The evloution of total knee and hip joint arthroplasty

The evolution of total joint replacement is not merely of historical interest. We review the historic development of total joint arthroplasty to look at what has been selected and what has not selected in the past. For more than 30 years, total joint arthroplasty has been progressively developed to improve functional outcomes and survivorship. There has been debate regarding the presence of posterior cruciate ligament (cruciate retaining vs. posterior stabilized) and bearing articulation (fixed vs. mobile). Unicompartmental knee arthroplasty is used through minimally invasive surgery with relatively good results. Still, liner wear and limitation in the range of motion were concerns, prompting the development of highly cross-linked polyethylene and hyperflexion design prostheses. Although there have been a number of improvements in the design and concepts behind hip joint arthroplasty for many years, fixation methods and bearing surfaces are still in debate. Future developments in total joint arthroplasty should be focused on improved function, wear reduction, enhanced kinematics, and increased range of motion. We can look forward to further advancements in total joint arthro-plasty in the area of new materials and designs.

The Effect of Continuous Nutritional Education and Oral Mucositis Management on Nutritional Status of Patients Undergoing Hematopoietic Stem Cell Transplantation / 종양간호학회지

PURPOSE: This study aimed to evaluate the effectiveness of continuous nutritional education and oral mucositis management on the nutritive status of patients who received hematopoietic stem cell transplantation (HSCT). METHODS: After randomly allotting 72 patients who received HSCT to either an experimental group or a control group, intensive and continuous care for preventing malnutrition was conducted in the experimental group while usual routine care was conducted in the control group. The changes of the body scale, blood chemistry profile, oral intake calories, nausea and vomitus, and oral stomatitis scores were measured at three points during their hospitalization using a oral assessment guide and nutrition analysis program: admission, HSCT, and discharge day. The differences between the scores of two groups were analyzed by repeated measures analysis of covariance. RESULTS: The number of total lymphocytes was significantly improved in the experimental group after transplantation (p<.001). Nausea and vomiting score was significantly decreased in the experimental group during the conditioning regimen (p<.001). CONCLUSION: It was found that continuous nutritional education and oral mucositis control is an effective intervention by improving immune condition. Further investigations concerning direct examination of oral intake with controlling the effect of the chemotherapy are needed to ultimately discern the impact of varying oral nutrition patterns during HSCT.

Bile Duct Stenosis & Intrahepatic Stones after a Transcather Hepatic Arterial Embolization: A case report

Transcatheter hepatic arterial embolization (THAE) is one of the treatment modalities that can be applied to hepatocellular carcinomas (HCC) and metastatic tumors of the liver. Complications such as cholecystitis and gallbladder necrosis, are common with THAE, but liver and peripheral bile duct necrosis are rare, and intrahepatic stones with main bile duct necrosis have never been reported. To prevent intrahepatic spread during operative manupulation and to decrease the vascularity and size of the tumor, we performed a THAE on a huge-sized HCC five times before performing the hepatectomy. We succesfully undertook a right lobectomy after the THAE with lipiodol, gelform, and adriamycin. However, severe bile duct stricture and intrahepatic stones were confirmed during the operation.