bluuebunny/crossref_metadata_2025_split huggingface dataset:
1244 Wound Dehiscence and Infection of a Total Knee Replacement Secondary to Postoperative ‘Dorsal Fin’ Intra-Articular Vertical Patella Dislocation
Authors: Redman I , Jones G 
Published: August 2023

Abstract
A 75-year-old man presented to our emergency department with a bleeding wound 19 days following a primary hinged left total knee replacement, performed elsewhere, for lateral tibiofemoral osteoarthritis.
Examination revealed a knee held in fixed flexion of 30°, with partial dehiscence of the wound, implant exposure and a visible patella. Radiographs revealed an abnormally raised joint line with a vertical appearance of the patella on the lateral image. The decision was made to proceed with a two-stage revision. At operation, the patella was confirmed to be vertically positioned in the trochlea groove of the femoral component and identified as the likely cause for the wound dehiscence. There was evidence of a large lateral release having been performed during the primary surgery. A joint orthoplastic wound debridement was performed, together with implant removal, and static cement spacer insertion. Following an eight-week interval of IV antibiotics, the second stage was performed. A new hinged implant was implanted, with metaphyseal sleeves and stems. A tibial tubercle osteotomy was required to address the lateral tracking patella and a gastrocnemius flap was necessary to address a distal soft tissue defect.
This case study highlights an unusual cause for wound dehiscence following total knee arthroplasty. Patella dislocation with vertical axis rotation has been described in the native knee1, but to our knowledge, this is the first report of this phenomenon following arthroplasty. This was almost certainly secondary to component malpositioning and emphasizes the significance of restoring the native joint line and correct implant rotation during knee replacement surgery.
145 Patient Experience of Bladder Outlet Surgery During Covid-19 in a District General Hospital
Authors: Maniarasu S , McNicholas D P , Mistry R 
Published: August 2023

Abstract

Aim
During the pandemic, bladder outlet surgeries (TURP,Urolift,Rezum) were delayed. Operations were prioritised (P2&lt;1month, P3&lt;3months, P4&gt;3months). We wanted to find out patient’s experience due to this.

Method
Patients identified who had surgery and on waiting list between January 2020 and June 2021. A questionnaire was designed to identify patient's experience and whether they felt their operation was delayed, if received correspondence about delays, if aware of the waiting-list grading, if attended GP/ED with issues, if felt their outcome affected by delays, listed P-grading, duration waited for operation, and overall satisfaction.

Results
56 patients were identified. 50% delayed. In delayed sub-group, 45% did not feel their operation was delayed. 82% delayed received information from the hospital. 70% knew about the grading system in place according to clinical urgency. In delayed sub-group, 41% felt their operation would be more difficult or less likely to be successful compared to 15% in non-delayed sub-group. 43% who were delayed attended GP/ED with issues compared to 9% in non-delayed group. 84% were happy or very happy (Likert4/5) with their experience.

Conclusions
Large numbers of BOO procedures were delayed due to the pandemic. Many patients aware of the waiting list grading system and understanding of the pressures on the NHS. There was good communication between the hospital to inform patients of their delays thus most patients were happy with the service they received, despite being delayed. Delays leads to significantly higher attendances to GP/ED and patients feel their operation is more likely to be difficult or unsuccessful.
458 Primary Renal Mesenchymal Neoplasms: A Retrospective Clinicopathological Study
Authors: Chacko A , Gopinathan V , Roy S , Prashanty A , Kumar S 
Published: August 2023

Abstract

Aim
Mesenchymal tumors are rare primary neoplasms of the kidney with limited demographic data in literature. We sought to study the prevalence of this rare subset of tumors in adults, at our tertiary care hospital focusing on the pathological and radiological characteristics.

Method
Clinico-radiological and intra-operative details were retrospectively analyzed for adult primary renal mesenchymal neoplasms received between 2006 and 2021 and correlated with the histopathology data.

