bluuebunny/crossref_metadata_2025 huggingface dataset:
946 Introduction: Closed Loop Audit Looking at How We Are Complying with Paediatric Supracondylar Fracture (BOAST 11) Management; Results Compared With 2018 To 2019 (Full Cycle)
Authors: Abdalla M , Barksfield R , Islam R
Published: May 2021

Background

Supracondylar fractures. Most common childhood elbow fracture. Can be difficult to manage. Risk of significant complications

Method

Results

• NV documentation, 2018:2019, Improved (36%à45%), Inadequate (45%) in comparison to BOAST guideline.

Night ops

• Appropriate as per BOAST guideline

Surgical technique

Conclusions

Recommendations:
955 An Audit for Reviewing the Soft Food Bolus Obstruction - Optimum Intervention and Referral Direction
Authors: Nargheese N , Peedika T
Published: May 2021

Introduction

Absolute dysphagia secondary to impacted soft food bolus in oesophagus can occur due to various reasons. Existing pathway was ENT if patient points above the suprasternal notch and GI if below or at the level of notch.

Objectives

To assess management in patients with soft food bolus dysphagia and reviewing old pathway.

Method

Data was collected via clinical governance, case notes on track and analysed overall pathway of patients and discussed with the consultants; Paid attention to patients requiring surgical interventions, compared the complications 0f OGD and rigidscopy. Also, effectiveness of Buscopan weighing its adverse effects.

Results

Total of 147 cases were included, 2 patients from upper GI being secondarily referred to ENT, 18 of ENT with GI, 3.8 of 19% complications has risk of perforations with Rigid scope. 2.6% had risk with OGD with no perforations. 2% needed OGD after rigid. 85% underwent intervention after Buscopan.

Conclusions

There is no compelling evidence for Buscopan - to be used only for patient satisfaction. Combining Multiple transfers & complex patient journeys causing delay for treatments with less complications of OGD, soft food bolus should be managed by local gastro/gen surgery teams who can provide timely appropriate intervention, ENT involvement only if airway or pharyngeal concern.
964 Telemedicine: Speedy Triage Tool or Clinical Record?
Authors: Ghareib A , Vinnicombe Z , Visser G , Ra A , Mantella M , Ali F
Published: May 2021

Introduction

St. George’s University Hospitals NHS Foundation Trust is a tertiary plastic surgery centre serving a population of 3.5 million in and around South West London. Telemedicine Referral Image Portal System (TRIPS) is integral to our service, allowing triage of patients in remote locations. During Covid, TRIPS helped in reducing footfall and streamlining out of hospital referrals to reduce unnecessary transfer. The aim of this project was to assess the quality of clinical documentation for emergency referrals to plastic surgery via TRIPS.

Method

We performed a retrospective review of all patients referred to plastic surgery via TRIPS during April 2020. Documentation standards were determined from national guidance. After introduction of a condensed guide, a second review was performed four months later.

Results

In April, 131 referrals were recorded on TRIPS. Only 22.9% of records met the standard. The most common omission was treatment advice. Following introduction of guidance, 215 TRIPS records were reviewed. The quality of clinical documentation improved in all aspects with a compliance rate of 89%.

Conclusions

Although TRIPS remains a useful tool for triage, it is a clinical document and must meet the standards of clinical record keeping. Introduction of clear guidelines improves overall compliance.
989 Improving the Completion of Hospital Anticipatory Care Plans in Orthopaedic Trauma Wards During The COVID-19 Pandemic
Authors: McCann C , Powell-Bowns M , Duckworth A , White T
Published: May 2021

Background

The COVID-19 pandemic has highlighted the importance of the Hospital Anticipatory Care Plan (HACP). New guidance recommends all patients admitted acutely to hospital should have a HACP completed within 24 hours. We aimed to assess how many orthopaedic trauma patients admitted to the study centre had HACP completed within 24 hours of admission.

Method

Departmental Quality Improvement Project (QIP) permission was granted, and standard audit protocol was utilised. Data were collected in a retrospective manner using our trauma database and online patient record system. Educational interventions including staff teaching sessions and dissemination of infographic posters were implemented. Cycle two was repeated in similar fashion.

Results

Cycle one (50 patients): 37/50(74%) had HACPs completed. Of those with HACPs, 18/37(49%) were completed within 24 hours. Median time to completion was 45.3 hours (range 0.4-275.1 hours). Cycle two (58 patients): HACP completion significantly improved (56/58, 97%; p < 0.01), with more completed within 24 hours (50/56, 89%; p < 0.01). The median time to completion was decreased to 4.92 hours (range 0.27-60.6; p < 0.01).

Conclusions

Unit compliance was initially poor however significantly improved with educational measures. Failing to identify ceilings of care early can result in difficult decisions having to be made in critical situations, risking suboptimal patient care.
1002 Calcium administration in Major haemorrhage Protocol
Authors: Akhtar A , O'Connor R , Rosen J , Brooks A
Published: May 2021

Introduction

Calcium gluconate is an essential part of the major haemorrhage protocol (MHP). It minimizes the exacerbation of transfusion coagulopathies due to the citrate preservative. As fifty percent of trauma patients present with hypocalcaemia prior to transfusion, the risk is pertinent. Given the importance of the issue, surprisingly current guidelines remain sparse. We analysed the percentage of patients who received calcium and their hypocalcaemia incidence.

