bluuebunny/crossref_metadata_2025 huggingface dataset:
831 Diagnosis, Management, and Follow Up of Patients with CT Proven Acute Uncomplicated Colonic Diverticulitis
Authors: Fatima A , Alnabhan A
Published: August 2024

Aim

Acute diverticulitis is one of the most common gastrointestinal diseases in the Western world. The aim of this audit is to evaluate the management of acute uncomplicated colonic diverticulitis as per the 2020 update of WSES guidelines:Clinical assessment, inflammatory markers, and CT AP in all suspected patientsAntibiotic therapy not recommended in immunocompetent patientsAmbulatory management for immunocompetent patientsRe-evaluation within 7 daysRoutine colonic evaluation is not recommended.

Method

Data collection proforma designed according to WSES guidelines Retrospective data collection: Acute admissions between July to September 2023 in a single centre Any age and gender CT proven acute uncomplicated diverticulitis Patients with complicated diverticulitis were excluded

Results

53 patients were included. Mean Age: 63, Age range: 34 – 89, and 70% patients were female. Commonest CT finding: Sigmoid diverticulitis (n=33).Complete clinical assessment as per guidelinesAll patients, regardless of their clinical status, received antibiotic therapyAmbulatory care offered to only 57% of patientsOnly a small percentage of patients were offered re-evaluation within 7 days (37% compliance)Patients were offered OP colonic evaluation (75% compliance)

Conclusions

Inconsistent compliance with WSES guidelines for management of acute uncomplicated colonic diverticulitis. Arrange teaching sessions for the surgical staff and devise a management plan for acute uncomplicated diverticulitis that is in accordance with the guidelines. Printouts of WSES guidelines to be made available on the acute surgical floor. Re-audit after 4 – 8 weeks.
964 Intra-Operative Tourniquet Use in Lower Limb Orthopedic Surgery: A BOAST Audit
Authors: Chahal K , Bethel J , Oduoza U , Begum R
Published: August 2024

Aim

Surgical tourniquets reduce operative time and blood loss and improve visualisation of the surgical field. However, risks include pain, neurovascular and local tissue damage. Operative tourniquet pressure should be baseline systolic pressure plus 70-130mmHg. Ischaemic tourniquet time should be less than 120 minutes. We aim to audit the use and documentation of surgical tourniquets of lower limbs surgery undertaken at a single DGH over a 6-month period against BOAST guidelines.

Method

Retrospective data collected on torniquet use, torniquet time, pressure and patient demographics recorded collected from operation notes and theatre logbooks.

Results

66 patients were included, mean age 55 (7-92) years. 95.4% (62/66) of lower limb procedures had recorded use of tourniquet. 78.5% (51/66) had the total tourniquet time recorded. Mean tourniquet time was 82.4 (15-130) minutes. 58.7% (37/62) had inflation pressure recorded. Mean inflation pressure was 265.7mmHg (150-300). 5 patients (7.6%) exceeded the maximum recommended tourniquet time without deflation.

Conclusions

Our results indicated that level of documentation of tourniquet use fell below the standards set out in BOAST guidelines. A second cycle will determine whether implemented changes in the theatre documentation system has conferred change.
967 Minimizing Radiation Dose in Non-Contrast CT KUB for Ureteric Colic
Authors: Jarral F , Hamdy A
Published: August 2024

Aim

To assess current local practice in CT KUB imaging alongside national data aimed at minimising the radiation doses & adherence to accepted practice.

Method

We undertook a retrospective analysis of 104 non-contrast CT KUB in July 2022 for patients with suspected renal/ureteric colic. PACS images were individually reviewed to assess the cranial level at which scan commences & level at which kidneys start. Data was collected and radiation Doses monitored in milliGrey (mGy) (standardized measure of radiation dose output of a CT scanner).

Results

A total of 104 non-contrast CT KUB was included where 50 (49% ) scans commenced from superior border of T10- T12 Level & 52 (51%) of scans commenced above T10- T12 Level. A further 1% started below T12 level. Only 1% (1) of scans showed upper poles of left kidney above T10. Individuals scanned at T10 or below (50/104) received on average 6.9mGy of radiation while individuals scanned at levels above T10 (52/104) received on average 9.82mGy of radiation.

Conclusions

Our results show 51% of scans commenced above the recommended level (T10) which exposed individuals to higher amounts of radiation on average than individuals whose scans commenced at or below the accepted level of T10. This concludes that more than half of the people who underwent CT KUB scans were exposed unnecessarily to higher radiation doses than the published diagnostic reference levels (NDRL).
1273 The Introduction of Digital Care Records Improves the Completion of Consent Forms
Authors: Poon C , Walker C , Nelson A
Published: August 2024

Aim

Ensuring the consent process is thorough and well documented is crucial in surgical care. A good marker for this is the accurate completion of consent forms. This audit aimed to assess completion rates of paper consent forms and then re-audit after the much-anticipated introduction of Encompass in Northern Ireland in November 2023. Encompass is a healthcare system widely used in the USA which provides a completely digital record for every patient. Our trust was the first to introduce the new system, which will be completely rolled out in Northern Ireland in the next 2 years.

