bluuebunny/crossref_metadata_2025_split huggingface dataset:
907 An Audit of Breast Ultrasonography in Patients Under 35
Authors: Fagbemi O , Khan M , Jafferbhoy S , Marla S , Narayanan S , Gopalan V , Soumian S 
Published: August 2023

Abstract

Introduction
Breast Ultrasonography (USS) is a major part of the triple assessment for breast presentations in those under 35 years. Currently, most institutions are running targeted separate U-35 clinics. The aim of this study is to audit the outcome of breast USS in patients under 35 years.

Method
Over a 5-month period, December 2021- May 2022, retrospective data was collected across 3 clinics. In total, 300 patients were analyzed.

Results
The age distribution was as follows: 16-20 years (30), 21-25 years (51), 26-30 years (107), 31-35 years (104). Of the 300 patients, 68% of referrals to clinic were for breast lump (fibroadenoma, cysts and on one occasion papilloma), with the 26-30 age group being the majority at 36%. Half of the patients had USS, with the most common indication being lumps, followed by nodularity at 28%. Other indications for ultrasound included: nipple discharge, palpable nodes, eczema, nipple inversion. The radiological findings were fibroadenoma 21% (32), cysts and abscess with 15% (23) and 2.6% (4) respectively. No cancers identified. Fifty four percent had no identified lesions.

Conclusions
Our studies showed that of those referred for USS, only 46% had a lesion detected. No cancers diagnosed. Thus, these targeted clinics are effective in meeting demand for services. To increase efficiency, it might be a worthy consideration to have even clearer guidelines on ultrasonography specifically for patients under 35 years.
703 Parsonage Turner Syndrome After COVID-19 Vaccination – a Systematic Review
Authors: Manoharan G , Gandhbir V , Jose J , Van Liefland M 
Published: August 2023

Abstract

Aim
Parsonage Turner Syndrome (PTS) is a rare acute neuritis usually reported after an antecedent event like surgery, infection, trauma, medication or immunisation. PTS presents as sudden, often unilateral, severe shoulder pain with progressive weakness and altered neurology. The global mass COVID vaccine program has resulted in increased reporting of post-vaccine PTS. The aim of this review is to report the outcomes of PTS after COVID-19 vaccination.

Method
A systematic review was conducted according to the PRISMA statement. An electronic search was performed on Medline, PubMed, Embase and CINAHL databases using the keywords ‘COVID-19’, ‘Coronavirus’, ‘Parsonage Turner Syndrome’, ‘Brachial neuritis’, ‘Neuralgic Amyotrophy’, ‘Vaccine’, ‘Immunisation’ and ‘Shoulder’.

Results
16 articles with a total of 35 patients, 24 males and 11 females, were reviewed. The mean age was 52 years. The median time to develop symptoms was 7 days, with 69% patients reporting ipsilateral symptoms to the vaccinated arm. 91% patients presented with sensory and motor symptoms. MRI scan was normal in 26% while denervation muscle oedema was present in 20%. 37% patients were treated with physiotherapy and rest, while 63% received steroid therapy. 23% showed no improvement while 69% showed partial or complete improvement. The mean follow-up time was 3 months (range one week to six months).

Conclusions
PTS is a rare complication described with vaccines like influenza, tetanus and hepatitis. PTS is also associated with the COVID vaccine. The limited reports suggest the treatment and recovery are consistent with that for other aetiology. This complication is not a reason to avoid the COVID vaccine.
949 ‘Host Stage Migration’ in Newly Diagnosed, Operable Colorectal Cancer During the First Wave of the COVID-19 Pandemic – A Multicentre Comparative Cohort Study
Authors: Brown L R , Gardner E , Thompson J J , McGovern J , Abbass T , Dolan D , Davenport R P , Boardley R S J , McMillan D C , Skipworth R J E , Hendry P O 
Published: August 2023

Abstract

Aim
The COVID-19 pandemic caused immeasurable disruption to cancer pathways across the United Kingdom, resulting in many patients presenting with more advanced stages of disease. This study explores whether migration of ‘host-stage’ was evident amongst patients who underwent resection for colorectal cancer during this period.

