bluuebunny/crossref_metadata_2025_split huggingface dataset:
338 Biceps Metastasis Presenting as A Presumed Abscess in Patient with An Undiagnosed Non-Small Cell Lung Cancer - An Unusual Presentation
Authors: Shah K , Hagiga A , Saleem O , Elfishawi M , Bashir T 
Published: May 2021

Abstract
Lung cancer is the most common cancer worldwide and has highest cancer mortality. Around 50% of cases present with metastasis, however skeletal muscle metastasis is rarely reported.
In this case we describe a fifty-nine-year-old male patient who presented complaining of fever and a mass on the distal biceps and proximal forearm over a five-month period, with no reported improvement despite debridement and antibiotics spanning three presentations to the emergency department. Subsequent biopsy at various anatomical sites showed adenocarcinoma, later identified as metastatic from a primary non squamous-cell lung cancer (NSCLC).
Metastases from lung cancer are more commonly limited to liver and adrenal glands. Presentation of such a mass in skeletal muscle would raise suspicion for the more-commonly seen soft-tissue sarcoma or hemangiomas. This case illustrates a rare example of lung cancer metastatic to skeletal muscle, more specifically, the biceps. Presentation of the mass was also unique in its morphology of an abscess with purulent discharge, raising the importance of cytology and suspicion for malignancy in an abscess unresponsive to antibiotics.
Non-small cell lung cancer can present with skeletal metastasis. A work-up of a mass or abscess of the muscle should include the possibility of soft tissue metastasis.
343 A Systematic Review of Symptomatic Hamartomas of The Jejunum and Ileum
Authors: Conroy M , Farkas N , Baig M 
Published: May 2021

Abstract

Introduction
Gastrointestinal hamartomas are rarely encountered benign growths made of an abnormal mixture of tissues normally found in the body where the growth occurs. Most hamartomas are asymptomatic and diagnosed incidentally. Evidence regarding symptomatic hamartomas of the jejunum and ileum is limited.

Method
The search terms ‘small bowel,’ ‘small intestine,’ ‘jejunum’ and ‘ileum’ were combined with ‘hamartoma.’ EMBASE, Medline, PubMed searches and Google Scholar hand searches were conducted. All English language papers from 01/01/2000-01/06/2020 were included.

Results
A total of 39 cases were reviewed, 29 adults and 10 paediatric (0-16 years). Presenting symptoms included: abdominal pain (87%), vomiting (56%), gastrointestinal bleeding (20.5%) and weight loss (5%). Stricturing was noted in 7 cases. 36/39 (92%) presented as emergencies. Diagnostic investigations included: Abdominal X-ray (49%), endoscopy (38%) and CT (56%). Initial management strategy was either open (30) or laparoscopic (7) surgery or endoscopy (2). All cases required surgery for definitive management. 9/39 cases were associated with hamartomatous syndromes. 2 mortalities were recorded.

Conclusions
This is the first review addressing symptomatic hamartomas of the jejunum and ileum. New data relating to demographic cohort, symptom profile, investigations, management strategies and morbidity and mortality provide greater insight to those encountering this challenging clinical finding in the future.
361 An Epidemiological Study into The Incidence of Facial Fractures Presenting to Addenbrooke’s Emergency Department
Authors: Hatoum A , Khokher Z , Basyuni S , Santhanam V 
Published: May 2021

Abstract

Introduction
Our aim was to present the epidemiological estimates of facial fractures within East Anglia.

Method
We recorded all patients presenting with facial fractures to our Emergency Department between 2014-2019. All features relating to the patient profile and injury were recorded. We used the English Indices of Deprivation, along with the UK Census (2011), to assess for a correlation between factors such as deprivation status and age with specific causes of facial fractures.

Results
2022 cases were collected totalling 2551 fractures. Mean patient age was 39. The overall leading causes of fractures were falls, assaults and sporting incidents (29.9%, 27.3%, and 17.1% respectively). Towns such as Newmarket and Cambridge demonstrated a distinct leading cause as a result of town-specific recreational activities; horse-riding and cycling respectively. We discovered a positive correlation between deprivation status and fractures due to assault. There was also a relationship between an older population and incidence of fractures due to falls.

