bluuebunny/crossref_metadata_2025_split huggingface dataset:
1266 Haemostasis Checklists-Are They an Effective Tool?
Authors: Amien B , Al-Jumaili Z , Harky A , Soppa G 
Published: August 2023

Abstract

Aim
Haemostasis checklists have been developed to decrease re-bleeding rates following cardiac surgeries. These checklists aim to identify the most common sites of bleeding, as well as reasons for coagulopathies and prevent them by early identification during surgery. The aim of this study is to Evaluate the effectiveness of the haemostasis checklist as a tool for reducing the rate of Re-exploration for bleeding in Liverpool heart and chest Cardiothoracic Centre.

Method
Retrospective study carried over the period of 2019 and 2022 (pre and post checklist implementation). This study included all patients who underwent elective cardiac surgery, 614 cases in each year. Data was analysed and classified into 3 categories: Number of Re-exploration cases in each year, Bleeding sites identified and the Number of post-operative days at which re-bleeding was noted.

Results
Total number of Re-exploration cases for bleeding in 2019 were 39(6.35%), as compared to 14(2.28%) cases in 2022. 60% of the re-bleeding cases in 2019 were identified within first 24 hours post-operative, while 77% were identified in the first 24 hours in 2022. Most common sites of bleeding identified in 2019, were no clear site (38%) and sternal wires (19%). While in 2022, no clear site (46%) and sternal wires (23%) were most identified during re-exploration.

Conclusions
Significant reduction of 64% was witnessed between the year of 2019 and 2022 after implementation of the checklist, therefore, Haemostasis checklist proved to be an effective tool in reducing the rate of Re-exploration for bleeding in cardiac surgery.
43 Case Report: A Novel Technique of Reconstruction Following Second and Third Ray Amputation and Excision of Lateral Sesamoid for Synovial Sarcoma of the Foot
Authors: AlSumadi M , Ogbuagu C , Chandrasekar C 
Published: August 2023

Abstract
Synovial sarcomas primarily occur in soft tissues close to the joints and extremities. When they arise close to the hallucal sesamoids, which play a role in the static and dynamic weight process of the foot, present a management dilemma.
We report a case of a soft tissue synovial sarcoma of the foot in a previously fit and healthy 17-year-old individual without any history of trauma. MRI of the foot showed the tumour near the lateral sesamoids. Histology obtained by ultrasound guidance confirmed a diagnosis of primary synovial sarcoma.
After radio-chemotherapy, Patient had an en-block excision of the second and third ray of the foot as well as excision of the lateral sesamoid and lateral stabilizing structures of the first metatarsophalangeal joint with transposition of the extensor hallucis longus of the second toe to the cavity of the excised lateral sesamoid.
Following recovery, with a preserved first ray, patient is still able to walk, run and tiptoe walk. Patient also remains tumour-free at 5-year follow-up. We hope that the reconstruction option can be used in selective indications to restore lateral stability of first metatarsophalangeal joint (MTPJ).
75 Intraoperative Use of Infrared Thermal Imaging Camera – a Clinical Aid for Pedicled Flaps in Hand Reconstruction
Authors: Lam C M , Begaj A , Patel N 
Published: August 2023

Abstract

Introduction
Venous insufficiency remains one of the commonest causes for flap failure. Forward-looking infrared (FLIR) thermography measures infrared emissions from dissipated heat and converts temperature values into an image. This has various advantages to the current use of indocyanine green (ICG) angiography to assess flap perfusion.

Case
A man in his mid-30s was involved in a road traffic accident and sustained extensive injuries to his right hand. These included multiple metacarpal fractures, degloving of the proximal aspect of the entire thumb and significant skin loss on the volar distal forearm. After several washouts and tissue debridement, a pedicled chest wall flap was performed. Five weeks later the chest wall flap was divided using an infrared thermal imaging camera (FLIR E5) intraoperatively as a clinical aid to assess perfusion. This detected a small area of venous congestion which was not detectable by clinical assessment.

