bluuebunny/crossref_metadata_2025_split huggingface dataset:
544 Vasculitic Subglottic Stenosis: A Question of Immunosuppression?
Authors: Zammit M , Hardy S , Harper J , Panarese A , Webb C 
Published: May 2021

Abstract

Introduction
Subglottic stenosis (SGS) is the commonest manifestation of tracheobronchial disease in granulomatosis with polyangiitis (GPA) and carries a high degree of morbidity.
Management of SGS-GPA is a double-edged sword. Delayed treatment may cause respiratory compromise and infectious complications. However, aggressive surgical management may initiate a systemic inflammatory response, reactivating the vasculitic cascade and potentially lead to long-term complications including renal vasculitis and consequential end-stage renal failure.
There is currently no internationally agreed management strategy for this disease.

Method
This retrospective review was undertaken to analyse our unique combination of surgical dilatations and immunosuppressive-focused adjuvant management strategy between years 2011-2020.

Results
Sixteen of our one hundred and nine GPA patients (14.7%) had SGS and were included in our analysis. Whilst three patients (18.8%) improved solely on medical treatment, thirteen (81.3%) required combined surgery and immunosuppression (consisting of cyclophosphamide or Rituximab regimens). Thirty-nine surgical dilatations and two tracheostomies were performed over a mean 53-month follow-up period, with a calculated mean procedure rate of one every 24.8 months (2.7 - 89 months).

Conclusions
Our current management strategy affords a lower procedure rate at every 24.8 months compared to other published studies with combined procedure rate at every 14.9 months.
560 A Rare Case Report of Cartilaginous Choristoma In Base of Tongue
Authors: Karadakhy O , Aziz M , Salama H 
Published: May 2021

Abstract

Introduction
Choristomas are rare, benign, tumour-like growths with histologically normal morphology in an ectopic location. Choristomas can constitute of various tissue types including cartilage, bone and muscle. Chondroid tissue choristomas are referred to as cartilaginous choristomas.

Case Presentation:
A 69 year old gentleman presented with three weeks’ history of foreign body sensation in his throat. No other red flag symptoms were present. Fine nasal endoscopy was unremarkable. Magnetic resonance imaging (MRI) scan revealed mild bilateral prominence of the lingual tonsils. Patient underwent Panednoscopy and biopsy. This confirmed the presence of a cartilaginous choristoma in base of tongue.

Discussion:
This is a rare case of cartilaginous choristoma in base of tongue. It was investigated as per potential head and neck cancers. The majority of previous cases in the literature were managed using surgical resection of the lesion. In this particular case, the patient was discussed in multi-disciplinary team (MDT) meeting and managed conservatively due to the benign nature of the lesion and symptoms.

Conclusions
Cartilaginous choristomas are rare benign lesions, which can present similarly to malignant head and neck tumours. Their size and symptoms should be carefully considered before management. There is a role for conservative management in select cases.
586 Subxiphoid Incisional Hernias Post Median Sternotomy: A Literature Review
Authors: Chan J , Oo S 
Published: May 2021

Abstract

Background
Subxiphoid incisional hernias are one of the complications following a median sternotomy, a surgical procedure to provide access to the mediastinum. Incidence has been reported between 1-4%, although the true incidence is not well known due to its asymptomatic nature.

Method
A comprehensive search was performed on multiple sites. Keywords included “incisional hernia OR Subxiphoid hernia” AND “Median sternotomy OR Cardiac Surgery OR Coronary artery bypass graft OR Transplant OR Valve replacement”. Articles up to 1st of August 2020 were included in this study.

Results
8 articles were included in the study, with a total number of 132 patient identified. The incidence ranged from 0.81% to 3.44%. There was a mixture of repair method and follow up period reported. Recurrence post-repair ranged from 10% to 43%.