Conclusions
Facial fractures reflect a significant cost-burden on the NHS, as well as an emotional burden on patients, which can be reduced by public health interventions and liaison between healthcare professionals and local county authorities. Sharing of these findings with the relevant parties may allow the implementation of location-specific interventions.
386 Proximal Femoral Nail (PFN) Versus Dynamic Hip Screw (DHS) In Unstable Intertrochanteric Fractures of Femur -A Comparative Clinical Study
Authors: Dubey V , Spiegelberg B , Shahane S , Samant A 
Published: May 2021

Abstract

Introduction
The goal of treatment of an intertrochanteric femoral fracture is restoration of patient's mobility as early as possible. The dynamic hip screw (DHS) has been used for several decades to treat these fractures. Proximal femoral nails (PFN) are reported to have an advantage in such fractures. This study aims at comparing the results of unstable intertrochanteric fractures femur treated with PFN and DHS.

Method
This was a prospective, randomized study which includes sixty patients. All patients were available for follow up with 30 patients in each group. The data about intraoperative blood loss, time to union, leg length shortening was collected. The functional outcome at the end of one year was evaluated using Harris Hip Score.

Results
Blood loss, duration of surgery, time to union and leg length shortening was significantly less in the patients treated with PFN (p &lt; 0.05). The mean harris hip score for patients managed with PFN was significantly more than in DHS group, 12 months after surgery (p = 0.05).

Conclusions
PFN requires a smaller incision, lesser operative time, less blood loss and has improved functional results. In our opinion PFN may be a better fixation device for most of the unstable intertrochanteric femur fractures.
388 Detection of Cytomegalovirus Infection in Infants with Biliary Atresia: A Meta-analysis
Authors: Elhassan A B E , Mohamed S , Ali A , Elbathani M , Abdallah O , Mohamed A , Ibrahim A , Salman M , Elni M , Elhassa M , Elkhidi I , Abuzie A 
Published: May 2021

Abstract

Introduction
Biliary atresia (BA) is the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal aetiologies, including a viral infection-induced auto-immune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis estimates to what extent CMV infection is detected in patients with BA.

Method
This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using StatsDirect statistical software.

Results
A total of 13 studies (covering 419 patients) that fulfilled the eligibility criteria were included in the meta-analysis. The pooled overall prevalence of CMV infection in patients with BA was 24.5% (95% CI 11.9 %– 33.9%).

Conclusions
The available data demonstrate that the detection of CMV infection is common in infants with BA. There is still a need for large studies with appropriate controls to examine various aspects of the association between CMV infection and BA.
393 What Are the Risk Factors for Anastomotic Stricture After Bile Duct Injury Repair? A Systematic Review and Meta-Analysis
Authors: Hall L , Halle-Smith J , Hodson J , Roberts K 
Published: May 2021

Abstract

Introduction
Hepaticojejunostomy (HJ) is the standard repair following major bile duct injury (BDI), but anastomotic stricture can result in long-term morbidity. There is a need to assimilate high-level evidence to establish risk factors for the development of anastomotic stricture after HJ for BDI.

Method
A systematic review of studies reporting the rate of anastomotic stricture after HJ for BDI was performed according to PRISMA guidelines. Meta-analyses of proposed risk factors were then performed.

Results
Meta-analysis included five factors (n = 2,198 patients, 17 studies). Vascular injury (OR 2.71; 95%CI 1.37-5.35; p = 0.004), postoperative bile leak (OR: 8.03; 95%CI 2.04-31.71; p = 0.003), previous repair (OR: 5.36; 95%CI 1.04-27.76;p=0.05) and repair by non-specialist surgeon (OR 11.29; 95%CI 5.21-24.47; p &lt; 0.0001) were associated with HJ stricture after BDI. Strasberg injury grade was not associated with HJ stricture (OR: 1.05; 95%CI 0.63-1.75; p = 0.86). Due to heterogeneity of reporting it was not possible to perform meta-analysis for impact of timing of repair on anastomotic stricture rate.

