Nihon Kyukyu Igakukai Zasshi
Online ISSN : 1883-3772
Print ISSN : 0915-924X
ISSN-L : 0915-924X
Volume 11, Issue 9
Displaying 1-8 of 8 articles from this issue
  • Takeshi Hirano, Hiroyuki Hirasawa, Takao Sugai, Shigeto Oda, Hidetoshi ...
    2000 Volume 11 Issue 9 Pages 421-427
    Published: September 15, 2000
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Plasma exchange (PE) has played a central role in artificial liver support (ALS) for fulminant hepatitis (FH) and contributed much to improving FH patient survival. Health insurance in Japan limits PEs for FH to less than 7 times for which patients are reimbursed. To study whether this limit is clinically appropriate, we retrospectively studied PEs 46 patients treated at the Chiba University Hospital ICU and diagnosed with FH based on Inuyama symposium criteria. Overall survival was 40.4%. Survival was better in patients with acute FH (50.0%) than in those with subacute FH (12.5%) (p<0.01). Average PEs 4.4±2.7 times in survivors and 7.4±4.1 times in nonsurvivors. Some 14 required PE more than 8 times. Two survived after receiving 9PEs. One patient received 10PEs before successful liver transplantation. PEs averaged 3.6 times in 8 predicted survivors and 7.2 in 38 predicted nonsurvivors based on the guideline proposed by the Acute Liver Failure Study Group of Japan. Some 13 had already received PEs on 5 consecutive days at the second evaluation time of the prognosis proposed by the guideline. We thus conclude that, ethically, it is inappropriate to limit the number of PEs for FH, especially when done as a bridge to liver transplantation. The number of PEs in FH should be discussed separately for acute and subacute FH. A special consideration on this limit should be made for FH patients slated to undergo liver transplantation.
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  • Shinji Ogura, Mayuki Aibiki, Michiyo Nakano, Keisuke Seki, Ichirou Hin ...
    2000 Volume 11 Issue 9 Pages 428-436
    Published: September 15, 2000
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Cytokines such as interleukin (IL)-6 and IL-8 may be key mediators in the development of organ failure induced by severe acute pancreatitis. We measured arterial plasma and peritoneal lavage fluid (PLF) levels of IL-6 and IL-8 in 6 patients with severe acute pancreatitis diagnosed based on criteria in Japanese patients. Peritoneal lavage was conducted for about 7 days to remove necrotic tissues and mediators released into the abdominal cavity using a fluid consisting of bicarbonate Ringer solution (SubloodTM) and ulinastatin (UTI: potent protease inhibitor; Mochida Pharm, Japan). Continuous infusion of UTI with an antibiotic (imipenam) to the celiac artery was also conducted in all patients. The PLF take-up ratio instilled was 85-90%, so we used this ratio to standardize cytokine levels. Statistical analysis was done by ANOVA with Scheffe's F-test (p<0.05). This study was approved by the Ethics Committee. Extremely high levels of IL-6 and IL-8 in PLF declined sharply after lavage but levels of both in arterial plasma decreased gradually over a period of 5 days. Differences between arterial plasma and PLF decreased markedly, associated with a rapid decrease in lactate dehydrogenase (LDH), an indicator of tissue damage, in PLF. All patients treated with these procedures recovered completely. These results suggest that peritoneal lavage as presented here, which is superior in outcome to those reported previously, is the treatment of chice for patients with severe pancreatitis, and indicate that early reduction of cytokine differences between plasma and the peritoneal cavity is beneficial in the treatment of acute severe pancreatitis.
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  • Makoto Mitsusada, Hiroshi Arai, Atsushi Matsuura, Tatsuro Wakayama
    2000 Volume 11 Issue 9 Pages 437-443
    Published: September 15, 2000
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Spleen preservation is paramount in splenic injury. Partial resection is often time-consuming and intricate due to the easy-to-tear nature of the capsule and parenchyma. Purpose: To evaluate safety and efficacy of splenic preservation using an ultrasonically activated scalpel (UAS) and stapler. The UAS, an ultrasonic coagulating dissector, effectively divides small vessels with minor thermal lateral injury. The adjustable linear stapler (ALS) was developed to avoid injury during organ stapling, We have used the ALS safely in stapling the pancreas, adjusting the gap gradually to match organ thickness. Method: Male Yorkshire pigs (about 20kg) underwent laparotomy under general anesthesia. The splenic parenchyma was transsected by scissors 10cm from the lower pole. Group A: Short gastric vessels and inferior branches of the splenic artery and vein were coagulated and divided using the UAS. The splenic parenchyma was then stapled with the ALS and resected at the site of maximum spleen thickness. Group B: The same vessels as in Group A were ligated and divided. The splenic parenchyma was then sutured at the site of maximum spleen thickness. Hemisplenectomy was conducted using electrical cautery. Results: In Group A, all vessels were divided safely and complete hemostasis attained with vesseles and with the surgical margins of the splenic parenchyma. In Group B, 3 cases required added sutures or electrical coagulation to attain complete hemostasis and about 15% hypotension was recorded in 1. Total operation times were short (p<0.05), and bleeding less (p<0.05) in Group A, but no significant difference was seen in surgical margin thickness or resected spleen weight between the 2 groups. We also discussed laparoscopic partial splenectomy using the UAS and surgical stapler and a clinical case of partial splenectomy. Conclusion: Splenic preservation using the UAS and ALS proved safe and effective in a porcine splenic trauma model.
