bluuebunny/crossref_metadata_2025_split huggingface dataset:
801 Simultaneous Resection for Metastatic Colorectal Cancer – What Should We Tell Our Patients to Expect?
Authors: Thiagarajan J , Choudhry H , Stratton M , Jones R 
Published: August 2024

Abstract

Aim
Almost half of colorectal patients will advance to liver metastasis during the course of their disease. The aim of the present study was to evaluate outcomes across different treatment arms in patients undergoing synchronous resection of primary colorectal cancer and liver metastases.

Method
2-year retrospective review of all patients receiving simultaneous resection of primary bowel cancer and secondary liver metastases at a single tertiary hepatobiliary unit, from a prospective operative database. Patients were stratified by extent of liver resection (major, &gt;3 segments or minor &lt; 3) and by bowel (rectal or colon) surgery performed. Primary outcomes were rate of complications within 30 days following surgery and length of stay (LOS) in hospital. Secondary outcomes were blood loss, pringle time, time spent in theatre and interval between first outpatient appointment and surgery.

Results
A total of 44 patients were recruited, of these, 38 patients were eligible for inclusion. Complication rates were 67% in the major liver resection and colon surgery group (group 3) and 38% in minor liver resection and rectal surgery group (group 2). Group 3 had the longest mean LOS (17.2 days) in comparison to group 2 (9.2 days). Major and minor hepatectomies resulted in a mean blood loss of 720ml and 445ml respectively.

Conclusions
Synchronous resections involving major hepatectomies are associated with a higher rate of post-operative and peri-operative complications. While surgery remains the best chance of cure for patients with resectable disease, it is important to set realistic expectations for surgical outcomes.
1221 Timing of Reversal of Ileostomy: A Single-Center Experience
Authors: Mandal I , Chaudhari V , Nasrudin A , Dharamavaram S 
Published: August 2024

Abstract

Aim
This paper aims to present a comprehensive overview of the reversal of ileostomy based on a single-center experience.

Method
A retrospective analysis was conducted on 39 patients who underwent the reversal of loop ileostomy between August 2021 and August 2023 at a District General Hospital in the UK.

Results
The average age of patients in the study was 65.82 years, with a standard deviation of 10.37. Reversal occurred, on average, after 755 days (2.06 years), with 41.02% of patients undergoing the procedure 1-2 years after the initial loop ileostomy. Notably, 46.1% of cases attributed the delay in reversal to COVID-19 alone. Combined factors, such as COVID-19 and adjuvant chemotherapy, adjuvant chemotherapy alone, and miscellaneous causes (patient and healthcare-related) each contributed to delays in 15.3% of patients. Complications of ileostomy, including anastomotic stricture, purulent peritonitis, prolapsed stoma, and parastomal hernia, accounted for a delay in 5.1%. Acute kidney injury caused readmissions in 15% of patients, while high output stoma and vomiting were responsible for 26% of cases. Notably, 59% of patients experienced no readmissions.

Conclusions
The average time for the reversal of loop ileostomy was 2 years, with COVID-19 identified as a primary contributor to delays. Recommendations include scheduling reversal dates immediately after low anterior resection to minimize delays. Addressing high output stoma and vomiting, the leading causes of readmissions, through early reversal (3-6 months) can potentially reduce complications, readmissions, and overall hospital costs, optimizing bed occupancy.
410 Post-Radiotherapy Infratemporal Extracranial Meningioma: A Case Report
Authors: Borg L 
Published: August 2024

