bluuebunny/crossref_metadata_2025_split huggingface dataset:
571 Squamous Cell Carcinoma After Adjustable Gastric Banding - a Case Report
Authors: Abbud N , Ackroyd R 
Published: August 2023

Abstract
Laparoscopic adjustable gastric banding (LAGB) is a widely accepted and effective bariatric procedure. Gastric cancer following bariatric surgery is uncommon, with only a few occurrences reported. There are nine incidences of gastric adenocarcinoma after gastric banding recorded in the literature. Squamous cell carcinoma (SCC) by comparison, is encountered far less in overall stomach malignancies. We describe the case of a 69-year-old woman who, seven years after having a gastric band placed, developed squamous cell cancer at the site of the band.
The patient initially presented with epigastric pain, and on endoscopy there was evidence of an ulcer at the gastric cardia. Extensive adhesions were also visualised around the gastroesophageal junction as a result of the band. Biopsies and staging laparoscopy confirmed a T3 N0, M0 R0 SCC of the stomach.
This is the first case report to document this rare sequela of events. We postulate that the squamous cell cancer developed secondary to chronic irritation at the site of the gastric band. Whilst rare, and symptoms vague, there is an argument to maintain a high index for suspicion of gastric cancer even following bariatric procedures.
585 Surgical Excision of Isolated Gastrointestinal Metastasis from Malignant Melanoma – a 10-Year Survey
Authors: Edah E , Kuan J Y , Pursnani K , Turner P , Ball C , Parkin E , Shetty V D 
Published: August 2023

Abstract

Aim
Patients with malignant melanoma (MM) can develop isolated metastasis years after treatment of the primary. The spleen and small bowel are the recognised intra-abdominal sites of isolated metastasis. Excision of these metastases is recommended as several international case series have shown good prognoses after excision.

Method
This is a 10-year retrospective study of patients with MM diagnoses who underwent excision of isolated metastasis at our Trust. Splenectomy and small bowel resection unrelated to MM and patients with disseminated metastasis were excluded. The surgical management, postoperative outcome and overall survival of the patients were assessed.

Results
In these 10 years, 2160 patients diagnosed with MM were treated in our Trust. Of these, 4 patients developed isolated splenic metastasis, and one had an additional small bowel metastasis. The primary MM location was the trunk in 2 patients, the posterior auricular region, and the left forearm in the other 2 patients. The patients developed metastasis an average of 47 months after treatment of their primary MM (range 11 - 96 months). The first patient underwent laparoscopic excision; the subsequent 2 patients underwent robotic-assisted excision. The patient with 2 isolated metastases underwent an open procedure. All four patients had no postoperative complications. The mean length of stay was 6 days with a zero-readmission rate. The mean survival time was 28 months (range: 3-60 months).

Conclusions
Isolated metastasis from MM is very uncommon. Surgical excision should be offered to all suitable patients. The feasibility of minimally invasive surgical excision should be considered in each patient.
1231 Radical Vulvectomy and Reconstruction for Severe, Refractory Crohn's Disease of the Vulva: A Case Report
Authors: Polluk D , Chappatte O , Attard-Montalto S , Mackey S 
Published: August 2023

Abstract
Vulval Crohn’s disease (VCD) is rare and can arise from direct infiltration, through fistulae or as non-contiguous lesions, so called metastatic disease. We present a case of a 32-year-old female with severe, refractory vulval Crohn’s disease (VCD), requiring radical vulvectomy and reconstruction.
She had a subtotal colectomy for Crohn’s disease 8 years previously, and for one year had experienced vulval swelling and pain associated with perianal fistulae for which she underwent an abdomino-perineal resection. Though she achieved long term remission of her gastrointestinal disease, she continued to experience severe vulval symptoms with recurrent infections and abscesses despite treatment with immunomodulators and biologics over a period of 10 years.
She then underwent a radical vulvectomy with bilateral gluteal fold flap reconstruction and skin grafting. She made an uncomplicated post-operative recovery. Histopathology showed active non-caseating granulomatous vulvitis. At 1 year follow up, there were no further disease flares, with significant improvement of her pain. Further plastic surgery is being considered.
Our case demonstrates the value of surgical management in refractory VCD to improve symptoms, function and quality of life. Though medical therapy with immunosuppressive agents is recommended as first-line treatment, the course of VCD is unpredictable and often relapses on treatment cessation. VCD may persist for long after remission of gastrointestinal disease and may require more aggressive surgery using a multispecialty approach even in the context of active infective disease.
1269 A Rare Case of Bilateral Phyllodes Tumour of the Breast
Authors: Ikram H , Wyld L 
Published: August 2023

