bluuebunny/crossref_metadata_2025_split huggingface dataset:
590 VTE Prophylaxis Post-Thoracic Cancer Surgery: An Audit
Authors: Ahmed A , Jesuyajolu D , Fontaine E 
Published: August 2024

Abstract

Aim
The administration of extended VTE prophylaxis for 28 days has been recommended by NICE for patients following major cancer surgery in the abdomen or pelvis. Manchester Foundation Trust (MFT) has expanded upon this guideline to include patients having thoracic cancer surgery. However, the policy is occasionally not adhered to, owing to prescription errors and more. Our aim was to investigate policy compliance and identify areas for improvement to help optimise patient safety.

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 above policy was followed. This included calculating the number of days for which Dalteparin was administered whilst the patient was in hospital, or, if the patient was discharged, (as in most cases), how many doses they were discharged with. Following this, a poster was created describing the MFT protocol and distributed across the thoracic ward, with an electronic version being sent on a secure messaging application to junior members of the team. 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 as 82%. Following the intervention, compliance had increased to 90%.

Conclusions
The distribution of the poster highlighting the protocol had increased the number of patients receiving the correct VTE prophylaxis. However, with VTE being a serious post-operative complication, it is essential to aim for 100% compliance. Perhaps this can be achieved through further intervention such as departmental teaching.
999 A Review of Left Atrial Appendage Occlusion for Peri-Operative Thromboembolic Risk Reduction at a Single Institution
Authors: Singh C , Hamid U , Chacko J , Nicou N , Boulemden A , Szafranek A , Qureshi S 
Published: August 2024

Abstract

Aim
Left Atrial Appendage Occlusion for thromboembolic risk reduction in patients with AF undergoing cardiac surgery is evidence-supported. We explored our practice to understand the scale of AF burden and challenges in undertaking adequate Left Atrial Appendage occlusion therapy in cardiac surgical patients.

Method
This was a retrospective analysis of surgical database, hospital records, and post-op re-admission spells with AF or with acute neurological events.

Results
Between Jan 2019 and Jan 2023 there were n=108 (5%) re-admissions due to AF and 39 (1.8%) secondary to AF-related Stroke/TIA. Fifty-seven (n=57, 38%) of these underwent DC cardioversion. Median time to re-admission was 2 months (range: &lt;1 month-2 years) with AF, and 4 months (range: 1 month-5 years) with neuro-thromboembolism.
In a cohort of n=144 patients undergoing cardiac surgery with pre-existing AF(Paroxysmal/established), 70 patients (48.6%) underwent concomitant Left Atrial Appendage clip application (size 35mm-45mm). In non-recipients (n=74, 51%); emergency/urgent status, redo surgery, and small LAA were the commonest reasons for non-application. Post-op anticoagulation was instituted in all with few exceptions. Four patients (2.7%) in the non-recipient group had a previous history of stroke. Two patients (1.3%) in the non-recipients had new post-op stroke whereas no patient in the recipient group had post-op stroke. Overall mortality in non-recipients was n=17, 23%, and in recipients was n=4, 5%.

Conclusions
Contemporary evidence supports significant thromboembolic risk reduction with Left Atrial Appendage Clip application. Our experience underpins benefits in a disease spectrum that is associated with significant morbidity and resource utilisation.
312 Giant Hepatic Cyst Misdiagnosed as Pancreatic-Pseudocyst: A Case Report
Authors: AlHassan N , Olaniyi O 
Published: August 2024

Abstract

Background
A hepatic cyst is a benign hepatic tumor that is usually asymptomatic with normal liver function tests. The diagnosis of hepatic cyst is sometimes incidental on exploratory laparotomy as misdiagnosis may occur upon radiological investigations. Different modalities of treatment of symptomatic cysts include percutaneous aspiration, injection of sclerosing agents, laparoscopic or open fenestration, and surgical cystectomy.

Aim
To highlight clinical and radiological challenges in the diagnosis of hepatic cysts and different management modalities.

