bluuebunny/crossref_metadata_2025_split huggingface dataset:
1119 Rib Fractures: To Fix or Not to Fix? a Single, Major Trauma Centre's Experience
Authors: Akintoye O , Okorocha C , Ahmed M , Surendrakumar V , Hernandez L , Martin-Ucar A , Kolokotroni S M 
Published: August 2024

Abstract

Introduction
Rib fractures are a common feature of blunt chest trauma. This retrospective study assessed rib fixation vs. conservative management of thoracic trauma patients presenting to University Hospital Coventry and Warwickshire (UHCW).

Method
A retrospective cohort study of all trauma patients presenting to UHCW over a 7-year period (2016 – 2022) was conducted and filtered for cardiothoracic surgery (CTS) admission. In-hospital survival (IHS) and length of stay (LOS) in patients who had no surgery, open reduction, and internal fixation (ORIF) or other operations (thoracic and non-thoracic procedures) were compared.

Results
3,386 trauma patients presented to UHCW over the 7-year period. Of the 1,147 patients with rib fractures admitted to CTS, 167 (14.6%) had ORIF ribs. ORIF patients had a 3-fold increase in IHS compared to those conservatively managed (p=0.002). However, there was no statistically significant difference in LOS (p=0.150). A statistically significant difference in IHS (HR 3.68 (95% CI 1.49-9.01) was also observed between ORIF patients and those who had other operations (p=0.005). Again, there was no significant difference in LOS between the groups (p = 0.212).

Conclusions
ORIF ribs is indicated for 3 or more consecutive rib fractures, displaced, flail segments, and severe chest wall deformity. The absolute indications for ORIF are still being debated but there is evidence that there are better survival outcomes in patients who have ORIF, as seen in our study. In conclusion, this study has shown that in blunt chest trauma, ORIF is beneficial in increasing in-hospital survival.
764 Acute Ischaemic Hand Following Intra-Arterial Injection into Ulnar Artery
Authors: Chan K , Wong K Y 
Published: August 2024

Abstract

Introduction
Intra-arterial drug injuries, although rare, have increased in number in the last decade due to the prevalence of intravenous drug use. Despite this and their potentially serious consequences, there are no standard guidelines on how to manage these injuries. We report a rare case of acute hand ischaemia following intra-arterial drug injection.
Clinical case: A 29-year-old male presented to the emergency department with pain and swelling of his right hand and forearm, following injection of crushed cyclizine tablets into his right antecubital fossa the day before. Clinically he had signs of compartment syndrome and an acute ischaemic hand. He underwent emergency fasciotomies of his right forearm. Intra-operatively, his ulnar artery was found to be thrombosed and an embolectomy retrieved a 15cm occlusive thrombus. However, there was no change in hand perfusion following this and the patient was started on therapeutic anticoagulation. Post-operatively, he developed necrosis of his right hand. Part of his thumb and index finger were viable and preserved to maintain pincer grip. He underwent staged debridement and resurfacing of his right hand with a pedicled groin flap.

Conclusions
Intra-arterial drug injuries are uncommon but serious injuries and should be considered in any patient with a history of intravenous drug use presenting with severe limb pain. Admission for 24 hours of close observation may be warranted as ischaemia may only occur 24-48 hours after the injury. In patients with ischaemia, anticoagulation may be considered. Our patient presented with signs of compartment syndrome requiring fasciotomies and staged debridement prior to definitive reconstruction.
1148 A Rare Cause of Small Bowel Obstruction by a Phytobezoar at a Meckel’s Diverticulum: A Case Report
Authors: Piyarathne S A , Wickramasinghe V C , Saranga K G V , Piyarathne N 
Published: August 2024

Abstract

Introduction
Small bowel obstruction (SBO) is a common surgical emergency, commonly caused by adhesions due to previous surgery or hernial obstruction. Rare causes include malignancy, inflammatory conditions, infections, congenital anomalies, and bezoars.