Discussion
There are drawbacks to the current intraoperative use of ICG angiography to assess flap perfusion. These include hot flushes and skin rashes, and the technique requires an intraoperative injection, extensive equipment involving a screen and a specialised camera. In comparison FLIR cameras are handheld, easy to use and involves a one-off cost of purchasing the camera that is relatively inexpensive compared to ICG angiography.

Conclusions
Thermal imaging techniques such as FLIR provides an alternative intraoperative option for patients who are unable to have ICG, for centres that do not have access to ICG and for surgeons looking for more convenient alternatives.
199 A Giant Left Atrial Myxoma: An Atypical and Fortuitous Mode of Revelation Case Report
Authors: Zebirate L , Djilali Saiah R , Draou N E , Hamdi T , Atbi M 
Published: August 2023

Abstract
A large atrial myxoma was discovered fortuitously in a patient that had a seizure, showing the importance of further investigations even after assuming a diagnosis.
A 63-year-old male with no medical issues was admitted to the emergency department after having tonic-clonic seizure. Initial examination found a hemodynamically stable patient scored 8/15 Glasgow, 48 hours later a contrast cerebral CT was performed showing no abnormalities, but electroencephalogram revealed epileptic foci in the left temporal-parietal territories. The staff decided to complete the investigations with a transthoracic echocardiography which visualised an enormous left atrial mass. A cardiac magnetic resonance imaging (CMR) confirmed the atrial mass, measuring (87*47) mm over 73mm attached to the interatrial septum with a surface of insertion of 30mm that does not protrude through the mitral valve. The patient underwent open heart surgery. Left atriotomy found a myxoid-looking mass adhering to the posterior-inferior wall of the left atrium of 11 cm over 5 cm. The patient was discharged uneventfully on his 8th post-operative day and pathoanatomical analysis revealed a myxoma. We oriented the patient to neurology after surgery and no complications were reported on his 3 months follow-up.
The aim of this case is to highlight three points: myxomas can remain asymptomatic for a long time despite their size, transthoracic echocardiography is a rapid and efficient bedside assessment, and a symptom can reveal more than one diagnosis.
273 Open Split Fracture of the Patella in a 14-Year-Old Child: An Unusual Occurrence
Authors: Sain B 
Published: August 2023

Abstract

Background
Patella fractures in children are rare, accounting for approximately 1 % of all paediatric fractures. Due to resilience and adequate flexibility, transverse patellar fractures are extremely rare. This case accounts for less than 10 cases of open transverse or split patellar fracture reported in literature among the paediatric population.

Case Presentation
A 14-year-old boy was brought in as a pediatric trauma call following a fall and collision of his right knee against a concrete wall on a turf ground while playing football. He had Crohn's disease (on Prednisolone). No history of bone or joint pain, fever, rashes, or juvenile idiopathic arthritis was noted.
On clinical examination, a 5cm open horizontal wound in the right knee with no visible bony fragments was noted. Imaging showed a split fracture of the right patella with wide separation of the superior and inferior fragments. Adjacent gas locules and haematoma which extended into the joint space were noted.

Clinical outcomes
Tension band wiring was done and the patient was placed in a full weight-bearing hinge knee brace with initial range of motion(ROM) of 0-30 degrees followed by an increase of 30 degrees at every 2 weeks.

Discussion
While sleeve fractures of the patella is more common, a transverse or split pattern is rather unusual and an open fracture in the paediatric population is rare. Other anomalies of the knee joint should be always excluded. The treatment protocol for children is the same as for adults. Restoring the extensor mechanism and realigning the articular surface is essential.
314 Isolated Tuberculosis of Appendix: A Case Report
Authors: Mathew M , Yilmaz O , Mathew T 
Published: August 2023

Abstract

Introduction
Stump appendicitis is a rare and delayed complication of appendectomy. In India, abdominal tuberculosis (TB) represents about 10% of the extra pulmonary TB and the appendix is involved in only about 1%. A combined occurrence of both conditions is very rare.

