bluuebunny/crossref_metadata_2025_split huggingface dataset:
TH1.8 Changes In the Operative Management of Breast Cancer During The COVID Pandemic -- Single Institution Experience
Authors: Khun Ng James Chean , Muhibullah Nazli , Cuffolo Giulio , Whisker Lisa 
Published: November 2022

Abstract

Aims
COVID has had a wide ranging impact on surgical practice; including staffing issues, procedural prioritisation and changes to perioperative practice. We aim to compare the operative management of breast cancer before and during year 1 of the pandemic.

Methods
A retrospective review of primary breast cancer surgery in women between 23/3/2020–23/3/2021 with sub-analysis looking at wave 1 of COVID (23/3/2020–23/7/2020), compared to pre-COVID (1/1/2018–31/12/2018). Data collected include type and complexity of surgery, re-operations and complications.

Results
Pre-COVID, 606 cancers were included, with 217 (35.8%) simple BCS, 241(39.8%) oncoplastic BCS, 88 (14.5%) simple mastectomies and 60 (9.9%) mastectomies with immediate reconstruction. During COVID study period, a total of 398 cancers were included, with operative number (percentages) being 104(26.1%), 176(44.2%), 83(20.9%) and 35(8.8%) respectively. During wave 1, 47 cancers were diagnosed and operated on. The operative numbers (percentages) during initial wave COVID pandemic were 9 (19.1%), 25(53.2%), 12(25.5%) and 1(2.1%) respectively.

Conclusions
In our unit COVID led to a shift of breast cancer operative management to more BCS and simple mastectomies. As a unit, we were able to maintain good oncoplastic BCS service, however, reconstruction options were limited.
TH1.9 Clinical relevance of postoperative elevated thyroglobulin antibodies in patients with differentiated thyroid cancer
Authors: Anderson Hannah , Gull Sadaf , Lim Kah , Oprean Raluca , Spence Kirsty , Cvasciuc Titus 
Published: November 2022

Abstract

Aims
20%–25% of patients with differentiated thyroid cancer (DTC) can have elevated thyroglobulin antibodies (TgAb). The study aimed to find any prognostic significance of elevated TgAb during follow-up.

Methods
10-year retrospective study from a tertiary centre including 79 patients with raised TgAb after total/staged thyroidectomy for DTC. We identified patients with stable (7.6%), increasing (15%) and decreasing levels of TgAb (77.2%); groups 1, 2 and 3 respectively. During follow-up we analysed TgAb in subcategories by TgAb trend (&gt;50% increase, &lt;50% increase, &gt;50% decrease, &lt;50% decrease, positive to negative, negative to positive and stable levels), gender, age, surgery, autoimmune disease, histology, RAI uptake, distant metastasis, and recurrence.

Results
The incidence of raised TgAb levels was 33.2%, with female predominance. No connection was identified regarding other parameters; 11.4% had distant metastasis. The highest mean level of TgAb was in group 2 (1918.75IU/mL) and the lowest in group 3 (412.70IU/mL). The recurrence rate changed significantly between the 3 groups: 50% in group 1, 75% in group 2, and 25% in group 3 (p=0.002). Recurrence rates decreased to 15% in the subcategory where TgAb become undetectable from positive (p=00001). In patients with negative to positive trend or &gt;50% increase, recurrence rates were 100% (p=0.041) and 70% (p=0.012) respectively.

Conclusions
Patients with increasing TgAb levels during follow up have a higher rate of recurrence distinctly for those with negative to positive and &gt;50% increase. These categories of patients need closer follow-up.
TH1.11 Outcomes of Sublay Mesh repair in Ventral Abdominal hernia; retrospective study
Authors: Noureldin Khaled , Issa Mohamed , Badawi Marwa , Darwish Mariam , Abdelaziz Ayyat , Makram Mahmoud 
Published: November 2022

Abstract

Introduction
Ventral hernia repair is one of the challenging surgical operations over time. It is suggested that sublay mesh repair has the lowest recurrence and surgical site infection in open anterior abdominal hernia repair. This study aimed to analyse the pros and cons of sublay mesh in ventral hernia repair to evaluate the significance of this technique as a treatment modality. Hospital stay, acute postoperative complications, and the recurrence rate were the main areas of investigation.

