bluuebunny/crossref_metadata_2025_split huggingface dataset:
90 Breast Abscess Management: What Is Best for Breast?
Authors: Tam C , Lane R , Sinnatamby R 
Published: August 2023

Abstract

Aim
To assess the speed of resolution of breast abscesses presenting to the unit.
There is significant variation in the management of breast abscesses between units at a national level. Whilst the MAMMA study results are awaited, we wished to understand our unit’s outcomes in order to improve the patient journey.

Method
A single centre retrospective service evaluation of acute breast abscesses. The project was approved on the hospitals online QSIS system. The data was collected by interrogating the health records database using the following criteria: female, minimum age 16, presenting between 01/01/2017 - 31/12/2021. ICD codes for; breast abscess and/or breast infection were analysed with Excel (v16.40).

Results
298 notes were reviewed as a representative sample of outcomes (n = 700). 73 patients (24.5%) were correctly coded to have a breast abscess. The median age was 41 years (IQR 50-29.5). All received an USS scan within 24 hours. The cohort was stratified along smokers (32%) and lactational (23%) risk factors. Smokers were most likely to require I&D (39%) and had the longest duration of antibiotics (24 days). The median time for resolution was similar between those treated with serial aspirations (40 days) and those who needed I&D (42 days).

Conclusions
The study demonstrated prompt access to USS and aspirations. Each abscess presentation took approximately 1 month to resolve and needed 4 visits to the unit. This aspect of care is an area for improvement so that we can streamline the process and take pressure off valuable clinic slots.
272 Clinico-Pathological Factors Determining Recurrence in Phyllodes Tumour of the Breast: The 25-Year Experience at a Tertiary Cancer Centre
Authors: Sain B , Gupta A 
Published: August 2023

Abstract

Aim
The study aimed to assess the clinico-pathological features, diagnostic modalities and therapeutic interventions with their outcomes leading to recurrence in Phyllodes tumour (PT) of breast.

Method
A retrospective observational study entailing clinico-pathological data of patients who were previously diagnosed or presented with new PT of the breast between 1996-2021 was done. Data included- total number of patients diagnosed with PT, age, type of tumour on initial presentation and biopsy, side, size, therapeutic interventions- surgery (mastectomy or lumpectomy) and adjuvant radiotherapy, final biopsy type, recurrence and its type and time to recurrence.

Results
Among the total 87 patients who were pathologically proven to have PT, 52.87%(n = 46) were found to have recurrence. All patients were recorded to be in the female gender with a mean age of diagnosis at 39 years (range 15–70). Age&lt;40 years had the highest incidence of recurrence (54.35%) followed by age&gt;40 years with 45.65%. 55.4% patients presented with primary phyllodes and 44.6% had recurrent phylloides at presentation. Average time of local recurrence from the time of completion of treatment were 13.8 months whereas for systemic recurrence it was 15.29 months. Surgery(mastectomy/lumpectomy) was the major determinant for local recurrence(p&lt;0.05) followed by adjuvant radiotherapy(p = 0.04) and initial biopsy type for systemic recurrence(p&lt;0.05).

Conclusion
Patients who received adjuvant radiotherapy had minimal recurrence. Patients who were found to have malignant tumour on initial biopsy were prone to systemic recurrence over local recurrence. Surgery played a determining factor leading to an increased rate of local recurrence following lumpectomy over mastectomy.
236 The Hypercoagulable State in COVID-19 and Implications for Free Flap Surgery in the Lower Limb
Authors: Stark D , Hendrickson S , Dejsupa C 
Published: August 2023

Abstract

Aim
COVID-19 associated coagulopathy is widely documented in severe COVID-19 infection and COVID-19 Vaccine-Induced Thrombotic Thrombocytopaenia. However, much of this evidence relates to macrovascular thrombosis with limited evidence on the impact of previous mild, asymptomatic COVID-19 infection, or vaccination on microvascular thrombosis in free tissue transfer. We compared the rate of thrombotic complications in traumatic lower limb injuries requiring free flap reconstruction in the pre- and post-COVID era.

