as a physiologically neutral point for the skin.
　Karaya gum（Steruclia urens）,a well known skin barrier is most frequently used for control stoma care. This action consists of a buffering actin to inactivate digestive enzymes and bacterioststic action to inhibit the proliferation of skins urface bacteria.
　The cause of peristomal dermatitis,and adequate treatment for this was explained with reference to the buffering action of skin barriers and bacteriostatic action.
　Effective treatment including the physiological technical response was pointed out.

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　In this paper,a process of an uroostomate at our department and qualifications for an ideal urostomate were dicussed. As merits and demerits from his experience,following points were mentioned; 1）being encouraged,2）dissolving lonely sensation,3）being informed of post-operative life（as merits）,4）abscence of medical informations,5）anxiety of prognosis of the ostomate（as demerits）. It is suggested that meetings between medical stuff and ostomy visitors should be held.

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