Surgeons In Japan Research Articles

Poster 008: Epidemiological Study of Malignant Tumors in the Oral and Maxillofacial Region—Survey of Member Institutions of the Japanese Society of Oral and Maxillofacial Surgeons

The purpose of this study was to investigate the epidemiology of malignant tumors found in the oral and maxillofacial region of patients who visited institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons in Japan. A questionnaire was sent to 234 institutions and those returned with medical records were used to create an epidemiological database of oral cancer patients who visited the affiliated oral surgery institutions in Japan in 2002. A total of 2128 patients records were returned, of which 1809 were evaluated. They represented patients treated at 148 institutions, including 39 dental university hospitals, 44 medical university hospitals, 64 general hospitals, and 1 other institution. Among the 1809 cases, 6 patients had intraoral multiple cancerous tumors (5 patients with 2 cancerous tumors, 1 with 3), thus a total of 1816 tumors were evaluated. The patients consisted of 1071 (59.2%) males and 738 (40.8%) females (male:female ratio, 1.45:1), who had a mean age of 65.2 years old (SD: 13.9). The tongue (40.2%) was the most common site affected, followed by the gingiva (32.7%), buccal mucosa (10.1%), and oral floor (9.0%). In histopathological examinations, squamous cell carcinoma (88.7%) was the most common type found, followed by adenoid cystic carcinoma (2.1%), and mucoepidermoid carcinoma (1.7%). In addition, non-epithelial tumors comprised 1.8%, of which malignant melanoma was the most common type. Cases classified as T2N0 were the most common (32.1%), followed by T1N0 (21.4%), T4N0 (8.0%), and T2N1 (7.6%). Distant metastasis occurred in 17 patients (1.0%). The sizes of the non-epithelial malignant tumors ranged from 1.0 to 7.0 cm, with a mean size of 3.7 cm. In Japan, tongue cancer is the most prevalent type of oral cancer. In the present series, histopathological examinations showed that squamous cell carcinoma was the most common, and stage 1 and 2 cases accounted for half of the patients. Nevertheless, nearly half of the patients had advanced carcinomas. These results indicate the importance of early recognition of oral malignancy.

女性医師の立場から見た女性外科医師問題

女性医師の立場から見た女性外科医師問題

Learning curve of coronary surgery by a cardiac surgeon in Japan with the use of cumulative sum analysis

Case-volume has been believed to be of paramount importance in becoming a good cardiac surgeon. However, for a training cardiac surgeon there is no evidence regarding the specific number of necessary cases to attain the medico-legally acceptable level. We attempted to observe the learning curve in performing coronary surgery with the use of the cumulative sum (CUSUM) method to provide some evidence. From April 2000 to March 2004, a cardiac surgeon, being board-certified but not being on the attending staff, performed 50 coronary artery bypass grafting (CABG) under supervision of three different chief attending surgeons at three different hospitals. His learning curve was analyzed with the use of CUSUM. Mortality and morbidity and the average time of crossclamp and operation at each hospital were examined. Also, the learning curve of 100 left internal mammary artery (LIMA) harvestings were analyzed via CUSUM in terms of harvesting time and injury rate. The CUSUM curve tended to come closer to the alert line (0.80 confidence) until the 23rd case, but never reached the alert line thereafter until the 50th case. The CUSUM curve never transgressed the alarm line (0.95 confidence) throughout 50 cases. The CUSUM curve of LIMA harvesting approached the alert line in the 38th case and the 59th case, but thereafter never reached the alert line and remained below the reassurance line from the 73rd case. Tentatively, it is inferred that approximately 23 cases of CABG may be sufficient to allow for independent practice and that 73 cases of LIMA harvesting are sufficient to allow independent practice.

Important contributions to cardiothoracic surgery by Japanese Thoracic and Cardiac Surgeons

Cardiothoracic surgeons in Japan have made outstanding contributions to our knowledge and therapy of diseases and anomalies of the heart, lungs, esophagus, chest wall and diaphragm. It is an honor for me to address this subject at the 57th Annual Meeting of the Japanese Association for Thoracic Surgery in Sapporo because your President, Tomio Abe, is a valued friend and colleague who worked with me and my group as a Research Fellow at Washington U. from 1970-1973. He was recommended by Prof. Juro Wada, then the Chief in Sapporo. I was privileged to meet Prof. Wada at U.S. meetings. One of Prof. Wada's many contributions was the first cardiac transplant in Japan. Dr. Abe's work in St. Louis led to 12 publications and he was the first author of two papers. Since, his contributions expanded to more than 550 publications on treatment of complex congenital heart diseases, ventricular assistance, myocardial protection, valvular heart disease and aortic aneurysms. An operation for correction of Taussig-Bing malformation reported in 1984 is now referred to as the Abe operation. Torikata, in 1925, introduced "free thoracotomy" with no differential pressure. In 1933, Ohsawa successfully resected the esophagus with immediate reconstruction-the first in the world. Wada, in 1963, developed a thermodisc oxygenator and in 1966 the first tilting disc heart valve-the Wada Cutter Valve and other contributions as a worldwide ambassador for Japanese Surgery. Kawata, et al. showed better ventricular function after patch reconstruction of left ventricular aneurysms. Ueda, et al. revived retrograde cerebral perfusion for repair of aortic arch aneurysms. Nakayama, Akiyama and Isono made important contributions to esophageal cancer surgery. Kimoto, et al., in 1956, performed open cardiac surgery under direct vision with brain cooling by irrigation. Sakakibara, et al., Hikasa, et al., Atsumi, et al., and Takano and Akutsu made contributions to cardiac surgery. There were many other contributions by Japanese Surgeons.

