bluuebunny/crossref_metadata_2025_split huggingface dataset:
1009 Surgical Site Infection: An Overview
Authors: Ravichandran S , Kumar A , Mohan Palliyil M M 
Published: August 2024

Abstract

Aim
Getting It Right First Time (GIRFT) in the UK is a national programme led by frontline clinicians to help reduce variations in various service parts in different medical specialities. Through this study, we can help mitigate enormous human pain and suffering and will save doctors' and nurses’ time and government/patients' money. This is the 2nd cycle of this audit. The aim is to reduce surgical site infection with measures to reduce hospital infections and disease-associated morbidity and mortality.

Method
Study conducted over one month- 1st to 30th June 2021. All General Surgical elective and emergency cases are included. Visited A&E and GP as Wound infection postop 30 days. Retrospective analysis of all case records of the admitted and readmitted patients in general surgery.

Results
22 patients had wound infection (15%) in this audit cycle out of 151 patients. Although most SSIs are post-emergency surgery, the ‘elective bowel resection’ category has the highest 30-day wound infection rate. More patients received antibiotic prophylaxis in this audit compared to the previous one. Most are superficial wound infections, with 6 delayed discharges in this audit compared to 11.

Conclusions
Surgical site infection (SSI) is a common complication after colorectal surgery, with a reported incidence ranging from 3% to 30%. Using alcohol preparation on the skin will reduce infection. In an era of enhanced recovery, early recognition and prompt treatment of SSIs should be at the forefront of medical care for patient safety and the cost-effectiveness of treatment.
1142 National Audit of NICE Guidance for Endovascular Repair of Popliteal Aneurysms: The Kings Experience
Authors: Green J , Eves J , Ammar T 
Published: August 2024

Abstract

Aim
To evaluate care for patients undergoing covered stenting for popliteal aneurysms against NICE guidance, and to assess peri-procedural and post-procedural outcomes of patients.

Method
Retrospective collection of data in patients who had undergone endovascular repair of popliteal aneurysms from 30/5/2010 to 30/5/2023. 11 patients met inclusion criteria. Data collection was based on the NICE guidance clinical audit tool for endovascular repair of popliteal aneurysms. This included presenting symptoms, demographics, pre-procedure imaging findings, procedure details, duration of patency of the stent, peri-procedural complications, post procedure medical management and whether limb salvage was achieved.

Results
All 11 patients had vascular MDT discussion prior to procedure. Mean age was 71, 9 patients were male and 2 females. 5 stents remained patent to time of data collection or at the time of their death from other causes. There were no significant immediate complications. Of 6 failed stents, only one patient required amputation. Three patients had stents which remained patent for over a year with mean patency of 37 months, and 3 remained patent for less than a year. Stents that failed &lt;1 year had reduced run-off vessels (mean 2). The smallest stent diameter (6mm) failed within 7 months. All patients had appropriate antiplatelet therapy.

Conclusions
Local experience of 11 endovascular stent for popliteal aneurysms. 6 failed and 3 failed within one year of insertion, with 1 patient requiring amputation. MDT input and full patient consent are mandatory prior to endovascular management of popliteal aneurysms. Technically, reduced run-off and narrower stents may be associated with poorer outcomes.
1274 Adherence to Best Practice Tariffs for Femoral Fractures Excluding Neck of Femur Fractures (NOF's)
Authors: Tathgar A , Gouveia S , Bleibleh S , Fenton P 
Published: August 2024

Abstract

Aim
In 2020/21 the UK BPT extended their patient cohort to include distal femur and femoral shaft fractures for time to surgery (TTS) of 36hrs. In 2018 UHB merging resulted in a new policy whereby all NOFs would be fixed at Birmingham Heartlands Hospital (BHH) and all other femoral fractures would be transferred to Queen Elizabeth Hospital (QEH) for fixation. This audit aims to assess the impact of this policy on both patient care and financial impact.

Method
The inclusion criteria were patients &gt;65 with a femoral fracture. We collected data on 50 patients’ pre-merger (2017) that presented to QEH and compared this to patients presenting in 2022 to QEH (30 patients) and BHH (28 patients) (post-merger). The main data points for comparison were TTS, length of stay (LOS) and 90-day mortality.

