bluuebunny/crossref_metadata_2025_split huggingface dataset:
887 A Review of the Management of Paediatric Spinal Injuries in Low- and Middle-Income Countries
Authors: Ejide C , Bandyopadhyay S , Lakhoo K , Dabasia H , Rosseau G , Demetriades A 
Published: July 2024

Abstract

Aim
Paediatric spinal cord injuries (SCI), particularly in the low-and middle-income countries (LMICs), present a pressing global health concern. There is a lack of dedicated research protocols for managing these injuries. To address this, we conducted a review to characterise the methods of management strategies of paediatric SCI in LMICs and drew comparisons with established protocols in high-income countries (HICs).

Method
MEDLINE, Cochrane library, and Global Index Medicus were searched from database inception to August 1, 2023. Studies reporting the management of paediatric SCI from LMICs were included. Randomised control trials and cohort studies reporting the management of Paediatric SCI from HICs were included. Pooled statistics were calculated using measures of central tendency and spread.

Results
A total of 685 studies were identified, of which 5 were included from LMICs. A total of 286 patients in the LMIC setting were included in our review with age of participants ranging from 0 to 18 years. The number of patients receiving prehospital immobilisation was characterised in one study (n= 6/36; 17%). Patients transported to the hospital by ambulance was characterised in only one study (n= 18/44; 41%). In the studies reporting the data, most patients underwent surgery (n=151/250; 60.4%). Patients receiving methylprednisolone or long-term management data was not present in any of the included studies.

Conclusions
There is a paucity of studies reporting the management of paediatric SCI in LMICs. There is insufficient data for accurate comparison and analysis. This study calls for more research to develop international guidelines that inform clinical practice.
670 Investigating Delay During Presentation of Trauma in Young Adults: A UK Major Trauma Centre Retrospective Audit and a Systematic Review of the Literature
Authors: Drinkwater E , Nightingale K , Burke J , Smith S R 
Published: July 2024

Abstract

Introduction
The current evidence in major trauma highlights that delays at multiple points along the patient care pathway, from incident to surgery, are associated with decreased survival. The aim of this audit was to assess performance across select delay parameters in juveniles aged 16-18 presenting to an adult MTC service following a systematic review of the literature.

Method
Patient records were interrogated between 1/10/2022-1/3/2023 and audited against 3 national standards: (1) Ambulance Response and Transfer (7 and 45mins respectively) (2) Tranexamic Acid infusion (&lt;3hrs) and (3) CT scan (&lt;60mins). A systematic search was also performed using EMBASE and OVID databases (01/01/2005-/01/11/2023). All studies assessing impact of time to theatre in patients with acute trauma were considered.

Results
32 consecutive patients (3F:29M) (median 18 years[16-18]) were identified within the audit period. 40%(n=13) presented following penetrating injury and 35%(n=11) following a road traffic accident. Mean time from incident to admission was 83mins[±36], from incident to tranexamic acid infusion 50mins[±35], and from admission to CT Trauma Series 61mins[+/-100]. Median length of stay was 4 days [IQR=5]. The systematic search yielded 25 studies which were included in the analysis. An Incident2Surgery framework is presented which highlights key time-critical points for diagnosis and intervention.

Conclusions
Local compliance to national standards for tranexamic acid infusion in appropriate patients and performance of trauma CT was excellent with poor compliance to ambulance arrival and transfer time. The proposed Incident2Surgery framework could be incorporated into mortality prediction and audit tools and assist in the assessment of interventions.
982 Timing of MRI Spine for Patients Presenting with Suspected Cauda Equina Syndrome (CES)
Authors: Zafar R , Dinesh A , Panselinas I 
Published: July 2024

Abstract

Introduction
Cauda Equina Syndrome (CES) is a neurosurgical emergency requiring urgent intervention within 24 to 48 hours to prevent irreversible paralysis and incontinence. Recognizing the gravity of CES, The Society of British Neurosurgeons and the British Association of Spine Surgeons set care standards in 2017, emphasizing the necessity for a 24/7 MRI service in every healthcare trust. The recently released GIRFT National Suspected CES Pathway also advocates for performing an MRI scan within 4 hours of presentation.

Aim
This study aimed to assess adherence to the 4-hour target for MRI scans in suspected CES cases at the Royal Surrey Hospital and examine the impact of delays on hospital stay length.

