bluuebunny/crossref_metadata_2025 huggingface dataset:
46 The Hidden Truth About Gender Bias in Surgery. A Systematic Review
Authors: Wong C , Lim W H , Jain S R , Ng C H , Tai C H , Devi M K , Samarasekera D D , Iyer S G , Chong C S
Published: May 2021

Introduction

Gender discrimination remains pervasive in surgery, significantly impacting current and future surgeons and population health. This study analyses the gender barriers and critical retention factors for female surgeons and trainees in surgery.

Method

Five electronic databases were searched till May 2020. Titles and abstracts were sieved, followed by a full text review. Data synthesis and inductive thematic analysis were conducted using the Thomas and Harden methodology.

Result

14 articles were included, involving 528 participants. Four themes were generated–unfavourable working environment, male-dominated culture, societal pressures and progress towards gender equality. Females in surgery often faced harassment, disrespect and perceptions of incompetence, resulting in hostile work conditions, which were aggravated by the inadequate support and mentorship. The persistence of male-dominated cultures was observed, with females facing prejudice and exclusion from professional and social circles. Differential treatment and higher expectations of female surgeons also arose from entrenched societal pressures. Despite these, increased acceptance of motherhood and greater recognition of contributions by female surgeons were reported, indicating some progress in gendered culture.

Conclusions

There is a need to increase female surgical leadership and allocate resources to address the deep-rooted causes of biased surgical culture and ingrained perceptions, to achieve greater gender equality in surgery.
114 Reducing Barriers to Learning With eBooks: An Internationally Accessible and Affordable Resource
Authors: Ellis R
Published: May 2021

Introduction

Training in Urology is often limited at an undergraduate level, especially in the wake of the COVID-19 pandemic. It is not uncommon that a trainee’s first experience of Urology is when they encounter urological patients as a clinician and studies have revealed that graduates are lacking knowledge and confidence in managing urological pathology. Many trainees across the world are unable to access vital learning resources to address this gap in knowledge due to exorbitant prices set by publishing companies.

Method

To address the need for affordable standardised education, ‘Urology for Medical Students and Junior Doctors’ was created. This self-published eBook was written and peer-reviewed by urologists to create a relevant learning resource that is affordable for all.

Results

Over 1000 copies of the eBook were downloaded in the first 90 days after publication by trainees across the world. It has been downloaded internationally by a diverse range of allied healthcare professionals. All profits generated from sales are donated to charities investing in medical education.

Conclusions

This eBook stands as an example of how we as educationalists and clinicians can produce affordable learning resources for trainees worldwide; standardising training, improving patient safety and reducing barriers to learning.
234 Remote Surgical Teaching During COVID-19: Early Feedback from Students and Teachers
Authors: Harris H , Khera G , Alanbuki A r , Ray K , Yusuf W , Harvey R
Published: May 2021

Background

On the 23rd March 2020 the government issued a nationwide lockdown in response to COVID-19. Using Microsoft Teams software, Brighton and Sussex Medical School transitioned to remote surgical teaching. We discuss the early feedback from students and tutors.

Method

All students (N = 40) and tutors (N = 7) were invited to complete an online feedback survey.

Results

Twenty students responded. Nine preferred remote teaching. The teaching was described as either good (10/20) or excellent (10/20). Small group teaching, lectures and student lead seminar sessions all received positive feedback. Students preferred sessions that were interactive. One hour was optimal (17/20). There was no consensus over class size. 15/20 (75%) would like remote teaching to continue after the pandemic.

All tutors responded. There was a preference towards shorter sessions: 45 minutes (2/7) one hour (5/7). Tutors found virtual sessions less interactive (6/7). All tutors would like remote teaching to continue after the pandemic. Three suggested extending teaching to remote surgical ward rounds.

Concern was raised by both students and tutors regarding the absence of practical skills.

Conclusions

The value of remote teaching has been highlighted by COVID-19. Our feedback recommends a transition towards blended learning; using the convenience of remote teaching to help augment traditional medical school teaching.
242 Maintaining Surgical Training During the Covid-19 Pandemic; A Novel Use of Surgical Simulators
Authors: Aung M , Obakponovwe O , Raymond A , Apostolidis K , Bahadori S , Wainwright T , Middleton R
Published: May 2021

Introduction

During Covid-19 pandemic, operation theatres limit the number of staff during each session, which causes a decrease in training opportunity. To counteract this lapse, the Orthopaedic Research Institute (ORI) designs an innovative training session. During the nationwide lockdown, the closure of the Institute allowed for the transfer of the VirtaMed ArthrosTM (VA), to our NHS facility. VA is a surgical simulator which enables the participant to practise knee arthroscopy.

Method

Participants with little arthroscopic experience were included in the study. Three fellowship-trained surgeons conducted daily teaching sessions. Participants were taught necessary arthroscopic skills before undertaking training modules on diagnostic arthroscopy. 90% of the participants attended the session at least three times.

At the end of every module, VA generates a score based on parameters which include procedure duration, visualisation of key structures and iatrogenic chondral damage. Structure questionnaires were also used to analyse feedback.

