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1.
The JPN Guidelines for the Management of Acute Pancreatitis are organized under the subject headings: epidemiology, diagnosis, management strategy, severity assessment and transfer criteria, management of gallstone pancreatitis, nonsurgical management, and surgical management. The Guidelines contain cutting-edge information on each of these subjects, as well as a section on the Japanese medical insurance system which provides information that should prove useful to physicians in other countries. The quality of the evidence was evaluated by the evidence-based classification method used at the Cochrane Library. The levels of recommendation of the individual management methods contained in the Guidelines were determined on the basis of the evaluation of evidence by the consensus of the members of the Working Group (see below). The Japanese Society for Abdominal Emergency Medicine, the Japan Pancreas Society, and the Research Group for Intractable Diseases and Refractory Pancreatic Diseases (which is sponsored by the Japanese Ministry of Health, Labour, and Welfare) were commissioned to produce the JPN Guidelines for the Management of Acute Pancreatitis. A Working Group of 20 physicians specializing in pancreatic diseases and emergency medicine investigated and analyzed 14821 cases retrieved by means of a Medline (1960–2004) search and discussed the available literature on acute pancreatitis (limited to human pancreatitis). The Working Group held many general discussions in order to reach a consensus on the content of the Guidelines. After producing a draft, the Publishing Committee of the JPN Guidelines for the Management of Acute Pancreatitis posted it on a website and asked for comments and criticisms. Subsequently, a final version of the Guidelines was published in Japanese in 2003. The Publishing Committee is now making the Guidelines available to a much wider readership by bringing out an English version.  相似文献   

2.
 To evaluate the gastrointestinal tolerability of nonsteroidal antiinflammatory drugs (NSAIDs) in osteoarthritis patients in Japan, a systematic review of Japanese randomized controlled trials was performed. This study consisted of double-blind, randomized, controlled clinical trials with 4-week NSAID treatment of osteoarthritis patients in Japan. The analysis included 4725 patients from 25 trials. On average the cumulative incidences of patients who had experienced any adverse reaction and any adverse digestive reaction were 14.3% [95% confidence interval (CI) 13.3%–15.3%] and 10.4% (95% CI 9.4%–11.4%), respectively. The cumulative incidence for the upper gastrointestinal (GI) symptoms such as abdominal pain, nausea/vomiting, and dyspepsia was estimated to be approximately 10.9%. When the risk of upper GI symptoms was compared between males and females, the summary odds ratio was 1.71 (95% CI 1.11–2.65). Comparing the risk of upper GI symptoms between patients 59 years of age and younger and those 60+ years old, the summary odds ratio was 1.07 (95% CI 0.75–1.52). Despite the incidence of adverse reactions varying across the drugs being used, there was an obvious increased risk of GI symptoms. Received: September 4, 2002 / Accepted: December 2, 2002 RID="*" ID="*" Offprint requests to: S. Uemura, Room 302, 2-21-9 Azabu-juban, Minato-ku, Tokyo 106-0045, Japan RID="*" ID="*" Acknowledgment. We thank the editors of the Journal of Orthopaedic Science for their valuable comments.  相似文献   

3.
 We have developed a Japanese self-administered questionnaire based on an English version of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) to measure subjective function and pain status of patients who undergo a total knee arthroplasty procedure. Using multiple international cohorts, the performance of the developed Japanese scale was compared to the results of the WOMAC in the United Kingdom, United States, Canada, and Australia. The developed scale showed a comparable level of internal consistency and construct/criterion validity. The responsiveness of the scale was superior to the concurrently measured MOS Short Form 36 Physical Function scale. These results suggest that the developed scale is reliable, valid, and responsive for assessing the effectiveness of total knee arthroplasty in the Japanese context despite the cultural life style differences from Western countries. Received: September 9, 2002 / Accepted: December 10, 2002 RID="*" ID="*" Offprint requests to: H. Hashimoto Acknowledgments. We acknowledge the Kinemax Outcomes Group.  相似文献   

