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For five years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Japan, the proportion of patients with undiagnosed symptomatic breast cancer remained elevated in the coastal area of Fukushima. These individuals experienced a prolonged interval from first symptom recognition to initial medical consultation (hereafter referred to as the patient interval). We aimed to investigate how this prolonged patient interval affected disease staging. Using patient records, we retrospectively extracted females with newly and pathologically diagnosed breast cancer who initially presented to Minamisoma Municipal General Hospital from March 2011 to March 2016. We estimated the proportion with advanced-stage disease (III, IV) according to the patient interval duration (

Rationale: Managing the health of vulnerable groups is an important component of health care. Given the long-term burden of radiation-release incidents among those exposed, managing the health of vulnerable groups following a nuclear disaster is very important. However, there is limited information available concerning the long-term management of the health effects of radiation exposure in vulnerable groups following nuclear disasters. After the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, Minamisoma City launched internal radiation exposure monitoring program for local residents, using whole body counter (WBC) units. In 2017, a man of low socio-economic status (SES), was found to have the highest level of internal contamination detected in a person living in the Soma District in recent years. This report describes the case so that the lessons learned can be applied in future nuclear disaster settings. Patient concerns: A 77-year-old Japanese man, who had been homeless for 2 months and had been staying in the exclusion zone of Minamisoma City, was brought to our hospital. He had become homeless because a lack of communication between social support services had led to his eviction from leased housing after free housing support for evacuees was terminated. Diagnoses: He was admitted with a diagnosis of dehydration and malnutrition. A WBC unit was used to assess his body burden of radioactive cesium. This revealed levels of Cs-134 and Cs-137 of 538 Bq/body and 4,993 Bq/body, respectively. Intervention: He received intravenous fluid therapy and health monitoring. The paperwork required for him to receive public income support was processed during hospitalization. Outcome: He was discharged to public housing after 9 days, and municipal workers started visiting him regularly after his discharge. Lessons: A high level of internal radiation contamination may occur after a nuclear disaster. This may be associated with a decline in social support, poverty, and social isolation, and may have more impact on people in poor health than on the general population. It would be useful to strengthen linkages between local government and welfare service providers to increase social support for vulnerable groups requiring health care, not only following disasters, but also under normal circumstances.

Rationale: The health vulnerability of certain populations such as children, the elderly and individuals with illnesses or physical disability can become significant in disasters. After the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, significant health impacts on vulnerable populations were observed during early or mid-term phase of the disaster, presumably associated with the evacuation. However, there is limited information available on the health impacts owing to long-term evacuation after disaster among them. Patient concerns: A 56-year-old physically challenged male with arteriovenous malformation on his right lower limb, diagnosed when he was 2 years’ old, lived near the FDNPP. He and his family were forced to evacuate immediately after the accident. Diagnosis: Three months after evacuation following the FDNPP accident, he developed a refractory foot ulcer associated with atrial fibrillation and congestive cardiac failure because of deterioration of arteriovenous malformation, presumably led by repeated evacuations. Intervention: Although anticoagulation therapy and diuretic therapy improved his cardiac failure in the initial admission, he decided to only be treated with supportive care after revelation that his arteriovenous malformation was no longer eligible for aggressive intervention. Outcome: Three years after the long-term evacuation in temporary houses, the patient died of bleeding and infection of the ulcer. Lessons: This case suggests that long-term evacuation for individuals with physical disability may lead to significant health impacts, and even premature death, through the deterioration of daily life activities due to physical and psychological burdens. This case presents a need for further research on ways that disasters impact the health of individuals with physical disabilities, and greater disaster preparation for the needs of populations with physical disabilities.

