Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
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Randomized Controlled Trial
Effect of bicarbonated Ringer's solution on the acid-base balance in patients undergoing abdominal aortic aneurysm repair.
The present study was designed to assess whether prophylactic use of bicarbonated Ringer's solution ameliorates metabolic acidosis in patients undergoing aortic surgery. ⋯ Aortic cross-clamping leads to the development of metabolic acidosis, with a decrease in pH and BE. The effect of administration of bicarbonated infusion fluid during elective abdominal aortic surgery had not significant compared with that of acetated Ringer's solution with respect to acid-base homeostasis.
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During laparoscopic myomectomy, it is difficult to determine the actual blood loss volume because physiological saline is used for lavaging to detect the bleeding point or to ensure no active bleeding site. We attempted to estimate blood loss by measuring the waste irrigation fluid's hemoglobin (Hb) concentration using HemoCue (HemoCue, Angelholm, Sweden). Twenty-three women enrolled in our study. ⋯ The HemoCue needs only 10 mcl of blood and it takes only about 45 seconds to produce the result. Furthermore, the HemoCue is a reliable device for measurement of blood hemoglobin concentration. Our method is easy and quick to perform, and blood loss estimation and surgeon's experience (subjective method) show accordance.
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The lumbar paraspinal muscles were examined by surface electromyography (EMG) in 22 patients with low back pain and 22 healthy volunteers. Surface electrodes were placed bilaterally on the lumbar multifidus and longissimus muscles at the level of the spinous process of the third lumbar vertebra. Kinesiologic EMG was recorded, in standing resting position, during the following trunk motions: trunk forward flexion and extension, lateral bending and axial rotation. ⋯ In the low back pain group, there was no such time lag. Paraspinal muscle activities restricted lumbar range of motion, and protect from injury for movement. This suggests their role as stabilizers.
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Education, resident training, guidelines, and evaluation are necessary to improve health care quality. Changing the resident system, re-organizing medical associations and Evidenced-Based Medicine (EBM) are becoming popular, and clinical practice using guidelines has been stressed in recent years in Japan. However, clinical evaluation is generally not so popular, except within internal conferences, and during short discussions at medical societies, although evaluation of the hospital services is on going by the Japanese Council for Quality Health Care (JCQHC). ⋯ Outcome reviews will offer the opportunity to assess comparability with national standards and norms. Trauma registry and evaluation are recommended for all emergency centers in Japan. These evaluation processes may be useful for systematic improvement of the emergency medical field.