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Friday Afternoon Instructional Courses

4:30 – 6:00 PM

 

Instructional Course 21
Moscone West 2002

Treatment of Complications Following Common Elbow Procedures

 
Target Audience: Intermediate
Keyword: Elbow
Category: Other
 
Upon completion of this course, participants will be able to:
• Describe the complications associated with common  surgical elbow procedures.
• Identify pearls and pitfalls for the avoidance of such complications.
• Aid the hand surgeon in managing these complications.
Description
This course will present common complications of common procedures performed about the elbow in adults and children.  Treatment strategies for the complications will be presented as well as ways to avoid their occurrence.  Teaching methods will include illustrative cases.
 
Moderator: A. Lee Osterman, MD
Speakers: Scott P. Steinmann, MD, Douglas P. Hanel, MD
 

Instructional Course 22
Moscone West 2004

Strategies to Reduce and Manage Chronic Post-Operative Pain

 
Target Audience: Basic
Keyword: Other
Category: Pain & Disability (chronic)
 
Upon completion of this course, participants will be able to:
• Discuss the perioperative medication options that can reduce post-operative pain in the at-risk patient.
• Prescribe a variety of therapy modalities designed to decrease post-operative pain.
• Identify diagnosis and treatment plan for patients with painful scars after surgery.
Description
Chronic pain after surgery is an all too frequent occurrence. Reported rates of chronic pain after common hand surgeries such as trigger finger and carpal tunnel are about 20%.  These post-operative pains states are particularly problematic for hand surgery patients because post-operative pain limits participation in rehab and ultimately can cause a technically perfect operation to have a suboptimal result.
 
There are a wide variety of interventions from medications to therapy modalities that can reduce post-operative pain.  Unfortunately most of this research has been published outside of hand surgery, which limits the diffusion of this information into our field.  This course will provide information on steps that surgeons can take to reduce the risk of post-operative pain.  There will be a multidisciplinary faculty to allow for a broad approach to managing post-operative pain.
 
This course will review the evidence on perioperative medication and anesthesia techniques that reduce the risk chronic pain.  It will also give information on what therapy modalities are particularly useful for the patient developing chronic post-operative pain process.  Finally we will review an approach to the patient with a painful scar and develop a treatment algorithm from medications to scar revision.
 
Managing post-operative pain begins with the surgeon; we hope that this course will expand the surgeon’s tool box so that she or he can best direct the patient’s care and ultimately improve results.
 
Moderator: Catherine Curtin, MD
Speakers: Ian Carroll, MD, Oleta Jones, PT, CHT
Catherine Curtin, MD's presentation will include discussion of Botox, an "off-label" or other non-FDA approved, investigational pharmaceutical product or device manufactured by Botox (most commonly manufactured by Allergan).
Ian Carroll, MD’s presentation will will include discussion of gabapentin, pregabalin, desipramine, duloxetine "off-label" or other non-FDA approved, investigational pharmaceutical products or devices.
 

Instructional Course 23
Moscone West 2006

Revision Peripheral Nerve Surgery - When and How


Target Audience: Intermediate
Keyword: Forearm
Category: Nerve/Neuromuscular
 
Upon completion of this course, participants will be able to:
• Identify the management of recurrent carpal tunnel syndrome.
• Identify the management of recurrent cubital tunnel syndrome.
• Describe the management of failed peripheral nerve repairs.
• Discuss role of vein wrapping and orthobiologics in revision peripheral nerve surgery.
• Describe the physiology of nerve regeneration and muscle reinnervation.
Description
All hand surgeons are well versed in the management of peripheral nerve compression and peripheral nerve injuries.  Carpal tunnel release, cubital tunnel release and peripheral nerve repairs are among the most common procedures performed by hand surgeons.  Overall high success rates are reported for the management of these common conditions; however, failures still occur and revisions are necessary at times.  Surprisingly, there is a paucity of literature and guidance for the management of failed primary peripheral nerve surgery. 
 
This course will first review the physiology of peripheral nerve regeneration and muscle reinnervation.  These basic principles will be built upon to present a scientific and rational approach to the evaluation and treatment of failed nerve repair surgery.
 
