bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.832A silver lining in the dark COVID cloud: Total neoadjuvant chemotherapy results in complete pathological response in locally advanced distal gastric adenocarcinoma
Authors: Clements Hollie Alice , Patil Pradeep , Ramkumar Prasad Guntur , Walsh Shaun , Petty Russell 
Published: October 2021

Abstract

Aims
Perioperative oncological therapies resulting in complete pathological response in diffuse type distal gastric adenocarcinoma are extremely rare. We report the first case of complete pathological regression in a patient with locally advanced diffuse type distal gastric adenocarcinoma (CT3N2M0) who received “total neoadjuvant” chemotherapy with FLOT due to the COVID pandemic.

Methods & Results
A 73-year-old male patient was diagnosed with cT3N2M0 diffuse type distal gastric adenocarcinoma. He received 4 cycles of neoadjuvant FLOT as planned with immune checkpoint inhibitor Durvlumab and interval PET-CT showed massive reduction in 18F-FDG avidity. However, his surgery was postponed due to the COVID-19 pandemic and given his excellent response to chemotherapy his 4 adjuvant cycles of FLOT were advanced into the preoperative setting. Subsequent PET-CT showed close to zero 18F-FDG uptake and he proceeded to laparoscopic radical subtotal gastrectomy with D2 lymphadenectomy. Histopathology of the resected specimen demonstrated no evidence of residual malignancy, a complete pathological response (TRG1a, ypT0N0 R0).

Conclusions
Amidst the dark cloud of COVID-19 there was a silver lining for one patient, who due to delayed surgery received total neoadjuvant FLOT (8 cycles). This should generate randomised controlled trials comparing the current standard of care with total neoadjuvant regimens and investigating the utilisation of interval investigations such as CT-PET in monitoring response to preoperative therapy, guiding optimal timing of surgical resection.
EP.WE.859Pain management in critical limb ischaemia patients: a clinical audit
Authors: Bagga Rahul , Imsirovic Anja , Almond Genevive , Elahwal Mohamed , Caruana Mario 
Published: October 2021

Abstract

Aims
Critical Limb Ischaemia (CLI) patients often present with ischaemic rest pain and uncontrolled pain can impact on quality of life. To improve pain control, a set a of trust-wide guidelines were developed to standardise pain management for CLI patients.

Methods
This was a prospective cross-sectional audit, which initially involved 30 patients admitted under vascular surgery at a tertiary centre with CLI between May and June 2020. The improvements implemented included an analgesia education session for junior doctors, inclusion of an analgesia dosing table in the vascular clerking proforma and a simplified analgesia table as a poster. The re-audit included 22 patients with CLI between September and October 2020. Data was collected from drug charts and Fisher’s exact test was used for the statistical analysis.

Results
Baseline data suggested poor compliance with guidelines with only 3% of patients prescribed the guideline recommended PRN opiate doses. This improved post-intervention to 52% (p &lt; 0.05). Following the interventions, naloxone prescribing significantly improved from 37% to 91% (p &lt; 0.05). Standard dosing of opiates was seen irrespective of age or renal function. 14% of patients with renal impairment were prescribed opiate analgesia above the initial ranges indicated by the guidelines; compared to 33% in the first cycle (p = 0.58).

Conclusion
This audit has demonstrated the successful implementation of targeted changes to improve compliance with trust pain management guidelines for patients with CLI. The challenge remains of overcoming the unknown eGFR at time of prescription and unknown background analgesia that can lead to over and under prescribing.
EP.WE.913Evaluation of upper GI cancer diagnosis in suspected patients referred for OGD directly by GP vs Two Week Referral pathways
Authors: Abdelwahed Ahmed , Slezak Izabela , Witting Sarah , Kumar Narayanan Vinod , Zach Rudolf , Warren Hugh 
Published: October 2021

Abstract

Aim
To assess whether the new direct pathway (requested by GP) has improved OGD accessibility and time of diagnosis for patients with suspected UGI cancer. The new system aimed to bypass a formal referral to UGI clinic.

