Successful Management of an Elderly Patient with Dementia Using a Dual Gastric Tube After Surgical Treatment of Gastroduodenal Ulcer

We describe a technique which was employed for simultaneous drainage and enteral nutrition using a dual gastric tube from a gastrostomy for postoperative management of a gastroduodenal ulcer. Gastrostomy was performed and a 18 Fr. gastric drainage tube was inserted into the body of the stomach intraoperatively. A second tube was inserted into the jejunum through the gastric tube postoperatively. Use of the gastric tube for drainage and the second tube for feeding enabled an early start of enteral nutrition without consideration of the gastric condition. The technique is simple and could be beneficial for patients who experience complications such as minor leakage and severe pylorus stenosis, particularly those in older age group with dementia

Comparison of re-revision rate and radiological outcomes between Kerboull-type plate and metal mesh with impaction bone grafting for revision total hip arthroplasty

BackgroundThis study compared the re-revision rate and radiographic outcomes of revision total hip arthroplasty (THA) using a Kerboull-type acetabular reinforcement device (KT plate) with bulk structural allograft and metal mesh with impaction bone grafting (IBG).MethodsNinety-one hips of 81 patients underwent revision THA for American Academy of Orthopedic Surgeons (AAOS) classification type III defects from 2008 to 2018. Of these, seven hips of five patients and 15 hips of 13 patients were excluded due to insufficient follow-up information (= 60 mm, respectively. The current study compared the survival and radiographic parameters of 45 hips of 41 patients using a KT plate (KT group) and 24 hips of 24 patients using a metal mesh with IBG (mesh group).ResultsEleven hips (24.4%) in the KT group and 1 hip (4.2%) in the mesh group exhibited radiological failure. Moreover, 8 hips in the KT group (17.0%) required a re-revision THA, while none of the patients in the mesh group required a re-revision. The survival rate with radiographic failure as the endpoint in the mesh group was significantly higher than that in the KT group (100% vs 86.7% at 1-year and 95.8% vs 80.0% at 5-years, respectively; p = 0.032). On multivariable analysis evaluating factors associated with radiographic failure, there were no significant associations with any radiographic measurement. Of the 11 hips with radiographic failure, 1 (11.1%), 3 (12.5%), and 7 (58.3%) hips were of Kawanabe classification stages 2, 3, and 4, respectively.ConclusionsThe findings of this study suggest that revision THA using KT plates with bulk structure allografts could provide poorer clinical outcomes than revision THA using a metal mesh with IBG. Although revision THA using KT plates with bulk structural allografts could set the true hip center, there is no association between a high hip center and clinical outcomes. The relationship between the position of the KT plate and the host bone might be considered more carefully