Nihon Geka Gakkai zasshi
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A critically injured chest trauma patient showing profound shock or cardiac arrest en route to the trauma center or in the emergency room sometimes requires emergency room thoracotomy and definitive repair. In some patients damage control must be performed because of the appearance of the deadly triad of hypothermia, acidosis, and coagulopathy. ⋯ Damage control procedures for chest injuries include aortic cross-clamping, hilar clamping, major vessel ligation, pulmonary tractotomy, simultaneously stapled pneumonectomy or lobectomy, cardiac stapling, balloon catheter tamponade, temporary intraluminal shunt, towel packing, towel clip closure, single en masse closure of the chest wall, etc. Every surgeon responsible for treating critical chest trauma patients should have knowledge of damage control and also be familiar with the techniques.
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Nihon Geka Gakkai zasshi · Jul 2002
[Paradigm shift from standard surgery to damage control surgery in major trauma].
"Damage control surgery (DCS)" is currently the most commonly used term to describe the surgical strategy for major trauma. Standard surgical approaches to trauma consist of a priority-driven sequence of steps, including exposure, homeostasis, repair, resection, and reconstruction. Patients with massive exsanguination, however, will not survive complex procedures. ⋯ The second step in DCS is systemic management in the ICU, where the care consists of ongoing core rewarming, correction of coagulopathy, fluid resuscitation, and optimization of hemodynamic status, as well as reexamination to diagnose all injuries. When normal physiology has been restored, reoperation is undertaken for definitive repairs of injuries and abdominal closure. In addition to the above three components, an earlier phase before the initial operation, referred to as "DC ground zero" has recently been added.
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"Damage control surgery" is a surgical strategy to cope with the lethal triad of death, i.e., acidosis, hypothermia, and coagulopathy, often seen in severely injured patients. Perihepatic packing was attempted by some trauma surgeons during the 1970s as an alternative to hepatectomy for severe liver injury, with favorable results. The concept of bail-out surgery and reoperation was introduced during the 1980s as a treatment modality for severe abdominal trauma. ⋯ The concept of damage control surgery is now applied not only to severely injured patients but also for other surgical patients in critical condition. Damage control surgery was introduced to Japan during the late 1990s. However, the Japanese experience has been limited because the volume of severe trauma cases is very small.
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Nihon Geka Gakkai zasshi · Mar 2002
Review[Problems and reformation of the board of medical specialties in Japan].
The Board of Medical Specialties, which is closely related to postgraduate training in Japan, including the Board of Surgery, has serious defects in its system because it has developed on its own initiative and has been administered by a medical society. Many of the public are not aware of its existence, and its workings are difficult for them to understand. ⋯ The management, examination, and evaluation of the board system should be under the control of a third party separate from the medical societies. The ideal Board of Medical Specialties should not only foster gifted physicians but also benefit the public, communities, and medical societies.