In recent years, surgical mesh in the treatment of pelvic organ prolapse have been widely used. But at the same time, many cases were reported about the complication of surgical mesh. The complications were bleeding, infection, and organ perforation. There are many surgical method without using surgical mesh. They are old but safe and reliable. FDA pointed out that the mesh operation have many problems, and manufacturers of surgical mesh recently decided that their mesh should not be used for the repair of pelvic organ prolapse. But sorry to say that many surgeons still use surgical mesh for the treatment of pelvic organ prolapse. Considering these situations, clinical results of surgical repair of pelvic organ prolapse without using surgical mesh were summarized. Old methods in the treatment of pelvic organ prolapse are far superior compared to mesh surgery.
Over the course of my anesthesiology career, I have noticed that volatile anesthetics have shown remarkable improvement with the introduction of sevoflurane. Inhaled sevoflurane allows a particularly smooth and quick induction, in addition to providing stable anesthetic maintenance. Another improvement has been the development of the synthetic opioid remifentanil. Because it undergoes degradation within a few minutes, there is no risk of respiratory depression after discontinuing drug administration. Remifentanil also depresses sympathetic activity centrally, which provides cardiovascular stability during anesthesia, and as a result, it is utilized in many different surgeries. For patients with a difficult airway, the development of the laryngeal mask airway has proven to be quite useful as it greatly eases management. Several types of laryngeal mask airway have been investigated and, with a few notable contraindications such as a full stomach and severe obesity, it is widely employed worldwide. In pediatric anesthesia, the most interesting advance has been the use of caudal anesthesia employing local anesthetics and select analgesics. Combining dexmedetomidine or clonidine rather than morphine with the caudal anesthetic agent prolongs the analgesic duration without generating major adverse effects.
Part one of this summary, which covers the decade from 1976 through 1984 when I transferred to Juntendo University Urayasu Hospital with the late professor Yoshihiro Yagi, focused mainly on my research, published under the title “Cellular Immune Abnormalities in Severe Burn Injuries, ”conducted in collaboration with Professor Yagi, as well as my clinical studies on direct surgical intervention (Sugiura Method) for esophageal varices conducted under the guidance of the late Professor Mitsuo Sugiura. In 1984, I transferred to Juntendo University Urayasu Hospital with Professor Yagi and launched the Department of Surgery, serving as an assistant professor. In 2004, I became the first head of the newly formed Department of Emergency Medical Care and worked to establish it as the second tertiary emergency and critical care center in the South Tokatsu Medical Care Zone. Upon obtaining approval from Chiba Prefecture for this facility to be a designated regional cancer care hospital in the prefecture, I launched the Cancer Center in Juntendo University Urayasu Hospital, serving as its first director. Furthermore, during the five years of my service as the head of the Department of Malignant Oncology (now Clinical Oncology), I established various protocols for promoting cancer treatment. On March 31, 2014, I retired from Juntendo University after 39 years of service. It has been my honor and privilege to serve Juntendo University Hospital and its patients.
In recent years, the number of elderly diabetic patients have been increasing. Elderly diabetic patients share many characteristics in terms of glycemic and insulin responses and clinical conditions such as complications. Additionally, decreased cognitive functions are more pronounced among elderly patients with poorly-controlled hyperglycemia. In elderly patients on insulin therapy, subjective symptoms including decreased cognitive functions caused by elevated blood glucose levels are more likely to disappear than when they are on oral hypoglycemic medications. To achieve successful outcomes with the treatment, it is important that medical professionals closely collaborate with each other to provide “medical team approach” that enables all participants to make the best use of their specialized skills.
I have worked as a pathologist for about 37 years at Juntendo University. While studying abroad, I was taught “Three Points of Diagnostic Pathology” by Professor Steven G. Silverberg in the USA. After coming back to Japan, based on what I had learned, I practiced diagnostic pathology: entering the operation room for intraoperative pathological diagnosis, pathological diagnosis in numerous cases, many conferences on pathological diagnosis, and teaching diagnostic pathology to pathologists, clinicians, and students. Also, along with my co-workers, I published many articles in international journals. Subsequently, 21 doctors gained a Ph.D. in Medical Sciences. Concerning international activities, with the support of Professor Cesar A. Moran, I held an “International Diagnostic Pathology Course in Tokyo” in 2009, 2011, and 2013. Based on my experiences, I think that the principle of diagnostic pathology is a blend of pathological diagnosis, education, and research. International activity leads to the advancement of diagnostic pathology. Pathological diagnosis is the basis of a patient’s diagnosis and treatment. So, pathologists should have a heart that considers and cherishes patients.
Tomizo Yoshida preached the individuality and diversity of cancer. He said that it is important to find out the common or most fundamental traits of cancer cells. Yoshida boldly stated that we humans play up the future-a sign of our inner desire to avoid reality. Apart from being a cancer pathologist, Tomizo Yoshida was also a thinker who eloquently used analogies of cancer to explain his outlook on life. In a world complex with many incomprehensible factors, confused by issues, my wish is that this teaching-the Philosophy of Cancer-sheds light on the path to the future.
