bluuebunny/crossref_metadata_2025_split huggingface dataset:
820 Atypical Presentation of Muscular Metastasis of Melanoma in the Contralateral Limb
Authors: Mondal A , Dingle L , Hough M 
Published: August 2023

Abstract

Case Presentation
A gentleman in his 50s presented to his GP with an asymptomatic, soft, enlarging mass on his left upper arm. He had previously been diagnosed with a 4.5mm cutaneous malignant melanoma (MM) on his right arm, which was treated with an excision biopsy and a further 2cm wide local excision. He further had a sentinel lymph node biopsy (SLNB), which confirmed no residual melanoma. He was subsequently followed up routinely by the skin cancer multidisciplinary team (MDT) for five years with no concern.
The patient subsequently underwent an ultrasound scan, a Magnetic Resonance Imaging (MRI) scan, and a final staging Computed Tomography (CT). Imaging was suspicious for an intramuscular soft tissue malignancy. Core biopsy of this mass suggested a diagnosis of metastatic MM. Excision was performed within three weeks of his core biopsy. The lesion was completely excised, and formal pathology confirmed the diagnosis of metastatic MM. He has been referred to the oncology services for the commencement of Nivolumab (anti PD-1 antibody) immunotherapy according to the genetic analysis.

Summary
This case highlights a rare example of muscular metastasis of MM, presenting in a distant site, despite a negative SLNB, over five years from the original diagnosis. Such cases highlight the unpredictable nature of MM, reminding clinicians of the need for a low threshold for investigation of soft tissue masses in patients with a history of cutaneous malignancy.
823 The Dilemma of Managing the Thyroid Gland After Incidental Diagnosis of Malignant Struma Ovarii, Is Radical Thyroidectomy and Radioactive Iodine Necessary? a Case Report and Literature Review
Authors: Batog W I , Riain C Ó , Abu Saadeh F 
Published: August 2023

Abstract

Background
Struma Ovarii is a unique type of ovarian teratoma which occurs when thyroid tissue constitutes 50% or more of the tumour. Most of these tumors are benign, however malignant transformation happens in less than 3%. Thyroid carcinomas can occur as distal metastasis with malignant struma ovarii (MSO) however, their diagnosis and treatment remain debatable.

Case
We report on a case of a 48-year-old woman whose MSO was discovered accidentally during a clinical trial. An ultrasound (US) depicted a complex left adnexal mass, which an MRI subsequently confirmed. The mass measured 4.5cmx 2.5cmx 5.0cm, a strong Doppler blood flow, and nodularity were noted. Salpingo-oopherectomy, omentectomy, appendicectomy, and left pelvic and para-aortic lymph node dissection were performed. The postoperative histopathological assessment of the tumour confirmed the diagnosis of MSO. The patient was then reviewed by a head and neck multi-disciplinary meeting. A 6mm thyroid nodule was located on the left lobe, and the cytology was reported as negative on fine needle aspiration (FNA). Nonetheless, the patient was treated with a radical thyroidectomy and radioactive iodine. Post-operative histopathology reported thyroid carcinoma, despite the negative cytology on FNA. No recurrence was noted.

Conclusions
This case highlights the importance of radical treatment of the thyroid in patients with MSO. Accurate preoperative diagnosis of thyroid carcinoma secondary to MSO is difficult, since pathological diagnosis is the gold standard. Our case showed that a radical treatment of thyroid with surgery and radioactive iodine minimises the risk of local and distal recurrences.
830 Surgical Management of a Patient with Triple Carcinoid Heart Valve Disease
Authors: Holland L , Ghouri S , Sahdev N , Liu G , Punjabi P 
Published: August 2023

Abstract

Background
Carcinoid heart disease is an uncommon manifestation of carcinoid syndrome that can present to a cardiac surgeon as a complex constellation of structural problems. Patients develop progressive valve disease, more commonly of the right-sided heart valves but sometimes involving the left, which will in turn impact cardiac function. Without intervention, carcinoid heart disease portends a dismal prognosis. Given the rarity with which these cases are encountered, in conjunction with their complexity, it is important for the cardiac surgeon to be equipped with the knowledge of how to operate on these patients and the challenges likely to be faced.

