bluuebunny/crossref_metadata_2025_split huggingface dataset:
27 Do Microbiology Swabs Taken During Incision and Drainage of Acute Perianal Abscess Affect Clinical Management and Future Clinical Course?
Authors: O'Connor A , Sabri S , Ullah S 
Published: May 2021

Abstract

Introduction
This study assesses whether microbiology swabs taken during incision and drainage of perianal abscesses have any impact on the post-operative clinical course and management.

Method
Data from emergency operative theatre lists were interrogated for patients undergoing incision and drainage of perianal abscess in the period March 2019 – March 2020. Each electronic medical record for patients who had perianal abscess surgery was interrogated for age, sex, smoking status, diabetic status, whether microbiology swab was taken for analysis, what organism was grown and any post-operative fistula development.

Results
71 patients met inclusion criteria. 55 (77.5%) patients had pus swabs sent at incision and drainage for microbiological analysis. Of the 55 patients swabbed, 20 (36%) had no organism growth, 22 (40%) had anaerobes growth – the most common organism in this study. Of all 55 swabs sent, only 14 (25%) were acknowledged. The presence of smoking (p &lt; 0.05) was statistically significantly associated with development of fistula-in-ano longer term.

Conclusions
Our data may indicate that microbiology swabs do not influence management of patients with acute perianal abscess. There are discrepancies in whether swabs are taken and acted upon. No organism was associated with fistula development. We would suggest national scale studies to explore our conclusions.
192 An Audit of The Delivery of Paediatric Orthopaedic Services at The Bristol Royal Children’s Hospital in Response to The British Orthopaedic Association Standards for Trauma (BOAST) COVID-19 Guidance
Authors: Benning M S , Berwin J , Monsell F , Carpenter C , Kendall J , Crosswell S , Thomas S , Knapper T 
Published: May 2021

Abstract

Introduction
Guidance from the BOAST helped structure our paediatric orthopaedic service n response to COVID-19. We assessed our compliance with 'BOAST COVID-19 standards', whether it is possible to run a safe and effective paediatric orthopaedic service.

Method
We performed a prospective audit of clinic and theatre data (16th March to 30th April 2020), from the paediatric orthopaedic department at the BRCH against the 'BOAST COVID-19 standards'. We also performed a retrospective audit.

Results
Patients booked into acute fracture clinic (AFC) and fracture clinic follow-up (FFO) reduced by 40% and 48% respectively from 2019 to 2020. A virtual fracture clinic (VFC) was implemented with an increasing trend seen. The number of patient initiated follow-up appointments increased in AFC and FFO from 16% to 75% and 12% to 35% respectively. Radiography was reduced; only 17% and 39% of AFC and FFO patients respectively required radiographs. On-call referrals and trauma cases dropped by 50% with similar case mix year-on-year. All elective operating was cancelled in 2020.

Conclusions
By reducing clinic admissions and theatre throughput, it was possible to run an effective paediatric orthopaedic service in a busy tertiary referral centre. Our aim now is to determine the long-term efficacy, cost, and sustainability of our COVID-19 service.
210 Prognosis of Breast Cancer in Very Young Age (Less Than 30 Years)
Authors: Abid M , Bano R , Salim M , Khan A I , Chaudhry M Z , Khan H M 
Published: May 2021

Abstract

Background
Breast cancer diagnosed at younger age has aggressive biology being triple negative and high grade and associated with poor prognosis.

Method
Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 was reviewed. Demographics studied were age at diagnosis, gender, pregnancy, or lactation associated, family history, histopathological diagnosis, stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, survival.

Results
One patient was male. Age range 20 -30 years, single patient had bilateral involvement. half 50.4%(n = 61) patients had locally advanced disease at presentation. Pregnancy/ lactation associated breast cancer was seen in 29.8%(n = 36). Most common stage was stage III (52.1%) & stage II (33.9%). IDC was the most common histology 94.2% (n = 114) Triple negative was most common molecular subtype present in 46.3%(56). After 5 years follow up, local recurrence was observed in 12.4%(n = 15), cancer related deaths were 42.1%(n = 51).

