bluuebunny/crossref_metadata_2025_split huggingface dataset:
176 Rare Case of Spontaneous Renal Artery Rupture Secondary to Wegner Granulomatosis A Case Report
Authors: Shaker G 
Published: August 2024

Abstract

Background
Wegener's granulomatosis (now known as Granulomatosis with Polyangiitis, GPA) is a rare autoimmune disorder primarily affecting small-to-medium-sized blood vessels. Renal involvement is a well-recognized complication, often leading to glomerulonephritis. However, spontaneous renal artery rupture, a life-threatening event, is an exceptionally rare manifestation of this disease.

Case Presentation
We present the case of a 58-year-old male with a long-standing history of GPA, who developed end-stage renal disease (ESRD) and required dialysis despite immunosuppressive therapy. He presented with sudden-onset severe abdominal pain, hypotension, and tachycardia. Imaging revealed a ruptured right renal artery aneurysm, ultimately diagnosed as spontaneous renal artery rupture secondary to GPA.
Investigation: Laboratory tests showed elevated inflammatory markers and deteriorating renal function. A CT scan with contrast confirmed the ruptured renal artery aneurysm.
Differential Diagnosis: While considering other causes of retroperitoneal haemorrhage, the patient's medical history and characteristic imaging findings led to the diagnosis of spontaneous renal artery rupture related to GPA.
Treatment, Outcome, and Follow-up: Emergency endovascular embolization successfully controlled the haemorrhage, stabilizing the patient's condition. Continuous immunosuppressive therapy was maintained, and regular follow-up evaluations were initiated to monitor disease activity and possible complications.

Discussion
This report underscores the rarity and life-threatening nature of spontaneous renal artery rupture in the context of GPA. Early recognition and intervention are pivotal to preventing fatal outcomes. Endovascular embolization emerges as a viable treatment option, particularly in cases where surgical intervention carries higher risks.
367 Flexible Cystoscopy Audit in Patients with Recurrent Urinary Tract Infections (rUTI) / Lower Urinary Tract Symptoms (LUTS): A Path to Clinical Excellence and Cost Savings
Authors: MacDonald-Nethercott M , Pereira M , Pai A 
Published: August 2024

Abstract

Aim
To minimize unnecessary flexible cystoscopy in patients with rUTI and LUTS, thereby enhancing patient care and optimizing the utilization of resources.

Method
Comprehensive data collection from the outpatient cystoscopy clinic, including demographics, indications (rUTI/LUTS), red flag symptoms and outcome.

Results
In October 2023, our DGH outpatient clinic performed 240 flexible cystoscopy procedures, with 24.1% (58 cases) for rUTI (32) and LUTS (26). Only 37.9% of patients exhibited one or more risk factors, necessitating flexible cystoscopy according to European Urological Association (EUA) guidelines. Additionally, over 13% of patients were under 40 years old with symptoms of rUTI/LUTS. Through collaborative efforts with the consultant body, we derived local consensus criteria for flexible cystoscopy, leading to the introduction of a new referral pathway. Departmental education may further contribute to a significant reduction in unnecessary procedures. Cost analysis, based on private clinic pricing, revealed a substantial predicted monthly saving.

Conclusions
The complex landscape surrounding the investigations and management of rUTI/LUTS, coupled with the decision on cystoscopy, often introduces uncertainty. By establishing a local consensus and implementing new criteria within our referral pathway, we have successfully brought clarity to the utilization of this procedure, which may result in enhanced and efficient patient care. Our adherence to EUA guidelines demonstrates our commitment to best practices. The predicted substantial cost savings emphasize the financial advantages of our interventions. Our collaborative and locally driven initiatives underscore our dedication to excellence in patient care and healthcare efficiency.
508 The Introduction of Daycase HoLEP in a Peripheral Hospital
Authors: Hughes J 
Published: August 2024

Abstract

Aim
To describe the introduction of daycase HoLEP in a geographically remote, peripheral hospital. Establish the safety of this compared to published data.

Method
Daycase protocol developed for bladder outflow obstruction surgery, including HoLEP. Special considerations were given to the challenges of introducing this in a remote hospital, with no ITU support and which may have a single anaesthetist and surgeon. Retrospective analysis of prospectively collected data from June 2022 to August 2023.

