bluuebunny/crossref_metadata_2025_split huggingface dataset:
1053 Primary Acinic Cell Carcinoma in a Young Female: A Case Report
Authors: Venkatasami M , Harrison K 
Published: November 2022

Abstract

Background
Acinic cell carcinoma (ACC) is a rare, low-grade tumour, accounting for about 5% of all primary salivary gland malignancies. ACCs predominate in the parotid gland, seen in the fifth and sixth decades of life and has a female predilection. Well-differentiated and low-grade tumours are associated with a favourable prognosis.

Case Description
We report a case of a 16-year-old female, presenting with a right parotid lump, slowly increasing over the last year. Clinical examination revealed a 1.5cm right parotid nodule with no facial nerve involvement and presence of cervical lymphadenopathy. Past medical history was unremarkable.

Findings
Radiological investigations revealed a well-circumscribed lobulated lesion in the anterior right parotid gland with presence of reactive lymph nodes bilaterally.
Differential diagnoses included Warthin's tumour, which would have been unusual in this age group, and the patient underwent a right partial parotidectomy.
Histological examination showed a multinodular appearance with some marked granular cytoplasm with oncolytic and lymphoid infiltrate. Immunohistochemistry was negative for S100, positive with DOG-1. There were widespread PAS-D-resistant granules throughout the tumour cells, with ki67 proliferation index of approximately 5%.

Results
The tumour was completely excised, and the patient made a full recovery and considered to have a good long-term prognosis.

Conclusion
This is an unusual case of ACC seen in this age group and gender, where less than 4% of cases of ACC have been reported in patients younger than 20. It is important to consider differential diagnoses of salivary gland pathology, such as ACC in the young female patient.
373 Evaluation of the Use of Water-Soluble Contrast Enema (CE) and Flexible Sigmoidoscopy (FS) prior to the Reversal of a Loop Ileostomy
Authors: Elzaafarany A , Nordin MN , Narayan P , Day A 
Published: November 2022

Abstract

Aim
To evaluate the routine use of CE and FS to check integrity of anastomosis prior to reversal of a loop ileostomy.

Method
This is a single centre retrospective observation study. All patients who underwent reversal of a loop ileostomy following low anterior resection for rectal cancer over period of five years, were involved in this study. All patients have CE and FS to check the patency of the anastomosis prior to reversal of ileostomy. The primary outcome was to investigate if routine CE adds clinically relevant information to a routinely performed FS by analysing concordance and diagnostic test accuracy. Secondary outcome to evaluate the accuracy of FS and CE in diagnosis of anastomotic stricture

Results
116 patients who had reversal of ileostomy had both CE and FS. Out of these, 110 (94.8%) had normal findings on CE and FS. Six patients had abnormal findings on either CE or FS.
Two patients (1.7%) had anastomotic leak shown on CE study, despite normal findings on FS.
One patient (0.8%) had a leak shown on both FS and CE.
One patient (0.8%) had a leak shown on FS despite a normal CE study.
Two patients (1.7%) had strictures shown on FS and stenosis on CE radiological reports.

Conclusions
The discrepancies between Ce & FS are minimal. Although it has been suggested in previous studies that CE is of little value, the concurrent use of FS as well as CE is useful in identifying any trivial leak pre-reversal of ileostomy, and that will be valuable in decision making.
513 Surgical Complications Following Reversal of Ileostomy
Authors: Elzaafarany A , Nordin MN , Skervin A , Grabham J 
Published: November 2022

Abstract

Aim
To identify the rate of patients who develop complications of Grade 3b or above according to Clavien-Dindo classification following reversal of ileostomies within 30 days from time of the operation.

Method
This is a retrospective observation study of a single cohort. 147 patients who underwent reversal of Ileostomy following Anterior Resection of Rectal cancer, over a period of three years, were involved in the study. The primary outcome is the 30 days adverse events rate of grade 3b or above of Clavien-Dindo classification following reversal of ileostomies. Secondary outcome is identifying risk factors for developing these complications: age, gender, ASA, comorbidities, BMI, pre-operative haemoglobin, interval between primary surgery and reversal of ileostomy, duration of operation, type of anastomosis, surgical experience.

