bluuebunny/crossref_metadata_2025_split huggingface dataset:
1252 Body Mass Index (BMI) and Estimated Blood-Loss (EBL) in Patients Undergoing Robot Assisted Radical Prostatectomy (RARP)
Authors: Connor C O , Msellati A , Collins P , Hegazy M , Beirne E O , Galvin D , Hegarty N , Connolly S , Nason G , Malley K O 
Published: August 2023

Abstract

Introduction
Higher BMI is a factor which urologists associate with increased difficulty during RARP. (1) One previous review of 218 patients undergoing RARP found no significant differences in EBL in patients with a higher BMI. (2) The aim of this study was to examine the relationship between BMI and EBL in patients undergoing RARP.

Method
Between April 2019 and March 2022, 155 patients underwent RARP. Demographic and clinical variables were collated including EBL, pre-operative and post-operative haemoglobin checks, need for transfusion, length of stay (LOS) and BMI.
Pearson’s correlation coefficient was calculated to examine the relationship between increasing BMI and blood loss.

Results
The mean age of patient was 62 years (range 45-79). The mean BMI was 27.98 (range 19.4-40). The mean blood loss was 281.2mls (range 50-1000). No patient required a blood transfusion. The mean LOS was 2.4 days (range 1-16). There was a positive correlation between higher BMI and higher blood loss (r = 0.1746, p = 0.0421).

Conclusions
This review found a statistically significant increase in EBL in patients with higher BMI undergoing RARP.
1256 Fabricating Artificial Kidney Stones of Different Physical Properties for Ex Vivo Experimentation
Authors: Connor C O , Lyons L , Murphy J , Hennessey D 
Published: August 2023

Abstract

Introduction
There have been several new technologies introduced recently for lithotripsy. The optimal settings of these devices are unknown for different kidney stone densities. This study aims to develop artificial kidney stones for ex vivo studies.

Method
BegoStone was prepared with a powder to water ratio (by weight) ranging from 15:3 to 15:6. The phantoms' acoustic properties were characterised by using an ultrasound transmission technique, from which the corresponding mechanical properties can calculated based on elastic wave theory.

Results
The measured parameters for BegoStone phantoms of different water contents were assessed with regard to longitudinal wave speed & density. If transverse wave speeds were measured then longitudinal acoustic impedance, transverse acoustic impedance, Young's modulus, bulk modulus, and shear modulus can be derived. Longitudinal (CL (m/s)) and density (ρ (Kg/m3)) of BegoStone phantoms with different powder to water ratios corresponded to the known properties reported in natural kidney stones (Calcium Oxalate Monohydrate, Brushite, Uric acid and Struvite). A BegoStone water ratio of 15:3 had similar properties to Calcium Oxalate Monohydrate, 15:4 to be similar to Brushite, 15:5 was similar to Uric acid, and 15:6 was similar to Struvite.

Conclusions
This BegoStone preparation method can be used to fabricate artificial stones with physical properties matched with those of natural kidney stones of various chemical compositions.
1272 Are We Repeating MRI Prostate Scans Unnecessarily in Our Management of Suspected or Confirmed Prostate Cancer Patients, When Referred to Urology
Authors: Rokan N , Ahmad S 
Published: August 2023

Abstract

Aim
MRI Prostate aids in the detection of prostate cancer, however often following a single MRI if cancer is suspected or confirmed, subsequent MRIs are performed, and it is unclear if these are unnecessarily repeated.

Method
We reviewed 196 patients who underwent at least two MRI prostate scans between January 2019 to December 2022. Imaging, clinic letters and MDT reports were reviewed with active surveillance (AS), treatment initiated or discharge back to GP as management outcomes. We analysed whether management changed following multiple MRIs.

Results
Following a single MRI scan 115/196 (59%) commenced/continued AS and 81/196 (41%) were discharged. Following a second MRI 83/115 (72%) continued AS, 18/115 (16%) commenced treatment and 14/115 (12%) were discharged. 69/115 (60%) AS patients had a repeat MRI within one year with the majority (46/69, 67%) continuing AS, 11/69 (16%) being discharged and 12/69 (17%) commencing treatment.
In those 81/196 initially discharged, 56/81 (69%), were discharged following repeat MRI, 18/81 (22%) started AS and 7/81 (9%) commenced treatment. 19/81 (23%) patients underwent repeat MRI within one year with 13/19 (68%) subsequently discharged, 4/19 (21%) starting AS and 2/19 (11%) commencing treatment.