Method
Data from a 6-month period (August 2022 to January 2023) involving 70 patients were collected using the Cerner electronic system and inpatient lists, excluding cases of outpatient MRI and urgent transfers to Saint George's Hospital.

Results
Results showed an average time from Emergency Department admission to scanning of 21.3 hours (range: 3.5 to 87.4 hours), with a mean wait from request to scan of 14.5 hours (range: 0.7 to 76.7 hours). Hospital stay duration averaged 4.5 days (range: 1 to 22 days).

Conclusions
Recommendations include empowering ED clinicians to order MRI scans, implementing an MRI Safety questionnaire on Cerner, collaborating with radiographers to meet the 4-hour target, and advocating for a 24/7 MRI service within the trust. Subsequent re-audit efforts will evaluate the impact of these recommendations and identify factors influencing the achievement or non-achievement of the 4-hour target.
217 Outcomes of Reoperation for Residual or Recurrent Obstruction After Previous Myectomy in Patients with Hypertrophic Cardiomyopathy
Authors: Qamar Y , Schaff H 
Published: July 2024

Abstract

Aim
Describe the mechanism(s) of residual or recurrent obstruction in patients who have previously undergone septal myectomy for hypertrophic cardiomyopathy and assess early outcomes of reoperation.

Method
From January 1989 to March 2022, we performed 73 repeat myectomies at our institution. Patients’ demographics, operative details, echocardiographic parameters, and postoperative complications were retrieved from a prospectively maintained surgical database and electronic healthrecords.

Results
Median age at reoperation was 48.3 years (IQR 38.6-58.6); 51 patients were women (69.9%). 90.4% presented with NYHA class III/IV symptoms. Median interval between previous myectomy and reoperation was 2.7 years (IQR 1.2-4.5). Mechanism of obstruction was an inadequate length of previous septectomy in 41 patients (56.2%), a combination of inadequate length and midventricular obstruction in 30 (41.1%), and isolated midventricular obstruction in 2 patients (2.7%). There were no instances of recurrent LVOT obstruction due to muscle regrowth at the site of previous resection. All patients had an extended transaortic septal myectomy; 14 patients (19.2%) had concomitant transapical myectomy. Preoperatively, the median LVOT gradient was 83 mmHg (IQR 60-122), which reduced to 2 mmHg (IQR 0-7) following repeat myectomy. There were no perioperative deaths. Postoperatively, 4 patients (5.5%) developed a new CHB, necessitating PPM implantation. The 5-,10-, and 20-year survival after reoperation were 100%, 91%, and 76%, respectively.

Conclusions
Inadequate resection at the time of primary septal myectomy is the commonest cause of residual or recurrent obstruction in oHCM patients. However, repeat myectomy, including a combined transaortic and transapical approach has minimal risk with excellent hemodynamic and long-term survival outcomes.
620 Outcomes of One Anastomosis Gastric Bypass Conversion to Roux-en-Y Gastric Bypass for Morbid Obesity: A Systematic Review and Meta-Analysis
Authors: Das B , Sargsyan N , Robb H , Namgoong C , Ali I , Mitra A , Fehervari M 
Published: July 2024

Abstract

Introduction
One anastomosis or ‘mini’ gastric bypass (OAGB) is a highly effective procedure to treat morbid obesity. However, conversion to Roux-en-Y gastric bypass (RYGB) for OAGB-related complications such as bile reflux is increasing. We therefore conducted the first systematic review to determine the weight outcomes, safety and efficacy associated with OAGB-RYGB conversion surgery.

Method
A systematic search was conducted by three independent reviewers using Medline, Embase and the Cochrane library following PRISMA guidelines. Data extracted included patient demographics, weight, and reflux outcomes. Risk of bias was assessed using the Newcastle-Ottawa scale. The mean BMI difference was analysed using a random effects model. This study was registered on PROSPERO (Registration ID: CRD42022379759).

Results
6 studies were selected which included data from 134 patients undergoing OAGB-RYGB conversion surgery. Follow-up ranged from 6-60 months. Patients' baseline BMI at conversion was 30.2 (S.D. 2.85). Common indications for conversion surgery were reflux (47.8%), malnutrition (31.3%) and inadequate weight loss (8.2%). Biliopancreatic limb length ranged from 50-200cm. Weighted mean of study outcomes demonstrated biliary reflux symptoms resolved in 90.9% cases (95 % CI 78.8-n100%). Studies reporting BMI at &gt;24 months reported overall stable medium-term weight (mean BMI difference -0.71 (-4.03-2.61)) with moderate study heterogeneity (I2 = 82%). The rate of major post-op complications was 14.7% (6.25%-23.1%).

