bluuebunny/crossref_metadata_2025_split huggingface dataset:
265 Granulomatosis With Polyangiitis Manifesting as Acute Otitis Media: A Case Report and Review of Literature
Authors: Aboulhosn R , Cooper F , Ah-See K 
Published: August 2023

Abstract
Granulomatosis with polyangiitis (GPA) is a rare necrotising vasculitis of unknown aetiology affecting small and medium-sized vessels of the upper respiratory tract, lungs, and other organs. It is the most common anti-neutrophil-cytoplasmic-antibody (ANCA) associated vasculitis disorder. While otologic manifestations are identified in up to 70% of cases, it is occasionally misdiagnosed in this cohort of patients. We present a case of GPA which initially manifested as isolated acute otitis media. A 52-year-old female with a history of type 2 diabetes presented with a 6-week history of bilateral otalgia, otorrhea, and hearing loss. She denied facial paresis, sensory deficit, arthralgia, myalgia, visual symptoms, rashes, or diarrhoea. Examination revealed a right tympanic membrane perforation and an erythematous left tympanic membrane. The patient was treated with different courses of oral and topical antibiotics for a diagnosis of otitis media with effusion, to no avail. Subsequent serum analysis revealed a C-ANCA pattern, in keeping with GPA. The patient is being treated accordingly and is making stable progress. Less commonly, GPA may manifest as isolated otolaryngologic symptoms as seen in this case. Mindfulness of this entity helps reduce the risk of irreversible organ damage and patient morbidity.
428 Progressive shortness of breath in a post CABG patient: Thinking beyond the obvious
Authors: Sain B , Chakraborty R , Varma A , Sarkar K 
Published: August 2023

Abstract

Background
Post-coronary artery bypass graft (CABG) chylothorax is rare accounting for 0.06-0.09% of the cases.

Case presentation
A 62 year old male patient presented with progressive shortness of breath (mMRC grade 1 to 3) for 6 months. He underwent CABG surgery 7 months prior due to ischemic heart disease. Clinical examination supplemented with radiological imaging revealed evidence of progressive bilateral pleural effusion. Pleural fluid aspiration showed bloody appearance of fluid on right side. Lipid analysis of the aspirate confirmed presence of chylomicrons along with a raised triglyceride level(138mg/dL).

Clinical outcome
A diagnosis of right-sided post CABG chylothorax with left sided transudative fluid was made. Patient was managed with ICD insertion on the right side and started on total parenteral nutrition (TPN). This was followed by permissible carbohydrate intake and TPN for 11 days. Gradual decrease in collection was noticed in the follow-up x-ray with no recurrence of symptoms.

Discussion
Most likely that the anterior mediastinal lymphatic chain got injured during the harvesting of internal mammary artery causing leakage of chyle into the thoracic cavity leading to dyspnoea and chest discomfort.

Conclusion
Lipid measurements may be indicated in all patients with undiagnosed pleural effusion in order to rule out chylothorax. Chylothorax can meet criteria of transudate if associated with congestive cardiac failure, cirrhosis, or nephrotic syndrome. However, the colour of pleural fluid is not always indicative of a chylothorax. While most of the patients can be managed conservatively, surgery is recommended if drainage lasts for more than 1-3 weeks, and daily drainage is 200-500mL.
437 Appedicular Endometriosis – a Rare Intra-Operative Finding
Authors: Kaur M , Singh A , Tonsi A 
Published: August 2023

