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Introduction: Blunt chest trauma contributes to a significant number of trauma admissions globally and is the leading cause of morbidity and mortality. Although numerous scoring systems and risk factors for prognosticating blunt chest trauma have already been developed, we are still lacking a gold standard in this field. Aim: This study was conducted to reassess the significance of available scoring systems and other indicators of severity in prognosticating blunt chest trauma. Materials and methods: This prospective observational study analyzed 50 patients over 12 years of age who suffered a blunt chest trauma and required hospitalization in the period between November 2016 and March 2018. the following nine risk factors were assessed: age of the patient, time of presentation after injury, number of ribs fractured, presence of bilateral thoracic trauma, evidence of pulmonary contusion, associated extra-thoracic injuries, the need for mechanical ventilation, as well as the results of Revised Trauma Score (RTS) and Modified Early Warning Sign Score (MEWS). the severity of blunt thoracic trauma was divided into three categories - SIRS, ARDS and death. Data was analyzed with the use of statistical software package SPSS v22.0. Results: The age of 50 patients included in our study ranged from 15 to 76 years old, while the median value was 35.5 years old. Statistically significant correlation was observed between the SIRS occurrence rate and multiple rib fractures (p-value - 0.049), associated extra-thoracic injuries (p-value - 0.016) and higher MEWS score (p-value - 0.025). Statistically significant correlation was also observed between the rate of ARDS occurrence and all risk factors excluding age. Mortality was higher among patients with delayed presentation to hospital (p-value < 0.001), multiple rib fractures (p-value - 0.001), presence of bilateral thoracic injury (p-value < 0.001), associated extra-thoracic injuries (p-value - 0.004), as well as in patients who required ventilatory support (p-value < 0.001) or demonstrated low RTS (p-value - 0.006) and high MEWS (p-value - 0.005) on admission. This correlation was found to be statistically significant. Conclusion: High MEWS, associated extra-thoracic injuries and multiple rib fractures are good predictors of poor clinical outcome in terms of SIRS, ARDS and death. Aggressive treatment protocols should be established in order to achieve better outcomes in these patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to evaluate the short-term results of Trendelenburg operation with stripping of GSV with minimally invasivesubfascial endoscopic perforator surgery (SEPS) in the management of varicose veins. This combined approach is known as hybrid technique. Methods: This is a single centre prospective study conducted from 1 November 2018 to 31 March 2020.All Patients of = 18 years with varicosity of Great saphenous vein (GSV) with saphenofemoral junction (SFJ) incompetence with multiple perforators in the legdocumented by colour doppler studywere included. This study included 30 patients with chronic venous insufficiency (CVI), who underwent hybrid technique (saphenofemoral flush ligation with stripping with minimally invasive SEPS) as part of themanagement of their CVI. Results: The mean number of incompetent perforators identified intraoperatively (3.77±0.62) was more than perforator identified preoperatively (3.23±0.67) on Doppler study. The mean pain score at 24 hours after surgery as per the visual analogue scale (VAS) was 4.67. The mean duration to return to normal daily activities was 2.43 days. Surgical site infection (SSI) was seen in only two patients (6.67%). Two patients(6.7%) had persistence of incompetent perforator veins ateight weeks postoperatively, as demonstrated by Doppler USG.Out of 6 patients with venous ulcer, five patients (83.3%) had complete healing of the ulcer at 8 weeks postoperatively while one patient (16.6%) had partial healing of the ulcer at eight weeks postoperatively. No improvement in skin changes was observed in the majority of these patients at eight weeks postoperatively. Conclusions: Hybrid technique (Trendelenburg operation with stripping of GSV with SEPS) has been found to be effective in the management of primary varicose veins in terms of reduced hospital stay, better yield of perforators, better ulcer healing, minimal post-operative pain, and less post-operative recurrence. [ABSTRACT FROM AUTHOR]

