1.Two Successful Proximal Reoperation Cases after Acute Type A Dissection Repair
Tomohiko Sakamoto ; Yasushi Tsutsumi ; Osamu Monta ; Keitaro Koshi ; Yousuke Takahashi ; Kimitoshi Kitani ; Hirokazu Ohashi
Japanese Journal of Cardiovascular Surgery 2010;39(6):355-358
We report 2 cases of successful proximal reoperations after acute type A dissection. Case 1 : A 53-year-old man underwent ascending aorta and aortic arch replacement and aortic valve re-suspension for acute type A dissection with aortic valve regurgitation in 1992. Thirteen years after the first operation, computed tomography demonstrated a Valsalva aneurysm (74 mm) and Doppler echocardiography showed moderate aortic valve regurgitation. Therefore, we performed an operation. We could not locate the dissection in the Valsalva sinus, and the aortic valve cusps had organic change. A David procedure was performed. The postoperative course was uneventful and he was discharged on the 19th postoperative day. Case 2 : A 65-year-old woman underwent ascending aorta replacement and aortic valve resuspension for acute type A dissection with aortic valve regurgitation in 1997, but 11 years after the first operation, computed tomography demonstrated a Valsalva aneurysm (55 mm) and arch aneurysm (65 mm) with stenosis of the innominate vein and she had facial and left arm edema. Doppler echocardiography showed moderate aortic valve regurgitation. We could not find the location of dissection in the Valsalva sinus or aortic arch, and aortic valve cusps had no organic change. A Bentall procedure and total arch replacement were performed and her postoperative course was uneventful.
2.Medical certification reduces the number of children requiring allergen elimination diets for school lunches
Seigo KOREMATSU ; Kenji TOYOKUNI ; Yousuke HANDA ; Chika GOTOH ; Rieko WASADA ; Rie KATO ; Nanae KAWANO ; Mayo IKEUCHI ; Tomoko OKAMOTO ; Maki KIRIYA ; Mizuho TAKAHASHI ; Tomoyuki TAKANO ; Atsuhiko HAIGO
Asia Pacific Allergy 2017;7(2):92-96
BACKGROUND: Following the increase in the number of children with food allergies, support systems are now required for school lunches, but a large-scale factual investigation has not been carried out. OBJECTIVE: We evaluated the features of elimination diet due to food allergy and the support system in kindergartens and schools. METHODS: A prefecture-based questionnaire survey regarding measures for food allergies in school lunches of all kindergartens, public elementary schools, and public junior high schools (631 facilities) was conducted in Oita Prefecture, Japan. RESULTS: The recovery rate of the questionnaire was 99.5%, which included 106,008 students in total. A total of 1,562 children (1.5%) required elimination diets. The rate of children on elimination diets in kindergartens and elementary/junior high schools that required medical certification by a physician was 1.2% (324 among 27,761 children), which was significantly lower than the 1.8% of children (1,227 among 68,576 students) on elimination diets at the request of guardians without the need for medical certification (p < 0.0001). A total of 43.9% of the kindergartens and schools said that they would contact guardians if symptoms were observed after accidental ingestion, while a low 8.1% stated that they provided support to children themselves, including the administration of adrenaline auto-injectors. CONCLUSION: Medical certification reduces the number of children requiring elimination diets, but it has not been adequately implemented. Furthermore, waiting to contact guardians after symptoms are observed may lead to the delayed treatment of anaphylaxis. Cooperation between physicians and teachers is desired to avoid the overdiagnosis and undertreatment of children with food allergies.
Anaphylaxis
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Certification
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Child
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Diet
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Eating
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Epinephrine
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Food Hypersensitivity
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Humans
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Japan
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Lunch
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Medical Overuse
3.Impact of Hospital Integration on Emergency Surgery Patients with Stanford Type A Acute Aortic Dissection
Hidekazu NAKAI ; Hidetaka WAKIYAMA ; Makoto KUSAKIZAKO ; Daiki KATO ; Ryota TAKAHASHI ; Yousuke TANAKA ; Ayako MARUO ; Hidehumi OBO
Japanese Journal of Cardiovascular Surgery 2024;53(2):49-55
Objective: Hospitals throughout Japan are being integrated and reorganized under the government's regional medical care plan. However, the effects on cardiovascular surgery practice remain unknown. In the year 2016, our institution employed hospital integration; we report its effects on patients with type A acute aortic dissection who underwent emergency surgery. Methods: This study included 89 patients who underwent emergency surgery for type A acute aortic dissection from May 2012 to December 2020. Evaluation items included preoperative patient factors, number of surgeries, surgical mortality, referral rate, patient transport time, transport distance, number of surgeries performed by young cardiovascular surgeons, and overtime work for surgery. Patients were categorized into pre-(group P: 29 patients) and post-integration (group A: 60 patients) groups, which were retrospectively compared. Results: Preoperative factors were not significantly different between the two groups. Operations accounted for 29 and 60 in groups P and A, respectively; they increased significantly after integration (p=0.005). Surgical mortality was 27.6 and 15% in groups P and A, respectively, with no significant difference (p=0.2). The referral rate was 17 (58.6%) and 21 (35%) patients in groups P and A, respectively; group A displayed a significantly lower referral rate (p=0.04). The interval from the onset of symptoms to arrival at the surgery cite was significantly reduced (p=0.01) in group A (112±140 min) compared to group P (206±201 min). There was no significant difference in the transfer distance between groups P (13.9±14.8 km) and A (13.5±16.2 km). The number of surgeries performed by young surgeons increased in 9 cases (31%) in group P and 34 cases (56.7%) in group A (p=0.02). Overtime work was substantially reduced:446±154 min in group P and 349±112 min in group A. Conclusion: Hospital integration resulted in increased number of acute aortic dissection surgeries and decreased interval time from the onset of symptoms to arrival at the surgery cite. The young surgeons performed more surgeries and reduced their overtime work.
4.5-1. Education on Diversity, Inclusion, and Co-Production in the Faculty of Medicine, the University of Tokyo
Yoshihiro SATOMURA ; Akiko KANEHARA ; Suzuka OKUBO ; Tatsuya SUGIMOTO ; Tomoe KATAOKA ; Yuka KONISHI ; Sakurako KIKKAWA ; Ryo KINOSHITA ; Mahiro SUEMATSU ; Yusuke TAKAHASHI ; Yousuke KUMAKURA ; Chie HASEGAWA ; Rie SASAKI ; Sosei YAMAGUCHI ; Utako SAWADA ; Yuki MIYAMOTO ; Norihito OSHIMA ; Shin-Ichiro KUMAGAYA ; Kiyoto KASAI
Medical Education 2024;55(2):121-127
The University of Tokyo Disability Services Office and the University of Tokyo Hospital have striven to advance the inclusion of individuals with disabilities and to encourage the co-production of research as well as mental health services with peer support workers. In convergence with these endeavors, the Center for Diversity in Medical Education and Research (CDMER) was founded in 2021. The Center aims to establish an environment and culture that facilitates the participation and success of medical professionals with disabilities. For this purpose, it is essential to integrate the perspective of the social model of disability into medical education and promote co-production in the medical field, which is among the most challenging areas that can realize co-production. The Center is involved in various educational and research activities, including managing educational programs for medical students and supporting student-led research.