Advances in biomedical research have created opportunities for innovative cancer prevention, detection, and treatment. Insights from the molecular mechanisms of disease enable investigators to identify new therapeutic targets and novel agents. A paradigm shift in oncology is on the way, from toxic chemotherapies to highly targeted therapies. Translation of biomedical discoveries into significant advances in cancer care relies on effective clinical trials systems. Both industry-sponsored trials as well as publicly funded investigations have played different but complementary role to prove improved survival in leukemia, lymphoma, breast cancer, and prostate cancer. However, next generation of research infrastructures to explore the precision medicine may not be easily established. Recently, the Institute of Medicine (IOM) issued a report to outline necessary, systematic changes for the Clinical Trials Cooperative Group Program (COGs) to more efficiently design, review, and conduct studies. In response to the IOM report, the National Cancer Institute (NCI) has launched the National Clinical Trials Network (NCTN), to facilitate the rapid initiation and completion of cancer clinical trials. In this review article, the author would like to provide up-to-date information on the new cancer clinical trials system.
Education in medical school used to be auditorium lectures or bedside-teaching. Paradigm shift took place recently in medical education is based on patient-oriented practice. Considering personalized care which is the current goal of oncology, multidisciplinary approaches are increasingly required. Therefore, we have started an educational trial designed to provide the best care for every patient by building a multidisciplinary team in which every member becomes a leader in turn.
Cancer has been the leading cause of death in Japan since 1981. There are concerns that the number of cancer deaths will grow with the rapidly increasing number of elderly people in Japan. The 3rd-term Comprehensive 10-year Strategy for Cancer Control has been underway since 2004, and it is scheduled to end in March 2014. During this period, the Cancer Control Act was established, in 2006. According to the Basic Plan to Promote Cancer Control Programs, which was revised in 2012, the government should set a new strategy for cancer research. An Advisory Council on Future Cancer Research has compiled a report with the slogan “Complete cure, prevention, and living with cancer - Cancer research in collaboration with patients and society.” Research issues to be addressed are as follows: 1) clarification of the true nature of cancer; 2) development of new drugs for unmet medical needs; 3) development of new patient-friendly medical technologies; 4) establishment of new standard therapy; 5) research focusing on life-stage and the characteristics of cancer such as childhood cancer, cancer in elderly, refractory cancer and rare cancer; 6) cancer prevention and/or early detection methods; 7) research aimed to establish a society in which both patients and survivors can live well with good survivorship; and 8) promotion and dissemination of cancer control activities.
Promotion Plan for the Platform of Human Resource Development for Cancer (CancerHR Phase Two) had been launched in FY 2012. The newly selected five-year-project consists of 43 chairs in faculty of medicine: 9 chairs specialized in radiation treatment, 7 chairs specialized in chemotherapy, 10 chairs specialized in palliative care, and 17 other chairs. The above plans are expected to improve the platform of cancer education and research.
Objective: Potassium channels play an essential role in neuronal potassium homeostasis. Kv2.1 is widely expressed in the mammalian brain and it undergoes dramatic functional modulation during brain ischemia. This study characterized the serial changes in brain Kv2.1 expression after transient focal cerebral ischemia in mice. Methods: C57BL/6 mice (n=45) were subjected to 60 min of middle cerebral artery occlusion followed by 1, 1.5, 2, and 3 h reperfusion. Hypoxic area was determined by hypoxyprobe-1 and Kv2.1 expression was measured by real-time PCR, immunofluorescence imaging, and western blotting. Results: Kv2.1 mRNA increased 1 h after cerebral ischemia-reperfusion injury, and then decreased. In western blotting, expression of Kv2.1 protein decreased at 1 h and decreased Kv2.1 protein level turned to peak level of Kv2.1 expression at 1.5 h. In immunohistochemistry revealed a gradual increase in Kv2.1 at 1.5 h after reperfusion. Conclusions: Kv2.1 expression transiently increased after cerebral ischemia. Our results suggest Kv2.1 may play an important role in potassium transport during the early period of focal cerebral ischemia.
Objective: Electroconvulsive therapy (ECT) is a highly effective treatment for severe depression. However, one major complication of ECT is the potential for temporary cognitive impairment. The purpose of this retrospective study was to explore the relationship between postictal confusion (PIC) and interictal disorientation (IID) as well as to clarify whether PIC is related to the improvement in symptoms or not. Materials: Patients with depression who were admitted to Juntendo University Hospital to receive ECT from April 2006 to January 2011 were recruited. Methods: PIC and IID for each patient was observed. The Hamilton Rating Scale to assess depression (Ham-D) was employed in depressive patients. All assessments were performed prior to first ECT session and a week after the final ECT session. Measurement and Results: Thirty-seven patients were registered, but eight patients were interrupted due to complications. PIC was associated with improvement of HamD (p=0.0459). IID prevalence was not significantly different between patients of PIC and non-PIC group. Conclusions: PIC is associated with a greater improvement after ECT, and is not related to IID.
The diagnosis of IgA nephropathy (IgAN) is based on the renal biopsy that contributes with other clinical and laboratory parameters to predict the outcome of the disease. This review describes the different risk scores used to estimate the development of end-stage kidney disease and the different approaches to treat IgAN patients. Finally, according to KDIGO guidelines, some recommendations based on the renal biopsy report and laboratory data are suggested by the author for the therapy of the disease.