Conclusions
This meta-analysis identifies factors that significantly increase the rate of anastomotic stricture after HJ for BDI. Knowledge of these risk factors will allow risk stratification in terms of follow-up for individual cases, better informed consent, and guidance for medico-legal cases.
401 Three Birds with One Stone: Ureteric Calculus Precipitates Diagnosis and Resection of Three Primary Neoplasms
Authors: Collins P , O'Connell C , Omer S A , Inder M S , Madden A , Smyth L , Casey R , Manecksha R , Thomas A , Browne R , O'Neill A , Tierney S , Flynn R 
Published: May 2021

Abstract
A 67 year-old female presented to our centre with a 2 day history of right flank pain, clinically suggestive of ureteric colic. Computed tomography (CT) confirmed a 6mm right ureteric calculus. However, CT also revealed a large 13cm ipsilateral renal mass, concerning for renal cell carcinoma (RCC). At ureteroscopy for management of the obstructing calculus, a small papillary lesion was noted in the bladder, and excised. Histology confirmed pTa low-grade transitional cell carcinoma.
Following discussion at the Urology multidisciplinary tumour board, MRI venogram (MRV) was recommended to delineate the extension of tumour into the renal vein, and to characterise a pelvic mass seen on original CT. MRV showed enhancing material extending into the IVC, consistent with tumour thrombus. However, it also identified a concerning 6cm solid ovarian mass.
The patient proceeded to open right radical nephrectomy and IVC thrombectomy, hysterectomy, bilateral salpingo-oopherectomy, and omental biopsy, with combined input from Urological, Gynaecological and Vascular surgical teams. Post-operative course was uneventful. Histology showed an 11cm pT3a G2 clear cell RCC, and 7.5cm ovarian fibroma, both fully excised. This case demonstrated the serendipity of a simple ureteric calculus precipitating a cascade of investigations, that ultimately led to complete resection of three primary neoplasms.
413 Posterior Stabilisation Without Formal Debridement for The Treatment of Non-Tuberculous Pyogenic Spinal Infection in A Frail and Debilitated Population – A Systematic Review and Meta-Analysis
Authors: Elmajee M , Munasinghe C , Aljawadi A , Elawady K , Shuweihde F , Pillai A 
Published: May 2021

Abstract

Background
Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where there is evidence of spinal instability or neurological compromise. The primary surgical procedure focuses on the anterior approach with aggressive debridement of the infected tissue regions. We aim to evaluate the effectiveness of the posterior approach without debridement.

Method
Several databases including MEDLINE, NHS evidence and the Cochrane database were searched. The main clinical outcomes evaluated include pain, neurological recovery (Frankel Grading System, FGS) post-operative complications and functional outcomes (Kirkaldy-Willis Criteria and Spine Tango Combined Outcome Measure Index, COMI).

Results
From the four papers included in the meta-analysis, post-operative pain levels were found to be lower at a statistically significant level when a random effects model was applied, with the effect size found to be at 0.872 (p &lt; 0.001, 95% CI: 0.7137 to 1.0308). Post-surgical neurological improvement was also demonstrated with a mean FGS improvement of 1.12 in 64 patients over the included articles.

Conclusions
Posterior approach with posterior stabilisation without formal debridement can results in successful infection resolution, improved pain scores and neurological outcomes. However, Larger series with longer follow-up duration are strongly recommended.
419 Endovascular Aortic Repair of Abdominal Aortic Aneurysm Early Re-Intervention Outcome, A District General Hospital Experience
Authors: Soliman H , Girish G , Shahed S 
Published: May 2021

Abstract

Introduction
Endovascular repair (EVAR) transformed abdominal aortic aneurysm (AAA) management. However, it is associated with higher re-intervention rate compared with open repair. This audit evaluates the early re-intervention rate at Watford General Hospital relative to the 4-yearly average rate in the draft evidence review by NICE (16.89%).

Method
EVAR procedures performed in 2015 and 2016 were retrieved. The follow up was analysed to identify re-intervention procedures performed to address complications related to the initial EVAR or sac expansion.