Abstract

Introduction
Phyllodes tumours are rare breast fibroepithelial neoplasms. More rare presentations of these tumours include bilateral disease. Surgical excision with clear margins is the treatment of choice.

Case Summary
We report a case of a 60-year-old female with bilateral asynchronous breast Phyllodes. She initially underwent an excision of a left breast lump that revealed a borderline malignant Phyllodes. Six years later she presented with a lump in her right breast for three months and underwent a lumpectomy that revealed a malignant Phyllodes. Subsequently she had an excision of the inferior margin, and a staging computed tomography scan showed no evidence of metastasis. She was referred for genetic testing and adjuvant radiotherapy.

Discussion
In conclusion, bilateral representation of Phyllodes is rare and this is one of few cases reported in literature. In view of limited evidence available, the management of these patients is quite challenging. The indication of radiotherapy and chemotherapy in managing these tumours remains controversial and highlights the need for clear guidelines.
957 Otitis Externa (Oe) Management Review in Tayside
Authors: Sunthara Moorthy M , Onwordi L , Green R 
Published: August 2023

Abstract

Introduction
Although otitis externa (OE) can usually be managed in the community, a large number are referred from GPs to ENT Emergency Clinics.

Aim
To assess primary care referrals of OE to NHS Tayside, with adherence to local guideline recommendations of investigations and management.

Method
The digital notes of patients with OE referred to NHS Tayside via Emergency Clinic between August 2021- February 2022 were examined, focusing on their swab sampling status, microbiology lab results and antibiotic treatment modalities. The resultant data was analysed and compared to data from the initial (Jan 2016 - Jul 2016) OE Audit.

Results
53 of the 518-patient seen in ENT Emergency clinics were referred with OE. 96.2% of these patients had swabs performed for culture and sensitivity (C&S) analysis. 18.9% had been treated with oral antibiotics despite no recorded signs of external infection. Pseudomonas (17.6%) and Candida (19.6%) were the most common organisms.

Conclusions
Comparisons to the initial audit shows that there has been a marked improvement in patients being swabbed prior to referral (96.2% compared to &lt; 65%). The percentage of patients with candidal growth were higher this time. However, it is possible that the previous insufficient swabbing may have led to incorrect treatment. Fewer patients were needlessly prescribed oral antibiotics when compared to the initial audit results. Oral antibiotics should only be prescribed if facial involvement is present. Swabbing and C&S aids effective treatment with an appropriate antibiotic choice.
696 “The Doctor Will See You… Soon”: The Impact of the COVID-19 Pandemic on Acute Biliary Surgery and Patient Experience
Authors: Carter A , Sabah Y , Weaver S 
Published: August 2023

Abstract

Aim
Managing biliary disease acutely is cost effective and has high patient satisfaction. Our unit has established a successful “hot” gallbladder pathway, but COVID-19 and reduced operating capacity has potentially impacted this. This study compares rates of “hot” cholecystectomy, patient satisfaction and quality of life (QoL) impact pre and during COVID-19 pandemic, to determine whether performance has been affected.

Method
Quantitative data on time from diagnosis to surgery was collected from September to March in 2016-17 and 2021-22. A QoL questionnaire was piloted and distributed to eligible patients in March-April 2017 and 2022, enquiring about symptoms, mental health, anxiety, and patient experience.

Results
Mean wait for non-elective cholecystectomy was 2.4 days (range 0-8) in 2016-17, versus 6 days (range 0-86) in 2021-22. 100% (n = 57) of patients in 2016-17 had surgery within 8 days, compared with 83% (n = 53) in 2021-22. Median number of “hot” cholecystectomies weekly was unchanged. Patient satisfaction was sustained; 92% of patients in 2022 would “definitely” recommend the service, compared to 100% in 2017. 33% of patients in 2022 reported that mental health was impacted “extremely” or “quite a lot”, compared with 27% in 2017. 38% of patients in 2022 were “extremely” anxious about recurrent symptoms before surgery, compared to 27% in 2017. 33% of patients felt that COVID-19 impacted access to services for gallbladder disease.