Abstract
This case report details the complex management of a 66-year-old male, Mr. CF, with a history of acromegaly treated by post-transsphenoidal hypophysectomy and radiotherapy. He presented with a gradually enlarging left preauricular lump, identified as a meningioma through imaging studies. Despite initial observation due to the absence of symptoms, the tumour exhibited rapid growth, prompting surgical intervention. The surgery was technical, due to surgical field and various critical structures, yet successfully managed to preserce the facial nerve.
Histological analysis confirmed a Grade I WHO meningioma. Subsequent follow-ups revealed residual extra-cranial meningioma tissue, prompting continued watchful waiting due to the low risk of malignant transformation for Grade I meningiomas. Follow-up imaging demonstrated growth in residual foci, highlighting the challenges of managing recurrent meningiomas.
The report underscores the importance of a multidisciplinary approach and vigilant monitoring in meningioma cases, especially when involving intricate anatomical regions. Despite postoperative complications, the patient remains asymptomatic, and the risk of malignancy remains low. Continued surveillance is planned, emphasizing the need for long-term follow-up strategies in the management of recurrent meningiomas. This case contributes valuable insights into the complexities of surgical decision-making and the ongoing challenges in treating meningiomas.
919 Retrospective Analysis of the Management of Necrotising Otitis Externa Patients: A Single Centre Study
Authors: Kumaresan K , Suleiman M , Gouda M , Pearson A 
Published: August 2024

Abstract

Introduction
Necrotising otitis externa is an invasive, infection, with minimal evidence underpinning its diagnosis and management. It is often recognised late and undertreated many a times requiring prolonged inpatient hospital stays where provision for outpatient antibiotic administration and robust multi-disciplinary care is lacking. National ENT UK guideline on Necrotising Otitis Externa (NOE) was published in 2020, until which point management was based on local specialist opinions across the UK.

Aim
This work was undertaken with an aim to analyse the local management in our hospital following the local hospital guidelines adapted from national ENT UK guidelines (2020) shedding light on the morbidity and mortality of these patients.

Method
Data was collected retrospectively from 22 patient records in the period between April 2018- November 2022.

Results
We found that the mean age was 79 years. Recurrence rate was 13.6% (3 out of 22). Culture swab was sent in all cases and Pseudomonas was the most common organism. Biopsy was also done in all patients when polyps/granulation was present. Pre-treatment CT was performed in 95%. MRI was performed in 90.9 % and the rest couldn’t have MRI for valid reasons.3 patients were lost to follow up (Compliance to follow up was 86%). Intra-venous & topical antibiotics were given alongside micro-suction. Infectious Diseases team review was considered in 63.6%. Hyperbaric oxygen was considered in 4 patients (17.4%).

Conclusions
96.5% overall compliance to guidelines was achieved. We aim to further understand the benefit of hyperbaric oxygen in NOE management by undertaking a prospective study.
1091 Comparing the Incidence of Superficial Surgical Site Infections Following Emergency Laparotomies with the Use of Negative Pressure Wound Dressings Versus Standard Wound Dressings
Authors: Cotter Fonseca P , Vlachos G 
Published: August 2024

Abstract

Aim
This study aims to investigate whether use of negative pressure wound dressings (NPWD) in emergency laparotomies has any effect on the incidence of superficial Surgical Site Infections (SSIs) compared to Standard Wound Dressings (SWD).

Method
Patients undergoing emergency laparotomies at one NHS trust in a 6-month period (01/01/2023-30/06/2023) were retrospectively identified using the National Emergency Laparotomy Audit database. Clinical documentation was then assessed for documented evidence of SSIs and type of dressing used.
This study used the UK health security agency’s definition of superficial SSI, therefore recorded evidence of i) purulent discharge ii) positive wound culture iii) symptoms and signs (pain, swelling, erythema, heat) iv) incision was deliberately opened or had clips removed to manage the infection v) documented clinical diagnosis of SSI. Exclusion criteria: repeat laparotomies in the same admission, deceased within 30-days. Categorical unpaired measures were compared using the Chi-squared test (5% alpha level).

Results
60 patients were identified as having emergency laparotomies in the 6-month period, of which 29 had NPWD and 31 SWD. There was no statistically significantly difference between NSWD and standard wound dressings in :pus discharge (6 versus[vs.] 11, p=0.20)positive wound culture (4 vs. 11, p= 0.09)&gt;2 pain/swelling/erythema/dehiscence (8 vs. 14, p=0.16)clip removal to treat SSI (8 vs. 12, p=0.36)clinical diagnosis of SSI.(7 vs. 12, p=0.23).