Abstract
Endometriosis is a known gynaecological condition in young women of reproductive age group. It presents with many different symptom complexes, most common presentation being pain abdomen especially during menstruation. Pelvis is the most common site for endometrial deposits. Gastrointestinal endometriosis is rare, appendicular endometriosis is rarer. There have been only a few case reports of endometriosis causing appendicitis.
We came across a case of perforation peritonitis in a young girl with a background history of endometriosis. Patient presented with sign and symptoms of acute appendicitis and on USS was found to have inflamed appendix. During diagnostic laparoscopy she was found to have gangrenous perforated appendix and a hard nodule, which on histopathology revealed endometriosis. Another important fact revealed on histopathology was bleeding into the endometrial tissue. This patient underwent laparoscopic right hemicolectomy. Postoperative recovery was uneventful. Patient was discharged from the hospital on 5th postoperative day.
We did literature research to find out that there have been only two cases reported in the literature of appendicular perforation caused by endometriosis.
504 A Curious Case of a Slow-Growing Intra-Oral Swelling in a Paediatric Patient
Authors: Budhdeo R , Graham A , Vaidyanathan M , Kabban M 
Published: August 2023

Abstract

Background
A 15-year-old male attended the paediatric dental department as an urgent self-referral. Clinical examination revealed a large, firm lesion in the right maxilla which had been slowly increasing in size for the past year. No altered sensation and facial numbness was detected. The upper right central incisor (UR1) was missing however, a primary central incisor was extracted at the dentist three months prior.

Investigations
An orthopantomogram (OPG) at initial presentation illustrated a well-defined radiolucency extending from the upper right first molar (UR6) to the upper left central incisor (UL1) with root displacement of adjacent teeth. A subsequent cone beam computed tomography (CBCT) scan identified a well-defined corticated radiolucency with an area of radioopacity of mixed density in the posterior-medial aspect. Buccal expansion and root displacement in the premolar segment were noted. The unerupted UR1 was extremely displaced, lying horizontal and just inferior to the nasal cavity.

Diagnosis/Management
Differential diagnoses for the anterior right maxilla radiolucency included calcifying epithelial odontogenic tumour, adenomatoid odontogenic tumour and an odontome. The histopathology of the cystic lining taken under general anaesthetic during enucleation and curettage revealed the diagnosis of a calcifying odontogenic cyst.

Discussion
Calcifying odontogenic cysts are very rare developmental lesions occuring due to proliferation of odontogenic epitheluim and scattered nest cells. As in this case, these cysts are usually associated with unerupted/impacted teeth. Awareness of dental eruption timelines is essential in identifying impacted teeth and associated pathology. Slow growing lesions in the maxilla should be identified early and investigated within multidisciplinary teams.
520 Malignant Melanoma: A Rare Primary Bladder Tumour
Authors: Desouky E , Al-Salti W , Jallad S 
Published: August 2023

Abstract
A 60-year-old male patient who has been referred by his GP to our ‘one stop hematuria clinic’ due to episodes of visible hematuria for 3 months.
The patient is Caucasian, non-smoker, drinking alcohol socially with no related family history of cancer. There is no occupational exposure to any carcinogens.
Flexible cystoscopy that showed a dark coloured bladder mass arising from left side of the bladder base. CT urogram that showed evidence of soft tissue lesion in the urinary bladder with upstream mild left hydro-uretero-nephrosis.
TURBT was performed carefully. Following complete resection of the tumour lesion, left ureteric orifice became visible.
The morphology and immunohistochemistry profile were consistent with malignant melanoma. The presence of in situ component indicated a bladder primary origin rather than metastatic deposit.
The case was discussed in our urology Multi-Disciplinary Team (MDT) meeting. Referral for dermatological consultation and radiological correlation were strongly advised in order to exclude any cutaneous or another mucosal primary malignant melanoma. The patient had no suspicious skin lesions.
There was no evidence of soft tissue lesions on CT scans. In addition, further PET CT scan failed to show any other malignant lesions except for the bladder.
After Histopathologic, dermatologic, and radiologic evidence; the diagnosis of primary urinary bladder malignant melanoma was established.
Patient declined radical cystectomy and opted to go for immunotherapy.
After completing a course of Nivolumab and Ipilimumab, patient is on a regular follow up cystoscopy with no evidence of recurrence.
567 Chest Wall Resection for Desmoid Fibromatosis with Neo Rib Reconstruction Using 3D Printing: A Case Report
Authors: Cohen C , Chandrashekara N , Raj Patil V , Hindiskere S , Chinder P S 
Published: August 2023

Abstract

Background
Desmoid fibromatosis, also known as desmoid tumor, is a locally aggressive tumour that develops from fascia and musculoaponeurotic tissue. Chest wall desmoid fibromatoses represent 10-20% of all fibromatoses. Surgery is a successful treatment option for desmoid fibromatosis; however it can be difficult depending on the tumour's location or local spread, and post-resected chest wall reconstruction is becoming a new challenge for surgeons in cases involving ribs.