Results

The overall confidence and module scores progress with each subsequent session. A keystone of success is the location and ease of access to the simulator.

Conclusions

Surgical simulators are a useful tool for surgical education and training. We should encourage their use in the future, especially in the UK surgical training programme.
267 Ascertain Impact of Using Low-Fidelity Simulation Scenarios in Preparation for Practical Surgical Finals
Authors: Awan M
Published: May 2021

Introduction

Simulation has become the new way of preparing doctors to deal with medical emergencies, we investigate it using in managing ward-based surgical emergencies.

Method

Final year medical students completed pre- and post-session questionnaires related to themes of preparedness, anxiousness, and confidence in management of acute surgical presentations versus post-operative complications.

The intervention was divided into classroom based teaching and common surgical scenarios enacted using Sim-Man.

Results

Preparedness increased by a third following participation in surgical simulation scenarios among participants. Anxiousness related to surgical finals decreased by 9%. Confidence in managing acute patients increased by 25% compared to pre-session results. Moreover, 35% of participants felt more confident in managing post-operative complications after the session. On average, participants scored 8/10 for usefulness of the sessions in highlighting areas to concentrate focus upon during revision.

Conclusions

Simulation is slowly becoming a staple in undergraduate training and our results emphasise positive impact of using this as a revision tool. Kinaesthetic learning is more memorable during simulation which serves as a confidence boost in self-perception of managing both acute and post-operative surgical patients. Anxiety associated with exams and managing real-life emergencies can be dampened by rehearsing scenarios and following a structured approach as championed by medical simulation.
457 Survey of Perceived Barriers to Medical Students for Progression into Surgery
Authors: Toh S , Jayawardena O , Fowler H , Fok M , Clifford R
Published: May 2021

Introduction

Applications for surgical training have been decreasing despite higher numbers of medical school graduates. We sought to explore the perceived barriers to medical students for progression into surgery.

Method

An online anonymised SurveyMonkey® questionnaire aimed at medical students was disseminated in May 2020, with survey invitations advertised through social media.

Results

A total of 271 responses were obtained, with 95% of respondents being undergraduates and a 7:3 female to male ratio. Approximately one-fifth (19%) were considering pursuing a career in surgery. 82% of students had observed in an operating theatre. 54% of respondents agreed that their surgical rotation was a positive experience, 21% neutral, 8% negative.

Most frequent perceived barriers included lack of work-life balance (77%), surgical culture (67%), lengthy post-graduate training pathway (63%), and competitive entry of surgical specialties (63%). Others included a lack of understanding of surgical career pathways (52%), limited exposure to surgery (47%), and lack of interest (37%). Notably, gender bias was a barrier for many (35%). Most wanted more exposure to surgery through surgical skills teaching (85%), theatre experience (67%), surgical placements (59%) and didactic teaching (33%).

Conclusions

Modifiable barriers need to be addressed in undergraduate and postgraduate training to boost the number of applications into surgical training.
562 Home Microsurgical Method: A Zero-Cost, Accessible, Simulator Using Home-Based Technologies
Authors: Tullie S , Abdaal A
Published: May 2021

Microsurgery is an advanced practice that demands a steep learning curve. Skill acquisition is reliant on repetition which is challenging with decreased trainee operating hours. Evidence indicates early skill acquisition in low-fidelity simulation is of equal efficacy to operating time. Our aim was to create a zero-cost, low-fidelity, microsurgery simulator using home-based technology.

The simulator has five components; a smartphone (iPhone/Android), laptop/computer, USB/lightning wire, ruler, and two supports of equal height. The ruler creates a platform between the supports on which to place the phone, camera focused downwards. The phone camera captures the surgical field between the supports, projecting the image onto the laptop screen via the USB connection.

The trainee operates in a ‘hands down, eyes up’ fashion, looking forwards at the laptop/computer screen whilst operating below in the field of the camera. Latest smartphones achieve magnifications equivalent to a microscope, preserving image quality whilst allowing recording of sim tasks for technical review.

Initial verbal feedback in informal advisory groups has been resoundingly positive. There is clear educational benefit with potential to work with consultant surgeons to develop free, accessible, online training modules. These would provide structured, remote, platforms for both qualitative and quantitative tracking of skill development.
621 Impact Of COVID-19 On Surgical Training at A District General Hospital in London
Authors: Kesharwani D , Buksh M M , Rawashdeh M , Arumainayagam N
Published: May 2021

Introduction

COVID 19 affected surgical training owing to changes in rotations, moving trusts/departments, surgical skills acquisition and new guidelines/protocols during unprecedented times. Aim was to infer how redeployment impacted surgical skills via an objective and subjective study.

Method

A retrospective observational study comparing lead surgeons in Laparotomy and Appendectomies between 23rd March- 31st July (2019/2020). A subjective survey was done to elucidate perspectives on skill, academic advancement and trust/deanery support. A focussed group discussion was also done to gain insight on physical and psychological well-being.

