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2002 Volume 38 Issue 7 Pages
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Shigeru Ueno, Seishichi Yokoyama, Hitoshi Hirakawa
Article type: Article
2002 Volume 38 Issue 7 Pages
987-992
Published: December 20, 2002
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Pediatric surgeons who are engaged in treating children with congenital and acquired surgical illnesses and surgical trauma are not regarded as fully established specialists in Japan, and should be keen to found a solid background in the society. Although we have a well-organized board system for specialties in pediatric surgery, ongoing rapid innovation in medical education programs make it difficult for undergraduate students and residents to learn about pediatric surgery because learning the basic clinical competence required for all physicians is emphasized by rounding only the core subjects during training. Based upon our innovative experience, we propose that pediatric surgeons should take part in medical education : In undergraduate education, clinical clerkship in pediatric surgery and involvement in pediatric practice in postgraduate training programs. It should be emphasized that the education program would reflect the basic clinical competence required for practice in the field of pediatric surgery and should include clear objectives, strategy and evaluation. As a result, they would not only be interested in practicing pediatric surgery but also get acquainted with its importance in pediatric practice and surgical speciality. Thus, more students and postgraduates would become interested in the field, understand its practice and possibly become candidates for future specialists. We would also like to emphasize that the evolution of pediatric surgery can be achieved through being stimulated by those of other related fields, and involvement in medical education would make it easy to access those evolutions.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
Article type: Article
2002 Volume 38 Issue 7 Pages
993-997
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Hideo Yoshida, Masahiro Tanabe, Tadashi Matsunaga, Katsunori Kouchi, T ...
Article type: Article
2002 Volume 38 Issue 7 Pages
998-1004
Published: December 20, 2002
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The pediatric medical care system is experiencing severe problems. The number of would-be pediatric surgeons is on the decrease. The overwork, shortage of manpower and unprofitability in the pediatric surgical field are not welcomed by medical students. Recently, some of them do not believe that they should sacrifice themselves for the patients. We emphasize that pediatric surgeons contribute to the care of children, and the well-being and future of children. Publicizing the need to reform the medical care system and improve the education system is a matter of urgent importance.
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Michio Kaneko
Article type: Article
2002 Volume 38 Issue 7 Pages
1005-1009
Published: December 20, 2002
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An analytical questionnaire was conducted targeting 78 pediatric surgical units in university hospitals in Japan in order to clarify the present status and to elucidate problems in education, research and clinical practices. Answers to the questionnaire were obtained from 44 institutions. Among the 83 medical schools in Japan, only 29 have independent pediatric surgical departments. There are serious inter-institutional differences in staff number and annual surgical operation number, particularly in neonatal surgical cases. Most of the qualified pediatric surgical units in university hospitals had no more than 20 neonatal cases annually. For appropriate allocation of qualified pediatric surgeons and institutions, and for proper education of undergraduate and postgraduate students as well as resident pediatric surgeons, a novel common nationwide education and training system, not individual institution, should be constructed and introduced. The Japanese Society for Pediatric Surgeons should take the initiative for the construction and proper introduction of such a system.
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Munechika Wakisaka, Koonosuke Nakada, Hiroaki Kitagawa, Yuriko Satoh, ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1010-1014
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Purpose : We extracted the problems of pediatric surgeons' present conditions in a private medical college and describe a design for appropriate measures in the future. Method(Problem Extraction) : At first, there is a massive amount of time spent on medical education. In the new curriculum, clinicians have to spend many hours for clinical training with the students. Secondly, the evaluation of doctors' promotions is still manuscript and a presentation for medical meetings. There are very limited grant applications available and limited time to share research. Another problem is difficulty of improving economic efficiency. The economic efficiency of pediatric surgery has been evaluated as being extremely low. The pediatric surgeon is a specialist, but there is no extra income for the qualification. Results (Improvement Points) : It is necessary to divide security and budget for the specialty staff of research, education and clinical medicine in private universities, and make a joint research institute. Society, as a whole, must recognize that child medical care is both necessary and complicated, increasing medical examinations and reward for treatment. Pediatric surgery is needed at all times and in areas. It is an attractive service occupation and requiring talented people. Conclusion : There are some problems regarding lifework in the field of pediatric surgery in private medical colleges. However, we believe that it is attractive to the public and the fostering of pediatric surgeons must be done by offering guarantees of reward and future positions.