Method
Adult patients undergoing lower limb free flap reconstruction were identified at a single centre over two three-month periods (2019 and 2021). Standard thromboprophylaxis was used for all patients (intraoperative intermittent pressure devices, post-operative thromboembolic deterrent stockings, and prophylactic low molecular weight heparin until discharge). Thrombotic complications were recorded and compared using a chi-squared test.

Results
In the pre-COVID cohort, 51 patients underwent 52 free flaps. One flap (1.9%) suffered anastomotic thrombosis resulting in flap compromise. Post-COVID, 39 patients underwent 43 free flaps. Nine flaps suffered anastomotic thrombosis (21%) and one patient suffered a pulmonary embolus. This increase was statistically significant (p = 0.002). In the post-COVID cohort, four patients had a COVID-19 infection and 25 patients (64%) had at least one dose of a COVID-19 vaccine before free flap surgery. No patients had an active COVID-19 infection on admission.

Conclusions
In the post-COVID era there was an increased rate of thrombotic complications in lower limb free flap patients. Further research is required to delineate the best course of action when planning free tissue transfer for patients who have had previous COVID-19 infection or vaccination.
727 The UK Targeted Lung Cancer Screening Pilot Programme: The Southampton Experience
Authors: Amo-Afful S , Harrison O , Woo E 
Published: August 2023

Abstract

Aim
Performance of the community-based targeted lung cancer screening pilot.

Method
22,829 people between the age of 55 and 75 with a smoking history were invited to attend a one stop assessment inolving a questionnaire-based interview with a nurse, cardio-respiratory observations, and then spirometry. The patient’s risk of developing lung cancer was quantified using the Liverpool Lung Project (LLP) or PLCOm2012. Participants were offered low dose CT-scan (LDCT) if the calculated risk was greater or equal to 2.5% or 1.51% respectively. Pulmonary nodules found was followed up in a protocolised fashion.

Results
As of June 2022, 7754 patients had attended. Of these 4562 (59%) were invited for a follow-up scan and 820 (11%) of the follow-up patients required a second follow-up scan. 1,163 (25%) of the attendees have been referred onward as 2-week lung cancer or other specialities such respiratory and vascular. 117 (1.5%) of screened patients were diagnosed with lung cancer and staged histogically. 83 (73%) of confirmed lung cancer were in stage 1, while 10, 15, and 7 people in stages 2, 3 and 4 respectivey.

Conclusions
Targeted community-based lung cancer screening programme can detect curable early-stage lung cancer at risk groups.
132 Pseudoaneurysm of the Facial Artery After Tonsillectomy Managed with Endovascular Coiling: A Case Report
Authors: Khanal D 
Published: August 2023

Abstract

Introduction
We present a case of pseudoaneurysm of the facial artery after tonsillectomy managed with successful endovascular coiling.

Presentation of Case
41-year-old lady presented with a history of throat pain and 3 episodes of hematemesis on the 3rd, 4th, and 7th postoperative days after tonsillectomy and styloidectomy. She had undergone the operation 20 days back. Neurological examination was normal. Contrast-enhanced computed tomography scan of the neck showed – contrast-filled dilatation of a branch of the right facial artery in the right palatine tonsillar fossa within the operative bed – likely pseudoaneurysm which was managed endovascularly. The patient recovered fully after treatment.

Discussion
Tonsillectomy can have various complications among which one is the pseudoaneurysm of the facial artery which can be managed with coiling in the catheterization laboratory.

Conclusions
Pseudoaneurysm of the facial artery is a rare complication of tonsillectomy. Endovascular treatment of a pseudo aneurysm can be done.
179 Postpartum Uterus Causing Mechanical Bowel Obstruction
Authors: Mohammed A , Wagner B , Chambers A , Doe M , Randall J 
Published: August 2023

Abstract

Background
Intestinal obstruction is a common surgical emergency. Common causes of mechanical large bowel obstruction include malignancy, sigmoid volvulus, and diverticular disease. Due to the risk of bowel ischaemia and perforation, large bowel obstruction requires urgent recognition and treatment to prevent morbidity and mortality.

