bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TH.41Breast Implant-Associated Anaplastic Large Cell Lymphoma
Authors: Moori Parisa , Ibison Fran , Jacob Deepa , Iddon Julie 
Published: October 2021

Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare, non-Hodgkin lymphoma which arises within the capsules of breast implants. These particular tumours have expression of CD30 and are negative for Anaplastic Lymphoma Kinase (ALK). Here, we report a case of BIA-ALCL in a 48-year-old woman post breast reconstruction. This case report is aimed at raising awareness and education on the significance of considering the development of BIA-ALCL in cases where cytology is negative and helping better understand this disease process.
EP.TH.49The Use of MRCP to Investigate Bile Duct Stones
Authors: Ma Jennifer , Jethwa Paras 
Published: October 2021

Abstract

Aim
Association of Upper Gastrointestinal Surgeons (AUGIS) latest guideline advocates stratification of patients with gallstone disease to determine their risks of common bile duct (CBD) stone and to perform Magnetic resonance cholangiopancreatography (MRCP) for those at intermediate risk. The study assessed the appropriateness of our local hospital's MRCP requests in accordance to the AUGIS standard.

Method
Inpatient MRCP requests for suspected ductal gallstones between June and December 2019 were identified retrospectively. Admission history, ultrasound, MRCP findings and liver function tests were collected from hospital electronic records. Patients with previous cholecystectomy were excluded. Patients were categorized into ‘low risk’, ‘intermediate risk’ and ‘high risk’.

Results
67 patients were included in the study and 24 patients were discovered to have CBD stones on MRCP. The majority of patients (54%) were considered ‘intermediate risk’, whilst the ‘low risk’ group consisted of 13% of the MRCP requests and ‘high risk’ group comprised of 33%. Amongst those in the ‘low risk’ group, only 1 of 9 patients (11%) had cbd stone identified on MRCP. 19% patients in the intermediate group were found to have CBD stone, whilst 73% patients in the high risk group were identified to have CBD stone. On average, patients underwent MRCP within a day of request.

Conclusion
A high proportion of patients at high risk for CBD stone were referred for MRCP, contrary to AUGIS guideline. Inpatient MRCP referrals should be considered carefully in this category as it potentially increases length of stay without change in clinical management.
EP.TH.63Predictive significance of tumour size in patients undergoing curative surgery for colorectal cancers: Retrospective cohort study
Authors: Hajibande Shahab , Barghash Mohammed , Khan Asaf , Ali Baqar 
Published: October 2021

Abstract

Aims
Evaluating predictive significance of tumour size in patients undergoing curative colorectal cancer surgery.

Methods
Patients undergoing curative surgery (77.6% Laparoscopic) for colorectal cancer by a single surgeon between January 2013 and January 2020 inclusive. Linear/binary logistic regression analyses were modelled to assess whether colonic or rectal tumour size could predict R0 resection, specimen length, length &gt;120mm, number of harvested lymph nodes, &gt;12 harvested lymph nodes, number of positive lymph nodes, lymphocytic infiltration, venous invasion, and overall survival.

Results
Total of 192 patients (124 colon and 68 rectal cancers) were eligible. In colon cancer patients, tumour size was independent predictor of the number of harvested lymph nodes (P &lt; 0.001), the number of positive lymph nodes (P = 0.001), and lymphocytic infiltration (P = 0.009). It did not predict R0 resection (P = 0.563), specimen length (P = 0.111), specimen length &gt;120mm (P = 0.186), &gt;12 harvested lymph nodes (P = 0.145), venous invasion (P = 0.103), 5-year overall survival (P = 0.543). Independent predictor in rectal cancers was the number of harvested lymph nodes (P &lt; 0.001), and the number of positive lymph nodes (P &lt; 0.001). It did not predict R0 resection (P = 0.108), specimen length (P = 0.774), specimen length &gt;120mm (P = 0.405), &gt;12 harvested lymph nodes (P = 0.069), lymphocytic infiltration (P = 0.912), venous invasion (P = 0.105), and 5-year overall survival (P = 0.413).

