bluuebunny/crossref_metadata_2025_split huggingface dataset:
1303 The Role of Cemiplimab in the Management of Locally Advanced and Metastatic Squamous Cell Skin Cancers: A Case Report
Authors: Kazzazi D , Bhojwani D , Coulson S , Fife K , Khatib M 
Published: August 2023

Abstract
This case report discusses the use of cemiplimab, an immune checkpoint inhibitor, as a single agent for management of locally advanced basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) in a 79-year-old male patient. The patient was initially referred to plastic surgery for facial lacerations closure after a fall and was incidentally found to have suspicious lesions on his central forehead, right lateral canthus, mid-face, & anterior shoulder. He had history of skin lesions treated with photodynamic therapy, and recent palliative radiotherapy and fixation of a right humerus pathological fracture. Biopsy of the lesions confirmed locally advanced BCC and SCC malignancies, and underwent staging imaging, which showed evidence of osseous metastasis and lymphadenopathy. The patient was offered operative treatment with hemi-maxillectomy, orbital exenteration, and neck and axillary dissection but opted for immunotherapy drug with cemiplimab in accordance with National Institute for Health and Care Excellence (NICE) guidelines for treatment. The patient's skin lesions improved significantly after 3 rounds of treatment with shrinkage of the right lateral canthus and right midface lesions, apparent resolution of the forehead lesion, and improvement in the chronic shoulder wound, and no palpable regional lymphadenopathy. This case report adds to the growing body of evidence supporting the use of checkpoint inhibitors for SCCs and BCCs, particularly in cases where surgery and radiotherapy are not suitable. It also discusses current guidelines and socio-economic implications of this treatment. Overall, further research/trials are needed to determine optimal management strategies and improve outcomes for patients with SCC and BCC.
336 Cardiopulmonary Fitness and CR-POSSUM in One-Year Outcomes of Colorectal Patients
Authors: Tay T , Fleet B , Golder U , Legga A , Davies E , Raymond T , Hawkin P , Janta E , Ryska O 
Published: August 2023

Abstract

Aim
Colorectal surgery can be a high-risk surgery. Risk stratification takes the form of calculation tools, like ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM), and measurement of cardiopulmonary fitness using exercise test(CPET). Literature search on Pubmed and Science Direct did not show any studies have reviewed correlation between both tests and postoperative outcomes of patients undergoing colorectal surgery. Hence, we aim to assess correlation of CR-POSSUM and CPET using postoperative morbidity as primary outcome.

Method
All patients with stage I-IV CRC who underwent CPET testing between January 2013-June 2021 were collected and followed-up for 30days. Major postoperative complications were classified using Clavien-Dindo Classification≥Grade 3. Anaerobic threshold (AT) and VO2Max were used as markers of cardiopulmonary fitness on CPET.

Results
In total, 160 individuals with both CR-POSSUM and CPET were included,64% were male,115 underwent surgery. Median age was 77.2(±8.0). Mean CR-POSSUM operative severity, physiology score and predicted mortality were 7.5(7-9), 11.7(6-18) and 7.0(0.7-28.4) respectively. Mean AT was 9.9(±2.27) kg/ml/min and VO2Max was 74.4(±15.2)%. These variables did not show normal distribution(p-&lt;0.05).
AT was correlated with VO2Max(p = 0.03), but not CR-POSSUM. VO2Max was correlated with CR-POSSUM physiology score(p = 0.002) and CR-POSSUM predicted mortality(p = 0.003). Fifteen (13%) patients experienced major post-operative complications. There was no correlation between presence of severe complications and AT, VO2Max or CR-POSSUM(p&gt;0.05).

