Intestinal obstruction is a common surgical emergency caused by varied conditions. Appendicitis as a cause is both uncommon and unsuspected. Strangulation of intestine caused by appendicitis is extremely rare with very few cases reported in literature. The diagnosis of such a condition is possible only on table, with CT having questionable value. This is a very rare and dangerous complication of a very common disease which can easily be overlooked. Every emergency surgeon needs to be aware of such a possibility.We report a case of a 24 year old male presenting with classical features of intestinal obstruction. On laparotomy strangulated bowel was seen and appendix was found to be the cause. Although we obtained a history of appendicitis in this patient, it was not correlated to the present condition due to the rarity of such a scenario. We reviewed literature to find similar cases reported in the past.
We welcome letters to the Editor concerning articles which have recently been published. Such letters will be subject to the usual stages of selection and editing; where appropriate the authors of the original article will be offered the opportunity to reply.Letters should normally be under 300 words in length, doublespaced throughout, signed by all authors and fully referenced. The edited version will be returned for approval before publication. The Oxford medial unicompartmental knee replacement using a minimally-invasive approach Sir, I read with great interest the paper by Pandit et al 1 in the January 2006 issue entitled 'The Oxford medial unicompartmental knee replacement using a minimally-invasive approach'. I wish to congratulate the authors on such a large series of Oxford unicompartmental knee replacements, followed up for a good period of time, with excellent survivorship and clinical results.Although it may not be very obvious in the manuscript (it occupies only one sentence), the way in which the authors reported the Oxford knee score (OKS) deserves careful consideration. The long story of the OKS lies behind that sentence.Since its first description, the OKS has been the subject of rigorous validation, which demonstrated the score to be a short, practical, reliable and valid outcome measure for knee arthroplasty that is also sensitive to clinically-important changes over time. The layout remained essentially the same; 12 questions with five possible answers for each, covering aspects of knee pain and function. The scoring system, however, has kept changing over the past two decades. In its original version as described by the Oxford group, the responses to each question were marked on a scale of 1 to 5. Adding up the marks yields a score of 60 for the worst possible knee, and a score of 12 for the normal, or best possible knee.My first encounter with the OKS was during my work and research at Oswestry, where the scoring system was different. Each question was marked on a scale of 0 to 4, and the total score ranged from 0 to 48. The worst knee therefore attracted a score of 0, and the best score of 48, was achieved by the normal or best possible knee. In their reply to a letter to the editor of the Journal of Bone and Joint Surgery [Br] about this specific scoring method, authors White, Jones and Harcourt commented that they preferred to use the scoring system along a conventional scale, and that this format of scoring the OKS was widely used. They also stressed that authors using the OKS should clearly describe how they use this instrument to avoid any confusion. By reading only the abstract, it was not possible to tell which scale was used in 16 of 24 references which studied or used the OKS. Four papers obviously used the score in its original form, and another four papers,
When inserting an uncemented hip stem, the objectives are to obtain a close fit of the stem in the canal and anatomic head placement. Our goals were to formulate a set of stems which would satisfy these two objectives, and to test the resulting templates on sequential radiographs of hip replacement patients. Using 98 cases for which a custom primary hip had been designed, thirteen dimensional parameters for a hip stem were defined, most importantly proximal medial width (PMW), proximal lateral width (PLW), head offset (HOF), head height (HHT), mid-stem diameter (BD), and distal diameter (DD). These parameters were analyzed in 155 patients' radiographs, and the resulting data were evaluated to obtain the optimal combinations of parameters. A 14-size stem system was defined and evaluated on the AP radiographs of 103 successive hip replacement patients. For each stem diameter between 11 and 17 mm, two pairs of PMW and PLW values, equivalent to 'varus' and 'valgus' shapes, provided the best fit for the population of radiographs. The template analysis showed that out of 103 cases, 93% of offsets were within 4mm of ideal, while 81% of heights were within 1mm of ideal, and 99% were within 4mm of the ideal. Canal fit was within 1.5mm in the proximal-medial Gruen Zone 7 in 58% of the cases. The dimensional parameters of the 14 size system enabled the close matching of the important dimensional parameters simultaneously. The error that did occur could largely be corrected by modular heads and by minor canal broaching. By providing two stem shape variations for each stem diameter, our system achieved an accurate head center position while simultaneously obtaining a sufficiently close fit in the canal.
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