Conclusions
Current study results suggest tumour size alone may not have a significant predictive value in terms of oncological or survival outcomes in patients undergoing curative surgery for cancer of colon or rectum.
EP.TH.81Contribution of Information on GP Referral Letters to Patient Management in a Rapid-diagnosis Breast Clinic
Authors: Gkigkelou Eleonora , Kirkpatrick Katharine , Ravichandran Duraisamy 
Published: October 2021

Abstract

Aims
GP referral letters to rapid-diagnosis breast clinics are often poorly scanned copies of standard 2 week-wait proforma that are difficult to read, lengthy, and contain a large amount of irrelevant information. We studied the contribution of information in referral letters in patient management and compared this with information provided by patients themselves.

Methods
Patients completed a standard questionnaire (one side of A4) on arrival at clinic. This included all information relevant to a breast clinic such as family history and comorbidities. A consultant surgeon then saw the patients with the questionnaire and performed clinical assessment and imaging as necessary, without referring to GP letters. The letters were read before patients left clinic. Any additional useful information was noted.

Results
202 consecutive new patients, median age 44 (16-93) seen in 23 clinics by 2 consultants were studied. The median number of pages in referral letter was 5 (1-14). Patient questionnaire took less than 30 seconds to read. The presenting complaints were real or perceived lump (n = 105), pain (n = 44), both (n = 14) and others (n = 39). 21 patients had cancer. Additional useful information in the referral letter was noted in 20 patients (10%). However, in no case this affected the patient management adversely.

Conclusions
GP letters are lengthy but contribute relatively little to the initial assessment and management of patients in a busy rapid diagnosis breast clinic. A patient-completed targeted questionnaire is quicker and can potentially replace a GP referral letter in most patients.
EP.TH.112The Use Ex-Vivo Renal Autotransplantation to Treat Hypertension Secondary to Renal Artery Disease: Two Case Reports
Authors: Saghir Noman , Saghir Reyan , Machado Bruno , Murilo Rene , Poojary Manoj , Sforza Marcos 
Published: October 2021

Abstract
Renal Auto transplantation (RAT) is the surgical procedure in which the kidney is initially removed and subsequently re-implanted in a different position, allowing for improved outcomes in conditions involving ureteral pathology, renovascular and neoplastic disease primarily.
In this paper, we aim to build upon the understanding of RAT and especially its effectiveness in treating patients with hypertension secondary to renal artery disease, intolerant to previous treatment approaches. In particular, the ex-vivo technique will be focused upon as introduced by Ota et al. in 1967 whereby the use of the workbench is frequently applied for patients requiring in excess of 45 minutes of ischaemic time.
We, therefore, put forth two cases managed in co-operation by the University of Arkansas vascular and urology departments. The first of which was a 52-year-old woman with an aneurysmal Lesion reaching the renal artery at the hilum. The second was an 18-year-old woman with Takayasu arteritis. The use of vasopressin had preserved some renal function however at the time of the diagnosis, they were experiencing difficulty in controlling their hypertension, and thus RAT was performed, and the subsequent patient postoperative outcomes and effectiveness have been recorded and analysed as part of this study.
EP.TH.164Staging CXR preoperatively in invasive breast cancer, is it time it should be abandoned? A single-centre cohort review of its utility
Authors: Fung Claire , Rowland Matthew 
Published: October 2021

Abstract

Aim
The use of preoperative chest x-rays (pCXR) for staging in invasive breast cancer has uncertain benefit. This review aimed to ascertain its utility in this cohort in a single centre.

Methods
Retrospective cohort review of consecutive patients with invasive breast cancer planned for surgery for 2018 was carried out. An 18-month follow-up allowed the identification of any subsequent lung pathology that may have potentially been seen on pCXR. Patients who had staging CT instead were excluded. Formal reports of pCXR and any subsequent imaging were reviewed.

Results
244 patients with invasive breast cancer that was planned for surgery for 2018 were identified, 214 of whom had pCXR. 194 had no abnormalities reported. 16 had lung pathology; eight were indeterminate and were advised to have follow-up imaging. Of the six who had follow-up CTs, three had lung nodules; they were all subsequently discharged from follow-up as they were determined as benign.
At 18 months, nine patients had new thoracic pathology: two had metastatic lung disease; six had lung nodules requiring follow-up. All nine patients’ pCXRs were reported as normal.