Conclusions
Some CPET variables correlates with CR-POSSUM physiology score and predicted mortality. Low level of cardiorespiratory fitness did not predict major postoperative complication.
602 Bilateral Warthin's Tumour of the Parotid Gland: A 16-Year Retrospective Analysis and Systematic Review
Authors: Gupta A , Siddiqui Z , Nam R H K , Huynh R C T , Jan M , Dusu K , Dhar V 
Published: August 2023

Abstract

Aim
Warthin’s tumour (WT) is the second most common benign parotid tumour in the United Kingdom. The World Health Organisation (WHO) states that WTs are bilateral in 5-14% of patients. However, current medical literature varies significantly more. We aim to assess the frequency of bilateral WTs over the last 16 years at a large head and neck unit in Kent, England and to perform the first systematic review of literature on bilateral WTs.

Method
A single-centre retrospective analysis of patients who were diagnosed with WT on histology between January 1st, 2005, and December 31st, 2020 was conducted. A systematic review (PROSPERO Registration Number: CRD42022326846) of literature was performed using PubMed and the Cochrane Library. The inclusion criteria were full-text published studies in English describing patients, at any age, who were diagnosed with bilateral WTs.

Results
290 patients (112 females) diagnosed with WTs were included in our retrospective analysis. 24.5% of our patients had bilateral WTs. WTs in female patients were bilateral in 28.6% of cases and 21.9% in male patients. Our systematic review identified 157 papers, of which 14 met our inclusion/exclusion criteria. These studies reported the prevalence of bilateral WTs to range from 0.65% to 40% and the mean was 12.5%.

Conclusions
Our study showed that 1 in 4 of our patients had bilateral WTs and nearly a third of WTs in females were bilateral. This varies significantly from the WHO guidelines (5-14% bilateral WTs). This will be of interest to surgeons who discuss this disease with future patients.
125 Central Lymph Node Dissection Increases the Rate of Postoperative Complications During Thyroidectomy Surgery - a Retrospective Observational Study
Authors: Brzeszczynski F , Pryt M , Kusinski M 
Published: August 2023

Abstract

Introduction
Total thyroidectomy is a commonly performed endocrine surgical procedure. Where thyroid malignancy is suspected, additional central lymph node dissection (CLND) may be performed intraoperatively leading to greater tissue dissection. The aim of this study was to assess the impact of CLND during thyroidectomy surgery on postoperative outcomes.

Method
This single center retrospective observational study was performed with reference to STROBE guidelines. Data from 712 patients undergoing total thyroidectomy and total thyroidectomy with CLND was collected during a 1-year period between September 2021 and September 2022. Patients were assessed by demographic data, surgical characteristics and complication rates including hypocalcemia, dysphonia and length of hospital stay.

Results
567 of the patients underwent total thyroidectomy and 145 patients underwent a total thyroidectomy with central lymphadenectomy. There was no statistically significant difference in age (55 vs. 58, p = 0.768) or sex (88% vs. 86% female, p = 0.914) between the groups. Overall, there was a 14% rate of complications in thyroidectomy with CLND group and 8% rate in thyroidectomy group (p = 0.022). 4% and 7% rates of hypocalcaemia (p = 0.140), 3% and 8% rates of dysphonia (p = 0.016) were recorded in thyroidectomy with CLND and thyroidectomy alone groups, respectively. There was no significant difference in oesophageal damage or post operative bleeding rates between the groups.

Conclusions
Thyroidectomy with CLND compared to thyroidectomy alone is associated with increased rates of post operative complications. These findings are most likely associated with greater tissue dissection and tissue manipulation.
1189 Identifying Opportunities for Global Surgery in Cameroon: An Analysis of Existing Health Policies and Events
Authors: Takoutsing B D 
Published: August 2023

Abstract

Aim
analyze existing national health policies and events in Cameroon to identify opportunities for surgery, obstetrics, trauma, and anesthesia (SOTA) policies.

Method
We searched the Cameroonian Ministry of Health’s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English and analyzed using the ‘eight-fold path’ framework for public policy analysis.

Results
We identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: Governance (n = 25), infrastructure (n = 21), service delivery (n = 11), workforce (n = 11), information management (n = 10), and funding (n = 8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. Nineteen (32.2%) health policies and events focused on Bellwether surgical procedures. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder.