Conclusions
OAGB to RYGB conversion surgery is associated with a high resolution of reflux symptoms. However, it is associated with weight regain, albeit this may be acceptable to patients to treat biliary reflux as the weight gain is small and stable over the long-term.
968 Optimal Timing for Endovascular Aortic Repair in Patients with Blunt Thoracic Aortic Injury: A Systematic Review and Meta-Analysis
Authors: Godoi A , Fernandez M , Ayala R , Velasquez C 
Published: July 2024

Abstract

Aim
The optimal timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injuries (BTAI) remains a topic of debate. We performed a systematic review and meta-analysis to compare early versus delayed TEVAR in BTAI.

Method
We systematically searched PubMed, Embase, Cochrane Central and Clinicaltrials.gov in up to October 2023 to include studies comparing TEVAR performed &lt;24 hours versus &gt;24 hours in BTAI. Safety outcomes were pooled as odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis was performed with propensity-score matching or multivariate-analysis studies. Statistical analysis was performed with RevMan 5.4.1 and R software. The protocol was registered in PROSPERO (ID:CRD42023427392).

Results
Nine studies with 4163 patients were included, of whom 30.2%(n=1257) underwent delayed TEVAR. Mortality was significantly lower in the delayed TEVAR group (OR 0.44; 95% CI 0.32–0.59; p&lt;0.001; I²=0%), with consistent results when restricted to multivariate studies (p&lt;0.001). Although delayed TEVAR resulted in significantly lower rates of sepsis (OR 0.37; 95% CI 0.18–0.78; p=0.009; I²=67%), it was also associated with increased durations of hospital stay (MD 3.28; 95% CI 1.58–4.98; p&lt;0.001), ICU stay (MD 2.53; 95% CI 0.92–4.14; p=0.002), AKI (OR 1.71; 95% CI 1.04–2.83; p=0.04), and ventilator use (MD 1.20; 95% CI 0.51-1.89; p&lt;0.001).

Conclusions
Our findings show that delayed TEVAR is associated with lower mortality and sepsis, but also an increased risk of in-hospital complications. This may guide future prospective studies to investigate optimal timings according to grades of injury and associated complications.
227 Retrospective Study to Assess Axillary Management and Oncological Outcome After Neoadjuvant Chemotherapy for Patients with Breast Cancer
Authors: Ewedah M , Asal M , El-Faiomy T , Abouelnagah G , Khedr G 
Published: July 2024

Abstract

Aim
Evaluation of the effect of neoadjuvant chemotherapy on axillary nodal status. The secondary objective was to evaluate the percentage of patients who are eligible for SLNB after neoadjuvant chemotherapy.

Method
This retrospective study was conducted by collecting data during the period from October 2019 to July 2021. The study included 64 patients who had biopsy-proven locally advanced breast cancer with clinically or radiologically positive axillary LNs, had been receiving neoadjuvant chemotherapy at the Clinical Oncology Department, and underwent surgery after neoadjuvant therapy at the surgical oncology unit of Alexandria Main University Hospital.
Exclusion criteria were as follows: Patients with early-stage breast cancer, metastatic stage IV breast cancer, unfit/refusing neoadjuvant therapy, aged less than 18 years or more than 75 years or clinically and radiologically negative axilla.
Data were collected retrospectively to assess the oncological and surgical outcomes after completing NAC. The files of 450 patients were reviewed, and only 64 patients were eligible patients to be included in our study.

Results
Complete pathological response (ypT0ypN0) was found in six of the 64 patients in our study. Four patients were triple-negative, and two patients were HER2-enriched biological subtype. One patient was T1, one patient was T2, one patient was T3, and three patients were T4. One patient was N1, four patients were N2, and one patient was N3.

Conclusions
Post-neoadjuvant ultrasound is essential for assessment of axillary response. Approximately 44.4% of patients with negative post-neoadjuvant axillary ultrasound can avoid unnecessary ALN clearance. Accurate axillary staging is the cornerstone for omission of axillary clearance after neoadjuvant among patients.
997 Ascending Aorta Pseudoaneurysm 40 Years Following Surgical Atrial Septal Defect Repair
Authors: Yong H J , Lang P , Dreisbach J , Veldtman G , Smith R , Nair S 
Published: July 2024

Abstract

Background
Ascending aorta pseudoaneurysm is a rare postoperative complication of cardiac surgery. It is often attributed to infection and dehiscence at sites of aortotomy, cannulation, cross-clamp placement, and proximal coronary anastomoses. Mortality risk is 29-46% and this requires prompt surgical intervention.

