Our study further supports the use of foam sclerosants including Polidocanol in BRTO, showing it is a safe and effective minimally-invasive procedure to treat gastric fundal varices in the short term.

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Surgical wound infection after a renal transplant procedure can lead to graft loss in the presence of host immunosuppression and graft exposure to the environment. Early cover of the wound with well-vascularized tissue will facilitate early wound healing and preservation of the graft. The pedicle anterolateral thigh perforator flap is a popular flap used for soft tissue reconstruction in the groin and perineum. We present a case of an anterolateral thigh flap used to cover an exposed transplanted kidney after surgical wound breakdown.

Right pulmonary artery-to-left atrial fistula is a rare congenital anomaly. Contrast echocardiography and cardiac catheterization diagnosed a right pulmonary artery-to-left atrial fistula in a 24-year-old female with a history of cyanosis since childhood, and recurrent thromboembolism. She underwent successful surgical closure of the fistula.

A 72-year-old gentleman was brought to the emergency department, after sustaining an allegedly accidental airgun-shot injury to the right side of his neck. A chest radiograph and plain CT chest revealed the bullet lodged deeply in the soft tissues of the right side of the neck. He was taken up for an emergency neck exploration for foreign

The delay reverse sural neurofasciocutaneous flap is used to reconstruct soft tissue defects in the lower third of the leg to improve outcome in patients with associated comorbidities such as diabetes mellitus, hypertension, hypercholesterolaemia, smokers and ischaemic heart disease. The author reports the use of a delayed reverse sural flap as soft tissue cover for a calcaneal defect in a patient with associated comorbidities who has an ipsilateral Gred 3C (Gustilo) tibial fracture after vascular reconstruction.

Background Resistance to antiplatelet drugs is a wellknown entity. However, data for aspirin and clopidogrel resistance, and its clinical significance, in Indian patients are meagre. Aims and objectives We sought to determine the prevalence of resistance to aspirin and clopidogrel in Indian patients with stable coronary heart disease (CHD), using the cone and plate(let) analyser (CPA) technology. Setting and design A single centre prospective study in a cohort of patients with stable CHD on chronic aspirin and clopidogrel therapy attending the cardiology outpatient clinic of a tertiary care hospital in Southern India. Methods Platelet function was measured using the Impact-R device (DiaMed, Cressier, Switzerland). Resistance to aspirin and clopidogrel was measured in a cohort of 100 patients with stable documented CHD. Relation of antiplatelet resistance to various clinical comorbidities was also assessed. Results Of the 100 patients, 85% were men, and 15% were above 65 years of age. 47% patients had diabetes, 29% of patients were hypertensive and 16% were smokers. Using the CPA, 12 patients (12%) were found to be resistant to aspirin and 19 patients (19%) were clopidogrel resistant. In addition, 10 patients (10%) were resistant to both aspirin and clopidogrel. There was no significant correlation between the presence of antiplatelet resistance and several baseline clinical variables, including age, sex, diabetes, hypertension and smoking. Conclusions Resistance to aspirin and clopidogrel and dual antiplatelet resistance are prevalent in Indian patients, comparable with the prevalence worldwide. The CPA is a feasible assay to determine antiplatelet resistance.

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