Method

Completion of 30 consent forms was audited pre-Encompass (paper consent forms) and following implementation (online forms signed with a tablet). Information audited included patient details, responsible consultant, name of procedure, site listed (if appropriate), explanation, complications, leaflet given, anaesthetic type, consenter signature, legibility, patient signature and date and whether copy was given to patient.

Results

The completion of introduction of online consent forms improved the completion rates in nearly every parameter. However, the most poorly completed parameters on both paper and electronic consent forms were if information leaflet and copy of consent form was given to patient.

Conclusions

The digital platform allows the automatic population of forms with several of the parameters, improving efficiency and accuracy. A complication list can be added easily using one of the pre-completed lists for common Urology procedures (taken from BAUS patient leaflets). In the future consent forms will automatically be sent to the patient, which will improve digital consenting further.
143 Comparative Study Between Breast Conservative Surgery (BCS) and Modified Radical Mastectomy (MRM) in Early Stage of Breast Carcinoma in a Tertiary Care Hospital in Dhaka, Bangladesh
Authors: Joty S M , Saiyara N , Islam F , Khan M R
Published: August 2024

Aim

To compare BCS and MRM in the treatment of early-stage breast carcinoma.

Method

This was a prospective observational study that involved 74 patients and was carried out in the department of surgery at Shaheed Suhrawardy Medical College & Hospital and Enam Medical College & Hospital, Dhaka, Bangladesh with an 18-months minimum follow-up. The time frame for inclusion was from July 2018 through July 2020. There were two patient groups, 37 patients in Group A who underwent breast conservative surgery and Group B was made up of 37 individuals who had MRM for early-stage breast carcinoma.

Result

With a mean age of 47.65 years in the BCS group and 48.19 years in the MRM group, the operative time for BCS was 1.04± 0.25 hours, whereas 3.20±0.48 hours for MRM. Statistically significant higher amount of post-operative drainage volume in MRM group compared to BCS group (p-value= 0.000). With an excellent aesthetic outcome rate in BCS group (p-value<0.0001) as well as better quality of life than MRM group.

Conclusions

Breast conservative surgery and modified radical mastectomy are both oncologically safe treatments for early-stage breast cancer with multidisciplinary approach. BCS offers less trauma, infection and hospital stay; better aesthetic outcome and quality of life than MRM, making it more deserving of being promoted clinically in the treatment of early-stage breast cancer. Keywords: Breast cancer, Breast Conservative Surgery, MRM.
171 Asymptomatic Emphysematous Pyelonephritis
Authors: Al-Gburi S , Abdalla O , Wong K
Published: August 2024

Introduction

Emphysematous pyelonephritis is a rare severe gas-forming infection of the renal parenchyma and its surrounding areas. It is usually common in poorly controlled diabetic patients or associated with urinary stones. We present a rare case of asymptomatic emphysematous pyelonephritis, which was diagnosed incidentally during a follow-up CT scan for the patient and treated successfully with a total of 10 weeks of antibiotics.

Presentation

A male patient in his 70s with a history of poorly controlled type 2 diabetes mellitus, chronic kidney disease, and benign prostatic hyperplasia was referred to the hospital due to findings of emphysematous pyelonephritis on a follow-up CT scan of the kidneys, ureters, and bladder (CT KUB).

Discussion

Emphysematous urinary tract infections are caused by gas-forming organisms and are categorized based on how the gas is distributed in the urinary tract. The causal agent of infection for emphysematous pyelonephritis is mostly Escherichia coli and Klebsiella pneumonia. To our knowledge, this is the second case of asymptomatic emphysematous pyelonephritis that was treated with antibiotics and without intervention.

Conclusions

Asymptomatic emphysematous pyelonephritis is rare, with only two case reports in the literature. The characteristics of asymptomatic emphysematous pyelonephritis have not been well understood due to their rare occurrence. It may serve as the very first sign of the development of sepsis or remain dormant while undergoing medical treatment. successful management of asymptomatic emphysematous pyelonephritis with a prolonged course of antibiotics can be done in very selected cases with careful monitoring.
326 Unprecedented Complications: First-Ever Case Report of Undetected Iatrogenic Bladder Rupture Presenting as Osteomyelitis of the Pubis and Fournier’s Gangrene
Authors: Golash A , Golash V
Published: August 2024

This case report details the first-ever documented occurrence of chronic extraperitoneal rupture of the bladder with osteomyelitis presenting as Fournier’s gangrene. The patient, a 78-year-old male with a history of prostate cancer, presented in the emergency department six months post urethral stricture dilatation, with sepsis, lower urinary tract symptoms, and painful right groin swelling.

An urgent CT scan revealed a gaseous collection in the right thigh and pubis symphysis destruction, suggesting Fournier's gangrene and osteomyelitis. The source of the collection was a 15mm defect in the anterior bladder neck, attributed to an iatrogenic injury during urethral stricture dilation. The patient underwent urgent debridement, with extensive necrotic tissue excision. Continuous urinary leak from the non-healing bladder wall injury necessitated a multifaceted approach, including Foley catheterization, bilateral nephrostomy, and a rectal tube. Polymicrobial infections with Aerococcus sanguinicola, Staphylococcus haemolyticus, and Enterococcus faecium further complicated the wound healing process. The patient underwent multiple debridements and was managed with a vacuum-assisted-closure dressing. Despite a healthy and shrinking thigh wound, the persistent urinary leak prevented skin grafting. A six-week course of co-amoxiclav addressed the osteomyelitis of the pubis. A follow-up CT scan after two months indicated a stable bone condition but confirmed the ongoing bladder defect.