Methods
A retrospective study on 79 Patients with ventral hernias were operated on (electively) with sublay mesh repair over 3 years. Fit patients with first-time ventral hernias (primary and incisional) were included. Recurrent hernia, associated decompensated cardiopulmonary disorders, and bleeding disorders were excluded. The project Performa includes; patient's demographics, operative details, length of stay, postoperative complications, and follow-up, up to 12 months.

Results
All patients underwent open mesh repair using the sublay technique. Ventral hernia was five times more common in females than males. Mean age of presentation was at 44.8 years old. Mean operating time was 67 minutes and a 1-day hospital stay. Para-umbilical and incisional hernias represented the majority of cases. Component separation approach was added in three cases (3.7%). Simultaneous cholecystectomy was performed in 2 cases (2.5%). Only 6 cases (6.3%) developed wound-related complications, while 2 cases (2.5%) had a recurrence.

Conclusion
Sublay mesh repair is favourable for ventral abdominal hernia reconstruction. It is associated with a smooth and short hospital stay and the least incidence of complications and recurrence.
TH1.12 Merkel Cell Carcinoma in the Breast: A rare Case Presentation
Authors: Rezkallah Emad , Elsaify Wael 
Published: November 2022

Abstract

Background
Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin. The annual incidence is 0.13–1.6 per 100.000. MCC arise from Merkel cells in the basal layer of the epidermis and hair follicles. It is characterized by poor prognosis and rapid progress with a mortality rate about 30%. Most patients are over 65 years. We represent a rare case of MCC in the breast and axilla.

Case presentation
A 71-years old lady initially presented with loss of weight. A CT scan reported a 45.97 mm malignant mass in the right axilla with no identified primary origin. No obvious tumors were detected in the breast on mammogram and ultrasound scans. Core biopsy eventually confirmed a metastatic Merkel cell tumor. The patient had neo-adjuvant chemotherapy followed by right axillary nodal dissection (level III). Post-operative radiotherapy was given. Six months later, the patient represented with two tumor foci in the right breast. The patient underwent right mastectomy. Two foci of Merkel cell carcinoma, 28 mm and 10 mm, were found.

Discussion
MCC is a rare highly aggressive cutaneous neoplasm. It affects primarily the sun exposed areas of the skin. 5-year survival in patient with MCC is 50–68%. Treatment options vary according to the disease stage. Surgical excision provides the best treatment for localized diseases. Radiotherapy and chemotherapy are provided for high stage MCC and/or lymph node involvement.

Conclusion
Treatment of MCC should be multidisciplinary. Early diagnosis and proper surgical resection provide the best management option. Long term follow-up is recommended.
TH1.13 The Role of Metanephrines in the Diagnosis of Pheochromocytoma
Authors: Rezkallah Emad , Elsaify Wael 
Published: November 2022

Abstract

Introduction
Pheochromocytomas are rare neuroendocrine catecholamine-producing tumors that arise from either the adrenal medulla (PHEO) or extra-adrenal paraganglionic tissues (paraganglioma/PGLs). PHEO is responsible for about 0.01–0.1% of the cases of hypertension. Assessment of the plasma/urinary levels of metanephrines (catecholamines metabolites) is now considered the gold standard for the diagnosis of PHEOs.
In this study, we aimed to investigate the role of the plasma and 24-hour urinary metanephrines levels in the diagnosis of PHEO/PGLs.

Patients and Methods
Retrospective review of 26 patients diagnosed with PHEO/PGLs. We measured the plasma/ 24-h urinary metanephrines. The data were compared with another set of 26 patients with other adrenal pathologies. The correlation coefficient between the tumor sizes and the plasma/24-hour urinary metanephrines levels was calculated.

Results
The mean tumor size was 4.88 ± 1.99 cm. The sensitivity and specificity of the plasma metanephrines were about 95.8% and 98%, respectively, while for 24-hour urinary metanephrines were about 83.3% and 98%, respectively. We found a strong positive relationship (r = 0.472, P = 0.05) between the tumor size and the summed plasma concentrations of metanephrines. The relation between the tumor diameter and summed 24-hour urinary metanephrine was potentially strong (r = 0.354, P = 0. 083).

