bluuebunny/crossref_metadata_2025_split huggingface dataset:
549 Reducing Inappropriate Abdominal X-Rays Requests for Acute Abdominal Pain in the Emergency Department: A Quality Improvement Project
Authors: Barrington M , O’Malley E J , Bethune R 
Published: August 2024

Abstract

Aim
Acute abdominal pain is a common presentation to emergency departments (ED) in the UK. Abdominal x-rays (AXR) were historically the first line investigation, however, have been largely replaced by more accurate imaging modalities such as computed tomography (CT) scanning. The Royal College of Radiologist iRefer guidelines list only a few indications for using AXR in acute abdominal pain. This quality improvement project aimed to reduce the number of inappropriate abdominal x-rays requested for acute abdominal pain in ED.

Method
Baseline data was retrospectively collected over 4 months. AXR indications were assessed against a locally agreed adapted iRefer guideline. Two interventions were introduced including altering the electronic AXR request form (intervention 1) and teaching to ED juniors (intervention 2). Further data collection took place following each intervention implemented. CT scan volume was collected to measure for impact from the request form change.

Results
Baseline data showed 82% of requests were inappropriate, bowel obstruction (BO) was the most frequently requested indication (75%). Inappropriate request rate improved to 74% following intervention 1 and 52% following intervention 2. BO request reduced to 60% and 42% following respective interventions. There was no change in the volume of CT scans requested.

Conclusions
Our project has significantly improved the use of AXR from 82% to 52% and reduced the request rate for BO. Further iterations of the AXR request are planned to continue this improvement and ensure the changes are maintained.
706 Correlation of Clinical Indication and Radiological Assessment for Core Biopsy in Symptomatic Breast Disease
Authors: Singh P , Marchitelli G , Geropoulos G , Elder K 
Published: August 2024

Abstract

Aim
The Royal College of Radiologists (RCR) issues clear guidance on the screening and imaging for symptomatic breast disease. A widely used scoring system (E) classifies clinical findings on a scale of 1-5 with 1 being totally benign and 5 being totally malignant. The RCR recommends that cases where imaging is normal but clinical suspicion is raised, equivalent to at least an intermediate risk (E3 score), require core biopsy. Similarly, patients with intermediate/suspicious ultrasound findings require needle biopsy. This audit aims to review the adherence to these guidelines in a single-centre breast surgery unit.

Method
All patients undergoing breast biopsies from 10/07/23-25/07/23 who were discussed at the breast surgery Multidisciplinary meeting (MDT) were included. Exclusion criteria included patients with known breast cancer diagnosis, or those with no clinical score (E) score reported.

Results
88 patients underwent a biopsy during this period, of whom 23 were excluded. Of the 65 assessed, 37 patients (56.9%) had a malignant result – all of whom had scored at least 3 on their E score. 4 patients were biopsied who did not meet the criteria for this, as they had a low score in each domain of the triple assessment. These biopsy results were all benign.

Conclusions
Our centre adheres well to the RCR guidance on breast biopsies, and the guidelines issued are accurate in detecting malignant breast disease. There remains scope to improve the efficiency of the service as there are instances of arguably unnecessary biopsies being conducted when assessment scores are below the advised threshold.
831 Diagnosis, Management, and Follow Up of Patients with CT Proven Acute Uncomplicated Colonic Diverticulitis
Authors: Fatima A , Alnabhan A 
Published: August 2024

Abstract

Aim
Acute diverticulitis is one of the most common gastrointestinal diseases in the Western world. The aim of this audit is to evaluate the management of acute uncomplicated colonic diverticulitis as per the 2020 update of WSES guidelines:Clinical assessment, inflammatory markers, and CT AP in all suspected patientsAntibiotic therapy not recommended in immunocompetent patientsAmbulatory management for immunocompetent patientsRe-evaluation within 7 daysRoutine colonic evaluation is not recommended.