This unprecedented case underscores the need for heightened vigilance in patients undergoing urethral interventions. It also highlights the challenges of managing delayed silent complications, emphasizing the importance of a multidisciplinary approach for successful outcomes. This case sets a precedent, prompting further research to refine surveillance and management protocols for similar intricate clinical scenarios.
504 Non-Gravid Uterine Torsion Associated with Small Bowel Obstruction
Authors: Goh B , Mathew S , Shamassi M , Rafique M
Published: August 2024

Uterine torsion is an uncommon condition. Even more so in cases of non-gravid torsion. We present the case of a postmenopausal woman in her 70’s who arrived to our emergency department with hypoxic respiratory failure and hypovolemic shock requiring prompt resuscitation with non-invasive ventilation and intravenous crystalloids following 4 day history of abdominal pain and vomiting.

Abdominopelvic Computed tomography demonstrated a small bowel obstruction secondary to a large palpable uterus. Diagnosis was made of small bowel obstruction secondary secondary to a large leimyomatous uterus associated with acute kidney injury and aspiration pneumonia.

Laparotomy demonstrated a large leimyomatous uterus that had torted on the cervical pedicle associated with perforation of the lower anterior segment. A segment of healthy jejunum was adhered to the uterine fundus and was easily mobilised with blunt dissection. Hysterectomy and bilateral oophorectomy were performed. The patient made a full recovery. Histopathology demonstrated a calcified leiomyomatous uterus with adjacent haemorrhagic infarction of the uterine wall.

This is the first case of small bowel obstruction associated with uterine torsion identified in the literature.

Uterine Torsion is defined as a more than 45-degree rotation around the long axis of the uterine body. The most common cause of uterine torsion relates to pregnancy, or abnormal foetal presentation. Non gravid causes include Leiomyoma, uterine abnormalities such as bicornuate uterus, pelvic adhesions, or adnexal masses. On CT/MRI the whirl/whorl sign of the uterine cervix is indicative of uterine torsion however this was not present in our case, and diagnosis was only made intra-operatively .
978 Simultaneous Orchidectomy, Hernia Repair, and the Discovery of Gonadoblastoma-Like Features in an Undescended Testis – A Rare Case Report
Authors: Wickramasinghe V C , Saranga K G V , Piyarathne S A , Madhawa J K G , Prashantha A H A
Published: August 2024

Introduction

Undescended testes, a congenital anomaly, present unique challenges when associated with clinical manifestations.

Case Report

38 years old patient, with no known co-morbidities, exhibited a two-year history of a stable lump in the right inguinal region. He had no history of tuberculosis exposure, no lower urinary tract symptoms or impotence but had history of primary subfertility. Clinical examination of the contralateral side showed no abnormalities.

Diagnostic Assessment - Surgical exploration entailed orchidectomy and exposed unexpected gonadoblastoma-like features in the undescended testis. Contralateral testis evaluation yielded normal LDH, AFP, and Beta hCG levels.

Therapeutic Intervention - Simultaneous exploration of the right inguinal region and orchidectomy aimed to address the undescended testis and revealed unexpected histopathological findings.

Histopathological Analysis - Microscopic examination of the undescended testis specimen demonstrated small-sized seminiferous tubules with a thick basement membrane. The tubules were lined by Sertoli cells, yet spermatogenesis was notably absent. Clusters of Leydig cells and foci of rounded nests composed of germ cells and small sex cord cells were observed.These findings collectively indicated gonadoblastoma-like features. Importantly, there was no evidence of germ cell neoplasia in situ or malignancy.

Discussion

The unexpected histopathological findings introduce complexities to the case, raising questions about the nature of gonadoblastoma-like features in the context of undescended testes. The absence of malignancy prompts consideration of long-term implications for fertility management.

Conclusions

This case report illuminates the challenges associated with undescended testes and introduces unexpected histopathological findings. The discovery of gonadoblastoma-like features during surgical exploration emphasizes the necessity for meticulous clinical evaluation and long-term surveillance in managing such cases.
1107 Intussusception Following Duodenal Switch: A Case Report
Authors: Jindal A , Shanti H , Patel A
Published: August 2024

Background

Intussusception accounts for 1% of small bowel obstruction in adults. There have been several reports of intussusception following jejune-ileal bypass and Roux-en-Y gastrectomy. To our knowledge, this is the first reported case of intussusception following Biliopancreatic diversion with duodenal switch.

Case Presentation

We present a 32-year-old woman who had a biliopancreatic diversion with duodenal switch procedure for weight loss three years ago. She had successful outcomes and lost 100kgs after surgery. She presented with recurrent episodes of self-remitting severe colicky abdominal pain and vomiting. A CT scan showed an intussusception at the side-to-side ileo-ileal anastomosis. On laparoscopy, telescoping of the small bowel was identified, the alimentary limb had intussuscepted into the anastomosis. The telescoped bowel was gently reduced. The bowel was viable, and decision was made to avoid resection. The alimentary and the biliopancreatic limbs were plicated for 5cm proximally and distally to prevent recurrence. She recovered well after the operation and remained well on six months’ follow-up.