Case summary
A 48-year-old woman who underwent atrial septal defect repair at 8 years of age, presented with chest pain radiating to the right shoulder and dyspnoea. Cardiac-gated CT angiography demonstrated a 21mm pseudoaneurysm arising anteriorly from the proximal ascending aorta, 6mm above the right coronary artery ostium, likely the site of previous cardioplegia cannula. There was active blood flow from the aorta into the pseudoaneurysm sac. It was heavily calcified, apart from a thinned irregular wall inferiorly, from which rupture was imminent. She underwent emergency surgery. Using femoro-femoral cardiopulmonary bypass, the chest was safely re-entered. Under mild hypothermia and distal ascending aorta cross-clamping, the pseudoaneurysm was resected and aorta repaired using a Gelweave patch. The patient recovered uneventfully and was discharged home after one week.

Discussion
Accurate imaging, primarily via cardiac-gated CT angiography, is crucial for diagnosis and surgical planning in patients presenting with aortic pseudoaneurysm, particularly those close to the aortic valve and coronary arteries. Operative strategy, including need for deep hypothermic circulatory arrest and/or graft replacement of aorta, depends on pseudoaneurysm anatomy. It is recommended that preventative measures are taken during the primary operation, inserting the cardioplegia cannula tip through full-thickness purse-strings and/or addition of separate oversewing sutures after decannulation. Alternative techniques of pseudoaneurysm repair are also discussed.
1235 Challenges in Glaucoma Management: A Case Study on OMNI® Surgical System Interventions for Primary Open-Angle Glaucoma
Authors: Coelho M 
Published: July 2024

Abstract

Introduction
This report explores the challenges faced in addressing early-stage primary open-angle glaucoma (POAG) in a 74-year-old male. Following a steroid-induced elevation in intraocular pressure (IOP) after endoscopic cyclophotocoagulation (ECP) in the right eye, the patient underwent minimally invasive canaloplasty and goniotomy using the OMNI® Surgical System (Sight Sciences) on his left eye.

Case Description
IOPs at diagnosis measured at 28 mmHg and 27 mmHg in the right and left eye, respectively, leading to the prescription of bilateral latanoprost. An adverse reaction to latanoprost resulted in eye swelling, hyperaemia, facial and jaw discomfort, and photophobia, prompting the cessation of the medication. In December 2022, bilateral selective laser trabeculoplasty (SLT) was performed, with minimal impact on IOP. Subsequently, in March 2023, right cataract surgery with ECP successfully reduced right eye IOP to 16 mmHg. Postoperatively, the use of dexamethasone 0.1% drops caused an intraocular steroid-response, increasing IOP (maximal IOP =25 mmHg), resolving upon medication completion. To mitigate prolonged steroid drop-associated complications, left eye phacoemulsification with OMNI canaloplasty and goniotomy was conducted in June 2023. Standard 4-week low-frequency steroid drops were administered postoperatively with no complications.

Conclusions
Pressure control was successfully achieved with IOP normalization to 15 mmHg bilaterally. Significant visual acuity improvements were noted post ECP (right eye=6/24 to 6/6) and OMNI (left eye=6/7.5 to 6/6). This case highlights the efficacy of OMNI combined with phacoemulsification in the safe reduction of IOP and sustained IOP control in POAG patients, alluding to its favourable safety profile.
247 Prophylactic Use of 3D Intraperitoneal Mesh in the Prevention of Parastomal Hernia in Permanent Colostomies After Rectal Cancer Resection
Authors: Ngo V , Rajendiran A , Ferrie S , Chadwick M 
Published: July 2024

Abstract

Background
Parastomal hernia (PSH) is the most common complication of stomas associated with significant morbidity. Prophylactic mesh in preventing PSH is less well studied, and evidence is conflicting. We compare PSH rates in patients in whom 3D intraperitoneal mesh was and was not used prophylactically in a cohort of rectal cancer patients undergoing elective curative resection.