Case
We present a case of a 3-year-old boy with an 8-month history of progressive abdominal distension. There was no history of jaundice or abdominal pain. No history of leg swelling or decreased urine output and no preceding abdominal trauma. A radiological assessment of pancreatic pseudocyst was made. Exploratory laparotomy revealed a giant hepatic cyst on the right and left lobe more on the anterior surface. The gallbladder was separate from the cyst. The cyst was completely excised and weighed 9kg. The histology report was in keeping with mesenchymal harmatoma.

Conclusions
A hepatic cyst is a benign tumor of the liver ranging from small to huge size causing compression of the adjacent structure. It is usually asymptomatic with rare malignant potential. A giant hepatic cyst poses a diagnostic radiological challenge leading to misdiagnosis which affects patient management. It is recommended that a giant hepatic cyst should be considered as a differential diagnosis of intra-abdominal masses.
683 An Aberrant Retropharyngeal Internal Carotid Artery (ICA) Associated with Airway Obstruction: A Case Report
Authors: Holland J 
Published: August 2024

Abstract

Background
The ICA ascends towards the skull base in the carotid sheath, posterolateral to the posterior pharyngeal wall. Various patterns of congenital and acquired ICA anomalies in relation to the pharynx have been described in the literature. Very few studies have associated these anatomical variations with clinical symptoms of airway obstruction.

Case report
An 85-year-old female patient presented to Accident & Emergency (A&E) with a recent history of several discrete episodes of positional airway obstruction on leaning forward. The description of symptoms from patient and first responders was consistent with stridor. No other relevant medical history was identified. Flexible nasal endoscopic examination (FNE) revealed a smooth pulsatile lesion in the posterior pharyngeal wall. No other abnormality was detected. CT head and neck characterized an anatomically aberrant and tortuous internal carotid artery in the retropharynx, partially obstructing the oropharynx/supraglottis. The patient was monitored for 48 hours without incident. No further treatment was recommended due to her frailty, and she was discharged with a telephone follow up.

Conclusions
Although causality cannot be proven, the partial obstruction of her airway by a large aberrant ICA vessel provides a likely explanation for her symptoms. No other cause for her symptoms was identified. This interesting case presents an unusual differential diagnosis for positional airway obstruction. It also highlights a rare but important anatomical variation in the path of the ICA which ought to be considered during oropharyngeal or laryngeal surgery to avoid catastrophic arterial injury.
974 Unexpected Finding of Fish Bone Perforation of Pylorus in a Patient with Epigastric Pain and Fevers
Authors: Tong C W , Alhayo S , Chu F 
Published: August 2024

Abstract

Objective
This case report describes an uncommon presentation of epigastric pain from pyloric perforation secondary to ingestion of a fish bone. The objective is to emphasize the need for increased awareness of foreign body ingestion as a differential for acute abdominal pain. Prompt diagnosis and endoscopic intervention is required in cases of gastrointestinal perforation due to foreign bodies.

Case
We describe a 43-year-old man G with a background of Crohn’s disease presenting with 2 days of epigastric and right upper quadrant abdominal pain, associated with fevers and loose stools. He had signs of epigastric tenderness with localised peritonitis and raised inflammatory markers. G was initially thought to have cholecystitis or Crohn’s flare up hence a computed tomography (CT) was requested, which surprisingly identified a fish bone lodged in the pyloric wall with evidence of localised fat stranding. Urgent gastroscopy performed confirmed a 3cm fish bone lodged in pylorus, which was successfully removed. G recovered well without complications and was discharged on postoperative day three.

Discussion
Accidental ingestion of fish bones is not uncommon, however, only 1% of cases cause gastrointestinal perforation. We explored the complexities of diagnosing gastrointestinal perforations, the role of CT in localisation and endoscopy as a first line intervention whenever feasible.