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  • Yoshiyuki Minowa, Akiyoshi Kasii, Sachima Inoue
    2000 Volume 11 Issue 9 Pages 444-450
    Published: September 15, 2000
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Objective: We studied th effect of helmet use by school children on the prevention of head injuries due to motor vehicle accidents (MVA) in Omiya, a city of 440, 000 located 20km north to Tokyo, Japan. Method: School reports were collected retrospectively for MVA among 200, 000 students at 36 schools in Omiya city from 1989 to 1995. All schools were less than 1km from major intercity routes 16 and 17. Accident reports from 8 schools (cases) at which helmet use was compulsory when going to school were compared with 28 other schools (controls). Cases were divided into 4 with compulsory helmet use group (group C) and 4 which voluntary helmet use group (group V). Group V changed from compulsory helmet use to voluntary use in 1991. Changes in number and MVA rates were evaluated for 1989-91 and 1992-95. Results: In 36 schools, the nonfatal MVA injury rate increased from 1.0 per 1, 000 pupils per year in 1989-91 to 1.4 in 1992-95 (p<0.05). Nonfatal MVA rates among group V pupils increased significantly from 0.4 in 1989-91 to 1.6 in 1992-95 (p<0.01). The rate among group C pupils decreased from 1.3 in 1989-91 to 0.4 in 1992-95. The rate among group C pupils plus group V pupils in 1989-91 was 0.7, lower than among controls plus group V in 1992-95 (p<0.05). There were 3 MVA deaths in 36 schools but no deaths in group C. Conclusion: Compulsory helmet use by student significantly reduced the rate of head injuries in nonfatal MVA and death.
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  • Akinori Matsumoto, Kazuaki Shinohara, Shin-ichi Nishida, Hiroto Ikeda, ...
    2000 Volume 11 Issue 9 Pages 451-455
    Published: September 15, 2000
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    The incidence of hemangioma is the highest of all benign liver tumors. Although subjective symptoms are rare, surgical treatment is considered only in symptomatic cases of giant tumors. We treated a 46-year-old male was admitted to our hospital with the rupture of a large cavernous hemangioma of the liver due to blunt abdominal trauma from a free-fall injury. Ultrasonography and computed tomography (CT) of the abdomen revealed intraabdominal bleeding in the left subphrenic space. Since the patient's vital signs were stable, we treated him conservatively. Subsequent enhanced CT, angiography, and MRI showed a ruptured hemangioma at the left lateral segment of the liver. Surgical intervention was conducted on hospital day 17. Pathological examination confirmed the ruptured cavernous hemangioma. Traumatic rupture of a hepatic cavernous hemangioma is surgery, the same as in spontaneous liver ruputure. In emergency cases, we consider it essential that careful diagnosis is vital using enhanced CT findings.
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  • Koji Yamaguchi, Ryou Chaki, Hidetoshi Inomata, Katsutoshi Tanno, Sakar ...
    2000 Volume 11 Issue 9 Pages 456-461
    Published: September 15, 2000
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    A 28-year-old man attempted suicide by drinking a glass of dilute solution of caustic hydrochloric acid and was admitted to the Sapporo Medical University Hospital 3 hours later. Laboratory examination on admission showed metabolic acidosis, BE -8.9mEq/l. Endoscopic examination showed corrosive changes indicating injury to the deep layer of the upper gastrointestinal tract. The patient underwent surgery for severe caustic ingestion injury of the esophagus, stomach and duodenum to prevent perforative complications. After 84 days, esophageal reconstruction using the right colon with the terminal ileum was conducted, with excellent results were obtained. He was transferred to another hospital without further complication. Diagnosis and surgical treatment of caustic ingestion injuries remain controversial. After severe caustic injuries, patient survival is closely related to the delay between ingestion and surgical treatment. Our experience indicated that the decision for early operative intervention played a basic role in preventing of perforative complications.
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  • 2000 Volume 11 Issue 9 Pages 462-463
    Published: September 15, 2000
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
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  • 2000 Volume 11 Issue 9 Pages 476
    Published: 2000
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
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