bluuebunny/crossref_metadata_2025_split huggingface dataset:
355 Incomplete Intestinal Rotation with Appendicular Abscess Causing Diagnostic Dilemma in An Adult Patient
Authors: Almafreji I , Nur N 
Published: May 2021

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

Abstract

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

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

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

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

Abstract

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

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

Abstract

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

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

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

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

Abstract

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

Case presentation:
A 59-year-old male patient, who underwent a ceramic-on-ceramic THR 8 years ago, presented to our centre with a five-week history of right hip pain, after he suddenly twisted his upper body and felt a sharp pain in his groin. Prior to the injury he had an excellent functional level with the prosthesis.
His examination findings confirmed a reduced range of movement with pain in the groin on internal and external rotation. X-ray and CT of the hip confirmed a ceramic liner fracture with protrusion of the femoral head into the pelvis. A revision THR was subsequently performed.

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

Abstract
We aim to evaluate whether intraoperative cerebrospinal fluid (CSF) sampling during ventriculo-peritoneal (VP) shunt insertion can predict future shunt infection or guide its management, as there is currently no evidence for this.
83 paediatric patients undergoing VP shunt insertion between February 2013 and July 2019 were retrospectively identified. Patient demographics, presence of pre-operative extra ventricular drain (EVD), pre-operative CSF results, and intra-operative CSF results were identified. All patients were followed up for a minimum of 6 months for identification of shunt infection.
90 VP shunt insertions were performed in 83 patients. Age at time of shunt insertion ranged from 5 days to 15.8 years (mean 44.2 months). Tumours were the most common aetiology for hydrocephalus (n = 24). 67 cases (74.4%) had intra-operative CSF samples, of which 2 revealed the presence of bacteria. Only 1 patient with intraoperative CSF sampling positive for growth developed shunt infection during follow up. Two cases developed a shunt infection despite normal intra-operative CSF results. Three cases did not have intra-operative CSF sampling but developed a shunt infection during follow up.
Our results show that intraoperative CSF sampling as a method to predict future risk of shunt infection and to help inform future antibiotic prescribing is unreliable.
468 Management of Acute Appendicitis During the Early Phase of the COVID-19 Pandemic: A Single NHS Centre Study
Authors: Buksh M , Jabri Y , Al Samaraee A 
Published: May 2021

Abstract

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

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

Results
Prepandemic-(43 patients): Mean age was 38.3 years. Mean length-of-stay was 1.7 days. Preoperative imaging was used in 32(74.4%) patients; this was diagnostic in 28(87.5%). Non-surgical management was used in 4(9.3%) patients; one needed surgery eventually. Surgical approaches in 40 patients were (laparoscopic: 38(95%), open: 2(5%)). Neither significant morbidity nor mortality was reported.
Pandemic-(35 patients): Mean age was 31.2 years. Mean length-of-stay was 2.2 days. Preoperative imaging was used in 30(85.7%) patients; this was diagnostic in 26(86.6%). Non-surgical management was used in 8(22.9%) patients; one needed surgery eventually. Surgical approaches in 28 patients were (laparoscopic: 10(35.7%), open: 18(64.3%)). Neither significant morbidity nor mortality was reported, apart from one patient with COVID-19 postoperative infection.

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

Abstract

Introduction

and

Aims

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

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

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

Discussion

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

Abstract

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

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

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

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

Abstract

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

Method
Medical records were used to access to all relevant clinical notes for the patient, including blood results, clinical documentation, imaging, and histology. The patient’s clinical journey was reviewed from initial referral to the ENT department to diagnosis with non-keratinising squamous cell carcinoma (NKSCC) stage IV b.
Progression of disease: The patient was initially referred to ENT with unilateral tinnitus and temporal headache and diagnosed in clinic with glue ear and hypertrophic adenoidal tissue. He was due to have grommets and EUA, which was postponed due to the COVID-19 pandemic and lack of clinical suspicion of SCC. Patient was later seen in ED for epistaxis, and then for neck swelling after which he was diagnosed with SCC.

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

Abstract
A 45-year-old gentleman presented to hospital with vomiting. Bloods demonstrated a corrected calcium of 4.48 and PTH of 979. CT neck showed a right sided thyroid lesion, which on FNA was reported as a possible thyroid or parathyroid neoplasm. A NM scan showed an enhancing nodule in the right thyroid gland and lytic vertebral and pelvic lesions. Bone biopsy showed parathyroid carcinoma.
He underwent palliative total thyroidectomy and right superior and inferior parathyroidectomy under the ENT team. His thyroidectomy specimen was reported as right inferior parathyroid carcinoma, infiltrating into the thyroid gland. His calcium levels did not normalise post-surgery and corrected levels were consistently above 3, with PTH &gt; 5000 despite fluid and calcimimetic therapy with only temporary normalisation with bisphosphonates and denosumab.
This refractory hypercalcaemia is due to the bony metastases producing PTH, which represents a primary cause of mortality. He is currently being managed with regular fluid infusions and bisphosphonates, with view to commence palliative chemotherapy.
Parathyroid carcinoma is extremely rare, and rarer still to present with metastatic disease. Treatment options are limited, with poor evidence behind chemoradiation and immunotherapy. Clinicians should be aware of the complications and management of refractory hypercalcaemia linked to this disease entity.
690 Intracranial Hypotension Due to CSF Leak Secondary to Ventral Thoracic Osteophyte Complex: Resolution After Transdural Thoracic Discectomy and Dural Repair
Authors: Kewlani B , Hussain I , Greenfield J 
Published: May 2021

