Domestic and international thoracic, cardiac and vascular surgery (TCVS) journals were evaluated using Impact Factor (IF) and h-index, since the information should be valuable when selecting a journal in this field to submit a manuscript. The h-index was introduced by Hirsch to show the quality and quantity of articles. Scientific databases such as PubMed, Scopus and Web of Science (WoS) were used in this study. For surgery, there were 452 journals in PubMed, 170 in WoS and 165 in the list of journal analytics of Scopus in July 2008. Two journals in surgery from Japan were listed in WoS. One of them was “Surgery Today (ST).” Four journals from Japan were listed in Scopus journal analytics, and ST had the highest h-index among the four. Citations of ST have increased in the last decade, although the numbers of published articles were similar for ST and Jpn. J. Thoracic. Surg. When “trend” is defined as the number of articles divided by number of citations, ST performed best among Japanese journals in the 2008 Scopus list. A strong correlation existed between IF and the h-index for TCVS journals. However, there are some limitations in the h-index, since it shows lifetime contribution. The order for IF and h-index was reversed occasionally because of the difference in the calculation methods. Eight TCVS-related journals were listed in WoS : J. Thorac. Cardiovasc. Surg. (JTCVS), Ann. Thorac. Surg. (ATS), J. Vasc. Surg. (JVS), Eur. J. Cardiothorac. Surg. (EJCTS), J. Cardiovasc. Surg. (JCVS), Thorac. Cardiovasc. Surg. (TCVS), J. Cardiac. Surg. (JCS), and Heart Surg. Forum (HSF). Three major journals in TCVS : JTCVS, ATS and JVS, had a high h-index greater than 117, compared to 59 for EJCTS. When the h-graphs were superimposed, the “h” values of JTCVS, ATS, and JVS were close to each other. When comparing the 4 minor journals in WoS : JCVS, TCVS, JCS and HSF, as well as ST, journal analytics showed that JCVS had the best trend among the five. It was concluded that the h-index is valuable for the evaluation and comparison of TCVS journals, since the index can be obtained easily using online databases, and the “trend” of a journal is helpful in making a choice when submitting a manuscript to minor TCVS journals.

Recently, the number of women doctors choosing a career in surgery is increasing. However, the situation of women doctors in Japan is still difficult, because most women doctors also have to take care of their homes and children, because the husbands rarely share child care or household chores in Japan. In 2008, the Committee on Women Surgeons of the Japan Surgical Society conducted a questionnaire survey among 105 academic societies, including 11 surgical societies who belong to the Japanese Association of Medical Sciences. The response rate was 96.2%. Among the 11 surgical societies, only 4 had a total of 16 women councillors, and only 1 society had a woman director. Only 1 surgical society had a woman editor, and the other 10 societies had none. The Japanese Surgical Society and the Japanese Society of Internal Medicine have never had a woman councillor since their inauguration over 100 years previously. Furthermore, the Japanese Society for Cardiovascular. Surgery also had no woman councillors. At the 38th annual meeting of the Japanese Society for Cardiovascular Surgery in 2008, no woman doctor was assigned the role of chairperson in any of the sessions. In obtaining or renewing board certification, only 38% of the academic societies recognized pregnancy, childbirth and childcare as conditions for retaining qualification. Improvements in working situations, gender equality, and support for professional commitment and child care are needed for women surgeons in Japan.