Case
A 72-year-old man, who had previously undergone small bowel resection for multifocal neuroendocrine tumours, was referred to our centre with significant symptomatic carcinoid heart valvulopathy affecting the tricuspid, mitral and aortic valves. He successfully underwent triple valve replacement and permanent epicardial pacing system implantation along with coronary artery bypass grafting. He was discharged after an inpatient stay of two weeks and is well at follow-up.

Discussion
Triple valve replacement is infrequently performed in the UK, but all centres ought to be prepared to offer this treatment in a select group of patients. In this report we describe the technicalities of performing such an operation and the relevant surgical anatomy, the rationale and technique of pre-emptive epicardial pacing system implantation, and both the pre- and post-operative management of such patients.
837 A Rare Case of Regional Odontodysplasia in a Young Male
Authors: O'Rorke R , Siddik D 
Published: August 2023

Abstract

Background
Regional odontodysplasia (ROD) is a rare localised developmental disorder affecting the dental tissues. It presents with specific clinical, radiographic, and histopathological features. There have been less than 180 reported cases of ROD in the literature.

Case Report
A 10-year-old boy was seen in the paediatric dental department with a complaint of missing teeth and pain in the left maxilla. Examination revealed retained fragments of primary teeth and a partially erupted upper left first permanent molar (UL6) with an unusual morphology, cavitation, and associated infection. The dental development in the rest of the mouth appeared to be normal. CT scanning of the left maxilla revealed all unerupted permanent teeth were present but had a characteristic "ghost-teeth" appearance suggestive of regional odontodysplasia. The patient underwent surgical exploration of the left maxilla and removal of the UL6. The remaining unerupted teeth in the area showed no signs of infection. Although they have a poor long-term prognosis, they were left in situ in order to preserve alveolar bone whilst the patient is growing. Histological examination showed thin disorganised dental tissues with large pulp chambers, confirming the diagnosis of regional odontodysplasia.

Discussion
ROD presents management challenges, particularly in children. This case highlights the importance of being aware of the clinical and radiographic features of rare disorders in order to aid diagnosis and treatment planning. This case also demonstrates the importance of targeted intervention and monitoring in order to improve outcomes for placement of dental prostheses in adulthood once growth is complete.
859 Bilateral Vocal Cord Palsy Secondary to Rheumatoid Arthritis: A Case Report
Authors: Hyland L , Saville R , Dwiddar N , Sovani M 
Published: August 2023

Abstract

Introduction
Rheumatoid arthritis (RA) affects the larynx in 13-75% of cases and is usually subclinical. Airway obstruction due to vocal cord fixation occurs late in RA and presents as an inspiratory stridor.

Case presentation
An 85-year-old woman presented to A&E Resus with tachypnoea, stridor and drowsiness. An ABG showed hypercapnic respiratory failure. A flexible nasendoscopy was performed which revealed adducted vocal cords with paradoxical breathing. The patient had been admitted with a similar presentation before which was attributed to her longstanding RA. Potential surgical options including tracheostomy, vocal cord lateralisation and vocal cord/arytenoid removal were considered but ultimately, these options were deemed unsuitable for the patient.

Conclusions
Stridor is a late but life-threatening complication of RA that has viable surgical options of tracheostomy and vocal cord lateralisation; however, the appropriateness of such procedures should always be correlated with the patient’s clinical status and background.
913 Role of Botulinum Toxin in the Medical Management of Respiratory Distress Secondary to Suspected Intraabdominal Hypertension After Abdominal Wall Reconstruction
Authors: Adeboye T , Kulkarni G , Atkinson T , Hammond T 
Published: August 2023

Abstract

Introduction
Botulinum toxin (BTX) is a neurotoxin which causes functional denervation of muscles. Botulinum toxin type A (BTX) has been approved for a wide range of clinical applications. In addition, off-label preoperative injection of BTX is increasingly used for chemical component relaxation of the lateral abdominal wall muscles prior to abdominal wall reconstruction.

