bluuebunny/crossref_metadata_2025 huggingface dataset:
FP3.10 - Do endoscopic tattoos upstage colorectal cancers?
Authors: Lim William , Chaudhury Madhu P , Manatakis Dimitri , Peristerakis Ioannis X , Kearsey Christopher C
Published: September 2024

Aims

Endoscopic tattooing in suspected bowel cancer is encouraged in all lesions >2cm by the national bowel cancer screening guidelines. However, a known risk of the procedure is tumour cell seeding leading to upstaging of cancers. Our aim is to investigate the relationship between endoscopic tattoos and recurrence rates. Additionally, we aim to investigate if overall survival (OS) is affected by endoscopic tattoos.

Methods

Data was collected retrospectively using electronic medical records (EMR) on all patients with colorectal cancer who had a resection between January 2017 and May 2021 (n=614) in our local trust. Data was also collected on patient demographics, site of tumour, type of resection, whether an endoscopic tattoo was applied or not, length of follow-up, recurrences, outcomes of recurrences and all-cause mortality.

Results

3 patients were excluded due to lack of information on EMR. In our cohort, the male:female ratio was 1.41:1. Patients ranged from 22-92 years old. 33.7% (n=206) of patients had an endoscopic tattoo and 66.3% (n=405) did not. At the time of data collection, 24.5% (n=150) of patients had a recurrence. Of these, 28.7%(n=43) had tattoos and 71.3% (n=107) did not.

Conclusions

Statistical analysis showed that OS remained similar in both groups (tattoo versus non-tattoo). However, we found that patients who had an endoscopic tattoo were less likely to have a recurrence (longer disease-free survival) than those who did not. Although this was not statistically significant, we can conclude from our study that endoscopic tattoos do not appear to upstage colorectal cancers.
FP4.4 - Everything is not always as it seems – Discordance between cross-sectional imaging and pathology. A case report
Authors: Thompson Luke , Fultang Joshua , Schmigylski Rudi , Nale Krsty , Maruthachalam Karthik
Published: September 2024

Cross-sectional imaging of colonic pathology is usually correlated with other investigations such as optical colonoscopy (OC) prior to surgical treatment. In situations such as acute inflammation, this is not possible and surgery is undertaken based on cross-sectional imaging without histopathological confirmation.

This case reports describes a 78-year-old female who presented with progressive shortness of breath associated with fatigue and unintentional weight loss. Initial bloods demonstrated a normocytic anaemia (Hb 105g/L, MCV 86fl), raised D-dimer (3460ng/mL) and raised C-reactive protein (133mg/L) with normal white cell count (8.6 x109/L). An unprepared computed tomography (CT) of the abdomen and pelvis revealed extensive bowel thickening in the caecum with radiological appearances consistent with a primary caecal malignancy. Preoperative colonoscopy was not performed as suspicion of perforation on CT imaging precluded the use of mechanical bowel preparation.

Preoperative optimisation of the patient was commenced and an elective right hemicolectomy performed. The patient had an uneventful post-operative recovery. Results on histopathology inspection revealed chronic xanthogranulomatous inflammation but no macroscopic or microscopic evidence of dysplasia or malignancy.

There continues to be an emerging role for the use of CT imaging, especially CT colonography, in the investigation and diagnosis of CRC. However, difficulty in distinguishing between malignant and non-malignant inflammation on CT endorses the quintessential place of OC with biopsy as the definitive investigation of CRC, especially if suspicion of CRC on unprepared CT. Xanthogranulomatous inflammation should be considered by clinicians, radiologists and pathologists as a differential diagnosis when CRC is suspected clinically and radiologically, without biopsy confirmation.
FP4.5 - An assessment of web-based patient information on bowel resection in Crohn's disease
Authors: Whitman Alexandra , Johnston Judith , Husnoo Nilofer
Published: September 2024

Aim

Most patients with Crohn’s disease (CD) have at least one bowel resection during their lifetime. 80% of patients with terminal ileal CD (the most common phenotype) will require a bowel resection at some point. Patients considering a bowel resection for CD will likely look for information online, as is common practice among patients with chronic illnesses. The aim of this study is to assess the quality and readability of web-based patient information on bowel resection for CD.

Methods

GoogleTM was searched using pre-defined search terms that were developed with input from patient experts. For each term, results from the first two pages were screened for eligibility. Patient-focused websites on bowel resection for CD were included. The quality of the information was assessed using the DISCERN tool, and the readability with the Flesch-Kincaid ease of readability (FK) score.

Results

Of the 118 sources identified, 91 were excluded and 27 sources were analysed. A third (n=10) did not discuss the different types of resections. Ileocaecal resection (the most commonly performed resection) was described in 7 sources. Discussion of management post-resection (n=7) and of lifestyle changes (n=12) were sparse. There were some instances of factually incorrect information. The mean DISCERN score was 3.2±0.31 (range 1-5), indicating moderate quality information. The mean FK score was 49.9 (corresponding to “difficult to read”).