Results
Out of 147 patients who underwent Reversal of Ileostomy, eight patients developed complications of Grade 3b or above. Five cases involved anastomotic leak requiring resection of anastomosis and ileostomy formation. One patient had an abdominal wall haematoma requiring evacuation of haematoma in theatre. One patient had a bleeding from anastomosis, required laparotomy and resection of anastomosis. One patient developed aspiration pneumonia followed by respiratory distress, multi-organ failure and died.

Conclusions
The rate of patients who develop complications of Grade 3b or above following reversal of ileostomies within 30 days from the time of the operation, in our centre is low and is comparable to published literatures. Methods to minimise these complications should be further evaluated including proper pre-assessment of these patients in outpatient clinic to identify those of high risk for surgery.
533 Readmission Rates After Elective Colorectal Cancer Surgery and Its Comparison to National Bowel Cancer Audit in 2019 (NBOCA 2019)
Authors: Elzaafarany A , Tawfik A , Igbekele T , Day A 
Published: November 2022

Abstract

Background
The NBOCA 2019 showed an overall 10.8% of patients had an unplanned readmission within 30 days of surgery (for both elective and emergency colonic resection (NBOCA, 2019).

Aim
To identify readmissions rates after elective colorectal cancer surgery in our hospital and comparing it to NBOCA 2019. Identifying reasons for readmissions.

Method
A single centre, retrospective, observational study was performed between January 2018 – January 2019. We included patients that required readmission to hospital following elective colorectal resections for cancer. Data was collected on patient demographics, primary operation, histopathology, stage, neo-adjuvant chemo/radiotherapy, date, and reason of readmission.

Results
Total of 123 patients had elective resection for colorectal cancer.13.8% (17/123) of these patients required readmissions. 70.6% (12/17) readmitted with 30 days of discharge, 29.4% (5/17) beyond 90 days of discharge. 58.8% (10/17) Of the operations that needed readmission were performed laparoscopically, with the most common primary operation resulting in readmission was LAR (52.9%, 9/17). Tumour grades using Dukes classification were A 41.1% (7/17), B 11.8% (2/17), C 35.2% (6/17), D 5.9% (1/17). Neo-adjuvant chemo/radiotherapy was given in 29.4% (5/17) of patients. Overall, the most common reason for admission was small bowel obstruction (SBO) and abdominal/pelvic collection, each by 23.5% (4/17), followed by wound dehiscence (11.8%, 2/17) and SSI (both deep and organ related) (11.8%, 2/17).

Conclusions
13.8% of patients who underwent elective colorectal surgery for cancer were readmitted within 30 days of discharge. Further study is required to investigate more contributing factors to readmission, in order to formulate strategies to help prevent them.
564 Late Presentation of Colorectal Neuroendocrine Neoplasia Is Associated with a Poor Prognosis
Authors: Goan R , Camilleri-Brennan J 
Published: November 2022

Abstract

Introduction
Although neuroendocrine neoplasms (NENs) arising from the colon and rectum are generally slow growing and present early, a minority demonstrate aggressive growth and present late with metastatic disease. The aim of this study is to analyse the clinical presentation, management and prognosis of patients presenting with advanced colorectal NENs.

Method
Data were collected from dedicated databases on patients with colorectal NENs who presented to our hospital between January 2015 and February 2021. Patients who presented with appendiceal NENs were excluded.

Results
13 patients with colorectal NENs were identified, of whom 3 patients (23%) had advanced disease at diagnosis. These 3 patients, 2 males (78 and 82 years old) and 1 female (71 years old), presented with weight loss, anorexia and altered bowel habit, with one patient also having rectal bleeding. The site of the primary was in the rectum (2 patients) and in the sigmoid colon (1 patient), the histology being poorly differentiated neuroendocrine carcinoma. All 3 patients had liver metastases at presentation, with 2 having lung and lymph node metastases as well. Due to their advanced disease, these patients’ treatment was carried out with palliative intent. All three patients passed away within a year of diagnosis.

