bluuebunny/crossref_metadata_2025_split huggingface dataset:
221 Prevalence of breast cancer patients with distant metastases at the time of presentation – A retrospective cohort study
Authors: Shanmugharaj Yogita , Hughes Tara , Jaskani Sadia , Shah Elizabeth 
Published: August 2023

Abstract

Introduction
About 8% of new breast cancer patients have distant metastases at presentation.[1] Current local practice is to perform staging CT on selected patients. The aim of this study was to investigate the prevalence of distant metastases in a cohort of newly diagnosed breast cancer.

Methods
A single-institution retrospective analysis of prospectively collected database of all newly diagnosed patients between January and June 2019 (pre-covid era). Patients with previous history of breast cancer were excluded. Data was collated from hospital medical records. SPSS version 21 was used for analysis.

Results
A total of 85 patients with a mean age of 66±15.593 were included. Tumour size ranged from 1.4 to 83mm. 22.4% were ER Negative, 14.8% HER2 positive and 37.3% node positive. Almost half of the patients (49.4%) underwent staging investigations at first presentation. The incidence of distant metastases within 1 year of presentation was 10.6% (9/85). 4/9 (44.4%) presented late with symptoms greater than 3 months duration. On applying one-way ANOVA to compare means, distant metastases at presentation was significantly related to grade (p-value= 0.002) and nodal status (p-value=0.006). There was no statistically significant relationship to age, ER/HER-2 status, tumour size or duration of symptoms.

Conclusions
Metastatic breast cancer at presentation in our cohort appears concordant with the literature. Distant metastases within a year of presentation is significantly related to grade independent of nodal status, and staging investigations should be considered in early breast cancer patients with higher tumour grade irrespective of other factors.
1. https://pubmed.ncbi.nlm.nih.gov/35018787/
232 The inGuinal heRnia OperatIon Notes (GROIN) Quality Improvement Project
Authors: Kapsampelis Panagiotis , Prce Daniela , Saunders Jada , Bezzaa Sabrina , Gerogiannis Ioannis 
Published: August 2023

Abstract

Aims
Accurate and comprehensive operation notes are crucial for patient safety, quality assurance and medico-legal purposes. Inguinal hernia repair is one of the most common surgical procedures. Thus, operative documentation should be precise and standardised. The GROIN project aims to improve the quality of inguinal hernia operation notes using evidence-based proformas and an operation note composition software.

Method
We retrospectively reviewed operation notes of inguinal hernia repair performed at our institution between August and November 2022. Operation notes were assessed against the Royal College of Surgeons' Good Surgical Practice standard, consisting of 18 items.

Results
The operation notes from 89 cases were reviewed. High-scoring items included: operation name (100%), operative findings (99%), surgeon's name (99%), closure technique (98%), operation date (90%) and signature (90%). Postoperative instructions were sufficiently detailed in 79% of cases. Regarding mesh placement, 63% of notes described mesh size and type, whereas 30% documented only the mesh type. The lowest-scoring items were: venous thromboembolism prophylaxis (31%), designation as elective or emergency (22%), operative diagnosis (6%), and estimated blood loss (2%).

Conclusions
We identified several areas for improvement in inguinal hernia operation notes based on our results. The next step of the GROIN project is to standardise operation note creation by implementing an evidence-based template, which will be delivered through a novel operation note composition software. This will allow accurate record-keeping and efficient operative data extraction analysis. Efforts to standardise operative notes and enhance their quality on a national and international level are imperative for patient safety.
235 A case of Painless Palpable Gall bladder - a rare Exception of the Courvoisier's Law
Authors: Pal Shreya , Pusalkar Aditya , Choudhry Mazhar , Pangeni Anang , Shrestha Ashish K 
Published: August 2023

Abstract

Introduction
The Courvoisier's law states that a painless palpable enlarged gallbladder with jaundice is unlikely to be caused by gallstones. There are however various exceptions to the law. We report a rare case of such an exception to make us aware of the clinical condition.

