Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Sep 2007
Review[Clinical impact of the Guidelines for Treatment of Gastric Cancer].
The first edition of the Guidelines for Treatment in Gastric Cancer (TGGC) was published in 2002 and it was revised in 2004. Those were the first Japanese treatment guidelines for any type of cancer. Questionnaires were then sent to committee members of the Japanese Gastric Cancer Association. ⋯ The following problems and areas for improvement were pointed out: 1) Some standard treatments are described in the clinical trial setting. 2) The renewal for chemotherapy is not performed on the basis of new evidence. 3) The announcement of time and contents of new TGGC is necessary by internet. 4) An explanation of the objective index for evidence and recommendation levels is necessary, similar to those in the guidelines for the treatment of cancer in other organs. Japanese physicians have a responsibility to contribute to the evidence for gastric cancer treatment to be considered worldwide. In the near future, a simpler, more easily understandable revision of the TGGC will be necessary.
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Aortic valve replacement with a pulmonary autograft (Ross procedure) was pioneered by Donald Ross in 1967. The advantages of the autograft valve include freedom from anticoagulation, hemolysis, and infection, optimal hemodynamic performance, and growth potential. Various materials have been used for the right ventricular outflow tract (RVOT). ⋯ Pulmonary allografts cannot be utilized in Japan, and thus other valves and materials must be used instead. The acceptance of these procedures has been slow because of the technical demands of the operations and the inherent need for reconstruction of the RVOT, thereby placing two valves at risk. In the past 20 years, the Ross procedure has been increasingly considered for pediatric patients with a wide spectrum of congenital abnormalities.
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Nihon Geka Gakkai zasshi · Mar 2007
Review[Selection of prosthetic heart valves for adult patients by age].
The use of bioprosthetic heart valves has dramatically increased over the last decade. In 2004, the ratio was 52% for mechanical and 48% for bioprosthetic valves in a survey by the Japanese Association for Thoracic Surgery. This increase in the use of bioprosthetic valves is related to evidence demonstrating the durability of such valves over the last 20 years. ⋯ Thus patients with contraindications to warfarin or a low risk of thromboembolism who are more than 65 years old are reasonable candidates for a bioprosthetic valve. It is also recommended that women of childbearing age receive bioprosthetic valves after being informed of the possibility and risks of reoperation. In addition to the information in the guidelines and physicians' preference for valve selection, factors such as the patient's lifestyle, wishes, cardiac function, other complications, and longevity must always be considered when selecting a valve prosthesis.
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Nihon Geka Gakkai zasshi · Dec 2005
Review[Smoke inhalation injury: diagnosis and respiratory management].
Smoke inhalation is a significant comorbid factor following major thermal injury. Smoke exposure is only a trigger for the sequence of events responsible for the development of inhalation injury. Noxious chemicals generated by incomplete combustion injure the exposed bronchoepithelium and stimulate the release of chemical mediators that cause a progressive inflammatory process. ⋯ At present, the diagnosis of inhalation injury is supported by the combination of history, physical examination, bronchoscopy, and laboratory findings For accurate diagnosis of inhalation injury, helical CT scanning and examination to detect activated leukocytes in bronchoalveolar lavage fluid may be warranted. In the respiratory management of inhalation injury, repeated removal of pseudomembrane by fiberoptic bronchoscopy and the use of adequate PEEP to avoid airway obstruction are essential. High-frequency percussive ventilation can be a suitable mode of ventilation for inhalation injury.
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Nihon Geka Gakkai zasshi · Dec 2005
Review[Experience of immediate burn wound excision and grafting for patients with extensive burns].
The treatment of the patients with extensive burns has advanced dramatically in the past 10 years, and the mortality rate has also been reduced. The establishment of the skin-bank network as well as the development of emergency and critical care medicine can be cited as reasons Moreover, immediate burn wound excision and grafting for patients with extensive burns may be beneficial. Meticulous management is required perioperatively to perform these procedures safely during burn shock. ⋯ We completed the surgery within 2 hours and excised burn wounds covering 40% of the total body surface area (TBSA). The mean age was 57 +/- 22 (mean +/- SD years), the mean burn surface area (% of TBSA) was 47 +/- 20, the mean burn index was 45 +/- 19, and the mean prognostic burn index was 94 +/- 36. There were 15 survivors and 11 deaths, for an overall mortality rate of 43%.