Next case presentations to highlight treatment options, timing of revision, and outcomes of revision carpal tunnel, revision cubital tunnel, and revision peripheral nerve repairs will be presented by the panel.  The distinction between persistent and recurrent peripheral nerve compression will be rfec and an algorithmic approach to revision surgery offered for both carpal tunnel and cubital tunnel surgeries.  Differential diagnoses as well as etiologies of failed surgeries will be reviewed for each case as well.  Intraoperative strategies and “pearls” will be discussed.
 
Lastly, the group will discuss nerve coverage for the chronically scarred nerve.  This will include the role of vein wrapping versus newer orthobiologic “nerve wraps” as compared to local, regional or free flap coverage in revision nerve surgery.
 
Moderator: Jonathan E. Isaacs, MD
Speakers: Glenn R. Gaston, MD, Gary M. Lourie, MD, Dean G. Sotereanos, MD
 

Instructional Course 24
Moscone West 2008

Common Fingertip Conditions and Injuries: Evaluation and Treatment


Target Audience: Advanced
Keyword: Hand
Category: Evaluation/Diagnosis/Clinical Treatment
 
Upon completion of this course, participants will be able to:
• Recognize the very distinct patterns of open and closed injuries to the various structures in the fingertip.
• Identify evidence based data analyzing treatment options and outcomes in the full spectrum of these injuries.
• Develop evaluation and treatment algorithms through a sound anatomical and physiological basis.
Description
Fingertip injuries are exceedingly common.  Taken in their entirety, they constitute the largest percentage of orthopedic injuries seen in the emergency room.  They are a leading cause of time off from work and Workers’ Compensation claims.
 
Mechanisms of injuries vary widely from crush, avulsion and degloving, laceration, amputation, eccentric tendon overuse with hyperflexion or extension of the distal phalanx.  Injuries can involve any and all of the structures in the fingertip and can be open or closed.  Closed injuries can result in fracture of the distal phalanx, dislocation and collateral ligament injuries of the distal interphalangeal joint, closed avulsions of the flexor digitorum profundus and mallet fingers.
 
Open injuries include dorsal and volar lacerations resulting in trauma to the nail apparatus or the terminal flexor and extensor tendons, digital nerves, nail bed crush and avulsion injuries which can coexist with open fractures of the distal phalanx.  Degloving injuries to the dorsal or volar skin frequently accompany crush injuries to the tip.  In extreme cases, the tip of the finger may be amputated by a sharp instrument leaving a deficit that is either transverse or oblique and either in the sagittal or coronal plane or the defect can be amorphous such as in a severe crush injury.  Amputations may or may not have exposed bone.
 
Treatment of these injuries can vary widely from simple splinting to complex microvascular reconstruction and pedicle flaps.  The goal of treatment is to restore an aesthetically pleasing, painless, tactile, mobile, stable fingertip that can sense pain, temperature, pressure, stereognosis and fine touch.  The fingertip must also be the terminus of the gripping mechanism of the hand.  Unfortunately, all too often these injuries are under-recognized, resulting in persistent tip numbness, dysethesia, cold sensitivity, nail growth abnormalities, nail fold and volar pad abnormalities, hyperesthesia and painful stiffness and deformity of the distal interphalangeal joint.
 
Upon completion of this course the audience will be able to recognize the various categories of injury to the fingertip, anatomy, physiology, mechanism of injury  and clinical presentation.  Treatment options, outcomes and possible complications of treatment will be reviewed.  The material will be presented in  both didactic fashion incorporating evidence based data and in detailed case presentations to highlight methods and consequences of treatment.  Hopefully it will serve to increase awareness of this frequently under-treated injury and lead to better care.
 
Moderator: Leo M. Rozmaryn, MD
Speakers: Ghazi M. Rayan, MD, David T. Netscher, MD
 

Instructional Course 25
Moscone West 2001

MOC Approved Treatment of Metacarpal Fractures: Best Evidence


Target Audience: Intermediate
Keyword: Hand
Category: Fractures and Dislocations
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Upon completion of this course, participants will be able to:
• Describe non surgical treatment methods for metacarpal fractures.
• Identify surgical treatment for metacarpal fractures.
• Discuss surgical treatment for thumb metacarpal fractures.
• Identify management of complications.
Description
This instructional course will review the best evidence for treatment of metacarpal fractures.  The course will focus on surgical and nonsurgical treatment strategies as well as managment of complications.  This course is an approved by the ABOS and ABPS as an interim educational course for practice improvement modules (PIMS).  This course is associated with a pre-test and post-test that must be completed to claim credit for use in the PIM process.
 
