bluuebunny/crossref_metadata_2025_split huggingface dataset:
O051 Incidence and management of axillary lymphadenopathy post COVID-19 vaccination in a symptomatic breast unit
Authors: Giblin K , Balasubramanian I , Downey E , Butt A , Allen M , Power C , Hill AK 
Published: November 2022

Abstract

Introduction
Following the mass rollout of COVID-19 vaccination, regional lymphadenopathy presents as a diagnostic dilemma for clinicians. The aim of this study explores the incidence and management of unilateral axillary lymphadenopathy following vaccination at a symptomatic tertiary breast unit.

Methods
This is a retrospective review of a prospectively maintained database of all patients who underwent axillary imaging for symptomatic or incidental axillary lymphadenopathy detected on imaging following COVID-19 vaccination between January 2021 – December 2021. Radiological and histological information were obtained from the hospital s NIMIS radiology and PIPE histology system. Additional patient and clinical information was obtained from patient's clinical notes.

Results
A total of 253 patients underwent axillary ultrasounds during the twelve-month interval. Of these 24 (9.4%) of patients underwent investigation for axillary lymphadenopathy related to recent COVID vaccination. Of these, 21 patients had image consistent reactive nodes while the remaining 3 patients had normal radiological investigation. Only 6 patients underwent ultrasound guided biopsy of these nodes which confirmed reactive notes.

Conclusion
Patient and clinician education is required to raise awareness in COVID-19 related axillary lymphadenopathy. Standardization in the management including the timing of breast screening and radiological investigation in relation to COVID vaccination is required, in order to minimize over investigation in this patient cohort.

Take-home message
COVID-19 vaccine related axillary lymphadenopathy is being seen in tertiary symptomatic breast clinic. Patient and clinician education is necessary to raise awareness of this and contribute to a standardised approach of investigation and management of this phenomenon.
O065 Mycotic extracranial carotid artery aneurysms: a systematic review
Authors: Hanger M , Baker W , Baker DM 
Published: November 2022

Abstract

Introduction
Mycotic extracranial carotid artery aneurysms are rare and their management variable due to a lack of evidence assessing outcomes. We undertook a systematic literature review to assess this.

Methods
Following PRIMSA guidelines, MEDLINE and EMBASE databases were searched for all cases of extracranial carotid artery aneurysms between January 1970 and March 2021. The search terms used were infect, abscess, mycotic, carotid, aneurysm, pseudoaneurysm. Aneurysm, infected and carotid artery disease” subject headings were used. Titles and abstracts were screened before full text papers were reviewed.

Results
193 such aneurysm cases were identified from 154 sources. Patients were predominantly male (71.4%) and age ranged from 6 months to 89 years old. The commonest presentations were a neck mass and fever, but included haemorrhage, respiratory distress and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.4%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (21.1%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In five cases there was antibiotic treatment alone. In the open surgery treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%.

Conclusion
Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer complications than open surgical management and is recommended.

Take-home message
Carotid infected aneurysms are rare. They arise from direct spread of a staphylococcus or tuberculous infections. Endovascular management offers the best results.
O067 Efficacy and safety of interventional therapy of low-flow vascular malformations based on the experience from a single specialist centre
Authors: Pang C , Arasakumar DRB , Evans N , Papadopoulou A , Khalifa M , Hamilton G , Brookes J , Lim CS 
Published: November 2022

Abstract

Introduction
To evaluate the efficacy and safety of embolo-sclerotherapy (EST) of low-flow vascular malformations (LFVM) in a specialist vascular anomalies centre.

Methods
All patients with LFVM who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. All ESTs were performed with foam STS 3%, ethanol, coils and/or other substances e.g. triamcinolone. LFVMs were grouped according to Puig's classification. The outcome measures were treatment effects and complications. Continuous variables were compared using ANOVA test. Other discrete variables were compared using Chi-squared tests. Differences were considered significant at P&lt;0.05.