Case Presentation
A 24-year-old male presented to the General Surgery outpatients’ clinic with a 2-week history of right iliac fossa pain with no other associated symptoms. The patient had undergone an open appendectomy for perforated appendicitis 3 months prior to the current presentation. Per abdominal examination showed tenderness at the McBurney’s point. A CT abdomen revealed thickened and enhanced stump appendix along with adjacent fat stranding and multiple mesenteric nodes, suggestive of stump appendicitis. In light of the upward trend seen in white blood cell count, the patient was planned for a diagnostic laparoscopy and pre-anesthesia clearance was obtained. Intra-operatively, adhesiolysis of dense bowel and omental adhesions were performed. About 3.5 cm appendicular stump was resected. Micro-nodular peritoneal nodules were resected. The specimens were sent for histo-pathology examination.

Results
The postoperative period was uneventful with symptomatic relief. The biopsy of the stump described morphological features of caseating granulomatous inflammation, suggesting the possibility of tuberculosis while the peritoneal nodules showed infiltration of inflammatory cells. The patient was started on specific anti-tubercular treatment.

Conclusions
Appendicular TB is rare and of uncertain physiopathological etiology. The peculiarity of our case was the finding of abdominal TB presented as stump appendicitis. This may even be the first report with similar findings.
432 A Rare Case of Ipsilateral Foot Drop Due to Common Peroneal Nerve Palsy at the Level of Fibular Head Following Total Hip Arthroplasty
Authors: Sain B 
Published: August 2023

Abstract

Background
Common peroneal nerve (CPN) palsy after primary total hip arthroplasty (THA) is a rare complication with poor functional outcome and has a prevalence of 0.3-2.1%.

Case Presentation
A 77-year-old gentleman was diagnosed with severe osteoarthritis of the left hip and underwent a hybrid left total hip replacement via posterior approach in right-lateral position. There was no usage of spinal anaesthesia, leakage from the wound, intra-operative nerve injury or any localised haematoma. Post-operatively on day 3, he was noted to have foot drop with loss of foot eversion and dorsiflexion with sensory loss along the distribution of the superficial peroneal and tibial nerve.

Clinical Outcomes
Nerve conduction study of left lower limb showed absent left superficial peroneal sensory response, absent left peroneal to extensor digitorum brevis and tibialis anterior motor responses with denervation across the anterior and lateral left lower leg muscles suggestive of a severe partial lesion of the left common peroneal nerve at the level of fibular head. Patient was placed in a foot drop splint with follow-up neurological evaluation.

Discussion
Post-operative CPN palsy are mostly neuropraxias caused due to direct compression, either by surgical instruments or anatomical structures, or from tension or ischemia to the nerve during intra-operative limb manipulation or limb lengthening. Additionally, usage of cement less components combined with Enoxaparin or due to any haematoma may compress the nerve. Age, BMI and initial severity of sensory and motor neurological deficits are prognostic factors indicating recovery. Full recovery is between 16-56% of cases at an average of 15 months.
436 Total Arterial Revascularisation Complicated by Unexpected Vasoconstrictor Requirements
Authors: Raj Krishna G , Taylor M , Nwaejike N 
Published: August 2023

Abstract

Introduction
The debate surrounding conduit selection in multi-vessel coronary artery bypass grafting (CABG) persists. Whilst combined arterial and venous conduits remains the gold standard approach, some studies report superior long-term outcomes with total arterial revascularisation (TAR).

Case Description
A 48-year-old male was admitted with acute coronary syndrome. Investigations demonstrated significant triple vessel coronary artery disease with preserved biventricular systolic function. He had no major comorbidities. He underwent uneventful urgent off-pump CABG x 3 with TAR. Conduits used were a skeletonised left internal mammary artery (LIMA) and a radial artery. They were anastomosed to make a Y configuration. The LIMA was anastomosed end-to-side to the mid-LAD and the radial artery was anastomosed side-to-side to the first obtuse marginal and end-to-side to the posterior descending artery. Post-operatively the patient had significant drain output, resulting in haemodynamic instability and a significant increase in vasoconstrictor requirements. This led to vasoconstrictive spasm of the arterial grafts and cardiac arrest ensued. The patient underwent emergency re-sternotomy and institution of cardiopulmonary bypass. The arterial grafts were removed, and the patient was re-grafted with three saphenous vein grafts. The patient was successfully discharged home in a stable condition on the tenth post-operative day.