Moderator: John G. Seiler, III, MD
Speakers: Donald H. Lalonde, MD, Warren C. Hammert, MD, Jerry I. Huang, MD
 

Instructional Course 26
Moscone West 2007

Elbow Arthroscopy: Indications, Techniques, Outcomes & Complications


Target Audience: Intermediate
Keyword: Elbow
Category: Arthoscopy
 
Upon completion of this course, participants will be able to:
  • Recognize indications and contraindications for elbow arthroscopy.
  • Outline techniques for performing arthroscopic procedures at the elbow.
  • Recognize strategies to treat rheumatoid arthritis, osteoarthritis, tendinopathy about the elbow and other conditions.
  • Define potential complications and strategies to avoid them.
 
Description
Arthroscopy is increasingly accepted for treatment of certain conditions about the elbow.  Published studies have investigated use of arthroscopic treatment for traumatic and degenerative conditions.  This course will outline techniques for performing arthroscopic procedures at the elbow with a specific focus on indications, tips and pearls, outcomes and alternative treatment strategies.  Potential complications will be studied with emphasis on how to avoid them.
 
Moderator: Julie E. Adams, MD
Speakers: Scott P. Steinmann, MD, Robert W. Wysocki, MD, Graham J.W. King, MD, FRCSC
 

Instructional Course 27
Moscone West 2009

Rotator Cuff Tears: Current Treatment Strategies and Techniques


Target Audience: Intermediate
Keyword: Shoulder
Category: Evaluation/Diagnosis/Clinical Treatment
 
Upon completion of this course, participants will be able to:
  • Describe methods to improve diagnosis of rotator cuff pathology and assist with decision making for treatment.
  • Discuss options for treating partial thickness, complete and massive tears of the rotator cuff.
  • Analyze current techniques, both arthroscopic and open, for treating various rotator cuff tears, indications for acromioplasty and treatment of associated proximal biceps tendon disorders.
  • Evaluate current strategies for orthobiologic use and recommended rehabilitation protocols.
 
Description
We will review common signs and symptoms of rotator cuff tears, and physical examination tools.  Current use of diagnostic tools such as MRI, CT arthrography and ultrasound will be summarized.  Non-operative treatment and surgical options to include arthroscopic vs. open treatment will be reviewed, and indications and advantages/disadvantages for each method will be discussed.  Set-up and basic arthroscopic techniques will be demonstrated.  Specifically, treatment of partial, complete and massive tears will be emphasized along with arthroscopic repair techniques, single vs. double row, if/when an acromioplasty is needed and techniques available to perform one, as well as treatment of concomittent biceps tendon pathology.  Additionally, common complications and the use of orthobiologics and reverse shoulder arthroplasty for massive rotator cuff tears will be detailed.  Finally, current rehabilitation protocols, nonoperative and postoperative, and outcomes will be analyzed and discussed.
 
Moderator: Kevin J. Renfree, MD
Speakers: Ethan R. Wiesler, MD, Christopher C. Schmidt, MD, Thomas W. Wright, MD
 

Instructional Course 28
Moscone West 3000/3002

Reconstruction of the Distal Radioulnar Joint - An International Perspective


Target Audience: Intermediate
Keyword: Wrist
Category: Arthroplasty
 
Upon completion of this course, participants will be able to:
  • Describe radiological interpretation of deformity.
  • Apply shared decision making.
  • Evaluate indications for different surgical procedures.
  • Evaluate outcomes of arthroplasties, fusions.
  • Identify surgical complications.
 
Description
The functional role of the distal radioulnar joint in upper extremity function is undergoing greater appreciation.  The kinesiology of the joint and surgical options for either traumatic or inflammatory conditions has expanded with the development of hemi, total or constrained arthroplasties.  This course will feature detailed descriptions of indications, applications and outcomes based on evidence-based literature as well as the experience of a panel of international experts.
 
