The number of physicians in Japan has been and will continue to be lower than that in other the Organization for Economic Co-operative and Development (OECD) countries. The admission capacity of medical schools, which has the greatest impact on the number of physicians, has been determined through discussions among the Ministry of Health, Labour and Welfare, medical associations, medical organizations, universities, and academics, depending on the medical supply-demand status on that era. In recent years, the maldistribution of medical specialties and regions has become an issue. For the involving this issue, Japanese government takes from multiple perspectives to address this problem, including “regional quotas” in admission quotas for university medical school and, setting a ceiling on the number of residency positions available in each prefecture as well as on recruitment capacity in the specialist physician system. The implementation of “work style reform” for physicians, focuses on shortening physicians’ working hours and has raised concerns regarding a shortage and regional maldistribution of physicians. The government’s policy is based on a key concern: rising healthcare costs could seriously threaten the country’s financial health. Therefore, the government has limited the increase in the number of physicians. Conversely, this year, the government has begun to argue that a regulatory approach is necessary to address the uneven distribution of physicians. Our proposition is to achieve a number of physicians comparable to that of other OECD countries and to create an environment that enables physicians to voluntarily address their regional and departmental maldistribution.

The number of physicians in Japan has been and will continue to be lower than that in other the Organization for Economic Co-operative and Development (OECD) countries. The admission capacity of medical schools, which has the greatest impact on the number of physicians, has been determined through discussions among the Ministry of Health, Labour and Welfare, medical associations, medical organizations, universities, and academics, depending on the medical supply-demand status on that era. In recent years, the maldistribution of medical specialties and regions has become an issue. For the involving this issue, Japanese government takes from multiple perspectives to address this problem, including “regional quotas” in admission quotas for university medical school and, setting a ceiling on the number of residency positions available in each prefecture as well as on recruitment capacity in the specialist physician system. The implementation of “work style reform” for physicians, focuses on shortening physicians’ working hours and has raised concerns regarding a shortage and regional maldistribution of physicians. The government’s policy is based on a key concern: rising healthcare costs could seriously threaten the country’s financial health. Therefore, the government has limited the increase in the number of physicians. Conversely, this year, the government has begun to argue that a regulatory approach is necessary to address the uneven distribution of physicians. Our proposition is to achieve a number of physicians comparable to that of other OECD countries and to create an environment that enables physicians to voluntarily address their regional and departmental maldistribution.

The number of physicians in Japan has been and will continue to be lower than that in other the Organization for Economic Co-operative and Development (OECD) countries. The admission capacity of medical schools, which has the greatest impact on the number of physicians, has been determined through discussions among the Ministry of Health, Labour and Welfare, medical associations, medical organizations, universities, and academics, depending on the medical supply-demand status on that era. In recent years, the maldistribution of medical specialties and regions has become an issue. For the involving this issue, Japanese government takes from multiple perspectives to address this problem, including “regional quotas” in admission quotas for university medical school and, setting a ceiling on the number of residency positions available in each prefecture as well as on recruitment capacity in the specialist physician system. The implementation of “work style reform” for physicians, focuses on shortening physicians’ working hours and has raised concerns regarding a shortage and regional maldistribution of physicians. The government’s policy is based on a key concern: rising healthcare costs could seriously threaten the country’s financial health. Therefore, the government has limited the increase in the number of physicians. Conversely, this year, the government has begun to argue that a regulatory approach is necessary to address the uneven distribution of physicians. Our proposition is to achieve a number of physicians comparable to that of other OECD countries and to create an environment that enables physicians to voluntarily address their regional and departmental maldistribution.