Conclusion
Plasma/24-hour urinary metanephrines are of great value in the diagnosis PHEOs/ PGLs as they are continuously produced by the tumor. There are strong relations between the size of these tumors and the plasma and urinary concentration of these metabolites, which can help to predict the size of the tumor even before imaging.
TH1.14 Major limb amputation during the Covid-19 pandemic – Have we seen a change in practice?
Authors: Fatima Kinza , Trinder Thomas , Rodger Chloe , McGivney Feldheim , Orr Douglas , Hussey Keith 
Published: November 2022

Abstract

Introduction
There have been significant changes in the delivery of health care as a consequence of the Covid-19 pandemic. Standard operating procedures have been re-defined to minimise harm from the reduction in access to services, whilst at the same time protecting hospitals (and in particular critical care units) from admissions.
We have explored major limb amputation (MLA) practice and compared this with a historical series.

Methods
Retrospective review of major limb amputations (March 2019 to October 2021). Historical datasets have also been scrutinised (2008–2010). Specific variables of interest included the annual number of major limb amputations, primary versus secondary amputation and ratio of transtibial (TTA) to transfemoral (TFA) amputations.

Results
A complete dataset was available for 282 patients during the Covid period. Patient demographics were as anticipated - 206 (73%) male, mean age 63-years (range 23 to 90-years). Peripheral arterial disease (190) and diabetes mellitus (149) were common. These demographics were comparable to the historical data. The annual number of MLA has not changed over the Covid period. The ratio of primary to secondary MLA was 1:1.3 in the historical series and 1:1 during the Covid period. The ratio of TTA to TFA was 3:1.8 in the historical series and 2:1 during the Covid period.

Conclusion
The trends suggest that practice has not changed significantly during the Covid period. There has been a slight change in the ratio of transtibial to transfemoral amputation, which may reflect patients presenting with later stage disease.
TH2.1 Antibiotics during Pancreatitis… Is it “NICE”??
Authors: Rai Anil , Singh Rhea , Mehana Omar , Kudchadkar Shantata , Mahmood Ahsan , Munasinghe Aruna 
Published: November 2022

Abstract

Aim
National Institute for Health and Care Excellence (NICE), British Society of Gastroenterology, the American College of Gastroenterology and the trust guidelines do not recommend prophylactic antibiotics in patients with uncomplicated acute pancreatitis. Our three-cycle study was focused on finding out adherence to these guidelines.

Method
Three cycles of the study were conducted over a span of 2 years with 87, 78 and 121 patients with the peak age range of 20–40 in the first, 41–60 in the others respectively. Unspecified acute pancreatitis and gallstone pancreatitis were the most common diagnosis in the second and third cycles respectively. Majority of patients were prescribed antibiotics on 1–2 days after admission in the first and second cycle and on the day of admission in the third cycle.

Results
44.8%, 39.7%, 35.5% of the patients admitted with pancreatitis were prescribed antibiotics in the three cycles respectively. Interestingly, in the first cycle 74.3% patients were prescribed antibiotics without any clear indication. However, we saw an improvement in the trend of prescribing antibiotics without indication from 45% in the second cycle to 37.2% in the last cycle. The maximum number of patients had a hospital stay of 2–4 days in all the cycles. Co-amoxiclav was the most prescribed antibiotic in the first and the third cycle. In the second cycle, the order was Metronidazole followed by Amoxicillin.

Conclusion
The prescription of empirical antibiotics in acute pancreatitis doesn't improve the duration or outcome of the disease. Therefore, antibiotics must be used judiciously in this era of ever-increasing antibiotic- resistant microbes.
TH2.7 Pancreatitis and Cancer. An evaluation of clinical practice with focus on links to the development of pancreatic cancer
Authors: Singh Gautam , Ghorpade Ashwini , Martindale Aleksis , Maroof Hannah , De'Ath Henry , Veeramootoo Darmarajah 
Published: November 2022

Abstract

Aim
Pancreatitis is a common surgical pathology that burdens all healthcare systems. Acute or chronic presentations require dedicated resources and evidence-based management. Literature suggests increased risk of cancer is two-fold with acute and up to 8-fold with chronic pancreatitis. Our study aims: 1. Assess current practice against NCEPOD 2016 guidelines, 2. Explore the incidence of cancer.

Method
Prospectively collected electronic records and clinical systems were interrogated from Jan 2015 to Feb 2018. Data was collected on patient demographics, analytics, clinical outcomes and follow up. All patients and hospital episodes’ data were included.

