Nihon Geka Gakkai zasshi
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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.
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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 · 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 · 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 · Sep 1991
Review[Recent progress and future prospect of the prolonged extracorporeal lung assist for respiratory failure].
Extracorporeal membrane oxygenation (ECMO) is becoming an accepted therapeutic option for acute respiratory failure in both infants and adults. ECMO has been applied for relatively short-term support and numerous centers have reported satisfactory results with emphasis on patient selection, techniques of cannulation and perfusion, and prevention of complications. To use ECMO for a prolonged support, however, new type of artificial lung and system need to be developed. ⋯ Full systemic heparinization can be avoided during ECMO by using heparin-coated perfusion equipment. Respiratory support by means of pumpless PA-LA extracorporeal membrane oxygenation driven by pulmonary arterial pressure is attractive because of its simplicity and might be suitable for prolonged use. Further studies are necessary to develop an oxygenator for long-term ECMO.