Case presentation
54-year-old female presented with abdominal pain and distension, vomiting and constipation following ingestion of ripened jack fruit (Artocarpus heterophyllus). Her presentation and investigations were suggestive of SBO. Following exploratory laparotomy, a phytobezoar causing complete luminal obstruction at a broad-based Meckel’s diverticulum, two feet away from the ileocecal junction was identified. Diagnosis was confirmed by histopathology. Management included partial resection of the ileum incorporating the Meckel’s diverticulum with end-to-end anastomosis followed by an uneventful recovery.

Discussion
Bezoars are aggregates of swallowed, undigested material found within the gastrointestinal tract and if plant-based origin termed as “phytobezoars”. It is a rare occurrence in humans usually found within the stomach and small bowel commonly associated with an underlying cause for stasis. Bezoar is the cause of mechanical intestinal obstruction in 0.4-4% of all cases. Meckel’s diverticulum, the commonest congenital anomaly of the gastrointestinal tract, is the persistent vitelline duct from fetal life with a prevalence of 0.3% - 2.9%. localized deficiency of peristalsis and collection of undigested food in a Y shaped ‘pantaloon’ at a Meckel’s diverticulum may predispose to phytobezoars.

Conclusions
Phytobezoar obstruction at a Meckel’s diverticulum is a rare cause for SBO. Even with advanced imaging this can be overlooked and challenging to diagnose preoperatively. It is a rare but an important differential diagnosis that require a high degree of clinical suspicion.
516 Diagnosis Following Two-Week Wait Colorectal Referrals in FIT Patients
Authors: Oyewole B , Animasahun V , Waheed L , Elwes C , Bepari M , Arun C 
Published: August 2024

Abstract

Aim
Audit to assess the final diagnosis in the cohort of patients referred by primary care via the two-week-wait pathway who were FIT positive

Method
Patients referred under the 2WW pathway over a two-month period were assessed for eligibility, the positive FIT threshold was 10 and above, patients above the age of 18 years old, primary care referrals and not known to have colorectal cancer were included. Diagnosis was confirmed based on imaging, endoscopy, or histological results.

Results
437 two week wait patients, 205 patients met the eligibility criteria, 103 (50.2%) males, 102 (49.8%) females, age range 27 to 93 years (mean 69.71 +/- 13.41).
84 (41%) were diagnosed with diverticular disease, 62 (30.2%) had polyps, 46 (22.4%) had haemorrhoids, 14 (6.8%) were diagnosed with cancer while 20 patients were diagnosed with other conditions like inflammatory bowel disease, infective colitis, intra-abdominal extra colonic tumours, gynaecological pathologies, irritable bowel syndrome or other incidental findings

Conclusions
Majority of patients had no underlying cause of the symptom complex necessitating 2WW referrals, Diverticular disease is a common cause of patients meeting the community criteria for 2WW colorectal review and positive FIT, there was a relatively high rate of cancer diagnosis while a large proportion of patients had colonic polyps and subsequent polypectomy which is essential to reduce the risk of malignant transformation.
556 Audit of Pharyngocutaneous Fistula Incidence Following Laryngectomy: A Retrospective Study at Royal Devon & Exeter Hospital
Authors: Shukla S , Barrett G 
Published: August 2024

Abstract

Aim
This audit aimed to evaluate the incidence of Pharyngocutaneous Fistula (PCF) after laryngectomy at Royal Devon & Exeter Hospital and identify potential predictors for its development, aiding in better preoperative counselling and postoperative care.

Method
Conducted between December 2020 and May 2023, this retrospective audit reviewed records of laryngectomy patients. Data on demographics, comorbidities, tumour characteristics, surgical techniques, and postoperative outcomes were analysed, focusing primarily on PCF incidence and potential predictors.

Results
The study involved 45 patients (82.2% male, 17.8% female, average age 69). PCF was observed in 20% of cases (66% in upfront, 33% in salvage cases). Patients with PCF had longer hospital stays (24.5 v/s 11.1 days) A majority (82.2%) were smokers or ex-smokers. Leak rates varied with the type of surgical flap used and were lower in upfront cases compared to salvage cases. Trends were observed correlating smoking and PCF incidence. PCFs developed more commonly with pec major than ALT flaps. Clear margins were less frequently obtained in supraglottic than glottic disease (45% v/s 93%).