Results
Of 2164 nephrectomies performed for neoplastic conditions, 97 (4.5%) were diagnosed as renal mesenchymal tumors. There were 59 (60.8%) benign, 10 (10.3%) with intermediate biologic behavior and 28 (28.9%) malignant tumors. The mean age was similar across these categories. Hematuria was seen in 11 of 38 (29%) intermediate grade and malignant tumors and in only 6 of 59 (10%) benign tumors a difference that was statistically significant (p = 0.017). Tumors ≥ 7cm were more likely to be malignant/intermediate grade than benign (p = 0.027). Classical angiomyolipomas constituted 90% of the benign tumors. Epithelioid angiomyolipomas and solitary fibrous tumors were the common intermediate grade tumors. Undifferentiated small round cell sarcoma was the most common malignant neoplasm. Immunohistochemical and molecular studies were useful for confirmation of diagnosis, particularly in cases of intermediate/malignant tumors.

Conclusions
Mesenchymal tumors constitute 4.5% of adult primary renal tumors, are predominantly benign tumors but are malignant in 1/4 th of cases. Malignant tumors are typically larger and more often present with hematuria. Immunohistochemistry (IHC) and molecular studies play a role in the diagnosis of intermediate and malignant mesenchymal tumors.
609 Improving Patient Counselling in Patients' With PI-RADS 3 Lesions with the Use of PSA Density, A Retrospective Study in a UK District General Hospital
Authors: Maniarasu S , Elsayed M , Barker H 
Published: August 2023

Abstract

Introduction
NICE and EAU guidelines recommend offering prostate biopsy for patients with PI-RADS 3 lesions in a multiparametric MRI. Employing PSA density (PSAd), to further risk-stratify these patients, is a promising approach to advocate for PSA surveillance over biopsies. Here, we appraise the ability of PSAd to risk-stratify PI-RADs 3 lesions across patients who underwent a prostate biopsy.

Method
A retrospective analysis was performed on all patients who had a multiparametric MRI with PI-RADs 3 lesions over 2-year period Jan 2021 – Dec 2022. Patients were divided into two groups according to their PSAd value and whether they have neoplastic features on histopathology. The data was analysed using Chi-Square to determine the association between PSAd levels and cancer incidence in PI-RADS 3 lesions.

Results
116 patients out of 613 had PIRADS 3 reported (19%). 83 patients had biopsies (72%). 44 was positive for neoplasia (53%) and 39 was negative (47%). 44 patients in the biopsy arm had a PSAd of &lt;0.15 (53%). Of these patients, 27 had no neoplasia (61.4%). 39 patients had PSAd &gt;0.15 (47%) and 12 had no neoplasia (31%). PSAd &lt; 0.15 PI-RADS 3 lesions were significantly associated with lower occurrence of prostatic malignancy on statistical analysis.

Conclusions
Out of all biopsied PIRADS 3 lesions, almost half (47%) had no neoplasia. More than half of patients with PSAd &lt;0.15 had no neoplasia. Patients with PSAD &lt;0.15 were statistically more likely to have no neoplasia compared to patients with PSAD &gt;0.15. This information is useful for prebiopsy risk stratification and patient counselling.
761 Effectiveness of Chemohypothermia with Mitomycin C vs Immunotherapy with BCG in High Risk Non Muscle Invasive Bladder Cancer Patients
Authors: Hasan M Y , Nawaz U , Khan F U R 
Published: August 2023

Abstract

Aim
Initial data to compare the effectiveness of Chemohypothermia with Mitomycin C (MMC) and Immunotherapy with Bacillus-Calmette-Guerin (BCG) in High risk Non muscle invasive bladder cancer (NMIBC).

Method
Sixty six patients who underwent Trans-urethral resection of bladder tumor (TURBT) were divided into two equal groups; hyperthermic intravesical chemotherapy group and BCG group. Six intravesical instillation's (one per week) of 40mg of hyperthermic MMC diluted in 40ml of distill water and heated at 43 C were given to patients for 60 min with HIVEC machine. For BCG group intravesical doses of BCG, once weekly for 6 weeks were administered at concentration of 80mg diluted in 50ml of normal saline. Follow up check cystoscopy at 3 months from initial TURBT was done to check effectiveness of both treatments. Patients were also accessed for side effects during the treatment.