Results
Patient eligibility for daycase surgery include living within one hour of hospital; ASA 1-2; prostate volume &lt;150cc and able to manage a catheter. Patients are placed on the morning list and leave theatre with a 22Ch 3 way catheter with irrigation running, which is switched off in recovery after 1 hour (if clear). They are reviewed by the surgeon at 4 hours post-op. Daycase discharge is completed if: urine was clear/rose, patient mobilising, eating and drinking, BP within 10% of pre-op level. 17 patients underwent daycase HoLEP (median age 69). 100% of patients were daycase. Mean pre-op prostate size 100cc (n=13), mean enucleated volume 51cc (range 3-95). One patient returned to theatre for haemostasis on the day. No patients required transfer to main hospital. One re-admission within 30 days (5.96%, compared to 5.5%-8% in literature). One patient failed TWOC at day five then passed at two weeks.

Conclusions
Daycase HoLEP in a remote hospital is safe and effective. This is a credible method of providing the service whilst taking strain of the main distract general hospital.
1213 The Endourological Management of Renal Infundibular Stenosis Secondary to Renal Tuberculosis: A Case Report
Authors: Singal S , Malik S , Ahmad S 
Published: August 2024

Abstract
Renal calyceal dilatation secondary to infundibular stenosis is a rare Urological condition for which management is necessary to treat symptoms and to prevent the formation of complications.
We present a case report which describes the presentation and investigation of a case of urinary TB which gave rise to infundibular stenosis and subsequent calyceal dilatation and flank pain in a 22-year-old lady.
Management of this condition is poorly described in the literature, in part due to its rarity. We extensively describe a novel endourological surgical procedure whereby dilation of the infundibular stenosis was achieved under direct vision using guidewires, Holmium laser and a flexible ureteroscope.
Under direct vision with a flexible ureteroscope, a sensor guidewire was used to create a punctum within the stenosed infundibulum and to passively dilate this. A 200-micron Holmium laser fibre was then used to extend this punctum creating an infundibulotomy. The sensor guidewire was repositioned to pass into the obstructed calyx which allowed for the flexible ureteroscope to be railroaded over the second guidewire into the right upper pole calyx, further passively dilatating the infundibulum. Finally, a 6Fr 26cm ureteric stent was passed into the right upper pole calyx.
The surgical management of this rare condition is poorly described in the literature. Our novel surgical technique is readily possible in most endourological units and will lead to an excellent clinical outcome.
1248 Novel Omentoplasty Technique in Salvage Robotic Prostatectomy Enhances Urinary Continence and Recovery
Authors: Asif A , Nathan A , Dhanoya G , Narain T A , Nathan S 
Published: August 2024

Abstract

Aim
We investigated an innovative surgical technique — omentoplasty at the bladder neck — used in salvage robotic prostatectomy for patients who have previously undergone radiotherapy. We hypothesise that this approach potentially decreases the incidence of anastomotic leaks, thereby reducing the duration of post-operative catheterisation and possibly enhancing early urinary continence outcomes.

Method
Between 2014 and 2023, consecutive patients who underwent salvage robotic prostatectomy (sRARP) following primary radiation treatment for prostate cancer were included. The ten most recent cases involved performing omentoplasty. Peri- and post-operative outcomes were prospectively collected on these cases. The primary outcome was duration of catheter dwell time.

Results
Out of 54 patients, 44 underwent standard sRARP, and 10 received omentoplasty sRARP. The average age was comparable between groups. The operative times were similar, with the omentoplasty group showing a slightly shorter duration. The omentoplasty group exhibited no post-operative complications and experienced a significant reduced catheterisation period (time to TWOC) (19.3 days vs. 63.61 days). Additionally, they had lower rates of anastomotic leaks and used fewer incontinence pads at three months.