Conclusions

Intussusception is a rare but serious complication after bariatric surgeries. While management of intussusception in adults usually entails reduction and resection to remove the lead point, plication and enteropexy can be utilised to avoid bowel resection. This is of value when such patients present to a non-bariatric centre.
1137 Case Report: Bilateral Nipple Sparing Mastectomy for BRCA2 Mutation Patients with Unusual Presentation of Nipple Raynaud's Phenomenon
Authors: Siddique M H , Hidayatul S , Soumian S
Published: August 2024

This case report delves into the surgical experiences of twin sisters with BRCA2 mutations undergoing bilateral nipple sparing mastectomy as a preventive measure. During immediate breast reconstruction, both patients unexpectedly encountered intense nipple pain resembling Raynaud's phenomenon. The study explores the intricacies of their cases, including potential contributing factors, management strategies, and the complexity of symptom exacerbation during pregnancy. The patients' mother, with a history of Raynaud's phenomenon, adds a familial component to the discussion. Challenges in symptom alleviation, including a skin burn from using hot water bottles for pain relief, are also addressed.

Bilateral risk-reducing mastectomy is common for BRCA2 mutation carriers, but this report sheds light on the unexpected manifestation of nipple pain, coupled with familial predisposition. The first patient, despite normal post-mastectomy histology, experienced persistent nipple pain, resorting to various therapies. A skin burn from hot water bottles prompted bilateral excision of the nipple and areola. The second patient, with intermittent left nipple pain, opted for the same procedure. The report highlights the exceptional occurrence of Raynaud's-like symptoms post-mastectomy in BRCA2-positive twin sisters. Bilateral excision emerges as a management option, emphasizing ongoing monitoring and a keen interest in long-term outcomes.
801 Simultaneous Resection for Metastatic Colorectal Cancer – What Should We Tell Our Patients to Expect?
Authors: Thiagarajan J , Choudhry H , Stratton M , Jones R
Published: August 2024

Aim

Almost half of colorectal patients will advance to liver metastasis during the course of their disease. The aim of the present study was to evaluate outcomes across different treatment arms in patients undergoing synchronous resection of primary colorectal cancer and liver metastases.

Method

2-year retrospective review of all patients receiving simultaneous resection of primary bowel cancer and secondary liver metastases at a single tertiary hepatobiliary unit, from a prospective operative database. Patients were stratified by extent of liver resection (major, >3 segments or minor < 3) and by bowel (rectal or colon) surgery performed. Primary outcomes were rate of complications within 30 days following surgery and length of stay (LOS) in hospital. Secondary outcomes were blood loss, pringle time, time spent in theatre and interval between first outpatient appointment and surgery.

Results

A total of 44 patients were recruited, of these, 38 patients were eligible for inclusion. Complication rates were 67% in the major liver resection and colon surgery group (group 3) and 38% in minor liver resection and rectal surgery group (group 2). Group 3 had the longest mean LOS (17.2 days) in comparison to group 2 (9.2 days). Major and minor hepatectomies resulted in a mean blood loss of 720ml and 445ml respectively.

Conclusions

Synchronous resections involving major hepatectomies are associated with a higher rate of post-operative and peri-operative complications. While surgery remains the best chance of cure for patients with resectable disease, it is important to set realistic expectations for surgical outcomes.
1221 Timing of Reversal of Ileostomy: A Single-Center Experience
Authors: Mandal I , Chaudhari V , Nasrudin A , Dharamavaram S
Published: August 2024

Aim

This paper aims to present a comprehensive overview of the reversal of ileostomy based on a single-center experience.

Method

A retrospective analysis was conducted on 39 patients who underwent the reversal of loop ileostomy between August 2021 and August 2023 at a District General Hospital in the UK.

Results

The average age of patients in the study was 65.82 years, with a standard deviation of 10.37. Reversal occurred, on average, after 755 days (2.06 years), with 41.02% of patients undergoing the procedure 1-2 years after the initial loop ileostomy. Notably, 46.1% of cases attributed the delay in reversal to COVID-19 alone. Combined factors, such as COVID-19 and adjuvant chemotherapy, adjuvant chemotherapy alone, and miscellaneous causes (patient and healthcare-related) each contributed to delays in 15.3% of patients. Complications of ileostomy, including anastomotic stricture, purulent peritonitis, prolapsed stoma, and parastomal hernia, accounted for a delay in 5.1%. Acute kidney injury caused readmissions in 15% of patients, while high output stoma and vomiting were responsible for 26% of cases. Notably, 59% of patients experienced no readmissions.

Conclusions

The average time for the reversal of loop ileostomy was 2 years, with COVID-19 identified as a primary contributor to delays. Recommendations include scheduling reversal dates immediately after low anterior resection to minimize delays. Addressing high output stoma and vomiting, the leading causes of readmissions, through early reversal (3-6 months) can potentially reduce complications, readmissions, and overall hospital costs, optimizing bed occupancy.
410 Post-Radiotherapy Infratemporal Extracranial Meningioma: A Case Report
Authors: Borg L
Published: August 2024

This case report details the complex management of a 66-year-old male, Mr. CF, with a history of acromegaly treated by post-transsphenoidal hypophysectomy and radiotherapy. He presented with a gradually enlarging left preauricular lump, identified as a meningioma through imaging studies. Despite initial observation due to the absence of symptoms, the tumour exhibited rapid growth, prompting surgical intervention. The surgery was technical, due to surgical field and various critical structures, yet successfully managed to preserce the facial nerve.