Method
Retrospective data from the Somerset Database and Electronic Patient Record were collected on patients under a single consultant surgeon between May 2016 and December 2021. Follow up was for a minimum of 2 years (excluding deaths). Appropriate statistical tests of difference significance were performed for proportions of categorical data, and time to hernia occurrence in patients with and without Dynamesh IPST placement. (Fisher’s Exact test; Kaplan Meier)

Results
From 397 colorectal cancer patients under the care of a single surgeon, 223 had elective surgery with curative intent, of which 63 (28%) underwent total mesorectal excision (TME) (30 TME & ileostomy, 12 TME Hartmann and 21 APER) - 90% laparoscopic.
16 patients had prophylactic mesh used. Demographics and co-morbidities between groups were similar. PSH incidence was 1 (6%) (radiological) vs.7 (41%) (clinical) in the mesh vs. non-mesh group; P=0.039. Post operative complications and pain scores differed only slightly. Time to hernia development did not differ between groups.

Conclusions
Use of prophylactic mesh during permanent stoma formation in our practice appears safe, and effective in preventing PSH. Further studies may answer the question “Should 3D collared mesh be routinely placed during the formation of permanent stomas to prevent parastomal hernia?”
669 Outcomes, Morbidity and Mortality Following Pelvic Exenterations at Cambridge University Hospitals
Authors: Theocharidou L , Dennis D , Manners W , Aker M 
Published: July 2024

Abstract

Aim
To evaluate patient outcomes following pelvic exenteration (PE) within the colorectal department, specifically length of admission, morbidity, and mortality over a 7-year period.

Objective
To identify factors affecting patient outcomes following PE.

Method
Data collected retrospectively on all colorectal patients who underwent PE from 2015 to 2022 at Addenbrooke’s Hospital, Cambridge, UK.

Results
89 patients underwent PE for colorectal cancer, with mean age 62.69 and male to female ratio 2:1. 74% had rectal adenocarcinoma, R0 resection was achieved in 82%. 82% experienced complications, most notably intra-abdominal collections (52%); this resulted in significantly longer admissions (p&lt;0.01). Length of admission was higher in patients undergoing PE for cancer recurrence (p 0.048). Median survival was 68 months, and on multivariate Kaplan-Meyer analysis R0 resection was found to be the only significant factor affecting survival (p &lt;0.01). In-patient mortality was 8% and 12-month mortality at 16%.

Conclusions
A similar study by Choy et al. 2017 reported 16% 12-month mortality and 87% post-operative complications, marginally higher than our findings. In comparison, our study examined a wider range of factors affecting PE outcomes and identified significance of R0 resection. Our study has one of the highest patient cohorts in literature and findings are consistent with similar studies. Complications following PE are common, the most frequent being intra-abdominal collections. Although morbidity is high, most patients survive over 3 years; the only factor affecting survival appears to be R0 resection.
241 Predictors of Post-Radioiodine Ablation Outcomes in Thyroid Cancer: Analysis of Four Years of Data from a Regional Centre
Authors: Jones-Anderson M , Iqbal S , Hamilton D 
Published: July 2024

Abstract

Aim
To assess correlations between patient demographics, tumour and lymph node pathology and outcomes for patients with non-metastatic thyroid cancer. Outcomes examined were evidence of post-ablation residual disease on blood testing or ultrasound or thyroid cancer recurrence.

Method
Electronic records for thyroid cancer patients at a regional centre undergoing thyroidectomy followed by Radioiodine-131 ablation in the years 2018-2021 were reviewed with 191 records contributing to the analysis. Patient demographics, tumour characteristics, numbers of positive lymph nodes and radioiodine dosages were compared against patient outcomes.

Results
Increasing age, T stage of the tumour and lymph node involvement demonstrated the strongest correlations with negative outcomes. Age appeared to be a strong risk factor for thyroid cancer recurrence with 70% of the patient’s experiencing recurrence aged over 60 despite patients over 60 making up only 33% of the sample. Removal of over 4 metastatic lymph nodes has previously been found to predict poorer patient outcomes. The findings support this however over 50% of positive nodes removed had a stronger correlation with negative outcomes compared with raw numbers retrieved. 52.2% of patients with over 50% positive lymph nodes experienced poorer outcomes compared with 40.1% who had over 4 positive nodes removed. The correlation was stronger still for those with over 4 positive nodes of which over 50% were positive of whom 57.9% demonstrated poor outcomes.

Conclusions
Rather than raw numbers of lymph nodes removed, proportion of metastatic nodes of those harvested or a combination of total numbers and proportion appeared to give a better indicator of prognosis.