BackgroundLittle information is available concerning how patient delay may be affected by mass disasters. The main objectives of the present study are to identify whether there was a post-disaster increase in the risk of experiencing patient delay among breast cancer patients in an area affected by the 2011 triple disaster in Fukushima, Japan, and to elucidate factors associated with post-disaster patient delay. Sociodemographic factors (age, employment status, cohabitant status and evacuation status), health characteristics, and health access- and disaster-related factors were specifically considered.MethodsRecords of symptomatic breast cancer patients diagnosed from 2005 to 2016 were retrospectively reviewed to calculate risk ratios (RRs) for patient delay in every year post-disaster compared with the pre-disaster baseline. Total and excessive patient delays were respectively defined as three months or more and twelve months or more from symptom recognition to first medical consultation. Logistic regression analysis was conducted for pre- and post-disaster patient delay in order to reveal any factors potentially associated with patient delay, and changes after the disaster.ResultsTwo hundred nineteen breast cancer patients (122 pre-disaster and 97 post-disaster) were included. After adjustments for age, significant post-disaster increases in RRs of experiencing both total (RR: 1.66, 95% Confidence Interval (CI): 1.02–2.70, p < 0.05) and excessive patient delay (RR: 4.49, 95% CI: 1.73–11.65, p < 0.01) were observed. The RRs for total patient delay peaked in the fourth year post-disaster, and significant increases in the risk of excessive patient delay were observed in the second, fourth, and fifth years post-disaster, with more than five times the risk observed pre-disaster. A family history of any cancer was the only factor significantly associated with total patient delay post-disaster (odds ratio: 0.38, 95% CI: 0.15–0.95, p < 0.05), while there were no variables associated with delay pre-disaster.ConclusionsThe triple disaster in Fukushima appears to have led to an increased risk of patient delay among breast cancer patients, and this trend has continued for five years following the disaster.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3412-4) contains supplementary material, which is available to authorized users.

Summary:A pedicled latissimus dorsi (LD) myocutaneous flap is a reliable reconstructive method for elbow flexion, though there are no reports regarding its application to a terminal nerve level injury of the brachial plexus. A 29-year-old man presented with dysfunction of elbow flexion, wrist extension, and finger extension. Physical examination and electromyography showed that the palsy was caused by an injury at the terminal nerve level of the brachial plexus without dysfunction of the axillary nerve. Bipolar transfer of LD for reconstruction of elbow flexion and subsequent tendon transfer for wrist and finger extension were performed. The final British Medical Research Council grade was 4 for elbow flexion, and active range of motion was 0/135. An injury at the terminal nerve level of the brachial plexus should be listed in the differential diagnosis of elbow flexion dysfunction even if shoulder function is intact, and a suitable reconstructive method for this atypical type of palsy could be bipolar transfer of a LD flap.

Long-term increases were found in the IRR of hospital visits for hymenopteran stings in an institution affected by the Fukushima nuclear disaster. Decontamination workers appear to have been particularly affected by this phenomenon. Better disaster field worker monitoring and education about potential environmental health hazards may help to identify and prevent worker exposure to insect stings and other vectors in these settings. (Disaster Med Public Health Preparedness. 2017;11:545-551).

BACKGROUND Acquired hemophilia is rare. In some cases, the bleeding in muscle causes compartment syndrome. However, it is not clear whether fasciotomy should be performed for the compartment syndrome caused by acquired hemophilia because of the risk of bleeding and the unknown functional results. CASE SUMMARY A 75-year-old woman was admitted with severe pain of the right forearm with no preceding traumatic event. The right forearm was obviously swollen, and stretch pain was observed. Subcutaneous hematomas were suspected in various parts of the body. Compartment pressure was 110 mmHg on the volar side. Activated partial thromboplastin time (aPTT) was prolonged to 54.9 s. Fasciotomy was performed, and hematoma was observed in the volar compartment. Postoperative laboratory examinations revealed a low level of factor VIII (FVIII) activity (12.5%) and a high level of FVIII inhibitor (15.2 bethesda units/mL). Acquired hemophilia A was diagnosed. Though recombinant clotting factors were administered, transfusion of red blood cells reached 46 units (140 mL/unit). Hemostasis was achieved 9 d after fasciotomy. The total cost of the clotting factor concentrates administered reached 28834600 yen. With prednisolone, FVIII activity and aPTT recovered gradually. Final function of the hand was good in the index finger and excellent in the others. CONCLUSION Fasciotomy resulted in good function of the hand in a case of non-traumatic compartment syndrome caused by acquired hemophilia, but life-threatening bleeding occurred, and the cost of clotting factor treatment was high. Preparation of sufficient blood transfusion, preoperative administration of recombinant activated clotting factor VII, and prompt fasciotomy could be ideal for such cases.

Introduction In breast cancer, delay in first presentation and self-interruption of continuous treatment are associated with lower survival. It has been suggested that risk factors for such behavioral patterns include poor social support. Minamisoma City, located within a 30 kilometers radius from Fukushima Daiichi nuclear power plant, has experienced rapid change in social structures following the Great East Japan Earthquake and the subsequent power plant accident. There has been a mass evacuation among young and middle-aged generations for fear of potential irradiation, and this has resulted in the separation of families and friends. These changes may have resulted in a deterioration of social support for residents, which could consequently lead to changed patterns of behavior in diseases such as breast cancer. Objectives This study compared the behavioral patterns before and after the disasters in patients with breast cancer in Minamisoma City. Methods We retrospectively analyzed data from patients with breast cancer who were diagnosed from January 2008 through March 2015 in the two main cancer centers in Minamisoma City. Demographic and clinical information was extracted from medical records, including age, stage, pathological findings, treatment, and the reason for the first hospital visit. The main outcome was a change of interval from the appearance of initial symptoms to the first hospital visit before and after the disasters. We also assessed whether continuous follow-up was maintained after the disasters. We used an unpaired t-test for numerical variables and a chi-squared test for categorical variables. Results A total of 102 and 97 patients were diagnosed with breast cancer before and after the disasters, respectively. There were no statistically significant differences between the 2 groups concerning average age (61 years old vs. 61 years old, p=1), stage 3 or 4 cancer (18% vs. 17%, p=0.81), invasive cancer (92% vs. 93%, p=0.87) and symptomatic patients (75% vs. 74%, p=0.74), respectively. However, after the disasters, there were significant increases in the ratio of patients with more than a one-year delay from the appearance of the initial symptom to the first hospital visit (5.4% vs. 15%, p&lt;0.05). The patients with more than a one-year delay had a significantly higher ratio of advanced stage cancer compared with patients who visited a hospital earlier. Continuous follow-up was maintained in all patients diagnosed after the disasters. Discussion The characteristics of patients were not significantly different before and after the disasters, while the ratio of patients with more than a one-year delay of the first hospital visit significantly increased after the disasters. Although information on social capital and other sociodemographic factors was not available, we speculate that poor social support due to changed social structures after the disasters might contribute to delay in first presentation in symptomatic breast cancer patients. Further study is warranted to clarify the factors associated with delayed hospital visits, in order to establish effective health interventions in the aftermath of mass disasters. Citation Format: Ozaki A, Tsubokura M, Nomura S, Morita T, Ochi S, Kato S, Saji S, Yokota T, Leppold C, Tanimoto T, Kami M, Tsukada M, Ohira H. Delayed hospital visits in patients with breast cancer after the great East Japan earthquake and the subsequent Fukushima Daiichi nuclear power plant accident: A retrospective comparative analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-04.