Histological analysis confirmed a Grade I WHO meningioma. Subsequent follow-ups revealed residual extra-cranial meningioma tissue, prompting continued watchful waiting due to the low risk of malignant transformation for Grade I meningiomas. Follow-up imaging demonstrated growth in residual foci, highlighting the challenges of managing recurrent meningiomas.

The report underscores the importance of a multidisciplinary approach and vigilant monitoring in meningioma cases, especially when involving intricate anatomical regions. Despite postoperative complications, the patient remains asymptomatic, and the risk of malignancy remains low. Continued surveillance is planned, emphasizing the need for long-term follow-up strategies in the management of recurrent meningiomas. This case contributes valuable insights into the complexities of surgical decision-making and the ongoing challenges in treating meningiomas.
919 Retrospective Analysis of the Management of Necrotising Otitis Externa Patients: A Single Centre Study
Authors: Kumaresan K , Suleiman M , Gouda M , Pearson A
Published: August 2024

Introduction

Necrotising otitis externa is an invasive, infection, with minimal evidence underpinning its diagnosis and management. It is often recognised late and undertreated many a times requiring prolonged inpatient hospital stays where provision for outpatient antibiotic administration and robust multi-disciplinary care is lacking. National ENT UK guideline on Necrotising Otitis Externa (NOE) was published in 2020, until which point management was based on local specialist opinions across the UK.

Aim

This work was undertaken with an aim to analyse the local management in our hospital following the local hospital guidelines adapted from national ENT UK guidelines (2020) shedding light on the morbidity and mortality of these patients.

Method

Data was collected retrospectively from 22 patient records in the period between April 2018- November 2022.

Results

We found that the mean age was 79 years. Recurrence rate was 13.6% (3 out of 22). Culture swab was sent in all cases and Pseudomonas was the most common organism. Biopsy was also done in all patients when polyps/granulation was present. Pre-treatment CT was performed in 95%. MRI was performed in 90.9 % and the rest couldn’t have MRI for valid reasons.3 patients were lost to follow up (Compliance to follow up was 86%). Intra-venous & topical antibiotics were given alongside micro-suction. Infectious Diseases team review was considered in 63.6%. Hyperbaric oxygen was considered in 4 patients (17.4%).

Conclusions

96.5% overall compliance to guidelines was achieved. We aim to further understand the benefit of hyperbaric oxygen in NOE management by undertaking a prospective study.
1091 Comparing the Incidence of Superficial Surgical Site Infections Following Emergency Laparotomies with the Use of Negative Pressure Wound Dressings Versus Standard Wound Dressings
Authors: Cotter Fonseca P , Vlachos G
Published: August 2024

Aim

This study aims to investigate whether use of negative pressure wound dressings (NPWD) in emergency laparotomies has any effect on the incidence of superficial Surgical Site Infections (SSIs) compared to Standard Wound Dressings (SWD).

Method

Patients undergoing emergency laparotomies at one NHS trust in a 6-month period (01/01/2023-30/06/2023) were retrospectively identified using the National Emergency Laparotomy Audit database. Clinical documentation was then assessed for documented evidence of SSIs and type of dressing used.

This study used the UK health security agency’s definition of superficial SSI, therefore recorded evidence of i) purulent discharge ii) positive wound culture iii) symptoms and signs (pain, swelling, erythema, heat) iv) incision was deliberately opened or had clips removed to manage the infection v) documented clinical diagnosis of SSI. Exclusion criteria: repeat laparotomies in the same admission, deceased within 30-days. Categorical unpaired measures were compared using the Chi-squared test (5% alpha level).

Results

60 patients were identified as having emergency laparotomies in the 6-month period, of which 29 had NPWD and 31 SWD. There was no statistically significantly difference between NSWD and standard wound dressings in :pus discharge (6 versus[vs.] 11, p=0.20)positive wound culture (4 vs. 11, p= 0.09)>2 pain/swelling/erythema/dehiscence (8 vs. 14, p=0.16)clip removal to treat SSI (8 vs. 12, p=0.36)clinical diagnosis of SSI.(7 vs. 12, p=0.23).

Conclusions

There was no statistically significant difference in superficial SSIs between NPWD compared to SWD, in emergency laparotomies performed in one NHS trust measured over a 6-month period.
1131 A Series of Three Consecutive Emergency Room Thoracotomies Performed Within a Period of One Month at the National Accident and Orthopaedics Services Department in Sri Lanka
Authors: Wijesundara A , Samarakoon K , Panapitiya N , Ranatunga S , Gunatheepan J
Published: August 2024

Introduction

Emergency room thoracotomy is an essential component of initial resuscitation in a proportion of patients who present following thoracic injuries.

