Doctor helicopter in Yamaguchi Prefecture（Yamaguchi Doctor-Heli）began to operate on January 21, 2011. After about two months from the start of operation, the Great East-Japan Earthquake has occurred. A request has been made to dispatch the Yamaguchi Doctor-Heli to the disaster area. After consultation with relevant agencies, the Yamaguchi Doctor-Heli was dispatched to the disaster area, and arrived at the Fukushima Medical University on the morning of March 13. At the request of the Disaster Prevention and Countermeasures Headquarters in Miyagi Prefecture, two patients were transported to Japanese Red Cross Ishinomaki Hospital from Miyagi Prefecture Athletic Park by the Yamaguchi Doctor-Heli. On March 14, the 91 hospitalized patients of Ishinomaki Municipal Hospital, severely damaged in the tsunami, were transported to the Ishinomaki Athletic Park by the five doctor helicopters. Approximately 20 patients have been transported by the Yamaguchi Doctor-Heli. We returned to the Yamaguchi University Hospital on the evening of March 15. The use of doctor helicopters in the disaster areas is expected to decrease in preventable death. Based on this experience, we will improve the activities of the disaster area.

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Two medical students in the third grade at Yamaguchi University School of Medicine visited Onagawa Town, an area stricken by the Great East Japan Earthquake, to undertake medical education training for disasters and community medicine for four days in March 2012. Onagawa Town had a population of about ten thousand before the earthquake, and almost ten percent of the population were victims of the earthquake. The students stayed in the Onagawa Town Hospital, which was partly destroyed by the earthquake and tsunami. The hospital staff aided the disaster victims and inpatients under the direction of Dr. Saito, the director of the hospital, with help from physicians from all over the country in the acute phase. Now, in the chronic phase of the disaster, the hospital staffs were engaged in home care for victims in temporary housing as well as general medicine. During the medical education training, the students interviewed outpatients, participated in community events, and accompanied staff conducting home care in the temporary housing. The revival of Onagawa has been ongoing. The hospital changed to the Onagawa Community Health Center, named“Hill of Hope”，and started providing primary care mainly by generalists and family physicians.

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We experienced a case of metachronous double cancer of the esophagus and stomach. This patient showed good prognosis with sequential adjuvant chemoradiation therapy. A 69-year-old man with a chief complaint of epigastralgia was admitted to our hospital in November 2009. Upper gastrointestinal endoscopic examination showed type 3 gastric cancer in the antrum. Pathological examination indicated that the tumor was an adenocarcinoma. After distal partial gastrectomy was performed, adjuvant chemotherapy with docetaxel and S-1 were administered. One year after surgery, upper endoscopic examination revealed a thoracic type 0-II esophageal tumor in the middle esophagus. Pathological examination indicated that this tumor was a squamous cell carcinoma. Laparotomy showed wide dissemination, and the tumor was diagnosed as metastasis from adenocarcinoma on the basis of intraoperative rapid pathological examination. Six courses of chemotherapy with CDDP and S-1 were effective, but 4 months later, the esophageal cancer recurred.Therefore, 4 courses of the same chemotherapy regimen were administered. The patient showed disease progression. Sequential radiation therapy for the esophageal cancer successfully reduced the size of the main tumor and metastatic lymph nodes. Two months later, endoscopic examination indicated recurrence of the esophageal cancer. Therefore, we started treatment with combined therapy with DTX and CDGP.

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A 74-year-old man complaining of nonproductive cough and wheeze had been treated with inhaled corticosteroid in diagnosis of bronchial asthma for 7 months. He was referred to our hospital because his symptoms continued and the tracheal stenosis was detected.CT scans on admission showed the stenosis of trachea, and thickened bronchial walls and several nodular lesions in the right upper lobe. A bronchoscopic examination showed the stenosis in the middle portion of trachea with edema and congestion of the mucosa. The ulceration with white coat of the mucosa was observed in the left main bronchus. Mycobacterium tuberculosis was detected on a bronchial lavage fluid and he was diagnosed to have endobronchial tuberculosis. Antituberculosis treatment with isoniazid, rifampicin, ethambutol and pyrazinamide was started. Symptoms improved soon by antituberculosis treatment. A bronchoscopic examination conducted at 6 months later, the stenosis of trachea still remained, but edema and congestion have improved. The ulceration with white coat have improved leaving scar.In the case of bronchial asthma refractory to the adequate treatment, we have to consider the possibility of endobronchial tuberculosis.

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We present a case of sigmoid colon cancer treated by stent placement and single-stage resection for acute colonic obstruction. The patient was a 71-year-old man who experienced sudden abdominal pain while travelling in Hokkaido. He was admitted to a regional hospital and was found to have a tumor in the sigmoid colon. The patient was diagnosed with colonic obstruction caused by a tumor in the colon and was emplaced with a self-expandable metallic stent, which relieved abdominal pain and constipation. Thereafter, he was admitted to our hospital and underwent a sigmoidectomy. The patient’s postoperative course was uneventful and he was discharged 10 days after surgery；he is in good health till date. Preoperative stent placement for acute colonic obstruction is suitable because it is a minimally invasive proce-dure and does not require multiple surgeries.

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