Method

A Retrospective review of red traumas during June to August 2019. The frequency of MHP and the patient’s ionised plasma calcium levels on VBG (1.15-1.26mmol/L) were identified. Our standard stated 100% of MHP should receive calcium. A massive transfusion was defined as 10 red blood cells units in 24 hours or 4 blood products within 30mins.

Results

27 red traumas were accepted to audit, MHP was activated in 85%. Out of these 75% received calcium and on average after 6.4 units of blood products. The incidence of ionised hypocalcaemia in all MHP patients was 67%.

Conclusions

We identified a standard that supplementary calcium should be supplemented in all MHPs. Hypocalcaemia was more frequency than our research stipulated. Improvement needs to be made to meet standards. We recommend incorporation of Calcium gluconate into major haemorrhage pack and transfusion guidelines.
1018 Implementing A Standardised Orthopaedic Admission Pro-Forma to Improve Adherence to The Royal College of Surgeons of England (RCSEng) Best Practice Clerking Guidelines
Authors: Peacock C , North D , Brookes T
Published: May 2021

Introduction

Within our Trust, Orthopaedic patients are clerked in on A&E notes via freehand text. Audit, clinical incidents, and root cause analysis revealed suboptimal documentation. Using RCSEng Best Practice Guidelines we designed, implemented, and evaluated the impact of an admission pro-forma on quality of clerking.

Method

An Orthopaedic clerking pro-forma was designed based on standards set by RCSEng and feedback from Orthopaedic colleagues. First- and second-cycle data collection involving quantitative analysis of clerking against RCSEng domains was conducted before (n = 23) and after (n = 25) intervention. Fisher’s exact test was performed to calculate the statistical significance of our data. A qualitative survey was performed to gain feedback on the pro-forma.

Results

Observations, allergies, and smoking history were omitted in over half of freehand documentations. Medical/surgical history and management plans were well documented regardless. Intervention resulted in statistically significant increases in 7 out of 12 RCSEng clerking domains, most notably allergies (p < 0.00001). Qualitative feedback was positive; 100% of those surveyed stated that the pro-forma ‘improved quality of clerking‘ and ‘benefited clinical decision making’.

Conclusions

Our study demonstrated that implementing an Orthopaedic pro-forma improved adherence to RCSEng best practice clerking guidelines compared to freehand documentation and standardised the process improving the level and quality of documentation.
1024 A Case-Controlled Series Examining the Utility of Nuclear Medicine Imaging in The Diagnosis and Management of Malignant Otitis Externa
Authors: Ringrose T , Crossley E , Biggs T , Hilton J , Graham-Hart L , Pringle M , Buckland J
Published: May 2021

Introduction

This study aimed to assess whether combination modality imaging (CT, and/or Technetium/Gallium) had any additional benefits over single modality imaging (CT) in the management of malignant otitis externa (MOE).

Method

A six-year retrospective case-controlled series was performed including 73 patients presenting with a potential diagnosis of MOE.

Results

CT imaging was undertaken in 69/73 patients, and of these the CT confirmed the diagnosis in 58% (40/69). Of the 42% (29/69) of CT negative patients, 25 underwent Technetium scanning, revealing 40% (10/25) to be negative. These patients were discharged on a short course of topical and oral therapy with no disease recurrence. Gallium scan results, performed at the end of treatment, were more inconsistent, with 47% (25/53) of imaging still positive despite extended intravenous/oral/topical therapy. However,40% (10/25) of these had their therapy stopped without any further disease relapse.

Conclusions

Combination modality imaging, with CT and Technetium, did infer additional benefit over single modality imaging using CT. However, this was not the case for Gallium scanning, used to determine treatment end, which seemed to be poorly representative of residual disease presence. This study was utilised to provide a management algorithm to guide future practice.
25 Operative Delay in Neck of Femur Fracture Management During the COVID 19 Pandemic Lockdown; Reasons and Impact
Authors: Khaleeq T , Patel A
Published: May 2021

All NOF patients beyond 24-hour window over the COVID Lockdown period From April 2020 to July 2020 were identified and causes of delay to theatre were stratified. Manual Data collection over a time period of April 2020 to July 2020, when lockdown was introduced. All patients with NOF who had surgery within 24 hours were excluded. Cases not within 24 hours were included. A total of 70 patients were included in the study. Cause for Delay beyond 24 hours included No list space 30, Medically unfit 20, Anticoagulation 18, COVID related 2 needing ventilatory support. Causes of medical Delay include chest infection (not COVID related), High anaesthetic risk, Cardiac, Anaemia, Electrolyte imbalance. Covid19 accounted for 2 % of operative delays of NOF patients. Other causes include medical optimization, theatre efficiency and use of anticoagulation. However, our study proved there is a vital requirement for robust protocols and pathways in the management of NOF especially during a global pandemic. This is important for the reduction of overall Morbidity and Mortality. Local Strategies should be put in place to address these with the importance of a MDT approach including the Anaesthetic and Orthogeriatic team.
44 Hipec Therapy-A New Development to Fight Cancer; Report Of 3 Cases
Authors: Prakash Narayan P , Dutta R
Published: May 2021

Introduction

HIPEC is highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. HIPEC delivers chemotherapy directly to cancer cells in abdomen. Cytoreductive surgery(CRS) combined with perioperative intraperitoneal chemotherapy is currently a valid treatment option for peritoneal dissemination of gastrointestinal, gynaecological cancers or primary peritoneal neoplasms.