The number of physicians in Japan has been and will continue to be lower than that in other the Organization for Economic Co-operative and Development (OECD) countries. The admission capacity of medical schools, which has the greatest impact on the number of physicians, has been determined through discussions among the Ministry of Health, Labour and Welfare, medical associations, medical organizations, universities, and academics, depending on the medical supply-demand status on that era. In recent years, the maldistribution of medical specialties and regions has become an issue. For the involving this issue, Japanese government takes from multiple perspectives to address this problem, including “regional quotas” in admission quotas for university medical school and, setting a ceiling on the number of residency positions available in each prefecture as well as on recruitment capacity in the specialist physician system. The implementation of “work style reform” for physicians, focuses on shortening physicians’ working hours and has raised concerns regarding a shortage and regional maldistribution of physicians. The government’s policy is based on a key concern: rising healthcare costs could seriously threaten the country’s financial health. Therefore, the government has limited the increase in the number of physicians. Conversely, this year, the government has begun to argue that a regulatory approach is necessary to address the uneven distribution of physicians. Our proposition is to achieve a number of physicians comparable to that of other OECD countries and to create an environment that enables physicians to voluntarily address their regional and departmental maldistribution.

OBJECTIVE: The purpose of this study is to evaluate the clinicopathologic characteristics of the torsion of the ovarian tumor in postmenopausal women. METHODS: We reviewed the medical records of 20 postmenopausal patients with a postoperative diagnosis of torsion of the ovarian tumor in Department of Obstetrics and Gynecology, Hanyang University Hospital from January 1989 to December 1998. RESULTS: The postmenopausal patients with torsion of the ovarian tumor constitute 20/94 (21.3%) of all adnexal torsion patients encountered during this period. The mean (+/-SD) age of the 20 patients was 63.5+/-9.0 years, with a range of 52-90 years. The mean time since menopause was 16.5+/-10.3 years, with a range of 1-39 years. The mean parity was 5.4+/-2.0 (range of 3-10). Lower abdominal pain (65%) was the most frequently presenting symptom, palpable mass(20%) or diagnosed mass(15%) being the second. But, in 20% of cases there was no lower abdominal pain. The torsion occurred at the right side in 11cases (55%) and at the left side in 9 cases. The most frequent degree of torsion was those cases that was rotated twice (720 degrees). The neoplasms undergoing torsion ranged in diameter between 5cm and 30cm and the most prevalent size was 6 to 10 cm (8 cases). Most of the patients (17cases) were treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy. The tumors that produce torsion varied histologically and the most common type was cystic teratoma (in 5 cases), simple cyst(in 3 cases), serous cystadenoma(in 2 cases), mucinous cystadenoma(in 2 cases). CONCLUSIONS: In our study, ovarian tumor torsion occurring in postmenopausal patients constituted approximately 20% of all torsion patients, therefore adnexal torsion should be considered when a postmenopausal woman presents with lower abdominal pain. When torsion is diagnosed, total abdominal hysterectomy and bilateral salpingo-oophorectomy is the usual treatment for postmenopausal patients. Histologically, in more than 90% of cases, the tumors that produce torsion were benign. If cancer is evident, more extensive surgery is required.
Abdominal Pain ; Diagnosis ; Female ; Gynecology ; Humans ; Hysterectomy ; Medical Records ; Menopause ; Mucins ; Obstetrics ; Parity ; Teratoma

No abstract available.
Humans* ; Kidney*

No abstract available.
Humans* ; Kidney*

Peritoneal pregnancies are classified as primary and secondary. Primary implantation on the peritoneum is extremely rare in extrauterine pregnancy and is a potentially life-threatening variation of ectopic pregnancy within the peritoneal cavity, representing a grave risk to maternal health. Secondary abdominal pregnancies are by far the most common and result from tubal abortion or rupture, or less often, after uterine rupture with subsequent implantation within abdomen. Early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. We report a case of primary peritoneal pregnancy in a 28-year-old woman, who had severe lower abdominal pain one day before laparotomy for a preoperative diagnosis of ectopic pregnancy. The conceptus was implanted on the left uterosacral ligament. A fresh embryo of approximately 8 weeks' gestation was found in the conceptus.
Adult ; Case Report ; Female ; Follow-Up Studies ; Hemoperitoneum/surgery ; Hemoperitoneum/diagnosis ; Hemoperitoneum/complications* ; Human ; Ligaments ; Ovum Implantation ; Peritoneum/pathology ; Pregnancy ; Pregnancy, Abdominal/surgery ; Pregnancy, Abdominal/pathology ; Pregnancy, Abdominal/diagnosis ; Pregnancy, Abdominal/complications* ; Rupture, Spontaneous/surgery ; Rupture, Spontaneous/diagnosis ; Sacrum ; Uterus/pathology