Conclusion

Professional bodies and clinicians should work alongside patient groups to develop online sources which are in appropriate lay language and evidence-based, and suit patients’ informational needs to aid patient decision making.
FP5.13 - Implementing a Lumbar Puncture Teaching Course at a General District Hospital
Authors: Patel Minesh , Katsura Chie
Published: September 2024

Aim

Prior to our course, there had been no formal lumbar puncture (LP) teaching at the hospital. Furthermore, a pre-course questionnaire had determined 50% of respondents (9/18) were “not so familiar” OR “not at all familiar” in describing the steps involved in performing an LP. 72% (13/18) were “not at all” confident in conducting the procedure. As the need for practical LP teaching was noted, a course was devised to familiarise trainees with LPs and improve confidence.

Method

The course was implemented with supervision from the anaesthetics department at the hospital. This included an E-module, face to face simulation of consenting and practicing LPs on a back model. The course was offered to foundation trainees and medical students from several universities in the region.

Results

From the post-course questionnaire the following results had been gathered 1) 7 out of 9 participants reported that they were “very familiar” in performing the steps of an LP (78%) 2) 5/9 were now “moderately” confident in performing an LP 3) 78% were “very familiar” with the indications and contraindications of LPs.

Conclusion

The course had led to a significant improvement in the understanding and confidence in performing LPs among the participants. Simulated learning is an effective method of teaching complex practical skills to junior trainees. Further work includes inviting trainees from within the region and implementing an online demonstration as part of the E-module.
FP6.7 - Assessing knowledge and effective utilisation of incentive spirometer across surgical floor
Authors: Alaeq Ali , Costello Amy , Zino Samer
Published: September 2024

Aim

to assess the level of knowledge of healthcare workers providing incentive spirometer and instruction provided to patient.

Methods

Snapshot audit between 25&28/05/23 assessing the knowledge and practice using two for patient and staff questionnaires.

Inclusions criteria were all adult patients in surgical wards, all healthcare staff. Exclusion criteria were patients who did not receive a spirometer and patients or staff who were not willing to participate in the study.

Results

75% of staff provided incentive spirometers, 84% of them never received formal education or training in the use of incentive spirometer. Only one staff member (1.85%) answered all the questions correctly. 83% of patients were not given the correct instructions and approximately 16% were instructed to exhale.

Implemented Changes

A video created with e-link; explaining the use of incentive spirometer. Training of medical and nursing staff by presenting the project in our local departmental meeting, the results and poster emailed to health professionals. A new patient leaflet was created containing clear instructions, the video link, and a table to record their usage.

Random sampling showed significant improvement. The Second cycle will be conducted at beginning of the new year and the results will be presented at the conference

Conclusion

The lack of training led to incorrect instructions being given to patients. This could lead to false reassurance to the senior medical staff, by assuming that patients are using spirometers correctly which could delay recovery and discharge. Simple training has resulted in significant increase in knowledge and correct use of a spirometer. Checking the staff knowledge is recommended, especially in common daily practice
FP7.6 - Comprehensive Analysis of Emergency Laparotomy in the Geriatric Population: A Retrospective Study
Authors: Lee Shiela , Kok Yu Ying , Ting Nicholas , Thambi Prem
Published: September 2024

Aims

The British Society of Geriatrics recommends that all patients undergoing emergency laparotomy aged >= 65 who score more than 5 on Clinical Frailty Score (CFS) or >= 80 years with any CFS should receive comprehensive geriatric assessment within 72 hours of admission to a ward or step down from critical care. Despite substantial evidence outlining an improvement in postoperative outcomes, efforts to refer patients and record CFS are still insufficient. The aim of our study is to evaluate the use of CFS assessment in patients aged ≥ 65 years undergoing emergency laparotomy.

Methods

This was a retrospective audit of 94 patients aged ≥ 65 years old undergoing emergency laparotomy between September 2022 to October 2023.

Results

The mean age of the cohort was 75 years old. The average length of hospital stay was 21 days. 50% of patients were referred for an in-patient geriatrician review. The interval between surgery and geriatrician referral averaged 7 days. However, the average duration between geriatrician referral and assessment only spanned 1 day. CFS were recorded for only 11% of patients during their hospitalisation, pointing to an area for potential improvement.

Conclusion

Understanding the factors contributing to prolonged stays is pivotal in enhancing postoperative care. These insights not only shed light on the procedural intricacies surrounding emergency laparotomies in the elderly but also highlight opportunities for refining patient care pathways and optimising interdisciplinary care.
FP7.9 - Caecal Volvulus with Ischaemia in Pregnancy Requiring Right Hemicolectomy
Authors: Gahunia Sukhpreet , Bayyari Abedalaziz , Kenington Cleo , Mohamed Yusuf Abdi Karim
Published: September 2024

Background

Caecal volvulus is a rare but significant pathology, accounting for 1-3% of all bowel obstructions. There are only 3 published case reports in pregnancy, and there is often a significant delay in diagnosis.

Presentation

A patient in her 30s was 22 weeks pregnant with her first baby conceived through IVF. She presented with a 2 hour history of severe epigastric pain and vomiting. Inflammatory markers were normal with lactate 3.5, which normalised after fluids. This was her third presentation of pain during pregnancy. She was treated as gastritis and kept in for observation. An ultrasound demonstrated free fluid with no cause. The patient remained in severe pain and repeat bloods demonstrated worsening inflammatory markers. By this time, MRI was no longer available so a CT occurred at 9pm which showed caecal volvulus with acute ischaemia.

Treatment

At emergency laparotomy, the diagnosis of caecal volvulus was confirmed with a non-viable ascending colon but no perforation or enteric contamination. A right hemicolectomy with ileocolic anastomosis was performed. She was admitted to ITU post-operatively, then stepped down to the ward on day 2 where she continued to make a good recovery and was discharged on day 5.