Case Presentation
35-year-old female developed nausea, vomiting and abdominal pain two days post emergency cesarian section at 39+5 weeks gestation. An abdominal X-Ray showed distended loops of large bowel and mechanical large bowel obstruction with a sigmoid transition point was diagnosed on CT. She was referred to the surgical team for further management and a flexible sigmoidoscopy under general anaesthetic was performed for decompression.

Results
The patient was reviewed the following day. She was asymptomatic and had opened her bowels. She was discharged from surgical follow-up at this stage following successful treatment and was able to return home with a healthy baby.

Conclusions
Mechanical compression from a postpartum uterus is a rare cause of mechanical large bowel obstruction, with just one previous case documented in the literature. Acute colonic pseudo-obstruction (Ogilvie syndrome) is a recognised postpartum complication, more common after cesarian section and an important differential with similar treatment options.
The recommend diagnostic imagining includes abdominal x-ray and/or CT scan with early surgical referral for consideration of interventional or surgical management in patients presenting with symptoms of bowel obstruction in the postpartum period. Conservative management should include lateral decubitus position.
261 Bilateral Femoral Neck Stress Fractures in an Active Adolescent Female: A Case Report
Authors: Nichols M , Aggarwal A , Duke K 
Published: August 2023

Abstract
Bilateral femoral neck stress fractures are uncommon injuries in adolescents. We present such a case in a 15-year-old athletic female with no preceding trauma or underlying metabolic bone abnormality. The patient presented to Accident and Emergency with a three-week history of left buttock and lateral thigh pain and one-week history of right lateral thigh pain. The pain developed during physical activity and was relieved upon rest. Activities included running, dancing, and attendance at a six-week cadet marching course. Simple analgesia did not alleviate the pain. History revealed low caloric intake and previous secondary amenorrhea. The patient was previously managed by the General Practitioner and physiotherapist for suspected atypical sciatica.
Physical examination showed a minimally antalgic gait and pain on palpation of the left groin. Both hips had full range of motion. Bone profile was normal. Radiographic films were initially interpreted as normal, however, formal reporting revealed sclerotic appearances to both femoral necks and a subtle break in the left femoral neck cortex. MRI confirmed the diagnosis of a complete displaced left femoral neck fracture and incomplete right inferomedial femoral neck fracture. Trace bilateral hip joint effusions were noted.
The patient underwent bilateral fixation with cannulated screws. One-month post-operative, she engaged in walking and swimming without pain. Radiographic appearances were satisfactory.
Early radiographic changes associated with stress fractures are subtle. This case highlights the importance of prompt formal radiological reporting and the early use of MRI as a diagnostic tool, particularly in patients with risk factors.
550 CSF Leak or Ear Wax? Logical Thinking in Emergency Management of a Collapsed Patient with Heat Stroke
Authors: Hern D 
Published: August 2023

Abstract
A man in his 60s presented to RESUS by ambulance on the hottest day of the year with suspected STEMI and collapse at home.
The patient was intubated and unresponsive (GCS 5), with global rigors. Hospital ECG showed sinus tachycardia. Body temperature was in excess of 41°C, confirmed on central temperature monitoring. Bilateral clear fluid was noted to be discharging from both ear canals.
Query CSF leak was indication for CT head, which was unremarkable. Considering this, efforts were focused on optimising body temperature. This was done with the use of ice packs and fans as well as continuous misting of cool water over the exposed patient. Improvement was shown with temperatures decreasing to 38°C.
In questioning the cause of the “clear fluid,” a swab of it placed on an icepack swiftly returned the fluid to its natural consistency of ear wax. As a result of the extraordinarily high body temperatures, ear wax had melted in both ear canals and started to leak out, giving the impression of a CSF leak.
This was simply identified at the bedside to refute the idea of a CSF leak. As CSF leak was the indication for a CT head, this could have been avoided with rapid cooling initiated earlier.
Unfortunately, this patient later died due to heat stroke.
Whilst avoiding the delay of a CT head most likely would not have changed the prognosis for this patient, it is useful to note the importance of logical thinking in an emergency setting.
851 Necrotising Otitis Externa Secondary to Ear Syringing in an Otherwise Healthy Patient: A Case Report
Authors: Hyland L 
Published: August 2023

Abstract

Introduction
Unrelenting unilateral otalgia in an elderly or diabetic or immunocompromised patient is clinically suspicious for necrotising otitis externa (NOE). This is an advancement of normal diffuse OE that can complicate into a number of severe neurological pathologies, and it is becoming increasingly common1. We report a case here of NOE that became acutely apparent following ear syringing, due to the introduction of micro-organisms into the external auditory canal (EAC). Literature review shoes only 3 previous articles that have explored this pathological link.

