Kyobu geka. The Japanese journal of thoracic surgery
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Virtual bronchoscopy 3-dimensionally displays the bronchial lumen based on helical data. This method is non-invasive, but the image quality depends on the data collection conditions for original images, and the understanding of appropriate threshold setting and artifacts is important. ⋯ For peripheral lesions, virtual bronchoscopic navigation in which virtual bronchoscopy is used as a navigator for the insertion of a bronchoscope was developed, facilitating examination in a short time. Due to technological advances such as multi-slice computed tomography (CT), virtual bronchoscopy can be readily performed, and its correct understanding for routine clinical application is important.
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A 63-year-old female had been treated for liver cirrhosis and hepatocellular carcinoma (HCC) since 3 years before. She developed symptoms of dyspnea and echocardiography revealed a large tumor in the right atrium. The stalk of tumor was attached to the intraatrial septum just above the tricuspid valve and the tumor was floating between the right atrium and the right ventricle according to cardiac rhythm. ⋯ She was operated for cardiac tumor under cardiopulmonary bypass successfully and the postoperative course was uneventful. But the pathology reported direct intracavitary metastasis of HCC without intravascular involvement. She was discharged on the 7th postoperative day for the treatment of HCC.
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Main part of the management of chronic heart failure is pharmaceutical therapy. In patients with chronic heart failure due to left ventricular systolic dysfunction, enhanced activation of neurohormonal systems including sympathetic nerve and renin-angiotensin-aldosterone system plays the most important role in its progression and poor prognosis. Therefore, principle of treatment of chronic heart failure is inhibition of the elevated neurohormonal activity. ⋯ Diuretics are also class I drug necessary for an improvement of symptoms of heart failure. Recently, implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) are implanted more frequently, because volume of evidence indicates benefits of these non-pharmacological treatments. In this paper, recent advance in medical therapy for patients with heart failure and its limitation is discussed.
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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.