Conclusion

Caecal volvulus is a recognised cause of mechanical bowel obstruction in pregnancy but can be difficult to diagnose. Optimum outcome of surgical complications in pregnancy relies on optimum treatment of the mother. Pregnant patients with pain out of proportion to their clinical presentation need a low threshold for cross-sectional imaging, which should be discussed promptly with radiology.
FP8.1 - Environmental Sustainability and Surgery: what are the attitudes and barriers to implementing sustainable change in operating theatres? A Qualitative Study
Authors: Boag Katie , Chapman Stephen , Sara Xenia , Scarborough Oliver , Please Helen , Peckham-Cooper Adam
Published: September 2024

Aims

Sustainability in surgery is an increasingly important focus in the bid to halt climate change. This study aimed to better understand how environmentally sustainable change can be made in theatre environments by exploring attitudes of healthcare professionals and patients, and identifying barriers to implementing change.

Methods

A mixed-method qualitative study was undertaken involving a national survey of 157 healthcare professionals (HCP’s), and follow-up semi-structured interviews with ten HCP’s and five patients. Participants were targeted via the survey and public engagement mailing lists. Interviews were informed by a topic guide developed with responses from the survey. Data were analysed thematically and presented as major topic themes.

Results

100% of participants agreed that operating theatres needed to make sustainable changes and reduce waste. Respondents understanding of the key issues centred around physical waste production and its effect on climate change. HCP’s identified issues around infection prevention and challenging current behaviour, whilst patients focused on maintaining current standards. Barriers to change included safety concerns, current clinical pressures, single-use culture and the perceived resistance to change within the NHS. HCP’s identified staff habits, lack of information and patient expectations as a barrier, whilst patients identified cost to be the main issue.

Conclusions

This study provides key insights into the current attitudes and perceived barriers of HCP’s and patients to implementing environmental change in surgery and aligned working environments. These provide useful data to aid future change strategies and implementation and ensure effective sustainable changes are made and delivered in theatre environments.
FP8.2 - Sustainability Within the Abscess Pathway
Authors: Ho Ning Xuan , Innes Ailsa , Kammath Vipin , Ali Oroog , Dent Barry
Published: September 2024

Background

Global warming and the current climate crisis remain a threat to global health. It is estimated that 5% of the total carbon footprint of an acute NHS organisation was attributable to general anaesthetic (GA) gases, which contributes to ongoing ozone depletion.

Aims

To review current practices in managing abscesses and improve sustainability within the abscess pathway in our trust.

Methods

Retrospective data on all patients who underwent incision and drainages (I&D) between January – July 2022 were collected and analysed. A new abscess pathway was introduced in June 2023 and departmental teaching provided to junior doctors on incision and drainage of abscesses under local anaesthetic (LA). Data on patients who underwent I&D between June – September 2023 were collected and analysed to assess the impact of the new abscess pathway.

Results

In the first-cycle audit, 162 patients underwent I&D, of which 119 (92%) were done under GA. Of these, 71 (60%) were suitable for LA I&Ds, 91% were admitted for their procedures. The estimated carbon footprint was 4525kg CO2e/year. In the second-cycle audit, 68 patients underwent I&D, of which 37 (76%) were done under GA. Of these, 31 (46%) were suitable for LA I&Ds, 41% were admitted for their procedures. The estimated carbon footprint was 3735kg CO2e/year.

Conclusions

Following implementation of the new abscess pathway, we reduced the number of patients having general anaesthetic procedures and inpatient admission. This not only improves the sustainability of our practice, but makes treatment and recovery quicker for patients, and has a lower financial burden.
FP8.7 - Standardising Sustainability: Towards reducing single-use items in elective surgery
Authors: McFarland Elise , Steuart Lois , Gough Vivienne
Published: September 2024

Aims

To examine the prevalence of single-use items routinely given to patients undergoing surgery in 5 hospitals within a single health board and to propose interventions to improve environmental sustainability.

Methods

Systems in five hospitals were examined. Patients were shadowed through their pre and post-operative journey, observing the distribution of single-use items at each stage. Structured interviews were conducted with 52 patients and 79 nursing staff across the 5 sites.

Results

Process maps produced for each hospital found large variability in items given out routinely at each site e.g. disposable underwear, anti-slip socks, scrub hats, plastic storage bags and cups

85% of patients cared about the negative environmental impact of healthcare. The majority felt that disposable hats (65%), underwear (71%) and socks (75%) were unnecessary. Only 1 patient was against bringing their own items.

84% of staff thought an overuse of single-use items existed. However, most staff felt that disposable items were necessary sometimes. 84% though it was acceptable for patients to bring in reusable dressing gown, slippers, and water bottles.

Exploring potential barriers to using patients’ own items identified concerns around infection control, hygiene, and losing patient’s items.

Conclusions

Unnecessary variation in disposable item use in the surgical journey exists between hospitals. Patients and nursing staff agree that too many single-use items are used. Use of disposable items should be standardised and minimised to reduce waste, cost and improve environmental sustainability. Pre-operative instructions to patients should include bringing their own bags, slippers and water bottles.
FP8.12 - Theatre time utilisation in General Surgery at a district hospital in NHS
Authors: Arifuzaman Mohammed
Published: September 2024

Aim

To understand the operation theatre time utilisation in the Department of General Surgery at a busy district NHS hospital. The time spent in each step of surgery and operating list at large and understand the patterns of cancellations and its’ predictors.