Conclusions
Most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.
1069 Radiological Diagnosis of Groin Hernia - The New Norm?
Authors: Nishith S , Greene K , Heshaishi M 
Published: August 2023

Abstract

Aim
Ultrasound is an effective means for diagnosis of groin hernia however, RCS England and The British Hernia Society recommend that herniae should be diagnosed clinically and ultrasound should not be arranged at a primary care level. Following an increase in radiologically-diagnosed herniae referred to the general surgery department, we sought to determine whether ultrasound was used as a primary diagnostic tool.

Method
Ultrasound requests received from primary care between January and December 2021 were identified using radiology department records. Exclusion of incomplete, follow up and paediatric scans (&lt;16 years old) was ensured. Electronic records were reviewed for clinical history, examination, radiology request and imaging report.

Results
342 patients were included. 193 patients had the right groin scanned and 149, the left. The predominant symptoms for which scans were requested were “lump/swelling” (46%) and “pain” (36%). 13% were for suspected recurrence. 27% had a hernia on examination and 45% had no documented examination findings. The most common clinical question on imaging requests was “?hernia” (63%). 143 (42%) of ultrasound scans positively identified a hernia. Of these, 52% had a documented hernia on examination.

Conclusions
Ultrasound imaging is commonly used to diagnose or confirm diagnosis of groin hernia in the primary care setting. This study was conducted during the COVID-19 pandemic; reduced access to face-to-face consultations may have resulted in increased use of imaging and absence of clinical examination in the assessment of these patients. Patients with suspected hernia should be reviewed by a secondary care specialist prior to diagnostic imaging.
1199 Impact of COVID-19 on Outcome from One-Stop Hernia Clinics at a District General Hospital – a Single-Centre Retrospective Observational Study
Authors: John J , Trung Le H B , Park E , Couper J , Mousfi S , Raja A , Malik M 
Published: August 2023

Abstract

Aim
The COVID-19 pandemic has created additional pressures on waiting lists for elective surgery due to cancellations and redeployment. There was a concern that clinicians may be reluctant to offer elective operations as a result. This study aims to investigate this by comparing the clinic outcomes of patients referred to our hernia clinic at a district general hospital pre- and post-pandemic.

Method
Data was collected retrospectively for patients reviewed at our department’s outpatient clinics between 01/04 – 01/07 2019 and 01/04 – 01/07 2022 to capture an equivalent pre- and post-pandemic era (n = 1,264). Demographic data (age, BMI, ASA, previous abdominal surgery) was collected based on the GP referral and the outcome was recorded from the clinic letter. A total of 234 (n = 101 in 2019; n = 133 in 2022) were referred to the one-stop hernia clinic and included in this study.

Results
The patients seen in clinic pre-pandemic had the following outcomes: 62.4% (63/101) were offered an operation, 19.8% (20/101) were discharged, 13.9% (14/101) had follow-up, and 4.0% (4/101) had imaging requested. In the post-pandemic era, the patients reviewed had the following outcomes: 68.4% (91/133) were offered an operation, 20.3% (27/133) were discharged, 4.5% (6/133) had follow-up and 6.8% (9/133) had imaging requested. The difference in operations offered between years was not statistically significant (p&gt;0.05). Furthermore. there were no significant differences in the demographics between the two patient groups that could have affected the analysis.

Conclusions
This study demonstrates COVID-19 has not made a significant impact on how frequently we offer our patients elective hernia operations.
894 Attitudes, Barriers and Difficulties to Discharge – a Qualitative Approach
Authors: Lukaszewicz A , Linganathan S 
Published: August 2023

Abstract

Aim
It is well accepted that prompt and effective discharges are crucial in order to sustain patient continuity of care, patient flow and create bed space for patients. Systematic difficulties and the health professional staffing crisis may create further barriers to satisfying the above statement. Thus, the authors have investigated the titled characteristics with a view to instigating beneficial changes.

Method
A curated questionnaire was designed and emailed to all health care professionals who worked within the general surgical department at the authors’ trust who completed discharge summaries. A total of 26 respondents completed the survey.