Although psychiatric patients are likely to be adversely impacted by disasters, information regarding the processes involved in adverse impacts is limited. In March 2011, Japan experienced an earthquake, tsunami, and the Fukushima Daiichi Nuclear Power Plant accident. In its aftermath, Takano Hospital, 22 km south of the power plant, underwent forced patient evacuation. A 54-year-old Japanese male with schizophrenia, who had been hospitalized in the psychiatric ward for over 20 years, was transferred and experienced a series of hospital relocations. Although his physical status was intact when he left Takano Hospital, his condition gradually worsened, presumably due to incomplete exchange of patient information between institutions and changes in the treatment environment. Having developed ileus a few days prior, he was bedridden when he returned to Takano Hospital in May 2011. Over the course of treatment, he developed aspiration pneumonia and died in August 2011. A review of medical records revealed that all his purgative medicines had been stopped after his evacuation, possibly contributing to the development of ileus. This case highlights the necessity of establishing systems enabling patient information sharing between institutions in disaster settings and the importance of recognizing that long-term evacuation may have fatal impacts for psychiatric patients.

Article, 【研究ノート】

We report the case of a Japanese woman with amyloid light chain (AL) amyloidoma in the abdominal aortic retroperitoneum and mesentery. Irregular soft tissue mass lesions with calcification in the abdominal aortic retroperitoneum and mesentery were initially detected by computed tomography at another hospital. The lesions gradually compressed the duodenum, causing symptoms of bowel obstruction. The patient was clinically diagnosed with retroperitoneal fibrosis, and prednisolone was administered at a dose of 40 mg/day. However, the lesions did not change in size and her symptoms continued. She was transferred to our hospital and underwent mesenteric biopsy for histopathology using abdominal laparotomy. The histopathological and immunohistological findings of the mesenteric specimen demonstrated lambda light chain deposition. Accordingly, the patient was finally diagnosed with AL amyloidoma with no evidence of systemic amyloidosis. After laparotomy, her general condition worsened because of complications of pneumonia and deep vein thrombosis. She died suddenly from acute myocardial infarction. We have concluded that abdominal aortic retroperitoneal and mesenteric AL amyloidoma may have very poor prognoses in accordance with previous reports. In addition, the size and location of AL amyloidoma directly influence the prognosis. We suggest that early histopathology is important for improving prognosis.

本研究は、地理情報システム(GIS) 技術を利用して、防災の観点を考慮しつつ、土地と建物の両面から東京の市街地の密集状態を把握することを目的として行った。この目的のため、まず東京23区を中心とした東京都東部の土地利用を分析した。分析にあたっては1989、94年の国土地理院細密数値情報の10メートルメッシュデータを用いた。対象地域は500メートル四方のグリッドに分割して、集計単位とした。分析対象とする土地利用は工業用地、一般低層住宅地、密集低層住宅地、空地とした。そして土地利用構成比、時系列変化、およびjoin分析の変形で、ある辺率によって隣接集塊性を把握した。続いてこの結果から、墨田区京島2丁目、豊島区南長崎3丁目、世田谷区北沢4丁目、杉並区今月11丁目を対象地域として選ぴ出した。これらの町丁目について、まず建物の影響を受けない空地である有効空地を抽出して分析した。さらに、木造建物・防火造建物・耐火造建物といった建物の構造種別を考慮して、建物の隣棟間隔を建物のクラスタリングによって分析した。, The aim of this study is to analyze agglomeration of land use and congestion of buildings in terms of earthquake disaster prevention using GIS (geographical information systems). First, the land use of the eastern part of Tokyo Metropolis, which includes Tokyo 23 Ku area, is analyzed. This analysis uses the 10 meter grid land use data of Tokyo Capital Region in year1989 and in 1994, which are supplied by the Geographical Survey Institute, Ministry of Construction of Japan. This study area is divided into 500 meter grid districts, which are used as aggregation units. The analyzed land use categories are industrial area, normal and congested residential areas of low-rise detached houses, and open space. Them aps of the land use ratios of each 500 meter grid district are made and studied. The characteristics of agglomeration of land use is also analyzed using edge ratios, which are derived from JOIN COUNT statistics. Second, considering the result above, four districts, which are Kyojima 2 Chome in Sumida Ku, Minami Nagasaki 3 Chome in Toshima Ku, Kitazawa 4 Chome in Setagaya Ku and Imagawa 1 Chome in Suginami Ku, are selected as study districts for detailed analysis. Effective open spaces, which are of a certain distance from buildings, are extracted in these study districts. The distances between buildings are also studied using a clustering method which considers the structure of the buildings in terms of fire proofing.