Conclusion
Poorly differentiated colorectal NENs with distant metastases were associated with a poor prognosis. Management involves a multidisciplinary team. The use of somatostatin analogue therapy and palliative chemotherapy are options for symptom control.
600 Acute Appendicitis as an Early Manifestation of Colorectal Cancer for Patients Aged 40 Years and Above
Authors: Yip CR , Lim ST , Ali S , Teoh WY , Vitone L 
Published: November 2022

Abstract

Aim
Presence of underlying colorectal cancer with acute appendicitis is not unfamiliar in medical literature. However, there remains no clear guidance in the follow-up care post-appendicectomy. This study aims to investigate whether acute appendicitis can be an early manifestation of colorectal cancer in older adults and determine the need of routine pre-operative CT imaging and post-operative colonoscopy as a follow-up screen for early detection of colorectal cancer.

Method
This is a retrospective study comprising 1236 patients, aged 40 years and above, who underwent appendicectomy between January 2006 to September 2021. Results of radiological investigation pre-appendicectomy and colonoscopy post-appendicectomy were reviewed. Patients who were diagnosed immediately and subsequently following appendicectomy were recorded and analysed.

Results
Of the 1236 patients underwent appendicectomy, 636 (51.5%) were male and 600 (48.5%) were female (Median age 53 years; range 40–96 years). Out of 412 (33.3%) patients who had CT imaging, only one revealed sigmoid tumour which was later confirmed as moderately differentiated adenocarcinoma. 71 (5.7%) patients had colonoscopy post-appendicectomy. Among these, two were diagnosed with caecal cancer. A total of 22 (1.8%) patients were diagnosed with colorectal cancer: 13 adenocarcinoma, 5 carcinoid tumours, 3 low-grade mucinous carcinoma peritonei and 1 lymphoma. 15 (1.2%) were diagnosed at the time of appendicectomy, whereas the remaining 7 (0.6%) were diagnosed between 6 months to 11 years post-appendicectomy.

Conclusion
Preliminary finding suggests this is an area that warrant further study. Patients aged 40 years and above may benefit from colonoscopy following appendicectomy to exclude the possibility of underlying colorectal cancer.
980 Readmissions Within 30 Days of Discharge Following Single Stoma Formation
Authors: Plonkowski A , Allison C , Philipson P , Brady R 
Published: November 2022

Abstract

Background
Patients who have stoma surgery are at higher risk for readmission following discharge. Some may benefit from closer post-discharge surveillance to detect complications earlier and provide timely treatment to avoid readmission. However, there are a paucity of contemporary tools to identify those at higher risk of readmission following discharge after stoma surgery. Here, we aimed to determine factors associated with readmissions, within 30 days of discharge, following stoma surgery.

Method
Retrospective review of all patients who underwent a single stoma formation at a single tertiary colorectal service (2019–2021).

Results
423 patients underwent 220 ileostomy and 203 colostomy formation surgeries. Overall, 87 (20.6%) patients were readmitted within 30 days of discharge. The rate of readmission in those with IBD (n=87) was 18.4%, cancer (n=208) 20.7%, diverticular disease (n=45) 17.8% and vascular disease (n=19) was 36.8% (p&gt;0.05). There was no association between readmission and gender, aetiology, smoking, weight, or discharge to social care. The only comorbidity associated with increased readmission was chronic heart failure (p=0.05), no other comorbidities were associated with increased readmission. There was an increased incidence of readmission in patients with post-operative stoma-specific complications (bleeding p=0.02; high-output stoma p=0.01) and in patients who received loop ileostomies compared to other stoma types (34.0% versus 18.6%; p=0.01). There was a protective effect in those given nutritional supplements post-operatively (p=0.04).