Conclusions
The “hot” cholecystectomy service has been impacted by COVID-19, but performance remains high. It is still possible to deliver a successful service despite COVID constraints. Despite increased delays, patients remain very satisfied with their care.
715 The Acute Abdomen: Have You Ruled Out Splenic Torsion?
Authors: Nebo V , Adeshina O , Cooke J 
Published: August 2023

Abstract

Background
Splenic torsion is very rare, with approximately 500 cases reported worldwide and an incidence of 0.2% (1). The aetiology is thought to be hypermobility of the spleen’s supporting ligaments enabling migration to the pelvic or iliac region of the abdomen. The presentation can range from asymptomatic to a surgical emergency.
It is thought that the under-diagnosis of this condition leads to the higher prevalence of surgical emergency type presentations.

Aim
We present a rare case of an acute abdomen, secondary to torsion, due to a massive splenic cyst. A literature review detailing the most common symptoms, signs and investigations in adult patients is reported, to aid the reader rule out this rare but life-threatening condition in clinical practice.

Method
We performed a PubMed search using the terms ““splenic torsion” or “twisted spleen” or “wandering spleen””. Only acute (&lt;3months) (3) symptomatic presentations in adult human patients (&gt;18years), who had confirmed splenic torsion were included. Of the 220 case reports/series found, 100 did not meet the inclusion criteria, were not accessible in English, or did not describe the patient symptoms.

Results
Of the 120 acute splenic torsion adult cases between 1974-2022 evaluated, the most common symptom was abdominal pain (95%) then vomiting (34.2%). The most frequent sign was abdominal mass (61.7%). Diagnosis was most commonly confirmed by CTAP (76.7%).

Conclusions
Splenic torsion is an important differential in the acute abdomen patient presenting with abdominal pain, vomiting and a palpable mass. This life-threatening condition can usually be excluded by CTAP.
819 ELLIPSE: Electrical Impedance Analysis in Patients Undergoing Emergency Abdominal Surgery
Authors: Aftab R , Matthews L , Wooton S , Edwards M 
Published: August 2023

Abstract

Introduction
An ageing population represents greater operative risk; therefore, preoperative risk stratification is required to allow patients to make an informed decision. One method of risk stratification is bioelectrical impedance analysis (BIA) which can provide information such as muscle and fat mass, providing a proxy for patient metabolic health.

Aim
Metabolic health is intrinsically linked to outcomes following surgery. We hypothesised that BIA is a feasible method of assessing patients undergoing emergency abdominal surgery and predicting postoperative outcomes.

Method
A BIA analyser was used to measure patients body composition. All adult patients who met the National Emergency Laparotomy Audit (NELA) inclusion criteria were prospectively recruited and followed up until 30 days postoperatively. These patients had serial BIA measurements and compared with a healthy population. The phase angle (PA) is a raw variable which can be standardised to a healthy reference population and matched for age and gender. In summary, a higher phase angle is associated with improved outcomes.

Results
31 patients were recruited and BIA analysis in patients undergoing emergency abdominal surgery was feasible. Patients with a phase angle lower than the reference population had a greater incidence of complications (p = 0.03) and had more severe complications (p = 0.023). Furthermore, the same patients also had a significantly higher NELA morbidity percentage (p = 0.022).

Conclusions
Our study shows that conducting BIA analysis in patients undergoing emergency abdominal surgery is feasible. The presence and severity of complications correlates with the phase angle. This represents a successful proof of concept study of BIA to predict postoperative outcomes.
1225 Retrospective Study of Emergency Right Hemicolectomies at a Tertiary UK Centre
Authors: Subramanian A , Singh A , Siby J , Swaminathan C 
Published: August 2023

Abstract

Aim
To assess the efficacy and complication rates of emergency right hemicolectomies conducted at a tertiary UK Hospital.