Case Presentations

A 51-year-old male, hospitalised within 45 minutes following a stab injury to posterior chest, went to asystolic cardiac arrest on admission. Emergency left antero-lateral thoracotomy was performed at 6minutes post arrest. It revealed massive hemothorax (3L), and active bleeding from intercostal vessels. Internal Cardiac Massage (ICM) with Aortic Cross Clamping(ACC) commenced and haemostasis achieved. Return of spontaneous circulation(ROSC) gained within 2minutes. He was extubated on day1 and discharged on day 8.

A 19-year-old male was transferred from a local hospital 4hours following road traffic accident(RTA) with poly-trauma to head, face, chest and abdomen. He went to asystolic cardiac arrest at 20minutes post admission. Left antero-lateral thoracotomy performed at 2minutes post arrest revealed, hemopericardium and left ventricular wall partial-thickness tear. ICM with ACC started and hemopericardium was released. ROSC achieved within 2minutes. Patient was immediately taken for exploratory thoracotomy and ventricular wall repair. After a brief stable post operative period, patient gradually deteriorated and passed away on day3 due to traumatic brain injury and diffuse axonal damage.

A 59-year-old male, hospitalised 30minute following RTA (with direct chest impact) was in asystole on admission. Emergency transverse thoracotomy performed at 15minutes of resuscitation revealed multiple lung contusions and bilateral hemothorax. ICM with ACC started but failed to achieve ROSC at 20minutes.

Conclusions

Shorter the time gap from asystole to thoracotomy, higher the probability of ROSC.
690 Paragangliomas: A Rare and Under-Appreciated Aetiology? a Case Series
Authors: Joyce A , Aspinall S
Published: August 2024

Aim

To assess the presentation and management of paragangliomas within NHS Grampian between 2018 to 2023.

Method

Retrospective data collection from electronic records of histo-pathologically confirmed paragangliomas for: mode of presentation (incidental vs symptomatic), location of tumour, biochemistry (urinary/ plasma metanephrines), management, genetics, follow-up, and outcome.

Results

Ten cases of paragangliomas were identified, with an age range of 17-76 years: two head and neck, one thoracic, six abdominal and one pelvic. Seven presented with symptoms. Five had elevated metanephrines, though these were only measured in four cases pre-operatively. Surgical excision was undertaken in six. Chemotherapy given in three. Nine were discussed in multidisciplinary (MDT) meeting. Six patients in remission with ongoing surveillance, three have persistent / recurrent disease, and one is deceased. Pathogenic Succinate Dehydrogenase germline variant present in three, no genetic variance in five, results pending in one and one unknown.

Conclusions

Paragangliomas are rare neuroendocrine tumours that may present to a diverse group of surgical specialties. They occur in any age group, have a high incidence of malignancy and germline genetic mutations; and should be suspected in an unexplained mass arising along the sympathetic chain. Biochemical evaluation should be assessed for metanephrine excess and alpha receptor blockade should be undertaken prior to invasive interventions in functional tumours to mitigate risk of provoking an adrenergic storm. Paragangliomas need discussion in endocrine/ neuroendocrine tumour MDT to ensure appropriate pre-operative workup and follow up. This may improve outcomes and aid in the earlier detection of recurrent disease.
1143 Audit of Conversion Rate from Laparoscopic to Open for Patients Undergoing Elective Colorectal Resection 2021-2022
Authors: Akhtar M A B , Khalid S Y , Zeeshan S
Published: August 2024

Aim

This audit aims to compare the conversion rates from laparoscopic to open procedures for elective colorectal surgeries done in our hospital during 2021 and 2022 and to compare the results with the standard conversion rate of 14.3% as mentioned by the journal of society of laparoscopic and robotic surgeons in 2014.

Method

Data was collected from hospital computerised system.

Inclusion criteriaPatients undergoing elective resection for colorectal cancer from January 2021 to December 2022.Patients undergoing elective colorectal surgeries for benign conditions including ulcerative colitis, sigmoid colon resections for recurrent diverticulitis, colectomies for endoscopically unresectable polyps with high grade dysplasia.

Total of 41 patients underwent surgery in 2021, and 45 in 2022.

Results

Over the 24-month period, 86 patients underwent colorectal surgeries. Laparoscopic approach was attempted in 83 (96.5%) patients, and primary open surgery was performed in 03 (3.4%) patients. Of the 83 Laparoscopic procedures, 78 (93.9%) were successfully completed laparoscopically and 05 (6.1%) were converted to the open procedure. The annual conversion rate for colon cancer resections was 10.3% (3 of 29 converted to open surgeries in 2021) and 9.5% (2 of 21 converted to open procedures in 2022). The annual conversion rate for rectal cancer was 0% for both years; all 8 procedures completed laparoscopically in 2021 and all 11 procedures completed successfully laparoscopically in 2022.

Conclusions

Our audit showed that the conversion rate in our hospital for colorectal surgeries is only 6 % which is better than the international standards.
613 Utilisation of Off-Site Theatre Capacity to Reduce the Waiting Time for NHS Patients with Chronic Deep Venous Disease in the Post Covid-19 Pandemic Environment
Authors: Hussain H , Natha B , Choudhury E , Morris R , Khan T , Black S
Published: August 2024

Aim

This audit aimed to assess the adherence to treatment pathways and the transfer of electronic patient care records in a cohort of patients with deep venous disease who underwent procedures off-site due to extended waiting times during the COVID-19 pandemic.