Results
In the pre-merger group, 22(48%) of patients had a TTS ≤36 hours. In the post-merger groups, 15(50%) QEH vs 2(7%) BHH patients had a TTS ≤36 hours. There was no statistical significance when comparing the pre-merger TTS with post-merger QEH (p=0.61); however, there was statistical significance when comparing: TTS QEH vs BHH (p=0.00034) and LOS QEH vs BHH (mean 15 vs 21 days, p=0.0092). There was a trend but no significance between mortality (13% QEH Vs 21% BHH, P=0.41).

Conclusions
This data demonstrated longer TTS and LOS for patients presenting to BHH. This not only could result in worse morbidity/mortality for patients but also has a financial impact on missed tariffs/penalties and hospital bed costs.
1296 A Closed Loop Audit to Evaluate the Enhanced Recovery After Surgery (ERAS) Protocol in a Tertiary Oncoplastic Breast Reconstruction Unit
Authors: Samuels S , Tamimy S 
Published: August 2024

Abstract

Aim
A closed loop audit to assess the enhanced recovery after surgery (ERAS) protocol before and after implementation of an ERAS proforma, in patients who have undergone breast free flap reconstruction. To analyse the impact on patients after implementation.

Method
Retrospective data collection from March to June 2022 and September to November 2023, in a tertiary oncoplastic breast unit. Inclusion criteria: all patients who had undergone breast free flap reconstruction for breast cancer. Thirty-one patients in total. An ERAS proforma was designed in line with Trust standards and based on input from the oncoplastic breast MDT. The proforma included the following categories: pre-operation, operation day, day one, two and three post operation. The data was collected, analysed, and compared to data collected before implementation.

Results
The first audit showed poor adherence to the ERAS protocol, this improved after implementation of an ERAS proforma in the following areas: location of the proforma in notes, 0% found in notes before, 92% after. Anti-emetics prescribed 32% before and 100% after. Anti-inflammatory medication plus proton pump inhibitor prescribed 32% before and 100% after. Analgesia, laxatives, and enoxaparin prescribed in 100% of patients before and after implementation. Day 1 TWOC occurred 0% before and 50% after implementation. Day 2 drain documentation/management 26% before and 100% after. The average length of hospital stay was 5.5 days before, 3.75 days after. Therefore, inpatient hospitalisation was reduced by 1.75 days.

Conclusions
Adherence to an ERAS protocol is beneficial in managing patients during the perioperative period and leads to reduced inpatient hospitalisation.
574 The Incidence of ‘Negative’ Axillary Node Clearance Following Neoadjuvant Therapy, Its Potential Clinical Significance, and Recommendations: One Breast Unit Review of Practice
Authors: Miah C , Akhtar Z , Yip C 
Published: August 2024

Abstract

Aim
To assess our unit’s approach in managing breast cancer patients with ‘negative’ axillary node clearance (ANC), following neoadjuvant systemic therapy (NST). ‘Negative’ ANC referred to scenarios where histologically proven metastasis were identified prior to treatment, but evidence of a positive node could not be found in the final surgical specimen.

Method
We retrospectively reviewed all ANCs performed in our unit over 8 months. Specifically, we focused on cases of ‘Negative ANC’. Each individual case was examined, reporting the incidence of ‘negative’ ANC and follow up investigations.

Results
Seventy ANCs were performed during the study period (September 2022 – April 2023). Notably, four cases, of which 3 patients had NST, were identified: indicating an incidence of 5.7%. Following surgery, each patient underwent numerous radiological investigations such as axillary ultrasound scans, CT chest, PET scans, over various timelines, ranging from 1 to 7 months post-surgery, to exclude the possibility of finding any residual node(s).