Method
Consecutive patients who underwent a potentially curative resection, for colorectal cancer newly diagnosed between 23/03/2020 and 23/12/2020, were identified from prospectively maintained databases. A cohort from the same dates in 2019 were sought for comparison. CT body composition analysis, at the L3 vertebral level, allowed calculation of skeletal muscle index (SMI) and density (SMD). Neutrophil-lymphocyte-ratio (NLR) was selected as a composite marker of systemic inflammation. The primary outcomes of interest were host body composition and systemic inflammatory response.

Results
Overall, 280 patients underwent a colorectal resection during 9-month periods in the COVID-19 pandemic (n = 117) and preceding year (n = 167). Age, ASA, sex, and tumour location were all comparable between cohorts. More patients in the COVID cohort had a T3/4 malignancy (83.6% vs. 67.7%, p = 0.04). Median SMI (42.4 vs. 44.3cm2/m2) and SMD (33.6 vs. 33.1 HU) were similar in COVID and pre-COVID populations. NLR was higher amongst patients during the pandemic (median 3.6, IQR: 2.2-5.8) than those in the previous year (median 3.3, IQR: 2.1-4.6, p = 0.05).

Conclusions
A higher proportion of patients who underwent resection of a colorectal cancer during the COVID pandemic had a locally advanced tumour. While CT-body composition was comparable between cohorts, higher levels of pre-treatment systemic inflammation were evident. This may be suggestive of ‘host-stage’ migration.
1008 Impact of COVID-19 Vaccination-Based Triaging on Recovery of Services for Plastic Surgery Hand Trauma in a Plastic Surgery Tertiary Referral Centre
Authors: Ishak L , Bramhall R , Murphy A 
Published: August 2023

Abstract

Aim
Evaluate the impact vaccination-based-triaging on recovery of operative services.

Method
Data was collected retrospectively on 120 patients who underwent surgical management for closed hand fractures, nerve injuries, and tendon injuries. Forty were in the pre-covid group (Jan-Mar 2019), 40 in the post-covid pre-vaccine group (Jan-Mar 2022), and 40 in the post-covid post-vaccine group (Jul-Sep 2022).
Outcome measures:Average number of days between decision to operate and operation (operative delay)Adherence to operative timing requirements, as set by the British Society for Surgery of the Hand (BSSH)

Results
In the post-covid post-vaccine group, operative delay was shorter than in the post-covid pre-vaccine group for hand fractures (3.6 vs 3.9) nerve injuries (3.8 vs 2.5), and tendon injuries (2.1 vs 2.2). Overall, the difference was not statistically significant (3.3 vs 2.7, p = 0.2526).
BSSH operative timing requirements were met in a higher proportion of patients for hand fractures (93% vs 85%), nerve repairs (100% vs 87%), tendon repairs (89% vs 85%) and overall (89% vs 85%).
In the pre-covid group, operative delay was shorter than both post-covid groups for hand fractures (2.5), nerve injuries (1.8), and tendon injuries (1.4). Overall, the difference was statistically significant compared to the post-covid pre-vaccine (1.9 vs 3.3, p = 0.0024) and pre-covid post-vaccine groups (2.7 vs 1.9, p = 0.0238).
Overall, BSSH operative timing requirements were met for a higher proportion of patients than both pre-covid groups (100% vs 89%).

Conclusions
Plastic surgery hand trauma services have not yet fully recovered. Further interventions are required to aid recovery to pre-pandemic standards.
1030 Impact of COVID-19 on Operative Timing for Plastic Surgery Hand Trauma in a Plastic Surgery Tertiary Referral Centre
Authors: Ishak L , Bramhall R 
Published: August 2023

Abstract

Aim
To evaluate the impact of COVID-19 on operative timing for hand trauma in a plastic surgery tertiary referral centre.

Method
Data was collected retrospectively on 80 patients who underwent surgical management for closed hand fractures, digital nerve injuries, and tendon injuries. Forty patients were in the pre-covid group (Jan-Mar 2019) and 40 in the post-covid group (Jan-Mar 2022).
Outcome measures:Mean number of days between decision to operate and operation (operative delay time)Adherence to the operative timing requirements, as set by the British Society for Surgery of the Hand (BSSH)

Results
There was a statistically significant difference in operative delay time between the pre-covid group and the post-covid pre-vaccine group for hand fractures (2.5 vs 3.9, P = 0.0503), tendon injuries (1.4 vs 2.2, p = 0.016), and overall (1.9 vs 3.3, p = 0.0024). There was no significant difference between the 2 groups for nerve injuries (3.8 vs 1.8, p = 0.3062).
In the post-covid group, BSSH operative timing requirements were met for a lower proportion of patients than the pre-covid group for hand fracture fixations (85% vs 100%), nerve repairs (87% vs 100%) tendon repairs (85% vs 100%). Overall, there was a statistically significant difference between the 2 groups (85% vs 100%, p = 0.0214).
Operative delays were documented as being related to COVID-19 in 100% of patients who did not meet BSSH operative timing requirements.