Results
The main obstacle in completing discharges was lack of patient knowledge (40% of respondents) followed by time pressure (28% of respondents). In addition, each discharge usually took 11 minutes or more. Discharge priority is deemed to be of variable importance, with 52% ranking it as moderate priority and 24% deeming it to be high priority. Multiple symbiotic factors were thought to be important in improving the discharge process. However, the single key factor was dedicated protected time to complete discharge paperwork (17.39% of respondents). 60% of respondents ideally favoured a typed discharge summary with 28% preferring dictation despite a lack of knowledge and understanding of the available resources.

Conclusions
This work has offered a valuable insight into the attitudes, barriers and difficulties surrounding discharges with scope to instigate improvements, such as the use of dictation software, protected time and subsequent possible policy changes.
586 A Systematic Review of Outcomes Following Pyrocarbon Hemiarthroplasty of the Shoulder
Authors: Low W X , Asokan A , Williams D , Aresti N 
Published: August 2023

Abstract

Aim
Pyrocarbon (PyC) is increasingly used in shoulder hemiarthroplasty (HA) due to its favourable tribology in reducing glenoid erosion. This systematic review aims to evaluate the clinical and functional outcomes, along with the survivorship of PyC HA.

Method
PubMed (MEDLINE), Cochrane, Embase, and Google Scholar were systematically searched from inception in accordance with the PRISMA guidelines. Searched terms included ‘Pyrocarbon OR Pyrolytic Carbon’, ‘Hemiarthroplasty’, and ‘Shoulder’. Studies reporting clinical, functional outcomes, or survivorship of stemmed PyC shoulder HA were included. Quality of evidence was assessed using the MINORS criteria.

Results
Six studies met the inclusion criteria. 197 shoulders with PyC HAs were analysed at mean follow-up of 30.1±7.6 months. The Constant Score improved from 35.1±16.5 preoperatively to 74.3±15.6 at final follow-up (p&lt;0.001). Patients with post-traumatic sequelae showed less of an improvement, from 25.4±15.4 to 50.5±20.7 (p&lt;0.005). Subjective Shoulder Value was reported in two studies, showing an improvement from 35.0±21.9 to 81.1±12.9 (p&lt;0.001). Statistically significant improvements in active range of motion were reported across five studies. Radiographic evidence of progressive glenoid erosion was observed in 24.6% of the shoulders, however only 1.7% were revised due to painful glenoid erosion. The overall revision rate was 7.4%.

Conclusions
The current literature suggests PyC HA provides promising clinical outcomes comparable to non-PyC alternatives. The rate of clinically significant glenoid erosion at short-term follow-up remains low. However, the paucity in the literature would benefit from larger and longer-term studies to validate the use of PyC HA over other forms of shoulder arthroplasty.
447 Haptoglobin Treatment to Improve Outcome After Aneurysmal Subarachnoid Haemorrhage: A Consensus Perspective on Clinical Translation
Authors: Galea I , Bandyopadhyay S , Bulters D , Humar R , Hugelshofer M , Schaer D ,   SAH Delphi Group
Published: August 2023

Abstract

Aim
Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating form of stroke with an unmet need to improve outcome. This study focusses on the development of intrathecal haptoglobin supplementation as a treatment by reviewing current knowledge and progress and arriving at a Delphi-based global consensus regarding the role of extracellular haemoglobin and research priorities for clinical translation of haemoglobin-scavenging strategies.

Method
A narrative review of the topic by searching PubMed with relevant keywords and through discussions with leading expert in the field of aSAH. A modified Delphi processes. Four virtual meetings were held, two prior to starting, and two during the first round. Otherwise, the study was conducted electronically.

Results
Clinicians (n = 72) and scientific experts (n = 28) from five continents participated in the Delphi study. Microvascular spasm, iInflammation, microvascular spasm, and initial intracranial pressure rise were deemed the most important pathophysiological pathways determining outcome. Extracellular haemoglobin was thought to play an important role mostly in iron toxicity, oxidative stress, nitric oxide homeostasis and inflammation. While useful, there was consensus that further preclinical work was not a priority, with most believing the field to be ready for early phase trial. The highest priorities were related to confirming haptoglobin’s anticipated safety, individualized versus standard dosing, timing of treatment, pharmacokinetics, pharmacodynamics and outcome measure selection.

