Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Sep 1989
[Cellular metabolic consideration in the pathophysiology and the treatment of shock].
Shock is defined as the summation of cellular dysfunction and resultant impairment of the function in various organs. The typical such condition can be observed in shock-induced multiple organ failure (MOF). Therefore, the most effective and fundamental management against shock should be the improvement of such cellular dysfunction. ⋯ Since tissue hypoxia and humoral mediator have been considered to play a key role in the development of such cellular dysfunction, protease inhibitor was administered to such patients and oxygen metabolism was improved with catecholamine. The CIS improved among survived MOF patients following those treatments. These results suggest that the shock-induced MOF is the summation of the cellular dysfunction which can be assessed with the CIS, and that such cellular dysfunction could be improved through the therapeutic approach to the humoral mediators and/or tissue oxygen metabolism.
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Ninety years have passed since the Japan Surgical Society was founded in 1899. During this period the development of surgery was unparalleled. What was the basis of this development? In this paper I take up surgery for gastric cancer as an example of the progress of surgical thought. ⋯ Since gastric cancer surgery started with the first gastric resection in 1897, it has been followed by lower esophagocardiectomy, total gastrectomy with jejunal interposition, combined resection of the common hepatic artery for thorough lymphadenectomy prior to Appleby, Nakayama's modification of Billroth-I and an extended radical operation. As the result of these surgeons' efforts, gastric cancer surgery with rational lymphadenectomy is now established as we claimed. I would like to reflect upon this history which was the progress of surgical thought.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nihon Geka Gakkai zasshi · Apr 1989
[Measurement of portal blood flow in man by a continuous local thermodilution method. III. Effects of dopamine on systemic and portal hemodynamics after hepatectomy].
We gave dopamine (3 micrograms/kg/min, 30 min) intravenously on the third day after hepatectomy to 19 patients, and studied the effects of the drug on systemic and portal hemodynamics. In another 42 patients, administration of dopamine at the same rate was started soon after hepatectomy and continued for about 2 weeks; the clinical results were evaluated. After hepatectomy, the systemic hemodynamics were hyperdynamic and the portal hemodynamics were hypodynamic. ⋯ Among 42 patients given small dosage of dopamine, the clinical symptoms of five of seven who had developed liver failure improved. None of the other 35 patients given dopamine preventively developed liver failure. Dopamine in small doses is useful for the management of liver failure after liver resection.
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Nihon Geka Gakkai zasshi · Feb 1989
[Experimental study of hepatic hemodynamics and hepatic oxygen consumption after hepatectomy].
This study was undertaken in order to clarify the hepatic hemodynamics and hepatic oxygen consumption in the remaining liver after 30% and 70% hepatectomy using adult mongrel dogs and moreover was investigated the improving effect of drugs (dobutamine (DOB), dopamine (DA), dibutyryl cyclic AMP (DBcAMP) and SS-094) after hepatectomy. The hepatic blood flow after hepatectomy decreased depending on the percentage of the liver resected but the hepatic blood flow per unit liver weight increased. The hepatic oxygen consumption also decreased but the hepatic oxygen consumption per unit liver weight increased, particularly after massive hepatectomy, resulting in the elevation of hepatic oxygen extraction ratio. ⋯ The administration of DOB, DA, DBcAMP and SS-094 after massive hepatectomy increased the hepatic arterial flow and portal venous flow and as a result the hepatic oxygen delivery was increased. The improvement of hepatic hemodynamics resulted in normalizing of the relation between hepatic oxygen demand and supply, and improvement of the uptake of lactate in the remaining liver. Therefore it was considered that those drugs favored the remaining hepatic hemodynamics and metabolisms after massive hepatectomy.
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Nihon Geka Gakkai zasshi · Oct 1988
Review Case Reports[Valve replacement in infective endocarditis with mycotic cerebral aneurysm. Report of a case with successful operation].
A 49 year-old woman was hospitalized with headache and left-sided weakness. Computed tomographic scan and carotid angiogram revealed mycotic aneurysms of the bilateral middle cerebral artery with intracranial bleeding. ⋯ At operation, infective endocarditis on the mitral valve was confirmed. Her postoperative course was uneventful and the second craniotomy for aneurysm of the left middle cerebral artery has been planning.