Background : Disaster preparation measures have come under review since the Great East Japan Earthquake in 2011. Users of long-term oxygen therapy (LTOT) are predominantly elderly, and there is some concern that isaster preparation measures for LTOT users may be insufficient, making it difficult for them to move in an evacuation. This study was performed to clarify disaster preparedness among LTOT users and to determine how they can best be supported by medical workers.
Materials and Methods : We conducted a survey of LTOT users visiting several outpatient clinics.
Results : The responses of 106 LTOT users (18.3％ response rate) were analyzed. Less than 40％ of the respondents had received information on disaster preparation. The number of preparedness items for disasters was significantly different among “with explanation”, “with counselor” and “with disaster registration”.
Conclusion : Medical professionals should repeatedly explain the necessity of preparation in a way that is suited to the individual situation, such as the physical condition and the living environment, provide consultations, and work with LTOT users to improve self-reliance in the event of a disaster.

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Background : Recurrent hepatitis and cirrhosis due to hepatitis C virus (HCV) infection is a major cause of graft loss in liver transplant (LT) patients. Although interferon (IFN)-based therapy has been used in patients with recurrent hepatitis C after LT, the safety and efficacy of treatment remains unclear. IFN-free regimens with direct-acting antiviral agents (DAAs) against HCV showed excellent results in terms of sustained virological response (SVR) in non-LT patients. Recently, the efficacy of DAAs for LT patients has been reported. However, drug-drug interactions, the increasing risk of hepatocellular carcinoma (HCC), and the existence of drugresistant gene variants require investigation in LT patients.
Method : This study included patients with recurrent hepatitis C after LT who failed IFN therapy and received IFN-free therapy. Medical records were reviewed retrospectively.
Results : Seven recipients were included. The median duration from LT to DAA treatment was 124 (34-181) months. HCV genotype was 1b in 6 patients and 2a in 1 patient. The Child-Pugh classification at IFN-free therapy was A in 6 patients and B in 1 patient. DAAs were used as follows : daclatasvir and asunaprevir in 3 patients, ledipasvir and sofosbuvir in 3, and sofosbuvir and ribavirin in 1. In all patients, sustained virologic response at week 24 was achieved without significant adverse events. No evidence of HCC has been observed.
Conclusion : HCV can be eradicated with interferon-free therapy in LT recipients with failed IFN therapy.

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A 48-year-old woman was seen at our hospital because of fecal occult blood. Endoscopic examination showed a submucosal tumor at the bottom of the cecum, and she was admitted to our hospital for further examination. Abdominal ultrasonography and CT did not detect a mass lesion. Barium enema showed a filling defect in the cecum and obstruction of the radix of the appendix. Since we could not rule out the possibility of an appendiceal tumor, we performed an operation as diagnostic therapy. Histopathological examination showed appendiceal endometriosis. Appendiceal endometriosis is a relatively rare disease, and presents a lot of difficulty in diagnosis. In the case of differentiating from appendiceal tumor, surgical treatment is needed, and this is usually a major operation. An operative method should be carefully determined while keeping appendiceal endometriosis in mind and examining preoperative and intraoperative findings sufficiently when encountering appendiceal masses in premenopausal women.

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A 64-year-old female was admitted to our hospital with complaints of right lateral abdominal pain and was diagnosed with a biliary colic attack caused by an incarcerated gallstone and swelling of the gall bladder. DICCT revealed atrophied subsegments of the liver covering the gall bladder and the intrahepatic bile ducts B4a and B5a running along the fundus. Enhanced CT and MRI did not show a clear image of intrahepatic ducts around the fundus. We performed laparoscopic cholecystectomy with identification of the B4a and the B5a. The postoperative course was uneventful and the patient was discharged on postoperative day 5. In this case, the intrahepatic bile ducts were closed safely owing to preoperative diagnostic imaging. If we had performed the operation without identifying these intrahepatic ducts, postoperative bile leakage might have occurrred. We report our experience with a case of laparoscopic cholecystectomy requiring attention to the intraheptic bile ducts around the fundus.

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We report herein a rare case of signet-ring cell carcinoma of the breast. A 60-year-old woman was admitted to our hospital because of a tumor in the right breast. On examination a 20×20mm, firm mass was palpable. Both fine needle aspiration (FNA) and core needle biopsy (CNB) showed invasive ductal carcinoma including signet-ring cell carcinoma. Partial resection of the right breast and sentinel lymph node biopsy were performed. Signet-ring cell carcinoma of the breast is very rare. Endocrine therapy has been performed because of positive findings on immunohistochemical studies against estrogen receptor.

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