Masui. The Japanese journal of anesthesiology
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Comparative Study
[Comparison of the effects of phosphodiesterase III inhibitors, milrinone and olprinone, in infant corrective cardiac surgery].
Clinical characteristics of phosphodiesterase (PDE) III inhibitors, milrinone and olprinone, is not fully understood in infants. We therefore retrospectively examined the hemodynamics, metabolism, and oxygenation of two different PDE III inhibitors in infants undergoing radical correction of ventricular septal defect with pulmonary hypertension. ⋯ The effects of the PDE III inhibitors, milrinone and olprinone, on hemodynamic parameters, acid-base balance and oxygenation were similar in these infants. Both milrinone and olprinone could be used safely in infant cardiac surgery.
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Review
[ECMO for the patients with severe respiratory failure associated with ARDS due to influenza].
Although the survival rate of H1N1-related severe respiratory failure following ECMO therapy was high in several countries, the rate in Japan has been low. Efforts should be made to supply suitable equipments, to train the physicians, and to establish transport system for the patient.
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The clinical criteria of acute respiratory distress syndrome (ARDS) defined by the American-European Consensus Conference (AECC) in 1994 was relevant to clinical practice, trials, and researches for two decades. However, a number of issues with the AECC definition have become apparent. ⋯ In the second section, the clinical significance and limitation of radiographic imaging, especially, high-resolution CT (HRCT) findings in ARDS were addressed. Although the early exudative phase of ARDS can not be detected even by HRCT, pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality with an increased susceptibility to multiple organ failure, along with ventilator dependency and its associated outcomes.
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Comparative Study
[Perioperative management of lung transplantations in patients with pulmonary arterial hypertension compared with that in patients with lymphangiomyomatosis].
The number of lung transplantation has tended to increase as a treatment for patients with pulmonary arterial hypertension (PAH) and lymphangiomyomatosis (LAM) in Japan. However, we have little evidence about the comparison of perioperative management in patients with PAH and that in patients with LAM. ⋯ The large difference in perioperative management between patients with PAH and those with LAM is an important knowledge for anesthesist.
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The definition of acute respiratory distress syndrome (ARDS) by American-European Consensus Conference (AECC) in 1994 has promoted clinical and epidemiological research leading to improved survival outcome of the ARDS patients by establishing lung protective ventilation. On the other hand, no pharmacological therapy has yet proved to be effective despite substantial effort devoted to development and research. ⋯ Recently, a randomized trial and clinical experience in treating severe influenza have demonstrated favorable outcome of ECMO therapy in the management of severe ARDS. Future progress will depend on developing novel therapeutics that can ameliorate lung injury and systemic derangements and facilitate lung repair.