Method

3 patients with peritoneal surface malignancy were selected. PET scan was done for all the patients to assess metastasis and peritoneal carcinomatosis index(PCI) calculated was<20 for all 3 patients They were then treated with CRS+HIPEC therapy with disease-specific chemotherapeutic agents like Cisplatin, Mitomycin and Doxorubicin and Oxaliplatin . Aim was

Results

All the 3 patients had a good post-operative recovery with no recurrence in the follow-up period

Conclusions

HIPEC and CRS plays synergistic role. A complete CRS followed by HIPEC with the disease-specific chemotherapeutic agent at 41-43ºC constitutes optimal treatment for certain malignancies. High regional concentration with low systemic concentration of chemotherapy, increased tissue penetration and thermal enhancement of cytotoxicity are some of the advantages with HIPEC therapy
95 Evaluating The Rate, The Predictors And The Outcomes Of Patients With Negative Appendectomy(NAR)
Authors: Noureldin K , Ayantunde A , Elkholy M , Shah Heer Shah H S , Hatim A
Published: May 2021

Introduction

Appendectomy is associated with complications and negative appendicectomy. We evaluated the rate and predictors of NAR in a cohort.

Method

Patients' data who underwent emergency appendicectomies over a year was analysed. A definition of NA; absence of inflammatory cells in the appendix. The NAR was calculated using (NAR-SDC) and (NAR-STC). Leucocytosis was a total WBC >11000/mm3, elevated CPR >5 mg/L.

Results

372 patients were included. Median durations of symptoms 2 days. The mean admission WBC, CRP and serum bilirubin levels were 12,600 (3000-38000)/mm3, 66.9 (1-323) mg/L and 12.7 (4-38) µmol/L respectively. Laparoscopic appendectomy was performed in 93.5% with a conversion rate of 4.6%.NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower WBC (p-value 0.014), CRP (p-value 0.0001) levels on admission. Female gender, duration of symptoms more than 3 days, lower WBC were found to be predictors of NAR.

Conclusions

NA is a problem in management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms more than 3 days, lower WBC were predictors of NA.
120 Genicular Nerve Radio-Frequency Ablation in The Treatment of Anterior Knee Pain in Patients with Osteoarthritis of The Knee Joint: Systematic Review
Authors: Farrugia M , Tinning C
Published: May 2021

Anterior knee pain is one of the main symptoms in osteoarthritis, resulting from the rich sensory innervation of its capsule. Pain control can be difficult to achieve, with non-responders to conservative and medical therapy often requiring a total knee replacement. Radiofrequency ablation (RFA) is a novel technique that could be beneficial in managing anterior knee pain by targeting the genicular nerves around the knee; however, its routine use is not included in current guidelines.

A literature search identified fifty-two results, which underwent screening using a study protocol and the final literature sources, of varying levels of evidence, underwent critical appraisal and analysis. The primary outcome included the significant improvement of pain scores from baseline, against their respective control treatments.

The ten studies included in the final analysis consisted of seven comparative studies and three non-comparative studies. Literature showed significant improvement in their mean pain scores, all meeting the primary outcome measure. Most studies also showed significant improvement from the control treatments used.

Current literature shows evidence that genicular nerve RFA is an effective and safe treatment modality in the management of anterior knee pain secondary to osteoarthritis. However, the literature available is limited and further comparative studies are required.
134 Quantitative Assessment of Visual Function for Pituitary Macroadenomas: A Practical Scoring Algorithm
Authors: Lee K S , Jeffrey S , Bradley K , Atan D , Williams A , Abhinav K , Teo M , Nelson R
Published: May 2021

Introduction

There is a myriad of existing terms by which visual capacity is recorded. The lack of a standardised categorisation of observations commonly results in ambiguities. We report the utility of a visual function score (VFS) in patients managed by transsphenoidal surgery.

Method

A VFS (expressed as a percentage) with a maximum score of 20 was calculated for each eye using the Snellen VA (40% weighting: score 0-8) and Humphrey Allergan 30-2 automated visual field (60% weighting: score 0-12).

Results

280 patients (560 eyes) underwent transsphenoidal pituitary adenoma resections with complete pre- and post-operative visual function assessment. Mean age 56 years; 56.4% male. 26.1% were treated by endoscopic technique and 73.9% were treated by microscopic technique. Pre-operative vision was normal in 38.0% eyes. All these had full post-operative vision. In patients with pre-operative visual loss (347 eyes), the mean pre-operative VFS rose from 70.8% to 87.5% post-operatively. 43.8% eyes attained full post-operative vision, 28% improved, and 25.6% remained unchanged. 9 patients (2.6%) had worse immediate post-operative vision.

Conclusions

The VFS is a convenient single measure of visual function that may facilitate local and national audit of transsphenoidal surgery. Studies are planned to correlate this with patient reported visual quality of life measures.
137 Giant Lipomas of The Hand; A Case Series and Review of a Rare Tumour
Authors: Abed H , Pickering G , Jose R , Chester D
Published: May 2021

Introduction

Whilst lipomas are the most common tumour of the human body, it is rare in the hand. Less than 50-cases are reported in the literature. We present six-cases from a specialist hand unit, UK, presenting over a 10-year period. All patients had a distinct swelling within the affected hand which was growing in size.

Method

Patients were investigated with MRI and given the benign appearance; no pre-excision biopsies were performed. All excised tissue was sent for histology. Only one patient reported altered neurology of the hand, describing altered sensation within the ulnar nerve distribution of the index finger.