Although sequential bypass with in situ arterial conduits (the left and right internal thoracic arteries; LITA and RITA, the right gastroepiploic artery; GEA) in coronary artery bypass grafting (CABG) is technically demanding, it is one of the most important procedures using a limited number of in situ arterial conduits to revascularize a wide area. In this report, we retrospectively investigated the clinical outcome of CABG with 4 or more distal anastomoses using only in situ arterial conduits. From December 1990 to May 1999, 62 patients underwent CABG with in situ arterial conduits, with at least one sequential bypass. There were 59 men and 3 women patients with mean age of 59.6 years (41 to 82 years). Mean postoperative follow-up period was 32 months (1 to 101 months). The total number of distal anastomoses was 4 (1 sequential bypass) in 54 patients, 4 (2 sequential bypasses) in 6 patients, 5 (1 sequential bypass) in 1 patient and 6 (3 sequential bypasses) in 1 patient. There were 5 emergency operations (8%), 37 patients (60%) had a history of myocardial infarction, 30 patients (48%) had diabetes mellitus and 6 patients (10%) had chronic renal failure and were on hemodialysis. Left ventricular ejection fraction was 40% or less in 15 patients (24%). There were no early deaths. Angiographic patency was satisfactory for each graft (sequential: individual, LITA 96.7%: 100%, RITA 100%: 100%, GEA 89.5%: 97.4%). Patency of a distal anastomoses of GEA was rather poorer than that of proximal (p=0.03). Three patients died during the follow-up period (all of them due to malignancy). The 5-year actuarial survival and cardiac event-free rate was 94.6% and 87.2%, respectively. In conclusion, although an indication of GEA sequential grafting needs further study, in situ arterial grafting with at least one sequential arterial conduit was associated with excellent results and achieved more complete revascularization with exclusive use of in situ arterial conduits in patients with diffuse coronary artery disease.

After bleeding is controlled with hemostats during surgery, the residual material should be resorbed without adverse effects such as inflammation, infection or scar formation. To evaluate the biocompatibility of hemostats, three kinds of commercially available collagen hemostats, cotton type (Integran^®), microfibrillar type (Avitene^®), and sheet type (TachoComb^®), were examined. A rabbit ear chamber (REC), a system for viewing materials in vivo, was applied to the auricle of male Japanese white rabbits. The REC was designed to leave a 50-μm-thick and 6.4mm-diameter chamber, and 0.5mg of each specimen (Integran; n=8, Avitene; n=6, TachoComb; n=6) was placed in the chamber. Macroscopic and microscopic observations were performed every week up to 5 weeks without anesthetizing or stressing the animal. In the Integran group, capillaries infiltrated between the collagen fibers, and the vasculature in the REC field was complete in 6 out of 8 animals at 5 weeks. Cotton type collagen fibers of Integran became thinner every week without effusion. In the TachoComb group, capillaries were directed toward the effusion at 2 weeks, while in the Avitene group, a similar phenomenon was not observed. The vasculature was incomplete, with either effusion or infection at 5 weeks in the Avitene and TachoComb groups. Material was recognized up to 4 weeks in the TachoComb group, whereas the space occupied by material remained vacant without vasculature in the Avitene group. Our results suggest that cotton type configuration is excellent as a collagen hemostat, with smooth capillary infiltration, rapid resorption of material and promotion of the healing process.

When local hemostatic agents are used in surgery, rapid dissolution followed by prompt absorption without adverse effect after successful hemostasis are essential qualities. Residual hemostatic materials greatly influence host cells during the wound healing process. Biocompatibility of material is also essential. Furthermore, hemostatic agents also should be free of cytotoxicity that may block mitosis and migration of host cells, so that wound healing can proceed smoothly. For the evaluation of biocompatibility and cytotoxicity, 4 commercially available hemostatic agents; oxidized regenerated cellulose (Surgicel^®), gelatin sponge (Spongel^®), microfibrillar collagen (Avitene^®) and cotton type collagen (Integran^®) were tested in vitro and in vivo. The hydrogen ion concentration (pH) of culture medium containing hemostatic agents was measured. Fibroblasts were cultured with the hemostatic agents in petri dishes for 5 days. A rabbit ear chamber (REC) model was used to evaluate tissue compatibility and the healing process. Each hemostatic agent was placed in the REC and evaluated macroscopically once a week up to 5 weeks. At 72h, the pH of the culture medium containing Surgicel was low at 7.2, while they stayed between 7.7-7.8 with the other agents. In the fibroblast culture containing Surgicel, cell detachment occurred and the cell numbers decreased, while no particular changes occurred with other hemostatic agents. In the REC model, after 5 weeks Surgicel was dissolved and remained in the effusion, and the healing process was disturbed by inflammation. Spongel was dissolved and absorbed, with normal vasculature. Avitene was dissolved and remained in the effusion, but did not induce strong inflammation. With Integran, the healing process was prompt but the material was still recognizable at 5 weeks. The 4 hemostatic materials tested showed differences in biocompatibility and cytotoxicity. The ability of hemostasis is important; however, after hemostasis is achieved, unused hemostatic material should be eliminated, leaving as little hemostatic agent as possible to avoid postoperative complications.