Conclusions
pCXR for invasive breast cancer has limited, if any, utility; it does not identify any management-altering pathology. Those that developed malignancy were not predicted by pCXR, but identified by post-operative symptoms, or on staging CT directed by post-operative nodal status. pCXR in this cohort, in the absence of respiratory symptoms, should therefore be discontinued. This would reduce cost, radiation exposure, hospital footfall, radiology reporting time, and likely improve patient satisfaction.
EP.TH.275The role of amino acid transporters SLC1A5 and SLC3A2 in primary breast cancer in older women
Authors: Parks Ruth , Alfarsi Lutfi , Green Andrew , Cheung Kwok-Leung 
Published: October 2021

Abstract

Aims
Breast cancer in older women has more favourable biology, compared to younger women. Increased glutamine metabolism is a hallmark of cancer. The prognostic role of amino acid transporters involved with glutamine flux, SLC1A5 and SLC3A2, has been shown in breast cancer in younger women. This study aimed to investigate the role of SLC1A5 and SLC3A2 in breast cancer in older women as possible prognostic markers.

Methods
Surgical specimens were obtained from an existing series of 1,758 older women (≥70 years) with primary breast cancer, treated in a single institution with long-term (37+ years) follow-up. Of this cohort, 813 had primary surgical treatment. As part of previous work, it was possible to construct good quality tissue microarrays (TMAs) in 575 cases.
Immunohistochemical staining for SLC1A5 and SLC3A2 was performed. H-score was considered as a continuous variable as well as using positivity cut-offs of ≥ 45 for SLC1A5 and ≥15 for SLC3A2, using X-tile software.
Association between H-score and tumour size, grade, ER status, local-recurrence-free-survival (LRFS), overall survival (OS) and breast-cancer-specific-survival (BCSS) was investigated.

Results
No correlation was seen between neither marker and LRFS, OS, or BCSS in older women with breast cancer. Both markers were associated with high tumour grade and negative ER status (both p &lt; 0.001).

Conclusions
These findings are contrary to those found in younger women, where these amino acid transporters are associated with shorter BCSS. This may suggest that breast cancer in older women is less reliant on glutamine metabolism, which is consistent with an overall less aggressive phenotype.
EP.TH.286Optimisation of Secondary Breast Reconstruction
Authors: Lovšin Klemen , Ahčan Uroš , Lapoša Andrej 
Published: October 2021

Abstract

Aims
The purpose of secondary breast reconstruction is to restore patient’s integrity. Autologous breast reconstruction has become the superior method of breast reconstruction, especially in cases with inadequate skin envelope and post-radiotherapy tissue damage. A 3D-template-enhanced secondary autologous breast reconstruction with restoration of innervation was developed at our department.

Methods
Thirty patients are planned to be included in the prospective double-blinded study. The reconstruction is performed with the deep inferior epigastric perforator (DIEP) free flap using 3D template from the contralateral healthy breast. Additionally, coaptation of the anterior branch of the 3rd intercostal nerve with the dominant lateral intercostal nerve innervating the DIEP flap is performed. Breast-Q questionnaires are collected before and after the reconstruction and the breast sensation is assessed on regular intervals.

Results
The preliminary results show an improvement in the sensation of the reconstructed breast and higher patient satisfaction score. Prior to abstract submission, no significant complications have been noted, in one patent abnormal sensation of the breast was reported.

Conclusions
According to previous studies, patients with innervated free flap reconstruction express higher level of satisfaction as the sensation of the reconstructed breast contributes significantly to the level of satisfaction. Furthermore, use of 3D model from the contralateral breast produces results that are superior to traditional methods. Preliminary results showed that the combination of both methods improved patient satisfaction regarding the aesthetic outcome and functional result. With the appropriate patient selection this type of optimised breast reconstruction should be performed.
EP.TH.289Diagnosis of the aetiology of acute pancreatitis at a district Hospital: A retrospective audit
Authors: Ravindran Sharanya , Shaaban Hossam , Mohsin Muhamed 
Published: October 2021

Abstract

Introduction
The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission. According to recently published NICE (NG 147) guidelines for diagnosis of aetiology of acute pancreatitis should be determined in at least 80% of cases and no more than 20% should be classified as idiopathic. We aim to overview our current practice compared to guidelines. Early identification of aetiology is essential.

Materials and Methods
Patients diagnosed to have pancreatitis presenting to surgical assessment unit from March 1st 2019 to December 31st 2019. Sample size audited 291. The diagnosis of acute pancreatitis is made with a combination of history, physical examination and laboratory evaluation. Further investigations were done for the ethology. These patients were identified from their discharge information. They had raised amylase along with history suggestive of pancreatitis and were analysed retrospectively.