Method
Data collection proforma designed according to WSES guidelines Retrospective data collection: Acute admissions between July to September 2023 in a single centre Any age and gender CT proven acute uncomplicated diverticulitis Patients with complicated diverticulitis were excluded

Results
53 patients were included. Mean Age: 63, Age range: 34 – 89, and 70% patients were female. Commonest CT finding: Sigmoid diverticulitis (n=33).Complete clinical assessment as per guidelinesAll patients, regardless of their clinical status, received antibiotic therapyAmbulatory care offered to only 57% of patientsOnly a small percentage of patients were offered re-evaluation within 7 days (37% compliance)Patients were offered OP colonic evaluation (75% compliance)

Conclusions
Inconsistent compliance with WSES guidelines for management of acute uncomplicated colonic diverticulitis. Arrange teaching sessions for the surgical staff and devise a management plan for acute uncomplicated diverticulitis that is in accordance with the guidelines. Printouts of WSES guidelines to be made available on the acute surgical floor. Re-audit after 4 – 8 weeks.
964 Intra-Operative Tourniquet Use in Lower Limb Orthopedic Surgery: A BOAST Audit
Authors: Chahal K , Bethel J , Oduoza U , Begum R 
Published: August 2024

Abstract

Aim
Surgical tourniquets reduce operative time and blood loss and improve visualisation of the surgical field. However, risks include pain, neurovascular and local tissue damage. Operative tourniquet pressure should be baseline systolic pressure plus 70-130mmHg. Ischaemic tourniquet time should be less than 120 minutes. We aim to audit the use and documentation of surgical tourniquets of lower limbs surgery undertaken at a single DGH over a 6-month period against BOAST guidelines.

Method
Retrospective data collected on torniquet use, torniquet time, pressure and patient demographics recorded collected from operation notes and theatre logbooks.

Results
66 patients were included, mean age 55 (7-92) years. 95.4% (62/66) of lower limb procedures had recorded use of tourniquet. 78.5% (51/66) had the total tourniquet time recorded. Mean tourniquet time was 82.4 (15-130) minutes. 58.7% (37/62) had inflation pressure recorded. Mean inflation pressure was 265.7mmHg (150-300). 5 patients (7.6%) exceeded the maximum recommended tourniquet time without deflation.

Conclusions
Our results indicated that level of documentation of tourniquet use fell below the standards set out in BOAST guidelines. A second cycle will determine whether implemented changes in the theatre documentation system has conferred change.
967 Minimizing Radiation Dose in Non-Contrast CT KUB for Ureteric Colic
Authors: Jarral F , Hamdy A 
Published: August 2024

Abstract

Aim
To assess current local practice in CT KUB imaging alongside national data aimed at minimising the radiation doses & adherence to accepted practice.

Method
We undertook a retrospective analysis of 104 non-contrast CT KUB in July 2022 for patients with suspected renal/ureteric colic. PACS images were individually reviewed to assess the cranial level at which scan commences & level at which kidneys start. Data was collected and radiation Doses monitored in milliGrey (mGy) (standardized measure of radiation dose output of a CT scanner).

Results
A total of 104 non-contrast CT KUB was included where 50 (49% ) scans commenced from superior border of T10- T12 Level & 52 (51%) of scans commenced above T10- T12 Level. A further 1% started below T12 level. Only 1% (1) of scans showed upper poles of left kidney above T10. Individuals scanned at T10 or below (50/104) received on average 6.9mGy of radiation while individuals scanned at levels above T10 (52/104) received on average 9.82mGy of radiation.

Conclusions
Our results show 51% of scans commenced above the recommended level (T10) which exposed individuals to higher amounts of radiation on average than individuals whose scans commenced at or below the accepted level of T10. This concludes that more than half of the people who underwent CT KUB scans were exposed unnecessarily to higher radiation doses than the published diagnostic reference levels (NDRL).
1273 The Introduction of Digital Care Records Improves the Completion of Consent Forms
Authors: Poon C , Walker C , Nelson A 
Published: August 2024

Abstract

Aim
Ensuring the consent process is thorough and well documented is crucial in surgical care. A good marker for this is the accurate completion of consent forms. This audit aimed to assess completion rates of paper consent forms and then re-audit after the much-anticipated introduction of Encompass in Northern Ireland in November 2023. Encompass is a healthcare system widely used in the USA which provides a completely digital record for every patient. Our trust was the first to introduce the new system, which will be completely rolled out in Northern Ireland in the next 2 years.