Results

In all cases, the lipoma originated in the deep palmar space from adipose tissue surrounding the deep palmar arch. They all extended distally, along natural tissue planes, encasing neurovascular and tendinous structures. In two cases the lipoma extended into the dorsum of the hand, following the perforating artery between the index and middle metacarpal heads. The lipomas all spread radialwards, penetrating the thenar muscles. The largest was 13x12x4cm in size.

Conclusions

Giant lipoma is a rare cause of symptomatic swelling of the hand. Compression of structures is extremely rare, but careful excision is critical as neurovascular bodies are classically enveloped within the growing lipoma.
220 Choice of UK Medical School Predicts Success in The Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination
Authors: Ellis R , Scrimgeour D , Cleland J , Lee A , Brennan P
Published: May 2021

Background

UK medical schools vary in terms of factors such as mission, specific curricula and pedagogy. As relatively little is understood about the impact of these differences at a post-graduate level, we examined the relationship between medical school and MRCS success.

Method

Using the UKMED database we analysed data on UK medical graduates who attempted MRCS Part A (n = 9729) and MRCS Part B (n = 4644) between 2007-2017. Univariate analysis characterised the relationship between medical school and first attempt MRCS success. Logistic regression modelling identified independent predictors of MRCS success.

Results

MRCS pass rates differed significantly between medical schools (P < 0.001). Trainees from standard-entry 5-year programmes were more likely to pass MRCS at first attempt compared to those from extended (Gateway) courses ((Part A (Odds Ratio (OR) 3.72 [95% Confidence Interval (CI) 2.69-5.15]); Part B (OR 1.67 [1.02-2.76])). Non-graduates were more likely to pass Part A (OR 1.40 [1.19-1.64]) and Part B (OR 1.66 [1.24-2.24]). Russell Group graduates were more likely to pass MRCS Part A (OR 1.79 [1.56-2.05]) and Part B (OR 1.24 [1.03-1.49])).

Conclusions

Medical programme and medical school are associated with MRCS success. Further research is needed to tease out the relationship between individual factors, medical school and MRCS performance.
297 Risks of Delaying De-Obstruction of an Acutely Infected Obstructed Urinary Tract
Authors: Karunaratne D , Akiboye D
Published: May 2021

Introduction

We investigated patients with acute urinary tract obstruction in a DGH to ascertain which factors predispose to CKD and mortality.

Method

Over five months there were 37 nephrostomy/stent cases, 18 female, 3 mortalities. Median age was 55.5 (18-93). Retrospective data was used in a multiple regression analysis. Input variables included the intervention indication, admission Creatinine, Charlson Co-morbidity Index, and intervention delay. Output variables were length of hospital stay, renal function and 90-day mortality.

Results

Positive urine cultures (p = 0.035) and co-morbidity (p = 0.018) were associated with CKD. Nephrostomy patients (p = 0.031) were associated with AKI post-procedure. Delay in disobstruction (p < 0.01) and delay-length (p = 0.026) were significantly associated with longer hospital stays. AKI severity on admission (p = 0.047) and intervention delay (p = 0.045) increased risk of 90-day mortality, with positive blood cultures (p = 0.071) trending towards significance. Malignant obstruction neared a significant association with CKD (p = 0.08) and 90-day mortality (p = 0.075).

Conclusions

The severity of presentation and delay in intervention all contribute to poorer outcomes and a longer admission. Co-morbid patients with malignant obstruction had a higher risk of 90-day mortality. Therefore, in those with poor baseline, are we intervening inappropriately?
298 Incidence and Causes of Aneurysm Growth Following Endovascular Sealing of Abdominal Aortic Aneurysms
Authors: Uhanowita Marage R , McWilliams R G , Fisher R K , England A , Karouki M , Yafawi A , Torella F
Published: May 2021

Objective

To analyse the incidence of aneurysm growth after endovascular aneurysm sealing (EVAS) and its relationship with adherence to the instructions for use (IFU).

Method

This study observed the clinical outcomes of patients who had an elective infrarenal EVAS procedure performed at the Royal Liverpool Hospital between 2013 and 2018. The primary outcome measure was the occurrence of aneurysm growth after EVAS. Aneurysm growth was defined as a 5% increase in the aortic volume between the renal arteries and the aortic bifurcation from the 1-month scan to subsequent annual scans.

Results

There were 71 patients with a mean (standard deviation) age of 76 (6) years who were eligible for inclusion in this study. Aneurysm growth was observed in 8 of 19 (42%) within IFU and 14 of 52 (27%) outside IFU (P ¼ .35). There was no relationship between aneurysm growth and adherence to IFU. Among the patients with aneurysm growth, the median (range) increase in abdominal aortic aneurysm volume was 11% (5%-20%).

Conclusions

Abdominal aortic aneurysm growth occurs in a significant proportion of patients at 1 year after EVAS and is not associated with adherence to IFU. Longer follow-up on a larger sample size is essential to understand the long-term clinical outcomes after EVAS.
331 The Role of Prophylactic and Therapeutic Fasciotomy in Acute Limb Presentations
Authors: Ding A , Machin M , Onida S , Davies A
Published: May 2021

Introduction

Acute compartment syndrome is a surgical emergency that can be of traumatic or non-traumatic nature. Missed or delayed diagnosis can cause significant morbidity. The aim of this systematic review was to assess outcomes following prophylactic and therapeutic fasciotomies performed for acute limb presentations.

Method

This systematic review was undertaken following a predefined protocol registered with PROSPERO, in accordance with PRISMA guidelines. Searches of MEDLINE and Embase databases retrieved 623 articles; 19 articles were included in the study. A qualitative synthesis was performed due to heterogeneity between the studies.