Conclusions
While the incidence of PCF aligns with existing literature, this audit suggests the need to explore risk factors beyond smoking. The influence of surgical flaps on leak rates, though apparent, warrants further study due to the small sample size. Future research should investigate broader factors influencing PCF and assess the effectiveness of different surgical techniques in preventing leaks. The study also recommends a re-audit and broader exploration of the role of nodal disease and surgical margins in PCF occurrence.
375 The Preoptimization of Multimorbid Patients Prior to Surgery
Authors: Mikula-Noble N , Harrison E , Kathir Kamarajah S 
Published: August 2024

Abstract

Aim
Currently, there are no standardised preoperative care protocols that account for multimorbid patients or specific clusters of disease. This systematic review aims to (i) summarise the current state of the extent to which standardised preoperative protocols apply to multimorbid patients, (ii) investigate protocol compliance, and (iii) provide recommendations.

Method
This systematic review investigated the current preoperative care approaches used in a worldwide array of multimorbid patient cohorts within five electronic databases. Primary data, including 30-day outcomes, readmission and reoperation rates, and overall complications were extracted. Every identified study underwent quality appraisal.

Results
Out of 3,376 studies reviewed, 25 papers were identified for analysis. The identified papers represented a worldwide population of multi and single-centre cohorts of mostly older patients. Across the identified studies, approximately 2342191(42%) patients were multimorbid. Six out of 25 (24%) papers reported on specific pre-surgical protocols for multimorbid patients. Two papers centred their preoperative care around holistic care for patients. Three papers used a risk score - Qualifying Comorbidity Sets (QCS) - and one paper utilised their own propensity score. The data suggests that a consistent propensity score is emerging (QCS), however, there remains no standardised holistic care protocols.

Conclusions
In consideration of paucity of data, more extensive research is recommended of multimorbid cohorts using a preoperative protocol geared towards multimorbid patients. Specific recommendations include the implementation of a standardised risk stratification score for multimorbid surgical patients as well as the development of a standardised set of preoperative protocol(s) for optimization of multimorbid patient outcomes.
1146 The Use of Ultrasound Compared to Clinical Examination in the Diagnosis of Complete UCL Tear of the Thumb
Authors: Jackowski A , Hassan M R , Kaurvirdee P , Smith G 
Published: August 2024

Abstract

Aim
To compare sensitivity and specificity of clinical examination and ultrasound scan in diagnosing complete UCL tear of the thumb.

Method
A retrospective cohort study was undertaken at QEHB Birmingham over a period of 8 years from January 2016 to June 2023. Case notes were analysed for 258 patients with thumb UCL injury. Patients who had a complete UCL tear on intraoperative findings were identified and their notes reviewed to establish the findings of pre-operative clinical examination and ultrasound imaging. Sensitivity, specificity, PPVs, and NPVs were calculated for both.

Results
75 patients had surgical exploration. Of these, 54 patients had a complete tear identified and 16 had incomplete tears, with 13 patients excluded due to unclear documentation. A final total of 41 patients with complete tears and 16 patients with incomplete tears were included in the study. 12 of these patients had ultrasound imaging of their UCL. The true positive, false positive, false negative and true negative values for clinical examination and US were 24,3,17,6 and 8,2,2,0 respectively. The sensitivity, specificity, PPV and NPV for clinical examination compared to US were 0.58 vs 0.80, 0.66 vs 1.00, 0.88 vs 0.80, 0.26 vs 0.00 respectively.

Conclusions
Ultrasound imaging of thumb UCL injuries has a higher sensitivity, specificity and PPV for diagnosis of complete tears compared to clinical examination. Further larger prospective studies are warranted to validate and further refine the role of ultrasound in the diagnostic pathway.
680 Increasing Surgical Junior Doctors Confidence and Knowledge in Treating Post-Thyroidectomy Hypocalcaemia
Authors: Chishty F , Hope C , Akhtar I 
Published: August 2024

Abstract

Aim
One of the risks of thyroidectomy surgery is hypocalcaemia. Symptoms of hypocalcaemia can be very distressing for patients. This can be challenging for surgical juniors to manage. The aim of the project was to review the current hypocalcaemia guideline at Sherwood Forest NHS Trust and provide teaching for surgical junior doctors.