Method
Completion of 30 consent forms was audited pre-Encompass (paper consent forms) and following implementation (online forms signed with a tablet). Information audited included patient details, responsible consultant, name of procedure, site listed (if appropriate), explanation, complications, leaflet given, anaesthetic type, consenter signature, legibility, patient signature and date and whether copy was given to patient.

Results
The completion of introduction of online consent forms improved the completion rates in nearly every parameter. However, the most poorly completed parameters on both paper and electronic consent forms were if information leaflet and copy of consent form was given to patient.

Conclusions
The digital platform allows the automatic population of forms with several of the parameters, improving efficiency and accuracy. A complication list can be added easily using one of the pre-completed lists for common Urology procedures (taken from BAUS patient leaflets). In the future consent forms will automatically be sent to the patient, which will improve digital consenting further.
143 Comparative Study Between Breast Conservative Surgery (BCS) and Modified Radical Mastectomy (MRM) in Early Stage of Breast Carcinoma in a Tertiary Care Hospital in Dhaka, Bangladesh
Authors: Joty S M , Saiyara N , Islam F , Khan M R 
Published: August 2024

Abstract

Aim
To compare BCS and MRM in the treatment of early-stage breast carcinoma.

Method
This was a prospective observational study that involved 74 patients and was carried out in the department of surgery at Shaheed Suhrawardy Medical College & Hospital and Enam Medical College & Hospital, Dhaka, Bangladesh with an 18-months minimum follow-up. The time frame for inclusion was from July 2018 through July 2020. There were two patient groups, 37 patients in Group A who underwent breast conservative surgery and Group B was made up of 37 individuals who had MRM for early-stage breast carcinoma.

Result
With a mean age of 47.65 years in the BCS group and 48.19 years in the MRM group, the operative time for BCS was 1.04± 0.25 hours, whereas 3.20±0.48 hours for MRM. Statistically significant higher amount of post-operative drainage volume in MRM group compared to BCS group (p-value= 0.000). With an excellent aesthetic outcome rate in BCS group (p-value&lt;0.0001) as well as better quality of life than MRM group.

Conclusions
Breast conservative surgery and modified radical mastectomy are both oncologically safe treatments for early-stage breast cancer with multidisciplinary approach. BCS offers less trauma, infection and hospital stay; better aesthetic outcome and quality of life than MRM, making it more deserving of being promoted clinically in the treatment of early-stage breast cancer. Keywords: Breast cancer, Breast Conservative Surgery, MRM.
171 Asymptomatic Emphysematous Pyelonephritis
Authors: Al-Gburi S , Abdalla O , Wong K 
Published: August 2024

Abstract

Introduction
Emphysematous pyelonephritis is a rare severe gas-forming infection of the renal parenchyma and its surrounding areas. It is usually common in poorly controlled diabetic patients or associated with urinary stones. We present a rare case of asymptomatic emphysematous pyelonephritis, which was diagnosed incidentally during a follow-up CT scan for the patient and treated successfully with a total of 10 weeks of antibiotics.

Presentation
A male patient in his 70s with a history of poorly controlled type 2 diabetes mellitus, chronic kidney disease, and benign prostatic hyperplasia was referred to the hospital due to findings of emphysematous pyelonephritis on a follow-up CT scan of the kidneys, ureters, and bladder (CT KUB).

Discussion
Emphysematous urinary tract infections are caused by gas-forming organisms and are categorized based on how the gas is distributed in the urinary tract. The causal agent of infection for emphysematous pyelonephritis is mostly Escherichia coli and Klebsiella pneumonia. To our knowledge, this is the second case of asymptomatic emphysematous pyelonephritis that was treated with antibiotics and without intervention.

