bluuebunny/crossref_metadata_2025_split huggingface dataset:
601 SAVI SCOUT® vs Wire Guided Localization in Breast Conserving Surgery: A Symptomatic Breast Care Centre’s Experience
Authors: Harrington C I , McCormack E , O’Donoghue G , Murphy S , Manning A 
Published: August 2024

Abstract

Aim
Wire localization (WL) for nonpalpable tumours has been the gold standard localization technique in breast conserving surgery. However, issues such as patient discomfort, schedule inflexibility, and dislodgement can be encountered. SAVI SCOUT® (SSL), uses radar localization and can be inserted up to a month pre-operatively and was introduced in this institution in February 2023. This study aims to assess oncological outcomes as well user reported outcomes using WL vs SSL in a tertiary referral centre.

Method
A retrospective analysis was performed of all patients undergoing SSL wide local excision (WLE) and those undergoing WL WLE, for biopsy confirmed breast cancer, over 18 months. Primary outcomes were positive resection margin rate and re-excision rate.

Results
Eighty-two patients were included. Thirty-eight SSL and thirty-nine WL. Successful lesion excision was achieved in 100% of cases. Positive margin rate and re-excision rate was 15.8% for SSL (n=6) and 7.7% in WL (n=3) (p=0.45). 100% of breast radiologists agreed that SSL easier to place and schedule than WL, and believed it was more comfortable for patients than WL. Surgeon outcomes: 50% agreed tumours were easier to identify with SSL and probes were more accurately placed. 100% agreed that SSL led to less operation delays.

Conclusions
Positive outcomes were reported for SSL amongst users. However, a higher positive margin rate was seen in SSL when compared to WL (15.8% vs 7.7%) but was not statistically significant. A larger cohort of patients and increased operator experience is necessary to assess long term outcomes.
1169 Local Trust Audit Reviewing the Use of NABCOP’s Fitness Assessment Guidance in Patients ≥70 Presenting to New Patient Breast Clinic in Royal Bolton Hospital Foundation Trust
Authors: Mallya A , Thomas M , Lim L , Pikoulas P 
Published: August 2024

Abstract

Aim
The National Audit of Breast Cancer in Older Patients (NABCOP) has developed a fitness assessment form which should be completed for all patients who are ≥70 years when initially attending the breast clinic for suspected cancer. This form aims to standardise frailty assessment within this population and assist with treatment decisions. The form comprises of three sections: Clinical Frailty Scale, Abbreviated Mental Test Score and three further questions regarding co-morbidities. The Royal Bolton NHS Foundation Trust Breast Unit was audited against this national standard.

Method
This was a prospective audit assessing the compliance and completion of the fitness assessment form in patients ≥70 years attending new patient breast clinics over a two-week period. The results were then presented, and teaching provided to staff on the importance of this national standard. The fitness assessment forms were re-printed on yellow paper and the nursing staff were instructed to highlight patients ≥70 years on each clinic list. Data was then re-collected over another two-week period to close the audit cycle loop.

Results
During the first cycle, 14 patients who met the inclusion criteria were identified with a 0% compliance rate. After the interventions, as outlined above, the second cycle identified thirty-four patients with an 88.2% (30) compliance rate.

Conclusions
The compliance rate in using NABCOP’s fitness assessment score at the Royal Bolton NHS Foundation Trust Breast Unit significantly increased following education and the introduction of yellow paper visual prompts in clinics.
598 Chest Drain Monitoring Post-Thoracic Surgery: An Audit
Authors: Ahmed A , Jesuyajolu D , Fontaine E 
Published: August 2024

Abstract

Aim
Most patients have a chest drain inserted during thoracic surgery to remove fluid (such as blood, pus, or chyle) and air from the thoracic cavity. They are also inserted to create negative pressure within the pleural space to aid re-expansion of the lungs. The monitoring of chest drains is therefore vital to enable monitoring and thus management of surgical complications.
Manchester Foundation Trust has a protocol concerning chest drain monitoring through documentation of certain parameters:Tube patencyDrain swingingDrain bubblingDrainage volume and typeDrain clampingDrain site conditionSuction levelBottle change date and time.
Our aim was to investigate protocol compliance to ensure optimal patient management.