Results

Laparotomy 2019 (n = 75) had 59%; 41%; 0% - Consultants/Registrars/ fellows respectively as lead surgeons. 2020 Laparotomies (n = 50) had 40% consultants; 41% registrars; 20% fellows

Similarly, Appendectomy 2019 (n = 94) had 8.5% consultants; 71.3% registrars; 3.2% clinical fellows, whereas 2020 Appendectomies (n = 67) had 18% consultants; 71.6% registrars and 10.4% fellows.

The Likert questionnaire showed 42.86% had mental exhaustion, less confidence/skills due to lesser opportunities/procedures. 57.14% expressed COVID 19 extremely affected surgical training while 28.14% believed in a reduction of 81-100% operative log book entries from before.

Conclusions

Although, the results were not significant in number of cases managed by trainees; many reported perceived loss of training( log book/portfolio), less teaching/training opportunities and mental exhaustion.
759 Maintaining Surgical Education and Team Morale During A Pandemic – Can A Virtual Educational Platform Deliver Effective Engagement and Personal Development of Non-Technical Skills?
Authors: Sambhwani S , Al-Shahwani A , Sheikh N
Published: May 2021

Introduction

The COVID 19 pandemic has brought unprecedented challenges in healthcare, leading to a dramatic change in service provision and impacting surgical training.

We developed a new educational timetable to maintain an ethos of education safely; focusing on providing an opportunity to develop non-technical skills and maintain reflective practice.

Method

Microsoft Teams was used in our department with two separate streams of weekly education; journal club with focus on developing critical evaluation skills, and a case based in depth discussion forum to develop presentation skills and evidence based management. A questionnaire was sent out after 10 weeks to evaluate the effectiveness and engagement.

Results

From 53 responses, 72% felt that their engagement in teaching increased with a virtual platform with an overall satisfaction of 88%. Reflective practice increased and 40% felt their non-technical skills improved. Overall, 68% preferred to continue learning virtually and 88% would recommend this to their peers. 92% felt that the platform played a pivotal role in helping maintain team morale during this period.

Conclusions

There has been good engagement with positive reflection and learning at a time of great change in the NHS benefiting training and non-training doctors. We recommend incorporating virtual platforms to provide education in all surgical departments.
929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess
Authors: Oyende O , Jackman J
Published: May 2021

Introduction

Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated.

Presentation

We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well.

Discussion

Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes.

Conclusion

Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.
935 Stridor in Multiple System Atrophy: An Otolaryngologist Perspective
Authors: Cameron M , Al M , Jain A , De Silva R
Published: May 2021

Background

Bilateral vocal cord paralysis is a rare emergency presentation for Parkinson's disease (PD) but an acknowledged complication of an atypical rarer form of PD called Multi system atrophy ( MSA). MSA is a neurodegenerative disorder comprising of autononic failure, cerebellar ataxia and parkinsonism. An early occurence of stridor can indicate a shorten survival and quality of life remains uncertain. Airway definitive management of this patient group can pose a dilemma for the Otolaryngologist who may be asked to provide a specialist opinion.

Case: We present a case of a 73 year old female who developed mild stridor, hours after an emergency right sided hemiarthroplasty. On day 23 of her admission, there was a sudden airway deteoriation. The otolaryngology and anasthetic emergency team stablised her conservatively with an option of non invasive ventilation. Bilateral vocal cord palsy was observed on nasendoscopy On day 27, she was eventually diagnosed with MSA and showed partial response to a trial of madopar. Both options of a tracheostomy and laser cordotomy were avoided. She was safely discharged with follow up.

Conclusions

There remains gaps in the literature towards an unaminous consensus on stridor management in MSA patients. However, raising awareness of this patient groups will strenghten decision making processes.
962 COVID-19 And ST3 National Selection in Surgery: What Happens to Core Surgical Trainees When We Remove the Face-to-Face Interview?
Authors: Leiberman D , Trivedy M , Kausar A
Published: May 2021

Introduction

The 2020 ST3 recruitment year for Higher Surgical Training (HST) did not have a face-to-face interview due to COVID-19. Candidates were solely scored on portfolio self-assessment alone. We have assessed the impact on Core Surgical Trainee progression into ST3 by comparing the 2020 recruitment year with 2019.

Method

Total numbers of applicants to ST3 for all 7 surgical sub-specialties that recruit at ST3 level were obtained via Freedom of Information requests from Health Education England (HEE). These were sorted by those who were in CST, had completed CST or had an alternative equivalence certificate.

Results

Overall applicant numbers were up in 2020, mainly from an increase in applicants with a Certificate of Readiness to Enter Higher Surgical Training. Overall ST3 positions appointed to were down. CST progression rate was down slightly, with an increase in appointees >10 years since graduation.

