A flanged socket was introduced by Sir John Charnley for use in his low-friction hip arthroplasty in 1976. Experimental evidence has suggested that the flange offers an advantage in terms of cement pressurisation at the time of implantation. We have reviewed 302 primary Charnley arthroplasties followed for 9 to 11 years to determine the effect of the flanged socket on the radiological appearance. The incidence of radiological demarcation at the cement-bone interface is significantly reduced in early radiographs after the use of a flanged socket, and the advantage is maintained in the long-term results.

Published guidelines recommend early transfer of patients with hip fractures to hospital wards and avoidance of unnecessary delays in A&E. We describe a protocol whereby the liaison of an orthopaedic trauma co-ordinator with A&E reduced A&E-to-ward transfer times by 43%. Following introduction of the new protocol, 39% of hip fracture patients were in a ward bed within 3 h of admission to A&E compared to 4% previously. The new protocol also reduces administrative workload for the on-call orthopaedic SHOs.

were included in this study. Before enrolment into the study, the patients were explained about the study and informed consent was obtained. The patients with unidentified colitis were excluded. The data on demographics, disease characteristics, FI (Vaizey score), and quality of life (IBD-Q) were collected. Data were analyzed using SPSS version 21. Results There were 184 patients (women = 101, 54.9%; UC = 153, 83.2%) with a female preponderance for UC (male/ female ratio = 1:1.5) and a male preponderance for CD (male/female = 2:1). Forty-eight (26%) patients reported symptoms of FI. Among the patients with FI, 70.8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range, 20-78 years). Average age of onset of FI was 48.6 (range, 22-74) years. Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 56.2% (n = 27), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty-one percent (n = 10) complained of disruption of their physical and social activity. There was no association between FI and type of IBD. Significant associations were found between FI and age (P = 0.005) and gender (P < 0.001). QOL in our cohort of patients was significantly affected by FI. Conclusions In our study, nearly a quarter of patients reported FI. There was a significant correlation between FI and QOL. Therefore, enquiring about FI in IBD patients can lead to identification of this debilitating condition. This will enable early referral for continence care in this group of patients.

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The first dose so aggravated her symptoms that I could not persuade her to take a second. I then returned to the acid treatment, in which she persevered for two days, being occasionally better, and then again as bad as ever. The symptoms at length yielded to the following combination:-R. Potass. Chlorat., Soda Sesquicarb., utrq., dr. j.; Tr. Cinchomn Co., dr. iv.; Sp. AEth. Sulph. Co., dr. j.; Infus. Cascarillae, oz. v. M. A fourth part every four hours. A glass of port wine twice a day.In about ten cases out of the fifty entered in my notebook, I first tried the chalk and opium treatment, before resorting to the acid; in only one was perfect relief afforded. The vomiting has been so severe in the prevailing epidemic, that it would seem as if the stomach was unable to bear so nauseous a mixture as that of -chalk and opium. And in most of the cases I have found the best, indeed the only efficacious plan to be, to relieve the intense gastric irritation by cold water, before resorting to the medical treatment. In some cases, if the stomach will bear it, the chalk seems to stop the diarrhoea, but to increase the nausea, and produce most uncomfortable sensations in the bowels on the day after its exhibition. This I have invariably observed in the olden plan of treatment.The conclusions to be drawn from my experience of the sulphuric acid in the treatment of diarrhoea and dysentery, are as follows: 1st. It is more efficaciou8 than alkalies, opiates, and astringents, in a proportion greatly exceeding ten to one.2nd. It is more rapid in its action, (especially in O,hildren,) in a proportion greatly exceeding twenty to one. 3rd. It seems to act in a more rational and (if I may so express myself) scientific manner, by increasing the tone of the mucous membrane of the alimentary canal, rather than by simply astringing its pores.4th. The worse the case, the more rapid and mar-'vellous seems to be the cure,-a most striking feature as compared with the treatment by chalk and opium. I would urge, in conclusion, upon my medical brethren, the desirableness of giving this system a fair trial; and I would, moreover, advise them, instead of giving the acid alone, with water, to combine it with a little sugar and (most rare and excellent of all tinctures,) compound tincture of cardamoms, which seem greatly to relieve the so-frequent distressing flatulence. Unless the character of this autumnal epidemic should greatly alter, they will arrive at the conclusion, after having -tested fairly the acid plan of treatment, that it does not admit of comparison, but only of contrast, with the olden system. P.S. Since writing the above I have seen one case in which the acid failed. Chalk and opium carried the day.