Conclusions
This case report highlights the importance of recognising foreign body perforation as a differential diagnosis in patients with acute abdominal pain and fevers. Endoscopic intervention is valuable in facilitating the extraction of foreign objects with minimal complications.
1060 A Rare Case of Upper Gastrointestinal Bleeding - Case Report
Authors: Rudwan A A , Al Badi N , Forde N , Al Bakhour A B , Haidaran A I D 
Published: August 2024

Abstract
The most common causes of upper gastrointestinal bleeds (UGIB) are peptic and posterior duodenal ulcers, usually resulting from a gastroduodenal artery (GDA) bleed. We present a case of a patient who suffered from an UGIB after the commencement of Apixiban to treat newly diagnosed Atrial Fibrillation. Despite endoscopic intervention, clear computed tomography angiography (CTA) and GDA embolisation, bleeding persisted leading to a hypovolemic shock. (Interventional Radiology images)
This is a rare occurrence which led the team to request a second CTA, revealing extravasation of contrast in the duodenum. This indicated persistence of bleeding which consequently led to an emergent surgery. The patient underwent an exploratory laparotomy and an ulcer was discovered during intraoperative endoscopy.
Because of the position of the ulcer in the posterior-lateral duodenal wall, and its persistence in bleeding despite GDA embolisation it is suspected that the bleeder was most likely to be the inferior pancreaticoduodenal artery (IPDA) or an aberrant blood vessel.
Our teaching points focus on the importance of considering the pancreaticoduodenal anastomosis and other anatomical variants as sources of bleeding when managing an UGIB.
1064 Cystic Parathyroid Adenoma: A Rare Occurrence in Setting of Stage IV Chronic Kidney Disease with Tertiary Hyperparathyroidism
Authors: McKnight K , Griffin K , Al Kendi B , Kerin M , Abd Elwahab S 
Published: August 2024

Abstract

Background
Cystic parathyroid adenomas represent a rare subtype of parathyroid adenomas characterised by cystic degeneration for which surgical intervention is the only curative treatment. Conservative medical management is a suitable option for patients with multiple comorbidities or mild symptoms. To our knowledge this is the first case of a bilobed cystic parathyroid adenoma in a patient with tertiary hyperparathyroidism secondary to long standing chronic kidney disease.
Case presentation: A 65-year-old lady with stage IV CKD was referred to the endocrine surgical department having presented with hip pain. Investigations revealed hypercalcaemia, high parathyroid hormone in the setting of bilateral small echogenic kidneys. Imaging identified a bilobed parathyroid mass. 99m-technetium sestamibi scan confirmed a parathyroid adenoma. Having failed conservative management a minimally invasive parathyroidectomy was performed with histological analysis reporting a cystic parathyroid adenoma.

Conclusions
Cystic parathyroid adenomas are a rare cause of tertiary hyperparathyroidism and usually present with signs and symptoms of high calcium and high parathyroid hormone. Accurate diagnosis requires a combination of laboratory investigations and imaging. Management commonly involves surgical resection especially following failure of conservative treatments.
1254 Radiofrequency Ablation for Treatment of Hemorrhoid Disease, Minimally Invasive Novel Treatment
Authors: Maharjan A , Ngo V , Win M , Rajaganeshan R 
Published: August 2024

Abstract

Aim
To describe our radiofrequency ablation(RFA) result, assessing patient symptoms and quality of life (QoL) before and after the intervention. We aim to evaluate the outcomes of this alternative procedure for managing grade 2-3 haemorrhoids at a single centre. Haemorrhoids are the most common surgical presentations, affecting up to 1 in 3 people. An alternative procedure is the use of radiofrequency ablation (RFA) to shrink and treat the haemorrhoids under local anaesthetic. The management is dependent on the severity of symptoms and the grade of haemorrhoids.

Method
A single centre retrospective study between March 2022 and July 2023 of patients who had RAFAELO under local anaesthetic without sedation for the treatment of grade 2-3 haemorrhoids. Primary outcomes were assessed by haemorrhoid severity score (HSS) and EQ-5D-5L VAS score before and after the procedure at 2-4 months and 12 months.

Results
53 patients were included for analysis. The mean age of patients was 55 years old (SD+/-14) with a 2:3 ratio of female to male. 14% of patients had grade 2 haemorrhoids and 86% had grade 3 Hemorrhoids. The mean HSS score pre-op was 13.78 which improved to mean post-op score of 5.6. The mean EQ-5D-5L VAS pre-op score was 64.75 which decreased to mean post-op of 28.49.

