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A man in his 70s presented with a chiefcomplaint ofbleeding during bowel movements. Subsequent colonoscopy revealed a submucosal tumor-like elevated lesion ofapproximately 4 cm situated in the sigmoid section ofthe rectum. EUS-FNAB was performed, and the lesion was identified as mucinous cancer. Based on a diagnosis of rectal cancer(cT4a, cN0, cM0, cStage II), a low anterior resection was performed. Histopathological analysis of the resected specimen revealed a well-differentiated mucinous cancer. The tumor had ruptured the proper muscular layer and was developing in a submucosal tumor-like manner, protruding from the wall within a fibrous capsule. In Japan, only 15 cases of submucosal tumor-like colorectal mucinous cancer have been reported to date. It is rare for such cases to be preoperatively diagnosed as mucinous cancer using EUS-FNAB and then to undergo radical resection.

An 89-year-old woman underwent low anterior resection for rectal adenocarcinoma(Ra, pT3N0M0, pStage II , Cur A)in 2008. In February 2016, she underwent an outpatient examination because of a defecation disturbance. Lower gastrointestinal endoscopy was performed and the stenotic region was biopsied. However, no malignancy was detected and the stenotic site expanded. However, the patient experienced recurrence of the same symptoms, developed severe anal stenosis, and underwent another examination in December 2016. Magnetic resonance imaging indicated a neoplastic lesion around the entire circumference of the anal canal. Transperineal needle biopsy results indicated squamous cell carcinoma. The patient was diagnosed with postoperative rectal cancer and metachronous anal canal squamous cell carcinoma(P, cT4bN2M0, cStage III b). Laparoscopic artificial anus construction was performed with the aim of unblocking the anal canal stenosis. Considering the patient's age and performance status, radiation therapy was administered. Two months after administering radiation therapy, the tumor decreased in size, and anal pain reduced.

PT, APTT, and coagulation factor activity are measured with clotting time-based methods. When coagula- tion and fibrinolysis are enhanced, TAT and PIC are detected, but evaluations of their hypofunctional state are difficult. We devised a new method that can be used to comprehensively and continuously evaluate coagula- tion and fibrinolysis in real time. We elucidated the clinical phenotype of congenital and acquired coagulation disorders using the following methods; (1) Clot waveform analysis (CWA) to evaluate fibrin formation; (2) Thrombin generation test (TGT) to monitor one-step before fibrin formation. (3) Thrombin/Plasmin generation assay (T/P-G) to evaluate fibrinolysis simultaneously with TGT. The results revealed that (1) CWA enabled the measurement of a very low FVIII activity level (FVIII:C 0.2-1.0 IU/dL) and detected a markedly severe type with FVIII:C <0.2 IU/dL. (2) For TGT, acquired hemophilia A showed a much lower value than that of congenital severe hemophilia A, being consistent with its severe bleeding. (3) CWA parameters for acquired factor V inhibitors in patients with bleeding symptoms were more impaired than with non-bleeding. Taken together these comprehensive assays can reflect the clinical phenotype and make it possible to analyze unidentified coagulation/fibrinolysis abnormality.

A woman in her 50s visited our hospital in February 2015 with a complaint of dull abdominal pain in the right lower quadrant. She had a medical history of appendectomy for appendicitis in her 20s. Computed tomography(CT)revealed a tumor 90 mm in diameter near the ileocecum. Elective surgery was planned under the suspicion of gastrointestinal tumor, malignant lymphoma, or ileal cancer. She was emergently hospitalized 1 day earlier than scheduled because of high fever and severe abdominal pain. CT revealed that the tumor had increased to 120 mm in diameter without free air. Her white blood cell count was not elevated, and her symptoms improved readily with medical treatment. Thus, we performed the operation as scheduled. A tumor with a dark red recess on the surface had invaded the transverse colon intraoperatively, and a small amount of purulent ascites was present at the pouch of Douglas. We performed ileocecal resection with partial transverse colectomy. Histopathological examination led to the diagnosis of desmoid tumor in the mesentery of the terminal ileum. The surgical margins were negative for tumor cells. The tumor surface around the recess showed peritonitis, and the ascites showed no bacteria or tumor cells. The patient had been doing well without recurrence after discharge. Some cases of desmoid tumor with peritonitis have been reported, but most were caused by tumor penetration into the intestinal tract. We report herein a rare case of intra-abdominal desmoid tumor with abacterial peritonitis.

The patient was a 36-year-old man who had been aware of a mild bleeding tendency since childhood, but did not show any history of severe bleeding. After lumbar epidural block was performed for pain caused by lumbar disc herniation, the patient developed paraplegia due to an acute epidural hematoma, and rectovesical disorder. He was admitted to our hospital, and wide fenestration and hematoma evacuation were performed. Because of persistent bleeding, reoperation was performed to achieve hemostasis. Although factor VIII antigen was 138%, its activity was decreased to 18% of normal. A diagnosis of cross-reacting material positive mild hemophilia A was made. Postoperative injection of a factor VIII preparation resulted in complete hemostasis. The activated partial thromboplastin time was within normal range. A thrombin generation test showed reduced endogenous thrombin potential, peak thrombin levels, and prolonged time-to-peak levels. The thrombin generation test, which allows comprehensive assessment of the coagulation profile, was useful for diagnosis and treatment of this case.

A 44-year-old women developed marked myopathy one year earlier, when she was treated with intravenous prednisolone for acute severe exacerbation of ulcerative colitis. When she was admitted to our hospital for another severe exacerbation, intravenous cyclosporine A was administered as monotherapy because she could not tolerate corticosteroid. The treatment was successful and she obtained complete remission. Cyclosporine A monotherapy is considered to be a valuable alternative to proctocolectomy for severe ulcerative colitis patients who cannot tolerate corticosteroid.

A 23-year-old man was admitted for treatment of acute exacerbation of ileitis and perianal abscess caused by Crohn's disease. After incision and drainage of the abscess, coupled with antibiotic therapy, 6-mercaptopurine (6-MP) was commenced. His white blood cell (WBC) count on day 12 after initiation of 6-MP was not decreased. However, on day 24 he was re-admitted because of severe myelosuppression (WBC: 300/microl), which was complicated by the recurrence of the perianal abscess. Myelosuppression was prolonged and required the administration of granulocyte colony stimulating factor (G-CSF). G-CSF was continued for 17 days to achieve recovery of his WBC count to a normal level.

A 23-year-old woman was admitted in November, 2002, complaining pain of the left side and buttock. She had ulcerative colitis when she was 16 and received medical treatment. Based on physical examination and findings of magnetic resonance imaging and bone scintigrapy, as sacroiliitis complicated by ulcerative colitis. was diagnosed Reports on sacroiliitis and ankylosing spondylitis complicated by inflammatory bowel diseases (IBD) are relatively rare in Japan, whereas they are common complications of IBD in Western countries. The efficacy of steroids on pain relief of sacroiliitis and ankylosing spondylitis is unclear.

Matrix metalloproteinase (MMP) plays an important role in degradation of cartilage matrix. The expression of MMPs in cartilage or syovial membrane was increased in osteoarthritis or rheumatoid arthritis. We summarized the regulation mechanism of MMP production, and described pharmacologic inhibitors such as non steroidal anti-inflammatory drugs, steroid and growth factors, which might be useful to prevention of joint destruction.