Conclusions
There was no statistically significant difference in superficial SSIs between NPWD compared to SWD, in emergency laparotomies performed in one NHS trust measured over a 6-month period.
1131 A Series of Three Consecutive Emergency Room Thoracotomies Performed Within a Period of One Month at the National Accident and Orthopaedics Services Department in Sri Lanka
Authors: Wijesundara A , Samarakoon K , Panapitiya N , Ranatunga S , Gunatheepan J 
Published: August 2024

Abstract

Introduction
Emergency room thoracotomy is an essential component of initial resuscitation in a proportion of patients who present following thoracic injuries.

Case Presentations
A 51-year-old male, hospitalised within 45 minutes following a stab injury to posterior chest, went to asystolic cardiac arrest on admission. Emergency left antero-lateral thoracotomy was performed at 6minutes post arrest. It revealed massive hemothorax (3L), and active bleeding from intercostal vessels. Internal Cardiac Massage (ICM) with Aortic Cross Clamping(ACC) commenced and haemostasis achieved. Return of spontaneous circulation(ROSC) gained within 2minutes. He was extubated on day1 and discharged on day 8.
A 19-year-old male was transferred from a local hospital 4hours following road traffic accident(RTA) with poly-trauma to head, face, chest and abdomen. He went to asystolic cardiac arrest at 20minutes post admission. Left antero-lateral thoracotomy performed at 2minutes post arrest revealed, hemopericardium and left ventricular wall partial-thickness tear. ICM with ACC started and hemopericardium was released. ROSC achieved within 2minutes. Patient was immediately taken for exploratory thoracotomy and ventricular wall repair. After a brief stable post operative period, patient gradually deteriorated and passed away on day3 due to traumatic brain injury and diffuse axonal damage.
A 59-year-old male, hospitalised 30minute following RTA (with direct chest impact) was in asystole on admission. Emergency transverse thoracotomy performed at 15minutes of resuscitation revealed multiple lung contusions and bilateral hemothorax. ICM with ACC started but failed to achieve ROSC at 20minutes.

Conclusions
Shorter the time gap from asystole to thoracotomy, higher the probability of ROSC.
690 Paragangliomas: A Rare and Under-Appreciated Aetiology? a Case Series
Authors: Joyce A , Aspinall S 
Published: August 2024

Abstract

Aim
To assess the presentation and management of paragangliomas within NHS Grampian between 2018 to 2023.

Method
Retrospective data collection from electronic records of histo-pathologically confirmed paragangliomas for: mode of presentation (incidental vs symptomatic), location of tumour, biochemistry (urinary/ plasma metanephrines), management, genetics, follow-up, and outcome.

Results
Ten cases of paragangliomas were identified, with an age range of 17-76 years: two head and neck, one thoracic, six abdominal and one pelvic. Seven presented with symptoms. Five had elevated metanephrines, though these were only measured in four cases pre-operatively. Surgical excision was undertaken in six. Chemotherapy given in three. Nine were discussed in multidisciplinary (MDT) meeting. Six patients in remission with ongoing surveillance, three have persistent / recurrent disease, and one is deceased. Pathogenic Succinate Dehydrogenase germline variant present in three, no genetic variance in five, results pending in one and one unknown.

Conclusions
Paragangliomas are rare neuroendocrine tumours that may present to a diverse group of surgical specialties. They occur in any age group, have a high incidence of malignancy and germline genetic mutations; and should be suspected in an unexplained mass arising along the sympathetic chain. Biochemical evaluation should be assessed for metanephrine excess and alpha receptor blockade should be undertaken prior to invasive interventions in functional tumours to mitigate risk of provoking an adrenergic storm. Paragangliomas need discussion in endocrine/ neuroendocrine tumour MDT to ensure appropriate pre-operative workup and follow up. This may improve outcomes and aid in the earlier detection of recurrent disease.
1143 Audit of Conversion Rate from Laparoscopic to Open for Patients Undergoing Elective Colorectal Resection 2021-2022
Authors: Akhtar M A B , Khalid S Y , Zeeshan S 
Published: August 2024

Abstract

Aim
This audit aims to compare the conversion rates from laparoscopic to open procedures for elective colorectal surgeries done in our hospital during 2021 and 2022 and to compare the results with the standard conversion rate of 14.3% as mentioned by the journal of society of laparoscopic and robotic surgeons in 2014.