Method
we present a rare case of chest wall desmoid fibromatosis involving right sided 9th rib in a 35-year-old male, which was discovered due to a thoracic wall mass. The patient underwent wide tumour surgical excision of the 9th and part of the 10th rib. To reconstruct a neo rib 3D printing of the rib lesion with 1:1 ratio was done in order to obtain a good orientation. Two cannulated cancellous screws were fixed between the two ends of the resected ribs. A simple sternal wire was anchored between the two screws and bone cement was moulded similar to the rib architecture over the sternal wire.

Results
Post operatively margins were free and lung expansion was satisfactory. 5 year post operative follow up showed no local recurrence.

Conclusions
This case report sheds light on rare tumour of the rib and provides a comprehensive approach towards its surgical management which includes reconstruction of a neo rib with no major complications.

Implications
This technique has helped in reconstruction of the chest wall with very limited and easily available resources.
635 Giant Paratesticular Liposarcoma Imitating a Recurrent Right Inguinoscrotal Hernia
Authors: Shulman N 
Published: August 2023

Abstract

Case
48-year-old male presented for elective open recurrent right inguinal hernia (RIH) repair due to ongoing right inguinoscrotal swelling; and an ultrasound suggestive of a large indirect inguinal hernia containing peritoneal fat and extending into the scrotum with displacement of the right testis.
Previous open RIH repair with mesh completed 12mths prior found a moderate direct inguinal hernia; and during a post-op phone review (given the COVID pandemic) noted he was healing well. No urinary/obstructive or systemic symptoms identified. Other history included alpha thalassemia trait, ex-smoker and non-English speaking background (NESB).
Intraoperatively there was no evidence of recurrent hernia, and the mesh was intact; however a large right scrotal mass was identified as the cause. An 18x8cm soft lipomatous mass surrounded the right testicle and extended up towards the cord structures at the superficial inguinal ring. Given the concern for malignancy, a right orchidectomy and excision of scrotal mass was performed.
Histology confirmed a well differentiated grade 1 liposarcoma. He recovered well and is undergoing close MRI surveillance - with no sign of recurrence.

Discussion
Liposarcoma is an important differential for scrotal masses and can imitate an inguinoscrotal hernia on ultrasound, MRI is the gold standard investigation.
The above case highlights the importance of physical post-operative examination and barriers to care during the COVID pandemic, particularly in those with NESB. Informed consent was imperative, we could safely proceed with the appropriate surgery as the patient had been explicitly consented for testicular loss due to recurrent nature of the operation.
636 Internal Dislocation of Scapula Following Ivor Lewis Oesophagectomy - a Case Report
Authors: Patel S , Ibrahim M , Tsai Al , Raza M , Moorthy K , Nandi J 
Published: August 2023

