Patients who were just operated on for artificial carpal bone replacement or total artificial hip joint replacement are at high risk of luxation. They are recommended to use pillow-like cushions for propping up their hips or legs for a couple of weeks postoperatively. Even after the removal of the props, there remains a chance of dislocation. Some patients, lying upon their back and spreading their legs apart day and night, complain of pain. With a view to allaying the patients' pain, we attempted to develop a cushion such that patients could toss and turn in bed easily. A questionnaire survey was carried out on all the nurses who had learnt a lot from experience in using pillows commercially available. Based on the findings of the survey, we trial manufactured cushions and used them in one capitate bone replacement patient and three hip joint replacement patients. The cushions were well received by the patients and rated high by a orthopedic surgeon who checked X-rays of the patients.
Prevention ; Dislocation, complete, NOS ; Skeletal bone ; Replacement of joint, NOS ; Surveys

Introduction: We report a case of severe headache caused by lung cancer metastasis to the base of the skull that was difficult to diagnose due to a lack of imaging evidence. Case: A 70-year-old man diagnosed with advanced lung cancer experienced sudden, severe headache. He was diagnosed as having a tension-type headache because magnetic resonance imaging of his head failed to detect any pathology. He was prescribed various drugs, which except for strong opioids failed to treat his headache. He referred to our palliative care unit to treat the pain. Re-evaluation of his head CT revealed metastasis to the clivas. His pain was treated with rapid titration of subcutaneous oxycodone injection. Conclusion: Even if radiographic investigations fail to identify the metastasis, the patient should be re-evaluated if the headache worsens and/or is accompanied with cranial nerve dysfunction.

This is a case of an 81-year-old male who underwent stent-graft (SG) placement for type B aortic dissection at the age of 79. Two and a half years after the surgery, he was diagnosed with SG infection. Although he was scheduled for SG removal and the in-situ replacement of the descending aorta, he had difficulty maintaining oxygenation under single lung ventilation and detaching the severe adhesion of the aneurysm to the lung; therefore, only the aneurysm sac was opened, and abscess drainage was performed. The continuous irrigation and drainage of the aneurysm sac were performed, but the infection did not improve. On the 6th day after the surgery, the aortic aneurysm in the lung adhesion area was left untreated, and an extra-anatomical bypass was performed from the distal aortic arch to the anterior position of the pulmonary hilum, anastomosing with the abdominal aorta. All SGs were removed, the abscess and intima of the aortic aneurysm were extensively excised, and the remaining cavity was filled with omentum. The infection rapidly improved after the surgery, and he was discharged on the 52nd day after admission. Fortunately, the infection did not recur for 2 years since the surgery. This procedure is useful as an option for surgical reconstruction for stent graft infection for which in-situ descending aorta replacement is difficult.