Conclusions
COVID-19 has had a significant impact on operative timing for plastic surgery hand trauma. Further studies are needed to evaluate the usefulness of various interventions in the recovery of services following the COVID-19 global pandemic.
712 Improving Post-Op Length of Stay (PLOS) in First-Time Coronary Artery Bypass Graft (CABG)- a Closed Loop Audit
Authors: Amo-Afful S , Ali S 
Published: August 2023

Abstract

Aim
To identify and improve our average PLOS for first-time CABG compared to the national average of 7.9 days.

Method
A baseline audit was performed by retrospective analysis of first-time CABG betwen June-August 2022. A re-audit was done in November following recommendations such as encouraging early nurse-led mobilization of post-op patients.

Results
Our cardiothoracic unit recorded an average of 9.4 days after first-time CABG over the period. Major contributors of increased length of stay were attributed to lesser physiotherapy sessions and post-op complications. After interventions, PLOS improved to 8.5 days in the re-audit.

Conclusions
Post-op length of stay can be functionally improved if more staff could encourage patient to mobilize with targets daily. Nurse-led mobilization will reduce the burden on physiotherapist and influence the outcomes of discharge.
1016 A Quality Improvement Project Addressing the Healthcare Dimension of Effectiveness in a Large Cardiothoracic Surgery Department by Ensuring the Contents of the Current Emergency Surgical Chest Drain Boxes Are Correctly Stocked Through Additional Rigorous Checks by June 2022, by Using the Model for Improvement Approach
Authors: Evans N 
Published: August 2023

Abstract

Background
Emergency chest drain insertion on cardiothoracic wards is frequent occurrence due to complications such as pneumothorax. The emergency insertion requires the immediate availability of a significant amount of sterile equipment. A box containing all the equipment on the ward was checked and restocked by the ward nursing staff, however, data suggested missing equipment was prevalent. This has implications for clinical effectiveness, timely intervention, and ultimately patient safety.

Aim
This project establishes the frequency of missing items and aims to reduce this frequency through more rigorous checks of the emergency chest drain box contents.

Method
Retrospective analysis of the box contents was performed over 3 months to establish baseline data. Thoracic surgery doctors completed a questionnaire, before and after the changes, about their experiences with the emergency chest drain boxes and missing items. A revised stock checklist was produced in collaboration with the project champion, the audit lead for thoracic surgery, and the procedural document team. The checklist introduction used transformational leadership. Subsequent completeness data was collected, in addition to a follow-up questionnaire.

Results
There was an 81% reduction in the 3-month average number of reported missing items following implementation; and a 92% increase in perceived confidence that the box will be correctly stocked.

Conclusions
An 81% reduction using two Plan Do Study Act (PDSA) cycles represents an improvement in effectiveness. There are plans to implement a single-use, pre-packed emergency chest drains insertion pack. The ongoing third PDSA cycle introduces the single-use pack, ongoing improvement will be demonstrated with repeat audits.
1053 An Insight into Cardiac Tumours Using Over 20 Years of Up-to-Date Historical Data.
Authors: Navarro A , Hara N , Rossi A , Smith A , Sheaff M , Lawrence D , Oo A , Shipolini A , Yates M 
Published: August 2023

Abstract

Aim
Cardiac tumours are uncommon and frequently incidental findings. The study aims at analysing the demographics, presentation, histological prevalence and outcomes for cardiac tumours over the past 21 years.

Method
An observational retrospective data analysis on an SCTS database of all patients undergoing cardiac surgery at 3 different centres in the UK was performed. Further data was collected through operative summaries, pathology reports and outpatient letters.