OBJECTIVES: To predict of the survival of patients with epithelial ovarian cancer, multivariable analysis was done to identify variables with independent prognostic factors. Based on materials from 191 clinical trials performed by Department of Obstetrics and Gynecology, Hanyang University Hospital, we constructed a prognostic index (Pp with considerable predictive power for long-term survival of patients with epithelial ovatian cancer treated with cis-platin based combination chemotherapy, METHODS: On identifying variables with independent prognostic value, statistical analysis were performed with clinicopathologic variables including age, FIGO stage, histologic subtype, histologic grade, residual tumor, presence of ascites, pretreatment levels of hemoglobin, platelet, and tumor markers(CA 125, CA 19-9). We also analyzed biological variables using immunohistochemical staining for GST-pie (glutathione-s-transferase-pie), p-glycoprotein, and MT (metallothinein) as a drug resistance and uPA (urokinase type plasminogen activator), PAI-1 (plasminogen activator inhibitor-l), nm23 (nonmetastatic gene 23) as a tumor invasion and metastasis. In addition, univariable analysis was performed followed by multivariable analysis using Coxs proportional hazards model to identify variables predictive of poor prognosis. Prognostic index (PI) was calculated based on sum of individual beta-coefficient of the most important independent prognostic value. RESULTS: With univariable analysis, age, FIGO stage, histologic grade, histologic subtype, presence of ascites, residual tumor, initial value of CA 125, MT, uPA, and PAI-1 were found to predict of patients survival. In the multivariable analysis and proportional hazard model, the pretreatment characteristics needed for the calculation of the PI are the age, the site of metastases expressed as stage, the histologic subtype, the size of residual tumor, the histological grade, and the presence of ascites. In the subgroup comprising the 10% of the patients with the best prognosis, 5-year survival rate was 78.9%, whereas in the subgmup comprising the 10% with the poorest prognosis, 5-year survival rate was 7.1%, which illustrates the large variability of the prognosis among patients. CONCLUSIONS: The PI was found to retain its value after response was achieved. The information provided by the PI can be expected to be useful in treatment planning and the proper stratification of patients in clinical trials.
Ascites ; Blood Platelets ; Drug Resistance ; Drug Therapy, Combination ; Gynecology ; Humans ; Neoplasm Metastasis ; Neoplasm, Residual ; Obstetrics ; Ovarian Neoplasms* ; P-Glycoprotein ; Plasminogen ; Plasminogen Activator Inhibitor 1 ; Prognosis ; Proportional Hazards Models ; Survival Rate

Twenty six cases of borderline ovarian tumor(BOT) were treated between Jan. 1985 and Dec. 1997 at the Department of Obstetrics and Gynecology, Hanyang University. The clinical records were reviewed for all patients including histopathology, clinical features, and follow-up. The frequency of BOT was 12%(26/214) of epithelial ovarian malignancies, and patients with these tumors tend to present at a younger age(36 yrs) than those with invasive carcinomas. In terms of histologic type, mucinous type(21/26: 81%) were more prevalent than serous tumor(5/21: 19%) in this study. The positive rate of CA 125 was 20% in serous, and the positive rate of CA 19-9 was 24% in mucinous tumor. The size of mucinous was larger than that of serous tumors(17.1 cm vs 9,3 cm). Almost all of these tumor categorized as early stage(stage I: 96%), however, only one patient with serous tumor had advanced stage of disease(stage III: 4%), Therefore BOT tend to be diagnosed as earlier than invasive carcinoma. About 2/3 of patients were treated as conservative surgery(unilateral salpingooophorectomy or enuclation). Postoperative adjuvant chemotherapy was not given about half of cases(13/26). Median follow-up was 43 months and recurrent case was found only one in serous tumor, All patients in this study are still alive and free of disease except one, 5-year survival rate was 100%. But large number of study and long-term follow-up are needed to make a decision to treat and manage of BOT.
Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Mucins ; Obstetrics ; Ovary* ; Survival Rate