Background Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. Methods In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964.

Excessive self-medication with over-the-counter drugs is an issue commonly encountered by health care professionals. It can result in uncommon presentations of life-threatening illnesses. These medications are frequently overlooked by clinicians when taking histories from patients, and their risks are often downplayed. We present the case of a 35-year-old woman with acute pancreatitis secondary to hypercalcemia. This condition occurred due to long-term excessive self-administration of calcium-rich antacid tablets. Her clinical course involved multifactorial rebound hypocalcemia after treatment and multiple complications from the abuse of other non-prescription medications. Acute pancreatitis secondary to antacid-induced milk-alkali syndrome has been minimally reported in the literature. There are no reports describing rebound hypocalcemia as a complication of its treatment or presenting this pathology in the context of multiple over-the-counter drug abuse. This case highlights the importance of taking thorough drug histories, including non-prescription medications, in acute clinical assessments.

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We present an unusual case of a 60 year old male who was noted to have primary hypothyroidism and decreased consciousness which did not respond to Levothyroxine. Further investigations revealed a diagnosis of Hashimoto’s Encephalopathy which responded well to steroids. We describe the case in detail and discuss the available relevant literature on this topic.