Nihon Kyukyu Igakukai Zasshi
Online ISSN : 1883-3772
Print ISSN : 0915-924X
ISSN-L : 0915-924X
Volume 15, Issue 1
Displaying 1-4 of 4 articles from this issue
  • Naoshi Takeyama, Takaya Tanaka, Nobuaki Matsuo, Tohru Yamamoto, Toshio ...
    2004 Volume 15 Issue 1 Pages 1-7
    Published: January 15, 2004
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    In an effort to assess surgical stress by means of the immune response, we focused on the T cell secretion of cytokines that regulate the critical balance of either T helper type-1 (Th1)-or Th2-mediated immune response on pro- and anti-inflammatory activities. We also measured histocompatibility leukocyte antigen (HLA)-DR expression and cytokine synthesis in peripheral blood monocytes. The patients admitted to our ICU between June 2000 and December 2002 were recruited for this study. In a prospective study, 6 septic patients, 5 patients with burn injury, 9 trauma patients and 6 healthy control subjects were included. Peripheral blood mononuclear cells (PBMCs) from each subject were isolated and stimulated with lipopolysaccharide, and phorbol myristate acetate plus ionomycin. Cell surface marker expression (CD4, CD14, and HLA-DR) and in vitro intracytoplasmic cytokine production (IL-1, IL-1ra, TNF, IL-10, IL-6, IL-4, and IFN-γ) were measured by flow cytometry. The frequency of IFN-γ-producing Th1 cells from burn (9.4±8.1, p<0.05), trauma (injury severity score±25)(11.3±7.5, p<0.05) and septic (6.2±2.3, p<0.01) patients was significantly decreased when compared with the healthy individuals (23.1±8.1). The frequency of IL-4-producing Th2 cells remained largely unchanged in all groups. Monocyte HLA-DR expression also was decreased in traumatic, septic and burn patients. Septic and traumatic patients showed significant suppression of Th1 cytokine production concomitant with the decrease in monocyte HLA-DR expression. The results therefore suggest that downregulation of Th1 cell-mediated immune response and monocyte deactivation defined as immunoparalysis may be an important mechanisms of immunosuppression observed after surgical stress and may contribute to increased susceptibility to infectious complication.
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  • Seiji Morita, Yoshihide Nakagawa, Shigeaki Inoue, Kazuki Akieda, Masay ...
    2004 Volume 15 Issue 1 Pages 8-12
    Published: January 15, 2004
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    A 72-years-old male consulted our hospital for oro-nasal bleeding after surgery for pharyngeal cancer. Systolic blood pressure was 62mmHg, suggesting shock. Neither gauze packing nor insertion of a Bellocq tampon was effective, and we considered that the source of bleeding was the pharynx. Hemostasis for pharyngeal bleeding was difficult, and a Sengastaken-Blakemore tube (S-B tube) was used. The tube facilitated bleeding control, and the circulatory kinetics became stable. Angiography revealed extravascular leakage. Coiling of the left external carotid artery was performed, but complete hemostasis was not achieved without the S-B tube. The inserted S-B tube was dilated for 16 hours, and then removed after hemostasis was confirmed. After removal, no additional bleeding occurred. The S-B tube was useful for achieving hemostasis for oro-nasal bleeding.
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  • Tadashi Kaneko, Hirotaka Hamada, Takeshi Inoue, Ryosuke Tsuruta, Shunj ...
    2004 Volume 15 Issue 1 Pages 13-16
    Published: January 15, 2004
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    Cardioreversion of ventricular fibrillation (VF) is one of the major targets in the therapeutic strategy for cardiac arrest. We report a case in whom intra-aortic balloon pumping (IABP) effectively treated VF caused by submersion and in whom the neurological outcome was relatively good. An 18-year-old man drowned after diving into a swimming pool. When he was rescued after 12 minutes, he was in cardiac arrest. We started advanced cardiovascular life support just after his arrival at our emergency and critical care center. The electrocardiogram revealed VF. Despite applications of direct current defibrillation and administration of vasopressin and nifecarant, VF occurred repeatedly. After we started IABP, his cardiac rhythm and vital signs stabilized. X-ray examinations revealed a cervical spine injury and severe pulmonary edema. Normothermia therapy and IABP support were performed, and high dose methylprednisolone therapy was also carried out for the cervical spine injury. Under this intensive care regimen, the patient's status improved. His Glasgow outcome scale was severe disability on discharge from our hospital. We believe that IABP is one of the effective therapies in a patient with intractable cardiac arrhythmia. In addition, IABP may be effective for maintenance of cerebral blood flow after cardiopulmonary resuscitation.
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  • Hirokatsu Hoshino, Satoshi Gando, Mineji Hayakawa, Takashi Kameue, Nao ...
    2004 Volume 15 Issue 1 Pages 17-21
    Published: January 15, 2004
    Released on J-STAGE: March 27, 2009
    JOURNAL FREE ACCESS
    We report a patient with pulmonary hypertension complicated with pneumonectomy in blunt traumatic injury to the bronchus successfully managed by percutaneous cardiopulmonary support (POPS). A 4-year-old girl injured in a traffic accident was transferred to our hospital. She had thoracic injury with respiratory failure, and we diagnosed bilateral hemopneumothorax. Despite insertion of bilateral chest tubes and intubation, the left lung was not inflated, showing continued massive air leakage. Pneumonectomy of the left lung was performed for the left main bronchial injury. After the operation, PCPS was started because of pulmonary hypertension associated with deteriorated hemodynamics and oxygenation. Following this, the respiratory and hemodynamic states became stable. PCPS was continued for 5 days and the ventilator was needed for 11 days. The patient was discharged on day 52. We considered the pneumonectomy, contralateral lung contusion, drugs, hypoxic pulmonary vasoconstriction, and ventilator as causes of pulmonary hypertension. PCPS is one of the useful treatments for severe chest trauma.
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