Results
28 patients (84.8%) had no recurrence and 5 patients (15.2%) had recurrence in chemohypethermia group while in BCG group 29(87.8%) patients had no recurrence and 4(12.2%) patients had recurrence.
3(9%) patients had bladder spasms, 1(3%) had hematuria, 3(9.1%) had Urinary tract infection (UTI) while 26(78.8%) had no adverse effect in Chemohyperthermia group. In BCG group, 1(3%) had bladder spasm, 4(12.4%) had hematuria, 5(15.2%) had UTI and 23(69.5%) had no adverse effect.

Conclusions
Chemohyperthermia is safe and efficacious treatment choice in patient suffering from NMIBC with outcomes comparable with BCG treatment and improved side effect profile.
789 Primary Ureteroscopy in the Emergency Setting: Our Experience from a District General Hospital
Authors: Moghe D , Ong K , Lunawat R 
Published: August 2023

Abstract

Aim
The aim of this study is to evaluate how many patients with ureteric stone disease underwent primary ureteroscopy in the emergency setting (eP-URS) and how many of them had their stone retrieved successfully. In those patients in whom eP-URS was not attempted, we assessed if a reason for not doing so was documented. In addition, we analyzed the possible factors influencing the decision to perform a primary ureteroscopy in the emergency setting.

Method
This is a retrospective observational study of patients presenting to the emergency department of our district general hospital between January and December 2022 with ureteric stone disease requiring emergency surgical intervention in the form of eP-URS or emergency stenting.

Results
Out of 160 patients presenting with ureteric stone disease, eP-URS was attempted in 35% (n = 56) of patients and in the majority of these patients (64.3%, n = 36), the stone was retrieved successfully. On the other hand, eP-URS was not attempted in 65% patients (n = 104), and a decision for emergency stenting alone was made. A reason for this was clearly documented in 46.1%(n = 48) patients: urosepsis, mucky urine, impacted stone, patient factors, obstructed infected system, while in 53.8% (n = 56) cases no reason was mentioned. In our study, the location of the stone and the presence of consultant in theatre were found to significantly influence the decision to definitive stone surgery (p-value &lt;0.05).

Conclusions
Despite clear guidance and potential benefits of definitive treatment of ureteric stones, eP-URS is yet to become an everyday practice. Reasons for not attempting eP-URS should be clearly documented.
1119 A Scoping Review of Kidney Transplantation in Africa: How Far Have We Come?
Authors: Davis S , Zubair A , Igbokwe M , Abu M , Chiedozie C A , Sanni Q , Jesuyajolu D 
Published: August 2023

Abstract

Aim
Kidney transplantation is a life-saving treatment for patients with end-stage kidney disease. However, the availability of kidney transplantation in Africa has lagged behind other regions of the world, leading to significant disparities in access to care. In this study, we sought to analyse indications for transplant, demographic characteristics, and outcomes of kidney transplantation in Africa from inception till date.

Method
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this study. PubMed, Google Scholar, and African Journal Online were searched. Data on procedure done, graft outcomes, donor, prophylaxis given for graft, post-op complications, and survival timelines were pooled together and analysed. Thirty-three studies fully satisfied the eligibility criteria and were used in this review.

Results
The most common causes of end-stage kidney disease requiring transplant included glomerulonephritis and Nephroangiosclerosis. Overall, open nephrectomy accounted for 95% of the surgical approach used. The other approaches documented were Hand-assisted Laparoscopic Nephrectomy (3.88%), Extraperitoneal approach (0.55%), and Simultaneous Unilateral native nephrectomy (0.12%). In total, 56.3% (4221) of all donors were living donors of which 68.5% were related to the recipient (living-related donor), while 43.7% (3280) patients received transplants from cadaveric donors. The commonest surgical complication was graft rejection (39.44%). In the follow-up period, 60.49% of patients who had a kidney transplant developed hypertension.