Results

Overall mortality rates of 0–19 % were reported for traumatic causes and 24.5–27% for non-traumatic causes. In general, comparative studies reported lower amputation rates (0–21.7% vs 6.6–50%) and neurological deficit rates in the prophylactic versus therapeutic fasciotomy arms (8.8–18% vs 12.5–42%). Complication rates of up to 42% and 35% were reported in traumatic and non-traumatic cases respectively, which included wound infection, nerve injury and ischaemic contractures.

Conclusions

Prophylactic fasciotomies appear to have superior outcomes than therapeutic ones. There is insufficient evidence for a specific time cut-off for the performance of therapeutic fasciotomies; retrospective analysis of outcomes via a fasciotomy registry may help to guide future practice.
370 Pure Primary Small Cell Carcinoma of the Prostate: A Rare Entity
Authors: Desai C , Bhojwani A , Parkin J
Published: May 2021

Introduction

We report a case of small cell carcinoma of the prostate (SCCP) which is a rare, high-grade malignant neoplasm accounting for 1% of all prostate cancers (CPa).

Case

Presentation

A 56-year-old male patient initially presented to primary care with a six-month history of frequency, nocturia and pain in the perineal region when seated. A positive family-history for CPa was noted, serum PSA was 11.58, and a rectal examination found a large, irregular mass. He was treated with antibiotics for possible prostatitis and referred to the colorectal team. MRI rectum confirmed a mass between the prostate and rectum, which was found to be pure SCCP on biopsy. Whole-body scanning found multiple lung and pelvic metastases. The patient was commenced on six cycles of Etoposide and Carboplatin therapy. The patient reported that his pelvic discomfort has improved following the first cycle.

Conclusions

SCCP metastasizes early and therefore the clinical presentation is often in an advanced stage. It is noted that there is limited value of serum PSA for SCCP diagnosis. Instead, pathological examinations and MRI rectum are vital. In terms of treatment, chemotherapy provides relief of the clinical symptoms and its use is in in accordance with the 2016 National Comprehensive Cancer Network guidelines.
392 Patient Reported Comorbidity Is Not A Reliable Data Source: A Systematic Review of The Literature
Authors: Lin C M A , Orman A , Clement N D , Deehan D J
Published: May 2021

Introduction

There is currently an increased demand for elective orthopaedic surgery. However, due to financial, time and resource limitations, there is a pressing need to identify those who would benefit most with the lowest risk of complications. Comorbidities play a fundamental part in this decision and the traditional way to ascertain this is through medical record data ion during pre-operative assessment, but this can be time-consuming and expensive. We therefore set out to establish whether patient self-reported comorbidities are reliable as a principal source of information.

Method

Searches of PubMed and Medline were performed by two independent researchers. Inclusion criteria were any published study assessing the reliability of at least one patient reported comorbidity against their medical record or clinical assessment as gold standard.

Results

There were 27 studies included 12 concluded with unreliability, 11 with reliability, 4 inconclusive. Factors found to affect the concordance included gender, age, ethnicity, level of education, living alone, marital status, number or severity of comorbidities and depression.

Conclusions

The majority of studies concluded that patient self-reported comorbidities are unreliable, even when their results showed good concordance. Although patient reported data is useful, it is not reliable enough to be used as a standalone measure.
407 Incidental Focal Intrahepatic Duct Dilatation (FIDD) – A Finding That Mandates Further Investigation That May Include Liver Resection
Authors: Kumar N , Kumar A , Mondal D
Published: May 2021

Background

The increasing use of imaging has led to incidental findings in the liver. The Western experience of managing focal intrahepatic duct dilatation (FIDD) is not well recorded. We present our experience based on a large prospectively maintained database at a tertiary hepatobiliary surgical unit.

Method

Patients with liver resection for FIDD between January 2003-December 2019 were retrospectively identified from the liver unit database. The demographics, symptomatology, blood test results, imaging, type of liver resection, morbidity, mortality, and histology of resected specimens were recorded.

Results

9 patients had FIDD among 994 liver resections performed (0.9%). 6 patients were asymptomatic, 2 upper abdominal pain and 1 recurrent gram-negative sepsis. Liver function tests were normal in all patients. Two patients had cholangiocarcinoma (CCA), 4 intrahepatic stones, 1 intraductal papillary neoplasm of bile duct (IPN –B) and 2 benign strictures.

Conclusions

FIDD is rare in the Western population. Most patients are asymptomatic with an incidental finding of FIDD on cross-sectional imaging. Differentiating benign and malignant pathology is difficult warranting liver resection in fit patients to resolve the diagnosis. Liver resection is safe and can be potentially curative in patients with a neoplasm, which can occur in 30% of patients with FIDD.
443 Minimally Invasive Versus Open Bronchial Sleeve Lobectomy for Non-Small Cell Lung Cancer: A Systematic Review and Meta-analysis
Authors: Gysling S , Caruana E
Published: May 2021

Introduction

Minimally invasive surgery (MIS) for bronchial sleeve lobectomy (SL) remains unproven in safety and efficacy. We sought to evaluate current literature on outcomes following MIS or open surgery (OS) for SL in non-small cell lung cancer (NSCLC).

Method

The MEDLINE, Embase and Cochrane Library databases were searched in August 2020. Studies of SL comparing MIS to OS were included. The primary outcome was disease-free survival. Data was analysed in Stata SE v16.

Results

506 patients (87.9% male) from 5 studies were included, with 325 (64.2%) OS, 164 (32.4%) VATS, and 17 (3.4%) RATS cases. Risk of bias was low to moderate in included papers.