Conclusions
Asymptomatic emphysematous pyelonephritis is rare, with only two case reports in the literature. The characteristics of asymptomatic emphysematous pyelonephritis have not been well understood due to their rare occurrence. It may serve as the very first sign of the development of sepsis or remain dormant while undergoing medical treatment. successful management of asymptomatic emphysematous pyelonephritis with a prolonged course of antibiotics can be done in very selected cases with careful monitoring.
326 Unprecedented Complications: First-Ever Case Report of Undetected Iatrogenic Bladder Rupture Presenting as Osteomyelitis of the Pubis and Fournier’s Gangrene
Authors: Golash A , Golash V 
Published: August 2024

Abstract
This case report details the first-ever documented occurrence of chronic extraperitoneal rupture of the bladder with osteomyelitis presenting as Fournier’s gangrene. The patient, a 78-year-old male with a history of prostate cancer, presented in the emergency department six months post urethral stricture dilatation, with sepsis, lower urinary tract symptoms, and painful right groin swelling.
An urgent CT scan revealed a gaseous collection in the right thigh and pubis symphysis destruction, suggesting Fournier's gangrene and osteomyelitis. The source of the collection was a 15mm defect in the anterior bladder neck, attributed to an iatrogenic injury during urethral stricture dilation. The patient underwent urgent debridement, with extensive necrotic tissue excision. Continuous urinary leak from the non-healing bladder wall injury necessitated a multifaceted approach, including Foley catheterization, bilateral nephrostomy, and a rectal tube. Polymicrobial infections with Aerococcus sanguinicola, Staphylococcus haemolyticus, and Enterococcus faecium further complicated the wound healing process. The patient underwent multiple debridements and was managed with a vacuum-assisted-closure dressing. Despite a healthy and shrinking thigh wound, the persistent urinary leak prevented skin grafting. A six-week course of co-amoxiclav addressed the osteomyelitis of the pubis. A follow-up CT scan after two months indicated a stable bone condition but confirmed the ongoing bladder defect.
This unprecedented case underscores the need for heightened vigilance in patients undergoing urethral interventions. It also highlights the challenges of managing delayed silent complications, emphasizing the importance of a multidisciplinary approach for successful outcomes. This case sets a precedent, prompting further research to refine surveillance and management protocols for similar intricate clinical scenarios.
504 Non-Gravid Uterine Torsion Associated with Small Bowel Obstruction
Authors: Goh B , Mathew S , Shamassi M , Rafique M 
Published: August 2024

Abstract
Uterine torsion is an uncommon condition. Even more so in cases of non-gravid torsion. We present the case of a postmenopausal woman in her 70’s who arrived to our emergency department with hypoxic respiratory failure and hypovolemic shock requiring prompt resuscitation with non-invasive ventilation and intravenous crystalloids following 4 day history of abdominal pain and vomiting.
Abdominopelvic Computed tomography demonstrated a small bowel obstruction secondary to a large palpable uterus. Diagnosis was made of small bowel obstruction secondary secondary to a large leimyomatous uterus associated with acute kidney injury and aspiration pneumonia.
Laparotomy demonstrated a large leimyomatous uterus that had torted on the cervical pedicle associated with perforation of the lower anterior segment. A segment of healthy jejunum was adhered to the uterine fundus and was easily mobilised with blunt dissection. Hysterectomy and bilateral oophorectomy were performed. The patient made a full recovery. Histopathology demonstrated a calcified leiomyomatous uterus with adjacent haemorrhagic infarction of the uterine wall.
This is the first case of small bowel obstruction associated with uterine torsion identified in the literature.
Uterine Torsion is defined as a more than 45-degree rotation around the long axis of the uterine body. The most common cause of uterine torsion relates to pregnancy, or abnormal foetal presentation. Non gravid causes include Leiomyoma, uterine abnormalities such as bicornuate uterus, pelvic adhesions, or adnexal masses. On CT/MRI the whirl/whorl sign of the uterine cervix is indicative of uterine torsion however this was not present in our case, and diagnosis was only made intra-operatively .
978 Simultaneous Orchidectomy, Hernia Repair, and the Discovery of Gonadoblastoma-Like Features in an Undescended Testis – A Rare Case Report
Authors: Wickramasinghe V C , Saranga K G V , Piyarathne S A , Madhawa J K G , Prashantha A H A 
Published: August 2024

Abstract

Introduction
Undescended testes, a congenital anomaly, present unique challenges when associated with clinical manifestations.