Conclusions
MRI is an important tool for diagnosis and AS in those with (suspected) prostate cancer, however we have shown that in the majority of patients, repeat MRI does not change the outcome of requiring treatment or AS in those initially discharged subsequent to MRI, particularly within 1 year. Discharged patients may require repeat imaging, however repeating this at a longer interval should be strongly considered.
1284 In Vitro Evaluation of Optimal Device Settings for the Swiss Lithoclast Trilogy Lithotripter
Authors: Connor C O , Lyons L , Hennessey D 
Published: August 2023

Abstract

Aim
The LithoClast Trilogy Lithotripter is the latest generation lithotripter. It has four modifiable settings for stone fragmentation - Impact (0-100%), frequency (0-12Hz), ultrasound (0-100%) and suction (0-100%). The configuration for different stone types is unknown. We aim to determine the optimal settings for four stone types.

Method
Calcium oxalate, calcium phosphate, uric acid and struvite 2cm3 phantoms were created using Begostone. Ultrasound and suction were kept constant at 100% and 40%. Impact and frequency were adjusted for a combination of 10 settings and repeated N = 3. Drill speed and fragment size were calculated using 34mm probes.

Results
One hundred percent impact and frequency of 12 Hz resulted in the fastest clearance times of Struvite phantom stones, mean 83 seconds. For uric acid stone phantoms, impact of 30% and a frequency of 4 Hz was the fastest setting for stone clearance, mean 83 seconds. Calcium phosphate phantom stones were treated fastest at an impact of 30% and frequency of 4Hz (mean 217 seconds). The fastest clearance rate for calcium oxalate stone phantoms was at an impact of 30% and a frequency of 12Hz (mean 204 seconds). The slowest rate of calcium oxalate stone phantom clearance was an impact of 60% and 8Hz (mean 269 seconds).

Conclusions
Stone clearance rates, drill speeds and average fragment sizes were calculated for the most commonly occurring stones using the Swiss Lithoclast Trilogy lithotripter. The results indicate that harder stone phantoms may fragment more efficiently at lower device settings.
174 Functional Outcomes in Older Patients Following Major Limb Amputation
Authors: Jamal S , Luckhurst J , Hussey K 
Published: August 2023

Abstract

Aim
More than 5,000 major limb amputations (MLA) are performed annually in the United Kingdom. The relationship between medical co-morbidity and frailty is complex and can have an adverse effect on both mortality and functional capacity. This may be particularly important for older patients. We have attempted to define functional outcome by describing place of discharge, functional capacity and limb-fitting.

Method
This was a retrospective review of a prospectively collated data set on MLA performed in a single Scottish Health Board (NHS Greater Glasgow and Clyde). Older patients were defined as those over 80-years at the time of MLA. Primary outcome measures were place of discharge, functional capacity at the time of follow-up and successful limb fitting.

Results
There were 389 consecutive MLAs performed of which 33 were in patients over the age of 80-years. There were 3 (9.4%) inpatient deaths, and the median duration of stay was 57-days. Only 13 (43.3%) patients were discharged home to independent living. The remaining patients were discharged to either supported living or nursing home care. There were 13 (43.3%) patients who were discharged bed bound. Only 7 (21.2%) were successfully limb-fitted. At 12-months 22 (73.3%) of patients were dead.

Conclusions
MLA in older patients is associated with loss of function and therefore loss of independence. Most patients have died within a year of surgery. These data should help modify expectations for patients, families and clinicians and will help with the process of informed consent.
287 Role and Efficacy of "Frequency-Modulated Electromagnetic Neural Stimulation" in Treatment for Painful Peripheral Neuropathy in Patients with Diabetes Mellitus: A Retrospective Cohort Study
Authors: Shehata R , Bishara R 
Published: August 2023

Abstract

Aim
Evaluate the efficacy of frequency rhythmic electrical modulation system "FREMS" as a symptomatic treatment for painful peripheral neuropathy(PN) in patients with diabetes mellitus

Method
Retrospective cohort study on 75 patients with Painful PN , who had 10 FREMS sessions using APTIVA device (Lorenz Biotech, Italy), from January 2019 - February 2020.
Patients’ data were collected through the Diabetic Foot Center digital database.

