Yasutoshi Saito

Endoscopic evaluation for cytomegalovirus enterocolitis after allogeneic haematopoietic stem cell transplantation

Cytomegalovirus (CMV) disease and graft versus host disease (GVHD) are serious complications after allogeneic haematopoietic stem cell transplantation (allo-SCT).1 As clinical manifestations overlap,2 it is difficult to make an early and accurate diagnosis of CMV enterocolitis in patients with gastrointestinal GVHD. This study aimed to estimate the usefulness of endoscopic examination for CMV enterocolitis after allo-SCT. Between 1999 and 2003, 425 patients received allo-SCT at the National Cancer Centre Hospital. Eighty seven patients with gastrointestinal symptoms underwent colonoscopy, and gastrointestinal GVHD was diagnosed in 75 patients. Thirty three of these patients with a median age of 46 years (range 4–67) who had persistent diarrhoea and/or abdominal pain despite optimal treatment underwent repeat colonoscopy. After informed consent was obtained, we examined from the terminal ileum to the rectum by colonoscopy. Biopsy …

Managing Type 2 Diabetes Mellitus through Periodical Hospital Visits in the Aftermath of the Great East Japan Earthquake Disaster: A Retrospective Case Series

Aims To assess the impact of the Great East Japan Earthquake Disaster on daily diabetes practice and to determine the feasibility of controlling type 2 diabetes mellitus in an outpatient department. Methods We retrospectively reviewed the data on disaster-affected patients with type 2 diabetes who periodically attended outpatient department of Soma Central Hospital. There were 767 patients with type 2 diabetes mellitus in total. The primary outcome measure was the change in HbA1c. Results HbA1c levels of 58 patients with periodical hospital visits did not deteriorate after the disasters. Moreover, there observed no significant difference in the mean of HbA1c levels among all age and sex throughout the year. While several changes in diabetes medication usage occurred, DPP4-inhibitor was the only oral diabetic agent that increased in frequency (+60%). Conclusions Patients with type 2 diabetes who were managed with periodical hospital visits did not show significant deterioration in HbA1c levels.

Hospital Staff Shortage after the 2011 Triple Disaster in Fukushima, Japan-An Earthquake, Tsunamis, and Nuclear Power Plant Accident: A Case of the Soso District

Introduction In 2011, Fukushima was struck by a triple disaster: an earthquake, tsunamis, and a nuclear accident. In the aftermath, there was much fear among hospital staff members about radiation exposure and many staff members failed to report to work. Objectives One objective is to measure this shortage in hospital staff and another is to compare the difference in recovery by hospital types and by categories of hospital staff. Design The monthly records of the number of staff members from May 2011 to September 2012 were extracted anonymously from the records of 7 local hospitals in the Soso district in Fukushima. Change in the number of staff was analyzed. Results Staff shortages at hospitals reached a maximum within one month after the disaster (47% reported to work). The shortage of clerks was the most severe (38% reported to work), followed by nurses (48% reported to work). The shortages remained even 18 months after the disaster. Conclusion After a disaster in which the damage to hospital functions surpasses the structural damage, massive support of human resources in the acute phase and a smaller volume of support in the mid-term phase appear to be required, particularly for non-medical staff.

A report from Fukushima: an assessment of bone health in an area affected by the Fukushima nuclear plant incident

Bone health was assessed for inhabitants of an area affected by the Fukushima nuclear plant incident. Osteoporotic patients, who had been treated with active vitamin D3 and/or bisphosphonate at Soma Central Hospital before the Fukushima incident, were enrolled. Changes in bone turnover markers and bone mineral density were retrospectively analyzed. Serum levels of a bone resorption marker, serum type I collagen cross-linked N-telopeptide were decreased in all the treated groups, whereas those of a bone formation marker, bone-specific alkaline phosphatase, were increased. Accordingly, bone mineral density, estimated by dual-energy X-ray absorptiometry, was increased in the lumbar spine of all groups, but bone mass increase in the proximal femur was detected only in the group treated with the two agents in combination. From the degree of these parameter changes, the antiosteoporotic treatments looked effective and were equivalent to the expected potency of past observations. At this stage, the present study implies that the Fukushima nuclear incident did not bring an acute risk to bone health in the affected areas.

Living in Contaminated Radioactive Areas Is Not an Acute Risk Factor for Noncommunicable Disease Development: A Retrospective Observational Study.

OBJECTIVE Although much attention is now being paid to the health risks associated with nuclear disasters, reliable information is lacking. We retrospectively evaluated the health effects of living in highly contaminated radioactive areas in Japan. METHODS The health evaluation was conducted in Tamano district, Fukushima prefecture, in 2011 and 2012. The surface deposition density of cesium in Tamano was 600 to 1000 kBq/m2 shortly after the Fukushima nuclear accident. Clinical parameters included body mass index, blood pressure, and laboratory examinations for blood cell counts, glucose levels, and lipid profiles. A screening program for internal and external exposure was also implemented. RESULTS One hundred fifty-five residents participated in the health evaluation. Significant decreases in average body mass index and blood pressure were observed from 2011 to 2012. Annual internal exposure levels did not exceeded 1 mSv in any participants. The levels of external exposure ranged from 1.3 to 4.3 mSv/y measured in the first test period but decreased to 0.8 to 3.6 mSv/y in the second test period. CONCLUSIONS These findings suggest that inhabiting nuclear contaminated areas is not always associated with short-term health deterioration and that radiation exposure can be controlled within safety limitations.

Detecting Residual Fluorine 18 From a Medical PET-CT Procedure During Population Whole Body Counter Screening in Fukushima

After the Fukushima Daiichi nuclear incident in 2011, radiation contamination of the affected area raised public health concerns about internal radiation exposure. Internal radiation exposure screening using a whole body counter (WBC) (Fastscan Model 2251, Canberra Inc, Meriden, CT) has been performed for the affected residents in Soma City, 40 km north of the Fukushima Daiichi nuclear power plant (Figure 1). Analysis was performed by use of the Apex-InVivo and Genie software (Canberra Inc). Detection limits were 220 Bq for cesium 134 and 250 Bq for cesium 137 with a 2-minute scan.

Pseudo-SLE by human immunodeficiency virus infection

A 61-year-old woman was admitted for long-lasting fever and recurrent opportunistic infections during the treatment of SLE. She had been diagnosed as SLE and type-IV nephritis based on a renal biopsy and serological findings. A colonoscopy and liver biopsy revealed disseminated Mycobacterium avium complex infection. Human immunodeficiency virus (HIV) infection status was then examined and found to be positive. From the clinical course, the first symptoms were inferred to have been those of HIV infection.