Case Report
38 years old patient, with no known co-morbidities, exhibited a two-year history of a stable lump in the right inguinal region. He had no history of tuberculosis exposure, no lower urinary tract symptoms or impotence but had history of primary subfertility. Clinical examination of the contralateral side showed no abnormalities.
Diagnostic Assessment - Surgical exploration entailed orchidectomy and exposed unexpected gonadoblastoma-like features in the undescended testis. Contralateral testis evaluation yielded normal LDH, AFP, and Beta hCG levels.
Therapeutic Intervention - Simultaneous exploration of the right inguinal region and orchidectomy aimed to address the undescended testis and revealed unexpected histopathological findings.
Histopathological Analysis - Microscopic examination of the undescended testis specimen demonstrated small-sized seminiferous tubules with a thick basement membrane. The tubules were lined by Sertoli cells, yet spermatogenesis was notably absent. Clusters of Leydig cells and foci of rounded nests composed of germ cells and small sex cord cells were observed.These findings collectively indicated gonadoblastoma-like features. Importantly, there was no evidence of germ cell neoplasia in situ or malignancy.

Discussion
The unexpected histopathological findings introduce complexities to the case, raising questions about the nature of gonadoblastoma-like features in the context of undescended testes. The absence of malignancy prompts consideration of long-term implications for fertility management.

Conclusions
This case report illuminates the challenges associated with undescended testes and introduces unexpected histopathological findings. The discovery of gonadoblastoma-like features during surgical exploration emphasizes the necessity for meticulous clinical evaluation and long-term surveillance in managing such cases.
1107 Intussusception Following Duodenal Switch: A Case Report
Authors: Jindal A , Shanti H , Patel A 
Published: August 2024

Abstract

Background
Intussusception accounts for 1% of small bowel obstruction in adults. There have been several reports of intussusception following jejune-ileal bypass and Roux-en-Y gastrectomy. To our knowledge, this is the first reported case of intussusception following Biliopancreatic diversion with duodenal switch.

Case Presentation
We present a 32-year-old woman who had a biliopancreatic diversion with duodenal switch procedure for weight loss three years ago. She had successful outcomes and lost 100kgs after surgery. She presented with recurrent episodes of self-remitting severe colicky abdominal pain and vomiting. A CT scan showed an intussusception at the side-to-side ileo-ileal anastomosis. On laparoscopy, telescoping of the small bowel was identified, the alimentary limb had intussuscepted into the anastomosis. The telescoped bowel was gently reduced. The bowel was viable, and decision was made to avoid resection. The alimentary and the biliopancreatic limbs were plicated for 5cm proximally and distally to prevent recurrence. She recovered well after the operation and remained well on six months’ follow-up.

Conclusions
Intussusception is a rare but serious complication after bariatric surgeries. While management of intussusception in adults usually entails reduction and resection to remove the lead point, plication and enteropexy can be utilised to avoid bowel resection. This is of value when such patients present to a non-bariatric centre.
1137 Case Report: Bilateral Nipple Sparing Mastectomy for BRCA2 Mutation Patients with Unusual Presentation of Nipple Raynaud's Phenomenon
Authors: Siddique M H , Hidayatul S , Soumian S 
Published: August 2024

Abstract
This case report delves into the surgical experiences of twin sisters with BRCA2 mutations undergoing bilateral nipple sparing mastectomy as a preventive measure. During immediate breast reconstruction, both patients unexpectedly encountered intense nipple pain resembling Raynaud's phenomenon. The study explores the intricacies of their cases, including potential contributing factors, management strategies, and the complexity of symptom exacerbation during pregnancy. The patients' mother, with a history of Raynaud's phenomenon, adds a familial component to the discussion. Challenges in symptom alleviation, including a skin burn from using hot water bottles for pain relief, are also addressed.
Bilateral risk-reducing mastectomy is common for BRCA2 mutation carriers, but this report sheds light on the unexpected manifestation of nipple pain, coupled with familial predisposition. The first patient, despite normal post-mastectomy histology, experienced persistent nipple pain, resorting to various therapies. A skin burn from hot water bottles prompted bilateral excision of the nipple and areola. The second patient, with intermittent left nipple pain, opted for the same procedure. The report highlights the exceptional occurrence of Raynaud's-like symptoms post-mastectomy in BRCA2-positive twin sisters. Bilateral excision emerges as a management option, emphasizing ongoing monitoring and a keen interest in long-term outcomes.