Conclusions
Implementing omentoplasty around the vesicourethral anastomosis seems to facilitate improved healing at the bladder neck following salvage robotic prostatectomy after radiation therapy. It not only shortens the necessary duration for post-operative catheterisation but also contributes to better early continence recovery. Even with the addition of the omentoplasty procedure, the overall operative time and hospital stay duration remained comparable to standard sRARP. Given this, we advocate considering this novel technique for patients undergoing salvage robotic prostatectomy post-radiation therapy.
595 Dilemma in the Management of Saccular Aortic Aneurysms
Authors: Pradip G , Gambhir R , Miller F 
Published: August 2024

Abstract
Saccular aortic aneurysms (SAAs), characterized by spherical protrusions along a segment of the aortic circumference, lack well-defined management guidelines compared to fusiform aneurysms. Despite geometric indications of higher stress forces and rupture predisposition, real-world experiences differ. ESVS guidelines suggest earlier treatment for SAAs, but with a IIb C recommendation and limited evidence. This study aims to analyse SAAs between 2012-2022.
All CT scan reports between 2012 to 2022 from a radiology database at a teaching were interrogated for the word “Saccular aneurysm”. The electronic patient records of these patients were then retrieved. Clinical and radiological findings were documented and analysed. Aneurysm growth rate was documented from the follow-up scans.
Fifty-six patients (male: female ratio 3:1, mean age 78) were identified. Locations included ascending aorta (11%), aortic arch (8%), descending thoracic aorta (17%), and abdominal aorta (56%). Associated aneurysmal diseases were prevalent (77%), with thoracic aortic aneurysms (TAA) in 25% and abdominal aortic aneurysms (AAA) in 73%. SAA sizes ranged from 0.6 to 4.9 cm. During follow-up, 12 patients died (none from SAA rupture). Among 42 patients with follow-up scans, the average annual SAA growth rate was 1.26 cm, TAA was 0.61 cm, and AAA was 1.23 cm.
Our small study did not find any faster growth rate of saccular aneurysm compared to the other co-existing fusiform aneurysms. Most incidental saccular aneuryms remained asymptomatic and relatively benign on follow up scans. Annual radiologic follow-up should be done for all but treatment should be offered after multidisciplinary discussion, on a case to case basis.
743 Validation of the Global Limb Anatomic Staging System in Chronic Limb Threatening Ischaemia Using the Bypass Versus Angioplasty in Severe Ischaemia of the Leg Prospective Cohort Study
Authors: Bello S , Meecham L , Kelly L , Bate G , Davies H , Bradbury A , Popplewell M 
Published: August 2024

Abstract

Aim
To evaluate the application of an angiographic tool (Global Limb Anatomic Staging System - GLASS) designed to predict immediate treatment failure (ITF) and other clinical outcomes in patients undergoing revascularisation for chronic limb threatening ischaemia (CLTI) using a large prospective registry.

Method
The Bypass versus Angioplasty in Severe Ischaemia of the Leg Prospective Cohort Study (BASIL-PCS) collated data regarding 152 patients with CLTI who presented to a large academic vascular unit and underwent infrainguinal endovascular treatment (EVT). Each patient was given a GLASS score based on review of appropriate imaging by blinded, trained assessors. The relationship of GLASS with the following clinical outcomes was assessed; immediate technical failure (ITF), amputation free survival (AFS), major adverse limb event (MALE), limb salvage (LS), and overall survival (OS).

Results
A higher technical failure rate was associated with increasing GLASS stage in those undergoing endovascular treatment (EVT), ITF rate for GLASS I, II and III were 1/21 (4.8%), 4/35 (11.4%) and 17/76 (22.4%) respectively. There was no significant relationship between GLASS and other clinical outcomes (AFS, MALE, LS, and OS).

Conclusions
In our cohort ITF was correlated with increasing GLASS stage which is in line with the assumptions of the Global Vascular Guidelines (GVG). However, GLASS did not predict other longer term clinical outcomes and requires further evaluation in a larger cohort.
755 Comparative Safety and Efficacy of Local vs General Anaesthesia in Patients Undergoing Radiofrequency Ablation of Truncal Varicose Vein with Multiple Avulsions
Authors: Jaques A , Haidar O , Guest M , Metcalfe M , Selvakumar S , Sadat U , Shaikh F 
Published: August 2024

Abstract

Aim
Local anaesthesia (LA) and general anaesthesia (GA) are both commonly employed in patients undergoing Radiofrequency Ablation (RFA) treatment for varicose veins. There is a current gap in the literature comparing the two methods with respect to patient safety and operative time efficiency. Assessment is vital in optimising patient outcomes, accurate risk counselling and planning service provision. We aim to compare the safety and efficiency of LA versus GA in patients undergoing RFA with multiple avulsions (MA).