Abstract
Internal dislocation of scapula is a known but rare complication following traumatic thoracic injury and lung resection. We report a case and the management in a 69-year-old Caucasian man who underwent a stage two Ivor Lewis oesophagectomy for a T3N1M0 oesophageal adenocarcinoma. Post-operatively, the patient required an FiO2 of 60% and two days later placing on Optiflow to maintain adequate oxygen saturations. A CT thorax on day 5 post-op demonstrated a marked chest well deformity with intrathoracic dislocation of the scapula on the site of thoracotomy, 4th rib displacement downwards into the pleural cavity, left basal atelectasis and a pneumothorax; there was no evidence of anastomotic leak or perforation. Following an unsuccessful trial of conservative management using chest drains, a decision was made for surgical exploration and repair. Intra-operatively, the redo thoracotomy from pervious surgical excision revealed that the initial suture had given way allowing the scapula to dislocate into the thoracic cavity; this was subsequently released, adhesions to the lung dissected and pleural effusion drained. The defect in the posterior section of the 4th rib, was closed using a double-layered 15 x 15 cm prolene mesh, which was further secured to the ribs above and below. Post-operative care with pain management and ionotropic support was required in the intensive care unit, and later ongoing chest physiotherapy for basal atelectasis. This case demonstrated the importance of considering rare thoracic complications after oesophagectomy and early decision for re-operation, with the placement of an inlay mesh shown to be effective.
654 Inflammatory Bowel Disease and Risk of Interval Colorectal Carcinoma: What’s Missing in Surveillance Endoscopy?
Authors: Epanomeritakis I , McGuigan C , Mark D 
Published: August 2023

Abstract
Colorectal carcinomas in ulcerative colitis patients are more commonly missed endoscopically compared to those in other symptomatic patients. They may present as flat lesions on a background of colitis, making them harder to visualise. Those presenting after negative colonoscopies are termed interval cancers, and account for up to 50% of colorectal cancers in patients with inflammatory bowel disease (IBD). Professional bodies recommend the use of chromoendoscopy for IBD surveillance to improve diagnostic yield by allowing targeted biopsies of non-polypoid lesions. We present an asymptomatic missed cancer in a patient with UC following a complete white light surveillance colonoscopy. After the sole endoscopic finding of a small, raised rectal lesion, found to be dysplastic, a CT scan incidentally demonstrated a missed ascending colon tumour. Had chromoendoscopy been used, this cancer may have been detected initially. This case report demonstrates that missed tumours remain a problem during surveillance endoscopy for IBD.
718 Pilonidal Disease: Diagnosis Which Can Be Unexpected
Authors: Kazimirchyk M 
Published: August 2023

Abstract

Background
Pilonidal disease is seen at sacrococcigeal region in prevalent number of cases. We present an unusual case of an abscess at lumbar region which turned out to be a pilonidal sinus.

Case presentation
A 18-year-old male presented to the outpatient clinic with swelling at lumbar area for 1 month. Physical examination revealed an inflammatory infiltrate 1,5*1,5cm, with fluctuation, located in the projection of L4-L5 vertebrae. The initial diagnosis of abscess was made.

Initial management
During incision and drainage of abscess 10 ml of malodorous purulent discharge emerged along with collection of hair. The subcutaneous tract was revealed which run caudally for 8 cm close upon gluteal cleft, where midline pit was discovered.

Diagnosis
Based on clinical presentation and intraoperative findings final diagnosis of pilonidal disease of sacrolumbar region was made.

Investigation
X-ray revealed asymmetric, deformed L5 vertebrae, with a possibility of being a developmental variation. The concurrent diagnosis of osteomyelitis was put into a question, which was rejected based on results of CT that revealed no bone-destructive pathology.

Final management
After healing of surgical wound subcutaneous sinusectomy at gluteal cleft was accomplished in the inpatient setting, no additional surgical interventions regarding the subcutaneous tract at lumbar region were performed.

Outcome
The patient was monitored intermittently after that for 9 months and no signs of recurrence were observed.

Conclusion
Draining sinus tract of a pilonidal cyst is able to spread to an apparently distant location that can markedly complicate the diagnosis.
747 Ten Year Outcomes After Surgical Fixation of Tibial Plateau Fractures
Authors: Khalid A , Nelson C , Howell M , Eseonu O , Doonan J , Blyth M 
Published: August 2023

Abstract

Aim
This study represents one of the largest clinical case series' evaluating long-term outcomes following surgical fixation of tibial plateau fractures over a 10-year follow-up. The primary aim is to evaluate the incidence of TKR and risk-factors associated with poor outcomes.