Methodology
Retrospective study, compared two groups of patients (total 329). Group A (173 patients, TWW referral to UGI clinic who had endoscopy between March and May 2017), and Group B (156 patients, Direct access pathway by the GP to have the endoscopy between March and May 2018). inclusion criteria includes patients referred directly by the GP between March and May 2018, TWW patients referred March-May 2017. Patients who had OGD with suspected diagnosis other than UGI cancer were excluded. Data was compared in terms of gender, age, interval time between referral and OGD, and cancer findings.

Findings
Time between presentation and diagnosis in patients referred via Direct Access pathway was shown to be significantly shorter compared to patients admitted via TWW. The difference was 7 days in favor of the Direct Access pathway which was statistically significant (p value 0.001).

Recommendations
Direct access pathway has decreased the waiting time, expedited the management, potential money saved, more available clinic space and less administrative work.
EP.TH.74An incidental finding of liver haemangioma on diagnostic laparoscopy for right sided abdominal pain in a young woman
Authors: Elsllabi Mohamed , Shams Muhammad 
Published: October 2021

Abstract

Introduction
Cavernous liver haemangiomas or hepatic haemangiomas are the most common benign neoplasm of the liver. They are more common in women with a male to female ratio of 2.5-5.1- likely due to estrogenic influence. They are composed of hepatic endothelial cells and are usually small in size (&lt; 4 cm). They are asymptomatic in most of the cases and incidentally discovered on diagnostic tests. Occasionally haemangiomas can exceed a size of 5 cm where they can cause symptoms such as nonspecific abdominal pain. Their exact aetiology is not well understood; they are thought to be vascular malformations with hormonal or congenital background. Haemangiomas belong to ‘Incidentaloma’ tumours, since they can be found incidentally while investigating for other unrelated pathologies. Although rare, but rupture and hemorrhage of liver hemangiomas can be fatal.

Case presentation
A 33-year-old woman was presented with abdominal pain which was started in central abdomen and then shifted to right lower abdomen abdomen. No other significant symptoms at presentation or past medical history.
On serial physical examination, the patient was more tender at the right lower quadrant of the abdomen. Although her inflammatory markers were normal the decision was made to proceed with diagnostic laparoscopy to rule out acute appendicitis.
During laparoscopy normal appendix was found with multiple liver lesions. Appendix was not removed.
Postoperatively CT Thorax, Abdomen and Pelvis with contrast and CT Liver Triple Phase was performed which confirmed benign liver haemangioma.
The patient recovered well after surgery and was discharged home with no routine surgical follow up.
EP.TH.96Recurrent Retroperitoneal Liposarcoma Presenting as Irreducible Inguinal Hernia
Authors: Farooqui Marryam Riaz , Bhatti Hamza Waqar , Chaudhary Noman Ahmed , Khan Huma Sabir , Hanif Muhammad 
Published: October 2021

Abstract

Introduction
Retroperitoneal sarcomas protruding though the groin are extremely rare with only about 12 cases reported in the past 31 years to our knowledge. . As the retroperitoneal space communicates with the inguinal canal, large lipomatous tumors, may protrude through this natural weak spot which may present as irreduciible inguinal hernia.

Case Report
We report a 43 year old male, previously operated for retroperitoneal liposarcoma with 4 cycles of adjuvant chemotherapy and 5 cycles of radiotherapy 4 years back now presented with irreducible inguinal hernia. On examination, a firm fixed mass of about 15 x 10 cm, with indistinct margins was palpable in right hemiabdomen, abdomen was soft with audible bowel sounds. A firm swelling of 8 x 5 cm in right inguinal region extending into scrotum with no cough impulse was also present. On CT imaging a large mixed density lesion noted in Right lower abdomen measuring 16.2 x 14.8 x 23.5 cm. It showed internal fat and solid components and recurrence with herniation through right inguinal canal which is a rare entity. The patient was treated symptomatically, bilateral DJ stenting was done by the urology team and the patient was prepared for debulking surgery. Patient was classified as ASA IV. Unfortunately, the patient died 6th post admission day secondary to cardiopulmonary arrest.