Results
207 patients underwent an operation for a cardiac tumour between 2001 and 2022, 66.2% were female and 33.8% male. Mean age was 62 years (17- 86 years). 62.3% were urgent procedures, 21.3% elective and 16.4% emergencies. 44 patients presented with chest pain, 29 stroke, 18 palpitations/arrhythmias, 15 shortness of breath and 7 syncope. In 51 patients the finding was incidental. Average cardiopulmonary bypass time was 80 minutes, and the average cross clamp time was 52 minutes. In 80.2% of cases the left chamber was involved, 10.6% right atrium, 1% left ventricle and 0.5% right ventricle. The final pathological specimen was reported as myxoma in 80.2% of cases, fibroelastoma in 3.9%, thrombus in 7%, sarcoma in 2.9 % and 1% calcified mass. Other histologies included osteosarcoma, lymphoma, granulation tissue, infected mass, cardiac fibroma, and lipoma. In-hospital mortality was 1.5%.

Conclusions
Despite the rarity of cardiac tumours and the lack of presenting symptoms, the study demonstrated that surgical mortality is low and although the overwhelmingly the commonest histology was confirmed to be myxoma, sarcoma is also an important differential as are the other histologies, which may be surprising.
1234 Enlarging Pericardial Cyst Compressing the Right Ventricle
Authors: Kho J , Shan A , Rizzo V , Sabetai M 
Published: August 2023

Abstract
52-year-old Indian builder initially presented to his General Practitioner with exertional breathlessness but no angina. His medical history included previous tuberculosis infection, Type 2 Diabetes Mellitus and hypothyroidism. He was referred to the cardiologist to exclude coronary artery disease.
Stress testing found T-wave inversion in the inferior electrocardiogram leads and transthoracic echocardiogram showed reduced right ventricular (RV) function with basal wall hypokinesia. Cardiac Magnetic Resonance Imaging (MRI) revealed a 5cm x 2.5cm pericardial cyst (Figure 1a). As imaging suggested minimal RV compression and no venous obstruction, the patient was investigated for other causes of breathlessness.
Repeat computed tomography (CT) two years later demonstrated enlargement of the cyst (6cm x 3.6cm) with contrast reflux into the inferior vena cava (IVC) (Figure 1b). Due to worsening breathlessness, surgical excision was offered.
Surgery was attempted through a lower hemi-sternotomy. However, due to limited access to the cyst and thickened pericardium, median sternotomy was performed. The cyst measured 10cm x 7cm and was heavily adherent to the RV wall, right atrium and IVC preventing complete excision. The cyst was therefore unroofed, releasing cheese-like material suspicious of a tuberculous cyst (Figure 2). Adhesiolysis was undertaken to remove remaining cyst wall. Prior to closure, inflamed pericardial tissue was excised.
Histopathology revealed a chronically inflamed pseudocyst with necrotising and non-necrotising granulomatous inflammation. Ziehl-Neelsen, Grocott, Gram and periodic acid-Schiff-diastase stains were negative. Intraoperative and histological findings and history of tuberculosis suggested a diagnosis of tuberculous pericardial cyst.
The patient recovered uneventfully with significant symptomatic improvement at 2-month follow-up.
66 Central Palmar Necrosis Following Steroid Injections for the Treatment of Carpal Tunnel Syndrome - a Case Report
Authors: Hassan M R , Brennan C , George S 
Published: August 2023

Abstract

Aim
Steroid injections are commonly used as a diagnostic tool or an alternative to surgical management of carpal tunnel syndrome (CTS) and are generally safe. Ischaemia is a rare complication with very few cases reported in the literature.

Method
We report a case of a 50-year-old female that presented with a necrotic wound to her left palm one month after a steroid injection into the carpal tunnel. She had a 2-year history of CTS in her left hand that was treated with six previous steroid injections in primary care during this period. The wound evolved from a blister to a necrotic ulcer which led to a painful, hollow defect in the centre of her palm. She did not report any history of trauma, nor did she have any co-morbidities. Clinical photographs were taken.

Results
On examination she had a 0.5cmx1cm defect in the palm of her left hand down to aponeurosis. There was purulent discharge in the wound with surrounding erythema but no spreading cellulitis. She had full function of her fingers but was very tender on movements and at rest.
She was admitted for intravenous antibiotics and underwent a debridement, washout and carpal tunnel release the next day. The defect was packed to heal by secondary intention and has now fully healed one-month following her operation.