Conclusions
This study supports that RAFAELO is a safe and effective procedure and can be performed in the outpatient setting. However, further studies with larger samples, longer follow-up and comparison with other procedures are still required.
1035 Digitally Enabled Pathways: A New Era for Otology and Rhinology Services
Authors: Spinos D , Lee J , Beech T , Coulson C , Muzaffar J 
Published: August 2024

Abstract

Introduction
Hearing and ear problems, alongside nasal symptoms, are common concerns in both primary and secondary healthcare worldwide. The advent of telemedicine has yielded promising results, reducing the waiting lists for specialist ENT review, and offering access to care to deprived and isolated communities. Although the benefits of remote ENT services have been highlighted throughout the literature, there is a significant lack of homogeneity in both the outcome measures of the different authors, but also the modality of technology employed. We undertook a scoping review to map all these interventions, identify their potential benefits and also highlight any potentially unexplored areas.

Method
We undertook a scoping review, following the principles of PRISMA-ScR guidelines. We reviewed four different databases- MEDLINE, EMBASE, Google Scholar and Cochrane Library.

Results
Initially 208 articles were identified for title and review. Reviews were excluded but used for snowball sampling. Full text review was performed for 88 articles, reporting a wide spectrum of applications being reported, including screening, diagnosis and intervention utilising both synchronous and asynchronous methods. An even wider range of interventions were mapped, including boothless audiometry, otoscopy, nasal endoscopy, and photographic assessment of nasal deviation. Different authors used qualitative, quantitative or mixed methods to assess the effect of their intervention, reporting patient and stakeholder satisfaction, economic benefit, face to face conversion rates and diagnostic accuracy.

Conclusions
Remote ENT is a new service delivery method with growing evidence across its different aspects highlighting its safety and efficiency, supporting its further expansion.
481 Management of Perianal Abscess at Basildon and Thurrock University Hospital
Authors: Lesi O , Islam T , Ahmad S , McDowell K 
Published: August 2024

Abstract

Aim
Perianal abscess is a common surgical presentation seen in the emergency secondary care setting; our aim is to evaluate the current surgical management at Basildon Hospital.

Method
A questionnaire was distributed amongst 24 surgical colleagues varying from consultants, registrars/SAS and core trainees to review their current management of perianal abscess. In conjunction, for comparison an audit was conducted of surgical operation notes for 35 perianal abscesses drained between April and September 2023.

Results
Following 17 responses to the questionnaire, the most common incision made was cruciate (41.20%), with radial being the least (11.80%). In addition, 47.10% reported documenting to continue packing post-operatively, with an equal proportion not doing so. Microbiology culture was routinely sent by 88.20% of respondents. In comparison, the audit concurred a cruciate incision was most commonly performed (25.71%), with radial, transverse and elliptical incisions equally the least performed (5.71%). Furthermore, 97.14% of cases had a post-operative plan instruction to continue regular packing, with this being dis-concordant with results of the questionnaire. In 91.42% of cases a microbiology culture was sent intra-operatively.

Conclusions
Amongst surgeons at Basildon variation exists in the incision utilised to drain perianal abscesses, however a circumanal incision is currently recommended by ACPGBI guidelines to avoid damage to external sphincters. Packing is persistently part of post-operative management plans despite studies demonstrating that this increases pain for patients as well as cost. The role of routine microbiology sampling must be reviewed in the department as it is of limited value in the management of patients with perianal abscess.
707 How Do Consultant Surgeons Identify Malnutrition in the Emergency Setting, What Are the Barriers and What Is the Impact for Patients? a Qualitative Study
Authors: Ashmore D , Baker D , Wilson T , Halliday V , Lee M 
Published: August 2024

Abstract

Background
Patients undergoing an emergency laparotomy are often malnourished. Identifying malnourished patients is a prerequisite to offering targeted nutritional support. This study explores how consultants identify malnourished patients, why they use that approach and the barriers experienced.

Method
General surgical consultants involved in emergency surgery were invited. We used purposive sampling to ensure a broad representation of consultant experience across different practice settings. Following ethical approval (University of Sheffield 050436), semi-structured interviews were conducted online, audio-visually recorded, and transcribed verbatim. Interviews were coded and analysed in NVivo. A framework was developed and reviewed by an independent researcher and supervising team. Interviews continued until saturation.