Discussion
Careful management of post-operative complications in patients who underwent TAR is required in order to reduce the risk of arterial graft spasm. Pre-operative planning should include the consideration of alternative conduit strategies in patients where higher post-operative vasoconstrictor requirements are anticipated.
439 A Rare Cause of Flap Loss and Wound Dehiscence After Immediate DIEP Flap Breast Reconstruction - Raising Awareness of Pyoderma Gangrenosum (Case Report & Literature Review)
Authors: Sayed M A , Wain R , O' Ceallaigh S 
Published: August 2023

Abstract

Aim
To raise awareness of post-surgical pyoderma gangrenosum (PSPG) as an uncommon but potentially devastating sequelae of free-flap breast reconstruction. Our patient developed PSPG ∼1 week after a DIEP flap. Symptoms and signs were of wound infection, and she was managed as such. Histology and MDT confirmed diagnosis 3 weeks later. Once appropriate treatment was commenced, a good response was seen. However, diagnostic delay meant multiple procedures, antibiotics, and a suboptimal outcome requiring secondary reconstruction.

Method
Retrospective case report compiled using CARE guidance. Literature review using PubMed/Science Direct.

Results
PSPG in free-flap breast reconstruction is rare (∼20 reported cases). Symptoms occur 4 days to 6 weeks post-op. Deteriorating wounds mimicking infection/ischaemia are classical, often associated with ulceration, irregular, raised borders. Positive wound cultures and late evolution of classic signs clouded diagnosis in our case. Our patient had several microbiological, haematological, and radiological investigations in the first 3 weeks; most were equivocal and, in retrospect, likely unhelpful.

Conclusions
PSPG should be considered when post-op wound infection is suspected in cases with non-classical signs. Given its potentially devastating effect on free-flap reconstruction, we recommend PSPG be discussed as a rare but serious complication during consent. A high index of suspicion is needed to avoid unnecessary antimicrobials, detrimental surgical procedures, and initiate appropriate medical management in a timely fashion. Good outcomes can be obtained if recognised early.
448 Case Study of a Giant Duodenal Perforation: Where Is the Ampulla?
Authors: Bin Mohamed Ebrahim M E , Lim C 
Published: August 2023

Abstract
Concurrent duodenal and gallbladder perforation is a rare finding. Whilst cholecystoduodenal fistulas have been observed in literature, massive duodenal perforation with gallbladder erosion has not been recorded. We present the case of a 77-year-old female who was found to have a giant duodenal perforation (measuring 10cmx5cm) with an associated gallbladder perforation as well. On patient’s first presentation, a Computed Tomography of the abdomen was performed due to abdominal pain and constipation. Images showed pneumoperitoneum and intra-abdominal free fluid. Upon performing an explorative laparotomy, findings of duodenal and gallbladder perforations were observed. Distal gastrectomy, cholecystectomy and gastrojejunostomy were performed. Due to uncertainty of the location of the ampulla to the ulcer edges, a cholangiogram catheter was advanced into the Ampulla of Vater via the Cystic Duct to definitively identify it prior to D1/D2 stapling. Gastrograffin study was conducted on Day-5, showing good contrast flow. No major events occurred during her post operative recovery. The main concern is inadvertent stapling of D1/D2 together with the ampulla. The passage of a catheter down the Cystic Duct, into the Common Bile Duct and through the ampulla is a definitive way to locate its position. In addition, Common Bile Duct patency with cholangiography can be ensured. Intra-operative improvisation such as advancing a cholangiogram catheter into the ampulla would assist surgeons in safely resecting proximal duodenum especially when it encroaches on the D1/2 junction.
539 Antegrade Manipulation and Retrieval per Rectum: A Novel Management Approach for Gallstone Coleus
Authors: Rosen J 
Published: August 2023

