bluuebunny/crossref_metadata_2025_split huggingface dataset:
297 Risks of Delaying De-Obstruction of an Acutely Infected Obstructed Urinary Tract
Authors: Karunaratne D , Akiboye D 
Published: May 2021

Abstract

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 &lt; 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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &lt; 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

Abstract

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

Abstract
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 &lt; 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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.