International Medical News

No.522ISSN 0535-1405

INTERNATIONAL MEDICAL NEWSInternational Medical Society of Japan
Since 1925
March 31, 2024
Published by International Medical Society of Japan,Chairman,Board of Directors:Kenichi Ishibashi, MD, PhD,Editors: K. Ito, MD, PhD, T. Kondo, MD,K. Ichihashi, MD, PhD, T.Murakami, PhD,R.Nagai, MD, PhD,T. Sumiyama, MD, PhD, I.Taniguchi, MD, PhD,andT.Yamazaki, MD,PhD.

1-11-9-3F Kamiuma,Setagaya-ku,
Tokyo154-0011,Japan.
TEL03(5486)0601 FAX03(5486)0599 E-mail:imsj@imsj.or.jp https://www.imsj.or.jp/

The 462th International Symposium on Therapy
The 462th International Symposium on Therapy was held by the Zoom Webinar onJanuary 18, 2024. Dr. Ko Ichihashi, Director of the International Medical Society ofJapan (IMSJ), presided over the meeting.

Watch the moment of recovery- remarkable ultrasonography Introductory Message from the Chair
Ko Ichihashi, MD, PhD
Director, IMSJInternational Medical News

【Discourse】
The method to analyze international relations objectively
A new approach based on IR theories

Shuji Amano
Associate Professor
Faculty of Health Sciences,
Nihon Institute of Medical Science

In recent years, there has been a growing awareness in Japan of the importanceof diversity. The idea that society is enriched by diversity in terms of nationality, race,gender, values, etc., is probably already accepted by many people. However, it is theinternational affairs that might prevent such a positive movement from moving
forward.
Indeed, the word “diversity” may sound nonsense in the face of a sense of crisis, as
if we ourselves might be caught up in a war. However, as long as we have an objective
and scientific perspective on international affairs, we can separate what is necessaryfor a country from what we should respect as individuals. And if we can respect eachother as individuals, this might be able to deter us to going to the war.
Knowledge of international relations (IR) theories are precisely what makes suchobjective analysis possible. In this report, I will explain the Balance of Power Theory,
which is considered the most important among the IR theories. The international
community is presumed as a state of anarchy in the Balance of Power Theory.
What is anarchy? In order to understand this concept, please imagine thissituation. Imagine, for example, that there were no police, government, or courts inJapan. Would you be able to get along with your neighbors all the time? What would
you do if your neighbor purchased a large quantity of weapons? The international
community is in just such a situation.
In a state of anarchy, each nation has a decision whether or not to use militaryforce, so that war can break out at any time. If some states are likely to use militaryforce, it will be difficult for other states to escape the competition. In anarchy, thehighest order goal of a state is survival. Power is a useful means to that end.
In an anarchic international society, nations act rationally to survive. What is theresultant situation for the international community as a whole? First, the strongest
nation is most threatened by the second strongest nation. Therefore, the strongest

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state prepares for the threat of the second strongest state by forming alliances withother states. The second strongest state does the same to prepare for the threat of
the strongest state.
Thus, in the international community, a balance of power is naturally formed by
two or more powers. The balance of power may break down for some reasons.
However, as long as the international community remains in a state of anarchy, thebalance of power is expected to be formed again.
In fact, the history of the international community shows that the cycle of
spontaneous formation of the balance of power and the outbreak of large scale war
when it breaks down has been repeated. Based on this theory, the international
community has never been peaceful, but only stable as long as the balance of poweris well maintained.
If this is the case, then changes in the distribution of power in the international
community will affect the behavior of each nation. To understand how changes in thedistribution of power in the international community affect the behavior of nations,this paper presents a model of power distribution limited to four nations (Japan, theUnited States, China, and Russia) as shown in Figure 1.

Figure 1. A Model of Power Distribution Limited to Four Nations (Today)International Medical News

Figure 2. A Model of Power Distribution Limited to Four Nations (30 Years Ago)

The basic elements of the power of a nation are military and economic power. TheU.S. has strong army, navy and air force. In addition to its conventional forces, theU.S. has overwhelming nuclear weapons capability. The U.S. also ranks first in theworld in terms of economic power. Therefore, the power of the U.S. is the greatest
compared to other countries (Figure 1). Russia has a nuclear weapons capability thatrivals that of the United States.
Although China is inferior to the U.S. and Russia in nuclear weapons capability,
it is currently the world's second largest economy. Therefore, it is estimated that
China and Russia have about the same power (This model is only intended to give asense of the concept of power distribution and is not based on a precise definition.)
Japan's power would be slightly smaller than that of China and Russia.
Figure 1 shows the current power distribution of the four countries. Next, look at
Figure 2. Figure 2 shows the power distribution of the four countries 30 years ago.
At that time, the U.S. had an overwhelming advantage in military and economic
power compared to the present. Japan was also the world's second largest economy.
Therefore, Japan was able to ensure its own security simply by maintaining an
alliance with the United States.
In recent years, however, as U.S. power has declined, Japan has been called upon
to play a more active role in security issues. In this paper, I have presented a model
limited to four states, but in the actual international community, there are many
more states and they interact with each other in more complex ways.
In this paper, due to space limitations, I only introduce the most famous theory,
the Balance of Power Theory. However, there are several other theories that areInternational Medical News

useful in analyzing international affairs. These theories are explained in detail in
my book, “Shin International Relations Theories” (East Press), published in August2022. Please take a look at the book, if you are interested in.