Results
Over the 3 years, 337 patients presented with a male: female ratio of 1:1. Median age was 61.2 (IQR 51.3–74.4). Diagnosis was acute pancreatitis 82% and chronic 18%. Aetiology was biliary 63%, alcohol-related 20% and idiopathic 10%. Ca19–9 was performed in 10% overall; and IgG4 in 10% of unknown aetiology. Ultrasound scan within 24 hours performed in 62% (improved to 79% on re-audit after an educational campaign). Within the study period, 120 patients completed 5 years follow up. 4 patients developed cancer: 3 (1.1%) in acute group and 1 (1.6%) in chronic pancreatitis group. All had Ca19–9 levels done at initial presentation with values of 6310, 19, 14 and 239u/ml respectively.

Conclusions
Compliance with guidelines is improved through awareness and clinical focus, to the benefit of patients. Pancreatitis can be an early marker of cancer, and Ca 19–9 (best validated serum tumour marker) may help clinical suspicion. Larger multi-centred collaborations may further the knowledge base.
TH2.9 The Incidence and Outcomes of Delayed Laparoscopic Cholecystectomy and Bile Duct Exploration on a Unit Adopting Index Admission Surgery for all comers. A Review of 5750 patients
Authors: Welsh Silje , Nassar Ahmad , Sallam Mahmour 
Published: November 2022

Abstract

Background
The timing of laparoscopic cholecystectomy (LC) for emergency biliary admissions remains inconsistent with national and international guidelines. The perception that LC is difficult in acute cholecystitis and the popularity of the two-session approach to pancreatitis and suspected choledocholithiasis result in delayed management.

Methods
Analysis of prospectively maintained data in a unit adopting “intention to treat” during the index admission. The aim was to study the incidence of previous biliary admissions and compare the operative difficulty, complications and postoperative outcomes with index admission LC.

Results
Of 5750 LC performed 20.8% had previous biliary admissions; one in 93% and two or more in 7%. Most presented with biliary colic (39.6%) and acute cholecystitis (27.6%). A previous biliary history was associated with increased operative difficulty (p&lt;0.001), longer operating times (86.9 v 68.1 minutes, p&lt;0.001), more post-operative complications (7.5% v 5.2%, p=0.002) and longer hospital stay (8.1 v 5.5 days, p&lt;0.001). However, conversion and mortality rates showed no significant differences.

Conclusion
Index admission LC is superior to interval cholecystectomy and should be offered to all patients fit for general anaesthesia regardless of presenting complaints. Subspecialisation should be encouraged as a major factor in optimising resource utilisation and post-operative outcomes of biliary emergencies.
TH2.10 YouTube videos as a source of patient information for gallstone disease
Authors: Westby Kealan , Mannion Evan 
Published: November 2022

Abstract

Aim
YouTube is a widely accessible platform & a popular source of health information for patients. This information has been shown to be generally of poor quality. The purpose of this study was to identify and assess the quality of YouTube videos as a source of information for patients with gallstone disease.

Methods
A cross-sectional study was carried out with the keyword “Gallstones” used to search the YouTube database. Only videos In English were included. Duplicated videos, advertisements and those videos in other language than English were excluded. Videos were listed by relevance and the first 50 videos identified were evaluated. Recorded video features included likes, dislikes, length and source. DISCERN + JAMA benchmark criteria were used for quality analysis

Results
50 videos were analysed, the majority of which were uploaded by healthcare professionals (60%). Mean DISCERN and JAMA scores were 40.5 and 2.5. Overall quality of the videos were low. The correlation between length of video and DISCERN and JAMA scores was positive.

Conclusions
There are a number of videos on YouTube concerning gallstone disease that are frequently viewed but unfortunately are of low quality. Health professionals should be aware of this and caution patients on their unreliable nature.
TH3.1 Implementation of a home finger-prick CEA test for follow-up of colorectal cancer - a pilot study of patient perspectives
Authors: Quinn Marcus , Reilly Annie , Niewdach Emma , Rodgers Sam , Pullyblank Anne 
Published: November 2022

Abstract

Aim
NICE guidance advocates 6 monthly CEA blood testing following curative colorectal resection. This usually takes place through face to face appointments with a phlebotomist, with associated monetary and resource cost to local services, as well as impacting on patient lives. This project piloted use of self-taken finger-prick blood tests in this patient population, to assess feasibility, patient perspectives and preferences.