Conclusions
These results highlight the pressing need for early phase trials of intracranial haptoglobin for aSAH, and the immense value of early input from clinical disciplines on a global scale during the early stages of clinical translation.
398 Histological Lymph Node Ratio and Long-Term Survival After Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma
Authors: Shaw C , Pericleous S , Patel K , Morare N , Khosh Zaban M , Davidson B ,   RAW Study Collaborators
Published: August 2023

Abstract

Background
Pancreatoduodenectomy (PD) is recommended in fit patients with a resectable pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. Early rates of recurrence are high and long-term survival is uncommon. This study aimed to investigate the association between histological lymph node ratio (LNR) and long-term survival.

Method
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n = 1484). Patients with histologically confirmed PDAC were identified, and five-year and overall survival rates were compared by LNR (number of positive resected nodes/total number of resected nodes). Analyses were performed using Fisher’s exact test, the Kaplan-Meier method, and the log-rank test.

Results
In total, 885 patients (59.6%) were found to have PDAC. Concerning LNR, 412 patients (48.3%) had a LNR &lt;0.2 and 437 (51.5%) had a LNR ≥0.2 (unknown: 36 cases). Five-year survival was significantly higher in the former (34.0% vs 10.5%, p&lt;0.0001). LNR was 0, &gt;0.0-0.2 and &gt;0.2 in 116 (17.5%), 261 (39.5%) and 284 (43.0%) patients, respectively (patients with missing data were excluded). Median survival was 646 (95% confidence interval: 526-766), 532 (483-581) and 438 (395-481) days, respectively (p&lt;0.00001).

Conclusions
In our multicentre study of PD patients with confirmed PDAC, a histological LNR ≥0.2 was associated with reduced five-year survival. Patients with a LNR of &gt;0.0-0.2 and &gt;0.2 lived a median of 114 and 208 days less than those with a LNR of 0.0.
1111 Should age affect the decision to offer pancreaticoduodenectomy to patients with a suspected malignancy of the pancreatic head? Results from a multicentre study
Authors: Patel K , Shaw C , Morare N , Pericleous S , Khosh Zaban M d , Davidson B ,   RAW Study Collaborators
Published: August 2023

Abstract

Aim
Prior studies have concluded that advanced age alone should not be an absolute contraindication to pancreaticoduodenectomy (PD). This study aimed to compare PD outcomes by patient age and quantify these risks.

Method
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n = 1484). Patients were grouped by their age and the following were compared: median length of stay (LoS), 30-day readmission rate, 90-day mortality rate, unplanned return to theatre rate, provision of nutritional support, five-year recurrence, and five-year survival. Comparisons were made using the Mann-Whitney U test and Fisher’s exact test.

Results
Concerning patient age, 7.1% were &lt;50 years, 15.7% were 50-59, 36.7% were 60-69, 34.1% were 70-79 and 6.3% were ≥80. 90-day mortality rates were 3.8%, 3.0%, 1.7%, 5.7% and 7.4%, respectively, and five-year survival was 31.1%, 41.2%, 32.5%, 28.5% and 21.9%, respectively. When those aged &lt;70 were compared to those ≥70, median LoS (13 vs 12.5 days, p = 0.8), 30-day readmission (9.6% vs 8.2%, p = 0.4), unplanned return to theatre rate (4.2% vs 6.0%, p = 0.15) and five year recurrence (62.4% vs 58.2%, p = 0.1) were similar but 90-day mortality (2.3% vs 5.8%, p = 0.0006) and five-year survival (34.6% vs 27.5%, p = 0.005) rates were significantly lower in the former.

Conclusions
Older patients should be considered for curative-intent PD if they have an appropriate performance status but one must consider the slightly higher rates of peri-operative mortality and reduced five-year survival.