There was no difference in disease-free survival (OR -0.20, 95% CI -0.63 - 0.23, p = 0.37), overall survival (OR -0.03, 95% CI -0.63 - 0.58, p = 0.93), 30-day survival (OR -0.60, 95% CI -1.73 - 0.54, p = 0.30), resection margin involvement (OR 0.16, 95% CI -1.07 - 1.39, p = 0.80), or intraoperative bleeding (MD -16.94 ml, 95% CI -63.05 - 39.16, p = 0.47).

MIS was associated with longer operative times (MD 53.90 min, 95% CI 36.57 - 71.23, p < 0.01) but shorter postoperative stay (MD -1.24 days, 95% CI -3.99 - 1.51, p = 0.41).

Conclusions

MIS for SL was associated with longer surgical time, shorter postoperative stay, and equivalent oncologic outcomes compared to OS.
447 What Age is Best to Perform Myringoplasty?
Authors: Wilks L , Mcleod R , Unadkat V
Published: May 2021

Aim

This systematic review and meta-analysis aims to assess this relationship and determine the most appropriate age for recommendation of surgery.

Method

According to the “Preferred Reporting items for systematic review and meta-analysis” (PRISMA) statement, a literature search was performed across Medline, EMBASE and the Cochrane library from 1946-2018. Articles examining a relationship between age and myringoplasty or type 1 tympanoplasty success rates were screened.

Results

20 articles encompassing data from 2244 procedures were included. The overall results conveyed a clear correlation between increasing age and rising success rate. A t-test was conducted which demonstrated a significant (P = 0.05) transition at aged 10, whereby success rate below age 10 was 70.6% and above 10 was 86%.

Conclusions

This systematic review and meta-analysis has uncovered a clear correlation between increasing age and increasing success rate for myringoplasty in the paediatric population. Furthermore, a significant transitional point has been demonstrated at the age of 10 and We hope that knowledge of increased success rates particularly after the age of 10 helps clinicians make more informed decisions about when to operate
480 Preoperative Templating in Hip Hemiarthroplasty Improves Femoral Offset and Function
Authors: Saleem S , Parikh S , Parratt T , Loeffler M
Published: May 2021

The use of preoperative templating for hip hemiarthroplasty increases the likelihood of successfully restoring offset. This study sought to identify whether templating improves radiographic and clinical outcomes in this group.

Data belonging to all patients that underwent hip hemiarthroplasty between March 2018 and March 2019 were collected. The patients were grouped based on whether or not their preoperative images were templated. Radiographs were studied retrospectively to calculate preoperative and postoperative offset and LLD for each patient. The clinical outcomes that were measured included the rate of periprosthetic fracture, dislocation and contra-lateral neck of femur fracture for each group. Data was analysed by SPSS.

There were 208 patients of which 72 were templated and 136 not templated. The percentage difference between the preoperative and postoperative offset was lower in the templated group (p < 0.05). There was no significant difference in radiographic LLD between the two groups. There was no significant difference in the clinical outcomes between the two groups.

A significantly closer restoration to the original offset was achieved with preoperative templating, which is likely to improve function in this group. There were no significant differences in the other clinical outcomes between the two groups.
488 Anatomical and Audiological Considerations in Branchio-otic/Branchio-oto-renal Syndrome: A Systematic Review and Narrative Synthesis
Authors: Biggs K , Crundwell G , Metcalfe C , Muzaffar J , Monksfield P , Bance M
Published: May 2021

Introduction

Branchio-otic/ Branchio-oto-renal syndrome (BO/BOR) is a rare autosomal dominant condition characterised by hearing loss, branchiogenic and renal anomalies. Anatomical variants, audiological outcomes and optimal management are considered.

Method

Systematic review and narrative synthesis. Databases searched: Medline, Pubmed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on year of publication.

Results

Searches identified 379 articles. Of these, 64 studies met the inclusion criteria, reporting outcomes in 503 patients from at least 104 families. In 308 patients hearing loss was categorised as sensorineural (29%), conductive (20%) and mixed (51%). Hearing outcomes were variable in terms of onset, pattern, and severity, ranging from mild to profound deafness. 43% patients presented with inner ear anomalies, 35% had middle and 36% had external ear abnormalities. In 44 studies, 58 ear operations were described. Mixed outcomes were reported in patients managed with hearing aids or middle ear surgery; however successful cochlear implantation was described in all five cases.

Conclusions

The anatomical and audiological profiles of patients with BO/BOR are variable. Cochlear implantation outcomes were good however the studies lacked long-term follow-up. Given the range of anatomical variants, management decisions should be made on an individual basis including full audiological and radiological assessment.
513 Understanding the Role of HMGB1 Post-Traumatic Brain Injury - The Complex Interplay Between Neuro-Inflammation and Neurogenesis
Authors: Marei O , Manivannan S , Elalfy O , Zaben M
Published: May 2021

Introduction

Traumatic brain injury (TBI) is a global public health burden. Although neurogenesis occurs post-injury, achieving long term survival of newly generated neurons remains elusive. High Mobility Group Box protein 1 (HMGB1) is a pivotal cytokine in hosting the neuro-inflammatory response to injury, but also mediates neurogenesis during physiological development. In this review, we examine current evidence for post-traumatic neurogenesis and HMGB1 as a therapeutic target.

Method

PubMed database was evaluated with the following search terms: HMGB1, isoforms, neurogenesis, traumatic brain injury, Toll-like receptor, receptor for advanced glycation end-products.