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Tatsuo Kuroda
Article type: Article
2002 Volume 38 Issue 7 Pages
1015-1019
Published: December 20, 2002
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The field of pediatric surgery in our country is recently obliged to face newly advancing problems such as the management of carry-over patients, fetal surgery and pediatric emergency. It has become to be almost impossible to deal with the variety of problems by the many independent pediatric surgery facilities individually under the present situation in Japan. Each facility and each pediatric surgeon must confront a drastic decrease in pediatric surgical cases because of the excessive increase in the number of facilities, which may make Japanese pediatric surgery less competitive both in clinical and research fields. To improve the current pathological situation of the pediatric surgery field in our country, we propose a re-organization and unification of the clinical and research facilities so as to build up comprehensive medical complex for clinics, research and education. We believe that an organic medical complex without barriers between facilities may provide a better opportunity for every young pediatric surgeon to achieve more competitive clinical and research work.
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Eisuke Ohashi
Article type: Article
2002 Volume 38 Issue 7 Pages
1020-1026
Published: December 20, 2002
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Today, the field of pediatric surgery is in crisis. Most pediatric surgeons can't figure out their own direction and prospects. Presently, there is an abundance of pediatric surgeons, but because of the uncertainty in this field, in the future there will be too few. Furthermore, the surgeons who find positions in upper-level institutions may be content with their work, but others may decide to open their own clinics or work at the first-level institutions. In either case, these doctors can't rely only on their surgical skill. They must also treat general pediatric patients. Therefore, they need more experience and knowledge in general pediatrics. The reverse can also happen, whereby a pediatrician desires to learn pediatric surgery. The system at present requires these doctors to study at least 5 additional years to achieve this. This is impossible. I propose setting up an intensive one or two-year course within the hospital where registered doctors can study to develop the skills they need. They would receive certification showing that they passed this intensive course. Following the course, if they open their own clinic, they can confidently treat all patients, general pediatric and pediatric surgery. They can become a "complete children's doctor." At present, the medical graduate educational system does not provide for the above situations.
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Gohei Ochi
Article type: Article
2002 Volume 38 Issue 7 Pages
1027-1031
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Purpose : Some pediatric surgeons who have trained to become a specialist have not been able to continue their practices in spite of a true desire to do so. In contrast, the number of pediatric surgeons opening their own clinics have been increasing gradually. I examined the role of a clinic in pediatric surgery, and clarified its clinical position and potential possibilities. Methods : An analysis of daily practices and medical check-ups of infants, which contains pediatric surgical methods, was established in my clinic. Using this, all results were analyzed to clarify the number of pediatric patients, including surgical and non-surgical diseases, and their clinical outcome. Results : For pediatric surgery and unique medical check-ups for infants, many patients have been coming to the clninic from the surrounding area, mainly from the southern part of Ibaraki Prefecture. Pediatric surgical patients accounted for approximately 10% of all patients. Some patients were sent to university hospitals or other children's hospitals, but most patients were able to be treated in my clinic. Medical check-ups of infants undertaken here had a good reputation, and this system could find surgical diseases in 30% of all infants. Conclusions : The role of clinics for pediatric surgery related to primary care is of great significance. I hope to provide the training for pediatric surgeons who wish to open clinics with pediatric surgical programs.
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Akinari Hirata, Akio Kurashina, Takako Yamada, Yasuhide Yonekawa
Article type: Article
2002 Volume 38 Issue 7 Pages
1032-1039
Published: December 20, 2002
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Purpose : The purpose of this article is to describe the development and utilization of a paperless computer-based patient record system (CPR) and explain a proposal made to The Japanese Society of Pediatric Surgeons regarding information technology (IT). Subjects and Methods : Since 1999, Shimane Prefectural Central Hospital has worked to develop a CPR. It is not ready-made, but a continuously changing and expanding system. There remain some points for improvement, such as access speed and quality of digital imaging, however the system offers not only a variety of benefits to physician practice, but safety and convenience to patients as well. During the development process, labor was required to input standard clinical vocabulary into the system. Results and Conclusions : The objectives of the CPR are to contribute to the standardization and quality assurance of medicine. The implementation of the system is a means, not an end. There are many kinds of CPR in Japan now, and a lack of standard software engineering methodologies has interfered with standardization. Strategies for standardizing the CPR were investigated, and a recommendation was provided for approaching the standardization process, at least in the field of Pediatric Surgery, where greater more utilization of IT was proposed.
