Friarage Hospital

Abstract Aim Acute severe gastrointestinal bleeding is a major cause of mortality, with fatality rates of 10% for upper GI bleeding (UGIB) and 3% for lower GI bleeding (LGIB). The Oakland score, with cutoff of ≤8, identifies low-risk patients suitable for discharge. This study aims to assess compliance with British Society of Gastroenterology (BSG) guidelines in managing ALGIB. Methods A retrospective single-centre study included 79 adult ALGIB patients managed by general surgery between September 1 and October 31, 2024. Data were retrieved from electronic records and analyzed using Excel and SPSS. Results The mean age was 65 years (range 28–97 years) with a 1:1 male-to-female ratio. Causes included haemorrhoids (21.5%), diverticular disease (17.7%), inflammatory bowel disease (13.9%), malignancy (10.1%) and others (radiation proctitis and infective colitis). Shock index and Oakland score documentation were 0% and 10%, respectively. Of seven CT angiograms, 43% were positive. The mean Oakland score was 16 (range 5–32), correlating with hospital stay and transfusion need. Four patients with an Oakland score ≤8 and 31 with scores >8 were discharged. Blood transfusion was required in 21% cases. Of six patients receiving tranexamic acid (TXA), three required transfusion, two had endoscopic intervention, one underwent embolisation, and one required surgery. Follow-up colonoscopy was performed in 43%. No 30-day mortality or readmissions reported. Conclusion Management of ALGIB showed poor adherence to BSG guidelines, including inadequate documentation, inappropriate discharges, and low follow-up colonoscopy rates. TXA use was limited, with mixed outcomes. Improvements in guideline compliance are needed to enhance care.

English anatomical terminology has evolved over the long history of anatomical practice, with major influences from ancient Greek, classical Latin, Arabic, and post-classical Latin. Beginning in the nineteenth century, there have been various attempts to standardise and rationalise anatomical language, beginning in 1887, and culminating in the publication in 2019 of the second edition of the Terminologia Anatomica. This paper presents a brief historical overview of the development of anatomical terminology and usage in English, followed by a summary of the results of an anonymised survey of current practices that was sent out by email to anatomy educators at 45 medical schools in the United Kingdom. This is followed by personal reflections by six senior academics and/or clinicians, reviewing their extensive experience of teaching, researching, and communicating the language of anatomy within United Kingdom medical and clinical institutions.

BackgroundChronic pain can disrupt the cortical representation of a painful body part. This disruption may play a role in maintaining the individual’s pain. Tactile acuity training has been used to normalise cortical representation and reduce pain in certain pain conditions. However, there is little evidence for the effectiveness of this intervention for chronic low back pain (CLBP). The primary aim of this study was to inform the development of a fully powered randomised controlled trial (RCT) by providing preliminary data on the effect of tactile acuity training on pain and function in individuals with CLBP. The secondary aim was to obtain qualitative feedback about the intervention.MethodsIn this mixed-methods pilot RCT 15 individuals were randomised to either an intervention (tactile acuity training) or a placebo group (sham tactile acuity training). All participants received 3 sessions of acuity training (intervention or sham) from a physiotherapist and were requested to undertake daily acuity home training facilitated by an informal carer (friend/relative). All participants also received usual care physiotherapy. The primary outcome measures were pain (0-100visual analogue scale (VAS)) and function (Roland Morris Disability Questionnaire (RMDQ)). Participants and their informal carers were invited to a focus group to provide feedback on the intervention.ResultsThe placebo group improved by the greatest magnitude for both outcome measures, but there was no statistically significant difference (Mean difference (95%CI), p-value) between groups for change in pain (25.6 (-0.7 to 51.9), p = 0.056) or function (2.2 (-1.6 to 6.0), p = 0.237). Comparing the number of individuals achieving a minimally clinically significant improvement, the placebo group had better outcomes for pain with all participants achieving ≥30% improvement compared to only a third of the intervention group (6/6 vs. 3/9, p = 0.036). Qualitatively, participants reported that needing an informal carer was a considerable barrier to the home training component of the study.ConclusionsThis pilot RCT found tactile acuity training to be no more effective than sham tactile acuity training for function and less effective for pain in individuals with CLBP. That the intervention could not be self-applied was a considerable barrier to its use.Trial registrationISRCTN: ISRCTN98118082

Key content Torsion of the ovary, tube or both is estimated to be responsible for only a small number of all gynaecological emergencies, but is a common diagnostic challenge in the emergency setting. Diagnosis can be difficult and is mainly based on clinical symptoms and imaging techniques such as ultrasound and MRI. A normal ultrasound scan does not exclude adnexal torsion and the decision to operate should be made on clinical grounds if symptoms are severe. Treatment is traditionally surgical removal of the ovary or adnexum, however, there is increasing evidence for conservative surgery, such as de‐torsion and oophoropexy, particularly in younger women. This article provides an overview of the symptomatology, ultrasound diagnosis and classification, as well as treatment options for ovarian torsion. Learning objectives To understand the clinical presentation and ultrasound characteristics associated with ovarian torsion. To review the literature on the available surgical options. Ethical issues Oophorectomy is commonly performed for adnexal torsion with a possible negative impact on fertility in women of reproductive age. De‐torsion is a more conservative surgical approach that should be considered in all younger women with ovarian torsion.

Nonspecific clinical presentations often lead to misdiagnosis of focal cysticercal myositis. This report emphasizes the role of ultrasonography and magnetic resonance imaging (MRI) in the diagnosis of solitary intramuscular cysticercosis. Six patients with persistent post-traumatic isolated muscular swelling were treated with analgesic and antibiotics, but the swelling did not subside. Radiographs showed soft tissue swelling with no bony abnormalities. Laboratory markers were inconclusive. Ultrasonographic and magnetic resonance images (MRI) showed typical features of intramuscular cysticercosis. Clinical, radiological, and fundoscopic evaluation of brain and eyes could not isolate any cysticercosis focus in these organs. Patients were treated with 3 weeks albendazole therapy. The identifying sonographic features of intramuscular cysticercosis, as evident from this case series, included an intramuscular elliptical or oval anechoic lesion with echogenic intralesional focus likely to be scolex. Magnetic resonance images showed orientation of the cyst along the direction of muscle fibers with T2W hyperintense signal and post-contrast perilesional enhancement. All patients responded to medical treatment. Cysticercosis may manifest as isolated muscular swelling without neurological or ocular involvement. Clinicians should be aware of this clinical condition to avoid misdiagnosis. Ultrasonography and magnetic resonance imaging are good diagnostic aids to establish soft tissue cysticercosis.

Tripathy, Sujit Kumar MS, DNB, Dip SICOT; Goyal, Tarun MS, DNB; Sen, Ramesh Kumar MS, DNB, PhD Author Information