Results
108 patients underwent EVAR during the 2-year inclusion period. 21 re-interventions (19.4%) were recorded, irrespective of type or cause of re-intervention. 30 patients (28.6%) developed endoleak but only 17 (56.7%) had a re-intervention. Type 1 endoleak was the main cause for re-intervention (28.6%). The majority of re-interventions were executed endovascularly (57%). 47.6% of the re-interventions were done during the first year following EVAR.

Conclusions
Even though our re-intervention rate was relatively above the international average, EVAR is still considered safe for AAA repair with low morbidity and mortality. As re-interventions are frequently required, long-term surveillance is essential. Conversely, most of re-interventions can be performed with minimal morbidity. We recommend discussing all cases in a formal MDT before surgery and any re-intervention.
454 Brace Brace: Modified Brsotrom-Gould Procedure with and Without Internal Brace for the Treatment of Chronic Lateral Ankle Instability
Authors: McGuigan J , Pillai A , Hall A 
Published: May 2021

Abstract

Introduction
The most common ankle injury is a sprain. Surgical management is only indicated when nonoperative treatment fails. Modified Broström-Gould (MBG) is the gold standard surgical technique. MBG technique may be augmented with an internal brace. This study aims to compare the clinical outcomes of MBG with and without internal brace for the treatment of chronic lateral ankle instability using validated patient recorded outcome measures.

Method
Retrospective analysis of patients that underwent lateral ankle ligament reconstruction between January 2012 and June 2019 were reviewed at and asked to complete the Manchester oxford foot and ankle questionnaire (MOXFQ). 29 patients (30 ankles) underwent lateral ligament reconstruction between these dates and completed the questionnaire, 20 patients (21 ankles) without internal brace and 9 patients with internal brace.

Results
The group with internal brace displayed significantly better results in the MOXFQ summary index score (20.49 ± 13.15 vs 43.53 ± 34.72, P = 0.014) and standing/walking subscale (15.48 ± 13.00 vs 45.92 ± 36.60, P = 0.023) compared to group without internal brace. There was no significant difference between Pain and Social interactions subscales.

Conclusions
Our results show that the addition of an internal brace to the MBG procedure for the management of chronic lateral ankle instability improves clinical outcomes.
465 No Role for Postoperative Antibiotics in Uncomplicated Appendicitis
Authors: Ayoub N , Tryliskyy Y , Baig M K 
Published: May 2021

Abstract

Introduction
Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines till now and so surgeons have different practice based on their preferences.

Method
This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection.

Results
90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1).

Conclusions
Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.
470 Could Covid-19 Change the Way We Do Clinics for The Better? A Comparison of Remote Versus Outpatient Clinic Follow-Up for Surgical Patients: A Meta-Analysis of Randomised Controlled Trials
Authors: Oates Emily , Hui Chin Lim Grace , Nevins Edward J , Kanakala Venkatesh 
Published: May 2021

Abstract

Introduction
As the Covid-19 pandemic hit the UK, the way the NHS operates changed overnight. One change was the move to remote appointments (RA) by video or telephone. This meta-analysis (MA) of randomised controlled trials (RCTs) looks at existing evidence on RA and aims to discover if surgical patients are satisfied with them.

Method
A literature search of RCTs of surgical patient satisfaction of RA versus conventional outpatient clinic (OPC) was performed. The PubMed, EMBASE and Google Scholar databases were searched to include articles from January 2000 to 2020. A random effects MA model was used to compare outcomes.

Results
All 5 RCTs showed that patients were as satisfied with RA as OPC (RR = 1.00, [0.97-1.03] p = 0.96). Furthermore, both patient cohorts would prefer RA for future follow-up (RR = 2.28 [1.85-2.82] p &lt; 0.00001). 1 RCT performed a cost analysis and found the cost to institutions was less in the RA group ($19.05 vs $52.76). All other RCTs suggested cost to patients and institutions would be less for RA.