Moderator: Jesse B. Jupiter, MD
Speakers: Diego L. Fernandez, MD, Michael Sauerbier, MD, PhD, Luis R. Scheker, MD, Alex Lluch
 

Instructional Course 29
Moscone West 2014

Fractures, Malunions and Nonunions about the Shoulder Girdle


Target Audience: Intermediate
Keyword: Shoulder
Category: Arthroplasty
 
Upon completion of this course, participants will be able to:
Identify differing philosophies on how to approach fractures and choose implants based on the clinical scenario of fractures, nonunions and malunions.
 
Description
Management of fractures around the shoulder is still as much an art as science.  Many treatment decisions rely on subtle individual judgments about what is the best treatment strategy.  Nonunions or malunions present an even greater challenge.  This course will examine 1) complex clavicular fractures and nonunion, 2) decision making based on variations of fracture morphology of the proximal humerus, 3) specific advantages of various implants and treatment methods and  4) what leads one to choose hemiarthroplasty vs. reverse arthroplasty.
 
Moderators: Neal C. Chen, MD, Marc J. Richard, MD
Speakers: Phani Dantuluri, MD, Richard S. Moore, Jr., MD
 

Instructional Course 30
Moscone West 3001/3003

Vascular Disorders: Diagnosis and Management


Target Audience: Intermediate
Keyword: Hand
Category: Vascular/Microvascular
 
Upon completion of this course, participants will be able to:
  • Discuss the impact of upper extremity vascular disease on health related quality of life, and recognize the signs and symptoms and understand the evaluation in patients with vascular disease.
  • Recognize non-operative and operative options.
  • Identify the indications, contraindications, techniques and outcomes of distal sympathectomy.
  • Identify indications, contraindications, techniques and outcomes of arterial reconstruction for aneurysms, thrombosis and embolism.
 
Description
Upper extremity vascular disorders are a significant societal burden.  A significant percentage (>10 %) of workers who use their hands as a hammer have occlusive disease, and > 20 % of women have significant cold intolerance.  As our population ages, vasospastic disorders (These include Raynauds disease and Raynauds-phenomenon, secondary to collagen vascular disease.) and occlusive events (These include aneurysms, thrombosis and embolism.) are increasing in incidence and prevalence.  This instructional course will detail the demographics, diagnosis, operative and nonoperative treatment options and delineate practical approaches to initial care, referral and complex management.   
 
Moderator: L. Andrew Koman, MD
Speakers: David S. Ruch, MD, William C. Pederson, MD, FACS, Suhail K. Mithani, MD
 

Instructional Course 31
Moscone West 2016

Infections of the Upper Extremity: What's the Latest?


Target Audience: Intermediate
Keyword: Other
Category: Evaluation/Diagnosis/Clinical Treatment
 
Upon completion of this course, participants will be able to:
  • Identify the role of the infectious disease consultant with respect to the evaluation and management of an upper extremity infection, including serological testing, diagnostic imaging, microbiology analysis, and the antibiotic/anti-fungal/anti-viral treatment regimen.
  • Recognize the established nonoperative and operative treatment principles for commonly encountered bone, joint and soft tissue infections of the upper extremity.
  • Explain the characteristic clinical features and treatment principles for unusual or uncommon infections of the upper extremity, including necrotizing fasciitis, atypical fungal, mycobacterial and Vibrio.
  • Review recent trends and developments in the management of infections of the upper extremity in immunocompromised patients.
  • Recognize the increasing problem of antibiotic resistance and the role of new antibiotics for treating difficult bacterial infections.
 
Description
Infections of the upper extremity are common, resulting in significant morbidity and mortality and a high societal cost.  The hand and upper extremity surgeon must become familiar with established treatment principles for various common and uncommon bone, joint and soft tissue infections of the upper extremity.  In addition, there is a need for increasing awareness regarding the recent trends of new bacterial strains, increasing antimicrobial resistance particularly with MRSA and VRE (vancomycin resistant Enterococcus faecium) and the development of new classes of antibiotics.
 
This instructional course will review the role of the Infectious Disease specialist with an emphasis on the role of diagnostic imaging, including MRI, ultrasound, and labeled WBC, as well as serological testing (WBC, ESR, CRP) and microbiological analysis.  There will also be an update on new antibacterial, antifungal and antiviral medications.
Through illustrative case examples, unusual or uncommon infections will be discussed including necrotizing fasciitis, atypical and opportunistic fungi, mucormycosis, mycobacterium species, Vibrio species and infections related to bioterrorism.  We will discuss the challenges in treating upper extremity infections in the immunocompromised host including the diabetic patient with coexistent renal failure, those who have had a bone marrow or solid organ transplant, those with Human Immunodeficiency Virus (HIV) and those taking anti-tumor necrosis factor alpha medications.
 