Case Description
72-year-old male, otherwise fit and healthy, presented to the Emergency department with epigastric discomfort, along with dark urine and pale-coloured stool. He was clinically examined to have jaundice, and a painless globular palpable gall bladder, with blood results confirming obstructive picture i.e. raised bilirubin (70 μmol/L), ALT (103 U/L) and Alkaline Phosphatase (590 IU/L). Ultrasound abdomen showed acute cholecystitis. CT chest-abdomen-pelvis showed cholelithiasis and choledocolithiasis with dilated common bile duct (CBD), as well as asymmetric gallbladder wall thickening. The MRCP showed concentric and uniform thickening of the entire gallbladder wall, with minimal pericholecystic fluid reflecting acute inflammation. Multiple calculi were noted to be present within the CBD and gall bladder, resulting in dilation of CBD (15.8mm).
The patient had ERCP with sphincterotomy and retrieval of multiple stones by balloon trawl. He was discharged the following day and is planned to undergo laparoscopic cholecystectomy as an elective procedure. His liver function test markedly improved at discharge bilirubin of 18 μmol/L and ALP of 364 IU/L.

Conclusion
This is an unusual case of painless jaundice with palpable gall bladder due to stones impacted in the CBD and not due to periampullary carcinoma, which is an exception to the Courvoisier's Law.
270 The Liberal Use of Magnetic Resonance Cholangiopancreatography (MRCP) can be switched over to its Selective use to detect choledocholithiasis
Authors: Haji Altaf , Elhassan Ali , Elkadi Mahmoud , Sivakumar Naveen , Piramanayagam Bala , Syed Ijlal Haider 
Published: August 2023

Abstract

Background
Gallstone disease is known in 10-15% of adults in Western populations. Cholangiopancreatography is the investigation of choice for choledocholithiasis; however, its use is varied, and guidelines are not well-defined. The NICE guidelines recommend MRCP be done when common bile duct dilatation ≥ 8mm or liver function tests) are abnormal but do not quantify this further. The liberal use of MRCP is gaining popularity as a roadmap prior to cholecystectomy, aiming to assess primarily for the presence of migrated gallstones within the cystic duct or common bile duct, as well as providing information regarding the anatomical features of the extrahepatic biliary tree on an individualized basis. Due to these reasons, MRCP is at times done unnecessarily which creates an economic burden and restricts access to patients in real need of imaging slots.

Method
It is a hospital-based retrospective observational study. The time frame was July 2021 to July 2022. The sample size was 230 patients.

Result
Our Study showed that isolated elevated Alanine Aminotransferase levels should not be a reason to evaluate patients for Choledocholithiasis. It concluded that elevated serum bilirubin levels, Alkaline Phosphatase, and Gamma Glutamyl Transferase are the strongest predictors of CBD stones in patients with gallstone disease and hence can be used to triage patients for undergoing MRCP.

Conclusions
To conclude elevated serum bilirubin levels, ALP and GGT are the strongest predictors of CBD stones in patients with gallstone disease and hence can be used to triage patients for undergoing MRCP. Isolated elevated ALT should not be a reason to evaluate patients for CBD stones.
279 Quality and Prognostic Value of Colorectal Cancer Pathology Reports
Authors: Papalois Zoe-Athena , Nash Daniel , Howard Mark 
Published: August 2023

Abstract

Aim
Comprehensive pathology reports are essential to inform clinical decision-making. An internal audit was conducted to determine whether the Trust Histopathology department fulfilled histopathological reporting standards for colorectal cancer (CRC) by the Royal College of Pathologists (RCPath).

Methods
Pathology reports for CRC surgical resection specimens between 2018-2021, were reviewed. Resections were from symptomatic (non-screening) patients, with no preoperative treatment. Benign or endoscopically obtained specimens, and non-primary CRC were excluded. Reports were reviewed for compliance with the CRC categories: I. median number of lymph nodes attained (≥12 per specimen) II. cases showing extramural venous spread (≥30%) III. cases showing peritoneal/serosal involvement (≥20%).