Conclusions
Surgical patients are satisfied with RA and in fact would prefer them, thus indicating that out with the Covid-19 pandemic RAs could be continued, and in doing so may well save money for patients and the NHS.
486 Are Surgical Resection Margins A Risk Factor for Crohn’s Disease Recurrence?
Authors: Haiduc A A , Patel R , Karim A 
Published: May 2021

Abstract
Despite advances in treatment, Crohn’s disease (CD) recurrence is still high. Various factors correlated with recurrence are studied however, there is no consensus regarding the importance of disease-free resection margins. Our goal was to ascertain whether surgical margins predict recurrence rates of CD and identify other potential factors correlated with recurrence.
This is a retrospective cohort study on patients who have had a colonic resection for CD from December 2016 to November 2019. Demographics, surgical procedure details, disease activity at resection margins and number of readmissions were recorded. Clinical recurrence was defined as readmission to hospital for a Crohn’s related flare-up within 12 months of surgical resection. Positive disease activity at the resection margins was defined histologically. We compared the readmission rate between all categories.
Of the 55 patients identified, 52 (22 female) were included. Of these, seven were readmitted, six are smokers, 19 had mesenteric excision and 33 had Crohn’s positive resection margins. Chi-squared tests showed there are no significant correlations between patient and procedure variables, and readmission rates (p &gt; 0.05).
We have not found sufficient evidence to conclude that a disease-free resection margin post colonic resection or any other patient-related factors are associated with decreased recurrence of CD.
501 Lateral Rectus Muscle Palsy Secondary to Sphenoid Sinusitis: A Case Report and Literature Review
Authors: Leong W S , Mulla O 
Published: May 2021

Abstract

Background
Isolated sphenoid sinus disease (ISSD) is a rare, often misdiagnosed condition of the paranasal sinus. If left untreated, it can lead to complications involving pituitary gland, cavernous sinus, neurologic, and vascular structures nearby.

Case report
We present a case of a 60-year-old female with a history of severe left-sided headache, facial pain, diplopia, and left lateral rectus palsy. She was initially referred to ophthalmology and rheumatology for possible giant cell arteritis. MRI scans revealed opacification in left sphenoid sinus consistent with left sphenoid sinusitis. There were no signs of cavernous sinus thrombosis. She was then referred to ENT and underwent endoscopic transnasal sphenoidotomy procedure. Culture results showed Haemophilus Influenza and fungal pseudohyphae. Her palsy and headaches recovered completely 3 months later with a course of antibiotics and antifungals.
Literature review for lateral rectus palsy secondary to sphenoid sinusitis without cavernous sinus thrombosis showed it is not a common condition and this case report should serve as a reminder to consider paranasal sinus disease when assessing these patients.

Conclusions
The onset of ISSD is often insidious and diagnosis of this condition remains a challenge. MRI and CT imaging remain the gold standard for recognising and managing this condition.
511 A Case Report of A 16-Year-Old Girl with Peritoneal Tuberculosis
Authors: Fabelurin C , Arora D 
Published: May 2021

Abstract
Peritoneal Tuberculosis (PTB) is a rare extra-pulmonary manifestation of Mycobacterium tuberculosis infection. It usually presents with non-specific symptoms that can mimic other intra-abdominal pathology. Therefore, a high index of suspicion is needed for diagnosis and early treatment of PTB. Some of the intra-abdominal conditions in young patients that may have similar presentations to PTB include Crohns’ disease, ovarian pathology and acute appendicitis. Diagnosing PTB in the paediatric population tends to be even more challenging as an obvious history of exposure may be difficult to obtain. Diagnostic laparoscopic biopsy and histopathology provides definitive diagnosis. Most studies recommend a 6-month course of anti-TB therapy for abdominal tuberculosis with a planned regimen using Isoniazid, Rifampicin, Pyrazinamide and Ethambutol.
This case report presents the case of a 16-year-old girl who presented with a history of recurrent abdominal pain, vomiting and pyrexia. Radiological, laparoscopic, and histopathological findings were used for final diagnosis of this condition. The patient was treated using the anti-tuberculosis therapy for 6 months following which, she was able to make a full recovery.