Method

Retrospective study of all elective general surgical patients from 1 Dec 2021 to 15 May 2022. Emergency cases were excluded and statistics were performed on Statsdirect3.

Results

Total surgeries performed were 182 with 153 true and 41 false cancellations. Mean surgical time was 84.5 minutes (mean 73min) for all general surgical cases. Lap cholecystectomies had a mean time of 92.3mins, upper GI surgeries took 178.6mins (mean) EUA and other procedures was 30.86mins, inguinal hernia 77.2mins, umbilical hernia 68.5mins. Mean anaesthesia time was 33 mins (median 31mins). Theatre time utilised was 56.45%, anaesthesia time utilised was 15.85%, surgery time utilised was 40.60% and non-clinical time was 43.55%. Mean delay in sending for first patient was 31.58mins (median 29min). Delay in calling for first patient is statistically significant (p=0.00015) for cancellation for the last patient in the list. Mean gap in between 2 consecutive cases was 35.74mins (median 22min).

Conclusion

Delay in sending for the patient will lead to cancellation of the last patient on the list which is proven statistically. We utilised 82.19% of the total surgery days and cancelled 17.81% days. Non clinical time comprised of 43.55%.
EP16 - Local Excision of Rectal Cancer by Transanal Endoscopic Microsurgery (TEM) – Review of outcomes and completeness of surveillance
Authors: Sebregts Sara , Wood J
Published: September 2024

Aim

To review outcomes and completeness of follow-up for patients undergoing TEM for rectal cancer.

Method

Retrospective review of outcomes of all TEM cancer operations performed by a single surgeon. Where completion surgery was not indicated, adherence to local surveillance protocol was assessed.

Results

20 Patients underwent TEM for cancer from January 2014-March 2022. 55.0% (n=11) Had submucosal excision and 45.0% (n=9) full-thickness excision.

35.0% (n=7) Went on to have completion surgery, 40.0%(n=8) had surveillance only, 10.0% (n=2) received adjuvant treatment then underwent surveillance and 15.0% (n=3) declined further treatment/follow-up or were unfit.

Histology was T1 in 75.0%(n=15), T2 in 20.0% (n=4) and T3 in 5.0% (n=1). Of T1 cancers 40.0% (n=6) received completion surgery, 46.7% (n=7) surveillance only and 13.3% (n=2) declined further treatment or were too unwell. Of T2 cancers 25.0% (n=1) received completion surgery, 50.0% (n=2) were considered high risk for surgery and underwent adjuvant treatment then surveillance and 25.0% (n=1) surveillance only. The patient with T3 cancer declined anything further.

Overall recurrence during TEM surveillance was 30.0% (n=3). For T1 and T2 recurrence was 14.3% (n=1) and 66.7% (n=2) respectively. Two patients underwent salvage surgery, and one underwent palliative chemotherapy.

Of 10 patients in surveillance after TEM, 80.0% (n=8) have currently received up to date follow-up 20.0% (n=2) have not, due to patient choice.

Conclusion

All patients undergoing surveillance have been offered time appropriate follow-up tests. In this sample all patients received timely and appropriate treatment.
EP23 - A rare case of “Gastric Outlet Obstruction (GOO) Secondary to Hydrops of Gallbladder” caused by recurrent acalculous cholecystitis: a variant of Bouveret’s Syndrome -a rare case and review of literature
Authors: Haji Altaf , Elhassan Ali , Abraham John , Piramanayagam Bala , Lourdusamy Selvam , Haider SyedIjlal
Published: September 2024

We present an extremely rare case of gastric outlet obstruction (GOO) in a young male attributed to hydrops of the gallbladder resulting from recurrent episodes of acute acalculous cholecystitis. Remarkably, approximately one and half years prior to this presentation, the patient was diagnosed with confirmed acute acalculous cholecystitis and had tested positive for Covid 19, despite exhibiting no respiratory symptoms.

While it is established that Patients with acute acalculous cholecystitis can develop gallbladder mucoceles due to the mechanism akin to mechanical cystic duct obstructions. This functional condition leads to a non-emptying, distended gallbladder where biliary mucus replaces bile salts (1). Conventionally, hydrops of the gallbladder is associated with prolonged blockage of the cystic duct, often caused by an impacted gallstone in neck / cystic duct or a stricture in cystic duct.

Bouveret’s Syndrome, characterized by GOO results from the impaction of a large gallstone in the duodenum or pyloric channel, typically secondary to a cholecystoenteric fistula (2),is a recognized rare entity. However, our case stands apart as it elucidates an infrequently reported cause of GOO- hydrops of gall bladder inducing extrinsic compression of the duodenum / pylorus and this case also emphasizes the distinction from Bouveret’s syndrome.