Hand-assisted laparoscopic gastrectomy for cancer: The next last frontier

5 urgical history is rife with declarations that “it has all been one, there is no place to go from here.” With the article ublished in this month’s Journal of the American College of urgeons, it would appear that minimally invasive extended adical gastrectomy has now been successfully conquered ith techniques by Uyama and colleagues from the Fujita ealth University in Aichi, Japan. Minimally invasive surery of the esophagus, from fundoplication to esophagecomy, has been developed and perfected in populations of uropean descent, but nearly all credit for the development f minimally invasive surgery of the stomach belongs to sia, and the art has been no better perfected than in Japan. n 1991, Kitano and Shiraishi performed the first aparoscopic-assisted distal gastrectomy for early gastric ancer. After that, laparoscopic gastric wedge resection and ntragastric mucosal resection were described by Ohgami nd colleagues and Ohashi, respectively. These three techiques are widely used in Japan for treatment of early gastric ancer that cannot be managed with flexible endoscopic ethods (using a mucosal lift technique), yet show no evdence of invasion deep to the mucosa. In a recent review of he subject by Kitano and Shiraishi, more than 4,000 such rocedures were reviewed. Although these large numers still represent the minority (20% to 30%) treatment f early gastric cancer in Japan, this represents significant enetration of the field by laparoscopy. This utilization ate exceeds that of laparoscopic hernia in the US and is bout on a par with laparoscopic appendectomy. Clearly, ost “advanced” laparoscopic surgeons in Japan are usng these techniques to manage early gastric cancer. Now ere comes the extension of these techniques to the more dvanced gastric cancers, one in which the stage of the isease necessitates resection of adjacent organs, includng the spleen and pancreas. Laparoscopic D3 dissection s described and is clearly “doable” by these skilled sureons. The data in this article suggest that there is indeed benefit to the patient when minimally invasive techiques are used. Although it is conceivable that hand-assisted laparocopic radical gastrectomy will become the next “gold stanard,” my best guess is that it will be viewed in 10 years as a

C234 停留精巣の診断支援のための領域自動抽出手法に関する検討

The testis usually descends to the scrotum through the groin, and normally reaches into the scrotum before birth. Cryptorchidism is a condition in which either one or both testes does not fully descended into the scrotum before birth. Instead, the testis gets stuck in the groin or even in the abdomen. Cryptorchidism is most common in premature babies, and mostly only one testis is affected. Before the surgery to bring an undescended testis down in the scrotum, the pediatric surgeon conducts CT inspection and checks the position and size of the undescended testis. Because there are only 443 qualified pediatric surgeons in Japan, it is worth helping them in the interpretation of many CT images in diagnosis of cryptorchidism.We propose a method of extracting regions from the CT images where an undescended testis may exist, based on the information of the other normal testis, and experiment with CT images of patients with an undescended testis.

The Market for Pediatric Surgeons in Japan : A Recommendation for the Appropriate Allocation of Qualified Pediatric Surgeons and Facilities

The Market for Pediatric Surgeons in Japan : A Recommendation for the Appropriate Allocation of Qualified Pediatric Surgeons and Facilities

Endoscopic Neck Surgery for Thyroid Carcinoma

In the past 5 years, endoscopic neck surgery has been performed by various surgeons in Japan. However, many problems remain to be solved, including indications for this related in malignant thyroid tumors. For small thyroid cancers and legions suspected of malignancy, we found that we could obtain radicality in endoscopic neck surgery that was comparable to that attainable by conventional methods. Here, we describe our recent endoscopic surgical experience in five patients with preoperative diagnoses of definite or suspected thyroid carcinoma.

Sphincter-preserving techniques for anal fistulas in Japan.

After the articles by Eisenhammer, Parks, Hanley, and Goligher and the classification system established by Sumikoshi, surgeons in Japan became very active in creating and modifying new sphincter-preserving surgical procedures for low intersphincteric and ischiorectal fistulas. This article reviews the literature, summarizes each procedure, identifies the transitions, and discusses recurrence rates, cures, and subsequent variations. Japanese surgeons favor sphincter-preserving techniques for low intersphincteric fistulas that involve partial or complete coring out of fistula tracts. Common sphincter-preserving procedures for ischiorectal fistulas involve coring-out techniques and muscle-filling procedures. The recurrence rates of sphincter-preserving procedures for low intersphincteric fistulas are between 5 and 6 percent, whereas the recurrence rates for the sphincter-preserving techniques used on ischiorectal fistulas are in the 7 to 10 percent range.