Results
Of all the pancreatitis patients admitted in SAU, 88 (30%) were due to biliary, 40 (16%) alcohol related, 20 (7%) other causes whereas 134 (46%) were classified as idiopathic. 3 patients self-discharged.

Conclusion
In our trust it seems that aetiology of acute pancreatitis is not adequately investigated. Most of other blood investigations were not performed in index admission and relevant drug history was not elicited. This failure of non-identification of gallstones could be attributed to operator dependant and they didn’t have second USS as advised. We formulated an action plan with detailed history with adequate step wise investigations which will benefit the patients.
EP.TH.299Is peritoneal lavage with water the optimal washout as a preventative method for peritoneal disease following colorectal cancer resection? A systematic review
Authors: Youssef Nadia , Beddingham James , Soliman Faris , Swarnkar Keshav 
Published: October 2021

Abstract

Aim
To study available data on the advantages of peritoneal lavage with distilled water following colorectal cancer resection in improving overall patient outcomes

Methods
PubMed, Google Scholar, and Cochrane databases were searched until October 2020. References from relevant articles were reviewed to widen the search.

Results
Overall, 3 experimental studies were identified. Water was found to be superior to other peritoneal lavage solutions in inducing tumorigenic cell lysis in vitro. Mice who underwent peritoneal lavage with water survived longer and had a significantly reduced peritoneal tumour burden compared to mice who did not undergo lavage or those treated with saline lavage solution. Peritoneal secretions were found to contaminate water lavage and reduce its cell-lytic effect. Nonetheless, complete cell lysis was achieved, in vivo, by prolonging the time of cell exposure to contaminated lavage solution by 20 min.

Conclusion
Single peritoneal lavage with water is probably safe and may have a positive influence on patient outcomes. Further evidence is required to regard sequential peritoneal lavages with water as beneficial and safe in humans.
EP.TH.305Savi Scout Radar versus Wire-Guided Localisation in Breast Cancer Surgery: A Systematic Review and Meta-Anaylsis of Surgical Outcomes
Authors: Latif Ahmed , Suliman Amna , Giono Ilaria , Doddi Sudeendra , Kasem Abdul , Uhercik Michal 
Published: October 2021

Abstract

Aims
Wire-guided localisation (WGL) has been the standard technique for localisation of non-palpable breast cancers (NPBC) for almost 40 years. However, WGL has disadvantages including peri-operative scheduling challenges and patient discomfort. Savi Scout localisation (SSL) is a novel alternative that utilises an implantable wireless non-radioactive reflector. A systematic review and meta-analysis was performed to compare outcomes of SSL versus WGL in NPBC surgery.

Methods
Embase, MEDLINE, PubMed and the Cochrane Library (1946 to December 2020) were searched using PRISMA guidelines for studies comparing SSL and WGL in NPBC surgery. Outcome measures analysed were operative duration, positive margins and re-excision. Results were pooled into meta-analyses using a Mantel-Haenszel Random-Effects model as Odds Ratios for dichotomous data and Mean Difference for continuous data.

Results
Four eligible peer-reviewed cohort studies involving 808 patients were identified comparing SSL (n = 462) and WGL (n = 346). There was no significant difference between SSL and WGL in operative duration (95% CI -0.27, -7.89 to 7.34, p = 0.94), positive margins (OR 0.73, 0.36 to 1.45, p = 0.36) and re-excision (OR 0.62, 0.33 to 1.16, p = 0.13). Inclusion of two non-peer-reviewed cohort studies (additional SSL n = 143, WGL n = 424) altered statistical significance for re-excision in favour of SSL (OR 0.55, 0.36 to 0.83, p = 0.004).

Conclusions
This study demonstrates that SSL is a safe and effective alternative to WGL. SSL uncouples pre-operative localisation from surgery, reducing scheduling challenges. This is particularly useful in the current COVID-19 climate, with pre-operative patient self-isolation requirements. SSL may decrease re-excision rates. Randomised controlled trials are required to investigate this further.
EP.TH.316Laparoscopic Cholecystectomy in KGH in 2019 - Comparing the Incidence of Complications and Patient Demographics to National Data
Authors: Islam A B Mohammad Monirul , Seddon Thomas 
Published: October 2021

Abstract

Aims
Bile Duct injury is one of the serious complications of Laparoscopic Cholecystectomy and should be avoided.
Several recent large studies that have examined Bile Duct Injuries (BDI) during cholecystectomy have found major BDI rates of 0.15-0.36% and an overall biliary complication rate of 1.5% if bile leaks are included.
We wished to identify our current complication rate and compare to national data.