This case underscores the importance of considering unusual etiologies in the diagnosis of GOO and emphasizes the need for timely recognition and intervention in such rare instances to ensure optimal patient outcomes. Additionally, we provide a comprehensive review of existing literature, highlighting the scarcity of reported cases with such relevant presentations.
EP33 - Nil by mouth in GI surgery: are we starving our patients longer than we need to?
Authors: Hern Daniel
Published: September 2024

Aim

Fluid intake preoperatively reduces postoperative nausea, vomiting and headache, and oral intake allows the patient to be metabolically active to respond better to surgery. However, a known risk to oral intake preoperatively is aspiration. Current guidelines state that a patient should be fasted from 6 hours preoperatively and should take clear fluids up to 2 hours preoperatively. We assessed how long GI patients admitted to the Surgical Assessment Unit (SAU) remained nil by mouth (NBM).

Method

Data was collected throughout November from SAU. Inclusion criteria was GI surgical patients and exclusion criteria was patients on home leave. We used electronic and paper notes to determine how long patients were kept NBM and their surgical outcome. We assumed that a patient was kept NBM from their admission (as per local protocol), until either noted to no longer be NBM, having surgery or being discharged.

Results

50 patients were identified. We found that only 20% of patients kept nil by mouth went on to have surgery. Of the remaining 80%, 60% were kept nil by mouth for >6 hours, with no surgical procedures.

Conclusions

Many patients are kept NBM unnecessarily. We need to reduce this as well as the time patients are starved. Furthermore, clearer documentation is needed for commencing patients NBM, and when they can resume eating. We can move away from the culture of prolonged fasting in surgical patients by improving organisation and planning as well as increasing education on preoperative fasting.
EP45 - Improving Management of Patients undergoing Inguinal Hernia Repair Who Experience Post-Operative Urinary Retention
Authors: Laurie Alex , Spellar Kayleigh , Bunting David
Published: September 2024

Aims

Post-operative urinary retention (POUR) is a common complication following inguinal hernia repair. Left untreated POUR can result in significant patient discomfort, acute kidney injury, detrusor muscle damage and infection. It was observed that the detection and management of POUR in our trust following planned day case inguinal hernia repair was varied, often resulting in unplanned admission. We therefore carried out a review of how our trust is managing these patients.

Methods

A retrospective analysis of all patients undergoing planned day case inguinal hernia repair in a single institution between March 2023 and August 2023 was performed. Patients having open, laparoscopic, or robotic repair were included. Data was collected on demographics, documentation of POUR, time to diagnosis, bladder scan volume, catheterisation, overnight stay and follow up for all patients.

Results

124 patients underwent inguinal hernia repair. 13 patients reported experiencing POUR (10.4%). 9 patients experienced POUR during their initial admission, of which 8 had unplanned overnight admissions. 5 patients were not managed with catheterisation despite having significant volume of urine detected on bladder scan (>700ml). Time to diagnosis varied with POUR not being detected for 24 hours for one patient. 4 patients went into retention after discharge and re-presented via the emergency department.

Conclusion

Significant variation in the detection and management of patients with POUR was noted in this cohort. Introduction of a POUR pathway in day-surgery describing both diagnosis and management has therefore been created to try and address this, to improve outcomes and reduce hospital admission.
EP51 - Uses of pharmaceutical and mechanical VTE prophylaxis - A clinical audit
Authors: Ravendran Kapilraj
Published: September 2024

Aim

Venous thromboembolism (VTE) is a serious global health care safety concern for both patients and staff. Although it has been amply demonstrated that pharmaceutical and mechanical methods of prophylaxis against VTE are effective, their application has been uneven and insufficient. The purpose of this audit was to assess junior physicians working in general surgery, regarding their adherence to local and NICE guidelines regarding the pharmacological VTE prophylaxis practice as well as the mechanical prophylaxis

Methodology

Pre-intervention audit took place for two weeks. Throughout the course, it covered every adult general surgical emergency inpatient admission at conquest hospital who were deemed indicated for VTE prophylaxis.

Each evening while the patients were still in the hospital, data was collected using the prescription charts, nursing and medical notes. The proforma used for data collection detailed the characteristics of VTE risk, the prophylactic medication prescribed for each patient, TED stockings and whether or not this aligned with the NICE clinical guideline (CG) 46,6.8.

Post intervention took place for two weeks after teaching of junior doctors and the same as above was carried out, using the new proforma

Results

Pre-intervention showed that 87% of patients had the proforma filled in and 100% of patients received the appropriate dose of pharmaceutical prophylaxis. However, less than 40% of patients received the appropriate mechanical prophylaxis. Therefore, intervention was made in the form of a new proforma and teaching to junior. Post intervention data is currently being carried out

Conclusion

Implementation was necessary to ensure that at-risk patients receive appropriate prophylaxis.
EP142 - "Unravelling the Enigma: Navigating the Diagnostic Dilemma of Abdominal Toxoplasmosis"
Authors: Anwar Kehkashan , Talal Muhammad Nasir , O’Connor Adam , Ullah Sana
Published: September 2024

Introduction

Abdominal toxoplasmosis, an infrequent yet medically significant manifestation of Toxoplasma infection, primarily caused by the protozoan parasite Toxoplasma gondii. Although toxoplasmosis can affect various organs, its occurrence in the abdominal region introduces unique diagnostic complexities, presenting symptoms such as abdominal pain, gastrointestinal disruptions, and systemic complications.

Case Report

In a notable case, a middle-aged patient presented with perplexing gastrointestinal symptoms, including nausea, vomiting, abdominal pain, and irregular bowel habits. With a history of anaemia and thrombocytopenia necessitating transfusions and yielding inconclusive bone marrow biopsies, the patient underwent OGD and colonoscopy with biopsies during initial management, revealing a hiatus hernia and diverticulosis that did not explain the symptoms. Despite being discharged pending biopsy results, subsequent normal findings failed to clarify.