Moderator: Peter J. L. Jebson, MD
Speakers: A. Bobby Chhabra, MD, Peter M. Murray, MD, Sandro Cinti, MD
 

Instructional Course 32
Moscone West 2018

Tendon Transfers for the Upper Extremity: Restoring Function Following Nerve Injury


Target Audience: Intermediate
Keyword: Other
Category: Nerve/Neuromuscular
 
Upon completion of this course, participants will be able to:
  • Recognize options for tendon transfers following peripheral nerve injuries.
  • Consider various tendon transfers for specific nerve deficits.
  • Evaluate strategies for the timing and surgical approaches for various tendon transfers of the upper extremity.
 
Description
Using a case-based format, tendon transfers for nerve injuries affecting the upper extremity will be reviewed, including strategies for the timing of surgery, surgical approaches and donor options for individual and multiple nerve deficits.  Pearls and pitfalls, as well as outcomes, will be discussed. 
 
Moderator: Fraser J. Leversedge, MD
Speakers: Dan A. Zlotolow, MD, Ryan P. Calfee, MD, John G. Seiler, III, MD
 

Instructional Course 33
Moscone West 2020

The Lost and Found Art of Percutaneous Pinning


Target Audience: Intermediate
Keyword: Hand
Category: Fractures and Dislocations
 
Upon completion of this course, participants will be able to:
• Discuss the biomechanics of smooth pin fixation.
• Identify fractures amenable to pin fixation.
• Recognize subtle fracture patterns that preclude pinning.
• Acquire the necessary tricks and tips for successful pin fixation.
• Define appropriate postoperative regimens for different fractures.
 
Description
We are now in the era of rigid internal fixation with fixed angle plates and locking screws.  These 3rd and 4th-generation devices are well designed and effective.  But one might argue that the marketing and use of such devises has taken on some degree of irrational exuberance to the point of obscuring other treatment options.  The art and efficacy of percutaneous smooth pin fixation for many hand and wrist fractures seems to have been lost in this rush to perform open reduction and rigid internal fixation.  Our ultimate goal is to re-acquaint some and expose others for the first time to the many applications of temporary smooth pin fixation and provide tricks and tips helpful to mastering these basic, inexpensive, minimally invasive and highly effective techniques.
 
Moderator: O. Alton Barron, MD
Speakers: Robert J. Strauch, MD, Steven Z. Glickel, MD, Louis W. Catalano, III, MD
 

Instructional Course 34
Moscone West 3014

Achieving Optimal Nerve Function Outcomes Following Upper Extremity Combat Injuries


Target Audience: Advanced
Keyword: Other
Category: Nerve/Neuromuscular
 
Upon completion of this course, participants will be able to:
  • Analyze pertinent injury and anatomic factors that contribute to decisions primary nerve repair versus reconstruction.
  • Identify optimal timing and setting for upper extremity nerve reconstruction.
  • Describe the role of and optimal timing for nerve transfers in the setting of combat injuries.
  • Describe the indications and technical considerations for implementation of targeted muscle reinnervation and subsequent myoelectric prosthetics following amputation.
 
Description
With America’s ongoing involvement in the Afghanistan war, unfortunately there are a number of servicemen and servicewomen who have suffered profound upper extremity nerve injuries.  A number of factors make these injuries challenging for both surgeon and patient including long distance to target muscle, large zone of injury and concomitant skeletal and soft tissue injuries.  The goal of this course will be to utilize both military and civilian expertise to teach techniques to optimize nerve injury outcomes for our combat-injured warriors.  The panel will first focus on nerve injuries in the acute period and will elucidate debridement and repair strategies.  Techniques and timing of repair and reconstruction will be addressed including various graft and conduit materials.  The panel will then focus on the sub-acute period following nerve injury and specifically discuss the role of nerve transfers for these devastating injuries.  Finally, the indications and techniques for targeted muscle reinnervation in preparation for myoelectric prosthetic use will be addressed.
 