Conclusions
There was inconsistency in following-up these four patients with ‘negative ANC’. Although the possibility of achieving complete pathological response (pCR) existed, it was necessary to ensure all nodes within the axillary basin were retrieved, especially when post-NST nodal status is an important determinant of disease-free and overall survival.
To address this oncological and histological concern, our unit will be clipping the biopsy proven node, prior to NST. This pre-NST localisation allows radiological assessment of the response during NST, providing an opportunity to de-escalate axilla surgery and re-evaluate the axilla in cases with ‘negative’ ANC outcomes.
218 Septal Myectomy and Left Atrial-to-Left Ventricle Valved Conduit for Severe Calcific Mitral Stenosis and Obstructive Hypertrophic Cardiomyopathy: A Case Report
Authors: Qamar Y , Schaff H 
Published: August 2024

Abstract
Mitral annular calcification with severe mitral valve (MV) stenosis can be difficult to treat with conventional MV replacement. Annular decalcification can cause atrioventricular groove disruption and bleeding. An alternative is to bypass the narrowed MV using a valved left-atrial-to-left-ventricle conduit.
A 48-year-old gentleman with obstructive-hypertrophic cardiomyopathy and severe calcific MV stenosis presented with progressive dyspnea, syncope, and fatigue. Medical history included hypertension, dialysis dependent ESRD, chronic-AF, pulmonary-hypertension, and NSVT. A grade III/IV mid-systolic murmur was audible at the LSE, and a grade II/IV mid-diastolic rumble. Echocardiography showed sigmoid septum with maximum thickness of 24-mm, severe calcific MV-inflow obstruction (MVA 0.87 cm2, mean gradient 15-mmHg, heart rate 60-bpm), and midventricular LVOT obstruction (resting gradient 96-mmHg). Because of NYHA class III symptoms, surgery was performed with plans for MV-bypass using a valved-conduit and midventricular myectomy. Following institution of CPB and cardioplegic arrest, the LAA was excised and a 26-mm Hemashield graft was beveled and sewn into the atriotomy. An anterolateral ventriculotomy was made near the apex of the heart and an extensive midventricular myectomy was performed through the incision. A 25-mm Hancock-II bioprosthesis was sewn into the conduit. Distal end of the conduit was beveled and anastomosed to the ventriculotomy. Postoperatively, median native-MV gradient reduced to 7-mmHg (heart rate 86-bpm). Recovery was uneventful. He was dismissed on postoperative-day 8 and continues to do well 5-months later.
MV-bypass using a valved LA-to-LV conduit is safe alternative to conventional MVR for relief of severe MS with MAC, particularly in patients with oHCM who require midventricular myectomy.
299 Small Right Coronary Artery Diameters in Two Turner’s Syndrome Patients Requiring ECMO Post-Bentall Procedure
Authors: Lysomirski A , Sypula Z , Mittal M , Von Klemperer K , Uppal R , Oo A 
Published: August 2024

Abstract

Aim
We aimed to establish the impact of coronary artery diameters (CAD) on the risk of ECMO requirement in patients with Turner’s Syndrome (TS) undergoing cardiac surgery.

Method
We reviewed 27 TS patients who underwent cardiac surgery. Out of these, only two cases developed severe cardiac complications (Case1: VF, Case2: STEMI) requiring ECMO post-Bentall procedure. CAD measurements (proximal RCA, LAD, LCX) were obtained from the post-operative CTCA for Case1. CAD were adjusted for the body surface area (BSA) using the Mosteller formula and compared to average BSA-adjusted CAD in Caucasians (Ghaffari et al., 2015).

Results
Case 1: CTCA report confirmed low-lying RCA ostium and left dominant coronary system. Our calculations showed small BSA-adjusted proximal RCA diameter. Case 2: Radiological reports (EPR) revealed “small caliber RCA with low lying origin, and a right dominant coronary system”. Other variables: CPB time &gt;150min increases the risk of right ventricular failure (Schuuring et al., 2013). CPB time Case1: 239 min, Case2: 171 min.

Conclusions
Coronary artery anomalies in Turner’s Syndrome (TS) patients are common but rarely considered in the perioperative plan (Silberbach et al., 2018). The only two patients who experienced complications related to the conduction system and heart muscle requiring ECMO post-operatively showed evidence of small caliber RCA for BSA. Small caliber RCAs, together with extended CPB time, may predispose to severe postoperative cardiac complications requiring ECMO. This suggests that preoperative CTCAs may be useful in identifying TS patients that require a closer involvement of the ECMO team preoperatively.
615 Audit of Documentation of Operation Name During Hospital Stay
Authors: Hampson S , Springthorpe T , Hara N , Kassouf M , Tully L , Yates M 
Published: August 2024

Abstract

Background
Errors in the handover of patients from the cardiothoracic operating room (OR) to the intensive care unit (ICU) can compromise patient safety. We have previously shown that standardising the operation names and educating junior medical staff enhanced the accuracy of operation note titles.