Upon readmission with persistent gastrointestinal complaints, a CTAP revealed two suspicious neoplastic focal areas of small bowel wall thickening and enlarged mesenteric lymph nodes. The MDT discussions ensued to rule out malignancy, leading to a follow-up PET scan suggesting nodal disease, raising concerns about lymphoma, small bowel adenocarcinoma, or carcinoid tumour and recommended an ultrasound-guided lymph node biopsy, 5 HIAA if asymptomatic, and diagnostic laparoscopy if symptomatic or obstructed.

Subsequent core biopsy of a neck lymph node unveiled appearances consistent with toxoplasmosis, prompting treatment with anti-parasitic drugs. The patient awaits capsule endoscopy, and a follow-up CT scan displayed a reduction in bowel lesions and lymph nodes.

Conclusion

This case highlights the swift and precise identification of toxoplasmosis, resulting in an optimal patient outcome. The clinical manifestations of toxoplasmosis are diverse and lack distinct characteristics, making it challenging to definitively diagnose, particularly in immunocompetent individuals.
EP191 - Laparoscopic right hemicolectomy in a patient with malrotation of bowel and ascending colon tumour
Authors: Pal Shreya , Pangeni Anang , Nai Shaun , Aravind Biju
Published: September 2024

Aims

Ascending colon (AC) tumour in a patient with malrotation of bowel can present diagnostic and surgical challenges.

We present such a case managed by laparoscopic resection, and share the difficulties encountered and our preparation to achieve a good outcome

Methods

A 72-year-old female with iron deficiency anaemia underwent CT colonography after an incomplete optical colonoscopy. The scan revealed malrotation, a pelvic caecum and a midline ascending colon, and a lesion suspicious of cancer in ascending colon with a CT staging of T3N0M0. Patient was scheduled for elective laparoscopic right hemicolectomy.

Results

Review of vascular anatomy was carried out with radiologist. Several modifications to standard procedure was used – first port-entry site, number of ports, plan of dissection, and site of specimen extraction. Additional challenges were due to the high BMI (40 kg/m2).

Patient was discharged on day-7 without major complications.

Conclusion

Multidisciplinary discussion, optimal pre-operative preparation, and thorough understanding of the vascular profile leads to successful management of these rare presentations by minimally invasive surgery. Pre-operative CT-scan is essential before planning surgical management. Laparoscopic right-hemicolectomy although challenging, can be successfully performed with appropriate expertise.
EP334 - What does ERAS mean to foundation doctors?
Authors: Pereira Fiona , Kynaston Liam , Chaudhary Osman , Torrance Andrew
Published: September 2024

Aims

To quantify the Enhanced Recovery After Surgery (ERAS) protocol knowledge of foundation doctors on the general surgical rotation from August 2023 to December 2023. ERAS protocol has decreased recovery time, length of stay, complications, and readmission rates. [1] ERAS protocol can be categorised into 5 domains: diet, pre-operative medications including bowel preparation, post-operative medications including nutritional drinks, mobilisation, and discharge. Foundation doctors should be aware of the details within ERAS protocol.

Methods

Survey questions were devised alongside a senior registrar to probe foundation doctors understanding of ERAS protocol. The questions were either single best answer questions out of 5 or had multiple correct answers. Foundation doctors who worked on general surgery between 2nd August 2023 and 5th December 2023 undertook this survey, carried out from 6th December 2023 to 28th January 2024. There were 10 respondents to the survey, out of 21 foundation doctors.

Results

Out of 10 surveys, foundation doctors correctly answered 47% of questions, with scores ranging from 36% to 57%. On further sub analysis the lowest scoring domains were mobilisation (21%), medication (post-op) (23%), and medication (pre-op) (50%).

Conclusions

Foundation doctors should have more knowledge of the ERAS protocol to improve the quality of patient care. Our proposed method of improving this involves presenting study findings and the ERAS protocol to foundation doctors at the next departmental Clinical Governance meeting, alongside ERAS nurses and senior team members. We aim to re-audit to identify whether an ERAS induction makes a difference to their understanding of ERAS.
EP366 - A single surgeon experience of total extraperitoneal inguinal hernia repair in a district general hospital
Authors: Azam Muhammad , Elshazly Mohammed , Jmor Sabah
Published: September 2024

Methods

This was a retrospective review of a prospectively collected and maintained data on elective TEP hernia repairs. All theatre list has been collected prospectively. All patient who had inguinal hernia repair between 2004 and 2021 has been identified from the list. The notes of all Patients who had laparoscopic hernia repair were reviewed including the operative notes, postoperative complications, and any subsequent referral to the surgical department at the Trust to see any recurrence. The data collections included age, sex, type of the mesh, fixing device, primary or recurrent, unilateral or bilateral and conversion to open procedure. Since 2014 all notes were electronic and restored on evolve application.

Result

All patients records were retrieved from the electronic database system. Out of this cohort, some of patients records were missing. The mesh was not fixed in primary hernia if it was small or medium size, but it was fixed in primary large direct hernia to reduce the risk of blowing in of the mesh inside the defect. Our results showed a recurrence rate with acceptable incidence of post operative pain and wound related complications compliant with the NICE guidance.