Conclusions
In conclusion, our study not only highlights the potential for kidney transplantation to improve the lives of patients in Africa, but also the need for further research and infrastructure development to make this a more widespread and successful option.
276 Favorable Outcomes for Endovascular Aneurysm Repair with Aorto-Uni-Iliac (AUI) Stent Grafts for Treatment of Abdominal Aortic Aneurysms (AAA) by a Single Team in 8 Years at South Mersey Arterial (SMArt): A Tertiary Care Vascular Surgery Centre
Authors: Shehata R , Aslam J , Nee beng T 
Published: August 2023

Abstract

Background
Endovascular Aneurysm Repair (EVAR) is established procedure for management of both elective and ruptured abdominal aortic aneurysms (AAA). However, in several cases, standard EVAR with bilateral limb extension cannot be done due to complex anatomy or calcified contralateral iliac artery. In such cases AUI stent graft and Fem-Fem cross over is a feasible option. This study aims to assess the outcomes of AUI with or without fem-fem cross over performed in SMART centre over 8 years

Method
A retrospective study on patients who had repair of AAA using AUI between 2014-2022, with or without crossover. Demographic, procedural, and radiological data was collected through digital database.
The outcomes were based on mode of admission, mortality rate, complications and patency rate of the graft at 2 years.

Results
A total of 28 patients had AUI between January 2014-January 2022. Median age was 79 years (59-94) with male predominance (85%). 50% of the patients presented with ruptured AAA, 46% had elective repair and 4% of patients presented with Acute limb ischaemia.
30-day mortality was found to be 21%. Local complications included endoleak, graft infection, groin bleeding, lymph leak and wound dehiscence and general complications included a predominance of HAP and cardiac issues.
The patency rate was checked at 6 months, 1-2 years. 6-month patency of the graft was found to be 93%. Similarly, 1 and 2-year patency was also found to be 93%

Conclusions
AUI with or without Fem-Fem crossover is an acceptable alternative treatment modality for ruptured or non-ruptured AAAs despite involving an extra-anatomical bypass.
600 Long-Term Clinical Outcomes of the Abdominal Aortic Aneurysm Get Fit Trial: A Randomised Controlled Trial of Exercise to Improve Fitness in Patients with Abdominal Aortic Aneurysm
Authors: Tay T , Haque A 
Published: August 2023

Abstract

Aim
Improved fitness of patients on Abdominal Aortic Aneurysm (AAA) surveillance is predicted to reduce cardiovascular events and improve perioperative morbidity and mortality. The AAA GetFit Trial was a randomised control trial comparing community exercise programme (CEP) with standard care which demonstrated improved CardioPulmonary Exercise Test-related fitness in AAA patients to inform a definitive RCT. This study aims to investigate longer-term four-year clinical outcomes of these individuals.

Method
The AAA GetFit trial recruited participants from Greater Manchester's AAA Surveillance programme, and randomly assigned participants to either i)24-week CEP with choice of gym or home exercises, or ii) standard clinical care. We performed a retrospective analysis of prospective clinical outcomes from this trial over four-year follow-up reviewing whether they underwent operative repair, 30-day postoperative morbidity, cardiovascular event, and mortality with four-year followup. We defined 30-day post-operative morbidity using Clavien-Dindo classification≥3.

Results
In total,56 participants recruited, 28 were randomised to CEP group, 86% were males. Mean age at time of enrolment was 72.8(SD5.7) years. At four-year follow-up, mortality in CEP and control were both 14%(n = 4). In each group, 25%(n = 7) underwent operative repair. There was no perioperative mortality.Perioperative morbidity(n = 2) was 29% in CEP and 0% in control.Cardiovascular events(n = 9) was 7% in CEP and 25% in control.Mean diameter of aneurysm increased slower in CEPvsControl(0.84vs0.93cm).

Conclusions
The AAA GetFit trial showed significant benefits in cardiovascular fitness through community-based exercise. Although clinical outcomes thus far were similar in both groups, there is a suggestion of reduced cardiovascular events in the CEP group.
941 A Systematic Review of Surgical Intervention Criteria for Thoracic Aortic Aneurysms
Authors: Neill H , Taylor S 
Published: August 2023

Abstract

Aim
Elective surgical repair of thoracic aortic aneurysms (TAAs) is the only treatment that prevents dissection or rupture. Current guidelines from the American College of Cardiology/American Heart Association and the European Society of Cardiology, recommend an aortic diameter threshold of 5.5cm for surgical intervention of TAAs. Recent studies have questioned the efficacy of current guidelines as they highlighted that the majority of dissections occur before reaching the threshold. This review aims to determine if an aortic diameter of 5.5cm is an appropriate threshold for prophylactic surgical repair of non-syndromic ascending TAAs.