Results
277 reports were included. Median lymph node yield was consistently &gt;12, throughout. &gt;30% of specimens demonstrated venous invasion between 2018-2020, however, 24% of specimens in 2021. Nearly all reports commented on the depth of venous invasion (e.g. ‘intramural’/‘extramural’) by 2021. &gt;20% specimens demonstrated peritoneal involvement between 2018-2020, however this was 16% in 2021.

Conclusions
The quality of reports was high and consistent. There was overall compliance with the RCPath requirement. Results from 2021 may be affected by changes to pre-COVID CRC treatment pathways, with more patients presenting at a more advanced stage and receiving initial neoadjuvant treatment. As venous invasion is an independent prognostic indicator, documenting the extent of invasion is a quality assurance factor.
309 Comparison of Lichtenstein Procedure with and Without Mesh Fixation for Inguinal Hernia Repair in Terms of Postoperative Pain
Authors: Riaz Ilyas , Rauf Sidra , Ayubi Azaz , Ajaz Hamda , Mujahid Sheeza , Sakhizada Fahim 
Published: August 2023

Abstract

Aim
Although advanced techniques have been adopted in inguinal hernia repair parallel to those in developing medical technologies, currently no consensus has been reached on the best method among all existing methods. Post-operative pain is the main reason far longer hospital stay and delay in return to daily routine work. Aim of study was to compare the mean post operative pain of Lichtenstein procedure with and without mesh fixation for inguinal hernia repair.

Methods
Randomized control trial was conducted for six months after approval of synopsis. After permission from the concerned authorities and ethical committee and informed consent, patients were selected from indoor-patient department. All patients were assessed by consultant surgeons with more than 2 years of experience after fellowship, and the patients were prepared for hernia repair. Two groups were formed, Group-A included those managed by without mesh fixation and Group-B who were managed withmesh fixation. All the patients were assessed for postoperativepain at 24 hours by visual analogue scale (VAS).

Results
In our study, comparison of mean post operative pain score in both groups shows 3.23+0.77 in Group-A and 3.98+0.76 in Group-B, p value was 0.0001.

Conclusion
We concluded that post-operative pain is less in patients managed by Lichenstein repair without mesh fixation as compared to patients managed with mesh fixation.
314 Comparison of hemorrhoidectomy by LigaSure and conventional Milligan Morgan's Technique
Authors: Akhtar Fahad , Rauf Sidra , Noor Aiman , Ayubi Azaz , Sakhizada Fahim 
Published: August 2023

Abstract

Aim
To compare outcomes of hemorrhoidectomy by LigaSure and conventional Milligan Morgan’s hemorrhoidectomy.

Methods
In this randomized controlled trial, we enrolled a total of seventy adult patients of either gender between age 17-80 years. All the enrolled patients presented with 3rd or 4th degree haemorrhoids and were planned for hemorrhoidectomy. The patients were assigned to two treatment groups. Group A (Milligan Morgan’s) patients were enrolled from one hospital and Group B (LigaSure) patients were enrolled form second hospital. Post-operative pain was assessed in both groups using VAS at 6, 12 and 24 hours along with amount of blood loss during the surgery. Duration of surgery (min) was estimated and compared in both the groups.

Results
There were 62.9% males and 37.1% females in group A and 80.0% males and 20.0% females in group B (P=0.112). Mean age in group A and group B patients was 43.3 years ± 11.3 SD and 46.4 years ± 8.2 SD respectively. In group A, there were 68.96% patients having grade III and 31.4% patients having grade IV haemorrhoids and in group B, 57.1% patients had grade III and 42.9% patients had grade IV haemorrhoids (P=0.322). Mean VAS at 6 hours, 12 hours 24 hours, mean amount of blood loss during the surgery and mean duration of surgery was significantly shorter (P=0.001) in patients of group A as compared to patients of group B.

Conclusions
The LigaSure method had significantly lower degree of post operative pain, lesser amount of blood loss during the surgery and shorter duration of surgery as compared to Milligan-morgan method.
342 The NHS in crisis; assessment of the impact of litigation trends over 20 years in general surgery
Authors: Wallace-King Sabina , Musbahi Aya , Coates Rachael , Mofidi Reza 
Published: August 2023

Abstract

Introduction
A rising proportion of the NHS annual budget is being spent on medico-legal costs, with over 1.6% of total UK healthcare spending on litigation in the year 2018/19. This is a risk to both patient care and public opinion of the NHS. Despite this, surgical litigation is a relatively understudied subject. This paper aims to assess the scale of the litigation crisis to fuel further work into mitigating it and improve value for patients and staff alike.