Conclusion
A retroperitoneal tumor especially a liposarcoma should be ruled out in a large, painless, non-reducible inguinal mass with abdominal complaints. Patients need regular follow up after resection of retroperitoneal liposarcoma for early detection of recurrence.
EP.TH.177Safety profile of SurgiMend Acellular Dermal Matrix and Mentor implant assisted immediate breast reconstruction – Our experience at the Princess Royal University Hospital
Authors: Shaaban Gamal , Khan Maryam , Ragad Lilia , Norman Carol , Kasem Abdul , Uhercik Michal 
Published: October 2021

Abstract

Background
ADM (Acellular Dermal Matrix) assisted implant-based immediate breast reconstruction (IBR) is a common technique worldwide. Various ADMs are available manufactured from different sources. The Surgimend ADM (fetal bovine dermis) is fenestrated and rich in type I/III collagen; it is claimed to reduce fluid accumulation and promote healing.

Methods
Retrospective observational analysis exploring safety profile using combination of SurgiMend MacroPorous (MP)/SurgiMend PRS and Mentor CPG/Mentor Siltex implants between January 2018 to December 2019. Patients with unilateral/bilateral IBR following Nipple sparing (NSM) or Skin sparing mastectomy (SSM) were included. The primary outcome was minor complications (seroma (&gt;100ml on USS), hematoma, wound infection and infected seromas). Secondary outcome was major complications (flap necrosis, capsular contracture, implant explantation and Red Breast Syndrome).

Results
Six (16.2%) bilateral and 31 (83.8%) unilateral IBR were performed in 37 patients. Mean age was 53.78 years.
No major complications were recorded.

Conclusions
The Surgimend ADM and Mentor implant combination demonstrate a good safety profile. Higher rates of seroma in this study could be explained by overdiagnosis and treatment at our unit, which in turn might imply as a result that no major complications were detected and no implant loss.
EP.TH.267Gastroesophageal Reflux Disease after sleeve gastrectomy
Authors: Khan Shujhat , Asad Sima Al 
Published: October 2021

Abstract

Aim
A prominent complication of a sleeve gastrectomy is gastroesophageal disease (GERD). Symptoms include chest pain, dysphagia, heartburn, regurgitation, chronic cough, and laryngitis. With the rise in obesity, and the already high prevalence of GERD in these populations, this is a significant cause of morbidity in western populations and is likely set to worsen.

Method
The literature search was carried out using Ovid MEDLINE and PubMed databases to search for keywords and MeSH terms including “bariatric surgery”, “sleeve gastrectomy”, “complications”, “gastroesophageal reflux disease”, “GERD”, “GORD”, and “obesity”.

Result
Approximately 20% of patients who undergo SG will develop de-novo GERD whilst 19% will have an increase in reflux symptoms. The exact mechanism of GERD in both obesity and post-operatively following SG is unclear. However, it can involve several different mechanisms. This includes poor surgical technique, disruption to physiological anatomy, increase in gastric pressure, increased risk of hiatus hernia, and disruption to normal hormonal balance. An effective approach to treat GERD includes the Stretta procedure with studies showing 72% of patients being symptom-free after 10 years. If this fails, conversion of SG to Roux-en-Y is effective but there is an increased risk of gastro-jejunal anastomotic leak (3% vs 1%). Alternatively, addition of hiatoplasty and 180° cardioplication can also be effective.

Conclusion
More evidence and international collaborations would help determine which patient groups require counselling and will benefit from novel management to minimise complications.
EP.TH.386Management of acute gallstone-related complications at Great Western Hospital
Authors: Castelhano Rute , Bartlett Jessica , Wooler Harry , Mahmoud Ahmed , Theofilis Aris , Shamali Awad 
Published: October 2021

Abstract

Aim
Gallstone-related disease accounts for a third of the admissions to the Surgical Department. In June 2019, an audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted timeframe, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented.