Method
For the first cycle, electronic records were scrutinised for patients who had thoracic surgery between 1st August 2023 to 14th August 2023 to ascertain if the aforementioned parameters were recorded. Following this, a poster was created highlighting the protocol and distributed across the department. For the second cycle the same method was adopted over a two-week period starting on 23rd October 2023.

Results
The first cycle demonstrated compliance for documentation of drain bubbling, fluid volume/type and suction as 90%, 84% and 87% respectively, and 0% for remaining parameters. The second cycle demonstrated compliance for documentation of drain bubbling, fluid volume/type, suction and drain site condition as 100%. Compliance for tubing patency was 14%, drain swinging 36%, drain clamping 21% and bottle change 21%.

Conclusions
The poster demonstrated improvement in documentation of all parameters, thereby aiding in the management of these patients.
1226 Audit of Chest Drain Stitch Removal in Thoracic Surgery Inpatients
Authors: Samara M , Langham Z , Naidu B 
Published: August 2024

Abstract

Aim
Most Thoracic Surgery inpatients undergo chest drain insertion during their hospitalisation. Some patients, however, experience extended stays or readmission after drain removal. Our departmental guidelines recommend removing stitches 5-7 days post-drain removal. This audit aims to evaluate and enhance our practice in this regard.

Method
This retrospective study included patients who remained as inpatients or were readmitted on day-7 following the removal of a chest drain that required stitches. The study was conducted in two cycles, the first cycle involved patients discharged from Thoracic Surgery between August 23rd and September 23rd. The second cycle took place six weeks after implementing an intervention that involved documenting the date of drain removal on the electronic medical records (EMR) with a recommended range for stitch removal.

Results
In the first cycle, there were 17 patients with 24 drains/stitches, with stitches remaining in place for a range of 6-44 days (median 10.5 days). In the second cycle, involving 14 patients with 22 drains/stitches, the range decreased to 4-18 days (median 7 days) post-intervention. Compliance improved from 20.8% to 54.5%. Importantly, we observed a reduction in incidents of bleeding, difficulty, or abandonment of stitch removal in the second cycle, as opposed to two cases in the first.

Conclusions
Timely removal of stitches following chest drain removal is essential for postoperative care, reducing the risk of complications associated with delayed removal. Our intervention significantly improved our practice. We recommend the continued implementation of EMR documentation as an effective means of enhancing patient care.
449 Pseudomyxoma Peritonei Peritonitis: An Unexpected Finding
Authors: Yannamani P , Oyewole B , Waheed L , Langford S , Shetty R 
Published: August 2024

Abstract
A 42-year-old male was admitted with a one-day history of sudden-onset abdominal pain, worst in the right iliac fossa. He had felt feverish but had no nausea, vomiting or diarrhoea. He had no significant past medical history. On examination he was peritonitic on the right side of his abdomen and the left side was soft. Blood pressure, heart rate and temperature were within normal parameters. His blood tests showed a CRP of 98, a white cell count of 13.6, and all other bloods were unremarkable. He was initially managed for appendicitis and received IV antibiotics.
CT abdomen pelvis with contrast showed a 6.5x10x18cm abscess with extension from the caecum up to the level of the right colonic flexure.
He was taken to theatre for an appendicectomy and a 5cm appendiceal mucocele was found. This had perforated and there was a large amount of mucin in the right anterior and lateral abdominal wall. All abdominal organs appeared grossly normal, there was no gross peritoneal seeding, and the appendiceal base appeared normal. The mucin was suctioned and sent for cytology. The appendix was sent for histology. The patient was booked for a staging CT thorax and outpatient colonoscopy. He was discharged home with no complications.
The learning points here are that operative diagnosis is essential for surgical planning as well as adequate specimen collection for histology and cytology. Secondly, while appendicitis is a common clinical condition, there could be uncommon clinical and histological findings.
491 Metastatic Micronodular BCC – a Multimodal Approach and Reconstruction in the MDT Setting
Authors: Van J , Plonczak A , Hamnett N 
Published: August 2024

Abstract

Introduction
BCC is the most common cancer. Metastatic BCC is limited to a small percentage &lt;1% of cases. This is usually local nodal invasion rather than true metastasis. BCC is deemed low risk with cure rates of 96% with predetermined margins.

