Rinsho byori. The Japanese journal of clinical pathology
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In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. ⋯ To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).
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Personalized medicine has been expected to be utilized in daily practice since the international human genome project completed sequencing of the entire genome in 2003. The aim of personalized medicine is to treat patients effectively and safely based on the genome characteristics of each patient, or to choose the right drug for the right patient at the right time and at the right dose. Regulatory agencies such as the United States Food and Drug Administration(FDA) and Pharmaceuticals and Medical Devices Agency (PMDA), Japan implemented guidance to facilitate the co-development of drugs and companion diagnostics. For the practice of personalized medicine, companion diagnostic tests are essential, although their availability is limited.
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It has been reported that fibrinogen products, such as fibrinogen concentrates, cryoprecipitate (CRYO), and fresh frozen plasma, are beneficial for treating coagulopathy due to massive blood transfusion. For the appropriate use of these products, it is necessary to evaluate the status of coagulopathy and determine the trigger level of the fibrinogen concentration for the administration of fibrinogen products. In our institution, we established a treatment procedure for coagulopathy due to massive transfusion in 2011. ⋯ According to the rapid coagulation test results, CRYO was administered to 27 patients. These results are satisfactory for treating critical bleeding patients. We stress the need for the establishment of a rapid coagulation test system in the central hospital laboratory. (Review).
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Procalcitonin (PCT) is a frequently used marker for bacterial sepsis. The present study was aimed to assess the usefulness of PCT measurement in patient with sepsis. We studied the relationship between serum PCT level and blood culture in clinical 209 cases admitted from January 2010 through June 2010. ⋯ Patients with PCT ≥ 2 ng/mL had significant correlation with the presence of sepsis. The PCT measurement could be performed and reported rapidly and provided valuable information before availability of culture results. In this study, we found that the PCT would be a useful biomarker for confirming and ruling out sepsis.
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There is an increasing demand for anesthesiologists to work outside the operating room in order to provide general anesthesia or monitored sedation for a variety of medical investigations or procedures in infants and children. The concept that treatment should be a pain- and stress-free experience is now well accepted, and this has placed additional responsibilities on anesthesiologists. We describe pediatric anesthesia and monitored sedation for diagnostic medical procedures. ⋯ The feed and wrap method is recommended. Satisfactory immobilization of the child during noninvasive medical procedures, including magnetic resonance imaging, may be achieved by intravenous sedation or general anesthesia. Monitored intravenous sedation using propofol is the most widely used for healthy children; general anesthesia with a laryngeal mask airway or endotracheal intubation and controlled ventilation is required for a critically ill child.