MRI is a useful and effective tool in the diagnosis of radiologically occult wrist injuries. It is feasible to do MRI scans in a timely manner in a district general hospital.

Introduction Gastrografin (GGF) is a radiopaque contrast medium commonly used for diagnostic examination of the gastrointestinal (GI) tract. Available evidence suggests it has therapeutic and predictive value in the management of adhesional small bowel obstruction (ASBO). Thus, we investigated the use of GGF amongst patients who had a small bowel obstruction and audited the practice in University Hospital, Ayr. Methods Initial retrospective data of patients who had gastrografin for small bowel obstruction were extracted from April 2015 to August 2019 and analysed. After our local presentation and on implementing a GGF protocol, we prospectively collected data from February to June 2020 to close our audit. Results GGF showed a comparable therapeutic effect on ASBO in both audit cycles (72.2%-66.7%). Approximately 50% of unresolved cases were operated within 24 hours of GGF administration in both cycles. GGF consistently demonstrated a therapeutic benefit in refractory faecal impaction (100% in both cycles) and postoperative ileus (≥ 80%). Early use of computed tomography (CT) (less than 24 hrs) did not confer any added advantage (82.5% v 61.5%), however, it helped in making an appropriate diagnosis and the subsequent early gastrografin usage (78.3% v 92.3%) in ASBO. Conclusion GGF serves a very good therapeutic purpose in resolving ASBO, refractory constipation, and in rare non-resolving cases of postoperative ileus. Early CT diagnosis of ASBO is advocated before the administration of gastrografin. Unsuccessful resolution after 24 hrs of GGF is an indication for operative intervention.

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Varicose veins, one of the oldest known diseases of mankind were treated by various modalities starting from simple phlebotomy to minimally invasive approaches. Aim and Objectives: In this study the outcome of two surgical treatment modalities of varicose surgery with and without venous stripping was compared based upon a follow up period of two months. Materials and Methods: Among the 92 patients operated for varicose veins between September 2018 to November 2019 in all surgical units of Trichy SRM Medical College Hospital, S50 patients of age group 16 -70 yrs were taken up for the study after matching. Results: In this study males contribute the maximum bulk of about 82%. As for as the age is considered, patients aged between 40 -70 yrs was more, which was about 58%.The hematoma formation after venous stripping was 28% whereas it was only 4% in the other group. There was no significant difference in healing of leg wounds in both the studies The first postoperative comfortable ambulation with minimal pain was possible in more patients who did not undergo venous stripping (92%) than who underwent stripping (68%).Long postoperative stay of more than 6 days was found in 8% of those who underwent stripping and 4% of the other group. The long stay was mostly due to pain and delayed wound healing. Pain relief was seen in 96% of those who had venous stripping and 88 % of those who did not undergo venous stripping at the end of second month. Conclusion:This study on observation concludes there was no significant difference in healing of leg wounds, hospital stay and pain relief in both the studies, but the Trendelenburg procedure with incompetent perforators ligation without venous stripping appears to be better than Trendelenburg procedure with incompetent perforators ligation with venous stripping.

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An 85-year-old man with no previous laparotomies and no herniae presented with a small bowel obstruction. CT imaging did not suggest any obvious cause; however, a transition point at the terminal ileum was noted. At laparotomy, the small bowel was unexpectedly found to be obstructed through a tight anterior hiatal defect. No resection was required and the defect was closed. On retrospective review of the CT images, the herniated small bowel can clearly be seen anterior to the oesophagus and can also be appreciated as a retrocardiac air–fluid level on chest X-ray (initially felt to be a small type I hiatal hernia). Our case highlights the surgical axiom that in patients with small bowel obstruction with no scars and no herniae consideration should be given to an unusual or sinister cause.

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Background: Research is integral part of post graduate studies. Informed consent is a vital ethical and regulatory requirement for the conduct of biomedical research.Methods: Mixed methods study was carried out from July to August 2017. Cross sectional part constitute quantitative component and forced field analysis (FFA) forms qualitative part. Approval from the institutional ethical committee was obtained. Pre-designed, validated, structured questionnaire was used to gather information from 114 participants about knowledge, attitude and practice (KAP) regarding informed consent process. FFA was employed to understand driving and restrictive forces in obtaining informed consent from the research participants.Results: Out of the 114 study participants majority participants were males i.e. 69.3% and pursuing post-graduation in clinical subjects. There is significant association between knowledge (p=0.008), attitude (p=0.032) among postgraduates from clinical and nonclinical departments. Among clinical 51.7% and 48.3% among non-clinical have good knowledge and 67.7% among clinical and 32.3% among non-clinical have good practice. Main driving forces for informed consent process identified during FFP were ICMR guideline for biomedical research, feeling morally right to inform the participants about what the research. Main restrictive force was fear of losing the participant due to signing on informed consent.Conclusions: There is good knowledge among postgraduates about informed consent process however there is scope of improvement in attitude and practice. Ethics training should address how to build trust with research participants and how to overcome the fear of losing the study subject.