Aim
This study aimed to assess operation name accuracy and consistency in OR and ICU notes, evaluating the impact of operation name standardisation and staff education.

Method
A prospective study of cardiac surgery patients at St. Bartholomew's Hospital was undertaken from November 29 to December 10, 2021. Operation notes were the standard and documents collected from the patients’ records were classed as fully accurate, containing acceptable/unacceptable variation, or inaccurate. Operation names were then standardised, and staff education followed. A subsequent data collection occurred from November 13 to November 19, 2023, under the same criteria.

Results
Pre-intervention, 30% of OR notes and 9% of ICU notes accurately named the operation. Post-intervention, this increased to 84% and 23%, respectively. Pre-intervention, the urgency was either incorrect or not documented in 2% of OR notes and 87% of ICU notes, which decreased to 0% and 29% post-intervention, respectively.

Conclusions
Improvements in documentation were observed post-intervention in both OR and ICU notes. However, significant discrepancies persisted in ICU notes. This is likely due to frequent staff turnover (every 2 years for surgical training, 3 months for ICU) and inadequate understanding of surgical details. In conclusion, continuous education is essential for sustained improvements in documentation accuracy.
222 Percutaneous Deep Venous Arterialization (pDVA)- a Realistic Option for No Option- Chronic Limb Threatening Ischaemia (CLTI)- a Case Report
Authors: Mishra A , Patel S , Zayed H 
Published: August 2024

Abstract

Background
No option- CLTI constitutes up to 20% of patients who are not candidates for revascularization and have a high risk of limb loss (40%) without further intervention.
pDVA is an endovascular procedure for patients with no option- CLTI, where arterial blood is channelled into the tissues via the venous network. We present two such cases with varying presentations.

Case presentation
A 52-year gentleman presented with bilateral Diabetic Foot infection and CLTI. CT Angiogram demonstrated bilateral occlusive Tibial disease. While the right leg underwent a major amputation, the MDT felt that although there were no arterial revascularisation options, pDVA was possible. This was successful with significant improvement in the foot. Four months post -procedure the foot had extensive dry gangrene with good Lateral Plantar doppler signals. Trans- metatarsal amputation and debridement followed by a Split- thickness skin graft was performed. At 8 months post- pDVA, the foot has healed well.
Another 65-year gentleman presented with left sided Rutherford Category 5 CLI. CT Angiogram concluded occlusive distal Tibial disease. He underwent Tibial angioplasty which soon re-occluded. Based on follow-up scans, the MDT declared him suitable for pDVA which was successful. Four weeks post- operatively the foot showed extensive necrotic tissue. Trans- metatarsal amputation followed by Split- thickness skin graft was performed. At 1- year post- pDVA, the foot has healed well.

Discussion
pDVA should now be considered for all patients with CLTI that are anatomically suitable, as it can be performed with high degree of procedural success to promote wound healing and prevent major amputations.
631 A Case Report of an Epiploic Hernia – a Mobile Right Colon Herniating Through the Foramen of Winslow
Authors: Jain S , Nessa A , Gandhi M , Ganesh R 
Published: August 2024

Abstract

Introduction
An Epiploic Hernia is an extremely rare type of abdominal hernia with &lt;0.1% incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here.
Presentation of Case: A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications.
Discussion: There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel’s diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02%. Less than 10% of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50%.

Conclusions
A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.
736 Spontaneous Adenosquamous Carcinoma of the Prostate, a Case Report
Authors: Ndonga S , Opondo D , Etabale M 
Published: August 2024

