In accordance with the development of society and the concentration of population into urban areas, disasters have involved more and more people globally. In the first half year of 2008, more than 230,000 people were killed by natural disasters and about 130 million were affected. About 10 million are living outside of their homeland as refugees and about 20 million as IDPs (Internally Displaced People). Humanitarian aid is offered from various international organizations, governmental organizations and NGOs (Non-Governmental Organizations) to save the lives of the disaster victims, and emergency medical relief service is considered to be one of the most important issues of humanitarian aid. However, there are many difficulties and problems on its actual performance especially when it is provided from foreign countries. They are; late arrival of medical assistance team from overseas, difficulty to grasp the real needs of the victims, duplication and sometimes competition of activities among different groups, dissociation from the local medical service plan of rehabilitation and development phase, and ineffective cost performance etc. UN (United Nations) organizations and international medical NGOs concerned are listed and introduced in this paper along with the Japanese NGOs extending emergency medical relief services after disasters. Sphere project which explains minimum standard of humanitarian relief and code of conduct that the international humanitarian workers and groups should respect and the guideline of humanitarian aid from international red-cross are also introduced in this paper. When we are exposed to unassuming expression of appreciation for medical services from disaster affected people of developing countries, we can receive utmost sense of satisfaction and happiness to be the medical profession. Despite the difficulties above written, humanitarian medical aid is considered to be one of the most important means of international contribution to developing countries from Japan which has scarce natural resources and relying heavily upon import from overseas for food and other essential natural products. Therefore, humanitarian aid is one of the important issues of “human security” from both side of the view of developing countries and our country.

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A 32-year-old primigravida underwent a cesarean section at 39 weeks and a male infant was born. Two hours later profuse vaginal bleeding was noted. After bilateral uterine artery embolization, the vaginal bleeding seemed to have been controlled. However, five hours and twenty minutes later she developed profuse vaginal bleeding again and fell into shock regardless of fluid resuscitation. An emergent subtotal hysterectomy was performed and she was diagnosed with disseminated intravascular coagulation (DIC) following surgery. Treatment for hemorrhagic shock and DIC was attempted with massive transfusion in association with continuous dopamine infusion. The total blood loss was estimated to be about 10,000 ml. On the third postoperative day DIC and hemorrhagic shock improved and ventilator weaning was accomplished, however she developed acute renal failure. Hemodialysis treatment for the following 16 days resulted in the improvement of renal function. She was discharged 41 day after delivery. Afterwards, it was realized that the plasma concentration of zinc coproporphyrin-I, a component of amniotic fluid, had considerably increased. Since there was no other cause for the severe bleeding, she should be diagnosed with amniotic fluid embolism (AFE). This case illustrates that AFE may develop an isolated DIC without antecedent hemodynamic or respiratory instability.

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Background: Diagnosis of Sudden Infant Death Syndrome (SIDS) may not always be made appropriately.
Objective: To examine the accuracy of clinical diagnosis of sudden infant death and the effects of autopsy or histological examination.
Subjects: Twenty-one patients aged less than 2 years old with cardiopulmonary arrest on arrival at our critical care center.
Methods: Data from medical records, death certificates and postmortem certificates, clinical diagnosis, post-macroscopic autopsy diagnosis, and histological findings were examined retrospectively.
Results: Among 15 subjects aged less than 1 year old, 14 died, including 11 (78.6%) in whom an autopsy was performed. Clinical diagnosis was difficult in 9 subjects, but abnormal findings were confirmed in 7 subjects by autopsy and histological examination. As a result, only 2 subjects were given a final diagnosis of SIDS. Of the 6 subjects aged over 1 year old, autopsy was carried out for 2 patients. One patient was diagnosed with SIDS.
Discussion: Only 3 of 21 subjects receiving a final diagnosis of SIDS. New findings were obtained in 7 of 13 subjects who underwent an autopsy, suggesting that an autopsy is necessary.
Conclusion: An autopsy should be performed in a case of sudden infant death that has no clear cause.

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A 73-year-old woman consulted her local hospital with left knee swelling and pain. Autolysis and ulcer formation had occurred at the site despite administration of antibiotics. She was diagnosed with necrotizing fascitis and was transferred to our department. Her past medical history was unremarkable. One day after resection of the ulcer and the surrounding necrosis, the knee pain deteriorated and she developed high fever and mucinous-bloody stool. She therefore underwent another radical resection of the inflammatory lesion above the fascia. After this procedure, she was initially afebrile without wound pain; however, a low grade fever and wound swelling subsequently recurred. Since colonoscopy suggested ulcerative colitis, and both culture and histological findings of the wound were negative for bacteria, she was diagnosed with pyoderma gangrenosum. Her knee lesion dramatically improved after ceasing antibiotics and commencing steroid therapy. Physicians should consider pyoderma gangrenosum when treating inflammatory necrotic lesions.

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Nonocclusive mesenteric ischemia (NOMI) is induced by mesenteric vasospasm after inadequate perfusion of the mesenteric artery. Persistence of mesenteric vasospasm and ischemia of the intestine induce bowel necrosis. We report two cases of NOMI, both of which had signs of bowel necrosis: hepatic portal venous gas (HPVG) and bowel pneumatosis on CT, and hyperlactacidemia. However, at operation, one demonstrated transmural necrosis while the other did not. Both patients were in shock on arrival at our emergency center. As both had the above-mentioned signs of bowel necrosis, we performed emergency laparotomy. One had transmural necrosis of the small intestine, requiring enterectomy. As the other patient had mucosal necrosis only, we avoided enterectomy by performing a second-look operation. In NOMI, when CT shows signs of bowel necrosis such as HPVG and bowel pneumatosis, emergency laparotomy is generally considered appropriate. However, one of our cases did not have transmural necrosis despite these findings. But at the current moment there is no reliable tool of preoperative diagnosis of bowel necrosis, clinicians therefore have no other choice of performing laparotomy.

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A 50-year-old Japanese man with a ten-year history of smoldering adult T-cell leukemia / lymphoma was admitted to a local hospital with ileus after two weeks of diarrhea. He developed shock, dyspnea, thrombocytopenia, and leukocytopenia four days later. He was immediately transferred to our hospital and underwent emergency laparotomy. Transmural necrosis of the cecum, ascending colon, transverse colon, and rectum was observed and total colectomy with ileostomy was performed. On the seventh day after operation, the report of histopathological analysis of the resected specimen indicated the presence of amebic trophozoites throughout the colonic wall and immediate microscopy of fresh stool confirmed amebiasis. In response to this, 500mg metronidazole was daily administered directly into the remaining rectum. Despite intensive therapy, the patient died of multiple organ failure on the ninth hospital day. Fulminant amebic colitis is defined as transmural and wide necrosis of the large bowel due to amebic invasion of the colonic wall. In our patient, computed tomography (CT) scan at the previous hospital had revealed significant wall thickening of the large bowel with intramural gas in the ascending colon. These CT findings may be useful for the diagnosis of transmural necrosis of the large bowel in amebiasis.

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