Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Jul 2008
Review[Current surgical treatment for acquired valvular heart disease].
We discuss the current status of surgical treatment for acquired valvular heart disease. Mitral valve repair for organic and functional mitral regurgitation is the first choice instead of valve replacement. It is important that surgery for functional mitral regurgitation restores the geometry of the left ventricle and mitral valve. ⋯ At present, the surgical procedure for both aortic stenosis and aortic regurgitation is valve replacement in most cases, although aortic valve repair has been attempted for aortic regurgitation in recent years. The early results of aortic valve repair are excellent, but the long-term results have not been clarified. The durability of valve repair in both the mitral and aortic position is a future issue and it may be improved by revising the indications for valve repair and using new surgical techniques.
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Nihon Geka Gakkai zasshi · Sep 2007
Review[Clinical impact of the Guidelines for Treatment of Gastric Cancer].
The first edition of the Guidelines for Treatment in Gastric Cancer (TGGC) was published in 2002 and it was revised in 2004. Those were the first Japanese treatment guidelines for any type of cancer. Questionnaires were then sent to committee members of the Japanese Gastric Cancer Association. ⋯ The following problems and areas for improvement were pointed out: 1) Some standard treatments are described in the clinical trial setting. 2) The renewal for chemotherapy is not performed on the basis of new evidence. 3) The announcement of time and contents of new TGGC is necessary by internet. 4) An explanation of the objective index for evidence and recommendation levels is necessary, similar to those in the guidelines for the treatment of cancer in other organs. Japanese physicians have a responsibility to contribute to the evidence for gastric cancer treatment to be considered worldwide. In the near future, a simpler, more easily understandable revision of the TGGC will be necessary.
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Aortic valve replacement with a pulmonary autograft (Ross procedure) was pioneered by Donald Ross in 1967. The advantages of the autograft valve include freedom from anticoagulation, hemolysis, and infection, optimal hemodynamic performance, and growth potential. Various materials have been used for the right ventricular outflow tract (RVOT). ⋯ Pulmonary allografts cannot be utilized in Japan, and thus other valves and materials must be used instead. The acceptance of these procedures has been slow because of the technical demands of the operations and the inherent need for reconstruction of the RVOT, thereby placing two valves at risk. In the past 20 years, the Ross procedure has been increasingly considered for pediatric patients with a wide spectrum of congenital abnormalities.