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Toshihiro Muraji
Article type: Article
2002 Volume 38 Issue 7 Pages
1040-1043
Published: December 20, 2002
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Background/Purpose : The author has been involved in an NGO activity that supports one perinatal hospital in western Nepal (under 5 mortality rate=100/1, 000 live births) since 1998. The problem of international support in pediatric surgery is reported and a solution is proposed. Description : The hospital was started in November 1998 in southern western Nepal, and developed to a regional hospital of 75 beds that provides neonatal care in NICU and Obstetrics with 24-hour availability of Caesarean section. In 2000, during my annual one-week visit, a newborn with omphalocele (2.5kg at birth) and a two-month old infant with Hirschsprung's disease successfully underwent one-stage closure of the abdominal wall and Swenson pull-through without colostomy, respectively. However, a problem remains regarding sustainable support. As it is difficult for an active pediatric surgeon to stay for a sufficient period of time to establish proper pediatric surgery routines in developing countries, a strategy for continuous systematic support is necessary. Summary/Proposal : 1. Organize an international team of Japanese pediatric surgeons that will be dispatched to a selected area. 2. The selection is made by amendments among the pediatric surgeons of the Asian Association of Pediatric Surgeons in the context of friendship and partnership.
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Kenji Shimada
Article type: Article
2002 Volume 38 Issue 7 Pages
1044-1045
Published: December 20, 2002
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To establish a better relationship between pediatric surgeons and pediatric urologists, I propose the following : 1. The Chairman of the annual meeting include requested themes of interest to pediatric urologists. 2. Some pediatric surgeons are willing to spend one or two years as a resident of pediatric urology in children's hospitals. Add this period of time as a requirement for specialist certification. 3. Develop ideas to encourage the pediatric urologists who contribute to the association. Creating the position of consultant pediatric urologist may be one option.
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Yasuaki Yoshino, Yukio Kanazawa, Kazuya Ise, Tsuyoshi Nemoto, Yoshinor ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1046-1051
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Purpose : The aim of this study was to evaluate whether or not PSARP is a suitable operation for imperforate anus and to clarify future problems of patients with imperforate anus. Methods : Thirty-five cases underwent radical operations for imperforate anus (except cut-back) in our hospital. After 1989, PSARP was performed for 19 cases and the remaining 16 cases were treated before 1989. Fecal continence was compared using clinical scores of fecal continence in the two groups. Results : Of 11 highly defective cases, the average score of 6 cases in the PSARP group was significantly better than that of the previous 5 cases. Of 16 intermediary defective cases, 9 cases in the PSARP group were significantly better than those of the previous 7 cases. In the 7 cases with ano-vestibular fistula, there was no difference in the score between PSARP and Potts' procedure, and many patients suffered from constipation in spite of the procedure. Conclusions : 1. PSARP resulted in a good fecal continence in cases with high and intermediate defects. 2. Constipation occurred in many cases of ano-vestibular fistula. The etiology of constipation needs to be studied in the future.
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Michihiro Sugai, Kiyoshi Murata, Hirohumi Munakata
Article type: Article
2002 Volume 38 Issue 7 Pages
1052-1056
Published: December 20, 2002
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Purpose and Method : The detection of neonatal ovarian cyst has increased since the introduction of routine prenatal ultrasonography. We reviewed six neonates and seven infants older than one-year-old with ovarian cystic lesions at the authors' institution between 1995 and 2001. Result : There is no consensus concerning optimal management. For neonatal ovarian cyst, monthly repeated ultrasound examination is necessary to monitor the size. We have advocated ultrasound-guided aspiration for simple neonatal ovarian cyst. All cysts disappeared in less than ten months. On the other hand, we recommended laparoscopic treatment for the complicated cysts with echoes that produced a solid mass appearance. Complicated cysts included ovarian torsion, mature teratoma and cystic adenoma in infants over one-year-old. Conclusion : We have described a conservative approach for neonates. Minimally invasive laparoscopic surgery provides a safe, definitive treatment for infantile ovarian cysts in patients over one-year-old.
