Background: Outcome of traumatic brain injury is multi factorial. It is common to follow up the conservatively managed patients with repeated CT scans at specific intervals. The study was to observe the epidemiology of TBI and ascertain utility of repeating CT scans in conservatively managed TBI.Methods: 318 patients with TBI admitted to a tertiary care center for a period of 1 year was studied. Adult patients, who have undergone multiple CT scans were included and patients underwent surgery or expired after first CT scan excluded. Personal details, clinical details and reason for repeated CT scan was studied. The change in management based on serial CT scans was measured as outcome.Results: Road traffic accidents were the cause of 69.1% of TBI. 72% of the patients were male. Commonest CT finding was occurrence of mixed lesions, seen in 44.3% patients. In patients who underwent repeated CT scans, the mean number of repeat CT scans were 3.7 CT (SD=1.001), while that of elective cases were 2.40 scans (SD=0.629). The use of routine CT scan for follow up did not alter the management of patients with TBI when compared to patients who underwent elective scans as none of them underwent any surgical intervention.Conclusions: RTA are commonest cause for TBI. Use of routine CT scans was not of advantage over elective scans as none of the patients had any change in management with use of repeat CT scans.

Continent cutaneous urinary diversion pouches are prone to complications like stoma blockage by mucus, metabolic derangements, infection, renal derangements and urolithiasis. Pouch urolithiasis is not uncommon, but presentation of a huge stone burden is rare. We report a case of giant pouch stones in a continent pouch which was a surgical challenge. We also highlight the need for adequate hydration, pouch irrigation and drainage by clean intermittent catheterization and regular follow-up, to prevent such a condition from arising.

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In the mid-twentieth century, Ontario abandoned a simple, full indemnity costs rule in favour of a discretionary, partial indemnity costs regime with hundreds of sub-rules. This article argues that this was a mistake. Partial indemnity has no doctrinal, principled, or practical benefits that cannot be incorporated into a full costs regime. Additionally, partial indemnity carries significant costs to access to justice. Instead, this article proposes a costs regime that incorporates the best features of both the old rule and the new regime. In brief, it proposes a full indemnity rule; capped at the losing party’s costs; with exceptions for divided success, impecuniosity, and public interest cases; and discretionary fines for engaging in misconduct or dilatory tactics. Collectively, these rules would advance access to justice more than the existing costs regime.