Results

Multiple studies support the existence of neurogenesis post-injury both in vitro and in vivo.

Different HMGB1 target receptors mediate different functions of HMGB1, though these are not mutually exclusive in the context of injury. Interaction with RAGE is responsible for developmental neurogenesis, whilst TLR-4 mediates the innate immune response. Though different HMGB1 isoforms are recognised, specific effects post-injury remains unexplored.

In vivo animal studies demonstrate positive effects of HMGB1 antagonism post-TBI, but long-term outcomes remain unclear.

Conclusions

Modulating HMGB1 may enhance post-TBI recovery, but a mechanistic understanding of its effects on neurogenesis is fundamental to avoid negating potentially beneficial effects.
551 The Relationship Between Canal Diameter and the DORR Classification - Presented by Dr John Vincent and Dr Ryan Doherty of NIMDTA, formerly Queen's University Belfast
Authors: Karayiannis P N , Cassidy R S , Hill J C , Dorr L D , Beverland D E
Published: May 2021

Background

Particularly in broach-only uncemented total hip arthroplasty, a narrow femoral canal presents a technical challenge. Traditionally such femurs have been considered to be Dorr A. To our knowledge, however, no study has reported on the relationship between isthmus width and the Dorr classification.

Method

We reviewed 500 high-quality, hard copy radiographs. Dorr classification and isthmus canal width were measured using an electronic caliper by 5 independent observers with intraobserver and interobserver error calculated. For this study, we defined a narrow canal as being 10 mm at its narrowest point (isthmus).

Results

Eight percent (40) were Dorr A, 85% (424) Dorr B, and 7% (36) Dorr C. With respect to isthmus width for Dorr A, 63% (25) were 10 mm compared to just 13% (55) of Dorr B. However, overall because there were more Dorr B femurs, 69% of those with an isthmus of 10 mm were Dorr B.

Conclusions

In this population, almost 70% of patients with an isthmus 10 mm were Dorr B, with only 30% being Dorr A. When using a broach-only technique, isthmus width should be routinely measured on the preoperative anteroposterior radiographs so as to alert the surgeon to potential problems.
630 Management and Outcomes of Primary Central Nervous System Lymphoma – Time to Improve the Patient Pathway
Authors: Norrington M , Kumar S , Islim A , Smith J , Husband D , Mills S , Jenkinson M
Published: May 2021

Introduction

The clinical and radiological presentation of PCNSL is diverse. Biopsy is required prior to commencing oncological therapy. Steroids administration or inconclusive histopathology may delay diagnosis. This study aimed to assess outcomes of patients managed under clinical oncology and haematology, and investigate factors related to survival.

Method

Retrospective cohort study (2004-2019) of 104 patients. Univariate analysis, using Kaplan Meier curves and multivariate Cox regression analysis were performed.

Results

Median WHO performance status was 1. 12 patients (11.5%) required repeat biopsy. 40 cases were managed under oncology, 25 males (median age 67 years; IQR 60-71). Median time from imaging to diagnosis (TTD) was 18 days (range 8-227). Median time from diagnosis to treatment (TTT) was 19 days (range 3-63). Median overall survival (OS) was 5 months (95% CI 0-15.6). 61 cases were managed under haematology, 32 males (median age 65 years; IQR 54-71). Median TTD was 25 days (range 10-233). Median TTT was 14 days (range 2-96). Median OS was 5 months (95% CI 2.1-7.9). No significant prognostic indicators of OS were identified on multivariate analysis.

Conclusions

PCNSL carries a poor prognosis regardless of treatment team. The wide range in time to treatment suggests that the management pathway needs streamlining to improve outcomes.
736 Optimal Time for Cholecystectomy After ERCP
Authors: Ibrahim R , Abdalkoddus M , Yao L , Franklyn J , Zainudin N , Aroori S
Published: May 2021

Introduction

Recent research on the management of cholecystolithiasis with co-existing choledocholithiasis suggests performing cholecystectomy within 24 hours after ERCP has favourable outcomes. However, this target can be difficult to achieve in the NHS due to limited resources.

Method

This retrospective study includes 444 patients who underwent successful ERCP before cholecystectomy. We examined the impact of the duration of ERCP to cholecystectomy and post ERCP complications on operative difficulty and patient outcomes. We also report on gallstone related readmissions and rate of retained stones.

Results

The median duration from ERCP to cholecystectomy was 75 days, with a 14% readmission rate between their first successful ERCP and cholecystectomy.

Our analysis showed a statistically significant negative correlation between ERCP-to-cholecystectomy duration and postoperative stay. Readmissions increased with time, but this did not reach statistical significance. The occurrence of post ERCP complications significantly increased postoperative stay and the open conversion rate.

Conclusions

In contrast to recent research, our analysis suggests that early cholecystectomy post ERCP is not associated with better outcome. However, the impact of gallstone related readmissions needs further analysis. Post ERCP complication could serve as a predictor for operative difficulty and longer postoperative stay. It should be considered when planning the cholecystectomy.
742 Conventional Surgery vs Endovascular Abdominal Aortic Aneurysm Repair in the Management of Mycotic Abdominal Aortic Aneurysms
Authors: Premnath S , Zaver V , Kuhan G , Rowlands T , Quarmby J , Singh S
Published: May 2021

Introduction

This study aimed to look into the short and long-term outcomes in Mycotic Abdominal Aortic Aneurysms (MAAA) managed by Conventional Surgery (CS) and Endovascular Abdominal Aortic Aneurysm Repair (EVAR)

Method

Data of 17 patients who underwent CS or EVAR for MAAA from 2001 to 2017 in a single centre were collected. Complications and mortality at 3 years post-procedure were also analysed.