Conclusions

The 2020 recruitment year for ST3 HST had a higher number of applicants and lower places available than 2019. The majority of the extra applicants were trainees who have not completed CST in the UK. CST progression rate to HST was down slightly. The lack of face-to-face interview may benefit some candidates graduating >10 years ago.
136 Intraoperative Neuromonitoring in Spinal Surgery: A Systematic Review and Meta-Analyses
Authors: Ang W W , Boutong S , Shetty N
Published: May 2021

Introduction

Intraoperative neuromonitoring (IONM) is widely used in spinal surgery as it has been shown to be highly sensitive and specific for detecting neurological injuries, although recent evidence has been conflicting in its cost-utility. The authors aim to determine whether the use of IONM during spinal surgeries significantly improves patient outcomes in terms of neurological events, and whether IONM is cost-effective.

Method

Literature search of studies looking at use of IONM for spinal surgeries from 2009 to 2020 was performed across several databases, following PRISMA guidelines. Quality of articles was assessed using MINORS criteria.

Results

The random effects model was used to evaluate the 5 studies comparing neurological events with and without IONM use. There was a higher incidence of neurological events without IONM, at 44 compared to 11 with IONM. However, pooled odds ratio was 0.56 (p = 0.11), indicating no significant difference. IONM was also found to be associated with longer operative times and costs, which is not cost-effective based on NICE recommendations.

Conclusions

- This study corroborate previous studies; there is no significant difference in patient outcome of neurological events with the use of IONM. There is, however, a higher incidence of neurological events without IONM.
436 Remote Surgical Education for Medical Students at UK Universities in the Time of COVID-19
Authors: Zaver V , Ahari D , Jayawardena P , Sayed Md A
Published: May 2021

Background

The novel coronavirus pandemic caused the cancellation of lectures and clinical placement-based education for medical students across the UK. With phased resumption of University teaching, remote delivery via online platforms has seen increased implementation to prevent overcrowding and comply with social distancing measures. This study explores the efficacy of a nationally delivered online surgical education programme to facilitate undergraduate surgical education.

Methods

An undergraduate surgical society in collaboration with two Core Surgical Trainees designed and organised an online surgical teaching programme. The syllabus was constructed in accordance with the Royal College of Surgeons England’s (RCSEng) National Undergraduate Curriculum in Surgery. Remote delivery was facilitated by Zoom (Zoom Video Communications, Inc.). Multiple-choice questionnaires were used to evaluate knowledge during the sessions and Likert scales were utilised to assess subjective improvement of knowledge.

Results

The average attendance for the lectures was 100. The average increase in correct answers between pre- and post-lecture multiple choice questions was +55.87% (+72.4, +18.6, +76.6). Likert scale analysis demonstrated 100% improvement of knowledge.

Conclusions

This study demonstrates a positive outcome to remote, extra-curricular surgical education in the time of COVID-19. The methodology outlined herein has the potential to be adopted by other Universities to facilitate undergraduate surgical education.
16 Re-Do of Laparoscopic CBD Exploration Through Cystic Duct Remnant Following Laparoscopic Cholecystectomy; A Case Series
Authors: Jardine R , Abdelmabod A , Habib M , Ghazanfar M
Published: May 2021

Introduction

Common bile duct (CBD) stones are detected in approximately 10-15% of patients with gallstone disease. They can be formed in the absence of gallbladder stones or in patients who underwent previous cholecystectomy. Laparoscopic common bile duct exploration has been documented since 1999, with increasing evidence illustrating the effectiveness of the transcystic approach. There is no review of re-exploration of the CBD, due to retained stones, following laparoscopic cholecystectomy (LC) via this approach. Four cases are presented detailing need for initial intervention, and intra-operative findings.

Method

Review of four cases in 2020 in Aberdeen Royal Infirmary. Each underwent re-do laparoscopic transcystic common bile duct exploration for retained stone, following previous laparoscopic cholecystectomy.

Results

Each case had successful stone clearance and resolution of symptoms.

Conclusions

With increasing laparoscopic technology and surgical skill, re-exploration of the CBD following previous LC due to emergency surgical presentations should be performed. This is feasible and safe. We recommend the transcystic approach due to reduced morbidity and high success rates of stone extraction.
97 What Are the Main Delays to Surgery After A Patient Presents with An Acute Type A Aortic Dissection?
Authors: Surendran A , Bleetman D , Whitaker D
Published: May 2021

Introduction

Acute-aortic-dissection (AAD) represents a serious cardiovascular emergency, with an associated mortality of 1-2% per hour after symptom onset. It is known that the relative infrequency of AAD and plausible differentials can negatively impact on a timely diagnosis. Female sex, absence of typical features and high-risk examination findings (hypotension/pulse deficits) shown to delay diagnosis. In UK, services for AAD are centralised, working on established volume/outcome relationships. However, this has the potential to introduce delays in rapidly diagnosing patients without on-site specialist support and in the logistics of transferring patients across large distances. This study aims to report on time taken for patients to receive surgery after first presentation at local hospital and identify points that contribute to maximal delay.

Method

Retrospective analysis of all operated type-A-aortic-dissections at our hospital in 2019. Hospital database used to identify patients, and local/referring hospital documentation reviewed to establish times.