Conclusions
Breast cancer in very young has very aggressive tumor biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy, furthermore there is need to identify possible environmental factors which may contribute in the rising incidence in this age group.
264 Intertrochantic Hip Fracture Fixation at Musgrove Park Hospital
Authors: Latif R , Macdonald H , Griffith A , Kelly A 
Published: May 2021

Abstract

Background
Hip fractures, the commonest fragility fracture in the UK, carry a 6.7% 30-day mortality. NICE-CG124 guide advises extramedullary implants for trochanteric (AO3.1A1/2) and intramedullary nails for subtrochanteric fractures.
We carried out a retrospective study on the use of cephalomedullary nails (CMN) at MPH to determine compliance with CG124.

Method
National Hip Fracture Database (NHFD) from 2019 was reviewed. Trust records were used for fracture type, surgery, and reasons for deviation from CG124.

Results
201 fractures were identified. NHFD revealed 38 A3 fractures of which 36 underwent CMN, one SHS and one non-operative management. Of 163 A1/A2 fractures, 33 received CMN and 130 CHS.
Only 77% of the NHFD data was correct. Further analysis revealed 18 CMNs were used for AO1/2 injuries. All had justifiable reasons for deviation from CG124, although not documented.

Conclusions
There is scope to improve accuracy of NHFD data. Deviation from guidelines may be appropriate but reasons must be documented and, when appropriate, discussed with patient. Similar nationwide inaccuracy can have significant implications for research based upon NHFD data. To prevent input of incorrect data, our recommendations include: Consultant to confirm AO grade during trauma meetings Reason CMN used for AO1/2 fractures to be documented Monthly local NHFD data audit
289 Blood Loss in Robotic-Assisted Knee Arthroplasty: A Retrospective Analysis
Authors: Khan H , Dhillon K , Mahapatra P , Popat R , Nathwani D 
Published: May 2021

Abstract

Introduction
Significant blood loss is associated with a delayed postoperative recovery in joint arthroplasty. Emerging evidence suggests robotic-assisted knee arthroplasty reduces soft-tissue trauma, length of stay, and can facilitate a faster recovery. This study compares the total blood loss in patients undergoing robotic-assisted knee arthroplasty compared to conventional methods.

Method
Patients undergoing robotic-assisted total knee arthroplasty (TKA) or unicomparmental knee arthroplasty (UKA) were identified using patient records. Robotic-assisted groups were compared against contemporary sex-matched controls undergoing jig-based arthroplasty. The mean total blood loss was estimated using the Gross equation. Statistical significance was identified using the Student's t-test and Mann-Whitney U test for parametric and non-parametric data, respectively.

Results
Robotic TKA and UKA groups were successfully matched to contemporary controls (n = 50 in all groups). No differences in preoperative haematological parameters or blood volume were found between the robotic-assisted and control groups. Robotic TKA experienced 23.7% less blood loss compared to control TKA (911.0ml vs 1193.7ml, p &lt; 0.01) which was found to be statistically significant. There was a non-significant difference in mean total blood loss in robotic UKA compared to control UKA (821.7ml vs 854.7ml, p = 0.69).

Conclusions
The use of a robotic surgical system reduces blood loss in TKA but not UKA in knee arthroplasty.
292 Publication of Individual Surgeon Outcomes Data: The Wishes of Orthopaedic Patients and Their Surgeons
Authors: Harris H , Poole W , Ricketts D , Rogers B 
Published: May 2021

Abstract

Background
The Paterson report recommended increased release of individual surgeon data to the public. There is limited evidence in the literature about patients’ or orthopaedic surgeons’ wishes regarding release of such data to the public.

Method
We surveyed 80 joint replacement patients and 41 orthopaedic surgeons to determine their wishes regarding collection and release of individual surgeon data to the public.

