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23 февр. 2011 г.

Training at KMU: Final Report


It is an open secret that modern GI endoscopy, especially diagnostics and treatment of an early GI cancer, originate from Japan. A "Japanese style" endoscopy implies precise diagnostics of minor and minute mucosal changes.


Professor Tohru Itoh, Head of the Endoscopy Department at Kanazawa Medical University Hospital, was the tutor of the training course.  


I was provided with the personal desk, the Internet access and a library pass. Every day, except Sunday, I was at my desk from 8.30 a.m. to 10.00 p.m. Of course I had lunch-time, but sometimes I didn't have time for lunch breaks, especially on Tuesday and Thursday (these are the busiest days). My duty was to took part in all endoscopic examinations (about 300) and operations (about 10) as well as read scientific literature and do sketches. 

Within the framework of the endoscopy training course at Kanazawa Medical University two Hands-on trainings on ex-vivo pig stomachs on the base of the Endoscopy Department were held on January 21, 2011 and on February 24, 2011. They were devoted to advanced therapeutic technologies in GI endoscopy. The highlight of the hands-on training was Endoscopic Submucosal Dissection (ESD) technique. A dedicated gastroscope (Olympus® EVIS LUCERA video gastroscope GIF-Q260J), electric ESD knives (IT-knife and Hook-knife Olympus®), and an Erbe electric generator were employed.
  
A total of 5 ESDs of “target lesions” on a healthy mucosa were performed by following the technique described. All target lesions were located in the upper body great curvature of the stomach. Resection specimens ranged from 2 cm to 5 cm in length (median: 3,5 cm). ESD duration ranged from 40 to 60 minutes (median: 50 minutes). ESD could be completed in all cases (technical success: 5/5 = 100%).
Hands-on Training February 24, 2011


Resected Specimen
One more specimens

During the training course I mastered: the principles of early GI cancer screening and detection, indications for endoscopic treatment of early GI cancer, all steps of ESD performance and methods for preventing complications.

The staff of the University Centre of International Exchange as well as the staff of the Endoscopy Department was very friendly and helpful. I also enjoyed the fact of my perfect accommodation in a well- furnished room of the University Dormitory. 


I found the "Japanese style" endoscopy exemplary because it's congenial to me in it essence and in everyday clinical practice at the Yaroslavl Regional Cancer Hospital I follow the same principles. The base ESD technique is extremely important for employing this therapeutic method for the treatment of early GI cancer. The experience gained by me is unique and extremely important for my future professional work.



I owe the success of my training course to professionalism and superb teaching skills of Professor Tohru Itoh.
Professor Thoru Itoh and Mrs. Nozaki-san, Doctor's Office Room


Professor Tohru Itoh, Dr. Kawaura, Mrs. Nozaki-san
Festive Dinner: Dr. Kawaura, Dr. Kitakata, Dr. Urashima, Dr. Hamada, Dr. Minato, Mrs. Nozaki-san


Festive Dinner: Professor Tohru Itoh and Dr. Gvozdev Alexey

16 февр. 2011 г.

St.Valentine's Day

On February 14th the people just use to say "I love you" to each other or something like this and give some presents to each other (chocolate, cards, etc.). Japanese like this Day very much and present gifts not only to people they adore but to their colleagues, friends, neighbors, parents, etc. I've got some small gifts too, and it was surprising and very pleasing for me.
It was really surprising

I wish world peace and love to all of you. Do love, make love, fall in love, give love and be loved.


14 февр. 2011 г.

Training at KMU: Endoscopy Department


There is a state-of-the-art Endoscopy Department at Kanazawa Medical University Hospital. It is headed by Professor Tohru Itoh, MD, PhD.

There are 6 endoscopy (examination) rooms, an X-Ray operation room, a bronchoscopy room, a therapeutic endoscopy room. The endoscopy rooms are equipped with Olympus® EVIS LUCERA video systems, and 3 rooms (including therapeutic endoscopy room) are also equipped with electrosurgical Erbe® appliances.

A reception area, a comfortable waiting area with a TV set, a cosy recovery area, a treatment (preparation) room with a TV set for patients, a separate wardrobe both for men and women, a treatment room (containing all drugs and medicines), a record room for doctors with PCs, a decontaminating area are available on the premises of the Department. All rooms and areas are equipped with a central air-conditioning system. 

The main directions of scientific work are diagnostics and treatment of early GI cancer as well as GI cancer screening. The department serves as a base for undergraduate, graduate and postgraduate students of the Kanazawa Medical University and not only. 