Results

Mean time from A&E presentation to surgery is 8-hours-and-30 minutes (4:16–13:43). Largest contributor to delay is time from A&E admission to CT scan.

Conclusions

Our findings suggest greatest impact on improving times from presentation to surgery is to increase awareness of AAD in regional, non-specialist hospitals and to encourage rapid imaging.
160 Applying the Free Energy Principle to Surgical Robotics
Authors: Asad S Al , Khan S , Friston K
Published: May 2021

Introduction

In an effort to build intelligent, autonomous systems, robotics has repeatedly used neuroscience as a source of inspiration for perception and control. This corresponds well with advances in neuroscience, particularly the free energy principle; a unified theory of the brain, integrating together notions of action, perception, and learning. Crucially for robotics, it provides a simple recipe to synthesise autonomous agents under the framework of active inference.

Method

We conducted a literature search assessing the practicality of autonomous agency within surgical robotics, and to understand the potential of applying the free energy principle to surgical robotics in a bid to optimise locomotion, spatial awareness, planning, and artificial curiosity.

Results

Numerous real-life examples demonstrate the feasibility of applying bayesian inference to humanoid robotics. Here we demonstrate a similar approach to adapting surgical robotics through the representation of sensory data through a probability density function over a group of unknown variables. In this manner, surgical robotics will be able to utilise sensory signals and can provide different weights to sensory cues, thereby efficiently integrating sensory input over space and time.

Conclusions

The free energy principle may be applied to surgical robotics to provide additional feedback, and control to improve patient prognosis.
352 A Retrospective Audit to Determine the Appropriateness of Antibiotic Use in Surgical Patients in MKUH
Authors: Stone H , Khanna A , Keeler B
Published: May 2021

Introduction

This audit’s aim is to determine the appropriateness of antibiotics dispensed in Emergency Surgery Clinic (ESC) for a two-month period in 2020. Antibiotic stewardship promotes appropriate antibiotic use in clinical settings whilst limiting unnecessary use. Appropriate antibiotic use is important in reducing the risk of antibiotic resistance.

Method

We extracted the following details from 801 patients’ electronic notes who attended MKUH ESC: diagnosis, prescription of antibiotics, hospital admission, and re-attendance at the ESC. Prescriptions were analysed as to whether they were in accordance with our microbiology guidelines. Patients were analysed as a collective and within diagnosis sub-specialities (appendicitis, wound infection, gallstones/cholecystitis, testicular pathology, UTI, diverticulitis, renal stones and abscesses).

Results

218 (27%) patients were given antibiotics, 180 (22%) patients re-attended ESC and 111 (14%) were admitted. Only 77 patients (35%) receiving antibiotics were prescribed appropriately. Outcomes also varied by diagnosis. All patients presenting with UTI (n = 15) were treated correctly. In contrast, only 71% of patients with renal stones (n = 68) were incorrectly treated with antibiotics.

Conclusions

Two-thirds of patients receiving antibiotics were inappropriately prescribed. This together with the variation by diagnosis would suggest further measures be introduced to support antibiotic stewardship and mitigate the risk of antibiotic resistance.
355 Incomplete Intestinal Rotation with Appendicular Abscess Causing Diagnostic Dilemma in An Adult Patient
Authors: Almafreji I , Nur N
Published: May 2021

Intestinal malrotation presents as an emergency in the neonate and within the first year of life. Incomplete intestinal rotation may remain asymptomatic and undiagnosed. Adult patients are usually diagnosed incidentally while being investigated for nonspecific abdominal symptoms. We report a case of a 43-year-old female who presented with a 10-day history of paraumbilical abdominal pain. Computed tomography demonstrated features of incomplete intestinal rotation and a centrally located inflammatory mass related to the appendix. She underwent a laparotomy and appendectomy. Upon a brief literature review of similar cases, there seems to be a conflict of views regarding the management of incidentally diagnosed adult incomplete intestinal rotation.
375 Local Anaesthetic Surgery for Penile Cancer – An Under-Utilised Option?
Authors: Winyard J C , Berridge C , Goddard J C , Summerton D J
Published: May 2021

Introduction

Surgery is the treatment of choice for penile cancer. Patients with advanced penile cancer are commonly co-morbid and require prolonged medical optimisation prior to general and regional anaesthesia. Local anaesthetic (LA) is often used in benign conditions and biopsies but is under-utilised in primary penile cancer surgery.

Method

Twenty-eight penile cancer patients underwent partial penectomy or glansectomy using LA. A penile dorsal and ventral block with 1% lignocaine and 0.5% Levobupivicaine was placed and 22ml of Instillagel© was instilled.

Results

Over 8 years nine partial penectomies, 17 glansectomies and one distal urethrectomy (n = 28) were done. The block was successful in 27/28 (96%) of cases. In a single case the block failed due to significant oedema. The patient elected for non-operative palliative care. In one case use of LA enabled emergency palliative surgery of a large profusely bleeding penile cancer, which successfully palliated local symptoms.