Results
75 patients had APTIVA sessions; Pain assessment was done using Visual analog pain score 0 to 5: 0 = no pain / 5 = severe pain.
16 patients were excluded as they did not complete the 10 sessions and 59 patients were reviewed.
No treatment-related adverse events were recorded during the study rather than very slight burning sensation at the site of electrode placement.

Pain at the beginning
46/59(77.9%) of patients suffered from severe pain (grades 4 & 5), 10/59(16.9%) of patients suffered from moderate pain (grade 3,2) and 2/59 (5%) of patients suffered from mild pain (grades 1 &0).
Pain at the last session : The percentage of patients that suffered from severe pain dropped from 77 % before treatment to 11% after treatment.
From the 46 patients that suffered from severe pain, 12/46 patients (25%) of them improved to mild pain and 27/46 patients (58%) improved to moderate pain.
By comparing the pain score in patients before and after APTIVA, there was a significant statistical difference between the 2 groups using “Paired t-test” with P&lt;0.0001.

Conclusions
APTIVA proved to be a safe & effective treatment in reduction of Pain for painful PN.
488 Comparison of Efficacy Between Suture-Mediated and Plug-Based Vascular Closure Devices Following Endovascular Procedures via Large-Bore Femoral Punctures
Authors: Hakeem A , Najem M , Chaudhuri A 
Published: August 2023

Abstract

Introduction
Endovascular aneurysm repair is typically performed via large-bore percutaneous femoral access; with haemostasis achieved using vascular closure devices (VCDs). Such VCDs include suture-mediated closure devices like ProGlide or plug-based such as the MANTA. We compared the efficacy of two techniques, early and late complications related to the devices.

Method
We undertook a retrospective analysis of a prospective database of large-bore access procedures from 2017-2022, comparing two groups by VCD used, designated Group A (ProGlide) and Group B (Manta). We classified haemostasis as Grade 1 (haemostasis without adjuncts), Grade 2 (haemostasis with adjuncts such as pressure dressings) and Grade 3 (failed haemostasis needing rescue). Grades 1 & 2 were considered successful haemostasis. We used Minitab 21 for statistical analysis.

Results
We assessed 207 endovascular procedures with 374 large-bore accesses (243 Group A and 131 Group B). The mean age was 74.9±8 (183 males), and the average BMI was 28±5.8. 191 had EVAR and 11 TEVAR. 5% had redo groins (11 Group A and 8 Group B, p = 0.47). The average sheath outer diameter was 16±2.5F. Successful haemostasis was achieved in 91.1% (222 in Group A and 119 in Group B). 8.8% needed a rescue operation (21 in Group A and 12 in Group B, p = 0.86). Pseudoaneurysms developed in 4.8% (n = 18) and were more frequent in Grade 2 haemostasis (11 Group A and 2 Group B, p = 0.058).

Conclusions
The overall success rate was comparable between the two groups. However, ProGlide deployments required more adjuncts to achieve haemostasis. Pseudoaneurysm formation was more frequent with adjuncts.
781 An Overview of Operative Notes in the Vascular Surgical Unit in Northern Ireland
Authors: Soh V , Healy D , Mowlood C , Eow S Y , Donnelly C , Dow E 
Published: August 2023

Abstract

Aim
This audit aims to assess the conformity of operative notes to the guidelines established by the Royal College of Surgeons England (RCSEng).

Method
We prospectively collected and analysed the date over a two-week period before we introduced the intervention. We created a poster featuring the guidelines and placed it in the vascular operating theatres. We also introduced an electronic operative note system in vascular surgery. The reaudit commenced two weeks after the intervention.
Result: All operative notes contained the date and time, names of surgeons, details of the operative procedure, descriptions of tissue removed, identification of prosthetics, and the surgeon's signature. Some areas saw significant improvement with the intervention, such as incision (26% to 89%), operative diagnosis (58% to 93%), closure technique (92% to 100%), and post-operative instructions (83% to 93%). However, there was a lack of documentation on DVT prophylaxis and antibiotic prophylaxis in both loops, resulting in a decrease from 63% to 50% for DVT prophylaxis and from 38% to 14% for antibiotic prophylaxis. Only two electronic operative notes were recorded in the second loop.

Conclusions
Some areas showed improvement, but not all achieved full compliance. The majority of vascular surgeons continued to utilize handwritten operative notes due to logistical and technological challenges. It is recommended that a future re-audit be conducted over a longer period of time, during which a greater number of cases should be reviewed.
885 Survival After Major Amputation in Elderly Patients
Authors: Mackay J , Hanna L , Edwards M 
Published: August 2023

Abstract

Aim
Conduct a retrospective analysis of survival of patients &gt;65-years who have undergone a major amputation for chronic limb threatening ischaemia (CLTI) in the Sussex Vascular Network.