Results
A total of 207 patients, with a mean age of 32 years (range 1–71 years) were included. The use of EST with foam STS was significantly lower for type I LFVM (61.8%) compared to others (p&lt;0.001). However, significantly higher type I LFVM (26.5%) were treated with surgery than EST (p&lt;0.001). Overall, outcome categories were significantly different across all types of LFVM (p&lt;0.001), with more discharges for Type I (52.9%) LFVMs but more failure to follow-up in patients with Type II (24.5%) LFVM. EST complications was significantly higher with type I (14.7%) LFVMs (p=0.030). The doses of STS in the first procedure were significantly different across all types of LFVM (p&lt;0.001) with most type I LFVM patients receiving ≤2 ml.

Conclusion
EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's Type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate.

Take-home message
EST particularly with foam sclerotherapy is clinically effective and safe for patients with LFVM especially in those with Puig's Type I and II lesions. This classification may provide an important guide to volume of sclerosant required and the potential success rate.
O074 Metabolic phenotyping in diabetic foot ulceration
Authors: Roy Choudhury J , Ding A , Onida S , Shalhoub J , Davies AH 
Published: November 2022

Abstract

Introduction
Diabetic foot ulceration is a devasting complication of diabetes contributing to significant morbidity. Delayed wound healing leads to limb loss and associated stress, anxiety and depression. Apart from systemic inflammatory markers and qualitative assessment of the ulcers, there is no molecular biomarker that can help prognosticate the fate of a diabetic foot ulcer. Metabonomics is a powerful toolset employed to describe metabolic signatures of diabetes in various biological systems. The aim of this systematic review is to summarise the existing evidence on the subject.

Methods
A systematic review was performed following a predefined protocol. Searches of Embase and MEDLINE by two independent authors, retrieved 292 articles, of which two were included in this study. A qualitative synthesis was performed due to heterogeneity between the studies.

Result
Two articles pertaining to metabonomics in diabetic foot ulcers were included. One study found that phospholipids (phosphatidylcholine, phosphatidylethanolamine and lysophosphatidylethanolamine) were associated with the development of diabetic foot ulcers. In the second study, amino acids such as arginine, isoleucine, leucine and threonine were found to be in greater concentration in the healed ulcer group as compared to the non-healed ulcer group.

Conclusion
The studies have highlighted disruption in the phospholipid pathway. They also suggest that specific amino acids are indeed deficient in non-healing ulcers. There is limited published literature on the application of metabolic phenotyping platforms in DFU. The methodology is heterogeneous and hence not directly comparable. Further studies are needed that utilize a biological approach, standardized design and additionally have translational application.

Take-home message
Diabetic foot ulcer healing is not fully understood. More study designs using metabolic phenotyping should be developed as they provide the most patient specific phenotype.
O077 Explantation vs graft preserving strategy following primary endovascular aneurysm repair: two decades of EVAR and lessons learned
Authors: Sultan S , Acharya Y , Hynes N 
Published: November 2022

Abstract

Introduction
Continuous sac expansion could result in rupture, requiring aggressive management with reintervention to abolish the risk of rupture. Re-intervention could be achieved through salvage of the primary endograft through graft preserving strategy or explantation as necessary. We aimed to scrutinise our 20 years of EVAR practice, strategies indications for management and reinterventions following primary endovascular aneurysm repair (EVAR).

Methods
We performed 1480 aortic interventions over the study period, including 910 EVARs. Using conventional and innovative diagnostic modalities with Prone contrASt enHanced computed tomography Angiography (PASHA), 133 endoleaks (ELs) were identified (15 type I, 98 type II; 18 type III; 5 type IV).

Results
In total, 44 patients underwent re-intervention post-primary EVAR;18 EVAR GORE SalvAge Fabric Technique (ARAFAT), 12 double breastings, and 14 explantations. Mean EL detection duration following primary EVAR was 53.3 ± 6.82 months, while re-intervention time was 70.2 ± 6.98 months. Mean sac size before the primary EVAR and re-intervention were 6.00 and 7.51 cm. Polyester (61.40%) was the most commonly employed stent-graft material. Factors associated with the need for reintervention and the likelihood of chronic fabric fatigue failure (CFFF) included the use of more than three modular stent-graft components (3.42 ± 1.31); with the proximal stent-graft diameter of 31.6 ± 3.80 cm and the use of iliac limbs more than 18 mm. We had one peri-operative mortality following explantation due to sepsis-induced multiorgan failure.

