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Lactosucrose is a non-digestible carbohydrate available for fermentation as a substrate for the intestinal microflora. It has been reported that lactosucrose is selectively used by the Biffidobacterium, and that its number significantly increase after the oral administration. In this study, we have examined the changes of the postoperative serum endotoxin level in ten patients with colorectal cancer. Five patients were served as controls, and the remaining five patients were given 30g of lactosucrose daily, during 1 week up to 3 days before operation. Serum endotoxin levels were measured prior and after lactosucrose ingestion, and also on day 1, 3, 5, and 7 postoperatively. Fecal pH, organic acid contents and intestinal microflora were also analyzed before and after lactosucrose administration. The control group had blood and fecal samples taken in a similar manner to the lactosucrose group. Fecal pH had the tendency to decrease, and the concentration of fecal organic acids had the tendency to increase in the lactosucrose group when compared with the control group. The count of Gram-negative rods, which were reported to produce endotoxin, decreased in a ratio statistically significant (p

30 out of 358 patients operated for a colorectal cancer had multiple cancer of the large intestine and other organs (multiple group). There was no difference in sex, age, location and macroscopic classification of colorectal cancers between the multiple and non-multiple groups. The most common site as the other organ was the stomach, followed by the uterus, lung, bladder, prostate and mamma. The most common histological classification was well differentiated adenocarcinoma in both groups, but, mucinous carcinoma was significantly more frequent in the multiple group. There was a tendency to having advanced cancers in the multiple group, and especially colorectal cancers preceded by the other organ cancer were significantly in a more advanced stage than those in non-multiple group. Therefore, it might be difficult to diagnose a colorectal cancer in an early stage during follow-up period for a cancer of other organ. Higher frequencies of family history of cancers, multiple colorectal cancers and complication of benign neoplastic polyp were demonstrated in the multiple group, and the existence of hereditary oncogenous factors was suggested. It is important to perform careful preoperative examination and postoperative follow-up, entertaining a probable multiple cancer, because it is very difficult to predict.

A new surgical approach using esophageal mucosal stripping technique in the treatment of major leakages of the esophagojejunostomy after total gastrectomy is presented. This procedure is indicated for patients with such major leakage in whom local infection can not be controlled even by sufficient drainage and nutrition management and fatal septic process is progressing. This procedure was successfully performed in 2 such patients. First, the intrathoracic esophageal mucosa is stripped off by the help of a vein stripper after separating the anastomosis. Edematous part of the jejunal end is resected and the stump is closed. After a Witzel jejunostomy is performed, the closed limb is brought out to the level of the abdominal wall and fixed subcutaneously. The cervical esophagus is exteriorized and both proximal and distal ends of the intrathoracic esophagus are tied. The merits of this approach are: 1) The ultimate objective which is mandatory for the treatment of infection is achieved, because the source of contamination is eradicated. 2) It is a rapid and technically easy procedure resulting in less operative trauma to the already compromised patient. 3) Enteral feeding can be started immediately after operation. 4) Differing from whole esophageal stripping, there is no risk of iatrogenic dissemination of infection intramediastinally. Hemostasis is easily achieved by the tamponadary effect of the accumulated blood in the esophageal muscle tube.

The changes in the intestinal microflora were examined in patients with advanced carcinoma of the large intestine, and healthy subjects were surved as control. Comparing to control, patients group revealed high fecal moisture and fecal pH, but showed low levels in various organic acids except succinic acid. Only succinic acid was detected in high level and frequency. No significant difference in the number and occupation rate of Gram-positive bacteria participating in the endogenous endotoxin production was noted between both groups. The pattern of fecal microflora in patients group was similar to that in control. However, the aerobic microorganisms including Staphylococcus were highly found in patients group. These results suggested that the colonic enviornment of the patients with large bowel carcinoma was in aerobic state in comparison with healthy subjects.

The clinical features of 6 operated cases of Crohn's disease experienced at the department were studied. The anatomical sites of these lesions were the small bowel, small and large bowels, and large bowel (including one case of rectal Crohn's disease) in each two cases. Indications for surgery included intestinal stricture in four cases, abscess, and fistula in each one case. Intestinal stricture was seen in two cases of enteritis, one case of enterocolitis, and one case of colitis (rectal lesion). Abscess and fistula were seen in one case of enterocolitis and colitis, respectively. Bowel resection was performed as short in length as possible, about 10 cm length from the margin of the main lesion. The postoperative recurrence occurred in one case. In this case, the recurrence lesion was improved by medical treatment. There were no cases of reoperation and death. Although postoperative follow-up is limited in durations from one and a half to ten years, all 6 patients are working without recurrence now.We discussed surgical treatment for Crohn's disease including indication for operation, surgical procedures and prognosis, together with a review of the literature.

A case of pseudomembranous colitis presenting with tachycardia, fever, and shock, but not accompanying by abdominal pain and diarrhea in an early stage after gastrectomy is described. Pseudomembranous colitis, if it occurs in an early stage after gastrointestinal operation, often lacks in abdominal symptoms. This case, being sucessfully diagnosed to start the treatment in a relatively early postoperative period, is rare.A 52-year-old man underwent total gastrectomy for primary malignant lymphoma. Cefotaxim (CTX) administration was started on the day of operation. From the 3rd postoperative day severe tachycardia, fever, and shock occurred, and nosotropic therapy failed to improve the general condition. Cause searching try also failed to disclose any complications such as anastomotic leakage and abdominal bleeding. On the 4th day a large amount of water diarrhea appeared. Endoscopic examination of the large intestine was performed. Based on macroscopic findings and biopsy cytodiagnosis, a diagnosis of pseudomembranous colitis was made. Administration of vancomycin hydrochloride and a large quantity of transfusion led to rapid symptomatic remission.