Method
A questionnaire was disseminated to surgical juniors, to assess baseline knowledge and confidence in recognising and managing hypocalcaemia in post-thyroidectomy patients. After completing the questionnaire, a hypocalcaemia information sheet addressing the pathology, symptoms and updated treatment guidelines was shared. The Trust hypocalcaemia guideline was updated to reflect BAETS hypocalcaemia guideline and redesigned to make it more user friendly. Surgical juniors were then asked to complete a follow-up questionnaire to assess how the information sheet and updated guideline impacted their knowledge and confidence in managing hypocalcaemia in post-thyroidectomy patients.

Results
Results found a specific increase in understanding of hypocalcaemia and an increase in confidence of postoperative hypocalcaemia management. The percentage of juniors scoring a 4/5 and 5/5 in managing hypocalcaemia symptoms increased from 17.6% and 5.9% to 47.8% and 21.7% respectively. 100% of respondents felt the information sheet and updated guideline increased confidence to diagnose and treat hypocalcaemia. Prequestionnaire n= 34, post questionnaire n= 23.

Conclusions
To conclude, there was an overall increase in confidence in managing hypocalcaemia, following a more user-friendly guideline which was up to date and specific for post-surgery. The information sheet which outlined key information increased 100% of surgical junior’s confidence in this area.
1298 Role of Tranexamic Acid to Reduce Blood Transfusion Requirements Peri-Operatively in Head and Neck Cancer Surgery
Authors: Mena J 
Published: August 2024

Abstract

Aim
Meta-analysis study to determine the efficacy and safety of tranexamic acid (TXA) in reducing blood loss in patients undergoing head and neck cancer (HNC) surgery.

Method
Database Selection: We conducted a comprehensive search across multiple reputable medical databases, including but not limited to PubMed, MEDLINE, Embase, Cochrane Library, and relevant specialized databases related to oncology and surgery.

Search Terms
To capture all pertinent literature, we formulated a robust set of search terms and keywords. These terms were designed to encompass the key concepts of "tranexamic acid" and "head and neck cancer surgery." Variations of these terms, including synonyms and related medical subject headings (MeSH terms), were incorporated into our search strategy. 3. Boolean Operators: We employed Boolean operators (AND, OR) to combine search terms effectively.

Results
The literature search resulted in 824 studies, after removing duplicates, a total of 709 studies were identified. After screening of s, 103 studies did not meet the criteria and were excluded. 81 were eligible for inclusion, the remining studies are Five studies (Total No. of patients = 479) were included in the present systematic review.

Conclusions
Our systematic review, provides a compelling body of evidence supporting the potential role of Tranexamic Acid in mitigating blood loss during head and neck cancer surgery. While the results collectively emphasize the promise of TXA in this context, they also highlight the need for further research to elucidate the full clinical implications and establish standardized guidelines for its application.
625 A Review of the Current Use and Future Impact of Smart Implants in Spinal Fusion Surgery
Authors: Bhuiyan Z 
Published: August 2024

Abstract

Aim
Spinal fusion is a surgical procedure performed to treat a range of different spinal disorders and conditions, with the aim of stabilising the spine and alleviating symptoms. A smart implant is an implantable medical device that incorporates emerging advanced technologies to enhance its functionality. The aim of this review is to explore the use of smart implants in spinal fusion and the clinical impact this has on patient care as well as future implications in practice.

Method
Studies were searched systematically using the Ovid MEDLINE and PubMed electronic databases. Key terms were used for the literature search, where a strict inclusion and exclusion criteria were utilised. Citation searching was used to further find relevant studies. The selected studies were critically appraised using the CASP tool, and the risk of bias was assessed.