Conclusions
Subxiphoid incisional hernias are rare, however, remain challenging to manage. A mixture of open and laparoscopic techniques was reported with a mixed recurrence or failure rate. Further work should be done with a large patient cohort comparing both the open and laparoscopic technique.
588 An Audit on CT Staging of Patients Prior To Robotically Assisted Radical Cystectomy
Authors: Umolu A , Quraishi M , Calleja E 
Published: May 2021

Abstract

Introduction
Muscle invasive bladder cancer(MIBC) is a complex disease requiring aggressive management. CT of the Thorax, Abdomen and pelvis is the optimal form of staging including CT urography for complete examination, according to the European Association of Urology. Cure is unlikely in the presence of metastases. The aim was to assess if patients were appropriately staged prior to Robotically Assisted Radical Cystectomy (RARC)

Method
Retrospective review of medical records of all RARC between Jan 2020 – June 2020 at our district general hospital. Demographics, date of cystectomies and date of imaging was collected.

Results
Seventeen patients were recruited. Median age of patients was 73years and the male to female ratio was 7:3. All (100%) of them had CT Thorax, abdomen and pelvis done prior to RARC. Of the patients studied 24% of them did not have CT Urography done. CT staging of 53% of patients was within 30 days prior to Cystectomy, 35% had CT staging between 30 – 90 days and 12% had CT staging between 90 and 200 days.

Conclusions
Findings showed good adherence to the guidelines requiring CT staging prior to RARC. To prevent understaging of MIBC prior to RARC, clarifications of timeframe between CT staging and RARC is required.
590 False Positives Bladder Scan in Anuric Patient with Ascites: A Case Report
Authors: Alamassi A 
Published: May 2021

Abstract

Introduction
Urinary retention is one of the common presentations. Sometimes the clinical examination is unreliable, especially in patients with high BMI, ascites or anasarca. This makes the diagnosis uncertain and the bladder scan readings should be interpreted with caution. Thus, radiological imaging might be required before planning further intervention.

Case presentation
An 83-year-old woman was admitted under the medical team for sepsis secondary to soft tissue infection. She had multiple comorbidities and morbid obesity with a BMI of 58. Lab results showed an AKI. Initial Bladder scan showed 900 cc. Five uneventful attempts of urinary catheter insertion by the medical team, but still, no urine output and the bladder scan showing positive readings. Supra public catheter was considered. On review, the urinary catheter was in place, no evidence of blood per urethra and the bladder scan showed a reading of around 900 cc. Based on patient’s significantly high BMI, background history, uneventful catheterization and persistent reading on bladder scan. False reading on bladder scan was suspected. Out of hours CTKUB showed significant amount of ascites.

Discussion:
Bladder scan is sensitive for detecting any fluid in the abdomen not specifically urine in the bladder.Formal imaging should always be considered to confirm diagnosis.
599 Acute Abdomen Secondary to Appendiceal volvulus: A Case Report
Authors: Alamassi A 
Published: May 2021

Abstract

Introduction
Appendiceal torsion is an uncommon precipitating factor for acute appendicitis. It is found to be in association with appendiceal mucocele.

Case presentation
A 38-year-old lady presented with acute peritonitis. CT Scan showed tubular fluid collection. This was suggested to be a torsion/volvulus of the appendix. The intraoperative finding were a distended appendix filled with mucus and twisted 720° at the base. Appendectomy was done. The histopathology showed low grade mucinus neoplasia.

Discussion:
Approximately, 50% of mucoceles are asymptomatic and incidentally discovered, whilst 40% present with acute appendicitis. There are two suggested pathogenesis: one being an obstructive mechanism causing high pressure in the appendix, resulting into gross mucinous accumulation and second being a neoplastic process. Appendiceal mucinous neoplasms are classified into LAMN, HAMN and mucinous appendiceal adenocarcinoma. It is important to differentiate between the pathological subtypes as the risk of occurrence of PMP may vary according to that. This would affect the treatment modalities; follow up planning, prognosis and risk of recurrence. It is important that extra precautions should be taken whilst handling the specimens intraoperatively to avoid spillage of the content as that might lead to implantation of neoplastic cells in the peritoneum and that might affect the overall survival rate.
613 Microsurgical Salvage of Neonatal Upper Limb Ischaemia Subsequent to Intrauterine Brachial Vessel Constriction
Authors: Clements J , McBride M , Fogarty B , Lewis H 
Published: May 2021

Abstract

Introduction
We report a case of limb salvage due to intra uterine brachial artery thrombosis. Treatment modalities include medical, endovascular, and surgical. Early recognition, prompt institution of appropriate treatment and monitoring is vital to achieve successful revascularisation and prevention of lifelong morbidity.