Method
Data was collected from hospital computerised system.
Inclusion criteriaPatients undergoing elective resection for colorectal cancer from January 2021 to December 2022.Patients undergoing elective colorectal surgeries for benign conditions including ulcerative colitis, sigmoid colon resections for recurrent diverticulitis, colectomies for endoscopically unresectable polyps with high grade dysplasia.
Total of 41 patients underwent surgery in 2021, and 45 in 2022.

Results
Over the 24-month period, 86 patients underwent colorectal surgeries. Laparoscopic approach was attempted in 83 (96.5%) patients, and primary open surgery was performed in 03 (3.4%) patients. Of the 83 Laparoscopic procedures, 78 (93.9%) were successfully completed laparoscopically and 05 (6.1%) were converted to the open procedure. The annual conversion rate for colon cancer resections was 10.3% (3 of 29 converted to open surgeries in 2021) and 9.5% (2 of 21 converted to open procedures in 2022). The annual conversion rate for rectal cancer was 0% for both years; all 8 procedures completed laparoscopically in 2021 and all 11 procedures completed successfully laparoscopically in 2022.

Conclusions
Our audit showed that the conversion rate in our hospital for colorectal surgeries is only 6 % which is better than the international standards.
613 Utilisation of Off-Site Theatre Capacity to Reduce the Waiting Time for NHS Patients with Chronic Deep Venous Disease in the Post Covid-19 Pandemic Environment
Authors: Hussain H , Natha B , Choudhury E , Morris R , Khan T , Black S 
Published: August 2024

Abstract

Aim
This audit aimed to assess the adherence to treatment pathways and the transfer of electronic patient care records in a cohort of patients with deep venous disease who underwent procedures off-site due to extended waiting times during the COVID-19 pandemic.

Method
Between 1st February 2022 and 19th July 2022, 41 patients underwent deep venous procedures at an off-site facility. Retrospective data collection from electronic records, operation notes, imaging, and patient outcomes was conducted. Demographics, procedure types, adherence to pathways, image transfer, and patient outcomes were analysed.

Results
41 patients (M:F - 16:25) were treated on a series of 17 lists aged between 24 to 79 years. Patients assigned for treatment off-site were highly selected for case simplicity. Procedures performed include diagnostic venograms, stenting, venoplasty, and varicose vein treatment. Stenting success was high (100% patent stents on discharge). No deaths occurred, with minimal complications and a few procedures needing to be rescheduled at the primary site. Image transfer to the parent site varied (87.5% electronic records, 50% imaging). The waiting list was reduced from 90 to 77 patients, inclusive of new additions during the study period.

Conclusions
Outsourcing theatre time effectively managed the backlog of patients with deep venous disease, offering a safe intervention approach. While there might be financial strain, the benefits in avoiding treatment delays and enhancing patient experience outweigh the potential costs. Overall, the audit supports the use of off-site procedures as a viable solution to address waiting time concerns during healthcare crises.
621 Sustainable Training-Friendly Service Provision to Reduce the Burden of Gallstone Disease: A Tertiary Care Surgical Unit Experience
Authors: Tay K L Y , Neelankavil Davis G , Ghazanfar M 
Published: August 2024

Abstract

Aim
NICE guidelines recommend laparoscopic cholecystectomy for symptomatic gallstones during the index admission. COVID-19 restrictions highlighted the need for a dedicated emergency theatre for acute biliary diseases, leading to the introduction of the 'Hot Gallbladder' service. This study assesses the service's impact on reducing recurrent admissions and expediting cholecystectomies in a University Hospital.

Method
A prospective study was conducted between March to August 2023 in a tertiary care surgical unit on patients referred to the Hot Gallbladder service. This service was a weekly Friday morning theatre list managed by registrars under consultant supervision. Data extracted included patient demographics, diagnosis, previous hospital admissions, cancellations, and admission duration.