Method

Between 1st February 2022 and 19th July 2022, 41 patients underwent deep venous procedures at an off-site facility. Retrospective data collection from electronic records, operation notes, imaging, and patient outcomes was conducted. Demographics, procedure types, adherence to pathways, image transfer, and patient outcomes were analysed.

Results

41 patients (M:F - 16:25) were treated on a series of 17 lists aged between 24 to 79 years. Patients assigned for treatment off-site were highly selected for case simplicity. Procedures performed include diagnostic venograms, stenting, venoplasty, and varicose vein treatment. Stenting success was high (100% patent stents on discharge). No deaths occurred, with minimal complications and a few procedures needing to be rescheduled at the primary site. Image transfer to the parent site varied (87.5% electronic records, 50% imaging). The waiting list was reduced from 90 to 77 patients, inclusive of new additions during the study period.

Conclusions

Outsourcing theatre time effectively managed the backlog of patients with deep venous disease, offering a safe intervention approach. While there might be financial strain, the benefits in avoiding treatment delays and enhancing patient experience outweigh the potential costs. Overall, the audit supports the use of off-site procedures as a viable solution to address waiting time concerns during healthcare crises.
621 Sustainable Training-Friendly Service Provision to Reduce the Burden of Gallstone Disease: A Tertiary Care Surgical Unit Experience
Authors: Tay K L Y , Neelankavil Davis G , Ghazanfar M
Published: August 2024

Aim

NICE guidelines recommend laparoscopic cholecystectomy for symptomatic gallstones during the index admission. COVID-19 restrictions highlighted the need for a dedicated emergency theatre for acute biliary diseases, leading to the introduction of the 'Hot Gallbladder' service. This study assesses the service's impact on reducing recurrent admissions and expediting cholecystectomies in a University Hospital.

Method

A prospective study was conducted between March to August 2023 in a tertiary care surgical unit on patients referred to the Hot Gallbladder service. This service was a weekly Friday morning theatre list managed by registrars under consultant supervision. Data extracted included patient demographics, diagnosis, previous hospital admissions, cancellations, and admission duration.

Results

Between March to August 2023, 152 gallstone-related admissions were recorded. Thirty-two cases were expedited to the Hot gallbladder service, consisting of 7 males and 25 females with a median age of 45 (32.5, 64.5) years. Twenty-six underwent cholecystectomy; two withdrew consent, and four were cancelled on the day due to theatre overrun. Two patients (8%) had same-admission cholecystectomies, while 24 (92%) were operated within 2 weeks, with a median of 2 (1, 2.75) previous hospital admissions.

Conclusions

The Hot Gallbladder service offered prompt definitive treatment to 21% of patients while providing valuable training for registrars. In the context of biliary presentations, failure to perform cholecystectomies on peri-index presentation not only incurs substantial financial costs but also predicts future readmissions, adding to the overall strain on scarcely resourced NHS services and significantly impacting patients’ quality of life. Data from this study will contribute to a cost effectiveness analysis.
1030 Role of International Webinar Among International Medical Graduates (IMGs) on Enhancing Understanding of the UK Surgical Training Pathways and Professional and Linguistic Assessments Board (PLAB) Test: A Global Perspective
Authors: Khatri A , Thapa B , Shakya S , Shrestha S , Walshaw J , Koirala S , Bhatta G , Karki B B
Published: August 2024

Aim

To educate the International Medical Graduates (IMGs) about UK surgical training pathways and ways to enhance portfolios. Professional Linguistic Assessments Board (PLAB) test.

Method

A webinar as a part of International Medical Teaching Series (IMTS), “PLAB & Beyond: Specialty Series” was organized in collaboration with Nepalese Doctor’s Association UK, Rotaract Club of KIST Medical College & Devdaha Medical College, Nepal on 4th November 2023. A pre-and post-webinar survey was designed to get the delegate’s insight.

Results

There were almost 80 delegates including IMGs and medical students representing more than 9 countries across various career grades. Pre-webinar survey established the need for a session focused on building strong surgical portfolio and general insights on the PLAB test. A two-hour session on surgical application, medical specialties and top tips on GMC exams was presented by the UK trainees. The post-webinar survey showed that 75% of the delegates achieved their aims and learning outcomes with over 80% of delegates satisfied with the presentation on CV building, and core surgical application. To enhance the academic surgical side among the IMGs which is often found lacking, a session on academic surgical training application was delivered by an academic surgeon with 97% positive reviews. Similarly, a session on higher surgical training (ST3) applications received a 100% positive response.

Conclusions

There is increasing need for global health professional workforce for the sustainability of the NHS. Optimizing the standard of care is possible via educating and rigorous training of IMGs where this virtual platform has proved to be an excellent way forward.
1041 Changes in Information Seeking Patterns of Medical Students in the Social Media and Artificial Intelligence Age: Preliminary Findings
Authors: Richa Y , Asif A , Burton O E , Richards H , Hennessey D
Published: August 2024

Aim

Non-traditional and novel online sources of medical information such as social media, large language models (LLMs) and video sharing platforms are providing medical students with opportunities for innovative learning. This cross-sectional study assesses current trends in use of these resources among medical students.