Methods
Retrospective study
Data time frame from:
01/01/2019 to 31/10/2019
Type of patients:
All patients who underwent elective or emergency laparoscopic cholecystectomy between the above dates

Results
312 patients identified and analyzed over the study period.
227 female (72.76%) and 85 male (27.24%)
268 Elective operations (85.9%). 44 Emergency operations (14.10%)

Primary outcome
Secondary outcomes

Conclusions
KGH performed 312 cholecystectomy operations between Jan - Oct 2019, putting it in the upper 1/3 of hospitals regarding the number of operations performed per year. (1)
The complication rate for the study period was 0.32%. This was one out of the 312 operations. Our incidence of complications is lower than published data reporting complication rates, including bile leaks, of up to 1.5%. There were no bile duct injuries during the study period.
The majority (&gt;85%) of cases were performed as elective operations.
EP.TH.328Present status of cancer burden in Sri Lanka based on GLOBOCAN estimates
Authors: Jayasinghe Ravindri , Sriskantharajah Varothayan , Jayarajah Umesh , Seneviratne Sanjeewa 
Published: October 2021

Abstract

Aims
We aimed to provide an overview of cancer burden in Sri Lanka including incidence, prevalence and mortality rates in 2018 by age groups.

Methods
We used the data from GLOBOCAN 2018 which provided worldwide estimates of cancer incidence, prevalence and mortality for each country and regions.

Results
Highest prevalence in both sexes (total = 56,054) in Sri Lanka included cancers of the breast (n = 9,534, 87.5/100,000 population), lip and oral cavity (n = 5,904, 28.2/100,000), thyroid (n = 4,387, 20.9/100,000), colorectum (n = 3,634, 17.3/100,000) and leukaemia (n = 3,234, 15.4/100,000), respectively. In males, the highest incidence was reported for lip and oral cavity, lung and oesophageal cancers and in females, breast, uterine cervix, thyroid and ovarian cancers. Cancers causing highest mortality among Sri Lankan males included lung, lip and oral cavity, oesophagus and leukaemia and in females, breast, uterine cervix, leukaemia and ovary.

Conclusions
The burden of cancer is increasing in Sri Lanka which is probably related to changing cancer risk factor profiles and rapidly aging population. New innovative strategies for prevention, early detection and improving the quality cancer treatment is essential to deal with this effectively.
EP.TH.375Inguinal hernia repair: A systematic analysis of online patient information using the modified Ensuring Quality Information for Patients tool
Authors: Chien Siobhan , Cunningham Danielle , Khan Khurram 
Published: October 2021

Abstract

Aims
Online resources are a fundamental source of healthcare information due to the increasing popularity of the Internet, therefore ensuring accuracy and reliability of websites is crucial to improving patient education and enhancing patient outcomes. Inguinal hernia repair is the most commonly performed general surgical procedure worldwide. This study aims to analyse the quality of online patient information on inguinal hernia repair using the modified Ensuring Quality Information for Patents (EQIP) tool.

Method
A systematic review of online information on inguinal hernia repair was conducted using 4 search terms: “inguinal hernia”, “groin hernia”, “inguinal hernia repair” and “inguinoscrotal hernia”. The top 100 websites for each term identified using Google were assessed using the modified EQIP tool (score 0-36). Websites for the paediatric population or intended for medical professional use were excluded from analysis.

Results
142 websites were eligible for analysis. 52.8% of websites originated from the UK. The median EQIP score for all websites was 17/36 (IQR 14-21). The median EQIP scores for Content, Identification and Structure were 8/18, 2/8, and 8/12, respectively. Complications of inguinal hernia repair were included in 46.5% of websites, with 9.2% providing complication rates and 14.1% providing information on how complications are handled.

Conclusions
This study highlights that the current quality of online patient information on inguinal hernia repair is poor, with minimal information available on complications, hindering patients’ ability to make informed decisions regarding their healthcare. To improve patient education, there is an immediate need for improved quality online resources to meet international standards.