Results
Between March to August 2023, 152 gallstone-related admissions were recorded. Thirty-two cases were expedited to the Hot gallbladder service, consisting of 7 males and 25 females with a median age of 45 (32.5, 64.5) years. Twenty-six underwent cholecystectomy; two withdrew consent, and four were cancelled on the day due to theatre overrun. Two patients (8%) had same-admission cholecystectomies, while 24 (92%) were operated within 2 weeks, with a median of 2 (1, 2.75) previous hospital admissions.

Conclusions
The Hot Gallbladder service offered prompt definitive treatment to 21% of patients while providing valuable training for registrars. In the context of biliary presentations, failure to perform cholecystectomies on peri-index presentation not only incurs substantial financial costs but also predicts future readmissions, adding to the overall strain on scarcely resourced NHS services and significantly impacting patients’ quality of life. Data from this study will contribute to a cost effectiveness analysis.
1030 Role of International Webinar Among International Medical Graduates (IMGs) on Enhancing Understanding of the UK Surgical Training Pathways and Professional and Linguistic Assessments Board (PLAB) Test: A Global Perspective
Authors: Khatri A , Thapa B , Shakya S , Shrestha S , Walshaw J , Koirala S , Bhatta G , Karki B B 
Published: August 2024

Abstract

Aim
To educate the International Medical Graduates (IMGs) about UK surgical training pathways and ways to enhance portfolios. Professional Linguistic Assessments Board (PLAB) test.

Method
A webinar as a part of International Medical Teaching Series (IMTS), “PLAB & Beyond: Specialty Series” was organized in collaboration with Nepalese Doctor’s Association UK, Rotaract Club of KIST Medical College & Devdaha Medical College, Nepal on 4th November 2023. A pre-and post-webinar survey was designed to get the delegate’s insight.

Results
There were almost 80 delegates including IMGs and medical students representing more than 9 countries across various career grades. Pre-webinar survey established the need for a session focused on building strong surgical portfolio and general insights on the PLAB test. A two-hour session on surgical application, medical specialties and top tips on GMC exams was presented by the UK trainees. The post-webinar survey showed that 75% of the delegates achieved their aims and learning outcomes with over 80% of delegates satisfied with the presentation on CV building, and core surgical application. To enhance the academic surgical side among the IMGs which is often found lacking, a session on academic surgical training application was delivered by an academic surgeon with 97% positive reviews. Similarly, a session on higher surgical training (ST3) applications received a 100% positive response.

Conclusions
There is increasing need for global health professional workforce for the sustainability of the NHS. Optimizing the standard of care is possible via educating and rigorous training of IMGs where this virtual platform has proved to be an excellent way forward.
1041 Changes in Information Seeking Patterns of Medical Students in the Social Media and Artificial Intelligence Age: Preliminary Findings
Authors: Richa Y , Asif A , Burton O E , Richards H , Hennessey D 
Published: August 2024

Abstract

Aim
Non-traditional and novel online sources of medical information such as social media, large language models (LLMs) and video sharing platforms are providing medical students with opportunities for innovative learning. This cross-sectional study assesses current trends in use of these resources among medical students.

Method
A prospective, cross-sectional, observational, and descriptive study using an online questionnaire was utilised. Data collected included platform used, frequency of use, preferences, perceived benefits, and challenges associated with the use of these tools in the learning experiences of medical students.

Results
273 medical students consented and completed the survey. 217 (79.1%) of students used social media or online video sharing platforms for educational purposes, mainly to supplement or replace course materials. The three reported benefits of using social media for educational purposes were: (I) accessing medical knowledge quickly and easily (87.7%), (II) accessing short duration compressed videos (70.8%), and (III) accessing infographics and visually appealing resources (67.5%). 143 (52.2%) of students have used Chat GPT or other LLMs. Of these, 54.7% have used LLMs for educational purposes (33% weekly and 44.3% monthly), and report using them mainly as resource when completing assignments, homework, or essays. 73.2% expressed concerns regarding unreliable medical information on social media, whereas only 54.8% expressed concerns with LLMs.

Conclusions
The survey results demonstrate that medical students are frequently seeking medical knowledge outside of core course materials. Medical educators must become aware of these changing trends. Guidance should be provided to medical students regarding the relative risks and benefits of these resources.