Results

Mean age was 66 (54 - 82 years), 15 (88.2%) were males. Mean aortic anterior-posterior diameter was 5.8cm (2.1 – 9.0 cm). 10 patients (58.8%) presented with rupture. 6 (35%) patients demonstrated positive cultures. 4 patients (23.5%) underwent CS and 13 (76.5) had EVAR of which 4 were surgeon modified EVARs. 5 (29%) patients developed complication within 30 days. 4 patients (23.5%) developed graft infection in long term. Total mortality was 5 (29.4%) of which one patient died within 30 days and two within 3 years of procedure. Long-term mortality was found to be significantly higher in patients treated with CS compared to EVAR (p-value 0.022).

Conclusions

CS for MAAA has a high mortality rate compared to EVAR. EVAR might be a simple and good alternative for this critical condition in centres with adequate expertise.
745 Risk Factors of Incident Renal Stones in Indian Population: A Hospital-Based Case-Control Study
Authors: Singh S , Gupta S , Mishra T S , Banerjee B D , Sharma T , Sharma S
Published: May 2021

Introduction

Nephrolithiasis is pathological calcification in the excretory passages of the body and is prevalent among 7.6% of Indians. We aimed to study the various risk factors associated with renal stones from India.

Method

It was a hospital-based case-control study conducted over 18 months in a tertiary hospital in Delhi. Cases were defined as patients with renal stones diagnosed on the basis of history and radiological examination. Controls were similar to cases in all respects except for the diagnosis and selected from the hospital. A total of 18 risk factors, including age, gender, heavy metals, stress, metabolic factors, alcohol intake, dietary habits, co-morbidities, etc. were assessed. Logistic regression analysis was performed to calculate the strength of the risk associations.

Results

In the analysis of 60 cases and controls, we found 6 times, 5.5 times, and 2.4 times increased odds of renal stones in patients with increased arsenic, cadmium, and lead concentrations in blood, respectively. Similarly, there are 3 times increased odds of renal stones in patients suffering from stress.

Conclusions

Exposure to smoke, occupation dust, and contaminated water may lead to an increased ingestion/inhalation of heavy metals like cadmium, arsenic, and predisposing people to an increased risk of renal stones.
751 Preoperative Factors Influencing Functional Rehabilitation After Major Lower Limb Amputation
Authors: Premnath S , Cox M , Hostalery A , Kuhan G , Rowlands T , Quarmby J , Singh S
Published: May 2021

Introduction

To identify the preoperative factors that influence functional rehabilitation after Major Lower Limb (MLL) amputation.

Method

This retrospective study analyzed all patients referred post-amputation to an amputee rehabilitation centre over a period of 1 year. The level of functional outcome at 6 and 12 months were recorded using SIGAM (Special Interest Group in Amputee Medicine) grading. Data on various preoperative factors were collected and analyzed for association with functional outcome.

Results

A total of 71 cases were analyzed. The mean age was 65.18 (range 24 - 91) years and 45 were males (63.4 %). Peripheral arterial disease was the major cause of amputation (80.3%). The level of amputation was above / through knee in 60.6%. Contralateral limb problems were present in 28.2%. Functional mobility was achieved by 38% of the MLL amputees within 6 months of rehabilitation, which increased to 46.5% at 12 months. Pre amputation mobility was a significant factor for a good functional outcome (p-value 0.002). An increasing value of BLARt (Blatchford Leicester Allman-Russell Tool) score showed a significant correlation with poor functional outcome.

Conclusions

Pre amputation mobility and BLARt score can be used in the prediction of functional outcome and can aid in better pre-operative decision making and rehabilitation planning.
758 Pre-Incisional Infiltration of Local Anaesthetic Is Associated with Reduced Intra-Operative Fentanyl Requirements and Lower Pain Scores in Recovery
Authors: Jones C , Baker-Wilding R , Coombs N
Published: May 2021

Introduction

Effective pain management is a pivotal component of day-surgical pathways. Intra-operative regional infiltration of long-acting local anaesthetic (LA) has been shown to be efficacious in reducing post-operative pain after general anaesthesia, yet few studies have explored the optimal timing of its use.

Method

Patients undergoing day-case breast/general surgical operations under a single consultant surgeon were randomised to receive LA infiltration (Levobupivicaine) before the initial incision, or during wound closure. All patients were given a propofol-based general anaesthetic. Primary outcomes were intra-operative/post-operative fentanyl requirements, and numerical pain scores (at 1 and 3 hours post-operatively). The study ran from October 2019 but was suspended during the COVID-19 pandemic. Non-parametric statistical tests were used.

Results

25 patients were randomised. Those receiving pre-incisional LA had lower fentanyl requirements intra-operatively (mean; 150mcg vs 186mcg, p < 0.05) but similar requirements post-operatively. Mean pain scores were lower in the pre-incisional LA group at 1 hour (1.2 vs 2.3, p < 0.05) and 3 hours post-operatively (0.7 vs 1.3, p > 0.4).

Conclusions

Pre-incisional infiltration of LA led to a significantly reduced requirement for intra-operative fentanyl, and significantly lower pain scores at 1 hour post-operatively. Larger studies should interrogate this effect at individual procedure level and assess for differences in rates of chronic pain.