Easy and accurate targeting of deep-seated hepatic tumors under laparoscopy with a forward-viewing convex-array transducer.

BACKGROUND: It is technically difficult to puncture deep-seated hepatic tumors by conventional laparoscopic ultrasonography with a linear-array probe. We have developed a laparoscopic ultrasonography system with a convex-array probe. METHODS: The laparoscopic system used had a fixed forward-viewing convex-array transducer, and a guide groove for puncture was added to the back of the unit. These characteristics enabled us to continuously monitor the position of the needle tip on the ultrasonographic image immediately after puncturing on the liver surface. We attempted tumor puncture in 11 patients with hepatocellular carcinoma under a new probe guidance. RESULTS: The mean puncturing distance up to the tumors was 38.7 mm. All punctures were successful on the first pass and the tumors were treated with radiofrequency ablation. CONCLUSION: Using this new equipment, puncturing hepatic tumors for treatment is relatively easy, irrespective of the position of the tumor.

Surgeons who contributed to the enlightenment of Japanese medicine.

Until the sixteenth century internal medicine, primarily Chinese medicine, had been predominant in Japan. From 1639, under the national seclusion policy of the Tokugawa Shogunate, Japan's doors were closed to the West; and Japan had no trade relations with any countries except China and Holland. Only in Nagasaki, where a Dutch settlement was located, were Japanese able to learn about Western culture and Western medicine. Through the medical education and services provided by Philipp Franz von Siebold, Western surgery was introduced to Japan. In 1854 Japan was opened to the world, and many German physicians were invited to provide medical education in Japan. The German medical education system continued until about 1950. After World War II, Japanese medical education was reformed, and several medical professors from U.S. universities were sent to Japan. One was Charles G. Johnston of Wayne State University. Thanks to the efforts of these visiting American professors, many young Japanese doctors were sent to the United States to study surgery, anesthesia, and the like. These doctors later became the leaders of medical education in Japan. The guidance and friendship of these foreign doctors had a profound effect on the progress and advancement of modern Japanese medicine.