Results
The studies reviewed explore the unique advantages of smart implants, including the combination of advanced sensors, monitoring, and wireless connectivity. This can provide real-time data on various aspects, including pressure, temperature, and movement, where surgeons can monitor the condition of the spine during and after surgery. This data can further be processed and analysed to enable personalised treatment approaches tailored to each patient’s unique requirements. Remote monitoring allows tracking of progress in the post-operative care period, hence reducing the risks of complications.

Conclusions
Smart implants in spinal fusion have a multitude of unique advantages that can enhance patient outcomes. However, further studies with larger cohorts are warranted to explore the implications of using smart implants in clinical practice.
1042 Optimising Sexual Health and Wellbeing Post-Prostatectomy – Development of a Streamlined Prehabilitation Pathway to Erectile Dysfunction Resources in One South Wales Health Board
Authors: Megson M , Patrick S , Saunders R 
Published: August 2024

Abstract

Aim
Radical Prostatectomy (RALP) has a significant deleterious effect on erectile function, with the majority experiencing insufficient erections, significantly affecting emotional wellbeing, which some patients feel poorly counselled for.
The aims:
1. Create a pathway to access Erectile dysfunction (ED) materials pre-operatively (online and visual resources).
2. ED treatment being commenced pre-procedure.
3. Improve RALP patient experience and outcomes with ED.

Method
We assessed records of 40 patients under 2 consultants between Aug 2022 and Feb 2023 across one health board, reviewing the pre-operative, 6 weeks post-operative, and specialist ED clinic. Notes were assessed for NICE guideline compliance to ED counselling, pre and post operative treatment and specialist clinic review.

Results
Mean age was 64 years (range 50-73). ED was mentioned in 75% of pre-op clinics, but only 15% mentioned specific ED treatments. ED treatment prior to RALP in 1 patient. None had ED quantification (SHIM) as per NICE guidelines. At 6-weeks 43% of all patients started on treatment. 72% of patients were eventually referred to specialist ED services. Current wait times to access the specialist ED service is poor, mean wait times 115 days.

Conclusions
These results demonstrate poor compliance with NICE guidelines, at present indicating poorly counselled patients with likely dissatisfaction affecting emotional and mental wellbeing. This audit provides an opportunity to streamline the service and create access to newly available resources for patients to access pre- and post-RALP and aim for re-audit to quantify new service with PROMS and better NICE guideline compliance.
1184 Bladder Nephrogenic Adenoma Occurred After Repeated IntravesicalOnabotulinumtoxinA (Botox®) Injection for Refractory Overactive
Authors: Rahman M 
Published: August 2024

Abstract

Background
This study explores a potential long-term complication of intravesical OnabotulinumtoxinA (Botox®) injections, a prevalent treatment for refractory Idiopathic Overactive Bladder (IOAB). An 83-year-old female, receiving Botox® since 2016, developed bladder superficial villous lesions during the fourth injection, later confirmed as nephrogenic adenoma. While short-term Botox® safety is well-documented, its extended effects remain understudied. Rat models indicate increased urothelial proliferation post-Botox®, and human studies reveal inflammatory changes in bladder urothelium. This case raises concerns about potential irreversible bladder histological changes linked to Botox®.

Discussion
Nephrogenic adenoma, a rare bladder metaplasia linked to chronic inflammatory states, presents clinical signs resembling urothelial carcinoma. The study reports the first case of nephrogenic adenoma following repeated intravesical Botox® injections, possibly related to urothelial bladder inflammation. Rat models and human studies suggest risks of increased urothelial proliferation and inflammatory changes post-Botox®. This case emphasizes the need for comprehensive longitudinal studies to confirm the prevalence of pathological changes associated with repeated intravesical Botox® injections.
In conclusion, the rarity of nephrogenic adenoma in this context underscores the importance of continuous research into the long-term safety of widely used intravesical Botox® injections for overactive bladder treatment. Vigilant monitoring and extended follow-up periods are essential to understand potential adverse effects and ensure the sustained safety of this therapeutic approach.