Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Jul 1999
Review[Progress in interventional radiology (IVR) in emergency medicine].
IVR has attracted much attention in Japan over the past decade, and it is expected to be rapidly developed and widely used. Not surprisingly, IVR has already become essential in emergency medicine. This paper addresses IVR of the thoracic and abdominal areas and the pelvis in emergency medicine, in particular the recent IVR focus on the vasculature. ⋯ Continuous regional arterial infusion of protease inhibitor, in an attempt to cure severe acute pancreatitis, significantly reduced the infectious rate at the necrotic lesion, and its resulting mortality rate. It is certain that great progress has been made in emergency medicine. We also should realize that it is desirable to be well versed even in new IVR.
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Acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF) are the most common causes of death in surgical intensive care units. A variety of stimuli, such as major surgery, trauma, shock, thermal injury, acute pancreatitis, and ischemia-reperfusion injury, initiate a systemic inflammatory response that contributes to the development of these complications. ⋯ Recently, measurement of the adequacy of gut circulation has been demonstrated as an excellent tool for prediction of outcome in these patients. The emphasis of this review is on events associated with intestinal ischemia-reperfusion and subsequent distant organ injury.
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During the past 100 years, specialization and differentiation in medicine have developed rapidly. As a field of culture, medical science has progressively been deprived of the philosophical and ethical elements that are the most important part of the practice of medicine. New technology has improved surgical techniques for curing diseases but often the patient as a whole human being has been lost sight. ⋯ No super-specialty that does not also fulfill the minimum requirements for general, fundamental medical and surgical knowledge and techniques will be accepted and respected by the majority of people. So-called straight residency training in super-specialties starting immediately after medical school must cease. A residency program of several years including primary-care training for general surgery is mandatory to educate well-balanced "surgical specialists." Such a curriculum must be developed and constantly revised in response to social needs.
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Nihon Geka Gakkai zasshi · Dec 1998
Clinical Trial Controlled Clinical Trial[Minimally invasive cardiac surgery--the efficacy of right parasterna approach].
The recent concepts of minimally invasive surgery have affected even cardiovascular surgery. Especially, the desire to lessen incisional pain and hospital stay has made minimally invasive cardiac surgery (MICS) desirable. However, its efficacy is still controversial. ⋯ Serum level of IL-8 after CPB was significantly lower in the M group than in the C group. These results suggested that MICS for mitral disease or ASD appears to be less invasive when median sternotomy is avoided. This suggest that MICS is a promising and contributed approach for open heart surgery to improve the QOL of the patients.
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Nihon Geka Gakkai zasshi · Dec 1998
Clinical Trial[Indications for and limitations of minimally invasive cardiac surgery with the lower ministernotomy approach].
The chief benefits of small skin incisions are reduced patient discomfort, accelerated recovery, and cosmetic satisfaction without compromising the quality of surgery. Since April 1997, the lower ministernotomy approach without femoral cannulation has been performed in 43 patients in the authors' institutions. The indications for this approach were initial single valve surgery and secundum-type atrial septal defect. ⋯ However, the patients was discharged after rectal muscle flap repair. There was one reoperation for mitral valve repair due to hemolysis. The improvement of surgical instruments and materials will further facilitate this procedure.