Method
This audit was registered with the University of Sussex Hospitals audit team (ref number 4654). A database was compiled of all patients who underwent a major amputation within the Sussex Vascular Network between 2016 to 2021 inclusive. Data sources to formulate the population of interest included theatre registry books, operation notes, electronic patient records and death certificates.

Results
A total of 454 patients underwent a major amputation (122 below knee amputation (BKA), 70 through knee amputation (TKA), 262 above knee amputation (AKA)) between 2016 to 2021. The mean age was 77 years (range 65-104). The median survival was 2.98 years. Survival was lower in older patients (&gt;80 years, p = .012) and patients with renal failure (p&lt;.001). Gender and diabetes had no significant effect on survival. Independent predictors of increased hazard of death included increasing age (HR 1.35, p = .030), renal failure (HR 1.56, p = 0.001), heart failure (HR1.68, p = .001) and ischaemic heart disease (HR 2.02, p&lt;.001).

Conclusions
Survival is poor following major amputations in patients with CLTI over the age of 65 years. Strategies to mitigate the burden of co-morbidities are needed to improve the outcome for these patients. Improved case selection is also needed to identify the patients who benefit most from a major amputation, and those who should perhaps be managed conservatively given the limited survival following a major amputation.
1071 Examining Blood Lipid Profiles and Lipid Lowering Therapy in Carotid Surgery Patients in a 1-Year Follow-Up Study
Authors: Sood M , Kwan J Y , Stocco F , Orozov N , Spencer-Jones K , Bailey M A , Coughlin P A , Scott D Julian A 
Published: August 2023

Abstract

Aim
Stroke patients are at a high risk of future major adverse cardiovascular events. Focusing on lipid lowering therapy (LLT), current ESVS and NICE guidelines advise high intensity statin (HIS) treatment with a target LDL-C of less than 1.8mmol/L.

Method
This is a retrospective cohort study on 205 patients who underwent carotid endarterectomy or stenting from 01/01/18 to 31/12/20 at Leeds Vascular Institute. Prescriptions and lipid profiles prior to intervention, at discharge, and 1-year post-intervention were recorded. Differences between time points were assessed using the McNemar test.

Results
There were 137 men, the median age was 73, and 175 patients underwent carotid endarterectomy. Increases in prescriptions of statins (65%vs93%, p&lt;0.001) and HIS (47%vs83%, p&lt;0.001) were observed at discharge compared to pre-intervention but no differences were seen at 1 year. At 1 year, 8 patients were not on statin therapy; 6 were intolerant and 3 were prescribed Ezetimibe.
At 1 year, there was a significant improvement in median LDL-C (2.4mmol/L IQR (1.9-3.3) vs. 1.6mmol/L (1.2-2.0)), and proportion of patients reaching target LDL-C of &lt;1.8mmol/L (21%vs59%,p = 0.003) compared to pre-admission. In patients with LDL-C≥1.8mmol/L, 92% had scope for LLT up-titration. No significant differences were noted in the proportion of patients who underwent lipid profile monitoring prior to admission and at 1 year.

Conclusions
Admission to our local vascular unit is associated with an increase in the guideline-directed prescription of LLT, and subsequently attainment of target LDL-C. Reasons for suboptimal lipid monitoring in the community need to be understood to allow for optimal risk reduction.
1137 Perioperative Glycaemic Control in Patients Undergoing Major Lower Limb Amputation – How Can We Improve?
Authors: Erete L , Obasi E , Nip L , Benaragama S 
Published: August 2023

Abstract

Aim
Patients with diabetes undergoing major lower limb amputation (MLLA) have higher rates of unfavourable postoperative outcomes compared to those without diabetes. Inadequate glycaemic management can lead to an increase in wound healing problems, infections, increased length of hospital stay and higher mortality rates. Guidelines from the Vascular Society for Great Britain and Ireland recommend that all MLLA patients should have early input from the Diabetes team. Our study aimed to evaluate local practice in perioperative glycaemic control in MLLA patients at our unit.