Conclusion
Increasing complications post-EVAR necessitates developing and studying reintervention strategies to salvage existing endograft and/or address graft-related complications.

Take-home message
Increasing complications post-EVAR necessitates developing and studying re-intervention strategies to salvage existing endograft and/or address graft-related complications.
O084 Adipose-derived stem cells attenuate the induction of tissue destructive and inflammatory fibroblasts by ionising radiation
Authors: Langridge B J , Abu-Hannah J , Carter R , Butler PEM 
Published: November 2022

Abstract

Introduction
Radiation-Induced Fibrosis (RIF) is a common complication of radiotherapy with no effective treatment, causing permanent, progressive disability and disfigurement of cancer patients. Autologous lipotransfer has promise as a treatment for RIF, with adipose-derived stem cells (ADSCs) proposed as the key effector mechanism. This study investigates the effects of ADSCs on irradiated human dermal fibroblasts (HDFs).

Methods
HDFs (n = 3), control or irradiated (10Gy), were grown in monoculture, co-culture with ADSCs or in the presence of ADSC-conditioned media (ADSC-CM) over a 2-week period. RT-PCR was used to determine the mRNA expression of 84 inflammatory and fibrotic genes. ELISA was used to measure the levels of MMP1, MMP3 and CCL2 secreted. Immunocytochemistry was used to stain HDFs for type 1 collagen and αSMA.

Results
Compared to control HDFs, irradiated HDFs demonstrated reduced proliferation and upregulated the mRNA expression and protein secretion of multiple fibrotic and inflammatory genes, including MMP-1, MMP-3, IL-4 and CCL2. Accompanying upregulation of these genes was increased expression of fibroblast activation markers FAPA and PDPN and decreased expression of THY1. Coculture with ADSCs or ADSC-CM attenuated many of these effects.

Conclusion
Ionising radiation promotes the generation of FAPα+THY1- tissue-destructive fibroblasts that secrete high levels of MMPs, degrading and restructuring the extracellular matrix of the skin. Elevated secretion of pro-inflammatory mediators CCL2 and IL-4, create a microenvironment permissive for the recruitment of monocytes and pro-fibrotic macrophages. ADSCs reverse many of the changes driven by ionising radiation, including the generation of tissue-destructive fibroblasts, through paracrine signalling.

Take-home message
Ionising radiation promotes the generation of FAPα+THY1- tissue-destructive fibroblasts that secrete high levels of MMPs, degrading and restructuring the extracellular matrix of the skin. ADSCs can reverse many of the changes driven by ionising radiation, including the generation of tissue-destructive fibroblasts, through paracrine signalling.
O098 A systematic review of the use of artificial intelligence for image analysis in total hip and total knee arthroplasty
Authors: Gurung B , Liu P , Harris P , Tucker K , Sochart D , Kader D , Field R , Asopa V 
Published: November 2022

Abstract

Introduction
Total hip and knee arthroplasty are common orthopaedic procedures that require post-operative radiographs to confirm implant positioning and identify complications. Artificial intelligence (AI) technology has the potential to automate image analysis. This systematic review reports on how AI-based technologies are currently being used and their accuracy in image analysis following THA and TKA.

Methods
EMBASE, Medline and PubMed libraries were systematically searched for articles published until 15/09/2021 using terms related to “x-ray analysis”, “total hip/knee arthroplasty”, and “AI”. The review was performed according to the PRISMA guidelines (PROSPERO#CRD42021276876). Study quality was assessed using a modified MINORS tool. AI performance was reported using the area under the curve (AUC) and accuracy.