Method
Between July 2022 and October 2023, 85 patients (43 males, mean age 58 years) who underwent radiofrequency ablation of truncal veins with multiple avulsions under general anaesthesia or local anaesthesia were retrospectively analysed.

Results
Of the 85 patients, 39 were LA and 46 were GA. Combined anaesthetic and operative time was significantly shorter in the LA cohort. Local anaesthetic procedures were associated with shorter time from anaesthetic room to operation start time (11.97 +/- 10.2) 29.26 +/- 10.9 mins [p&lt;0.001]) and shorter procedures (57.85 vs 70.67 mins [p&lt;0.05]). There was no significance increase in postoperative venous thromboembolism and or emergency attendance within 30 days between the two groups. Findings were consistent when controlling for age, sex, ASA grade, anaesthetic type, and disease severity (as per CEAP scoring).

Conclusions
Performance of RFA with multiple avulsions in the treatment of varicose veins under local rather than general anaesthesia increases time efficiency of operative services without compromising on patient safety. Vascular surgeons should utilise local anaesthetic, where possible, to manage the long waiting lists patients with superficial venous incompetence.
1051 Audit of Statin Optimisation in Peripheral Arterial Disease and Abdominal Aortic Aneurysmal Disease
Authors: Chowdhury T , Christoforou S , Harland G , Ali S , Nair H 
Published: August 2024

Abstract

Aim
High-intensity statins are clinically an effective option for secondary prevention of cardiovascular disease and shown to improve patient outcomes, particularly in patients with peripheral arterial disease (PAD) or abdominal aortic aneurysms (AAA). NICE guidelines state Atorvastatin 80mg as the most cost-effective choice. This guideline provides a clear standard for all patients, which is auditable.

Method
A prospective study of 314 inpatients under vascular surgery of which 124 were part of the initial data collection. Following an educational intervention, 190 were collected in the second round. Exclusion criteria were applied to both cycles and a total of 52 and 67 patients remained respectively. Those that were switched to Atorvastatin 80mg on discharge were deemed to have been successfully optimised.

Results
Patients who were suitable for optimisation were compared to those who were discharged on Atorvastatin 80mg showing that 15 out of 52 patients were optimised in the first round and 43 out of 67 patients in the second round. Overall, the percentage optimised increased from 29% to 64% between the two cycles of data collection demonstrating a 2.2-fold increase in the percentage optimised.

Conclusions
Educational awareness between MDT members has successfully increased statin optimisation amongst PAD and AAA patients. This audit is applicable to most vascular comorbid patients and vital in preventative efforts to reduce the risk of future adverse limb or cardiovascular events, improving overall survival benefit.
1239 Morbidity and Mortality Following Salvage of Acute Limb Ischaemia
Authors: Rao M , Chand C , Ali R , Tang S , Wallace T 
Published: August 2024

Abstract

Aim
Beyond short-term technical results, the wider clinical impact of Acute Limb Ischaemia (ALI) is not well described in the literature. This study aims to establish the outcomes following surgical thromboembolectomy for ALI, with specific reference to amputation-free survival and 12-month survival.

Method
A retrospective review of all patients who underwent surgical thromboembolectomy, 01/01/2019 – 01/01/2022. Patients were identified from our unit database and their EPR interrogated with a follow-up period of 12 months. Patients with known established peripheral arterial disease, or cases of acute-on-chronic ischaemia were excluded.

Results
81 patients met the inclusion criteria (38 male vs 43 female). The median age was 78 (IQR 53-85), with a median clinical frailty score of 4 (IQR 3-5). Patients were grouped according to their presenting symptoms using the Rutherford classification for ALI, and 57% were presenting with immediately threatened limb (Class IIb). Successful revascularisation was established in 74 patients; 5 of these still progressed to major limb amputation (MLA), while 4 of 7 failed revascularisations resulted in MLA. Overall, 12-month amputation-free survival was achieved in 72 patients. 30-day MACE (including pulmonary embolism) occurred in 11 cases and 30-day mortality was seen in 7 cases. All-cause mortality was seen in 24 of 81 patients at 12 months.