Conclusions

Partial penectomy and glansectomy can be effectively performed under LA. Penile cancer patients with high anaesthetic risk should be considered for surgery under LA with curative and palliative intent. LA is safer, requires less peri-operative optimisation and enables surgery on those who would otherwise be denied a GA and should be considered as an option in these patients.
391 Multiple Unilateral Upper Limb Fractures in The Paediatric Setting – A Case Report
Authors: Ang W W , Overton A , Ahmad M
Published: May 2021

Introduction

5% of forearm fractures in children have associated supracondylar fractures, hence any forearm fractures warrant careful examination of the elbow, and radiographs taken should visualise the elbow and wrist joint for other injuries. We report a case of multiple upper limb fracture in a child, comprising of lateral condyle and both-bone forearm fracture.

Case Presentation:

A 5-year-old boy was admitted having fallen from a ladder approximately 1.5 metres high in a playground. The left limb was significantly deformed, with no open injury, and neurovascularly intact throughout. Radiographs demonstrated a minimally displaced lateral condyle fracture of the left elbow, a mid-shaft ulna fracture and a displaced off-ended distal third radius and ulna fracture of the left wrist. Any metabolic bone disease and non-accidental injury was ruled out. CT imaging was performed to completely assess the fracture pattern and discussion with our local regional trauma centre. Given the minimal displacement of the lateral epicondyle, conservative management was decided for this. The displaced distal radial fracture was managed with open reduction and internal fixation with a plate, and the ulna shaft fracture with manipulation and plaster cast application. By 12 weeks after surgery there was full range of movement of the elbow, wrist, and forearm, with complete radiological union.
406 Bioabsorbable Screws in Scaphoid Fractures; a systematic review
Authors: Feeley A , Feeley I , Ni Fhoghlu C , Kennedy M , Sheehan E
Published: May 2021

Background

Scaphoid fractures account for 90% carpal injury. Due to the limited vascular supply achieving adequate reduction and healing is important to avoid complications including avascular necrosis. Recent technological advances have led to renewed vigour in bioabsorbable material research to develop devices which could be used without the need for removal and complications including stress shielding and suboptimal imaging.

Method

A systematic review was made using PubMed, Ovid Medline, and Google Scholar databases according to PRISMA guidelines.

Results

Initial search results yielded 852 studies. 124 studies were screened, resulting in 7 studies which were included in this review. The level of evidence of studies ranged between III-IV of low power. Analysis demonstrated mixed findings with generally comparable outcomes to traditionally used screws. Heterogeneity of studies prevented a meta-analysis.

Conclusions

Development in bioabsorbable materials has yielded promising results in orthopaedic studies, however there is a dearth in research using these devices in the scaphoid. Further robust research is needed to establish the efficacy and applicability of bioabsorbable devices in the scaphoid bone.
421 Intrapelvic Protrusion of a Femoral Head in A Ceramic-on-Ceramic Total Hip Replacement, A Case Report
Authors: Altell T , Massa E , Edwards M
Published: May 2021

Introduction

Ceramic on ceramic bearing in Total Hip Replacement (THR) is associated with a low but evident risk of ceramic linear fracture, which can lead to catastrophic failure if not diagnosed and treated early.

Case presentation:

A 59-year-old male patient, who underwent a ceramic-on-ceramic THR 8 years ago, presented to our centre with a five-week history of right hip pain, after he suddenly twisted his upper body and felt a sharp pain in his groin. Prior to the injury he had an excellent functional level with the prosthesis.

His examination findings confirmed a reduced range of movement with pain in the groin on internal and external rotation. X-ray and CT of the hip confirmed a ceramic liner fracture with protrusion of the femoral head into the pelvis. A revision THR was subsequently performed.

Discussion

The usual pattern of liner fracture in this type of bearings is that the femoral head stays contained inside the metal cup. In our case, the ceramic femoral head uniquely fractured the liner and passed into the pelvis. To the best of our knowledge, this is the third reported case in literature where a ceramic femoral head protrudes through the metal cup into the pelvis.
438 Is Cerebrospinal Fluid Sampling Necessary at The Time of First Ventriculo-Peritoneal Shunt Insertion in Paediatric Patients?
Authors: Chia C W L , Leach P
Published: May 2021

We aim to evaluate whether intraoperative cerebrospinal fluid (CSF) sampling during ventriculo-peritoneal (VP) shunt insertion can predict future shunt infection or guide its management, as there is currently no evidence for this.

83 paediatric patients undergoing VP shunt insertion between February 2013 and July 2019 were retrospectively identified. Patient demographics, presence of pre-operative extra ventricular drain (EVD), pre-operative CSF results, and intra-operative CSF results were identified. All patients were followed up for a minimum of 6 months for identification of shunt infection.

90 VP shunt insertions were performed in 83 patients. Age at time of shunt insertion ranged from 5 days to 15.8 years (mean 44.2 months). Tumours were the most common aetiology for hydrocephalus (n = 24). 67 cases (74.4%) had intra-operative CSF samples, of which 2 revealed the presence of bacteria. Only 1 patient with intraoperative CSF sampling positive for growth developed shunt infection during follow up. Two cases developed a shunt infection despite normal intra-operative CSF results. Three cases did not have intra-operative CSF sampling but developed a shunt infection during follow up.