Results
Of the 455 studies identified, 12 were included: nine reported implant identification, three described prediction of implant failure and three compared AI performance with orthopaedic surgeons. AI-based implant identification was precise (AUC 0.992–1) and most algorithms reported accuracy &gt;90%. Two of these studies reported AI performance to be similar or superior to human experts. AI prediction of dislocation risk following THA was acceptable (AUC 76.67), diagnosis of hip implant loosening was good (accuracy 88.3%) and measurement of acetabular angles on post-operative x-rays was comparable to humans (Cohen's kappa 0.76–1.00).

Conclusion
AI technology can be trained to identify implant models on post-operative x-rays with a performance that is comparable to that of human experts. However, the technology requires further development to enable analysis of other post-operative radiographic features following arthroplasty surgery that could improve patient care.

Take-home message
Artificial intelligence image analysis through deep learning can classify hip and knee implants, and measure malposition and detect features of loosening of hip implants.
O100 The effect of nickel hypersensitivity on outcome of total knee arthroplasty and value of skin patch testing: a systematic review
Authors: Peacock C , Fu H , Asopa V , Clement N , Kader D , Sochart D 
Published: November 2022

Abstract

Introduction Aims
of the systematic review were to assess the sensitising potential of TKA, explore the relationship between Nickel hypersensitivity and clinical outcomes, and evaluate the utility of skin patch testing pre- and/or post-operatively.

Methods
A literature search was performed through EMBASE, Medline and PubMed databases. Articles were screened independently by two authors. Levels of Evidence were assessed using OCEBM criteria, and quality assessed using MINORS and Cochrane risk-of-bias tools.

Results
Twenty studies met the eligibility criteria, reporting on 1354 knee arthroplasties. Prevalence of Nickel hypersensitivity ranged from 0% to 87.5%. Only one study which compared prevalence of hypersensitivity in the same patient group before and after surgery noted newly positive patch test reactions in 4.1%. Three studies reported lower prevalence of hypersensitivity in post-operative patients compared to pre-operative patients. Seven studies suggested hypersensitivity might cause complications; six studies did not support any relationship. Seven studies recommended pre-operative patch testing in patients with history of metal allergy; nine studies concluded testing may be valuable post-operatively.

Conclusion
Patients undergoing TKA do not seem to be at increased risk of developing Nickel hypersensitivity, however there is conflicting evidence that patients with established hypersensitivity are more likely to experience adverse clinical outcomes. Patch testing remains the gold standard diagnostic method; evidence suggests performing this test pre-operatively in patients with history of metal allergy to aid selection of the most appropriate prosthesis, and postoperatively once common causes of implant failure have been excluded, since implant removal or revision with hypoallergenic implants may alleviate symptoms.

Take-home message
Patients undergoing total knee arthroplasty do not seem to be at an increased risk of developing nickel hypersensitivity, and there is mixed evidence that patients with hypersensitivity are more likely to experience adverse clinical outcomes. Evidence suggests performing patch testing preoperatively in patients with a history of metal allergy to aid selection of the most appropriate prosthesis, and post-operatively only once more common causes of implant failure have been excluded.
EP-29 The prevalence of a small occult umbilical hernia during the trans-umbilical approach in general laparoscopic surgery
Authors: Jones Stacey , Sheredi Mohamed 
Published: November 2022

Abstract

Aims
The aim of this study was to firstly determine the prevalence of a small occult umbilical hernia during the trans-umbilical incision technique in general laparoscopic surgery. Secondly, to determine patient satisfaction with post-operative pain and cosmesis.

Methods
This was a prospective study of 128 patients who underwent a trans-umbilical incision during general laparoscopic surgery by a single surgeon between January 2020 and July 2021. Demographic data, type of surgery, presence of small occult umbilical hernia, time to gain access and time of incision closure were obtained from the operation note. Following the procedure each patient was contacted via telephone and asked questions regarding, post-operative pain, surgical site infection, post-operative complications and cosmetic satisfaction.