LectureⅠ
Actual practice of ultrasound-guided reduction of pediatricintussusception

Masashi Uchida, MD
Director of Health Management Center
Health Management Center / Pediatrics of Tokuyama Central Hospital,
Japan Community Healthcare Organization
I explained the clinical picture, diagnosis, and treatment of pediatric intussusception,and presented a video about the practice of ultrasound-guided reduction.
１．What is pediatric intussusception?
Intussusception is a disease in which the proximal intestinal tract enters the anal intestinal
tract and the intestinal tract overlaps, causing intestinal obstruction. The mesentericartery and vein are drawn in along with the intestinal tract, resulting in strangulated
intestinal obstruction. Therefore, it is important to relieve the obstruction through early
diagnosis and early reduction.
Types of intussusception include ileo-colic, ileo-ileo-colic, colo-colic, and small-intestinal
type. In children, most cases are of the ileocolic type, in which the terminal ileum passes
through the ileocecal valve and inserts into the ascending colon from the cecum. The
ileo-ileo-colic type often has pathological lead point such as Meckel's diverticulum.
Pathological lead points include Meckel's diverticulum, duplicate intestinal tract, polyps,
malignant lymphoma, and gastrointestinal lesions of IgA vasculitis.
２．Clinical features of pediatric intussusception
The most common age of onset is from 6 months to 4 years of age. The three main
symptoms are intermittent abdominal pain (uncomfortable and crying in infants),
vomiting, and bloody stool (strawberry jelly-like), with abdominal pain being the mostimportant in clinical practice. Since it can be easily diagnosed by ultrasound examination,
recent cases can often be diagnosed only from the first episode of abdominal pain, andInternational Medical News

there are more cases in which the three main symptoms are not present. The cause isoften unknown, but it is often preceded by viral or bacterial enteritis.
３．Diagnosis and treatment of pediatric intussusception
Before ultrasound examinations, if we suspected intussusception based on the patient's
age and symptoms, enema fluoroscopy was performed for both diagnosis andtreatment. The diagnosis was confirmed by observing the crab claw sign, and the patient
continued to undergo reduction with high-pressure enemas.
If intussusception is suspected after an ultrasound examination, it can be diagnosed
almost 100%, so after the diagnosis of intussusception is confirmed, high-pressure enemas
are performed using the method appropriate for each facility. High-pressure enemas
include fluoroscopic reduction (using air or 6x diluted gastrografin) and ultrasoundguided reduction (using saline). If it is determined that reduction cannot be achieved
with high-pressure enema, surgery is performed. Absolute contraindications to highpressure enemas are patients with poor general condition, such as shock, peritonitis, andintestinal perforation.
The rule of threes, which emphasizes safety, has been historically and empirically used
for high-pressure enemas. In other words, the height <pressure> is 3 feet, the time for one
reduction is 3 minutes, and the number of times reduction is performed is 3 times. This wasdone in consideration of reducing radiation exposure under X-ray fluoroscopy, butexposure is not a problem under ultrasound, so it should be carried out 3 times, 3 minutes,
on a case-by-case basis, taking into account the general condition. is consideredpossible.
The basic ultrasound images for diagnosing intussusception are a cross-sectional view
(target sign) and a longitudinal view (pseudokidney sign) of the intussusception. A mass
3 to 4 cm in diameter is visualized just below the abdominal wall, so it is unlikely to bemissed.
Fluoroscopic reduction must be performed in a fluoroscopic room, and although it isrelatively easy to confirm reduction, there is radiation exposure. Ultrasonic reduction canbe performed anywhere, including outpatient treatment rooms and hospital wards, andthere is no radiation exposure, but experience and familiarity are required to confirm
reduction. The difference between the two is the method of confirming the process ofreduction, but in order to begin reduction under ultrasound, a person (a doctor or anultrasound technologist) who can use ultrasound is required, and I believe that thehurdles to do so are quite high.
４．Actual practice of ultrasound-guided reduction of pediatric intussusception
I presented a video of the ultrasound-assisted reduction in 3 cases. The video of themoment of recovery is moving. It is often carried out in a well-lit environment with a family

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member accompanying them. It is important to tightly close the anus and immobilize thelower limbs to prevent the balloon from falling out. Since ultrasound images are importantin ultrasound-assisted reduction, it is important to provide adequate sedation at first.
Important findings during ultrasound reduction are: (1) peninsula sign (a peninsulashaped mass protruding), (2) crab-claw sign (edematous ileocecal valve), (3) postreduction doughnut sign (edematous terminal ileal wall), and (4) honeycomb sign (afinding in which saline has flowed into the small intestine and formed a honeycomb) areto be confirmed.

LectureⅡ
Capture a moment of reduction -The amazing of ultrasound-

Ayana Kitta, MDAssistant Professor
Tokyo Women’s Medical University Yachiyo Medical Center,division of orthopedic surgery“ Orthopaedics" is a Greek word derived from "orthos" meaning "straight" and"paedios" meaning "child". “Orthopaedics" means "the technique of preventing andcorrecting physical deformities in children". Since the declining birthrate and aging
population, there are fewer opportunities for outpatient examination for pediatricmusculoskeletal diseases, which were the origin of orthopaedics. As a result, missed
or delayed diagnosis has become a problem. It is necessary to diagnose diseasesthat require early intervention at an appropriate time since children are still growing
and developing. This presentation will discuss "Pulled Elbow," in which the moment ofhealing can be seen, and "Arthritis," in which ultrasound findings can lead totreatment.