Description
A male baby at (36 + 6week) gestation was born to a nulliparous mother with gestational diabetes via uncomplicated elective caesarean section. The child was noted to have a ‘flail’ ischeamic limb post-delivery. There were no palpable pulses in the limb and ultrasonography confirmed thrombosis of the proximal brachial artery. Aetiology was due to dense fibrotic circumferential constriction of the brachial vessels and plexus. Successful revascularisation was achieved with a contralateral interposition reversed great saphenous vein graft.

Discussion
Neonatal limb ischaemia is a rare disease entity with devastating morbidity- including compartment syndrome, tissue loss, limb loss, reduced limb growth, irreparable neuropathies and Volkmann’s syndrome. The initial diagnosis is based on the characteristic sequelae of ischaemia. Therapy should be individualised based on the clinical presentation. Early recognition, prompt institution of appropriate treatment and monitoring is vital to achieve successful revascularisation and prevention of lifelong morbidity.
646 Appraisal of International Guidelines for Malignant Melanoma Management Using the AGREE II Assessment Tool
Authors: Jacklin C , Harrison C , Tan M , Sravanam S 
Published: May 2021

Abstract

Background
Recently, the widely accepted NICE guidelines for melanoma management have been challenged by a UK-based expert consensus statement. A review of alternative clinical practice guidelines (CPGs) could guide future CPG updates and developments. The AGREE II tool assesses CPGs across six domains: ‘Scope and purpose’, ‘Stakeholder involvement’, ‘Rigour of development’, ‘Clarity of presentation’, ‘Applicability’, and ‘Editorial independence’.

Method
We conducted a systematic search of Pubmed, Medline and online CPG databases to identify melanoma CPGs published between January 2014 and March 2020 providing recommendations for: adjuvant treatment, radiotherapy, surgical management, or follow-up care. Three authors independently assessed the quality of identified CPGs using the AGREE II assessment tool. Inter-rater reliability was assessed by Kendall’s coefficient of concordance (W).

Results
Twenty-nine CPGs were included and appraised with excellent reliability (Kendall’s W for overall GPC score 0.85, p &lt; 0.001). Overall, melanoma CPGs scored highly in the scope and purpose and clarity of presentation domains, and poorly in the applicability domain. The NICE guideline achieved the best overall scores.

Conclusions
The NICE melanoma CPGs are higher quality than alternatives but should be updated to reflect recent landmark trials. The AGREE II tool is currently limited by its incapacity to compare guidelines to latest evidence.
653 DRAFFT Dodging? Fixation Methods for Distal Radial Fractures Since 2014 In A UK Trauma Unit
Authors: Gilbert J , Akehurst H , Mutimer J 
Published: May 2021

Abstract

Introduction
The 2014 randomised, controlled Distal Radius Acute Fracture Fixation Trial (DRAFFT) compared K-wires to internal fixation for management of dorsally displaced distal radius fractures. The authors found no clinical difference between the two fixation methods, concluding ‘The results of this trial will reverse the trend towards locking-plate fixation for this injury’. Our study aimed to measure local change in practice since 2014.

Method
From the DRAFFT CONSORT diagram, we calculated just 10.7% of eligible cases required locking plate fixation. 300 patients, 50 per year from 2014-19 meeting DRAFFT eligibility criteria undergoing fixation, were randomly selected from an electronic trauma database. Radiographs were reviewed to see whether patients received internal fixation or K-wires.

Results
Age and sex distributions of the study sample were not significantly different to the DRAFFT population (p &lt; 0.05). Over 60% of recruited patients received internal fixation each year. No increasing trend in use of K-wires was detected (p = 0.27). No trend was observed in either fixation method adjusting for intra versus extra-articular fractures (p = 0.36).

Conclusions
Local practice remains unchanged in fixation of dorsally displaced distal radius fractures since 2014. Internal fixation remains the most prevalent surgery, and there has been no detectable increase in use of K-wires.
659 Unilateral Infarction of Adrenal Gland During Pregnancy: A Case Report and Important Learning Point
Authors: James S , Lafaurie G , Hafeez R 
Published: May 2021

Abstract

Background
Abdominal pain in pregnancy offers a challenge for the General surgeon. Unilateral adrenal infarction is an extremely rare event.