Results
Patients expected more current monitoring of data than actually occurs. Of the patients, 95% wanted data to be available describing surgeon experience, length of stay and complications. Regarding currently available data, 50% of patients who were aware of it were likely to view it on the internet.
Surgeons were aware of the data available, but 80% did not think it was accurate. Surgeons did not think this data improved standards, that it negatively affected innovation (61%) and training (76%) and led to risk averse behaviour (61%). Surgeons wanted a minimal data set accurately presented and risk adjusted.

Conclusions
We recommend an agreed minimum dataset of good quality data is collected and discussed in clinical governance sessions. It can then be released to the public with explanatory notes.
311 Can We Predict Extraprostatic Extension (EPE) Prior To Radical Prostatectomy? – A Single Institution Comparison of Pre-Operative Biopsy Histology and Multiparametric MRI (mpMRI) With Radical Prostatectomy Specimen Histology
Authors: Pavithran A , Gowda B G , Pillai R , Corr J , Deshpande A 
Published: May 2021

Abstract

Introduction
Prostate biopsies and mpMRI play an integral role in diagnosis of prostate cancer. The aim of our study was to assess the ability to predict EPE based on pre-operative histology and mpMRI.

Method
We retrospectively analysed 235 patients who underwent radical prostatectomy between January 2015 and April 2017. All patients underwent pre-biopsy mpMRI scans and prostate biopsies. All mpMRIs were reported by dedicated uro-radiologists and all histology was reported by dedicated uro-pathologists.

Results
17/25 patients showing EPE on mpMRI had it confirmed on final histology.
a53/210 patients showing organ-confirmed disease on mpMRI had EPE on final histology.
40/49 patients who had Gleason 6 adenocarcinoma were organ-confined.
61/186 patients with &gt; Gleason 7 adenocarcinoma had EPE.
Sensitivity of mpMRI was 25% with a specificity of 95%. The positive predictive value (PPV) was 68% and negative predictive value (NPV) was 75%.
The specificity of pre-biopsy Gleason score &gt; 7 to predict EPE was 81% and sensitivity was 33% with a PPV of 87%.

Conclusions
Our data suggests that by using &gt; Gleason 7 and mpMRI as a combination, we can reliably predict EPE on final histology which in turn will help counsel patients appropriately for treatment options. Further data collection is ongoing at our institution.
381 Is There A Role for Tranexamic Acid in Upper GI Bleeding? A Systematic Review and Meta-Analysis
Authors: Burke E , Malik H , Awan F , Balfe P 
Published: May 2021

Abstract

Introduction
Upper Gastrointestinal bleeding is associated with increased morbidity and mortality. It has been suggested that tranexamic acid (TXA) may be useful in arresting bleeding.

Aim:
To synthesise available evidence of the effect of TXA on upper GI bleeding.

Method
A systematic review was conducted. PubMed, EMBASE and Cochrane central register of controlled trials were searched for relevant studies. A random effects meta-analysis was performed to determine the risk ratio of primary and secondary outcomes.

Results
8 studies were included in the review. Total number of patients included was 12994 including 4550 females (35%). The effect of TXA on mortality: risk ratio was 0.95 which favoured TXA however the 95% CI ranged from 0.80 to 1.13 and was not statistically significant. The re-bleeding rate risk ratio was 0.64, which favoured the TXA group and with a 95% CI ranging from 0.47 to 0.86 this was statistically significant. The risk of adverse thromboembolic events: risk ratio was 0.93 favoured the TXA group however the 95% CI extended from 0.62 to 1.39 and so was not statistically significant.

