Disaster is defined as an occurrence causing widespread destruction and distress, affecting human life or social life due to natural phenomena or human actions. The medical care provided when the demand for it significantly exceeds the supply capacity due to such an event, so that the same medical care as under normal circumstances cannot be provided, is described as disaster medicine. Surgeons involved in emergency medicine in rural hospitals encounter and deal with similar situations on a daily basis. Their experience, knowledge and skills as surgeons are often put to great use in actual disaster medicine, enabling them to make appropriate decisions and responses when their own hospital is affected. These characteristics are also useful in acute disaster medicine, and many surgeons have been dispatched to disaster-affected areas, working in disaster medical assistance teams or other medical teams. Surgeons are expected to play an active role in all aspects of disaster medicine, from responding at hospitals in the disaster area to providing medical care as part of a disaster medical team, transporting patients to hospitals outside the disaster area, and treating victims who are brought to their own hospital.

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The number of aortic emergencies with a high mortality rate is increasing due to the rapid aging of the population, and the mortality rate for ruptured abdominal aortic aneurysms is known to be exceptionally high. The role of information and communication technology (ICT) is attracting attention as a national policy begun in 2019 ipromotes improvements to the medical system for aortic emergencies. Our department has been aiming to improve the life-saving rate of patients with ruptured abdominal aortic aneurysms in a remote regional area through telemedicine imaging information using ICT. In cases in neighboring regions, collaboration with emergency medical services (EMS) in prehospital management may provide a key to improving the regional life-saving rate. In the future, it is desirable to promote efficient medical care using ICT and establish a regional cooperation system, regardless of the region of onset.

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Many chest injuries result in death within a few hours after the injury. Death in the first few hours after injury is called preventable traumatic death, and some patients can be saved with appropriate initial treatment. In high-energy chest trauma, there are three major mechanisms of injury: a) direct external force, b) internal pressure propagation, and c) shear force due to acceleration. The A (airway), B (breathing), C (circulation), D (central nervous system damage), and E (general exposure and warming) approach has been formulated as the basis of the “primary survey” in initial medical care. Chest trauma requiring emergency treatment is identified by physical examination, chest radiography, and facial drooping, arm weakness, speech difficulties and time to call emergency services (FAST). It is essential to understand the injury mechanism and to provide prompt initial evaluation and treatment, as well as appropriate surgical intervention.

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We performed an open right hemicolectomy and D2 dissection for a 70-year-old man diagnosed with cancer of the ascending colon. Postoperative chemotherapy was not initially planned for the patient; however, due to elevated tumor markers (CEA and CA19-9) and suspected recurrence, chemotherapy was initiated 6 months after surgery with sequential administration of TS-1 (alone), followed by TS-1 + irinotecan (IRIS), and then TS-1 + oxaliplatin (SOX). Based on CT and gastrointestinal endoscopic examinations, which revealed no signs of recurrence, and considering the patient’s preferences, follow-up care was initiated 2 years and 10 months after the surgery. Despite the absence of apparent recurrence, persistently elevated tumor marker levels were observed. The patient survived thereafter with no obvious signs of recurrence and 11 years after the surgery, he died due to pneumonia, suspected to be caused by aspiration. Tumor marker tests are valuable for estimating cancer progression before surgery, predicting recurrence, and assessing treatment effectiveness post-surgery. However, it is important to note that elevated levels of tumor markers can also be observed in patients with benign disorders. Diabetes mellitus may have played a role in the elevation of tumor markers in this particular case. In this report, we discuss this aspect briefly along with a review of the relevant literature.

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Minimally invasive cardiac surgery (MICS) is a helpful technique when you have to perform cardiac surgery for a patient with chronic tracheostomy. To avoid risk of sternal wound infection and mediastinitis, MICS may be a safer approach than medial sternotomy for tracheostomy patients. Here, we present a septuagenarian male patient. He was diagnosed with acute heart failure due to mitral valve regurgitation (MR) with such deteriorating general condition that a tracheostomy was necessary. After transfer to our hospital, Mitral Clip was performed for his MR, after which, he developed a fever from suspected infectious endocarditis (IE). We ultimately performed minimally invasive mitral valve plasty to eliminate the MR and treat the IE, without post operational complications.

