Purpose: The aim of this study was to evaluate the effects of budesonide foam as a treatment option in patients with ulcerative colitis experiencing failed therapy with a maximum oral dose of mesalazine.

Patients and Methods: This was a retrospective, observational, single-center study. We enrolled patients with active ulcerative colitis treated with budesonide foam who underwent endoscopic evaluation before and after budesonide foam treatment and who received maximum-dose oral mesalazine between January 2017 and January 2019.

Results: We enrolled 16 patients. Mayo scores and MES were significantly lower following budesonide foam treatment for a mean of 52.1 days (from Mayo score 5.1 ± 2.3 and MES 2.1 ± 0.6 to 1.9 ± 2.6 (p<0.001) and 0.7 ± 0.8 (p<0.001), respectively). The complete mucosal healing rate (MES = 0) was 36.4% among 11 patients who received the maximum dose of MMX mesalazine. The complete mucosal healing rate was 44.4% among nine patients who received prior topical therapy. A suspected glucocorticoid-related adverse event appeared as acne in one patient.

Conclusions: The majority of patients treated with budesonide foam achieved clinical remission and mucosal healing even in patients receiving the maximum dose of mesalazine and in those changing from another topical therapy.

Purpose: This study aimed to explore the effect of posture on physiological measurements in patients with fecal incontinence (FI).

Methods: Anal manometric and rectal volumetric studies were performed in 51 female patients with FI in the left-lateral position and the erect position.

Results: Defecography showed that 31 had rectoanal intussusception (RAI) and 20 had non-RAI. Endoanal ultrasound showed no difference in the incidence of sphincter defect between the patients with RAI and non-RAI. In the RAI patients, maximum squeeze pressure (MSP) [cm H₂O, median (range)] was significantly lower in the erect position than in the left-lateral position [121 (66-454) versus 147 (65-604), p=0.046]. In contrast, in the non-RAI patients, the posture did not affect the measurements. A subgroup analysis showed that MSP was significantly lower in the erect position than in the left-lateral position in the RAI patients without rectocele, but the posture did not affect the measurements in the RAI with rectocele. Minimal defecatory desire volume was significantly higher in the erect position than in the left-lateral position both in patients with RAI or non-RAI.

Conclusions: Squeeze ability was reduced in the RAI patients without rectocele in the erect position, and this might be another pathogenesis of FI.

A 75-year-old male underwent right hemi-colectomy for the treatment of transverse colon cancer at another hospital. At the blood test before operation, the eosinophil count was elevated with fever. Following the administration of prednisolone, the eosinophil count decreased. After one year, he was admitted to our hospital for treatment of sigmoid colon cancer. At the blood test, the eosinophil count was elevated again. He underwent Hartmann's operation after administration of prednisolone and was discharged. While tapering the dosage of prednisolone, the eosinophil count became elevated again. Because CT showed no recurrence, the patient is seeing a doctor regularly. Eosinophilia in solid malignancies is rarely reported; there are only five reports of hyper-eosinophilia in colon cancer in Japan. We report this case of colon cancer with two episodes of hyper-eosinophilia.

A 93-year-old man was admitted to our hospital with a bloody perianal wart. The wart was 15 mm in size and a sessile polyp. Although it was resected as seborrheic keratosis, histopathological examination of the specimen revealed that it was basal cell carcinoma and cancer cells remained at the excised end. We additionally cut and removed the cancer with a margin of 3 mm. Basal cell carcinoma appears commonly in body areas exposed to the sun, and rarely in unexposed areas such as perianal skin. This is the oldest patient at the Japan Medical Abstracts Society between 1991 and 2019.

A 75-year-old woman was admitted to our hospital due to right lower abdominal pain. Computed tomography revealed cecum cancer with para-aortic lymph node swelling. Ileocecal resection with regional lymph node dissection and sampling of para-aortic lymph nodes were performed. Histopathological examination revealed regional and para-aortic lymph node involvement. One month after operation, the CT scan delineated a swollen lymph node in the right external iliac region. Following the administration of systemic chemotherapy, the mass remained stable with some favorable controlled para-aortic nodules, and no other new metastatic legions were recognized. Para-aortic and right external iliac lymph node dissection was performed, however, lymph node recurrence in the right inferior epigastric and mesenteric region developed. As high microsatellite instability with BRAF V600E mutation was confirmed, pembrolizumab was administered. Further investigations into distant lymph node metastasis from colorectal cancer, including the relation to such tumor genetic features or tumor location, are expected.

The patient was a 55-year-old man who had undergone simultaneous pancreas-kidney transplantation from a brain-dead donor. Follow-up CT 5 years after the transplantation revealed a cystic lesion just above the pancreatic graft in the right iliac fossa. MRI showed that the cystic lesion derived not from the pancreatic graft, but from the vermiform appendix, suggesting appendiceal mucinous neoplasm. Ileocecal resection with D2 lymph node dissection was completed, without injuring the pancreatic graft. Histological diagnosis demonstrated low-grade appendiceal mucinous neoplasm. This is the first report of low-grade appendiceal mucinous neoplasm after pancreatic transplantation.