Abstract
Gallstone ileus is a rare complication of gallstone disease, while gallstone coleus is rarer still. Like gallstone ileus, it affects mainly elderly female patients. It is associated with high mortality and morbidity, as frailty is a significant issue in the patient demographic.
In this case report, we discuss a 94-year-old, who presented with large bowel obstruction secondary to a large gallstone in the mid-sigmoid colon. Neither conservative management nor retrieval via flexible sigmoidoscopy were successful. Due to worsening bowel obstruction, the decision to operate was made. Due to frailty, a pre-operative decision was made that she would not be for bowel resection or enterotomy. A hybrid flexible sigmoidoscopic/ laparotomy assisted removal was successful: a Pfannenstiel incision was made, the stone was milked distally, and eventually retrieved with flexible sigmoidoscopy via the anus.
We propose that in frail patients, a combined approach using laparotomy and flexible sigmoidoscopy may be considered as a method of gallstone removal. This avoids the significant risks associated with enterotomy or bowel resection.
569 Resection of Massive Pelvic Chondrosarcoma Using Custom Made 3D Printed Jig: A Case Report
Authors: Cohen C , Chandrashekara N , Hindiskere S , Chinder P S 
Published: August 2023

Abstract

Background
The pelvis is a complex structure associated with major neurovascular structures and so pelvic surgery can be challenging. In the field of skeletal tumours, the surgeon's main aim is to achieve adequate margins, which modern 3D printed technology can assist with.

Method
A 43-year-old man was found to have a 20(CC) x 13(AO) x 9.3(TR) cm chondrasarcoma at the inner aspect of the right iliac bone. The patient was consented for right sided type 1 hemipelvectomy and tumour resection using customised 3D Printed Jig. A 64-slice spiral CT pelvis was transferred to an image processing software (Materialise Mimics 21.0 and Materialise 3 Matic 13.0) to generate a 3D model. The Jig was printed by the FDM machine in ABS material and sterilised. Incision was made through standard ilioinguinal approach and tumour was visualised. Soft tissue was dissected over the posterior aspect of the Ilium for the placement of the jig and then fixed with k wire, following which osteotomy was done.

Results
Postoperatively the patient had no complications. At final follow up of 4 years, the patient was independently ambulant. Post op x-ray showed no signs of tumour recurrence at the operated site.

Conclusions
This case highlights the importance of preoperative planning and the use of modern technology in surgical resection. Customised 3D printed jigs help surgeons achieve good resections with R0 margins.
572 Pseudoaneurysm of Profunda Femoris Artery in a Patient Post Dynamic Hip Screw Fixation for a Neck of Femur Fracture: A Case Report
Authors: Cohen C , Chandrashekara N , Jamil W 
Published: August 2023

Abstract

Background
Profunda femoris artery (PFA) pseudoaneurysm as a complication of hip fracture is rare [1]. The majority of recorded cases of PFA pseudoaneurysm are caused by femur fractures, surgical operations, and penetrating trauma [2]. We present a case of PFA pseudoaneurysm following surgical fixation for neck of femur fracture with dynamic hip screw (DHS) and canulated cancellous screw.

Case Presentation
The patient sustained a fractured neck of femur fracture following a fall and was on long term antiplatelet therapy for ischaemic heart disease. Thery underwent surgical fixation with DHS and canulated cancellous screw but developed an unexpected drop in their haemoglobin post-op. Initial thigh ultrasound indicated a large, localised hematoma. Further investigation with CT angiography however demonstrated pseudoaneurysm of the branch of the profunda femoris artery. The patient was treated with coil embolization and was able to fully weight bear with support.

Discussion
Vascular injuries following hip fractures are becoming more common complications [2-4]. Pseudoaneurysms of the profunda femoris artery are an unusual but well-recognized consequence of proximal femoral fractures. When post-operative pain is unexplained, or the haemoglobin level drops, there should be a high index of suspicion for vascular injury. Ultrasound and CT angiography are useful investigations.

Conclusions
We present a case of pseudoaneurysm of the PFA in a patient following DHS for fractured neck of femur. This is a rare yet recognised complication of femur fractures and should be suspected where pain is increased or there is a sudden decrease in haemoglobin.