Methods
A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone-related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission. Only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed.

Results
Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary related re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year.

Conclusions
This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.
EP.TH.507An Audit of Consent Documentation and Chaperone Use in Patients Presenting to Acute Settings with Breast Complaints
Authors: Dunlop Hannah 
Published: October 2021

Abstract

Aim
To compare current practice of documenting consent and offering chaperones when performing breast examinations in the acute setting, with standards set by regulatory bodies (General Medical Council, Royal College of Emergency Medicine and Royal College of Surgeons).

Method
Data was collected retrospectively from all patients presenting with breast complaints to either the emergency department (ED) or the surgical assessment unit (SAU) over a 34-month period. From the clerk-in notes, the role (Dr/Nurse), grade (FY1 to consultant) and gender of the examiner was noted, as well as whether consent was documented and if a chaperone was offered.

Results
Of the 64 patients presenting in this time frame, consent was documented in 7 sets of notes (11%). Furthermore, 17 were offered a chaperone (27%), of which examiners correctly documented the name and role of the chaperone on 11 occasions.
Results also demonstrated that ED trainees were most likely to offer a chaperone and GP trainees were the best at recording consent. It also revealed that although male examiners offered a chaperone 50% of the time compared to 6% of female examiners, women examiners were better at documenting consent when compared to their male counterparts.

Conclusion
The audit results indicate that there is significant room for improvement across all roles, grades and genders with regards to documentation of consent and the use of chaperones within the acute setting, in order to meet current standards of practice as set out by regulatory bodies.
EP.TH.515A Case of mucinous adenocarcinoma of the breast in a young male patient presenting with a subcutaneous axillary lump
Authors: Suliman Amna , Latif Ahmed , Metafa Anna , Uhercik Michal 
Published: October 2021

Abstract

Aims
Mucinous adenocarcinoma of the breast is rarely encountered clinically, and makes up only 0.01% of Breast cancer (BC) cases and &lt; 1% of male breast cancer (MBC). We describe an extremely rare case of mucinous carcinoma in accessory axillary breast tissue in a male.

Case details
A 48-year old male presented with a subcutaneous lump in his left axilla. Ultrasound described a 30mm hypoechoic mass and core biopsy confirmed mucinous adenocarcinoma, strongly positive for oestrogen and progesterone receptors, HER2 negative. A solitary enlarged axillary node in was sampled (C2) and mammogram reported a 32mm spiculate mass (M4) on the left. PET scan showed uptake only in the known axillary mass.

Management
Wide Local Excision and Sentinel Lymph Node Biopsy (SLNB) was completed. Histology showed a 27 mm grade 2 mucinous carcinoma, and the patient completed adjuvant radiotherapy and was commenced on tamoxifen.

Conclusions
MBC is rare, and accounts for only 1% of all BC. Men tend to be diagnosed at an older age (mean is 67 years) and usually have genetic/hormonal risk factors. Histologically, invasive ductal carcinoma makes up 95% of MBC. In every regard therefore, our case breaks the mold since, he was young, had no genetic/family history and no background of gynaecomastia (present in 6-38%). Literature review suggests that this is only the second case of its kind and from it we can learn to be vigilant for MBC in accessory axillary breast tissue as well as the more typical presentations.
EP.TH.531Occult breast cancer: Breast conservation or Mastectomy in terms of recurrence. A single center experience
Authors: Javed Muhammad Rizwan , Abidi Syeda Sakina , Vohra Lubna Mushtaque 
Published: October 2021

Abstract

Aim
We sought to compare breast conservation therapy & mastectomy as treatment of occult breast cancer in terms of recurrence.