Case report
We present a 55-year-old male with no significant past medical history who developed metastatic basal cell carcinoma (BCC) to the regional inguinal lymph nodes 5 years post complete excision of a micronodular/infiltrative BCC with perineural invasion to the lower leg.
CT chest, abdomen and pelvis showed a left groin mass invading the sartorius muscle and MRI pelvis showed encasement of left femoral artery and no evidence of distant metastases.
The patient underwent ilio-inguinal dissection and resection of common femoral artery with Dacron graft reconstruction covered with sartorius muscle flap. The photos show a large soft tissue defect post-resection which was reconstructed using perforator-based flap containing multiple perforators based on lateral femoral circumflex artery. The patient then completed adjuvant radiotherapy 50Gy/25# over 5 weeks.

Conclusions
Metastatic BCC in a young fit patient requires radical surgery and adjuvant radiotherapy. Complex reconstruction was planned within the MDT setting resulting in limb salvage, restoration of form, function and normal gait. Learning points include looking for metastasis in high-risk subtypes of BCCs. It is important to manage these rare cases with an MDT approach and emphasize patient education regarding recurrence and metastatic risk post-diagnosis and at time of discharge.
630 Conservative Management for Recurrent Small Bowel Obstruction Related to Ileostomy in Pregnancy
Authors: Baxter N , Brewis L , Arkle T , Shaikh I 
Published: August 2024

Abstract
Management of small bowel obstruction in pregnancy poses significant challenges, further complicated in rare cases where this is related to an ileostomy. Existing case reports describe both operative and conservative management strategies. This is the first case report to document conservative management of recurrent episodes.
We report the case of a 27-year-old nulliparous patient, who presented at 24+0 weeks gestation with a short history of abdominal pain, bilious vomiting and reduced stoma output. She had a background of subtotal colectomy and ileostomy formation two years prior for refractory ulcerative colitis. MRI demonstrated small bowel obstruction with a transition point close to the ileostomy site. The obstruction was resolved through insertion of a per-stomal nasogastric tube, as in previous case reports, and she was discharged. At 27+0 weeks she was readmitted with recurrent symptoms, to relieve the obstruction a Foley catheter was placed into the ileostomy to traverse the transition point and positioning confirmed on MRI, allowing discharge. At 34+5 weeks she was readmitted and managed similarly, however it became apparent the gravid uterus was contributing to obstruction and early delivery was the best option. She received dexamethasone and underwent an uncomplicated caesarean section at 35+2 weeks with the stoma functioning normally post-delivery. She was successfully discharged with her baby.
In conclusion, novel use of a Foley catheter permitted oral nutrition and time for steroid administration to aid foetal lung maturation. Joint care with obstetrics was vital to determine optimal timing for delivery, balancing risk to the mother and pre-term delivery.
992 Prostatic Abscess in an Immunocompetent Adolescent: A Rare Case Report
Authors: Cheng Y S , Chuang Y H , Hosny K 
Published: August 2024

Abstract

Background
Prostatic abscess (PA) is uncommon, typically seen in the middle age population. PA in adolescents is extremely rare. Risks factors include diabetes mellitus, immunodeficiency, recurrent urinary tract infection and urological procedure. The diagnosis of PA is challenging due to its vague and non-specific symptoms. It is recommended that a PA larger than 1 cm is treated with surgically drainage and adequate antibiotics

Case Presentation
We present a case of PA in a 19-year-old Afro Caribbean male. He presented with swinging pyrexia, generalised abdominal and rectal pain. He denied urinary symptoms. He had no significant past medical history. Digital rectal examination yielded pain on palpation of prostate. Immunodeficiency history and screening were negative. CT showed a multilocular prostatic abscess measuring 6.0 x 3.4 x 4.9 cm. Blood and urine culture were negative. The patient was treated initially with ciprofloxacin and gentamicin for a week. Then later discharged with six weeks of ciprofloxacin. MRI was performed after 3 months which showed only post-inflammatory changes in the prostate gland but no residual PA