Conclusion

A TEP repair for both primary and recurrent inguinal hernia has a minimal recurrence rate when performed by the specialists in this area giving full attention to the details.
EP406 - Exploring the Nexus: Serum Fluoride, Lipid Profiles, and Gallstone Formation in a Cross-Sectional Study
Authors: Sreeramulu Pradhay , Nagaraj Shashidhar Krupad , Kamisetty Krishna Prasad , Nadipanna Sreeramulu Patrapalli , Rangareddy Harish
Published: September 2024

Objectives

Assessing and comparing serum fluoride and lipid profiles in individuals with gallstones and in healthy controls. Investigating the correlation between serum fluoride levels and lipid profiles specifically in gallstone cases. Estimating concentrations of fluoride, cholesterol, triglycerides, bilirubin, calcium, and magnesium in gallstones.

Methods

This cross-sectional study recruited twenty-five gallstone patients seeking evaluation and treatment at the General Surgery department over a two-month period. Twenty-five age- and gender-matched controls were enrolled using purposive sampling.

Results

Our findings revealed that, regardless of age group (26-70), individuals with higher serum lipid levels and gallstones exhibited fluoride levels in the gallstones ranging from 0.5 to 1 PPM, suggesting a positive impact of fluoride on gallstones. Notably, calcium and uric acid levels were significantly elevated, measuring 19 and 14 mg per gram, respectively. These finding prompts clinicians to consider the independent role of fluoride in regions with higher exposure and chronicity.

Conclusion

Our study uncovered a positive correlation between elevated serum lipid levels and gallstones, highlighting fluoride concentrations in gallstones ranging from 0.5-1 PPM. Increased calcium and uric acid levels, particularly in regions of heightened exposure, point to fluoride's independent role in gallstone formation. Patients with gallstones showed heightened lipid levels, positioning fluoride as an influential factor. Notably, cations like calcium and magnesium, alongside non-protein substances such as uric acid, displayed stronger associations with gallstones, with negligible gender-based differences. These findings offer clinicians valuable insights, underscoring the potential significance of fluoride and related factors in understanding and addressing gallstone disease.
EP480 - Auditing antiplatelet and statin prescription around admission on an inpatient vascular surgical unit
Authors: Magrangeas Thibault , Gouda Yasmeen , Lee Yeon Joo , Proctor Matthew , Gambhir Raghvinder
Published: September 2024

Aims

Antiplatelet and Statin management is crucial in ensuring optimal outcomes for patients after peripheral arterial interventions (Vitturi et al, 2023; National Institute for Health and Care Excellence, 2020). The aim of this study was to interrogate if the patients were being discharged on the correct drugs and dosages following hospitalisation.

Methods

We investigated antiplatelet and statin prescription around admission and matched this with documented management plan on an inpatient vascular unit. Ward rounds were done by registrars along with Foundation Year 1 doctors (FY1s). Newly graduated FY1s with no prior vascular training rotated through the unit every four months. In October 2022, FY1s were educated on existing guidelines and they then handed over verbally to new FY1s in December, when a template was implemented documenting ward rounds and discharge planning. Two sets of data collection were done in October 2022 and then January 2023.

Results

Of 24 patients discharged in October 2022, 17(71%) received a statin, 7 did not. 15 (63%) patients received their planned antiplatelets, 1 received a different regimen; 8 (33%) had no clear plan outlined. Of 25 patients discharged in January, 15 (60%) received a statin; 10 were discharged without, but only 1 had a documented plan for this. 16 (64%) patients received antiplatelets as planned; 9 (36%) had no clearly documented plan.

Conclusions

Established guidelines recommend statin and antiplatelet treatment in Peripheral arterial disease. A clear plan should be outlined at discharge, with tools to ensure this particularly when working with juniors without prior experience. Of note, the documentation template developed was not used consistently.
EP484 - Triple negative male breast cancer: a case report
Authors: Kumar Shashi
Published: September 2024

Background

Male breast cancer (MBC) is a rare malignancy, may present at advanced disease stage. Triple negative breast cancer (TNBC) known to have the poorest prognosis of all other histological types of breast cancer. This paper presents a case of 71 years old gentleman diagnosed with TNBC.

Materials and Methods

A 71 years old male patient, presented with a right breast lump. Clinically he had a skin dent and a palpable 3cm lump underneath in the right breast axillary tail. Mammogram and breast US showed suspicious lesion in right breast axillary tail in addition to a suspicious lymph node in right axilla. Imaging guided core biopsies were taken from the breast and axillary abnormalities. The histology revealed grade1 invasive ductal carcinoma NST, ER 0, PR 0 and HER 2 negative. The Breast-Multidisciplinary Team meeting advised for mastectomy and axillary clearance, this has been performed.

Result

The postoperative Pathomorphology report revealed 23 mm triple negative invasive ductal carcinoma NST, grade 1with Ki67 10%, T2N1M0. The postoperative MDT recommended annual surveillance with mammogram for 5 years.

