Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Dec 1996
Review[Prevention and treatment of postoperative septic MOF and DIC and efficacy of blood purification].
Pathophysiologic concept of SIRS has been proposed for the better management of postoperative severe infection and septic MOF, and the concept has been found to be very useful. It is very important to identify the high risk SIRS patients of the development of septic MOF and to treat those patients aggressively to prevent the development of septic MOF. ⋯ CHDF has been claimed to be very effective to removal of causative humoral mediators from the blood stream. The concept of DIC has been changed recently and the concept of DII (disseminated intravascular inflammation) should be applied instead of DIC, since the main feature of this pathologic condition is the damage of endothelial cells due to extensive systemic inflammation.
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Nihon Geka Gakkai zasshi · Dec 1996
Review[Cytokine-mediated biological response to severe infections in surgical patients].
Cytokines serve to initiate the acute inflammatory response and to integrate nonspecific and specific immunological responses to infections occurring in perioperative patients. Microbial substances induce macrophages to produce pivotal cytokines (TNF-alpha and IL-1 beta). This results in an activation of other cytokine productions including IL-2, IL-3, IL-4, IL-6, chemokines, and IL-10. ⋯ This condition is termed "Cytokine Storm" by the author. In cytokine storm, not only proinflamamtory cytokines, but also anti-inflammatory cytokines appear in circulating blood, leading to septic shock, multiple organ dysfunction, and immunosuppression. With further understanding of the roles of cytokines in sepsis, modulation of cytokine responses could be a new modality of the treatment.
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Nihon Geka Gakkai zasshi · Sep 1996
Review[Cytokine storm in the pathogenesis of multiple organ dysfunction syndrome associated with surgical insults].
Multiple organ dysfunction syndrome (MODS) is a critical condition developing in the patients under overwhelming surgical insults such as a major surgery, severe trauma, extensive burn, and systemic sepsis. The host response to those surgical insults is the main pathogenetic factor contributing to the development of shock and MODS seen in surgical patients. The proinflammatory cytokines, TNF-alpha (TNF) and interleukin-1 beta (IL-1), are known to play a pivotal role in the pathogenetic mechanisms of MODS. ⋯ In the cytokine storm, not only proinflammatory cytokines but also anti-inflammatory cytokines are elevated in the blood stream. With the recent understanding of the biological and pathological roles of cytokines and other mediators, a new therapeutic strategy has been developed. In addition to the reduction of the surgical insults, a variety of anti-cytokine therapy and anti-mediator therapy has been tested in an attempt to prevent or treat the life-threatening MODS.
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Nihon Geka Gakkai zasshi · May 1995
Clinical Trial[Endotoxin eliminating therapy in patients with severe sepsis--direct hemoperfusion using polymyxin B immobilized fiber column].
PMX is a blood purifier containing chemically immobilized polymyxin B fiber (PMX-F). To evaluate its effectiveness on the severe septic human, direct hemoperfusion (DHP) using a PMX-F was performed for 2 hours. The changes in various circulatory parameters, symptoms of septic shock, and blood endotoxin concentration and the survival rate, were evaluated. ⋯ DHP was performed 61 times in 42 patients, of whom 38 had septic MOF, 25 with gram-negative bacterial infection. At the initiation of this treatment, 33 patients were receiving vasoactive agents, and 36 were under artificial ventilation via endotracheal intubation. The mean septic severity score (SSS) in all patients was about 46.6. Twenty-two of the 42 survived. The endotoxin concentration (mean +/- S.E.; pg/ml) was 85.0 +/- 27.2 immediately before treatment but significantly decreased to 57.5 +/- 28.4 after treatment (n = 50) and to 28.2 +/- 4.4 on the next day (n = 23) (p < 0.01). The endotoxin concentrations at the inlet and outlet of the PMX also significantly decreased 30 minutes after the initiation of DHP. Circulatory parameters, BP, CI, SVR and Vo2I demonstrated significant improvement. Body temperature also showed the same results. The removal of endotoxin in the blood using PMX was effective for severe sepsis or septic MOF. Various symptoms due to endotoxin was alleviated after this treatment.
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Nihon Geka Gakkai zasshi · Apr 1994
[An experimental study on the correlation between hepatic hemodynamics and ultrastructural and immunohistochemical changes in sinusoidal endothelial cells after major hepatectomy].
The correlation between hepatic hemodynamics and changes of sinusoidal endothelial cells after major hepatectomy was studied using adult mongrel dogs. The sinusoidal endothelial cells were examined both ultrastructurally and immunohistochemically. Three types of hepatectomy, i.e., 30%, 70% and 84% resection, were applied to these animals, 16 each. ⋯ Twenty-four hours later, however, the difference was not significant. 2) Portal vein pressure and the vascular resistance after operation were much higher in 84% hepatectomized dogs than those in 30% and 70% hepatectomized dogs. Only 2 of 84% hepatectomized dogs survived more than 8 hours, and the two dogs also died of circulatory insufficiency 24 hours postoperatively. 3) Electron microscopic observation revealed that the sinusoidal endothelial fenestrae in 70% hepatectomized dogs were contracted 3 hours after operation but dilated 24 hours postoperatively. These changes in 70% hepatectomized dogs correlated well with hepatic hemodynamics. 4) Immunohistochemical observation using thrombomodulin staining method indicated that the sinusoidal endothelial cells in 84% hepatectomized dogs were seriously damaged 3 hours after operation.