Case presentation:
We report the case of an obese 23-year-old pregnant female G4 P1 + 2 diagnosed with unilateral adrenal infarction and hemorrhage. She presented at 34 + 5 weeks with severe RUQ and flank pain under the obstetric team. After initially being discharged, she later returned with intractable pain. Examination and initial investigations (USS KUB and abdomen) were inconclusive. She was empirically treated for pylonephritis. During the night she underwent emergency c-section due to uncontrollable pain. Subsequently, a CT abdomen demonstrated a unilateral right adrenal infarct with hemorrhage.

Discussion:
Unilateral adrenal infarction often leads to a delay in diagnosis and should be part of differential diagnosis in patients with severe RUQ pain (1.3%). It is a rare event diagnosed generally by CT or MRI scan showing attenuation or swelling of adrenal glands. Physiologically it is due to the state of venous circulation during pregnancy alongside others coagulation risks factor.

Learning point:
To consider adrenal infarction with severe RUQ pain when first line diagnosis normal.

Key Investigations:
MRI during pregnancy and CT AP after. Discussion in MDT and screen for coagulation disorder.
698 A Systematic Review of Smartphone Applications for Enhanced Recovery After Surgery (ERAS) Following Colorectal Surgery
Authors: Aseem R , Cribb E , Liccardo F , Daulatzai N , Smith J , Pawa N 
Published: May 2021

Abstract

Introduction
Length of stay (LOS) following colorectal surgery has reduced due to enhanced recovery after surgery (ERAS) programs. Telemedicine has shown potential for patients to remotely access support, communicate progress with their medical team and enhance patient empowerment. We conducted a systematic review of smartphone applications for ERAS following colorectal surgery measuring patient outcomes and experience.

Method
The review was performed adhering to PRISMA guidelines, using search terms pertaining to ERAS, colorectal surgery, and mobile applications via electronic databases. All peer-reviewed English articles were assessed for inclusion and quality by two reviewers. A qualitative analysis was conducted to evaluate methodologies, patient experience, and outcomes.

Results
206 abstracts were identified from which 5 articles (2 RCTs and 3 cohorts) were included in the analysis. Studies surveyed patient adherence to ERAS, LOS, readmission, intra and postoperative complications. Four studies recorded patient satisfaction, whilst one assessed quality of life and application validation.

Conclusions
The review highlights paucity in the use of smartphone applications after ERAS in colorectal surgery but demonstrates high patient satisfaction levels. Service delivery in the NHS has increasingly moved to a virtual platform during the coronavirus pandemic. More research and engagement in the development and use of smartphone applications would enhance care for patients.
700 Audit on Antibiotic Prescriptions in Neuro-Rehabilitation Wards (C2 And L1) Of Salford Royal Foundation Trust
Authors: Ugwu O , Cheng L 
Published: May 2021

Abstract

Background
Antibiotic-guidelines protect patients by reducing the burden of antibiotic-resistant strains. Some also contain charts for safe dosage and monitoring. Adherence to guidelines promotes patient safety.

Method
Data was collected retrospectively. Electronic records of all in-patients in Neuro-rehab wards on 24/7/2020 were initially analysed. Patients who had not received antibiotics from 1/5/2020 to 24/7/2020 were excluded. Data was analysed using tally chart.

Results
23 patients received antibiotics. Antibiotics were prescribed 45 times over study period. Urinary Tract Infections (UTIs) accounted for 37.8% of cases. Chest infections and skin infections accounted for 22% and 15% respectively. Sepsis of unknown origin and Other-Causes each accounted for 8.9%. In 95% of prescriptions, an indication was documented. Also, 100% compliance was recorded in Allergy status review and documentation of course-length of antibiotics. However, only 53.4% met clinical criteria for antibiotics administration. Of the cases which did not meet the clinical criteria, only 52.3% had been discussed with microbiology department /senior clinician.

