bluuebunny/crossref_metadata_2025_split huggingface dataset:
870 The Efficacy and Safety of Bariatric Surgery in Kidney Transplantation Candidates: A Systematic Review and Meta-Analysis
Authors: Varma J , Fernando S , Dengu F , Menon V , O'Callaghan J 
Published: November 2022

Abstract

Introduction
Kidney transplantation (KT) remains a high-risk procedure which requires extensive pre-operative assessment and optimisation. Obesity is known to increase the risk of adverse post-operative consequences. Bariatric surgery (BS) is an effective solution to obesity. The authors aim to summarise the evidence for the efficacy and safety of BS in KT candidates.

Method
We performed a systematic review and meta-analysis to determine the efficacy and safety of BS in patients KT candidates. A literature search of MEDLINE, EMBASE and Web of Science was conducted from inception to April 2021. The methodological quality of selected studies was assessed using the Newcastle-Ottowa tool. Our primary outcome was change in BMI, with secondary outcomes including adverse events, graft outcomes and KT rate.

Results
Nine observational studies met the inclusion criteria with a total of 179 patients (48% male). Mean change in BMI following BS was -11.2 (-12.9 to -9.5, p &lt; 0.001) within a median follow up time of 43 months (IQR 36 to 47 months). Sleeve gastrectomy (44.7%, n=80) and gastric bypass (46.9%, n=84) were the most common procedures. Median time from BS to KT was 17 months (IQR 6 to 18 months) with a mean KT rate of 80.1% (SD = 14.9).

Conclusion
This review highlights that BS is both safe and efficacious for KT candidates and can be an effective means of optimising BMI prior to transplantation.
703 Is the Grass Always Greener on the Other Side? – How Do Breast Cancer Patients Feel About Moving to a ‘Green Hub’?
Authors: Ribbits A , Bowyer C , Kori R , Uddin S , Subramanian A , Shah L 
Published: November 2022

Abstract

Aim
Between January and September 2020 our base hospital recorded zero COVID-19 incidence in breast surgery patients, in 30 days post-op, with stringent admission protocols including 14 days self-isolation, PCR testing, ‘green’ wards and designated ‘green’ theatres. However, as the UK entered its third lockdown in January 6th2021 the decision was made to move breast cancer surgery off-site to a ‘green hub’ 43 miles away. The aim of this study was to assess the impact this had on patients.

Method
Patients who had surgery moved off-site were requested to anonymously complete a questionnaire which was either posted or handed to them at follow-up. The questionnaire contained 11 Multiple Choice questions and a comments section.

Results
16 of 19 patients (84.21%) responded to the questionnaire. 16 of 16 (100%) understood the reason for the move. 2 (12.5%) stated that it increased anxiety/stress levels while 3 (18.75%) reported the opposite, and the remainder were neutral. 14 (87.5%) said the move made them feel safer, 1 (6.25%) did not feel safer, with the remaining 1 (6.25%) unsure. 15 (93.75%) felt they received enough information at base and 16 (100%) received sufficient discharge information at the ‘green hub’. All 16 (100%) were satisfied with the move off-site but only 15 (93.75%) supported the decision.

Conclusions
The responses indicate that the decision to move breast surgery off-site was supported and well understood. And while for a minority of patients this increased pre-operative anxiety/stress levels, it did make the majority feel safer.
773 Standardising Autologous Breast Reconstruction Referrals – a Quality Improvement Project
Authors: Hardwick E , Rutherford C , Johnson L , Oezdogan Y 
Published: November 2022

Abstract

Aim
Autologous breast reconstruction should be discussed with all suitable patients undergoing mastectomy, reinforced by the most recent Oncoplastic guidelines. This generates a large volume of referrals to the Plastics team, which are variable in content, and may neglect pertinent information. The aim of this project was to prospectively audit the quality of plastics referrals prior to the introduction of a standardised proforma with the aim of streamlining the patient pathway.