Method
A search of Ovid MEDLINE and Pubmed databases was performed. Search terms included “ascending thoracic aortic aneurysm”, “ATAA”, “aortic diameter” and “aortic size paradox”. Non-English papers, animal studies and case reports were excluded. Reference lists from each article were assessed for further literature which met the inclusion criteria.

Results
22 studies were included. Four themes emerged from these papers which support lowering the threshold for prophylactic surgery: quantifying the changes in aortic diameter that occur during dissection, the discovery of the aortic size paradox, the identification of a new hinge point, and the improved safety of modern surgery. Regardless of this evidence, it appears to be unjustified to lower the threshold based on relative risk calculations.

Conclusions
Despite current guidelines, the use of aortic diameter as a risk assessment tool for TAAs is inadequate. Multiple studies have shown the ineffectiveness of a 5.5cm threshold, suggesting revision of current surgical guidelines is warranted.
1233 Role of Preoperative Embolization in the Surgical Management of Carotid Body Tumors: A Systematic Review and Meta-Analysis
Authors: Kaya M G , Romagnoli S , Mandigers T J , Bissacco D , Domanin M , Settembrini Al , Trimarchi S 
Published: August 2023

Abstract

Aim
The role of preoperative embolization in the surgical management of carotid body tumors (CBT) remains a topic of debate. The aim of this study was to evaluate the effect of preoperative embolization on CBT resection.

Method
A systematic review and meta-analysis was conducted following the PRISMA protocol. Pubmed, Scopus and Web of Science were screened for studies published between 2010-2022. Primary outcomes investigated were intraoperative blood loss, operative time, length of hospital stay, and perioperative complications such as TIA/stroke, vascular injury and cranial nerve injury. Quality assessment of selected studies was performed using the Newcastle-Ottawa Scale (NOS). Publication bias was assessed using funnel plots and Egger’s regression test.

Results
Twenty-five studies were included in the systematic review, involving 1649 patients. Twenty-three studies were eligible for meta-analysis. The incidence of vascular injury necessitating intervention was significantly less in the preoperative embolization group (OR = 0.60; 95% CI: 0.42-0.84; P = .003). There was no statistically significant difference between the two groups with regards to intraoperative blood loss, operative time, length of hospital stay, incidence of TIA/stroke and cranial nerve injury. Subgroup analyses did not show significant difference between Shamblin I, II and III subgroups with regards to operative time.

Conclusions
This systematic review and meta-analysis found preoperative embolization to be significantly beneficial in reducing vascular injury. No statistically significant difference was found between the two groups regarding intraoperative blood loss, operative time, length of hospital stay and complications such as TIA/stroke and cranial nerve injury.
1240 Life Expectancy of Octogenarians Following EVAR
Authors: Sultana E , Seraj S , Jones S 
Published: August 2023

Abstract

Background
The aim of elective Abdominal Aortic Aneurysm (AAA) repair is to prevent premature death from rupture. The Endovascular Aneurysm Repair (EVAR) 2 trial showed that patients with AAA who are not fit for open repair do not benefit in terms of life-expectancy from EVAR. In our region, the average life expectancy for men is above the national average but controversy remains when offering octogenarians expensive procedures with the aim of prolonging life. This study aimed to quantify the life-expectancy following an EVAR between octogenarians and younger patients.

Method
A retrospective review was performed of the electronic notes of all patients receiving EVAR at our unit between October 2009 to October 2019. Survival post EVAR was compared between the octogenarian group and the younger patient group. A survival analysis was undertaken using the SPSS software to calculate a Kaplan-Meier curve.

Results
294 patients received EVAR between 2009-2019. Patients were between ages 45 and 89 (Median: 75); 87.4% were male. 169 patients died during follow up (n = 64 ≥80 years, n = 105 &lt;80 years). Time of death post-EVAR in octogenarians (average age 82.91 years) ranged between 0 - 131 months, whilst those under 80 years (average age 71.77 years) ranged between 1 - 152 months. Log rank (Mantel-Cox) analysis demonstrated statistical significance (p = 0.017). Median years post-EVAR for ≥80 years was 3.02 - 4.98 and &lt;80 years was 5.12 - 6.87.

Conclusions
Octogenarians undergoing EVAR have a shorter life-expectancy compared to those under 80 years of age. This should be considered when discussing elective options with patients and their relatives.