Nihon Geka Gakkai zasshi
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Reperfusion injury is recognized as a syndrome which impairs an ischemic organ as well as remote organs throughout the entire body. Previous research has revealed that the various inflammatory mediators, such as cytokines, platelet-activating factors, and free radicals, are involved and interact with each other in reperfusion injury. More recently, it has been demonstrated that neutrophils play an important role in the development of reperfusion injury. ⋯ The same systemic reaction is also observed in multiple organ failure (MOF) or systemic inflammatory response syndrome (SIRS), where organ failure is a major determinant factor for the prognosis of patients. Regarding the treatment of organ failure due to reperfusion injury, several approaches using monoclonal antibody of adhesion molecules or receptor antagonist for cytokines have been introduced. Despite the current accumulation of knowledge, however, prevention is still the regimen for reperfusion injury and concomitant organ failure.
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Multiple organ failure (MOF) is a critical condition developing in patients with overwhelming bodily injury resulting from major surgical insult, severe trauma, extensive burns, acute pancreatitis, and sepsis. It has recently become evident that the host response to such injury is the main pathogenetic factor contributing to the development of MOF. The proinflammatory cytokines tumor necrosis factor (TNF) and interleukin (IL)-1 are known to play a pivotal role in the pathogenetic mechanisms of MOF. ⋯ The resultant systemic inflammation may develop into MOF mainly through neutrophil-endothelial cell interaction when the primary injury is overwhelming or a second inflammatory insult such as sepsis triggers an exacerbated inflammation. It has recently been confirmed that the transcription factor NF-kappaB is involved in the up-regulation of a variety of proinflammatory genes and that cell-mediated immunity is down-regulated in the event of major bodily injury through a shift in the balance between T helper 1 (Th1) and Th2 cytokine response patterns. The molecular immunological mechanisms by which these factors participate in the development of MOF should be characterized.
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Postgraduate training in Japan and board certification by the Japanese Surgical Society are reviewed by comparing them with those in other countries to clarify the inherent problems and possible solutions. The following are pointed out as some of the problems: there is no subjective way to evaluate facilities and doctors for certification; the scope of the training curriculum varies among institutions, and there is no consistent continuity between education at medical schools and postgraduate training. ⋯ The lack of social appreciation and of extra stipends for board-certified specialists who expend enormous effort are other problem areas. Unless those problems are resolved, the postgraduate surgical training system in Japan will remain far from ideal, and it is feared that if the situation persists titles will be without substance.
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Nihon Geka Gakkai zasshi · Jan 1998
Review[Early treatment for body fluid shifts and circulatory derangement in patients with extensive burns].
The initial postburn period is characterized by body fluid shifts and circulatory derangement, or so-called burn shock. The fluid shifts are mainly due to a marked increase in capillary permeability. This loss of capillary integrity is so great that colloid including albumin, readily disperse into the extravascular space. ⋯ Therefore fluid resuscitation should be initiated immediately after injury. Currently a number of methods for achieving adequate volume replacement are available. In this paper we review fluid resuscitation methods for patients with extensive burns and also introduce recent topics on new regimens for resuscitation.
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Nihon Geka Gakkai zasshi · Dec 1997
Review[Development of extracorporeal membrane oxygenation for neonates with severe respiratory failure].
Extracorporeal membrane oxygenation (ECMO) is one of the most highly developed artificial organ treatment of the last decade. Especially for severe neonatal respiratory failure, ECMO has become standard treatment in Japan following the same pattern as in the USA. In the USA, more than 12,000 infants have been registered for ECMO treatment by the Extracorporeal Life Support Organization (ELSO), and their total survival rate is above 80%. ⋯ We performed an experiment on fetus ECMO as artificial placenta. The fetuses were incubated for 10-237 hours by A-V ECMO using a centrifugal pump successfully and maturation of the lung was revealed. In the future the fetus ECMO could be introduced clinically as a back-up system for fetal surgeries and incubation for extra-premature infants.