Conclusion
Readmission following single stoma formation is related to variables that potentially provide the means to triage, risk score and potentially predict readmission. Further work is being undertaken to develop and prospectively to validate a model.
994 The Evolving Role of Interventional Radiology in the Management of Diverticular Abscesses: A Review of Practice at University Hospital Waterford Over 10 Years
Authors: Murphy B , McLoughlin M 
Published: November 2022

Abstract

Background
Historically, intra-abdominal sepsis was managed conservatively, or with operative intervention, which is associated with significant morbidity and mortality. Image-guided drainage of abscesses or collections provides a useful alternative and has become more common with the increasing prominence of Interventional Radiology, offering faster recovery, reduced length of hospital stay and cost of treatment. Modern procedural tools, techniques and expertise allow high levels of percutaneous drainage success. The scope of practice has widened to include targets which previously wouldn't have been amenable to drainage.

Aim
To quantify the use and benefit of IR drainage for complicated diverticulitis at University Hospital Waterford over the past ten years. The size and location of collections drained throughout the ten years was observed. Length of hospital stay for each mode of management (conservative, percutaneous drainage and surgical) was used as an endpoint to assess morbidity.

Method
Using NIMIS, all CT abdomen/pelvis reports containing the words “abscess” or “collection”, and “diverticul” over the past 10 years was compiled. These patients were categorised by their management, into groups of conservatives, percutaneous drainage, surgical intervention, or a combination of these. NIMIS was used to determine who underwent IR drainage. T-pro, theatre logbooks and patient notes were used to determine who had surgical management, and iPMS was used to assess length of hospital stay.

Results
IR drainage has become more common year-on-year in UHW and was shown to be more effective for all abscess sizes as compared with conservative management, as outlined in the table shown
998 Improving Accuracy of Tumour Site Identification During Colonoscopy; a Retrospective Analysis
Authors: Jeilani M , Hassan M , Riad M 
Published: November 2022

Abstract

Aim
Colonoscopy is essential for accurate pre-operative colorectal tumour localisation. Due to variable colonic length and lack of internal landmarks, tumour site identification can be difficult, posing risks of inappropriate operations being offered. To avoid this, we must correctly identify the tumour site on endoscopy in &gt;95% of patients as per BSG guidelines. In 2019, accuracy levels compared to radiology and histology fell significantly short of this standard. We therefore made improvements to our endoscopy database and displayed relevant guidelines in endoscopy rooms. Here, we evaluate improvement in accuracy of endoscopic tumour localisation after implementation of these initiatives.

Method
Retrospective study of results of all colonoscopies (214) showing suspicious lesions at our trust in 2020, compared to results of counterpart radiology and histology tests, and audited against the BSG standard of &gt;95% accurate identification of tumour position by colonic segment.

Results
Accuracy of endoscopic tumour localisation was 92.2% and 92.3% compared to histology and radiology respectively. Although this does not meet the national standard of &gt;95%, it is a significant improvement from the year prior - 80.2% and 78.8% compared to histology and radiology respectively. The greatest degree of error appears in the rectum, often being confused with recto-sigmoid and sigmoid.

Conclusions
Guideline reminders and database improvements were crucial to increased accuracy. However, clearer definition of colonic territories is required to avoid confusion when attributing localisation. We recommend following the American guidelines in which the term ‘recto-sigmoid’ is abolished in favour of a boundary 15cm from the anal verge that represents the division between rectum and sigmoid.
1037 The Use of Fluorescence Angiography with Indocyanine Green in Colorectal Surgery – A District General Hospital Experience
Authors: Adegbola S , Ghafoor H , Kirmani N 
Published: November 2022

Abstract

Introduction
Indocyanine green (ICG) fluorescence imaging is used in a variety of procedures in in colorectal surgery. It optimises intraoperative vision of anatomical structures by improving blood and lymphatic flow. ﻿Traditionally, the vascularization of the colonic stump is subjectively evaluated by the surgeon based on the colour of the bowel wall, the bleeding of the colonic stump, and pulsation of the terminal artery. ICG aims to improve objectivity of this assessment.

Aim
To assess the feasibility and efficacy of ICG in colorectal operations and report on initial experience since introduction in November 2021.

Method
Retrospective review of prospectively collected database of all patients undergoing colorectal operations with intraoperative ICG use for any indication. Data collected included patient demographic details including age/gender/comorbidities; operative details including indication/type of surgery, 30day-complications, details/outcome of intraoperative ICG use.