Method
Study type: Retrospective data analysis. Study period: 2016-2021.

Inclusion criteria
All cases requiring an emergency right hemicolectomy performed by an individual surgeon (To eliminate surgeon bias).

Exclusion criteria
Elective resections and cases involving open conversion.
Parameters checked included demographics, duration from admission to theatre, duration of hospital stay and complications. These results were compared to known standards available in indexed journals.

Results
A total of 48 patients were studied, of which 29 were male and 19 were female. The mean age was 63.41 years. Mean duration of stay was 15.14 days. 26(54.2%) patients were discharged in under 10 days.
The most common diagnosis was adenocarcinoma of the colon (23- 47.9%)- mostly presentling as large bowel obstruction. The second most common diagnosis was ileo-caecal Crohns(8-16.6%) presenting either as stricturing disease or as an abscess. 20 patients were taken to theatre within 48 hours of admission(41.66%) of which 2 were taken back to theatre ( for anastamotic leak and post-operative adhesions ).7 had major complications(35%) commonest being pneumonia(20%). 4 developed post op ileus (20%).No deaths. 28 patients were taken to theatre after 48 hours of admission. One returned to theatres (anastamotic leak). 3 deaths (10.7%,6.2% overall) were noted. Pneumonia was noted in 7 patients (25%).

Conclusions
Mortality and morbidity results were comparable to acceptable levels in the literature. Early mobilisation especially in diagnostic dilemmas leads to lower mortality and morbidity.
1264 The Impact of ‘Rib Block’ Administration on Patients with Multiple Rib Fractures at a Major Trauma Centre: A Retrospective Observational Study
Authors: Bethel J , Christodoulou A , Smart Y W , Fernando K , Emer N , Vasireddy A 
Published: August 2023

Abstract

Aim
Rib fractures carry a mortality rate of 10% which is doubled in the elderly population. They are common following blunt thoracic trauma and are a marker of injury severity. The timely delivery of regional analgesia is crucial to prevent pain induced hypoxia, atelectasis, pneumonia and respiratory failure.
We compare the trauma-related injuries and outcomes between patients with &gt;2 rib fractures who received regional analgesic blocks with those who didn’t receive blocks.

Method
Retrospective data was collected from 187 patients presenting as a trauma call with &gt;2 rib fractures over a period of 18 months. Patient demographics, ISS, length of stay and respiratory complications were collected from electronic patient records (EPR).

Results
69 patients received a regional rib block compared with 118 who did not. Patients who had a rib block were older compared to those who did not have a block (62.1±17.6 vs 55.4±18.2, p = 0.007). There was no significant difference in number of rib fractures (6.8±3.2, p&lt;0.2), post-admission chest infection rate (23.1±42.5 vs 20.8±40.8, p&lt;0.4), or length of hospital stay (18.7±13.3 vs 21.7±19.1, p&lt;0.2). ISS score was significantly higher in non-blocked patients compared to blocked patients (27.4±14.3 vs 19.5±9.5, p&lt;0.05).

Conclusions
Patients with significantly higher ISS scores did not receive a regional rib block, however this did not appear to impact on post-admission chest infection rate or length of stay. Further work is needed to identify the reasons behind this trend.
355 Surgical Images and Social Media- Patient Centred or Just a Desperate Need for "Likes"?
Authors: Digne-Malcolm H , Butler R , Reid R , Mohamed R , Ahmed M , Htet W , Peters P , Khan J S , Wilson Jeremy , Magee Conor 
Published: August 2023

Abstract

Aim
Social media platforms, such as Twitter, are an expanding space for education/interprofessional discussion. Guidance regarding doctors’ use of social media is available but much is left open to interpretation, unlike the stringent guidelines used for traditional media. Public social media postings are unpoliced and can go viral - with sometimes devastating fallout.
We aimed to ascertain whether professional standards are adhered to when patient images are shared through Twitter.

Method
Prospective review of Twitter posts with patient images. Outcomes: is there a statement of patient consent? Has confidentiality been maintained? Does the Tweet purpose justify the images included? Are professional standards maintained?