4.
There are no evidence-based-criteria for the diagnosis, severity assessment, of treatment of acute cholecysitis or acute cholangitis. For example, the full complement of symptoms and signs described as Charcot's triad and as Reynolds' pentad are infrequent and as such do not really assist the clinician with planning management strategies. In view of these factors, we launched a project to prepare evidence-based guidelines for the management of acute cholangitis and cholecystitis that will be useful in the clinical setting. This research has been funded by the Japanese Ministry of Health, Labour, and Welfare, in cooperation with the Japanese Society for Abdominal Emergency Medicine, the Japan Biliary Association, and the Japanese Society of Hepato-Biliary-Pancreatic Surgery. A working group, consisting of 46 experts in gastroenterology, surgery, internal medicine, emergency medicine, intensive care, and clinical epidemiology, analyzed and examined the literature on patients with cholangitis and cholecystitis in order to produce evidence-based guidelines. During the investigations we found that there was a lack of high-level evidence, for treatments, and the working group formulated the guidelines by obtaining consensus, based on evidence categorized by level, according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence of May 2001 (version 1). This work required more than 20 meetings to obtain a consensus on each item from the working group. Then four forums were held to permit examination of the Guideline details in Japan, both by an external assessment committee and by the working group participants (version 2). As we knew that the diagnosis and management of acute biliary infection may differ from country to country, we appointed a publication committee and held 12 meetings to prepare draft Guidelines in English (version 3). We then had several discussions on these draft guidelines with leading experts in the field throughout the world, via e-mail, leading to version 4. Finally, an International Consensus Meeting took place in Tokyo, on 1–2 April, 2006, to obtain international agreement on diagnostic criteria, severity assessment, and management.  相似文献   

5.
Background/Purpose. Some patients with unresectable malignant biliary stenosis can survive for more than 1 year after the insertion of self-expandable metallic stents (SEMS). The aim of this study was to analyze the background of the longterm survivors. Methods. In our study, 111 patients with inserted SEMS were divided into two groups: patients who died within 1 year and patients still alive for more than 1 year. The parameters analyzed were survival rate, survival period, patent period of the inserted SEMS, adjuvant therapy, and complications. Results. The number of those who survived for more than 1 year totaled 24 (21.6%). Their diagnoses were bile duct carcinoma (15/31; 48.4%) and pancreas carcinoma (9/28; 32.9%). There were no survivors with other diseases. The survival period and stent-patent period of the patients with bile duct carcinoma (429.2 days and 589.7 days, respectively) and pancreas carcinoma (270.1 days and 336.4 days, respectively) were significantly longer than those of the patients with other diseases. The specific complication of the longterm survivors was duodenal obstruction. Conclusions. Many patients with bile duct carcinoma and pancreas carcinoma survived for more than 1 year and adjuvant therapy should be performed to improve the survival of those patients. Received: April 24, 2002 / Accepted: October 23, 2002 RID="*" ID="*" Offprint requests to: H. Kawamoto  相似文献   

6.
Dumbbell-type solitary fibrous tumor in the cervical spine   总被引:4,自引:0,他引:4  
 We report a dumbbell-type solitary fibrous tumor in the cervical spine. Eight spinal solitary fibrous tumors have been reported previously, but the cervical location is rare and this may be the first report of a dumbbell-type tumor. Histopathological examination showed that the tumor was composed of spindle cells in a collagen-rich matrix, although regional variability was noted. Diffuse immunostaining for CD34 and vimentin was noted in the cytoplasm of the tumor cells. This rare tumor should be recognized in the differential diagnosis of cervical spinal tumors. Received: October 8, 2002 / Accepted: January 22, 2003 RID="*" ID="*" Offprint requests to: K. Endo  相似文献   

7.
The Tokyo Guidelines formulate clinical guidance for healthcare providers regarding the diagnosis, severity assessment, and treatment of acute cholangitis and acute cholecystitis. The Guidelines were developed through a comprehensive literature search and selection of evidence. Recommendations were based on the strength and quality of evidence. Expert consensus opinion was used to enhance or formulate important areas where data were insufficient. A working group, composed of gastroenterologists and surgeons with expertise in biliary tract surgery, supplemented with physicians in critical care medicine, epidemiology, and laboratory medicine, was selected to formulate draft guidelines. Several other groups (including members of the Japanese Society for Abdominal Emergency Medicine, the Japan Biliary Association, and the Japanese Society of Hepato-Biliary-Pancreatic Surgery) have reviewed and revised the draft guidelines. To build a global consensus on the management of acute biliary infection, an international expert panel, representing experts in this area, was established. Between April 1 and 2, 2006, an International Consensus Meeting on acute biliary infections was held in Tokyo. A consensus was determined based on best available scientific evidence and discussion by the panel of experts. This report describes the highlights of the Tokyo International Consensus Meeting in 2006. Some important areas focused on at the meeting include proposals for internationally accepted diagnostic criteria and severity assessment for both clinical and research purposes.  相似文献   