Objectives: Aim of this study is to determine the incidence, etiological factors, demographic profile, mechanism of injury, anatomical distribution, diagnostic methods, management and outcome of hollow viscus perforation due to abdominal trauma. Methods: This is a prospective study, including patients with abdominal trauma leading to hollow viscus perforation admitted to Dr. Ram Manohar Lohia hospital New Delhi, over a period of 3 years (January 2016 to December 2018). A total of 105 patients with hollow viscus injury due to abdominal trauma, who underwent laparotomy in our institute, were reviewed for various parameters. Results: Out of 105 patients, 88.5% were male, and 11.5% were female. The mean age of patients was 31 ± 14.12 years. The most common site of injury was jejunum (34.2%), followed by ileum (20%). Blunt trauma abdomen was the most common mechanism of injury (46.9%), followed by a road traffic accident (28.2%). Free gas under the diaphragm on erect abdomen radiography was seen in 80% of cases, while preoperative CT Abdomen was done in 45% of cases. Treatment consisted of simple closure of the perforation (58.2%), resection and anastomosis (21.8%) and stoma formation (14.2%). The major complications were burst abdomen (5.32%), stitch abscess (17.8%), sepsis (14.7) and anastomotic leak (2.9%). The average hospital stay was 13±6 days. The overall mortality rate was 22.8%. Conclusion: Early recognition of intestinal injuries from abdominal trauma is very important due to its great life-threatening potential. Age of the patient, associated injuries, anatomical site and time of presentation are probably the main prognostic factors in terms of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Ileosigmoid knotting is a rare cause of intestinal obstruction. It is also called as compound volvulus or double volvulus. It is caused by the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa. It is a rapidly progressive condition, leads to acute intestinal obstruction and gangrene in ileum as well as in the sigmoid colon. Early diagnosis and intervention is the key to a better outcome. Due to the rarity and unfamiliarity of this entity, diagnosis is usually made intraoperatively. Surgical removal of the gangrenous segment with either stoma formation or anastomosis is the only hope. An additional systemic search of the literature was done in PubMed, MEDLINE, ISIS, Embase, and CAS searches with the following free text keywords: ileo-sigmoid knotting, ileosigmoid knotting, intestinal knotting, compound volvulus and double volvulus in English literature. Around 64 studies were identified, out of which 38 studies were selected for this article after the removal of duplicates and unrelated articles. These case series and reports were reviewed for aetiopathogenesis, presentation, diagnostic modalities, surgical interventions, and outcome. Along with this review article, there was a case report of Ileosigmoid knotting in a 38-year-old male patient that presented in the surgical Emergency Department; with complaints of generalised pain and distention of abdomen for two days. Also, he had complained of not passing flatus and motion for two days. On examination, patient had generalised tenderness and bowel sounds were absent. X-ray abdomen showed dilated small and large bowel with multiple air-fluid levels. After resuscitation, an emergency exploratory laparotomy was done, and the diagnosis of ileosigmoid knotting with gangrene of both ileum and sigmoid colon was made intraoperatively. After resection of both gangrenous segment, colocolic anastomosis and double barrel ileostomy was performed. The postoperative course was uneventful, and patient was discharged on 7th postoperative day. [ABSTRACT FROM AUTHOR]

Addison's disease was first described by Thomas Addison in 1855. He demonstrated the destruction of bilateral adrenal gland by tuberculosis (TB) in six patients. Since then, the incidence of TB has declined in the Western world, but in developing countries, it is still the most common cause of adrenal insufficiency. Because of the introduction of antituberculous chemotherapy, the incidence of adrenal TB has been declined in the past decades. The most common symptoms are nonspecific; therefore, diagnosis is often delayed, and patients may first present with a life-threatening adrenal crisis. The most commonly identified organism for adrenal failure in adrenal TB is Mycobacterium tuberculosis infection. Adrenal TB involves bilateral adrenal glands more frequently than unilateral glands. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are useful investigations to differentiate between tuberculous Addison's disease and the other causes of adrenal insufficiency. In CT scans or MRI, features of adrenal TB are bilateral adrenal enlargement and peripheral rim enhancement with or without calcifications. Antituberculous drugs, biochemical monitoring of adrenal function, and steroid therapy are essential for the management of adrenal TB and adrenal insufficiency. Here, we describe a case of adrenal TB with abscess formation followed by a review of the current literature of adrenal TB for better diagnosis and management of this condition., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)