Abstract
Spontaneous adenosquamous carcinoma of the prostate is a rare and aggressive subtype of prostate cancer with no well-established treatment guidelines.
A 63-year-old man presented with chief complaints involving the lower urinary tract and bowel. He complained of urgency urinary incontinence, frequency, and hematuria. He reported fecal urgency with hematochezia and no history of constipation. He had scrotal and penile pain with erectile dysfunction. He did not report any history of low back pain or lower limb paresthesia. He had no significant medical or surgical history.
On clinical examination, the prostate was enlarged, non-tender with a palpable nodule and a TRUS volume of 35 grams. The serum PSA was 18.9 ng/dl.
Multiparametric MRI of the prostate was done with instillation of a rectal gel given both his lower urinary tract and bowel symptoms. It showed an enlarged prostate with irregular prostatic outlines, heterogenous signals in all sequences, a prostatic cyst and a preserved recto-prostatic plane.
A systematic trans-rectal ultrasound guided biopsy of the prostate showed a Gleason grade 5 + 5 in all cores, with glandular features on &lt; 10% and squamous features in &gt; 90%.
There were widespread bone metastases with no visceral metastases. We initiated androgen deprivation therapy with Goserelin 10.8 mg pending evaluation for docetaxel chemotherapy. The patient had a rapid downhill clinical decline and died 6 months after the diagnosis and initiation of Goserelin. This case illustrates the aggressive nature of adenosquamous carcinoma and its poor response to hormone ablation therapy.
1044 Colo-Colic Intussusception with Large Bowel Obstruction in Adults
Authors: Salam A , Chikr B , Barghash M , Mansour M 
Published: August 2024

Abstract

Background
Intestinal intussusception in adults is rare and accounts for 1% of all bowel obstructions. Almost 90% of adult intussusceptions are caused by a pathological lead point like malignancy, polyp or a benign neoplasm. Colonic adenocarcinoma account for 60% of the cases, whereas colonic lipomas are the most common among benign pathologies.

Case Presentation
60-year-old female presented with crampy abdominal pain and bloody diarrhoea with mucous discharge. On examination, she was tender in the left lower quadrant and had raised white cell count (WCC) and C-reactive protein (CRP). Computed Tomography (CT) scan reported colo-colic intussusception from proximal to mid sigmoid colon with early ischemic changes. Patient underwent a laparoscopic assisted en-bloc sigmoid resection with end colostomy. The patient had uneventful recovery. The histopathology showed benign lipoma with intussuscepted portion ischemic and necrosed.

Discussion
Intussusception is common presentation in children with bowel obstruction, often caused by enlarged lymphoid tissue and the treatment is usually conservative. However, in adults, it is a rare occurrence and presents with sub-acute abdominal pain and vague obstructive symptoms. CT scan is a useful investigation with diagnostic accuracy of 58-100%. The standard treatment involves surgery, with controversy about reduction of intussusception prior to surgery. Due to the risk of perforation and dissemination of malignancy, en-bloc resection is often recommended.

Conclusions
Colo-colic intussusception in adults is a rare presentation of acute bowel obstruction. A thorough history, appropriate investigations and timely intervention can ensure safe patient outcomes.
1193 Could Acute Severe Pancreatitis Have Caused These Oesophageal Strictures?
Authors: Feyang Limbu D , Campbell T , Aravind B 
Published: August 2024

Abstract

Introduction
Benign oesophageal strictures, primarily characterised by dysphagia, have many causes with gastro-oesophageal reflux disease (GORD) being the most common. This case study presents an unusual occurrence of oesophageal strictures following necrotising pancreatitis.

Case
This woman in her 40s had an episode of acute severe necrotising pancreatitis secondary to gallstones, which was treated conservatively including ITU support and a prolonged hospital stay. Serial CT imaging revealed peri-pancreatic and distal oesophageal inflammation. During her hospitalisation, she experienced haematemesis and an OGD revealed distal oesophagitis. Four months post-discharge, she complained of dysphagia and multiple oesophageal strictures were found on OGD and barium swallow. Her symptoms are managed currently with regular balloon dilatations at a tertiary level centre where other causes of stricture were ruled out.

Discussion
Cases of oesophageal strictures associated with acute pancreatitis exist in literature, but the pathophysiology is poorly understood. Similarities with bowel strictures following acute pancreatitis hint at potential pathophysiology for oesophageal stricture formation. This reported benign oesophageal stricture is likely secondary to inflammation following the pancreatitis with imaging showing inflammation towards the distal oesophagus as other reasons are ruled out.

Conclusions
This case study suggests a link between acute pancreatitis and oesophageal strictures, particularly when peri-pancreatic inflammation extends to the oesophagus. We hope to improve the awareness of such long-term sequela following acute severe pancreatitis.