The staff of the Endoscopy Department consists of 5 dedicated endoscopists, 8 nurses, 2 receptionists and a Secretary. It is the responsibilities of gastroenterologists and surgeonst to examine patients as well. About 30-40 gastroscopies and sigmoidoscopies and 4-5 colonoscopies are performed per day on average. All endoscopic investigations are conducted with intravenous sedation.  

The plan of the Endoscopy department with some admissions 
Dr. Gvozdev, Professor Tohru Itoh, Dr. Kitakata, Dr. Kawaura, Dr. Hamada 


6 февр. 2011 г.

Training at KMU: Sightseeing - Kenrokuen garden

The garden was named Kenrokuen in 1882. The Lord of Shirakawa Domain in Oshu, Matsudaira Sadanobu was asked to name it by the 12th Lord Narinaga. It's thought that he got name from Rakuyo Meienki, a classical Chinese book about famous gardens of Luoyang. The name Kenrokuen literally means "Garden of the Six Sublimities", referring to spaciousness, seclusion, artificiality, antiquity, abundant water and broad views, which according to Chinese landscape theory are the six essential attributes that make up a perfect garden.
 
Today there was a special event in Kenrokuen garden. The Light Show is organized twice a year. It's an unbelievably fantastic entertainment. It started at 5.30 pm. The evening was quite warm and the snow was lying on the ground. The lovely live music of the instrumental trio (flute, violoncello and oboe) added some magic to an unreal atmosphere of the evening. It was a wonderful and an unforgettable day in Japan.

Pictures taken at night with essential stereo-effects.















3 февр. 2011 г.

Training at KMU: First sunny day

Today is the first sunny day after the gloomy January 2011. I decided to have a walk around the town. The snow is still lying on the ground but it's melting every minute. I went to other side of the river over the Uchinada Bridge. It was a very pleasant stroll. The sun was shinning on my face and the wet wind was blowing through my hair. I found a very lovely place there - the Arbor of  Lovers. I spent about an hour there. 
 You are welcome to see my pictures.

Uchinada Bridge and Kanazawa Medical University

Japanese Sea

Long shot of the Mountains 

The Arbor of  Lovers with the Bell

2 февр. 2011 г.

Training at KMU: Meal

There is a very attractive cafeteria for clinical staff on the 12th floor of the Kanazawa University Hospital. The personnel of the cafeteria are always kind, friendly and helpful. The food is healthy, wholesome, low-calorie, delicious and mouth-watering.

View from the window on the 12th floor 

Mmm... delicious

Fish and ...chips...of course Rice! And Miso-soup.
Japanese lunch
One more

And more

And more...

1 февр. 2011 г.

Training at KMU: Environment

I'm accommodated at the Dormitory of Kanazawa Medical University. My apartment is located on the 9th floor of the 9 storey building.
Dormitory
It's a well-equipped comfortable single room with a small kitchen and a bath/wc. An air-conditioner, a TV set, a washing-machine, a cooker, an air funnel, a fridge, a microwave oven, an electric kettle and a toaster are availible.
My room 

Kitchen

A view from my window: Japanese Sea

Training at KMU: Hands-on Training on Ex-vivo Pig Stomachs


Within the framework of the endoscopy training course at Kanazawa Medical University the Hands-on training on ex-vivo pig stomachs was held under the guidance of Professor Tohru Itoh on January 21, 2011 on the base of the Endoscopy Department. It was devoted to advanced therapeutic technologies in GI endoscopy. The highlight of the hands-on training was ESD (Endoscopic Submucosal Dissection) technique.
The ESD technique introduced by Hirao et al[1] has subsequently been modified by several investigators, allowing curative en bloc resection of broad superficial tumors with the use of special cutting knives.
A dedicated gastroscope (Olympus® EVIS LUCERA video gastroscope GIF-Q260J), electric ESD knives (IT-knife and Hook-knife Olympus®), and an Erbe electric generator were employed.
           According to Professor Tohru Itoh the base ESD technique includes:



A total of 2 ESDs of “target lesions” on a healthy mucosa were performed using the following technique described. All target lesions were located in the upper body great curvature of the stomach. Resection specimens ranged from 1 to 2 cm in length (median: 1,5 cm). ESD duration ranged from 40 to 60 minutes (median: 50 minutes). ESD could be completed in all cases (technical success: 2/2 = 100%).

The base ESD technique is an extremely significant therapeutic method for the treatment of the early GI cancer. The practical experience gained by me is unique and will be used in future professional career as an Endoscopist.
 
Training model - ex-vivo harvested pig stomach

From right to left: Professor Tohru Itoh, Dr. Gvozdev, Dr. Kitakata

From right to left: Dr. Hamada, Dr. Kawaura, Professor Tohru Itoh, Dr. Gvozdev, Dr. Kitakata