Rationale
Postoperative intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) with consequent organ dysfunction can be a potential complication after abdominal wall reconstruction. The IAH and ACS clinical practice guidelines suggest improving abdominal wall compliance in their medical management algorithm including neuromuscular blockade.

Method
Following an open retrorectus mesh repair with left component separation via transversus abdominis release of a midline incisional hernia, we report a case of postoperative respiratory distress and acute kidney injury suspected secondary to increasing intraabdominal hypertension due to ileus unresponsive to standard conservative measures including nasogastric tube insertion, use of prokinetic agents and judicious fluid management. We performed Botox A injection under ultrasound guidance to the lateral abdominal wall musculature. This resulted in improved abdominal wall compliance, consequent resolution of respiratory symptoms and reversal of acute renal injury with eventual resolution of ileus and a good post operative outcome. There was an increase in length of stay by 2 days compared to our average. The patient remains well at 3 months post operatively.

Conclusions
Botulinum Toxin A injection can be considered as adjunct in the medical management of IAH and ACS if it has not been used in the pre-operative setting.
929 Case Report -Post Cataract Surgery Fungal Infection Presenting as a Mass Lesion
Authors: Arun Shankar A P 
Published: August 2023

Abstract

Purpose
Fungal endophthalmitis is rare and usually causes poor outcome in untreated patients. It is important to document and be aware of uncommon presentation of fungal endophthalmitis.

Case report
68-year-old male presented with complaints of redness, pain, and blurry vision in the right eye for the past 5 months. He underwent an uneventful cataract surgery in the right eye 5 months ago elsewhere and in the post operative follow-up was found to have high intraocular pressure for which he was started on antiglaucoma medications. Aqueous tap did not reveal growth of any microorganism. On examination his vision in both the eyes were 20/20. Slit lamp examination revealed congested conjunctiva, corneal superficial punctate keratitis, anterior chamber 2+ cells and 1.2mm white mass over the iris which was encroaching towards the pupillary margin. Ultrasound bio microscopy revealed 0.8mm x 1.5mm mass in the iris at 11 -12 o’clock position. Since there was a diagnostic uncertainty, excision biopsy was done which revealed fungal filaments on KOH staining. The patient was started on tablet voriconazole and advised to review in 1 month.

Conclusions
Due to the rare frequency, there is a lack of understanding of presentation of fungal endophthalmitis. Many cases series analysis have suggested that the late fungal endophthalmitis presents as clumpy anterior chamber or posterior chamber inflammation [1], white plaque over the lens [2], peripheral vitreous lesion or as chorioretinitis. Our case report shows a rare presentation of fungal endophthalmitis in the form of mass lesion on the iris.
997 Traumatic Jejunal Rupture Following Gaelic Football Game. Case Report
Authors: Croitoru C , Mallon C , Harron M 
Published: August 2023

Abstract

Aim
Abdominal injury accounts for just 6.3% of injuries in sport. The most common mechanisms are contacts with a player (74.5%), a surface (8.1%) or equipment (0.6%). Only twelve cases of Jejunal rupture are described in the literature.

Method
This case involves a young Gaelic football player who had significant abdominal contact with other players’ knees. He experienced nausea and left flank pain radiating to the groin. At the Emergency Department the heart rate was 95 beats per minute and blood pressure was 120/70 mmHg. There was bruising in the left flank at the impact site and some guarding. Initial investigations showed normal inflammatory markers and a normal Chest X-ray. Nine hours later the white cell count had increased to 17.85x10^9 and CRP to 106mg/L. Abdominal and Pelvic CT scanning suggested a bowel injury with free fluid in the left flank and pelvis.

Management
Exploratory laparotomy identified a jejunal rupture 10cm distal to the duodenal-jejunal flexure. A primary two-layer repair was performed. Antibiotic and anti-fungal cover were prescribed, and he was discharged well on day 5.