Results
During the study period ten patients underwent colorectal surgical procedures with intra-operative use of ICG. Surgical options included resectional surgery (right hemicolectomy/transverse colectomy/anterior resection) and reconstructive surgery (reversal of hartmann's operation). Majority were done for colorectal cancer and one for inflammatory bowel disease. ICG was reported useful in all cases in demonstrating vascularity in anastomoses/resection margins. One notable case demonstrated decreased ability of discerning ICG uptake in the presence of tattoo pigmentation (preoperative tumour marking). No adverse events were reported.

Conclusion
The ICG assessment of colonic vascularization was simple, feasible, with no adverse events in our cohort. Our experience suggests caution is required when interpreting ICG readings in the presence of colonic tattoo.
128 Trends in Diseases of Vestibular Function - a Retrospective Study into the Diagnosis of Different Types of Vestibular Disorders in Admitted Hospital Patients in England 2014–2020
Authors: Bodimeade C 
Published: November 2022

Abstract

Aim
The vestibular system is a sensory organ of the inner ear contributing towards balance, orientation, and coordination. Symptoms of vestibular dysfunction are a common presentation to hospitals in England.

Method
Using the NHS Digital website and accessing the Hospital Admitted Patient Care Activity datasets, we identified episodes of “Disorders of Vestibular Function”. This definition was further broken down into seven sub-types of different vestibular disorder. The data covers all NHS funded work in English hospitals resulting in admission. Using a 6-year period between 1st April 2014–31st March 2020 trends in number of admitted patients were recorded.

Results
There was an 84% increase in the number of patients admitted to hospital for diseases of vestibular function. From 6,473 admissions in 2014, to 11,960 in 2020. The largest increase was seen in patients admitted with Benign Paroxysmal Positional Vertigo (BPPV) with an increase of 4,154 admissions, equivalent to a 126% rise. The trend was progressive and consistent year on year. All other conditions such as vestibular neuritis, other peripheral vertigo and unspecified vestibular disorders increased, however diagnoses of Ménière's disease fell 2%. Patients with BPPV had the highest average age upon diagnosis.

Conclusions
There is a clear need to investigate the drivers of the increase in number of diagnoses and admissions. Hypothesised reasons include an ageing population, improved diagnostics, or coding errors. It may also be a result of increasing hospital attendances and a decrease in see and treat of patients with BPPV in A&E.
308 Fine Needle Aspiration Cytology vs Ultrasound Guided Core Biopsy in the Diagnosis of Parotid Neoplasia: An Up-to-Date Review
Authors: Karunaratne N , Hurry K , Westley S , Ramesar K , Williams M , Howlett D 
Published: November 2022

Abstract

Aim
Parotid tumours account for 80% of salivary neoplasms. Regarding diagnostic techniques, fine needle aspiration cytology (FNAC) has long been the technique for tissue sampling and can be optimised with ultrasound or presence of a cytopathologist. USCB differs in that it obtains a core of tissue which allows preservation of the tissue architecture. The authors performed a literature review to provide an update on current practice and outcomes of both techniques

Method
A literature review of EMBASE, Medline, PubMed and Google Scholar were conducted. Regarding USCB, four systematic reviews and meta-analyses were identified, alongside three other studies that were not included within these papers. Regarding FNAC, three systematic reviews and meta-analyses were identified, alongside seven other studies, not included within these papers, using optimised FNAC in sample sizes of over fifty.

Results
USCB has higher sensitivity, specificity, and lower non-diagnostic rates than optimised fine needle aspiration cytology (FNAC). It also has a significantly higher sensitivity for the detection of malignancy. Complications post-USCB are uncommon, with only one reported case of tumour seeding and no cases of permanent facial nerve dysfunction. The technique is less operator dependent than FNAC, with less variation in results between institutions.

Conclusions
USCB can be considered as the optimum tool of choice for diagnosis of parotid neoplasia. This would particularly be the case in centres utilising FNAC with high non-diagnostic rates or reduced diagnostic accuracy when compared to USCB published data or in centres establishing a new service.