Conclusions
We cannot recommend the routine use of TXA in the setting of acute upper GI bleeding outside its use in randomised controlled clinical trials.
404 Endonasal Endoscopic Management of Spontaneous Cerebrospinal Fluid Rhinorrhoea: Birmingham Experience
Authors: Jolly K , Gupta K K , Bhamra N , Aslanidou A , Batra R , Ahmed S 
Published: May 2021

Abstract
Spontaneous cerebrospinal fluid (CSF) leak (SCSFL) occurs in the absence of any trauma, surgery or underlying intracranial pathology. SCSFL can lead to complications such as brain abscess, meningitis, decreased intracranial pressure (ICP), headache and brain herniation. We present our experience of SCSFL repair performed by a single surgeon at a tertiary centre via the endonasal endoscopic approach.
All patients who underwent CSF fistula repair at the Queen Elizabeth Hospital Birmingham, between 1st January 2012 and 31st December 2019, were identified and had their case notes analysed retrospectively.
We identified 33 patients who satisfied our inclusion criteria. They consisted of 27 (81.8%) female patients, ranging in age from 31 to 81 years (mean age 55.2 ± 13.2 years). Combined CT/MRI imaging was able to identify the leak in 30 patients (91%). Post-operative complications occurred in 2 patients (6.1%) with 1 patient developing meningitis (3.0%) and 1 patient experiencing epistaxis (3.0%). Overall, there was a successful primary repair in 32 (97.0%) cases.
Endoscopic endonasal repair of SCSFL has rapidly grown in popularity and now become the treatment of choice, overtaking open transcranial approaches. Several studies have demonstrated success rates of between 80-94% for spontaneous leaks however not all have addressed the issue of concurrent IIH post-operatively.
439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes
Authors: Durity E , Elliott G , Gana T 
Published: May 2021

Abstract

Introduction
Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management.

Method
We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017.

Results
Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years).
CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s.
Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%).

Conclusions
In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.
466 Resection or Enucleation for Extremely Giant Hepatic Haemangiomata? A Case Report and Review of The Literature
Authors: Fraser R E , Layton G R , Kuan L L , Dennison A R 
Published: May 2021

Abstract

Background
Cavernous hepatic haemangiomas are benign liver tumours and although common when small, giant haemangiomas (usually accepted as being greater than 10cm) are infrequent. Treatment is indicated in patients who are symptomatic or if diagnosis is unclear, although with giant haemangiomas, many support expectant management of asymptomatic lesions due to the risk of major complications. Traditionally hepatic resection has been the primary treatment option for these lesions, but a variety of other techniques, including enucleation, have been described as safe and effective alternatives. There remains equipoise in respect of the best management of giant haemangiomas above 10cm. Cases of such size are rare and so there is a paucity of data available.

Case presentation
We present a case of a 65-year-old male who underwent successful anatomical liver resection for a 5kg giant cavernous haemangioma of 26cm diameter following its incidental identification during an ultrasound scan. We also discuss and compare the role of resection and enucleation for the treatment of haemangiomata greater than 20cm in diameter.

Conclusions
This case demonstrates successful resection of an unusually giant haemangioma which, in contrast to the majority of literature, provides a valuable addition to the limited evidence base for management of this condition by anatomical resection.
502 Pain Prevention with Intraoperative Music: A Review and Meta-Analysis of The Impact of Intraoperative Music on The Post-Operative Pain of Abdominal Surgery Patients
Authors: Dale V 
Published: May 2021

Abstract

Introduction
Postoperative pain is a significant problem that can lead to a range of complications including inadequate healing. Music has been shown to reduce postoperative pain across a range of surgical disciplines. This poster is novel as intra-operative awareness is an area of some debate and there has not previously been a systematic review of the impact of intraoperative music on the post-operative pain of abdominal surgery patients.

Method
A systematic review of Cochrane Library, PubMed, and Scopus identified randomised controlled trials comparing an intraoperative music intervention with standard care with postoperative pain as a measured outcome. To assess the quality of the studies and determine inclusion in meta-analysis the author collaborated with Robot Reviewer software based on the Cochrane bias methodology. Meta-analysis used standard mean difference and a random-effects model.

Results
The review found the majority of studies looking at intraoperative interventions determined that there was no significant impact on postoperative pain. However meta-analysis of the 250 subjects included determined that there is a significant reduction in pain (p = 0.02). The studies included also looked at opiod use, however this was not reported.

