The objective of this study was to evaluate the efficacy of t-PA in patients who developed ACS in remote islands. We reviewed retroactively the consecutive 32 ACS cases with ST elevation who were transferred from remote islands by helicopters from April 1, 2005 to March 31, 2009. In 32 patients, 24 males were included. Mean age was 64.4（±13.4) years old. 11 patients who were treated with t-PA were designated to t-PA group while the other 21 were to non-t-PA group. 64% of t-PA group had the culprit stenotic lesions in LAD, comparing with 42.8% of non-t-PA group. This meant that t-PA was tended to be administered in more severe cases. In the coronary angiography, 36% of t-PA group gained initially TIMI3 flow, but only 23% of non-t-PA group. In spite of better angiographycal results, there was no difference in elevated CK level and LVEF afterwards in both groups. The average time of 2 hours from initial admission to the local medical services to t-PA administration would be the reason for unfavorable results. In t-PA group, the adverse event rate such as hemorrhagic events or fatal arrhythmias was not different from that of non-t-PA group. t-PA is effective treatment for ACS patients in islands far away from PCI centers. It is a clinical challenge to introduce t-PA in adequate cases promptly.

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Our gastroenterology department and the medical facilities of islands have treated patients in cooperation with each other．In 2008，6 cases were treated with chemotherapy for cancer or anti-cytokine therapy for inflammatory bowel disease．In this report，we presented 4 cases．The number of patients who need coordinate treatment，especially chemotherapy，is expected to grow in the future．We need to build a close cooperation system further

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　The scale of the medical institution is different according to each island in Tokyo, and the disease and conditions that the institution can treats are also different. Hachijo Town Hospital has 6 doctors and 52 beds, relatively can treat various diseases. However, when the treatment of disease and the transfer to support hospitals using of airplane or ship is considered to be difficult, emergency helicopter transport is needed. The total time required for transport using helicopter has shortened gradually, but it is rare to investigate the process of treatment before transport. In the present study, we investigated about the details of helicopter transport cases and the time from patient's consultation to dispatch of helicopter. The time from patient's consultation to request of emergency helicopter was 1 hour 48 min, and the distribution of this time had two phase what were early phase and late phase. The cases in the early phase group were mainly acute myocardial infarction, intracranial hemorrhage, and serious injury. In these cases, there was no significant difference in the time from patient consultation to request of helicopter according to the time zone of patient's consultation and doctor's years of experience. Therefore, it was considered that capacity of medical institution less affected the time between patient's consultation and request of helicopter. On the other hand, the cases in the late phase group were that we treated for a while in our hospital but the condition became worse or didn't get better, or what needed advanced treatment by support　hospitals although the condition became steady. In these cases, the time until transporting could be shortened by consultation to support hospitals beforehand. The time from request of helicopter to dispatch of helicopter was 1 hour 10 min. Among these, the reason of relatively late cases was mainly bad weather condition. One-month survival rate after helicopter transport was about 90%, so it was considered that helicopter transport systems had operated effectively.

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　Only limited medical providers are working in islands of Tokyo. They sometimes face difficult problems which they need to consult with specialist. We are using transmission of still images and telephone to support them. JAXA (Japan Aerospace Exploration Agency) and Ogasawara village planed telemedicine experiment using Wideband Internetworking engineering test and Demonstration Satellite“Kizuna”which is feasible for transmitting moving image and high vision image. We cooperated on this experiment and assessed whether those image could be used in clinical situation. The result was satisfactory. Ogasawara village will use same transmission capacity by an optical fiber cable this year. The new type of medical support can be provided by this cable for the future.

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[in Japanese]

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