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Yasuhiro Ohtsuka, Tadao Okada, Hideo Yoshida, Tadashi Matsunaga, Katsu ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1057-1063
Published: December 20, 2002
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Purpose : To investigate the factors of increasing platelet count after partial splenic embolization (PSE) for hypersplenism associated with biliary atresia. Methods : Since 1995, 10 children with hypersplenism associated with biliary atresia (4 boys and 6 girls, ranging in age from 2 to 11 years) were subjected to PSE according to our protocol. According to the platelet-increasing ratio, which was calculated by platelet count of one year after PSE as compared to before PSE, the 10 patients were divided into two groups : effective group (platelet-increasing ratio≧2 ; n=6) and noneffective group (platelet-increasing ratio<2 ; n=4). The two groups were compared retrospectively using clinical data. Results : The pretreatment status and backgrounds of the patients were clinically homogeneous between the two groups except for the male and female ratio. The splenic embolized ratio measured with enhanced CT scanning 1 to 2 weeks after PSE was significantly higher in the effective group (84.7±11.7% versus 51.6±7.5%, mean±SD) and had a significant correlation with the platelet-increasing ratio (γ=0.723). The types of formations of the portal-systemic collaterals were not significantly different between the two groups. All the patients showed transient and mild liver dysfunction after PSE ; however, no patients had significant complications. The length of hospital stay was significantly longer in the effective group. Conclusions : We propose that more than 70% of the spleen should be embolized utilizing a careful technique to obtain satisfactory results that increase platelet count.
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Toru Ichikawa
Article type: Article
2002 Volume 38 Issue 7 Pages
1064-1068
Published: December 20, 2002
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Two cases of omental cyst in children are reported. Girls aged 4 years and 7 years were admitted for abdominal distension. pain, fever, leucocytosis and elevated c-reactive protein. Abdominal ultrasonography and computed tomography revealed a large cystic intra-abdominal mass. Cystic lymphangioma originating from omentum or mesenterium was suspected. The cysts originated from lesser omentum in the first case and omentum in the second case. Cyst fenestration was performed laparoscopically. Post-operative course was satisfactory, and both girls were discharged on the 6th and 7th post-operative days respectively. Symptoms have not relapsed after 20 and 29 months follow-up, respectively.
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Masayuki Obatake, Eiji Nishijima, Shigeru Takamizawa, Atsushi Horiuchi ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1069-1073
Published: December 20, 2002
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Mayer-Rokitansky-Kuter-Hauser (MRKH) syndrome is a rare disorder and has an occurence rate of 1 in 4, 000-5, 000 live female births. The typical form of MRKH syndrome is characterized by congenital absence or rudimentary vagina. Patients with MRKH syndrome have a 46XX karyotype and normal secondary sex characteristics with a normal appearance of the external genitalia. We encountered a 1-year-and 6-month-old girl who had underwent cut-back procedure for her initial diagnosis as a superficial anorectal malformation in another hospital. She was diagnosed with vaginal agenesis and MRKH syndrome with intermediate anomaly of anorectal malformation during the correction of her anteriorally located anus. We simultaneously operated on the anomalies by posterior sagittal anorectoplasty and vaginoplasty, and separated the rectovaginal fistula.
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Minoru Iwasaki, Shinji Uemoto, Eri Ogawa, Akiko Yokoi, Koichi Tanaka
Article type: Article
2002 Volume 38 Issue 7 Pages
1074-1079
Published: December 20, 2002
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Before an operation, it was suggested by diagnosis that the liver neoplasm was probably malignant. Following division of the resected specimen, cryptonic pyogenic liver abscess was diagnosed. This is a rare case for small infants. It is common to perform liver excision for single or localized pyogenic liver abscesses, however, there are cases where malignancy cannot be denied completely. Since a malignant tumor was suspected in this case, we judged that liver biopsy before operation was extremely dangerous, and right lobectomy was performed via abdominal incision. The pathological diagnosis of the resected specimen presented findings compatible with pseudo tumor. It is believed that liver excision was a suitable medical treatment for pyogenic liver abscess in this case.