Case presentation
A lady in her 90s with no known diabetes or immunocompromise, presented with a combination of otalgia, otorrhea and profound hearing loss. This plethora of symptoms had developed and persisted following ear syringing she underwent for chronic wax impaction. A diagnosis of NOE was made based on the clinical symptoms, presence of a polyp on the anterior aspect of the external auditory canal (EAC) as well as positive Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) findings. Prompt administration of intravenous (IV) antibiotics was initiated in addition to biopsy of the polyp to send for histological analysis. Her overall clinic status improved, and she was ultimately discharged with a prolonged IV antibiotic course alongside outpatient antibiotic team (OPAT) support and advice given on the avoidance of ear syringing/aural irrigation or at least a reduction in frequency of its use.

Conclusions
This rare case emphasises the significance of ear syringing in precipitating NOE by the transmission of Pseudomonas aeruginosa via irrigation fluid or lavage instrumentation.
1146 Laparoscopic Retrieval of a Retained Video Endoscopy Capsule: Case Report and Review of Literature
Authors: Mian A , Georgiades F , Rajaratnam K 
Published: August 2023

Abstract
Video-Capsule-Endoscopy (VCE) is a non-invasive method and a useful tool in determining the aetiology of obscure gastrointestinal bleeding and in the diagnosis of Crohn’s disease. Despite its proven utility, VCE carries risks, primarily capsule retention (CR). This refers to the failure of the capsule passing by day 14. CR may suggest underlying pathology, but in the process can lead to several sequelae including obstruction. We report the case of a 28-year-old patient with suspected Crohn’s disease requiring laparoscopic bowel-resection and retrieval of the capsule. The patient presented in 2019 with bloating, crampy abdominal pain and altered bowel habits. Initial endoscopic and blood investigations were unremarkable, however subsequent tests revealed raised calprotectin and anaemia. OGD and colonoscopy remained negative. In April 2021, he underwent VCE, demonstrating an inflamed distal ileum with structuring. However, the capsule failed to pass. After a period of watchful waiting and multidisciplinary discussion resulting in a trial of infliximab and steroid therapy, the capsule remained in-situ as confirmed by sequential X-rays and CTs. In March 2022, he underwent uncomplicated 3-port laparoscopic small bowel resection and retrieval of the retained capsule and was discharged 2 days later. Our case demonstrates an optimal approach in the management of CR. An initial conservative trial with medical therapy was attempted. MDT discussion ensured both gastroenterologists and surgeons were involved in the decision-making. Finally, our literature review demonstrated a lack of concise guidelines. Thus, based on the latest evidence we developed an algorithmic flow chart for the management of retained VCE.
1226 The Role of Extracorporeal Membrane Oxygenation in William’s Syndrome Following Cardiac Surgery: A Case Report
Authors: Ali F , Cvetkovic M 
Published: August 2023