Results
Of the 128 patients within the study, 57.8% were female with a mean age of 44.4 years and a BMI of 26.6 kg/m2. The most common operation performed was laparoscopic cholecystectomy in 51.6% of patients. 62.5% of patients were found to have the presence of a small occult umbilical hernia with a mean of 1.1 minutes to gain access and 6 minutes to close incision. Approximately, 80% of patients stated that post-operative pain experienced was as or less than expected. All patients were satisfied with scar cosmesis.

Conclusion
Well over half of patients were found to have a naturally occurring small umbilical hernia that could make gaining access to the abdominal cavity via a trans-umbilical incision easier, quicker and safer. As well as excellent patient satisfaction with regards to scar cosmesis and lower than expected post-operative pain scores.
EP-70 Gangrenous appendix with an abscess in femoral hernia cavity-a rare case of De Garengeot's hernia
Authors: Syed Tayyaba , Chowdhury Ashim , Shrestha Ashish 
Published: November 2022

Abstract

Background
De Garengeot's hernia (DGH) is a Femoral Hernia that contains an appendix and has been named after Rene De Garengeot, a French surgeon in 1731. It is a rare entity that is mostly identified as an incidental finding during exploration of an incarcerated Femoral Hernia and even rarer is the incidence of a gangrenous appendix in these cases.

Case
An 81 years-old female patient presented to Accident & Emergency complaining of a progressively tender enlarging mass in the right groin region, associated with local inflammation. CT scan of abdomen and pelvis (CTAP) performed showed suspected perforated caecum with large groin abscess. She underwent groin exploration which confirmed femoral hernia sac containing a gangrenous appendix with a surrounding abscess. The abscess cavity extended from the right groin to medial aspect of thigh. Appendectomy was performed, abscess cavity drained and washed with normal saline/ Betadine followed by suture repair of the femoral hernia defect . She made an uneventful recovery following the surgery.

Discussion
DGH itself is rare surgical pathology with an incidence of about 0.18% to 0.13%, however, the presentation like our case is even rarer. Emergency surgery is the definitive treatment of DGH to avoid any complications. During surgery, appendectomy and femoral hernia repair are performed consecutively.
In conclusion, appendicitis within a femoral hernia often lacks a classical presentation. CTAP can be helpful in diagnosis, however there can be limitations. Appendectomy with mesh-free hernia repair is an acceptable treatment for DGH.

Keywords
De Garengeot hernia, Incarcerated femoral hernia
EP-86 Preventable errors in hand surgery: analysis of data from NHS England
Authors: Hafez Ahmed , Omar Islam , Ang Andrew , Mahawar Kamal 
Published: November 2022

Abstract

Background
Avoidable medical errors and never events represent a significant problem with negative consequences on the patient, the healthcare professionals, and the healthcare facilities. Hand surgery is a unique multidisciplinary speciality in which orthopaedics, plastic and general surgery are usually involved in the care of their patients, which makes this speciality prone to medical errors. The study highlights these preventable errors in hand surgery in NHS England.

Methods
We analysed hand surgery-related preventable medical errors published by the NHS England during the last ten years from 2012 till July 2021.

Results
Out of 3742 never events during the review period, only 50 never events related to hand surgery were found, representing (1.3%).
The majority were under wrong-site surgery category 30 (60%), which included 17 (57%) wrong finger or digit surgery followed by five wrong digit or thumb injections, three wrong K wire placement, and three scaphoid bones were mistakenly removed during trapeziectomy.
The second most common category was wrong incision 15 (30%), with 13 wrong finger incisions, two wrong carpal tunnel incisions for trigger finger release.
Four patients had wrong procedures, including CTR rather than trigger finger or Dequervain release or an unnecessary carpal tunnel release in addition to one wrong hand tendon transfer. Lastly, only one patient had a wrong injection for carpal tunnel that was intended for another patient.

Conclusions
Hand surgery-related medical errors represent 1.3% of the whole Never Events reported.
Awareness of these incidents will help prevent their occurrence in the future.