Conclusions
Owing to the rarity of bowel injury after blunt trauma, soft peritoneal signs and radiological insensitivity, the diagnosis of small bowel perforation is often delayed and can be associated with marked morbidity and mortality. Serial examinations and a high index of suspicion is required to detect bowel injuries in the case of blunt abdominal trauma in contact sports.
1036 Colonic Erosion of a Laparoscopically Inserted Adjustable Gastric Band
Authors: Saini K , Fakih-Gomez N 
Published: August 2023

Abstract
The popularity of laparoscopic adjustable gastric band surgery has declined over the past decade. This is partly due to concerns about a high rate of long-term complications, including band erosions occurring in over 1% of cases. Erosion into the colon is exceedingly rare, with only three reports in the literature. Our images/video illustrate the case of a 51-year-old female patient presenting in February 2022 with abdominal pain and two chronically discharging sinuses around her port site. She had a gastric band initially fitted in 2010, which was revised in 2018. The port was re-sited in 2021 following port-migration and flipping. On this presentation, a CT scan revealed 16cm of tubing within the lumen of the descending colon. Our procedure began with diagnostic laparoscopy, showing the gastric band tubing entering an inflammatory phlegmon in the left flank involving omentum and descending colon attached to the abdominal wall beneath the port site. The tubing was cut near to the gastric band. The gastric band was freed, divided, and removed. The previous port site incision was extended around the external opening of the fistula, which was excised. The port and tubing were easily removed, though partly covered in faeces. A decision was made, based upon prior discussion with the patient, to leave the colocutaneous fistula in-tact. This avoided the risk of colonic resection and anastomosis in freeing the bowel. Stapling across the phlegmon and tract risked diverting colonic contents into another potential tract headed towards the stomach. Postoperative recovery was uneventful.
1142 Using Lipofilling to Improve Skin Quality Following Severe Radiation Necrosis to Enable Successful Joint Replacement – a Case Report and Literature Review
Authors: Satkunabalan M ri , Cavallaro D , Govindan Srinivasan K , Jagadeesan J 
Published: August 2023

Abstract

Case
A 74-year-old female patient presented with severe osteoarthritis and pathological fracture of the left knee, following treatment with radiotherapy of osteosarcoma over a decade ago. Surgical management of the fracture was initially not possible, due to radiation-induced fibrosis of the skin. She was referred to the plastic surgery department where she underwent a total of three sessions of fat grafting over nine months. The rigotomy approach was applied to the large area of irradiated skin. As a result, her skin quality improved such that a successful total knee replacement was possible. The outcome of this was better mobility and improved quality of life.

Conclusions
Skin quality after radiotherapy can limit surgical options, even decades after treatment. Fat grafting, also known as lipofilling, is a commonly utilised reconstructive and cosmetic adjunct. However, recent reports of its effect on skin quality are gaining popularity. We present a case of successful use of fat transfer to improve irradiated skin quality prior to successful joint replacement; this is a novel use case which we believe to be the first published.
1299 Puerperal Shoulder Pain: A Rare Case of Glenohumeral Joint Septic Arthritis
Authors: Kulkarni K , Khan A , Jump C , Hadi S 
Published: August 2023

Abstract

Introduction
Native glenohumeral joint septic arthritis is a rare manifestation of an occult bacteraemia. Without urgent diagnosis and intervention, septic arthritis can lead to rapid cartilaginous and joint destruction. We report an unusual presentation of postpartum streptococcal glenohumeral arthritis.

Case Description
A fit and healthy 34-year-old woman gravida 2 para 3 developed unremitting shoulder pain, reduced range of movement and tachycardia day 1 postpartum after a vaginal delivery associated with a grade two perineal tear. Initial blood work revealed rising inflammatory markers, CRP 275, WCC 16.2. Initial radiographs showed no significant abnormality. T2 weighted MRI revealed a large glenohumeral joint effusion. All samples from joint aspirate grew Group B streptococcus (GBS), concordant with a high vaginal swab taken in the late third trimester. The patient underwent urgent arthroscopic washout and synovial sampling, growing GBS. Transthoracic echocardiogram revealed no imaging evidence of infective endocarditis. The patient was commenced on an appropriate 6-week intravenous antibiotic course and clinically improved. Physiotherapy and rehabilitation improved shoulder range of movements.