Trauma Surgeons in Japan

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Graduate medical education

Present status and problems to be solved in graduate medical education for surgeons in Japan were described. To make graduate medical education be effective and valid, the author proposed to establish a agency like the Accreditation Council for Graduate Medical Education (ACGME) in the United States, which gathers and provides informations of characteristics of each programs and evaluates them.

Personal reflections on the surgical treatment of portal hypertension.

Reports, early in this century, on the treatment of portal hypertension by surgical diversion of the portal blood flow about the liver were largely ignored because of the anticipated high mortality. Whipple, Blakemore and Lord in the early 1940's described a technique of performing a splenorenal or portacaval shunt with an epithelial lined vitallium tube. Blalock, whom I assisted, was one of the first outside of the Whipple Group to successfully perform such an operation. Although he used the vitallium tube technique in his first cases he soon became convinced that the results were better with a direct suture anastomosis. Venous shunts, which seemed such a logical way to treat portal hypertension, were widely and quickly adopted. Little attention was paid to the problem of portal encephalopathy which had been described in experimental animals years before by Pavlov. As some of the follow up studies on these shunted patients began to appear it was evident that this was a common and at times a severe problem. Some of the earliest doubts about the shunt operation were expressed by surgeons in Japan. The most successful methods developed to date for the treatment of portal hypertension provided a shunt for blood from the esophageal variceal region while at the same time preserving portal blood flow through the liver. Two of these methods have been the distal or selective splenorenal shunt proposed by Warren & Zeppa and the coronary caval shunt first described by Inokuchi. These methods, although somewhat more difficult technically than end to side portacaval shunts, reduce portal hypertension and preserve blood flow through the liver thereby lowering significantly the incidence of encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

亜急性壊死性リンパ節炎の１例

A case of subacute necrotizing lymphadenitis in a, 26-year-old man was reported. He showed the typical clinical features: swelling cervical lymph-nodes, slight fever with poor response to antibiotics and erythemas on the skin. No abnormal findings were presented in the chest X-ray, and the PPD reaction test was negative. WBC was 3, 800/mm3 in which lymphocytes comprised 50%. Biopsies from the lymph-nodes demonstrated the characteristic features histopathologically: 1) focal lymphocytic and histiocytic proliferation, 2) necrosis involving not only paracortex but also cortex and 3), nuclear debris and phagocytosis in the necrotic foci. However, the biopsies were free from neutrophilic leucocytes infiltration in any specimens.Subacute necrotizing lymphadenitis has been recognized as a new disease classification in recent years, and 6 cases have been reported by oral surgeons in Japan.

Differences in attitude toward the management of biliary atresia among surgeons in Japan and in North America

Fifty-three Japanese surgeons, who have treated approximately 1400 patients with biliary atresia during the past two decades, were interviewed with respect to this experience and their current attitude towards the management of this disease. Sixty surgeons from the United States and Canada with a demonstrated interest in biliary atresia were interviewed or polled by questionnaire in respect to the same aspects of this problem. The response of these two groups were compared. The volume of experience with biliary atresia of some Japanese surgeons greatly exceeds that of American surgeons active in this area. Japanese surgeons employ the laparotomy to establish diagnosis of biliary atresia and, after this is accomplished, proceed with a Kasai-type procedure. At operation, they are less concerned with the detailed structure of the extrahepatic biliary tract remnants than their American counterparts, as such factors would not alter this approach. They usually manage what were formerly regarded as correctable and noncorrectable types of biliary atresia identically. Many Japanese surgeons believe that the degenerative changes in the biliary tract are progressive in the extrahepatic ducts, as well as in the liver, increasing the importance of early surgical intervention. The attitudes of Japanese surgeons reflect a somewhat more favorable experience with Kasai-type procedures and a slightly greater optimism in respect to the long-term results of this approach. The indications for secondary revision of the hepato-biliary intestinal anastomoses after Kasai-type procedures are similar in the two countries; but these procedures are carried out with greater frequency in Japan. It is apparent that there are different interpretations of current management concepts or, at least, of their application to specific situations, among surgeons in Japan and North America. On the other hand, the surgeons who work in institutions in which the largest groups of patients with biliary atresia are seen in both countries, have similar responses to the problems presented by this disease process.

Miscellanea Japonica: Being Occasional Contributions to Japanese Studies. Vol. I, An English Surgeon in Japan in 1864-1865

Miscellanea Japonica: Being Occasional Contributions to Japanese Studies. Vol. I, An English Surgeon in Japan in 1864-1865