Method
All patients who underwent MLLA between November 2021 and April 2022 were identified by reviewing theatre records. Patient records were reviewed to collect data on diagnosis of diabetes, diabetic medications, capillary blood glucose (CBG) levels on admission, preoperative HbA1c levels, and perioperative and post-operative glycaemic control.

Results
33 MLLA were performed (17 AKA, 16 BKA), age range 41 to 85 (mean age 66), 20 male and 13 female patients. 25 patients (76%) were diabetic, 19 patients (58%) had a preoperative HbA1c recorded and all 33 patients had a CBG recorded on admission. 10 diabetic patients (40%) were found to have inappropriate management of their diabetic medication. 18 patients (55%) were identified as having poor glycaemic control on admission (HbA1c &gt;48 or CBG &gt;11.1). Of these, 12 (67%) were reviewed by the Diabetes team.

Conclusions
Surgical teams must be actively involved in the management of diabetes of their MLLA patients. Patients undergoing MLLA should have HbA1c checked on admission to help identify those who need review by the Diabetes team.
1168 Case Report: Lower Limb Trauma with Vascular and Orthopaedic Injury in a National Level Gymnast
Authors: Whitcroft A , Chong D , Hardy T 
Published: August 2023

Abstract
Traumatic injuries in high-functioning athletes can have devastating consequences and require cross-disciplinary management for both initial presentation and subsequent management.
We would like to present the case of a 17-year-old female, national level gymnast who presented with a traumatic lower limb injury. During a run-up to a trampoline, her right knee gave way with immediate pain, deformity, and inability to weight-bear.
At initial assessment she was noted to have a large joint effusion with inability to straight leg raise and Xray showed a tibial plateau avulsion fracture. Initially she was neuro-vascularly intact, however on splinting, posterior knee dislocation occurred with loss of foot pulses, sensation, and motor function of the lower leg. Computerised tomography angiogram showed an 8cm filling defect at the popliteal artery.
A multidisciplinary approach between Vascular and Orthopaedics decided on initial surgical management with support from Paediatrics and Anaesthesia. The popliteal artery was approached posteriorly for long-term durability and function, despite the potential difficulty in exposure, with a medial approach bailout.
Exposure of the popliteal artery revealed a section of torn intima with occlusion which was resected and replaced with a long saphenous vein interposition graft. Finally, four-quadrant fasciotomies and spanning external fixation of her knee was performed. Completion diagnostic angiogram confirmed graft patency and restored 2-vessel run off.
The patient recovered from this limb-salvage procedure and although required several more orthopaedic procedures, she was eventually discharged mobilising with crutches. This case illustrates the importance of a multidisciplinary approach in managing complex trauma especially in high-performing individuals.
1178 Management of SFA Disease Delineated by Disease Type – a Multicentre European Analysis
Authors: Fitzpatrick N , Owen R , Sherazi A , Katsogridakis E 
Published: August 2023

Abstract

Aim
The study aimed to assess how SFA disease is treated in patients with critical limb ischaemia and patients with claudication.

Method
Data was collected from the RandomSTOP European registry database. Patients were categorised into those with critical limb ischaemic (CLTI) and those with claudication (nCLTI). Patient demographics were stratified by sex, Rutherford classification, lesion length, smoking status, history of diabetes, history of chronic kidney disease, history of hypertension and pre-admission medications. Procedural variables were stratified by type of treatment. Post-operative complications including perforation, dissection, embolization and in hospital reintervention were compared. Chi-squared analyses were used to compare the two groups.

Results
Data on 1,567 patients who underwent surgery for SFA disease was analysed. 64% (n = 1,009) of patients had CLTI, and 36% (n = 558) had nCLTI. Those with CLTI were statistically significantly more likely to be older (p&lt;0.0001****) and female (p&lt;0.0001****). Those with CLTI were more likely to have CKD (p&lt;0.0001****) and diabetes (p = 0.002**) Those with nCLTI were statistically significantly more likely to be on a statin and antiplatelet (p&lt;0.0001****). Most patients underwent percutaneous transluminal angioplasty (PTA), (75% of CLTI and 84% of nCLTI) with some form of vessel preparation (the most common being Drug Coated Balooning; 36% CLTI and 64% nCLTI). Those with CLTI had greater incidence of post-operative complications including perforation (p = 0.002**), embolization (p = 0.0004***) and secondary intervention (p = 0.016).

Conclusions
This is one of the largest contemporary series on the real-world management of SFA disease. Vessel preparation and PTA appear to be the mainstay of managing complex SFA disease.