Nihon Geka Gakkai zasshi
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Japan Ministry of Health, Labour and Welfare alleviated the rule of advertisement of medical specialists. The new rule included several contents: The scientific society must be a corporation and have a minimally 5 years training system. The Ministry also established a new postgraduate training system which will start in April, 2004. ⋯ The Japan Surgical Society negotiated with other 4 surgical subspecialties: cardiovascular, respiratory, gastroenterological and pediatric surgery, and established a new postgraduate surgical training program. The first step of the program is in common with that of other subspecialties. After application for admission to the Japan Surgical Society, registration of surgical case experiences has been able to be made through the home page of the Society.
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Several specific nutritional substrates have been shown to augment and/or modulate host immune function. Some enteral formulas enriched with specific immune-modulating nutrients are presently available for clinical use in Japan. Such nutrients include n-3 fatty acids, arginine, glutamine and nucleotides. ⋯ The benefits of enteral immunonutrition to be most pronounced in GI surgical patients. However, in critical illness, it is difficult to draw any conclusion on the effect of immunonutrition because of the heterogeneity of the critically ill patients and few clinical trials Further clinical trials to determine which groups of patients are indicated for immunonutrition, as well as what is the optimal combinations of specific nutrients, are needed. Studies are also required to determine the safety of immunonutrition.
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In elective gastrointestinal (GI) surgery, the patients' nutritional status should be assessed and if protein-energy malnutrition exists, preoperative nutritional support should be scheduled 7 to 14 days before surgery. In malnourished patients in particular, preoperative nutrition with total parenteral nutrition (TPN) reduces postoperative complication rates of infection. Preoperative enteral nutrition (EN) is considered to be as effective as TPN in improving postoperative surgical outcome. ⋯ When TPN is administered, hyperglycemia due to overfeeding should be carefully controlled. Patients who undergo distal gastrectomy or colectomy can start oral intake 3 to 4 days after surgery, with pertinent peripheral infusion. Immunonutrition containing immune-enhancing nutrients such as arginine, n-3 polyunsaturated fatty acid, glutamine, etc., especially administered preoperatively, is a promising nutritional therapy for reducing postoperative infectious complications.
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Nihon Geka Gakkai zasshi · Jun 2003
Review[Duodenum-preserving total pancreatic head resection and pancreatic head resection with segmental duodenostomy].
A duodenum-preserving pancreatic head resection (DPPHR) was first reported by Beger et al. in 1980. However, its application has been limited to chronic pancreatitis because of it is a subtotal pancreatic head resection. In 1990, we reported duodenum-preserving total pancreatic head resection (DPTPHR) in 26 cases. ⋯ When performing DPTPHR, the surgeon should ensure adequate duodenal blood supply. Avoidance of duodenal ischemia is very important in this operation, and thus it is necessary to maintain blood flow in the posterior pancreatoduodenal artery and to preserve the mesoduodenal vessels. Postoperative pancreatic functional tests reveal that DPTPHR is superior to PPPD, including PHSRD, because the entire duodenum and duodenal integrity is very important for postoperative pancreatic function.
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Nihon Geka Gakkai zasshi · Jun 2003
Review[Anatomy of the head of the pancreas and various limited resection procedures for intraductal papillary-mucinous tumors of the pancreas].
The surgical anatomy, as well as the results of anatomic investigation of the pancreas, are reviewed. Anatomic descriptions, which are useful not only for ordinary pancreaticoduodenectomy or distal pancreatectomy, but also for limited resection of the pancreas for low-grade malignancy such as mucin-producing tumors or cystic lesions of the pancreas, are also provided. The fusion fascia of the head of the pancreas is called the "fusion fascia of Treitz" and that of the body and tail of the pancreas is termed the "fusion fascia of Toldt." The fusion fascia is histologically composed of a loose connective tissue membrane. ⋯ On the other hand, distal pancreatectomy that preserves both the splenic artery and vein and the spleen is steadily gaining popularity. Although this procedure is somewhat complicated, it is not technically difficult and can be safely performed by any surgeon. This procedure is indicated for some cases with chronic pancreatitis and IPMT.