Conclusions
Neuro-rehabilitation patients present with complex conditions and are sometimes non-communicative. This makes it difficult to adhere to clinical criteria as some of these require symptoms from patients. Such cases must be discussed with microbiologist/senior clinician.
701 Combined Endovascular and Percutaneous Treatment of Traumatic Pseudoaneurysm of Profunda Femoris Artery: A Case Report
Authors: Malik P , Makar R , Joshi S , Balakrishnan A 
Published: May 2021

Abstract
Pseudoaneurysms of the profunda femoris artery are rare complications of femoral fractures, seen especially after orthopaedic interventions for the same.
We present a case of an 89-year-old Caucasian male with a left neck of femur fracture, repaired with a dynamic hip screw. He presented to us a month later with a painful swollen thigh and deep vein thrombosis. The patient underwent arterial duplex and CT angiogram scans and was found to have a pseudoaneurysm in his left profunda femoris artery, measuring 3x3x4.5cm. This was treated with balloon angioplasty and stenting. However, his stent surveillance duplex scan, a month later, showed that the pseudoaneurysm was largely thrombosed with a patent core that was being fed by a communicating vessel from the superficial femoral artery. A subsequent angiogram showed no obvious feeding vessel. The patent pseudoaneurysm was then treated by percutaneous injection of thrombin. Exclusion of the pseudoaneurysm was confirmed by a follow-up duplex scan.
It is essential to treat all feeding vessels of pseudoaneurysms in the presence of a rich collateral supply. Profunda femoris false aneurysms can thus be treated entirely by endovascular/percutaneous methods and so, potentially avoid open surgery.
726 Return to Sport, Patient Reported Outcomes and Satisfaction Following Anterior Cruciate Ligament Reconstruction
Authors: Simpson C , MacDonald D , Keating J 
Published: May 2021

Abstract

Introduction
Anterior Cruciate Ligament(ACL) rupture is a common sporting injury. Return to sport is a key objective for patients.
The aim of this study was to investigate return to pre-injury level sport at 12- and 24-months post reconstruction and to relate this to types of sport and to patient satisfaction.

Method
A questionnaire was developed, piloted, and then completed by 77 patients that had undergone ACL reconstruction between 2013-2016.

Results
30% of patients returned to pre-injury level of sport at 12 months and 43% by 24 months’ post ACL reconstruction. There was a significant(P = 0.037) relationship between the type of sports that participants played prior to injury and the return to pre-injury level. Sports that involved jumping, hard pivoting and cutting were associated with a lower rate of return to sport. General health profile of the patients was found to be significantly higher in patients that returned to sport(P = 0.024). There was a significant association with return to sport and higher satisfaction and healthcare experience score(P = 0.001).

Conclusions
Patient satisfaction correlated with return to sport. This was inversely related to sports involving jumping, hard pivoting and cutting. Which further illustrates how patient satisfaction post ACL reconstruction was linked to type of sport.
728 Histomorphology Of the Subregions of The Scapholunate Interosseous Ligament and Its Enthesis
Authors: Liew M Y , Mortimer J W , Paxton J Z , Tham S , Rust P A 
Published: May 2021

Abstract

Introduction
The scapholunate interosseous ligament (SLIL) is commonly ruptured following a fall onto the outstretched hand. This ligament has three subregions: dorsal, proximal, and volar. The SLIL enthesis, a specialised region where this ligament attaches to the scaphoid and lunate, has not previously been studied despite its important mechanical function in the wrist joint biomechanics. This study therefore aims to compare the histomorphological differences between the three SLIL subregions, including at their entheses, to inform subregion prioritisation during surgical reconstruction.

Method
Twelve fresh-frozen human cadaveric wrists were dissected and the gross dimensions of the SLIL subregions measured. Subregions were histologically processed for analysis, including quantification of enthesis calcified fibrocartilage (CF) area.

Results
From the gross measurements, the dorsal subregion was the thickest (dorsal=3.04 ± 0.26mm, volar=1.69 ± 0.08mm, proximal=1.51 ± 0.06mm). The dorsal and volar subregions had fibrocartilaginous entheses while the proximal subregion was attached to articular cartilage. The dorsal subregion had significantly more CF than the volar subregion.

Conclusions
The dorsal subregion is the thickest and has the greatest CF area, which is consistent with the greatest biomechanical force subjected to this subregion. These results confirm that the dorsal subregion is the strongest subregion, suggesting important implications in the study of graft incorporation during SLIL reconstruction.