Method
Data was obtained via a Freedom of Information request from NHS resolution for all claims relating to General Surgery between January 2000 and December 2020.

Results
17,542 claims were made against General Surgical units in England with a gradual increase in claims per year. The successfully closed claims cost £1.3 billion. This was out of proportion to both inflation and case volume. The three most common causes for claims were intra-operative problems, failure/delay of treatment and failure/delay of diagnosis.

Conclusion
The NHS is threatened by a litigation crisis, with case volume and cost rising out of proportion to surgical workload and inflation. The most common causes for claims against surgical units are known complications discussed as part of a standard consenting process, indicating that current practice may fail to achieve adequate patient understanding of surgical risk. More research is required to design methods to improve the current consenting process, and to identify specific demographics that may increase an individual’s propensity to make a claim and establish modifiable risk factors.
364 Surgical confidence over a rotation in foundation year one doctors in a busy district general hospital
Authors: Savage Daniella , George Jayan , Wafai Ahmad Hisham , Samuel Nehemiah , Yeluri Sashidhar 
Published: August 2023

Abstract

Aims

Methods
FY1 doctors were surveyed in December 2022. Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
10 FY1 doctors (10/10) completed the pre-questionnaire and post-questionnaire.
Confidence levels were greater across all Likert scale questions at the end of the rotation.
Confidence levels at the start of the rotation had a modal score of 1 in managing the deteriorating surgical patient, end-of-life care and prescribing pre-emptive medications.
The lowest confidence levels at the end of the rotation were for speaking to a dying patient’s family and speaking to a patient about their management when their condition is unknown.
Common concerns of FY1 doctors were not being able to contact a senior in theatre and the busyness of the specialty.
Most FY1 doctors felt that case-based discussions would be the preferred method to increase understanding of general surgery.

Conclusions
Confidence levels improved by the end of the rotation. Targeted case-based discussions may support increasing confidence before and through the rotation.
381 A Rare Case of CBD obstruction secondary to Endometriotric cyst
Authors: Nadeem Tehmina , Lim Jieqi , Lykoudis Pavlos 
Published: August 2023

Abstract

Background
Bile flow obstruction due to bilary tree pathology is well documented. Intramural causes include gallstones and infections such as clonorchis sinensis and Ascaris Lumbriocodes1 mural causes include autoimmune diseases e.g Sclerosing cholangitis. Extrinsic compression are usually due to malignancy e.g Cholangiocarcinoma or pancreatic head carcinoma. we encountered a rare case of common bile duct (CBD) obstruction cause by large endometriotic cyst.

Case report
A fit & well, 85 year old female presented with gradual onset of Obstructive jaundice. admission Liver function tests indicated a Bilirubin of 485 subsequent Ct scan revealed a large endometriotic Cyst (15cm x10 cm) indenting the CBD and stomach. Endoscopic ultrasound confirmed the presence of a large cystic fluid collection. Patient`s biliary system was indirectly decompressed with AXIOSTM via gastric wall into cyst Copious dark brown non-viscous fluid was drained into stomach. Cytology results reported benign cyst contents without mucin or neoplastic epithelial cells. Fluids Amylase was 121 U/L. the patient recovered well, with resolution of Bilirubin.

