In 2004 a program of community health and medicine was included in the national residency system. However, the contents and achievements of this program have not been adequately studied. We surveyed residents, program directors, and collaborating facilities for clinical training in community medicine in the Tohoku–Hokuriku region of Japan about the contents, practices, training period, curriculum development, and other aspects of the program.
1)We conducted a survey of 230 residents who had completed the program, 82 program managers, and 101 collaborating facilities.
2)The survey consisted of surveys of residents (survey 1), of program directors (survey 2), and of collaborating facilities (survey 3) and asked about the programs' consistency with the training objectives of the Ministry of Health, Labour and Welfare and satisfaction with community medicine.
3)Approximately 70% of residents, program managers, and collaborating facilities believed the training period for community medicine is appropriate.
4)Furthermore, 69.1% of residents, 65.5% of program directors, and 85.2% of facilities believed that the community medicine program in the national system was important or very important.
5)Training programs should be enhanced so that residents "understand and practice health care in outlying and rural areas" and to increase active involvement of program directors.

Atlanto-occipital dislocation (AOD) is rarely seen in clinic because it is characteristically immediately fatal. With recent progress in the pre-hospital care, an increasing number of AOD survivors have been reported. However, because the pathophysiology of AOD is not clearly understood yet, the appropriate strategy for the initial management remains still unclear. We report a case of successful AOD treatment and describe important points in the management of this condition. It is important to note that abducens nerve palsy is a warning sign of AOD and that AOD can result in a life-threatening distortion of the arteries and the brain stem. We recommend the application of a halo vest to protect the patient's neural and vascular competence as the immediate initial step in the treatment of AOD. Horn's grading system is useful in assessing indications for surgery. Finally, when performing posterior fixation, C2 should be included because of the anatomy of the ligamentous architecture.
Abducens Nerve Diseases ; Arteries ; Atlanto-Occipital Joint ; Brain Stem ; Dislocations* ; External Fixators ; Humans ; Internal Fixators ; Ligaments ; Mental Competency ; Survivors

Microsurgery techniques are useful innovations towards minimizing the insult of canal stenosis. Here, we describe the trumpet laminectomy microdecompression (TLM) technique, advantages and disadvantages. Sixty-two TLM patients with lumbar disc herniation, facet hypertrophy or yellow ligament or intracanal granulation tissue. The symptoms are low back pain, dysesthesia and severe pain on both legs. Spine levels operated Th11-S1; the patients who had trumpet-type fenestration, 62.9% had hypertrophy of the facet joint, 11.3% had intracanal granulation tissue, 79.1% had hypertrophy of the yellow ligament and 64.5% had disc herniation. The average of procedure duration was 68.9 min and intraoperative blood loss was 47.4 mL. Intraoperative complications were found in 3.2% of patients, with dural damage but without cerebrospinal fluid leakage. The TLM can be performed for all ages and all levels of spinal canal stenosis, without the complication of spondilolistesis. The TLM has a shorter duration, with minimal intraoperative blood loss.
Cerebrospinal Fluid ; Constriction, Pathologic* ; Granulation Tissue ; Humans ; Hypertrophy ; Intraoperative Complications ; Laminectomy* ; Leg ; Ligaments ; Low Back Pain ; Microsurgery ; Paresthesia ; Spinal Canal ; Spine ; Zygapophyseal Joint