Nihon rinsho. Japanese journal of clinical medicine
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Thrombolysis is generally accepted in patients with acute massive pulmonary embolism, however, thrombolytic agents could not be fully administrated for cases with a high risk of bleeding. On the other hand, catheter intervention is an optimal treatment for massive pulmonary embolism patients having contraindications for thrombolysis, and is a minimally invasive alternative to surgical embolectomy. It can be performed with a minimum dose of thrombolytic agents or without, and can be combined various procedures including catheter fragmentation or embolectomy in accordance with the extent of thrombus on pulmonary angiogram. Hybrid catheter intervention for massive pulmonary embolism can reduce rapidly heart rate and pulmonary artery pressure, and can improve the gas exchange indices and outcomes.
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In Japan, around one hundred and thirty pediatric living donor liver transplantations (LDLT) have been done every year, while cadaveric transplants are only 11 in the past 10 years. The indication has been extended to newborn babies as small as 2.5 kg of body weight. Five-year patient-survival of pediatric LDLT in Japan is 84.4%. ⋯ Ten-year graft survival is improving in recent cases, and it is 79.4% in cases done after 1992. Living donor kidney transplantation has been possible in children as small as 7 or 8 kg of body weight. With such a technical success, discussion to enhance the preemptive renal transplantation has been started in Japan.
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The revised organ transplantation law has been gone into effect from July, 2010 in Japan. We discuss about the problems for organ procurement system from the point of a donor hospital. These problems are heavy burden for donor hospital and organ procurement from a donor of child. ⋯ For example, it takes about more than 45 hours from the diagnosis of clinical brain death to the end of organ harvesting. To reduce a heavy burden for a donor hospital, supporting system have to be established for the donor hospital and the donor family. The organ procurement procedure is strictly regulated by the legal guidelines; we propose that the new framework is redesigned rapidly within the new law and the guidelines.