Conclusions
We were able to demonstrate treatment success in a large PA in an adolescent without surgical drainage which is usually the mainstay treatment. The early diagnosis and treatment based on patient selection in this case remain pivotal in development of a treatment algorithm and improving patient outcomes.
1117 Treating an Ongoing Headache with a Gastrectomy
Authors: Zulhilmi Nadesan H , Samy A N W , O’Connor D 
Published: August 2024

Abstract
A 51-year-old male originally from the west coast of Africa and at the time of presentation to hospital resident in the west of Ireland, was brought in by ambulance following an unstable upper gastro-intestinal bleed. The patient was resuscitated with packed red cell transfusion and intra venous crystalloid and proceeded to definitive endoscopic management within 12 hours of presentation. During secondary survey, it transpired that the patient had been taking a supra-therapeutic dose of over the counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of a headache during the preceding 8 weeks. At endoscopy, haemostasis was achieved endoscopically with a combination of subcutaneous injection of adrenaline and application of a haemostatic powder, licenced for such cases. The patient made an excellent initial recovery but on day 6 developed catastrophic secondary haemorrhage. Further endoscopic management was unsuccessful, and a decision was made to proceed to laparotomy. At laparotomy the findings included an ulcer of the distal gastric body, multiple lesions of the liver, peritoneum, and extensive lymphadenopathy. The patient proceeded to undergo an oncologic subtotal gastrectomy and D2 lymphadenectomy with biopsy of a representative liver lesion. Histology revealed the surprising finding of tuberculosis and subsequent imaging identified a large tuberculoma of the left parietal lobe as the source of original headache.
This case demonstrates the importance of a wide differential list for intra-operative findings of lymphadenopathy, particularly in a globalised society and describes the unusual presentation of miliary tuberculosis, albeit indirectly, as an upper gastro-intestinal bleed.
1157 A Giant Pseudoaneurysm of Carotid Artery
Authors: Nawaz S M A , Ahmed H , Harkin D , Babiker M , Ahmed A 
Published: August 2024

Abstract

Introduction
Pseudoaneurysm(PA) post carotid endarterectomy(CEA) is infrequent and potentially lethal complication, with incidence rate of less than 1%. Most of the described case reports are associated with infection. We present a case of 73-year-old man with a giant left carotid pseudoaneurysm post bilateral CEA.

Case Presentation
A 73 year old man presented with pulsatile left neck swelling after 17 years of left CEA, also had right CEA 13 years ago. Swelling was pulsatile and gradually increased in size. Initial ultrasound(USS) showed anteroposterior diameter of 1.5cm carotid pseudoaneurysm associated with patch. Decision of embolisation with stenting was made in vascular multidisciplinary-team(MDT) meeting however, patient declined the treament at that time. Following year, size of the swelling progressed, now tender and causing dysphagia. CT-Angiogram demonstrated giant left carotid bulb pseudoaneurysm. Open surgical repair with revision patch angioplasty was performed after the patient agreed. Post operative day-2 patient developed large neck haematoma which was managed conservatively and showed good recovery in follow-up clinic.

Discussion
The most common cause of pseudoanuerysm is trauma or previous surgery. However, presentation after many years of surgery without any signs of infection makes our case interesting.

Conclusions
Carotid artery pseudoaneurysm can be life-threatening if not diagnosed early. Any neck swelling should be investigated vigorously regardless of any previous trauma or surgery.
773 Quality of Life in Patients with Colostomy: A Comparative Analysis of Surgical Settings and Procedure Types
Authors: Binti Yusri N A 
Published: August 2024

Abstract

Aim
Quality of Life (QoL) is a crucial metric for evaluating the success of clinical interventions. This study aims to assess and compare the QoL of patients with a stoma based on surgical settings, types of procedures undergone, and the amount of support received before discharge.

Method
The methodology involved the identification of patients and the administration of a structured QoL questionnaire (ASCN UK). The sample population included individuals who underwent five different surgeries which were Hartman’s, sigmoid colectomy, anterior resection, low anterior resection, and abdominal perineal excision of the rectum in the past three years, encompassing both elective and emergency settings.