Abstract
The hallmark symptom of spontaneous intracranial hypotension (SIH) is orthostatic headaches which manifests secondary to cerebrospinal fluid (CSF) hypovolaemia. Well-recognised aetiologies include trauma which includes procedures such as lumbar punctures and spinal surgery. More recently, structural defects such as bony osteophytes and calcified or herniated discs have been attributed to mechanically compromising dural integrity consequently resulting in CSF leak and symptom manifestation. A thorough literature review noted only a handful of such cases.
We report the case of a thirty-two-year-old Asian female who presented with a one-month history of new-onset progressively worsening orthostatic headaches. Workup included MRI of the thoracic spine which revealed an epidural collection of CSF consequently prompting a dynamic CT-myelogram of the spine which not only helped to confirm severe cerebral hypotension but also suggested the underlying cause as being a dorsally projecting osteophyte-complex at level T2-3. Conservative and medical management including bed rest, analgesia, mechanical compression, and epidural blood patches failed to alleviate symptoms and a permanent surgical cure was eventually sought. The surgery involved T2-T3 laminectomy and osteophytectomy and at a 3-month follow-up, complete resolution of symptoms was noted.
738 Missed Injuries in Trauma Patients Attending a London Trauma Centre
Authors: Johnston P , Durand-Hill M , Ike D I , Drummond I , Vris A 
Published: May 2021

Abstract

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

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

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

Conclusions
Significant injuries can be missed despite primary, secondary, and tertiary surveys in trauma patients. Clinicians involved in the care of trauma patients should therefore remain alert to evolving/new injuries throughout hospital admission.
782 A Rare Complication in A Post-Operative Bariatric Patient: COVID-19 Induced Mesenteric Venous Thrombosis
Authors: Winstanley J , Goodfellow M 
Published: May 2021

Abstract

Introduction
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has provided enormous challenges in the delivery of surgical care. In addition to respiratory tract infections, coronavirus disease 2019 (COVID-19) is associated with both arterial and venous thrombotic complications.

Case Details:
We present a case of acute superior mesenteric venous (SMV) thrombosis in a 36-year-old female patient who underwent Roux-en-Y gastric bypass three years previously. Her presentation with acute abdominal pain occurred 6 days after a positive nasopharyngeal swab. An admission CT scan demonstrated an abrupt cut off in the proximal SMV with resultant small bowel oedema. Subsequent thrombophilia screening and mutation testing for myeloproliferative neoplasms were all negative. She had also previously carried three pregnancies to term without any thrombotic complications. Hence, the high suspicion of acute COVID-19 induced mesenteric thrombosis.

Conclusions
In patients who have previously undergone Rouy-en-Y gastric bypass and lost significant weight, acute abdominal pain normally raises a high suspicion of internal hernia. However, as the pandemic progresses surgeons need to be mindful of COVID-19 induced mesenteric thrombosis as a differential diagnosis during the workup of acute abdominal pain. This was well demonstrated on a CT scan with intravenous contrast.
937 Is the Dog Still Man's Best Friend?
Authors: Ashraf S , Waseem M 
Published: May 2021

Abstract

Introduction
It is colloquially known that dogs are man’s best friend. However, animal attacks cause a large number of injuries and deaths worldwide, with 70% of injuries being caused by pets. This study highlights the impact of dog related injuries.

Method
Data was collected retrospectively over 1 year in a small district general hospital. The search term “dog” was used to find patients who had attended A&E or fracture clinic. This data was analysed for patient demographics, injury type and severity, management, and cost to the NHS.

Results
The majority (77%) of patients were female and elderly, with the modal age group being 70-79. Of the 38% of patients requiring admission, average length of stay was 6.7 days. Fractures made up the majority of injuries (56%) and 17% of patients required operative management. A further 2% suffered from post-operative complications. The average cost to the NHS was £1,695 per patient.

Conclusions
Dog related injuries disproportionately affected women and the elderly, with a large portion requiring operative management. Some patients developed further complications. As well as health burden there was also a financial burden associated with these injuries. These health and financial detriments are not often considered when deciding on pet ownership.
1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development
Authors: Esworthy G , Johnson N , Dias J , Divall P 
Published: May 2021

Abstract

Background
Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is &gt; 2mm; this value is often used as an indication for surgery if closed reduction is not possible.

Method
A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present.

Results
Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with &gt;2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation.

Conclusions
Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.