Abstract
Williams-Beuren Syndrome (WS) is a genetic syndrome seen in childhood, characterised by intellectual disabilities, outgoing personalities, elfin-like faces and cardiovascular complications. We report the story of a girl with WS who underwent complex cardiac surgery requiring extracorporeal membrane oxygenation (ECMO), to raise awareness of the perioperative challenges with WS.
At 2 years old, a cardiac murmur was incidentally discovered. Further investigations revealed WS with cardiac manifestations including peripheral pulmonary artery stenosis (PPAS) and supravalvular aortic stenosis (SVAS). Isolated SVAS repair was feasible, however the severity of pulmonary artery hypoplasia deemed her inoperable. Her care was redirected to palliation. 18 months later, she remained in good clinical condition which prompted the multidisciplinary team (MDT) to change their decision and proceed with complex SVAS repair surgery (Brom technique) at the age of 5. Postoperatively, 3 failed attempts to wean from cardiopulmonary bypass preceded veno-arterial ECMO, which lasted 7 days. She stayed in intensive care for 17 days, and in hospital for 28 days. Frequent MDT decision making was crucial during her complex care. The patient is currently 15 years old, in good clinical condition, albeit exercise restrictions.
WS patients have a known increased risk of perioperative sudden cardiac death and increasing use of paediatric ECMO, hence great attention and thorough preparation is required. Clear perioperative care guidelines for WS are essential to secure good outcomes in this patient population. This case demonstrated that MDT involvement and regular communication with the patient were key to deliver the appropriate care throughout her life.
455 Fine-Needle Aspiration, Ultrasound and Thyroidectomies in Patients with Thyroid Nodules Presenting to a District General Hospital – a Retrospective Audit
Authors: Hirayama Y , Kochilas X 
Published: August 2023

Abstract

Aim
To determine whether fine-needle aspiration, ultrasound and thyroidectomies were being performed appropriately in patients with thyroid nodules, and to compare the percentage of malignant cases for each histological classification with the national standards.

Method
Patients undergoing thyroidectomy in Northwest Anglia Trust (East of England) between October 2021 – October 2022 was identified retrospectively using the OPSC-4 codes. Medical records of 132 patients were retrieved, and data points extracted.

Results
We identified 103 female and 29 patients. The female cohort had a younger age distribution (median 52y) compared to the male cohort (59y). 42 patients underwent total thyroidectomy, 89 underwent hemithyroidectomy and 1 underwent lobectomy. 21% of the specimen was reported to be malignant, of which 74% was papillary cell carcinoma, 15% follicular cell carcinoma and 11% Hurthle cell carcinoma. Our percentage of malignancy in the Thy1a/c category was higher (5%) compared to the national figures of malignancy risk reported by RCPath (4%), whilst the rest were lower than the national figures (Thy2 = 0%, Thy3a = 13%, Thy3f = 19%, Thy4 = 50%, Thy5 = 94%). 100% of Thy3, Thy4 and Thy5 patients underwent diagnostic hemithyroidectomy. 15 patients did not have documentation of the U classification prior to thyroidectomy. There was 84% compliance with repeat FNAC requirements prior to surgery and 97% compliance with MDT discussion.

Conclusions
Current BAETS guideline states that thyroid nodules with benign appearances (U1 and U2) do not need to be followed-up, however we found a 15% of malignancy in these patients. Costs, risks and benefits of regularly undertaking fine needle aspiration in these patients must be considered.
809 Direct Referral Pilot- Speech and Language Therapy-ENT, Ninewells Hospital
Authors: Ganesh V , Thompson C , Kaighin S , Haddow K , Kennedy C 
Published: August 2023

Abstract

Aim
Ear, nose, and throat (ENT) specialists and speech and language therapists (SALT) work very closely together in management of speech and language disorders. Here at Ninewells Hospital, we have created a pilot project for a direct referral system, where voice referrals which have been vetted are referred directly to SALT, in which patients receive the necessary treatments and are then referred to ENT specialists if required.

Method
This is a retrospective audit. Patients who were referred directly to SALT were included in this study. A questionnaire was developed to assess patient’s satisfaction with this pathway via telephone. Five questions were asked about their satisfaction with different aspects of this study, including waiting times, concerns addressed, provided with clear explanations, patient involved in plans and overall satisfaction with ratings of between very good, good, fair, poor, very poor and prefer not to answer.

Results
41 responses were obtained, out of 67 patients included in this study. Majority of patients responded with very good and good in all aspects of the questionnaire 48.8% had a very good overall satisfaction from this project. 29.3% had a good outcome and 4.9% responded with fair and poor respectively.

Conclusions
This study highlights that SALT play a significant role in not only improving quality of treatment for patients but also the quality of streamlining to specialist care as and when needed. More work is required to look into this pathway further and to assess its feasibility for implementation in the future and in other hospitals across the UK.