Conclusions

MBC is uncommon entity, accounting for < 1% of all breast cancer diagnosed in both genders and the MTNBC still is rarer, and mastectomy is the mainstay of surgical treatment in addition to chemotherapy and radiotherapy , however the later doesn’t affect the cause-specific survival rate.
EP525 - A Survey of Medical Students’ Attitudes Towards Sustainable Healthcare
Authors: Stephen Sarah , d'Souza Hanna , Divekar Omkaar , Kanegaonkar Rahul
Published: September 2024

Aims

As the climate crisis becomes increasingly prevalent, so does emphasis on environmental sustainability. The healthcare sector (a significant contributor to environmental impact) is particularly of interest: sustainable healthcare and awareness within the NHS is crucial. However, few medical schools include environmental teaching in their curricula. We undertook this survey to assess environmental awareness and perspectives amongst medical students.

Methods

An online questionnaire was distributed to London medical students. Participants were asked demographic data, questions concerning the environmental impact of products and practices in the NHS, and methods to reduce healthcare’s environmental impact.

Results

87% of students stated that healthcare’s environmental impact is of concern to them, 97% agreed that the environmental impact of products should be considered during development. 65% agreed that the environmental impact of a product should influence its use, but 95% agreed that a device being recyclable/reusable would influence their practice. Students felt the factor most negatively impacting the environmental burden of healthcare was ‘disposable plastic items’, in 57% of responses, and ‘general waste’ in 44%.

Conclusions

Most medical students found healthcare's environmental impact concerning, expressing a desire to choose the most sustainable options. Whilst the distribution of academic year and the London demographic limited this study, we believe it is the first of its kind assessing medical student's attitudes towards the environmental impact of healthcare. With this initial benchmark, we hope future surveys will assess and improve the environmental awareness of doctors in training, as well as the inclusion of environmental teaching in medical school.
Reflections on the absence of stomata on the gametophyte generation of extant land plants: a focus on poikilohydry
Authors: Duckett Jeffrey G , Renzaglia Karen S , Pressel Silvia
Published: September 2024

The recent realization that bryophyte sporophytes are homoiohydric enabled the present analysis of morphological features specifically associated with poikilohydry. The only morphological feature absolutely diagnostic of poikilohydry is schizolytic intercellular spaces. In vascular plants these are gas-filled from the outset, but in bryophytes are liquid-filled initially. They remain in this condition in liverwort gametophytes but become gas-filled following stomatal opening in hornworts and mosses. These have fixed apertures and are completely unresponsive to environmental cues. Stomata in Devonian fossils may have had similarly fixed apertures. Unistratose lamellae, characteristic of moss and liverwort leaves and pteridophyte gametophytes, are optimal structures for reversible cell shrinkage and recovery accompanying de- and rehydration. In 1 M sucrose, gametophytic tissues and filmy fern leaves undergo shrinkage, whereas sporophyte cells plasmolyse. Under extreme desiccation, hydroids are the only bryophyte cells to undergo cavitation. Like bryophytes, desiccation-tolerant streptophyte algae undergo reversible cell shrinkages. Mucilage secretion is unimportant in bryophyte desiccation biology and developmental differences rule out homology between the mucilage clefts and stomata in hornworts and Blasiales. Elaborate placental walls in basal liverwort lineages and a stomatal toolkit in the capsule walls of Haplomitrium suggest that liverworts’ ancestors may have had more complex sporophytes than those in extant taxa.
Piezo2 channels and tactile pain: an intriguing voltage connection
Authors: Fernández-Trillo Jorge , Gomis Ana , Viana Félix
Published: September 2024

This scientific commentary refers to ‘Piezo2 voltage-block regulates mechanical pain sensitivity’ by Sánchez-Carranza et al. (https://doi.org/10.1093/brain/awae227).
Amlexanox targeted inhibition of TBK1 regulates immune cell function to exacerbate DSS-induced inflammatory bowel disease
Authors: Hui Lu , Huang Meng-ke , Dai Qing-kai , Miao Cheng-lin , Yang Yun-long , Liu Chen-xi , Liu Ting , Jiang Yong-mei
Published: September 2024

Amlexanox (ALX) is a small-molecule drug for the treatment of inflammatory, autoimmune, metabolic, and tumor diseases. At present, there are no studies on whether ALX has a therapeutic effect on inflammatory bowel disease (IBD). In this study, we used a mouse model of dextran sulfate sodium-induced colitis to investigate the effect of ALX-targeted inhibition of TBK1 on colitis. We found that the severity of colitis in mice was correlated with TBK1 expression. Notably, although ALX inhibited the activation of the TBK1-NF-κB/TBK1-IRF3 pro-inflammatory signaling pathway, it exacerbated colitis and reduced survival in mice. The results of drug safety experiments ruled out a relationship between this exacerbating effect and drug toxicity. In addition, ELISA results showed that ALX promoted the secretion of IL-1β and IFN-α, and inhibited the production of cytokines IL-6, TNF-α, IL-10, TGF-β, and secretory IgA. Flow cytometry results further showed that ALX promoted T-cell proliferation, activation, and differentiation, and thus played a pro-inflammatory role; also, ALX inhibited the generation of dendritic cells and the polarization of macrophages to M1 type, thus exerting anti-inflammatory effect. These data suggest that the regulation of ALX on the function of different immune cells is different, so the effect on the inflammatory response is bidirectional. In conclusion, our study demonstrates that simply inhibiting TBK1 in all immune cells is not effective for the treatment of colitis. Further investigation of the anti-inflammatory mechanism of ALX on dendritic cells and macrophages may provide a new strategy for the treatment of IBD.