Our results show that intraoperative CSF sampling as a method to predict future risk of shunt infection and to help inform future antibiotic prescribing is unreliable.
468 Management of Acute Appendicitis During the Early Phase of the COVID-19 Pandemic: A Single NHS Centre Study
Authors: Buksh M , Jabri Y , Al Samaraee A
Published: May 2021

Introduction

Early during the COVID-19 pandemic, surgeons were advised to use conservative management/open surgery for appendicitis. This single-centre study has explored the resulted management differences.

Method

Retrospective study covering Prepandemic-data over March-May,2019 & Pandemic-data over March-May,2020.

Results

Prepandemic-(43 patients): Mean age was 38.3 years. Mean length-of-stay was 1.7 days. Preoperative imaging was used in 32(74.4%) patients; this was diagnostic in 28(87.5%). Non-surgical management was used in 4(9.3%) patients; one needed surgery eventually. Surgical approaches in 40 patients were (laparoscopic: 38(95%), open: 2(5%)). Neither significant morbidity nor mortality was reported.

Pandemic-(35 patients): Mean age was 31.2 years. Mean length-of-stay was 2.2 days. Preoperative imaging was used in 30(85.7%) patients; this was diagnostic in 26(86.6%). Non-surgical management was used in 8(22.9%) patients; one needed surgery eventually. Surgical approaches in 28 patients were (laparoscopic: 10(35.7%), open: 18(64.3%)). Neither significant morbidity nor mortality was reported, apart from one patient with COVID-19 postoperative infection.

Conclusions

There was a tendency towards conservative approach/open surgery during the pandemic. Though this was statistically significant (p < 0.05), the total number of patients was small to achieve stronger conclusions. Laparoscopy was selectively used during the pandemic where the benefit outweighed the risks.
489 The Role of Sentinel Lymph Node Biopsy in Cutaneous Head and Neck Melanoma: A Systematic Review and Meta-Analysis
Authors: Johnston E , Taylor S , Bannon F , McAllister S
Published: May 2021

Introduction

and

Aims

The aim of this systematic review is to provide an up-to-date evaluation of the role and test performance of sentinel lymph node biopsy (SLNB) in the head and neck.

Method

This review follows the PRISMA guidelines. Database searches for MEDLINE and EMBASE were constructed to retrieve human studies published between 1st January 2010 and 1st July 2020 assessing the role and accuracy of sentinel lymph node biopsy in cutaneous malignant melanoma of the head and neck. Articles were independently screened by two reviewers and critically appraised using the MINORS criteria. The primary outcomes consisted of the sentinel node identification rate and test-performance measures, including the false-negative rate and the posttest probability negative.

Results

A total of 27 studies, including 4688 patients, met the eligibility criteria. Statistical analysis produced weighted summary estimates for the sentinel node identification rate of 97.3% (95% CI, 95.9% to 98.6%), the false-negative rate of 21.3% (95% CI, 17.0% to 25.4%) and the posttest probability negative of 4.8% (95% CI, 3.9% to 5.8%).

Discussion

Sentinel lymph node biopsy is accurate and feasible in the head and neck. Despite technical improvements in localisation techniques, the false negative rate remains disproportionately higher than for melanoma in other anatomical sites.
495 A Retrospective Seven-Year Study on The Incidence of Cruise Ship Orthopaedic Injuries and Their Impact on A Major Trauma Centre (MTC)
Authors: Hayat Z
Published: May 2021

Introduction

Cruises have increased in popularity worldwide. Falls are the most common seafaring accident, a leading cause of morbidity and mortality. The aim of this, the first UK study, was to analyse the incidence of orthopaedic injuries sustained on cruise ships presenting to an MTC over a seven-year period.

Method

A retrospective analysis of cruise injuries resulting in admission or ongoing follow up by the orthopaedic department was conducted. Demographic details, injuries sustained, management and length of stay were reviewed.

Results

Over the seven-year period, 204 patients were identified, 29 a year on average. The median age was 74 with 70.6% female patients. Of the 221 injuries, 80.9% were fractures (n = 179); neck of femur fractures predominated (27.7%,). There were 140 admissions with a total of 1250 days in hospital. Linear regression models showed the increasing number of admissions to be statistically significant (p < 0.05), as was the upward trend in the number of lower limb injuries (p < 0.05).

Conclusions

The majority of injuries occur in elderly females, where fragility fractures are common. It is vital that cruise ships put measures in place to minimise the risk of such accidents occurring; we hope our findings can assist the formulation of such protocols.
509 Nasal SCC in a Young Caucasian Male
Authors: Calmuc A
Published: May 2021

Introduction

Nasal squamous cell carcinoma (SCC) is common in Asian men in their 50s. However, 1 - 2 per million 15–19-year-old Caucasian patients will also develop nasal SCC. This case reports a rare finding of a 19-year-old Caucasian male with nasal SCC.