Method

A prospective, cross-sectional, observational, and descriptive study using an online questionnaire was utilised. Data collected included platform used, frequency of use, preferences, perceived benefits, and challenges associated with the use of these tools in the learning experiences of medical students.

Results

273 medical students consented and completed the survey. 217 (79.1%) of students used social media or online video sharing platforms for educational purposes, mainly to supplement or replace course materials. The three reported benefits of using social media for educational purposes were: (I) accessing medical knowledge quickly and easily (87.7%), (II) accessing short duration compressed videos (70.8%), and (III) accessing infographics and visually appealing resources (67.5%). 143 (52.2%) of students have used Chat GPT or other LLMs. Of these, 54.7% have used LLMs for educational purposes (33% weekly and 44.3% monthly), and report using them mainly as resource when completing assignments, homework, or essays. 73.2% expressed concerns regarding unreliable medical information on social media, whereas only 54.8% expressed concerns with LLMs.

Conclusions

The survey results demonstrate that medical students are frequently seeking medical knowledge outside of core course materials. Medical educators must become aware of these changing trends. Guidance should be provided to medical students regarding the relative risks and benefits of these resources.
1067 Prevalence of SIJ Pathology: A Retrospective Observational Study
Authors: Chooi J Y , Elmarawany M N , McCarthy M
Published: August 2024

Aim

Sacroiliac joint (SIJ) pathology is often said to be an underdiagnosed cause for lower back pain (LBP), with the literature suggesting a point prevalence of 25%. However, there is limited published evidence to support the true prevalence of SIJ pathology. This single-centred retrospective observational study aims to produce evidence on the prevalence of SIJ pathology detected through imaging.

Method

Patients presenting with LBP at a single spinal surgeon clinic from 2014 to 2022 were identified. Among them, patients who underwent SIJ imaging were selected. Their baseline characteristics, medical history, risk factors, examination findings, and imaging results were collected and analysed.

Results

A total of 969 patients were found to have presented with lower back problems. Within this group, 265 patients went on to have SIJ imaging, and 31 patients were found to have pathological SIJ. This suggests a pathological SIJ prevalence of 3.2% amongst patients presenting with LBP (31 out of 969 patients). A medical history of previous spinal surgery showed a strong correlation with degenerative SIJ (p=0.0049). Other known risk factors were not found to have a statistically significant correlation with the incidence of SIJ pathology. Examination findings of pain provocation tests, when used in combination, suggest a high specificity score.

Conclusions

The low prevalence rate from this study might suggest a lower index of suspicion for SIJ pathology. The real prevalence of SIJ pathology remains inconclusive. Further meta-analysis is required to understand the true prevalence rate of SIJ pathology.
1108 Teaching the Principles of Surgery Online – A Programme for UK Medical Students
Authors: Keogh K , Yadav Nongrum R , Komperla S , Titcombe R , Wahdan Q , Worden J , Lim C J , Byfield A , Khalil M
Published: August 2024

Aim

The RCSE publishes a National Undergraduate Surgical Curriculum on essential surgical knowledge for medical students. However, anecdotally, teaching on such topics varies across medical schools. This study looks to evaluate the impact of an online surgical teaching programme for medical students.

Method

Surgical societies from five UK medical schools collaborated on creating an eight-part teaching series on the principles of surgery, endorsed by ASiT. Topics include Anaesthetics and Pain Management, Surgical Wounds, Pre-Operative Preparation, Post-Operative Care, Nutrition and Fluids, Common Surgical Emergencies, Human Factors and Patient Safety, and Preparing an Operating List. Teaching is delivered by clinicians via Zoom. Self-perceived knowledge of topics is assessed before and after the programme, and feedback is collected for individual sessions. To date, three sessions have been delivered.

Results

163 participants completed the pre-course questionnaire, 87% of which were UK medical students (years 1 – 5). Questions were answered on 5-point scales, with 1 indicating low and 5 indicating high ratings for the relevant outcome. Self-rated knowledge of topics was poor, with more than 69% choosing 1 or 2 for all topics. Feedback for delivered sessions shows high ratings for relevance (more than 73% rated them 4 or 5) and confidence in topics (more than 82% rated them 4 or 5). Statistical analysis will be used to assess outcomes further once teaching is completed.

Conclusions

Initial results suggest strong interest for teaching on basic surgical principles, and that regular structured online teaching can be effective in increasing student confidence and knowledge attainment.
1206 Emergency Repair of a Traumatic Carotid Artery Rupture in a Bovine-Type Aortic Arch: A Case Study
Authors: Hurrell O , Strickland J
Published: August 2024

This joint vascular and cardiac case relates to a 14-year-old female who was involved in a pedestrian versus car collision and suffered polytraumatic injuries, the most life threatening of which was a tear to the base of the left common carotid artery (LCCA). This case became unique upon discovering the presence of a bovine-type aortic arch which limited endovascular options and led to the requirement of a surgical approach with cardiopulmonary bypass support.

The bovine-type arch with a proximal LCCA take-off had implications in surgical planning including the need for cardiopulmonary bypass support due to challenging clamp placement to ensure both cerebral and cardiac protection. This case presented challenges from both a cardiac and vascular perspective, due to atypical anatomy, patient size and uncertainty in an emergency scenario which led to multidisciplinary discussion and preparation for various surgical approaches.