Results
Results revealed the mean QoL score for elective procedures was notably higher at 78.6%, compared to 62.6% for emergency settings. Among elective surgeries, sigmoid colectomy demonstrated the highest mean QoL score (90.4%), while Hartman’s procedure showed the lowest (72.4%). In emergency settings, Hartman’s procedure had the highest mean QoL score (75%), contrasting with anterior resection's lowest score (46%).
The study emphasized the multifactorial nature of QoL, highlighting the positive impact of pre-surgery information and support. Gender and age were significant contributors, with males and older individuals exhibiting higher QoL scores.

Conclusions
In conclusion, QoL in patients undergoing elective settings was significantly higher than in emergency settings. This trend was consistent across different procedures, as elective settings consistently yielded higher mean QoL scores compared to their emergency counterparts where applicable. This study highlights the pivotal role of support in enhancing QoL for colostomy patients, providing valuable insights for healthcare decision-making and management planning.
1192 Role of Gastrograffin Enema in Loop Ileostomy Closure Preparative Assessment: A Retrospective Study
Authors: Nasrudin A A B , Mandal I , Dharamavaram S 
Published: August 2024

Abstract

Aim
This study aims to ascertain the role of gastrograffin enema in assessing anastomotic failures, stricture or leaks, in primary loop ileostomy patients with time-to-closure duration longer than 90 days.

Method
A retrospective analysis of ileostomy closure in a district hospital within 2 years (August 2021 to August 2023) with the time-to-closure duration exceeding 90 days from primary ileostomy. Gastrograffin enema and flexible sigmoidoscopy performance and findings will be identified to assess their role in pre-closure anastomotic failure detection.

Results
39 patients were identified, of which 24 (61.5%) had gastrograffin enema before closure and only one patient (4.2%) was found to have an anastomotic leak in the gastrograffin study but with a subsequent normal study. The remainder had normal findings with no strictures reported from any of the gastrograffin studies. 28 patients (71.7%) in total underwent flexible sigmoidoscopy, of which 21 of them (53.8%) had dual study (gastrograffin enema and flexible sigmoidoscopy). 11 sigmoidoscopy findings (39.2%) in total were reported abnormal of which 3 were strictures (10.7%). 2 of the stricture findings had the dual study but were not initially picked up from the gastrograffin enema, while the remainder had no previous enema (p=0.0014).

Conclusions
The sensitivity of gastrograffin for anastomotic stricture was poor in patients with extended time-to-closure duration but was useful in anastomotic leak detection. This raises the question of the safe role of routine gastrograffin as an independent study to specifically detect strictures as opposed to a dual study in patients with absent clinical suspicion of anastomotic failure, regardless of duration.
646 Is There a Difference in Anastomotic Leak Rates Requiring Re-Operation Following Emergency Right Hemicolectomy Between Colorectal and Non-Colorectal Surgeons?
Authors: Mandal P , Campbell T , Bisheet G , Fernandes R 
Published: August 2024

Abstract

Aim
Right sided colonic cancers can often obstruct and present as an emergency. The decision to perform an anastomosis following the right hemicolectomy resection is often multifactorial. This study explores whether there are differences in leak rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy.

Method
A retrospective study was conducted at a 3-site Trust in South-East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon. Discharge summaries and clinic letters were then used to ascertain return to theatre for an anastomotic leak.

Results
There were 281 patients who had undergone an emergency right hemicolectomy in this time interval. There was a 152:129 female:male ratio. 17 out of 37 patients had an anastomosis undertaken by an Upper Gastrointestinal Surgeon. 2 out of the 17 (12%) had an anastomotic leak. 129 out of 244 had an anastomosis undertaken by a Colorectal Surgeon. 17 of the 129 (13%) had an anastomotic leak. There was no significant difference between the leak rates between colorectal and non-colorectal surgeons (p=0.888).

Conclusions
The study shows that there is no statistical difference in right hemicolectomy anastomotic leak rates between colorectal and non-colorectal surgeons in the emergency setting.