Results
Eighteen interviews were conducted (14 male, consultant experience ranging 6 months-23 years) across three hospital settings (4 district general, 10 teaching, 4 intestinal failure unit). Identifying malnutrition consisted of three themes: ‘surgeon’ (knowledge, experience, planning ahead); ‘patient’ (selection, composition, clinical progress, operative considerations); and ‘institution’ (collaboration, extended surgical team). Three themes also encompassed the barriers experienced: ‘surgeon’ (understanding, culture, ownership, time constraints); ‘institution’ (provision, staffing, conflict, hospital setting); and ‘wider context’ (research, external factors). These influenced clinical decision making, which had two themes; ‘to join or not to join’ (risk taking, site of anastomosis) and ‘nutritional support’ (timing, delivery).

Conclusions
This study highlights a range of barriers that consultants experience when assessing patients for malnutrition, which affects operative and clinical decision making. It provides a framework upon which issues can be addressed by surgeons and policy makers in order to improve outcomes for malnourished patients.
1014 Vermi-Bourne Appendicitis - More Common Than You Might Think
Authors: Seehra J , Boam T , Gemmill E 
Published: August 2024

Abstract

Aim
Enterobius vermicularis is a common parasitic infection, however its direct association with acute appendicitis remains highly debated. Systematic reviews in the African and American continents have identified prevalence of E.vermicularis-associated appendicitis ranging from 33% in Nigeria to &lt;1% in Venezuela with an average global prevalence of 4%. UK rates are poorly documented. We aim to investigate prevalence and histological effects of E.vermicularis associated with acute paediatric appendicitis at a district general hospital.

Method
A retrospective case series of paediatric patients with aged between 5 and 16 who underwent operative intervention for presumed appendicitis between 01/08/2021 to 31/10/2023 was undertaken.

Results
Of 132 included patients, 13 patients had histologically proven E.vermicularis (9.8%) and 102 had acute appendicitis (77.3%). 11 of 13 E.vermicularis cases had associated acute appendicitis (84.6%). Majority were male patients (55.3%) with a mean age of 11.8 years. Histology identified serositis in 69.23% and lymphoid hyperplasia in 53.85% of E.vermicularis cases. None presented with acute perforation and majority cases were clinically diagnosed (92.31%) with a 7.69% readmission rate.

Conclusions
E.vermicularis should be considered as a differential causative agent for appendicitis. A tailored and specific history should be taken keeping a high level of suspicion in the paediatric population. Post-operative advice should include over-the-counter oral mebendazole for the patient and all household family members.
169 De-Mystifying the Characteristics of Gall-Bladder Malignancies in an Underdeveloped Country
Authors: Madhusudanan Pillai G , Girijavallbhan Nair P 
Published: August 2024

Abstract

Aim
To consolidate existing research on the epidemiology, risk factors, pathogenesis, clinical presentation, diagnostic approaches, treatment modalities, and prognostic factors associated with gallbladder malignancies.

Method
A systematic review was conducted across major databases to identify studies, case reports, and clinical trials related to gallbladder malignancies. Articles published within the last few decades were studied, and the findings were analysed and compared against a brief case review of 8 patients, who presented to a single centre in India.

Results
In our case series, 3 out of 8 patients with GBC were diagnosed post operatively on histopathology and were subjected to radical resections as a second procedure. 4 out of 8 were diagnosed at an advanced stage and treated with palliative intent and 1 was found to have metastatic disease intra operatively. The literature review covers the global prevalence, and disparities in incidence of gallbladder malignancies. It evaluates the role of imaging modalities, biomarkers, and advancements in surgical, chemotherapeutic, and targeted therapeutic interventions. Challenges in early detection and the need for effective screening programs are highlighted.

Conclusions
The synthesis of this review stresses on the need for further research and improved clinical approaches to improve the understanding, early detection, and management of gallbladder malignancies, ultimately aiming to improve patient outcomes and challenge the existing data on the epidemiology of GB malignancies in under-developed countries, thus prompting further exploration of this topic in larger prospective trials.