8.
Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. The mortality rate of severe acute pancreatitis exceeds 20%, and some patients diagnosed as mild to moderate acute pancreatitis at the onset of the disease may progress to a severe, life-threatening illness within 2–3 days. The Japanese (JPN) guidelines were designed to provide recommendations regarding the management of acute pancreatitis in patients having a diversity of clinical characteristics. This article sets forth the JPN guidelines for the surgical management of acute pancreatitis, excluding gallstone pancreatitis, by incorporating the latest evidence for the surgical management of severe pancreatitis in the Japanese-language version of the evidence-based Guidelines for the Management of Acute Pancreatitis published in 2003. Ten guidelines are proposed: (1) computed tomography-guided or ultrasound-guided fine-needle aspiration for bacteriology should be performed in patients suspected of having infected pancreatic necrosis; (2) infected pancreatic necrosis accompanied by signs of sepsis is an indication for surgical intervention; (3) patients with sterile pancreatic necrosis should be managed conservatively, and surgical intervention should be performed only in selected cases, such as those with persistent organ complications or severe clinical deterioration despite maximum intensive care; (4) early surgical intervention is not recommended for necrotizing pancreatitis; (5) necrosectomy is recommended as the surgical procedure for infected pancreatic necrosis; (6) simple drainage should be avoided after necrosectomy, and either continuous closed lavage or open drainage should be performed; (7) surgical or percutaneous drainage should be performed for pancreatic abscess; (8) pancreatic abscesses for which clinical findings are not improved by percutaneous drainage should be subjected to surgical drainage immediately; (9) pancreatic pseudocysts that produce symptoms and complications or the diameter of which increases should be drained percutaneously or endoscopically; and (10) pancreatic pseudocysts that do not tend to improve in response to percutaneous drainage or endoscopic drainage should be managed surgically.  相似文献   

9.
To clarify how the kinetics of nitric oxide (NO) and active oxygen species are correlated with the occurrence of organ dysfunction in sepsis, the levels of monocyte-associated NO2, NO3, and active oxygen species were examined in severely septic patients with multiple organ dysfunction syndrome (group M; n=5), and the results compared with those of postoperative patients who had undergone gastrointestinal surgery (group S; n=5) and healthy volunteers (group C; n=10). The production of NO2 and NO3 by monocytes was significantly higher in group M than in the other two groups, while the production of active oxygen species by monocytes was significantly higher in groups M and S, than in group C. A significant correlation between the production of NO2 and that of active oxygen species by monocytes was noted only in group M. These findings indicate that the simultaneous activation of NO and active oxygen species production by monocytes is a prerequisite for the onset of multiple organ dysfunction in severe sepsis.This paper was originally presented at the 22nd meeting of the Japanese Society for Abdominal Emergency Medicine held in Takarazuka in 1994.  相似文献   

10.
Purpose. Sentinel-node biopsy is becoming widely accepted in breast cancer treatment. Using the radioisotope technique, a lower risk of identification failure is related to the amount of radiocolloid in the sentinel nodes. The aim of this study was to identify the factors associated with the colloidal uptake of the sentinel nodes. Methods. Technetium-labeled colloid was injected peritumorally, with or without subdermal injection. According to the maximum radioactivity of the sentinel nodes, patients were divided into high (≥100 counts/s) or low (<100 counts/s) uptake groups. The uptake was compared in relation to the clinicopathologic and technical features. Results. The sentinel node was identified in 183 of 186 patients (98.4%), with 60 and 123 patients in the low- and high-uptake groups (mean: 39 and 1003 counts/s), respectively. Multivariate analysis showed that an age of 65 years or older and a sentinel-node size of 8 mm or more were significantly more predominant in the low-uptake group. Conclusion. Care must be taken when performing sentinel-node biopsy, especially for aged patients and for those with large sentinel nodes. The optimal technique should be determined on the basis of these results. Received: March 29, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: K. Sato  相似文献   

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