Results
54 images were identified for review from 18/12/20 to 26/09/22. Most tweets were by consultant surgeons (74%). Only one image had a statement of patient consent despite 48% being deemed identifiable or potentially identifiable. Location was shared for 27% of cases and the external patient was visible in 48% of Tweets. 17% were potentially identifiable through rarity of the case. 52% images had educational value; 31% promoted the owner of the Tweet or their colleagues; 18% were identified as posted for general interest. Only half of the Tweets were felt to justify the use of patient images.

Conclusions
Patient images are being shared through Twitter without being kept to the same rigorous standards as through traditional media. These risks breaching patient confidentiality and undermining professional standards on which patient trust depends. There is a pressing need for robust guidelines to protect both patients and healthcare professionals.
1211 Review of the Factors Leading to an Unplanned Inpatient Stay Following a Day Case Laparoscopic Cholecystectomy in a Tertiary Centre
Authors: Rao A , Rao M , Doyle C , Karki B 
Published: August 2023

Abstract

Aim
To review the factors responsible for an unplanned Inpatient Stay (IPS) following a day case Laparoscopic Cholecystectomy (LC).
To develop strategies preventing unnecessary hospital stays after Day Case LC.

Method
We retrospectively collected data on all the LC performed in a Tertiary Centre over 3 months (January – March 2022).

Results
162 patients underwent LC during this period; 135 (83.3%) patients were planned day cases out of which 68/135 (50.37%) had an IPS and 67/135 (49.62%) were same-day discharges (SDD). 27/162 (16.66%) patients had emergency LC. 54% n = 37 LC performed in the afternoon had IPS compared to 14% n = 10 among the SDD [p&lt;0.0001]. 47% n = 32 In-patient LC performed by non-consultant grade compared to 32% n = 22 among the SDD.
7% n = 5 IP due to social issues, 10% n = 7 no documented IP causes identified and 4% n = 3 had booking error, booked as Inpatient despite the patient having SDD. Other identified causes were drain Insertion (9% n = 6), longer operations (n = 1; mean operation time 92 min IP vs 82 min SDD) and late recovery (9% n = 6).

Conclusions
The rate of an unplanned overnight stay was found to be significantly high (50.37%, n = 135). Several human factors such as errors in the booking proforma, late-afternoon lists, and no clear discharge planning in the post-op notes were among the few factors which could easily be improved. A review of these factors is deemed necessary not only for improving patient outcomes & quality of care but equally for reducing healthcare costs.
694 An Undergraduate Virtual Neurosurgery Lecture Series: Knowledge Acquisition, Career Insights and Perspectives Upon Neurosurgical Teaching in the Current Medical Curriculum
Authors: Dhaliwal J , Mihaela-Vasilica A 
Published: August 2023

Abstract

Aim
The undergraduate medical curriculum succeeds in providing students with a generalised approach to medicine yet limits in delivering adequate exposure to explore subspecialties. Conferences are integral to students’ career decisions. Our deliverance of the ‘Encephalon Lecture Series’ encompassed nine neurosurgery talks from world-renowned clinicians to allow students to further their interests. This study aims to analyse the impact of the lecture series on attendee knowledge improvement and elucidate opinions towards the amount of neurosurgical teaching within the medical curriculum.

Method
Attendee feedback was collated from questionnaires after each webinar session. Self-improvement of knowledge and neurosurgical career interest was extracted from all responses using a 10-point interval scale to determine the significance of the conference and to evaluate the differing views concerning the lack of neurosurgical teaching in the medical curriculum.

Results
A total of 199 attendees were recorded over the lecture series. The post-webinar feedback questionnaire was completed by 83 attendees (41.71%). Attendance resulted in a 62% average increase in self-reported improvement in knowledge among participants. Of the sessions, the greatest areas of knowledge improvement were indicated after the Brain Mapping webinar (110.71%), followed by the Skull Base Neurosurgery webinar (93.55%) and the Functional Neurosurgery webinar (66.15%). A mean of 8.39 ± 1.47 reflected webinars’ relevance to attendees’ future professional development.

Conclusions
Conferences are prominent resources for students to propel their knowledge, network with clinicians and discuss career options. Neurosurgery is an ever-evolving profession, and greater undergraduate exposure to the speciality will demystify the field and clarify the training pathway for students.