Kyobu geka. The Japanese journal of thoracic surgery
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The thoracic surgery practice in Japan has characteristics such as strong burden to surgeons and young trainees for high-risk procedures under poor health care manpower system and less qualification for their high-level practices. The presence of too many numbers of certified surgeons and teaching hospitals for cardiac, general thoracic and esophageal surgeries has been well recognized providing low quality maintenance and poor training system. The Japanese Association for Thoracic Surgery has recently made a step towards to open the data of hospital quality promoting the discussion to reunify the hospitals and surgeons into reasonable numbers to respond to the social demand. The new 2-year postgraduate clinical training and also a new specialty medical board approval for advertisement have provided various problems and controversies, and we must make efforts to overcome these problems by providing new strategies to make our practices more qualified.
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Ten years ago, I attempted to make a prospective over-view on the future of Japanese thoracic and cardiovascular surgery in this journal. Similarly, I am giving a perspective on the same subject from the American point of view. The steady increase in Japanese contribution to the 2 peer-reviewed American journals is impressive. ⋯ Finally, their cooperation with other Asian and Pacific colleagues deserves praise from the U. S. as well. It is my humble opinion that the Japanese thoracic and cardiovascular surgery has reached the matuirity and is ready to produce abundant fruits.
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The recent 10-year progress and prospective views of the Board Certificated Cardiovascular Surgeon in Japan were described. Although total framework of the Japanese Board of Medical Specialist is not yet established, the certification standards of the Board Certificated Cardiovascular Surgeon and training hospital were substantially revised in 2005 and 2006 for increasing those quality. Hereafter, we should tackle to make new systems for the trainee's registration, gaining of incentive for the Board Certificated Cardiovascular Surgeon, and education of coworkers in surgical fields.
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Graduate and postgraduate education in the specialty of cardiovascular and general thoracic surgery may become more attractive by turning by itself to focus on producing competitive specialists and by having mature specialty boards to aim at. For this to accomplish consensus must be formed among hospital surgeons who are now united through specialty associations. In our country specialists may reasonably be less than 1000 in number in each thoracic specialty to call for specialist doctor's fee.
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Artificial heart or heart transplantation are required for the treatment of profound heart failure. Total artificial heart (TAH) and ventricular assist system (VAS) were developed from late 1950s and 2 extracorporeal pneumatic Japanese VASs (Toyobo VAS and Zeon VAS) were introduced to clinical field from 1980. Now, over 850 patients were applied several types of VASs including Japanese VASs. ⋯ Small size implantable left VAS (LVAS) are required and several types of non-pulsatile pump, including 2 Japanese made centrifugal pumps, are under clinical trials. And destination therapy by using implantable pulsatile LVAS for end-stage heart failure patients has been started in United States and is performed in United States and Europe. In near future, artificial heart and heart transplantation will be selected according to the conditions of the patients with profound heart failure.