Method
Patients receiving surgical fixation of tibial plateau fractures between 2008 – 2012 were included. Those requiring arthroplasty or endoprosthesis post-injury were excluded. PACs was used to analyse case notes and radiographic imaging. Articular reduction and alignment (mPTA) were measured using pre-operative radiographs. Comparisons were made with radiographs post-fracture union (6-weeks to 6-months), assessing fracture reduction maintenance. Long-term outcomes were assessed for patients receiving imaging thereafter. Patients were checked using the Scottish National Imaging Archive.

Results
130 patients presented various fractures (Schatzker I-III n = 78, IV n = 12, V n = 9, VI n = 29) and 2 open-fractures. 32 patients required further surgery, 13 required multiple operations - resulting in 47 operations. These included metalwork removal (n = 28, 21.5%), TKR (n = 12, 9.2%), washout for infection (n = 3, 2.3%), osteotomy (n = 2, 1.5%), sequestrectomy (n = 1, 0.8%), and above knee amputation (n = 1, 0.8%). ≥ 2mm articular reduction was maintained in the majority (84%); however, good articular reduction did not prevent progression to arthroplasty (average step 1.4mm in TKR versus 1.8mm in non-TKR). Good alignment correlated with favourable outcomes - average mPTA being 90.8° in non-TKR versus 93.5° in TKR.

Conclusions
These findings support previous literature in this field demonstrating that malalignment, rather than articular depression, increases the risk for post-traumatic arthritis requiring arthroplasty. The incidence of TKR after tibial plateau fracture fixation at 10-years was 9.2%.
813 Management of Massive Air Leak with Persistent Pneumothorax and Pneumoperitoneum in a 1.2kg Preterm Neonate – a Case Report
Authors: Woodun H , Thomas J , Fraser N 
Published: August 2023

Abstract
Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birthweight, low APGAR scores and caesarean-section delivery. A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment caesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apnoeic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day-10, gradual removal of five chest drains by day-19 and extubation on day-24. Transillumination and chest radiography were main diagnostic investigations. Laryngotracheobronchoscopy on day-16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis and pulmonary hypertension and was discharged home on day-66. Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Lung ultrasound would improve diagnosis and monitoring. Management is patient-specific and includes needle and tube thoracocentesis and HFOV. Use of blood patch, fibrin glue or chemical agents, selective bronchial ventilation have been reported. Surgery is usually applied in unstable patients where bridging the defect is not feasible. nonsurgical pneumoperitoneum should be considered in ventilated neonates and those with airway injury to avoid exploratory laparotomy. Our case demonstrates challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum with conservative management.
816 A Benign Diagnosis for Suspected Malignant Differential of a Sacral Lytic Lesion.
Authors: Matthews J , Matthews M , Garcia S 
Published: August 2023

Abstract
49-year-old relatively healthy man presented to the ER with abdominal and associated low back pain. Past history was significant for excision of spinal benign tumor excision and 30-year pack history of smoking. Review of systems was significant for recurrent leg swelling and muscle aches.
Neurological exam was non focal. CT scan of the abdomen and pelvis revealed a lytic sacral lesion with soft tissue component. The rest of the skeletal survey and system evaluation was unremarkable. Patient was referred to Oncology, suspecting the localized plasmacytoma variant of multiple myeloma with an inconclusive sacral mass biopsy report. Full blood count, comprehensive metabolic panel, Beta-2 microglobulin serum protein electrophoresis (SPEP), and free light chains assays undertaken were all within normal ranges. Further second opinion was sought for the biopsy results to undertake special stains which concluded the biopsy as schwannoma. In view of the persisting recurring pain and swelling, further MRI imaging and IR guided biopsy was suggested. However, the patient was with limited insurance coverage. He opted to defer further evaluation and adopted a “wait and see” approach and has since remained stable.
Sacral schwannomas are rare. It is possible that his previous extradural lesion could have been a schwannoma. Schwannomas are slow growing and relatively asymptomatic. As they are typically lytic lesions can easily be mistaken for malignant lesions and have to be considered in the differential of osteolytic lesions as they can grow in close proximity to bony structures.