Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Dec 2005
[Fluid management and care for multiple organ dysfunction syndrome in patients with extensive burns].
Burn shock and multiple organ dysfunction syndrome (MODS) are the main causes of death in patients with extensive burns, and thus fluid management and care for MODS are crucial in the treatment of these patients. Several fluid formulas have been developed, although there is still controversy over the best formula. The important point is to understand how to deal with the different side effects inevitable with each fluid therapy: fluid restriction and/or diuretic administration in the refilling phase in fluid therapy with crystalloid, care for hypernatremia and/or a hyperosmolar state in fluid therapy with hypertonic lactated solution (HLS), etc. ⋯ MODS in extensively burned patients is attributed to overwhelming burn stress and complicated sepsis, including bacterial translocation (BT). A dysfunctioning organ impairs another organ (organ interrelationships), and therefore substitution and/or recovery of a dysfunctioning organ are crucial. Debridement of skin with third-degree burns, suppression of BT, sanitary airway management, avoidance of unnecessary stress, and mediator modulation to stop the mediator cascade inducing MODS are also crucial.
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Overall five-year survival of Childhood rhabdomyosarcoma (RMS) is reported to be 70% in the Intergroup Rhabdomyosarcoma Study Group (IRSG), however, the figure in Japan is almost 15% lower than that of IRSG. Treatment regimen of RMS essentially depends on the histology of the tumor, site, preoperative staging and postoperative grouping that leads to the risk classification. VAC is a standard chemotherapeutic regimen for low and intermediate risk group. Clinical trial with CPT-11 or high dose chemotherapy are underway for high risk RMS.
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Nihon Geka Gakkai zasshi · Jun 2005
Review[Review and evaluation of limited resection for early lung cancer].
Limited resection for early lung cancer has been associated with significantly higher local recurrence rates based on previous reports such as those from lung cancer study groups. On the other hand, a few groups demonstrated that patients with small peripheral cancer who undergo limited resection have comparable survival rates with those who undergo lobectomy. Recent advances in radiologic investigation and pathologic analysis have broadened the indications for limited resection. ⋯ Although limited resection is still controversial intentional segmentectomy for localized bronchioloalveolar carcinoma or less than 20 mm or less in diameter may be recommended without evidence-based medicine. It is important to accumulate further evidence clarifying the survival and function benefits of limited resection. New therapeutic modalities for limited surgery for small-sized lung cancer may increase patient life expectancy.
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Arrhythmia is the most common perioperative cardiac complication during noncardiac surgery. Most perioperative arrhythmia is benign, but fatal arrhythmia can occur, requiring emergency care. Arrhythmia is divided into tachycardia and bradycardia. ⋯ Hypertensive heart disease or valvular heart disease can lead to atrial fibrillation or supraventricular tachycardia. Although patients may not have cardiac disease, hypoxia, hypovolemia, electrolyte disturbance, acidosis, and hypothermia can also cause arrhythmia. Patients with pacemakers or implantable cardiodefibrillators (ICDs) are affected by electric cauterization, which interferes with the sensing and inhibits the pacing of pacemakers as well as ICDs If this occurs, the mode of pacemakers and ICDs must be reset during surgery.
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Nihon Geka Gakkai zasshi · Apr 2005
[Surgical strategy based on the spread mode of gallbladder carcinoma].
Cancer recurs even from early stage of gallbladder cancer if the bile spills over during surgery. The most important point to determine the surgical strategy for gallbladder cancer is the spread mode For pT1b gallbladder cancer, cholecystectomy in the entire layer and regional lymphadenectomy are necessary. Even for pT2 cancer the same surgery is sufficient if the invasion into the subserosal layer is minimal. ⋯ If massive direct hepatic invasion is present, central hepatectomy or extended right hepatectomy is indicated. If the right Glissonian triad is involved, right extended hepatectomy is mandatory but the addition of pancreatoduodenectomy must be carefully considered to avoid surgical risk. The presence of liver metasis, jaundice, apparent paraaortic lymph node metastasis, and involvement of the major vessels are not indications for surgery.