Nihon Geka Gakkai zasshi
-
Nihon Geka Gakkai zasshi · Mar 2007
Review[Selection of prosthetic heart valves for adult patients by age].
The use of bioprosthetic heart valves has dramatically increased over the last decade. In 2004, the ratio was 52% for mechanical and 48% for bioprosthetic valves in a survey by the Japanese Association for Thoracic Surgery. This increase in the use of bioprosthetic valves is related to evidence demonstrating the durability of such valves over the last 20 years. ⋯ Thus patients with contraindications to warfarin or a low risk of thromboembolism who are more than 65 years old are reasonable candidates for a bioprosthetic valve. It is also recommended that women of childbearing age receive bioprosthetic valves after being informed of the possibility and risks of reoperation. In addition to the information in the guidelines and physicians' preference for valve selection, factors such as the patient's lifestyle, wishes, cardiac function, other complications, and longevity must always be considered when selecting a valve prosthesis.
-
Nihon Geka Gakkai zasshi · Sep 2006
[Therapeutic antimicrobial agents for postoperative infections: appropriate use of antibiotics from the viewpoint of pharmacokinetic/pharmacodynamic theory].
Pharmacokinetic/pharmacodynamic (PK/PD) parameters can be used predict the potential for bacterial eradication with antimicrobial therapy. The validity of these parameters is supported by both animal and clinical studies. Two major patterns of antimicrobial activities are time-dependent killing and concentration-dependent killing. ⋯ Concentration-dependent killing is characteristic of aminoglycosides. The major PK/PD parameter correlating with the efficacy of these agents is the 24-h area under the curve or peak serum level. This type of antibiotic should be administered as the total daily dose once daily.
-
Nihon Geka Gakkai zasshi · Dec 2005
[Fluid management and care for multiple organ dysfunction syndrome in patients with extensive burns].
Burn shock and multiple organ dysfunction syndrome (MODS) are the main causes of death in patients with extensive burns, and thus fluid management and care for MODS are crucial in the treatment of these patients. Several fluid formulas have been developed, although there is still controversy over the best formula. The important point is to understand how to deal with the different side effects inevitable with each fluid therapy: fluid restriction and/or diuretic administration in the refilling phase in fluid therapy with crystalloid, care for hypernatremia and/or a hyperosmolar state in fluid therapy with hypertonic lactated solution (HLS), etc. ⋯ MODS in extensively burned patients is attributed to overwhelming burn stress and complicated sepsis, including bacterial translocation (BT). A dysfunctioning organ impairs another organ (organ interrelationships), and therefore substitution and/or recovery of a dysfunctioning organ are crucial. Debridement of skin with third-degree burns, suppression of BT, sanitary airway management, avoidance of unnecessary stress, and mediator modulation to stop the mediator cascade inducing MODS are also crucial.
-
Nihon Geka Gakkai zasshi · Dec 2005
Review[Smoke inhalation injury: diagnosis and respiratory management].
Smoke inhalation is a significant comorbid factor following major thermal injury. Smoke exposure is only a trigger for the sequence of events responsible for the development of inhalation injury. Noxious chemicals generated by incomplete combustion injure the exposed bronchoepithelium and stimulate the release of chemical mediators that cause a progressive inflammatory process. ⋯ At present, the diagnosis of inhalation injury is supported by the combination of history, physical examination, bronchoscopy, and laboratory findings For accurate diagnosis of inhalation injury, helical CT scanning and examination to detect activated leukocytes in bronchoalveolar lavage fluid may be warranted. In the respiratory management of inhalation injury, repeated removal of pseudomembrane by fiberoptic bronchoscopy and the use of adequate PEEP to avoid airway obstruction are essential. High-frequency percussive ventilation can be a suitable mode of ventilation for inhalation injury.