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We report the case of a 61-year-old woman who was being treated with multiple drugs for refractory rheumatoid arthritis. After laparoscopic cholecystectomy for acute cholecystitis, she was discharged on the 6th postoperative day with good progress, but on the 12th postoperative day she was brought to our emergency department with massive ascites and shock. Laparoscopic drainage and endoscopic intrabiliary decompression were performed for the diagnosis of bile leakage. However, the patient's bile leakage did not improve, and she underwent reoperation 6 days later. An anatomical variant of the cholecystohepatic duct was found to be leaking, and the patient was cured by suture closure. In patients receiving multiple anti-rheumatic drugs, perioperative management is affected by suppression of inflammation and symptoms. In this case, the drugs made it difficult to assess the difficulty of the surgery preoperatively and may have delayed the diagnosis of bile leakage, leading to shock. Very careful perioperative management is necessary for patients on multiple anti-rheumatic drugs.

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The patient, a man in his 50s with a history of repeated failures of repeated artificial hip joint implantation failures due to a severe allergy to various metals, such as cobalt, tin, gold, nickel, chromium, and iron. He required mitral valve surgery for severe mitral regurgitation, a consequence of healed infectious endocarditis. Given his reliance on a wheelchair and the risk of associated with sternal wire use, mitral valve surgery was planned through a right minithoracotomy. Preoperative echocardiography revealed thickening of mitral valve leaflets indicating a potential for repair failure. The mitral valve was successfully repaired using a silicone-made artificial ring without metal allergens. Because most of the devices used in heart valve surgery contain metal, patients with metal allergies may experience serious complications. To prevent such risks, secure history taking of metal allergy and appropriate operative planning are mandatory.

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G-CSF preparations are used to suppress the onset of febrile neutropenia caused by cancer chemotherapy. We herein report a case of aortitis that occurred due to pegfilgrastim administration during postoperative chemotherapy for breast cancer. The patient was a 69-year-old woman. After total left mastectomy and sentinel lymph node biopsy for left breast cancer, four courses of epirubicin and cyclophosphamide therapy were administered in combination with pegfilgrastim as postoperative chemotherapy, followed by HPD therapy (trastuzumab, pertuzumab, and docetaxel) . Seven days after the first pegfilgrastim administration, a fever of 38℃ was observed in HPD therapy. As a result of close examination, a high inflammatory reaction value and contrast-enhanced CT showed an inflammatory image in the thoracic aorta and aortitis was suspected. With the introduction of steroids, both the fever and laboratory findings improved. In 2018, major vasculitis was added to the package insert as a side effect of pegfilgrastim, and caution should be taken if a fever of 38°C or higher or a blood test with a CRP level of 20 mg/dL or higher is observed after administering this drug.

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We experienced a case in which a pulmonary nodule was discovered 23 years after surgery for right breast cancer. Two years later it was diagnosed as a pulmonary metastasis of breast cancer based on its changing nature. The patient was 55 years old and had undergone right mastectomy and axillary dissection for right breast cancer. There was no metastasis or recurrence for 19 years after surgery. Twenty-three years after surgery, CT revealed a small nodule in S3 of the left lung. CT follow-up was performed every six months, and 2 years later the nodule was found to be enlarged. Suspecting lung cancer, a thoracoscopic partial left lung resection was performed. The pathology of the lung tumor revealed breast cancer metastasis. The patient is being treated with letrozole.

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The majority of primary liver malignancies in children are hepatoblastomas. However, there is a new disease classification, hepatocellular neoplasm not otherwise specified (HCN NOS), which has both hepatoblastoma and hepatocellular carcinoma components and develops in older children. We report two cases of HCN NOS that had different histories after surgical treatment. Case 1: A 10-year-old boy. Following the effective management of intra-abdominal bleeding resulting from a liver tumor rupture with transarterial embolization (TAE), the solitary S5/6 liver tumor was resected in a single stage. Two months after surgery, the serum alphafetoprotein (AFP) level increased and lung metastases were detected, prompting the addition of cisplatin-tetrahydropyranyl-adriamycin (CITA) chemotherapy . The serum AFP level was temporarily normalized, but peritoneal metastasis and multiple liver metastases were observed after the completion of chemotherapy, and the patient unfortunately died 1 year and 6 months after the onset of the disease. Case 2: A 15-year-old girl. A liver mass was identified during a physical examination of the patient for abdominal discomfort. At the time of diagnosis, there was no evidence of distant metastasis. Primary tumor resections (S5/6, S2) were performed based on the assumption that the tumor was hepatocellular carcinoma. Postoperative chemotherapy (PLADO) was initiated. The patient is currently alive two years after surgery without recurrence.

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