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Tetsuo Hori, Michio Kaneko, Kenichi Ikebukuro, Teruyoshi Amagai, Yasuh ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1080-1085
Published: December 20, 2002
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Seven days after birth, a male patient presented a left lateral cervical mass with upper airway obstruction. Plain X-ray film and CT of the neck revealed a mass with an air-fluid level on the left side of the neck. A barium esophagogram did not show a minute communication between the left piriform sinus and the cyst. The cyst was punctured and antibiotics were administered. After withdrawal of local inflammation, piriform sinus cysts and fistulous communication were excised. The lower end of the cyst was adjacent to the left lobe of the thyroid gland. The fistula penetrated the inferior pharyngeal constrictor muscle to the piriform sinus at the level of the inferior horn of the thyroid cartilage. Histopathologic examination showed that the cyst wall was composed of damaged epithelium containing parathyroid tissue. Piriform sinus fistula accompanied by cervical cyst is rare in neonates. Enlargement of the cyst in neonates may cause significant obstruction of the trachea and esophagus, which necessitates prompt aspiration or drainage. Only 28 neonatal cases have been reported in literature. Patients were predominantly male (18 of 26), and tumors were almost exclusively on the left side (26 of 28). Respiratory symptoms are recognized more frequently in neonates and infants than in older pediatric subjects.
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Masaki Nio, Takamichi Kamiyama, Megumi Nakamura, Shigehiko Yoshida, To ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1086-1091
Published: December 20, 2002
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We report the case of a three-month-old boy with intralobar pulmonary sequestration who was successfully operated on using the video-assisted thoracosopic surgical approach. A left supradiaphragmatic mass was revealed by prenatal ultrasonography at 26 weeks of amenorrhea (WA). The patient was born by cesarian section at 28 WA, secondary to unexpected ongoing delivery and unstable maternal conditions. Magnetic resonance angiography at the age of one-month demonstrated two aberrant arteries originating from the descending aorta. The lung specimen was pathologically confirmed to have a component of congenital cystic adenomatoid malformation, Stocker type II. The postoperative course was uneventful.
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Masahiro Kawasaki, Yoshiteru Takada, Yasuta Takahashi
Article type: Article
2002 Volume 38 Issue 7 Pages
1092-1095
Published: December 20, 2002
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This report describs a female neonate in whom a right suprarenal cyst 20 mm in size was diagnosed by ultrasonography prenatally at 34 weeks of gestation. The cyst showed a tendency to enlarge postnatally for one month, but thereafter it spontaneously decreased in size at the age of 2 months. Adrenal cyst in fetus is relatively rare. Differentiation of a benign cyst from neuroblastoma is of clinical importance, but differential diagnosis is very difficult. It could be ascertain whether the cyst in this case was benign or malignant, but unnecessary surgical procedure could be avoided by careful follow-up for 2 months.
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Kentaro Okamoto, Yumi Inoue, Yoshiko Usui, Toshiki Ohya, Shigeki Arii, ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1096-1099
Published: December 20, 2002
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An eight-month-old boy with congenital immuno-insufficiency and pneumocystis carini pneumonia underwent CV catheter insertion through the subclavian vein using the Seldinger method. During this procedure, the guide wire was ablated and wire of about 3 cm in length remained in the subclavian region. An angiogram showed that the fragment was out side of the vein. Five months later, his general condition improved and the remaining guide wire section was removed under general anesthesia. In small infants, there is little merit in using the J-shaped guide wire, furthermore, it may cause an extraluminal aberration or wire damage.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1100-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1100-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1100-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1100-1101
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1101-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1101-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1101-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2002 Volume 38 Issue 7 Pages
1101-1102
Published: December 20, 2002
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Article type: Article
2002 Volume 38 Issue 7 Pages
1102-
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