Discussion
Endometriotic cyst have been reported to cause organ obstruction such as CBD and ureter1,2 patient's from previously reported cases had to endure major surgery to achieve symptomatic relief.
AXIOSTM stent is a device commonly utilized for drainage of pancreatic pseudocyst and we report the use of it as a Novel and minimally invasive technique in this rare case of CBD obstruction.
References:
1-A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol. 2019 Feb 28;25(8):1002-1011.
2-Liver Tumours Due To Endometriosis And Endometrial Stromal Sarcoma".
420 Parathyroid surgery outcomes - 2 surgeons outcomes for the past 9 years in a teaching hospital
Authors: Kho Jason , Kuan Jen Yee , Turner Paul , Shetty Vinutha 
Published: August 2023

Abstract

Aim
The success of parathyroid surgery in hyperparathyroidism is defined by the sustained improvement in calcium levels without the need for re-exploration. Reoperation rate in the United Kingdom currently sits at 1.6%. It has been shown that the need for repeat parathyroid surgery is related to surgeon annual volume. We aimed to review the outcomes of parathyroid surgery for hyperparathyroidism performed by two upper gastrointestinal surgeons experienced in parathyroidectomies.

Methods
Retrospective review of consecutive parathyroidectomy cases performed by VS and PT in a teaching hospital was conducted between April 2013 and December 2022. Data was obtained from local hospital database. Primary outcome was re-exploration within one year of index procedure. Secondary outcomes included methylene blue uptake by adenomas and postoperative vocal cord palsy.

Results
211 parathyroidectomies were performed during the study period. Patient cohort was predominantly female (n=153, 72.2%). Mean age of study population was 57±13 years. Histopathology confirmed 171 (81.0%) parathyroid adenomas, 34 (16.1%) multiglandular hyperplasia and 6 (2.8%) normal glandular tissue. None were malignant adenoma. 4 (1.9%) patients required re-exploration within one year of index procedure, three of which were found to be ectopic adenomas. Preoperative methylene blue infusion was used in all cases to assist identification of adenoma; uptake was evident in 169 (80.1%) cases. 2 (0.9%) patients developed permanent recurrent laryngeal nerve damage, resulting in mild voice hoarseness.

Conclusion
Our dedicated parathyroid service led by experienced surgeons was associated with comparable re-exploration rates and high cure rates. Preoperative methylene blue infusion helps in intraoperative identification of parathyroid glands.
425 Appendicular Endometriosis- A rare presentation
Authors: Kaur Mandeep , Singh Anurag , Tonsi Alfredo 
Published: August 2023

Abstract
Endometriosis is a known gynaecological condition in young women of reproductive age group. It presents with many different symptom complexes, most common presentation being pain abdomen especially during menstruation. Pelvis is the most common site for endometrial deposits. Gastrointestinal endometriosis is rare. Appendicular endometriosis is rarer. There have been only a few case reports of endometriosis causing appendicitis.
We came across a case of perforation peritonitis in a young girl with a background history of endometriosis. Patient presented with sign and symptoms of acute appendicitis and on USS was found to have inflamed appendix. During diagnostic laparoscopy she was found to have gangrenous perforated appendix and a hard caecal nodule, which on histopathology revealed endometriosis. Another important fact revealed on histopathology is bleeding into the endometrial tissue. This patient underwent laparoscopic right hemicolectomy. Post – operative recovery was well and uneventful. Patient was discharged from the hospital on 5th day post operation.
We did a literature research to find out that there have been only two cases of perforated appendicitis mentioned in literature. While endometriosis is a common disease and may lead to appendicitis but it is not very common for it to present it as perforation peritonitis.
426 Litter's Obturator hernia- A Rare presentation
Authors: Singh Anurag , Kaur Mandeep , Abogabel Sameh , Khera Goldie 
Published: August 2023

Abstract
We are reporting this case of Obturator hernia with Meckel’s diverticulum as content.
Obturator hernias are one of the rarest hernias accounting for 0.07-1% [1] of all the hernias. Litter’s hernia, as described by Alexis De Litter in 1700s, is the protrusion of a Meckel’s diverticulum through a potential abdominal opening [1]. It is also a rare phenomenon [2]. After thorough review of literature we were able to find only 4 papers regarding similar occurrences, which make this case extremely rare [3] [4] [5] [6].
In this case report we will be presenting a case of 77 year old lady who presented with symptoms of small bowel obstruction. CT scan abdominopelvic was suggestive of small bowel obstruction due to obturator hernia. It was intra-operatively diagnosed as to be Obturator hernia with Meckel’s diverticulum as content i.e. a Litter’s Obturator Hernia