Conclusions
Acute limb ischaemia carries significant morbidity and mortality despite surgical success for many. A greater understanding of longer-term outcomes should aid patient counselling.
Extent of Equivalence of Results for Urine Albumin among 3 Candidate Mass Spectrometry Reference Measurement Procedures
Authors: Miller W Greg , Bachmann Lorin M , Budd Jeffrey , Beasley-Green Ashley , Phinney Karen W , Tan Hwee Tong , Teo Tang Lin , Liu Qinde , Shiba Seiei , Seegmiller Jesse 
Published: August 2024

Abstract

Background
Urine albumin (UA) is an important biomarker of chronic kidney disease. Current in vitro diagnostic medical devices (IVD-MDs) for measuring UA are not standardized, and median results among IVD-MDs differ by approximately 45%. Since fixed decision values are used to interpret UA, higher-order reference measurement procedures (RMPs) are needed for metrological traceability. Three candidate liquid chromatography-tandem mass spectrometry RMPs have been developed for UA.

Methods
Eight single-donation human urine samples were measured by 3 candidate RMPs. Results were compared using t-test and variance component analysis.

Results
The mean results for each urine sample from each RMP laboratory were not statistically different from the overall mean value by t-test. The median total CV including contributions from bias and imprecision among the 3 RMP laboratories was 6.23% using variance component analysis for each sample. The allowable bias to the RMP for an end-user IVD-MD was ≦9.0% or ≦3.0% based on the desirable or optimal total allowable error of 30% or 24%, respectively. A maximum allowable standard uncertainty for an RMP result was determined to be 4.3% or 3.3% for desirable or optimal performance, respectively. The standard uncertainties for all of the RMP laboratories meet the desirable and optimal standard uncertainty specifications.

Conclusion
The candidate RMPs for UA in these 3 laboratories have suitable agreement of results and uncertainties for use as higher-order RMPs in the metrological traceability of end-user IVD-MDs for measuring UA.
Comparison of 2 Free Light Chain Assays: Performance of the Free Light Chain Ratio as a Risk Factor for MGUS Progression
Authors: Wang Qian , Andress Benjamin D , Pazdernik Vanessa M K , Larson Dirk R , Coker Jonathan D , Dasari Surendra , Rajkumar Vincent , Dispenzieri Angela , Murray David L , Willrich Maria Alice V 
Published: August 2024

Abstract

Background
New immunoglobulin free light chain (FLC) assays are available. Despite analytical differences, it seems possible to use free light chain ratios (FLCr) generated by different assays and apply similar cut-points for the diagnosis of multiple myeloma. It is still unknown if we can use different assays for risk stratification of patients with monoclonal gammopathy of undetermined significance (MGUS).

Methods
Patients diagnosed with MGUS (N = 923) had FLC tested using a nephelometric FreeLite (Binding Site) assay on BNII instruments (Siemens) and a Sebia FLC assay (Sebia) on a DS2 ELISA analyzer (Dynex). Patients were followed up for progression to any plasma cell dyscrasia (PCD) for several decades. The Mayo MGUS risk stratification model for progression was assessed with both assays (M-spike &gt;1.5 g/dL; non-IgG isotype and abnormal FLCr), using package insert reference intervals (RI) and a new metric called principal component 2 (PC2).

Results
There were 94 events of progression to PCD in the cohort during a median of 38 years of follow-up. Freelite and Sebia FLC showed similar hazard ratios in the risk models for elevated FLCr. An alternative clinical decision point lower than the package insert RI was evaluated for the Sebia assay, which improved risk stratification for patients with a low FLCr. The PC2 metric showed similar performance to the FLCr in models, without superior benefit.

Conclusions
The Sebia ELISA-based FLC assay can be employed in an MGUS risk stratification model with similar performance to the original 2005 risk stratification model using the FreeLite assay.