Methods
During colorectal outpatient clinics, patients undergoing face to face CEA surveillance in primary care were offered postal finger-prick assessment. Recruitment stopped once 50 patients had been recruited. Recruited patients were sent finger-prick blood testing kits with pre-paid return packaging. Follow-up questionnaires were undertaken to assess patient perspectives and future preferences.

Results
67.6% (50/74) of eligible patients agreed to participate. 76.0% (38/50) of patients successfully completed finger-prick CEA assessment. 46.8% (22/47) of patients felt they would prefer finger-prick rather than phlebotomy for future CEA testing, whilst 19.1% (9/47) had no preference. 38.3% (18/47) patients felt finger-prick testing was worse than their previous experience. No significant differences in preference existed between patients aged &lt;65 and 65+. Qualitative data showed difficulties with pain, discomfort and sample collection. Patients felt that finger-prick samples were convenient and easier to fit in with their lives.

Conclusions
Whilst some patients prefer finger-prick CEA assessment, there are significant numbers for whom it is challenging, unnecessary or less preferable. Finger-prick CEA testing may represent a future strategy for reducing burden of follow-up blood tests on resources, but this would currently be acceptable only to limited patient groups.
TH3.2 Audit of acute lower GI bleed admissions - outcomes and management
Authors: Sami Sharukh , Hemadasa Niroshini A , Loh Cheryl , DeCruz Antony , Mirza Muhammad 
Published: November 2022

Abstract

Background
Lower GI bleeding (LGIB) is a common surgical emergency. The British Society of Gastroenterology (BSG) in 2019 developed a UK national guideline on the management of LGIB. Our aim is to audit the current practice and standards for patients admitted with LGIB.

Methods
This retrospective audit identified patients presenting to the Emergency department and Surgical assessment unit between September 2020 to February 2021 with LGIB. The shock index and Oakland score (OS) at first presentation were calculated.

Results
A total of 27 patients satisfied the inclusion criteria. Average age of patients was 64.7 years. Three patients had an OS of ≤8 with 1 patient being hospitalised. 21 patients had an OS of &gt;8 and 7 out of the 21 patients were discharged instead. 14 patients (51.8%) were on anticoagulants/antiplatelets of which 1 was on dual antiplatelet therapy. 10 patients had their drugs suspended appropriately and 2 did not. Eight patients were referred for OP endoscopy.

Conclusion
We found that improvements can be made with respect to suspension of anticoagulant and antiplatelet drugs and duration to colonoscopy. A more pragmatic approach to both intervention and interval to endoscopy may have to be applied due to service constraints.
A checklist has been developed based upon the guidelines to
TH3.3 “Closing the loop”: what is the delay in Reversal of Hartmann's procedure?
Authors: Roberts Victoria , Mandagere Vinay , Crisp George , Biggs Sarah , Shabbir Jamshed 
Published: November 2022

Abstract
Reversal of Hartmann's procedure is performed to restore intestinal continuity. There is conflicting literature on the best time for reversal, with little evidence suggesting waiting longer than a year is beneficial. We assessed the experience of our patients.
Patients were identified from the local Enhanced Recovery After Surgery (ERAS) database over a 9-year period (2012–2021) at a University Hospital. Data was collected from digitalised hospital notes on patient demographics; timings to reversal of Hartmann's; defunctioning stoma; reasons for delay; length of stay; and complications.
Forty-three patients underwent reversal of Hartmann's procedure. Median age was 57 (38–83) years; 19 (44%) of patients were female. Surgery was performed laparoscopically in 18 (42%); laparoscopic converted to open 6 (14%); open in 19 (44%) patients. Average length of stay was 6 days. Indications for primary Hartmann's procedure were diverticular disease (67%), malignancy (21%), and other causes (14%). Median time from the index operation to reversal of Hartmann's was 85.2 weeks (range 19.9–312.4 weeks). Only 9 (21%) patients underwent reversal Hartmann's within 1 year of primary surgery. Of the reasons known for the delay in reversal; 15 (35%) were due to patient complications, 6 (14%) were due to administrative reasons, 2 (5%) were due to COVID-19 associated delays and 1 (2%) patient choice.
This retrospective analysis highlights the varied patient experience within just one centre, further research incorporating detailed patient experience is needed. It also highlights a paucity of national evidence-based consensus on optimal timing for challenging revisional surgery.