Conclusions
Whilst the meta-analysis is promising, findings support further investigation into intraoperative music as a low-cost addition to postoperative pain management.
507 Total Lower Lip Reconstruction: A Systematic Review and Treatment Algorithm
Authors: Ang K K , Jones C D 
Published: May 2021

Abstract

Introduction
To critically appraise the outcomes of different techniques described for total lower lip reconstruction in a retrospective study, where these factors were specifically documented.

Method
A comprehensive literature review was conducted over a 20-year period using Pudmed and EMBASE using the search terms “local”, “regional”, “functional”, “total lip reconstruction”. Data collected included: patient demographics, aetiology for lip reconstruction, reconstruction methods and outcomes (functional, aesthetic, complications).

Results
204 patients from 28 studies were included. Squamous cell carcinoma of the lower lip (93.1%) was the most common cause for reconstruction. Of all the flaps, 67% were local flaps, 8.5% were regional flaps and 24.6% were free flaps. Most studies used a wide variety of objective and subjective outcome measures whereas only 4 used validated scoring systems to determine functional and aesthetic outcomes.

Conclusions
Despite a myriad of different techniques described, we are currently unable to determine a superior technique. Given the ultimate goal of reconstruction is to restore form and function, we recommend the use of a standardised recording of functional and aesthetic outcome measure to allow comparison and identification of best technique for lower lip reconstruction to optimise patients' outcomes.
510 Case Series: Four cases of Orbital Extension of Cutaneous Squamous Cell Carcinoma and Their Management
Authors: Gaston-Grubb M , Boylan C 
Published: May 2021

Abstract

Introduction
Cutaneous squamous cell carcinoma (cSCC) invading the orbit is exceedingly rare. Understanding its presentation and management is of great value to the plastic surgeon.

Method
Retrospective case series of four patients aged 54 to 88 years. All patients presented with cSCC of the face or scalp which infiltrated the orbit. All underwent tumour excision and appropriate reconstruction.

Results
Case 1 and 2 involved cSCC originating from the right temporal and medial maxilla region, respectively. Case 1 posed the further challenge of irreversible blindness in the other eye, making exenteration very undesirable. In Case 2 the tumour extended along the infraorbital nerve and required several reconstructions of the eyelid to improve functionality and aesthetics.
Cases 3 and 4 involved cSCC originating from the forehead and temporal region, respectively. Both required burring of the bony outer table and soft tissue reconstruction. Case 4 presented with the additional challenge of perineural spread to the cavernous sinus.

Conclusions
This case series provides an insight into a rare, advanced presentation of cSCC. Eyeball exenteration has significant physical, aesthetic, and psychological impacts and therefore should be avoided if possible, particularly if the tumour has not breached the orbital septum.
637 Enterolith Ileus Secondary to Small Bowel Diverticulum: A Rare Cause of Small Bowel Obstruction
Authors: Elmasry M , Dey A , Marshall R 
Published: May 2021

Abstract
Small intestinal diverticula are rare and possibly acquired secondary to bowel dyskinesia, abnormal peristalsis, or high intraluminal pressures. Enterolith formation and obstruction are a less encountered complication of these diverticula.
An elderly man, with no history of abdominal surgery, presented with 10 days of colicky right iliac fossa pain and recurrent episodes of bilious vomiting. He initially reported diarrhoea but complained of eventual absolute constipation for last 5 days. Physical examination revealed distended abdomen with right-sided tenderness and no mass or faeces on rectal examination. Abdominal CT revealed a 3.5 cm calculus in the distal ileum causing obstruction initially flagged as gallstone ileus. No gallstones or pneumobilia were identified although some intrahepatic duct dilatation was noted. An emergency laparotomy was conducted, where the radiological findings were reinforced, and the calculus was extracted via enterotomy. There were no abnormal communications between gallbladder and intestinal tract. The small bowel traced from duodenojejunal flexure to terminal ileum did not reveal any further calculi or diverticula. FTIR spectrum analysis of the extracted specimen indicated similarities to enterolith. Retrospective analysis of radiological images revealed a possible duodenal diverticulum. The case highlights the diagnostic conundrum and therapeutic challenges of small bowel diverticular enterolith.