Methods
It is a retrospective cross sectional study conducted on patients diagnosed to have occult breast cancer and going for either breast conservation therapy or mastectomy at The Aga Khan University Hospital Karachi between January 200o to December 2018, patients will be divided into two groups, first group will be consisting of patients who underwent breast conservation therapy and 2nd one will be of patients who had mastectomy. Patients will be included by consecutive sampling technique. Hospital database will be used to identify patients and data collected on a self designed tool using files and electronic patient records. Patients in both groups will be followed to see local recurrence from date of diagnosis to 2 years post operatively in hospital data base and their files, and then their data will be compared with the reference studies reported in this article.

Results
Awaited as the study is ongoing.

Conclusions
Awaited as study is ongoing.
EP.TH.691Necrotic Liver Abscess secondary to Duodenal Perforation caused by ingestion of a Fish Bone – A Case Report
Authors: Surtee Shazmeen , O'Connor Adam , Fani Mazyar , Hassan Ahmed , Satyadas Thomas , Jamdar Saurabh 
Published: October 2021

Abstract

Introduction
Ingestion of foreign bodies are not uncommon, however enterohepatic migration of fish bones causing liver abscesses remains a rare phenomenon.

Case Report
We present the case of a 58-year-old female admitted with 11 days history of fever, rigors, shortness of breath and malaise associated with vomiting and diarrhoea. Her COVID-19 rapid antigen test was negative. She was tender in the left lower quadrant of her abdomen and inflammatory markers were markedly high so initial differential diagnosis included colitis and diverticulitis.
Contrast Computed Tomography of the abdomen and pelvis showed an 8.1cm irregular hepatic lesion initially thought to be a multi-loculated abscess, malignancy or complex cyst. She was started on broad-spectrum antibiotics, escalated to Intensive Care Unit (ICU) and discussed at the hepato-biliary multi-disciplinary team (MDT) where magnetic resonance images demonstrated a perforated duodenum from a 2.5cm fish bone penetrating from the duodenal wall into the liver parenchyma causing a necrotic abscess.
She underwent percutaneous drainage of the hepatic abscess. Endoscopic retrieval was then attempted; however, the fish bone was not visualised. Definitive management followed with laparoscopic removal of the fish bone and primary duodenal repair.

Discussion
Identification of the cause of the abscess during MDT discussion enabled prompt source control which was key in managing intra-abdominal sepsis – radiological drainage in the first instance prevented secondary peritonitis from a potentially ruptured abscess and enabled the patient to be de-escalated from ICU. Previous literature suggests endoscopic retrieval however, laparoscopic surgery remains safer for managing complications following removal of sharp foreign bodies.
EP.TH.747Audit of antibiotic prophylaxis in groin hernia repair
Authors: Patel Maitreyi , O'Balogun Aleem , Kirmani Naveed 
Published: October 2021

Abstract

Aims
To review practice of antibiotic prophylaxis in patients undergoing groin hernia repair against the International guidelines for groin hernia management 2018, in order to improve compliance with International Guidelines. We also assessed the risk category of patients.

Methods
Retrospective data of all patients undergoing groin hernia repair from November 2019 to March 2020 was collected using hospital software. Data collected included patient demographics, details of hernia repair including; primary/recurrent hernia, emergency/elective, laparoscopic/open repair and use of mesh. The details of antibiotic prophylaxis were recorded. Descriptive statistics was used. Data was analyzed using Microsoft Excel.

Results
67 patients were included, of which 38(57%) were high risk. 62 (92.5%) primary repairs were done, of which 48(72%) were open. 62(92.5%) were operated electively. 46(69%) patients underwent open repair with mesh, 6(9%) had open repair without mesh, while 15(22%) had laparoscopic repair with mesh. A total of 45 (67%) patient received antibiotic prophylaxis. Adherence to International guidelines for groin hernia in open hernia surgery was 82.67%, while that for laparoscopic surgery was 60%. Overall adherence to the Guidelines was 56.67%.

Conclusions
The audit reflects the need for improved understanding and adherence to the International Guidelines. Data collection of surgical site infection can help inform and influence practice to minimize the risk for surgical site infection and assist in better communication with patients regarding risk. Risk assessment for surgical site infection of patients prior to procedure helps to identify those with indication of antibiotic prophylaxis.