Discussion
There is a scarcity of orthopaedic complications reported with obstetric pathology. Atraumatic joint pain associated with physiological, or biochemical signs of infection should alert the diagnosing surgeon to consider septic arthritis. Haematogenous bacterial translocation can cause atypical presentations of septic arthritis. Routine biochemical parameters and arthrocentesis continues to prove to be the gold standard of diagnosis. A compilation of a case series detailing location, microorganism, complications, and effective treatment would prove useful to tailor management of these rare presentations.
376 Neoplasms of the Appendix- Are They Managed Appropriately?
Authors: Amir A H , Chia T M , Choy M , O'Connell L , Meshkat B , Nugent E , Joyce M , Regan M , Hogan A 
Published: August 2023

Abstract

Aim
Appendix neoplasms are rare. Half are neuroendocrine tumours (NET). Incidence of NET is 0.4 per hundred thousand and of low-grade appendix mucinous neoplasm (LAMN) is 0.2-0.3 per hundred thousand. Most are diagnosed incidentally on appendicectomy specimens. The aim of this study was to ascertain the incidence of appendix neoplasms managed in a tertiary referral centre and to ascertain compliance with international guidelines.

Method
A prospectively maintained gastrointestinal oncology database was interrogated over a six-year period (July 2016-July 2022). Histologically confirmed primary appendix neoplasms were included. Data collected included patient demographics, clinical presentation, management and follow up (median 38 months). Histopathological staging was according to the AJCC 8th edition. Institutional review board permission was not required.

Results
Incidence of appendix neoplasm over the study period is 1.3% (16/1259). These included 8 NET, 5 LAMNs, 2 invasive adenocarcinoma and 1 adenocarcinoid. A majority were managed with definitive appendicectomy. One patient underwent right hemicolectomy following discussion at tumour board meeting. Four patients were enrolled on a surveillance programme. A further four with LAMN underwent appendicectomy only and one had appendicectomy and partial caecectomy. Surveillance was not deemed necessary in any of the LAMN cases.

Conclusions
Incidence of appendix neoplasm in our centre is comparable to that reported in larger series (2%). All cases were discussed at tumour board meeting. Management in all cases was in keeping with current guidelines. While most patients had adequate margin clearance with appendectomy alone, a small number required further surgery and/or surveillance.
824 Complete Mesocolic Excision Is Safe and Results in Increased Lymph Node Harvest: Further Justification for Randomised Trials
Authors: Jones T , Butnari V , Hawkins R , Kung V , Banerjee S , Kaul S , Huang J , Rajendran N , Boulton R 
Published: August 2023

Abstract

Aim
Complete mesocolic excision (CME) for right hemicolectomy encompasses embryonic dissection planes, radical lymphadenectomy and vascular pedicle ligation at the origin. Compared to conventional D2 dissection, CME is associated with increased disease-free survival in population studies. Critics argue that morbidity from CME may be higher. We sought to examine complication rates and specimen oncologic characteristics in a cohort from a single NHS trust.

Method
We conducted a retrospective cohort study of all right hemicolectomies performed for adenocarcinoma between 3/1/2019 and 15/11/2022. The choice of CME or D2 lymphadenectomy was at the discretion of the operating surgeon. Data were collected from paper notes and electronic records. Statistical analyses used non-parametric testing.

Results
CME was performed in 30 patients and D2 resection in 99. The CME group were younger (70 vs. 72 years, p = 0.04) and preoperative nodal staging was higher. There were no differences in duration of surgery, estimated blood loss, postoperative haemoglobin or transfusion requirement. Only 20% patients in the CME group had a significant complication compared to 40% of the D2 group (p = 0.05) and length of stay was reduced (5 vs. 7 days, p = 0.02). Nodal harvest was increased in the CME group (24 vs. 19, p = 0.01) with no difference in R0 resection rate.

Conclusions
CME appears to be safe and does not result in increased complication rates in this single institution cohort. Nodal harvest is increased with comparable margin clearance. Whether this translates to increased disease-free survival is unclear. There is equipoise and randomised studies examining long-term outcomes are justified.