Moderator: Jeffrey B. Friedrich, MD
Speakers: Ky Kobayashi, MD, Brian T. Carlsen, MD, George P. Nanos, MD, Alexander Y. Shin, MD
 

Instructional Course 35
Moscone West 3016

Longitudinal Instability of the Forearm: the Essex-Lopresti Lesion


Target Audience: Basic
Keyword: Forearm
Category: Fractures and Dislocations
 
Upon completion of this course, participants will be able to:
  • Describe the pathoanatomy of longitudinal instability of the forearm.
  • Recognize the features suggestive of longitudinal instability of the forearm and determine the appropriate investigations.
  • Evaluate the treatment options for the management of longitudinal instability and synthesise a treatment plan.
  • Describe the salvage options for the failed treatment of longitudinal instability.
 
Description
Longitudinal instability of the forearm (Essex-Lopresti Lesion) is a rare traumatic injury that can result in devastating loss of function and persistent pain.  This instructional course will review the anatomy and the normal biomechanics of the forearm.  The importance of the condylar elements of the proximal and distal interphalangeal joints and the central condensation of the intra-osseous membrane will be explained.  The mechanism for the development of longitudinal instability of the forearm will be described to explain the pathoanatomy and the rationale for treatment.  The natural history of the condition will be discussed.  With the use of lectures and case discussions, the attendees will be taught when to suspect this lesion and the most appropriate investigations to determine the diagnosis including dynamic ultrasound, MRI and examination under anaesthesia with the aid of fluoroscopy.  The delegates will be presented with an analysis of the available treatment options including radial head replacement, ulnar shortening osteotomy and techniques for reconstruction of the intra-osseous membrane of the forearm.  The faculty will present pearls and pitfalls of management throughout the discussions.  The recognised complications will be reviewed and the synthesis of appropriate solutions presented through faculty discussions.  Techniques of surgical salvage for chronic instability of the forearm with creation of the one-bone forearm will be analysed.
 
Moderator: Adam C. Watts, MBBS
Speakers: Michael J. Hayton, MBChB, Sumedh C. Talwalkar, Mch (Orth), Ian A. Trail, MD, Raj Murali, MD
 

Instructional Course 36
Moscone West 3018

Kids Don’t Always Make You Look Good – Complications of Common Pediatric Procedures


Target Audience: Intermediate
Keyword: Other
Category: Congenital/Pediatric
 
Upon completion of this course, participants will be able to:
• Identify the complications associated with common pediatric procedures.
• Describe pearls and pitfalls for the avoidance of such complications.
• Aid the hand surgeon in managing these complications.
Description
This course will present common complications of common hand surgery procedures - both congenital and traumatic - performed in children.  Treatment strategies to avoid complications and to appropriately address them when identified will be addressed.  Teaching methods will include illustrative cases.
 
Moderator: Charles A. Goldfarb, MD
Speakers: Scott H. Kozin, MD, Donald S. Bae, MD, Joshua M. Abzug, MD
 

Instructional Course 37
Moscone West 3020

Microsurgical Reconstruction of Hand Trauma


Target Audience: Advanced
Keyword: Hand
Category: Vascular/Microvascular
 
Upon completion of this course, participants will be able to:
• Evaluate outcomes of replantation in upper extremity.
• Describe strategies using surgical classification and technical tips on fingertip replantation.
• Discuss the effective anticoagulation therapy and postoperative management.
• Explain useful thin perforator flaps for the various soft tissue defect of the hand.
• Describe the key anatomy and clinical application of toe transfer for mutilated hand.
Description
We will review practical knowledge on microsurgical reconstruction of hand trauma, focusing on the following three topics: 1) Replantation surgery is still difficult. We believe, however, it can be made safe and sure by an appropriate vein graft for crush-avulsion case and anticoagulation therapy including urokinase. 2) Radial forearm perforator flap, anterior lateral thigh(ALT) flap and thraco-dorsal artery perforator flap with capillary perforators(TAP cp)flap, these three perforator flaps (the perforator trios) are very useful for the various soft tissue defect of the upper extremity. 3) Making the sensate and cosmetic acceptable thumb or opposite fingers by toe transfer is very important to regain pinch function for mutilated hand.
 
Moderator: Tokio  Kasai, MD
Speakers: Isao Koshima, MD, Tashiro Kensuke, MD, Naoya Sawamoto, MD
 

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