Conclusions
This is an extremely rare complication of steroid injections to the carpal tunnel and may have been avoided by earlier referral for surgery rather than treatment using multiple steroid injections.
138 Case Report: Frontal Sinus Mucocele Following Frontal Bone Fracture
Authors: Hassen A , Hundia R , Tighe D 
Published: August 2023

Abstract

Introduction
Giant frontal mucocele of the frontal sinus is a rare benign pathology caused by retention of mucous secretions. They develop when the opening of a paranasal sinus becomes obstructed due to trauma, infection, chronic sinusitis, polyps, malignancy, bony tumours, or congenital anomalies.
This case reports a giant mucocele of the frontal sinus caused by conservative management of frontal bone fracture 30 years ago.

Presenting case
64 –year- old male was referred by his GP to the maxillofacial department after noting a slow growing lesion between his eyebrows resulting in him not being able to wear his glasses. He reported a history of horse-riding trauma 30 years ago, resulting in a frontal bone fracture, which was managed conservatively. This lesion has been slowly growing over 30 years.
Medically he suffers from uncontrolled hypertension and has had a metallic aortic valve replacement and coronary artery bypass grafting.
MRI and CT imaging demonstrates a 2cm cystic lesion consistent with a mucocele with proteinaceous or hyperdense fluid.

Discussion
Fractures of the frontal bone, which involves the frontal sinus, are relatively uncommon injuries, comprising up to 5% of all maxillofacial injuries.
Mucocele development is a long-term complication, which can arise or persist 6 months to decades after. Management of these cases require a joint surgical approach with Ear, Nose and Throat for removal of the mucocele and Maxillofacial for reconstruction of the frontal sinus and frontal bone via endoscopically using a frontal balloon or an osteoplastic flap/spectacle incision.
181 Lessons Learned from Complex Abdominal Wall Reconstruction for the Management of Giant Paraoesophageal Hernia - a Case Analysis
Authors: Yip J , Hicks G , Chan D , Fisher O 
Published: August 2023

Abstract

Aim
In this case report, we present a new method in the management of a giant hiatus hernia: the use of crural relaxing incisions. This new method in combination with previously known strategies including botox and preoperative optimisation for surgery with weight loss and prehabiliation can result in a more effective surgical hiatus hernia repair and subsequently lead to a reduced risk of hiatus hernia recurrence.

Case Presentation
71yo man admitted to hospital with a one-week history of generalised abdominal pain, nausea, vomiting and chest pain. He had a background of a known large hiatus hernia for the last 10 years. An abdominal CT showed a large type IV hiatus hernia containing the stomach, transverse colon, pancreatic body, and pancreatic neck.
CT guided botulinum toxin A injections were given by interventional radiology during which the muscle bellies of the transversus abdominus, internal and external obliques were targeted. The patient was placed on a meal replacement (Optifast) diet.
A laparoscopic thoraco-abdominal hiatus repair was performed finding a giant hiatus hernia containing the entire stomach, first part of the duodenum, left lobe of liver, transverse colon, small bowel and distal pancreas. Due to the size of the hiatus hernia and the potential tension likely to result from a repair, both right and left crural relaxing incisions were made to facilitate closure. Crural closure was reinforced with a Bio A mesh secured in a C configuration covering the right crural relaxing incision. The patient recovered well postoperatively. Follow up imaging did now show recurrence.
222 Pediatric Pulse Oximetry to Monitor the Post-Operative Integrity of Free Flaps
Authors: Scampos M , Brady C , Nikkhah D 
Published: August 2023

Abstract

Introduction
The post-operative monitoring of free-flaps can be a challenge, particularly for junior staff on-call and in patients with darker or mottled skin. We present a case employing paediatric pulse oximetry to monitor a free flap where clinical assessment was challenging, illustrating its value as an adjunct to existing techniques such as doppler.

Case
A 23-year-old patient underwent tenolysis to his anterior right leg compartment due to a painful, tethered scar following injury. He subsequently had a superficial circumflex iliac perforator (SCIP) flap anastomosed end-to-side to his posterior tibial artery. The operation was technically challenging, but the flap had a strong doppler and remained clinically well until day 4 post-op, where it became mottled but remained warm and soft. Clinical assessment was equivocal, and a paediatric pulse oximeter was taped to the flap, consistently showing saturations &gt;95%, providing reassurance out-of-hours and facilitating the decision to delay haematoma evacuation for the following day. The flap survived and the patient did well.

Conclusions
The use of paediatric pulse oximetry to assess free flaps is a useful technique for clinically ambiguous cases where re-exploration could compromise survival. It is cheap, widely accessible and can be easily employed by junior clinicians and nurses who may be relatively inexperienced in their assessment of flaps’ clinical condition.