Method

Medical records were used to access to all relevant clinical notes for the patient, including blood results, clinical documentation, imaging, and histology. The patient’s clinical journey was reviewed from initial referral to the ENT department to diagnosis with non-keratinising squamous cell carcinoma (NKSCC) stage IV b.

Progression of disease: The patient was initially referred to ENT with unilateral tinnitus and temporal headache and diagnosed in clinic with glue ear and hypertrophic adenoidal tissue. He was due to have grommets and EUA, which was postponed due to the COVID-19 pandemic and lack of clinical suspicion of SCC. Patient was later seen in ED for epistaxis, and then for neck swelling after which he was diagnosed with SCC.

Conclusions

As the patient is a young, caucasian and a non-smoker, the initial diagnosis was lymphoma rather than SCC. This highlights the difficulties of diagnosing this type of cancer in young Caucasian patients.
663 Metastatic Parathyroid Cancer with Refractory Hypercalcaemia
Authors: Karunaratne D
Published: May 2021

A 45-year-old gentleman presented to hospital with vomiting. Bloods demonstrated a corrected calcium of 4.48 and PTH of 979. CT neck showed a right sided thyroid lesion, which on FNA was reported as a possible thyroid or parathyroid neoplasm. A NM scan showed an enhancing nodule in the right thyroid gland and lytic vertebral and pelvic lesions. Bone biopsy showed parathyroid carcinoma.

He underwent palliative total thyroidectomy and right superior and inferior parathyroidectomy under the ENT team. His thyroidectomy specimen was reported as right inferior parathyroid carcinoma, infiltrating into the thyroid gland. His calcium levels did not normalise post-surgery and corrected levels were consistently above 3, with PTH > 5000 despite fluid and calcimimetic therapy with only temporary normalisation with bisphosphonates and denosumab.

This refractory hypercalcaemia is due to the bony metastases producing PTH, which represents a primary cause of mortality. He is currently being managed with regular fluid infusions and bisphosphonates, with view to commence palliative chemotherapy.

Parathyroid carcinoma is extremely rare, and rarer still to present with metastatic disease. Treatment options are limited, with poor evidence behind chemoradiation and immunotherapy. Clinicians should be aware of the complications and management of refractory hypercalcaemia linked to this disease entity.
690 Intracranial Hypotension Due to CSF Leak Secondary to Ventral Thoracic Osteophyte Complex: Resolution After Transdural Thoracic Discectomy and Dural Repair
Authors: Kewlani B , Hussain I , Greenfield J
Published: May 2021

The hallmark symptom of spontaneous intracranial hypotension (SIH) is orthostatic headaches which manifests secondary to cerebrospinal fluid (CSF) hypovolaemia. Well-recognised aetiologies include trauma which includes procedures such as lumbar punctures and spinal surgery. More recently, structural defects such as bony osteophytes and calcified or herniated discs have been attributed to mechanically compromising dural integrity consequently resulting in CSF leak and symptom manifestation. A thorough literature review noted only a handful of such cases.

We report the case of a thirty-two-year-old Asian female who presented with a one-month history of new-onset progressively worsening orthostatic headaches. Workup included MRI of the thoracic spine which revealed an epidural collection of CSF consequently prompting a dynamic CT-myelogram of the spine which not only helped to confirm severe cerebral hypotension but also suggested the underlying cause as being a dorsally projecting osteophyte-complex at level T2-3. Conservative and medical management including bed rest, analgesia, mechanical compression, and epidural blood patches failed to alleviate symptoms and a permanent surgical cure was eventually sought. The surgery involved T2-T3 laminectomy and osteophytectomy and at a 3-month follow-up, complete resolution of symptoms was noted.
738 Missed Injuries in Trauma Patients Attending a London Trauma Centre
Authors: Johnston P , Durand-Hill M , Ike D I , Drummond I , Vris A
Published: May 2021

Introduction

Patients attending following trauma present a diagnostic challenge. Missed injuries may lead to increased morbidity, mortality and length of hospital stay. We reviewed the incidence of and contributing factors to missed injuries in trauma patients attending a London Trauma Centre.

Method

The records of all trauma patients admitted to a London Trauma Centre during September 2019 were studied to determine the extent and type of missed injuries. Missed injuries were classified as: Type 1 – missed during initial management (on primary and secondary survey) or Type 2 – missed on primary, secondary, and tertiary survey, but detected prior to discharge.

Results

Forty-two (42.4%) of 99 patients (24 Female, 75 Male) had 63 missed injuries (an average of 1.5 missed injuries per patient). Thirty-seven type 1 missed injuries occurred (5 fractures, 28 soft tissue injuries, 4 neurological injuries). Twenty-six type 2 missed injuries occurred (13 fractures, 7 soft tissue injuries, 3 neurological injuries and 3 visceral injuries).

Conclusions

Significant injuries can be missed despite primary, secondary, and tertiary surveys in trauma patients. Clinicians involved in the care of trauma patients should therefore remain alert to evolving/new injuries throughout hospital admission.