Method
A prospective audit of 19 consecutive referrals for autologous breast reconstruction was performed in December 2021 in a single centre. Referrals were assessed for the following essential data: immediate or delayed surgery, BMI, smoking status, neoadjuvant chemotherapy, and planned adjuvant treatment, specifically chemoradiotherapy.

Results
Immediate or delayed reconstruction status was reported in 18 (94.7%) of referrals made. Neoadjuvant chemotherapy was mentioned in 13 (68.4%) referrals. Plans for likely adjuvant treatment, including radiotherapy was mentioned in 15 (78.9%) referrals. Co-morbidities were reported in 6 (31.6%) referrals. Only 2 (10.5%) referrals reported on BMI and 4 (21.1%) on smoking status.

Conclusion
There is significant variability in the detail and quality of referrals for autologous breast reconstruction. Consequently, a standardised proforma was introduced to the unit which was presented at the Trust Audit Day. The proforma information was felt to be crucial in assessing the patient's appropriateness for surgery and its timing. This referral was introduced as an online tick-box form sent to a shared Plastics email. This has since been widely adopted allowing for efficient time-saving referrals with relevant information included.
819 Management of Maxillofacial Trauma Emergency Department Presentations in an Evolving Pandemic. Did COVID-19 Change Our Practice?
Authors: Owen A , Brewer E 
Published: November 2022

Abstract

Aim
Trauma encompasses a significant proportion of referrals to Oral Maxillofacial Surgery (OMFS). COVID-19 called for clinicians globally to tailor practice and follow-up patterns. Multiple government-imposed lock downs saw changes in patterns of emergency department (ED) attendances nationally.
The aim of this audit was to examine the impact of COVID-19 on Maxillofacial trauma presentations, admissions, and existing practice in University Hospital of Wales (UHW).

Method
Data was collected using an electronic patient database “Team Talk”. Patients filtered by pathology (Soft tissue trauma, fractures) and location (ED). Annual data collected for 2019, 2020 and 2021, to compare pre-pandemic (2019), evolving pandemic (2020) and established pandemic (2021) figures.

Results
Trauma made up 74%, 73% and 78% of total OMFS referrals (2019, 2020, 2021). There was an 83% decrease in the number of trauma referrals between 2019 and 2020, despite UHW becoming a major trauma centre. No correlation identified between trauma presentations and lockdown events (2020) but lifting of restrictions (September 2021) showed an increase in presentations. 16.8%, 16.4% and 16.2% (2019, 2020 and 2021, respectively) of ED referrals were offered follow up follow up. Percentage of follow up appointments used for removal of sutures (ROS) decreased by 30% (2019–2020).

Conclusions
941 The Effect of COVID-19 on Orthopaedic Trauma Theatre Efficiency and Surgical Training in the North and East of Scotland Major Trauma Centres – a Year On
Authors: Lim JW , Lindsay E , Rehman H , Tong EYH , Ammen bin Badekrizaman M , Withall A , Dalgleish S , Mitchell M , Boddie D 
Published: November 2022

Abstract

Aim
To determine the orthopaedic trauma theatre efficiency in two large major trauma centres (MTCs) in Scotland before and after the outbreak of Coronavirus disease (COVID-19) pandemic.

Method
All trauma patients presented to the North and East of Scotland's MTCs prior to the outbreak of COVID-19 (7th May to 7th June 2019), during the first peak of COVID-19 (7th May to 7th June 2020), after Aerosol Generating Procedures updates (7th November to 7th December 2020) and the ‘new normal’ (7th May to 7th June 2021) were retrospectively reviewed. Training opportunities and theatre time were compared. The Kruskall-Wallis test was used.

Results
There were no significant differences in the length of hospital stay (p=0.117, 0.065) and time from injuries and surgery within groups in both MTCs (p=0.508, 0.384). The pandemic has negatively affected the anaesthetic and surgical preparation time, time between end of procedure and send for next case, and turnover time, with more profound effect on the North of Scotland's MTC. The trainee's involvement as main surgeon had decreased with the outbreak of the pandemic, with the junior trainees being affected most severely in North of Scotland. The time taken for patient to arrive to theatre after sending and total downtime were twice as long in the North of Scotland.

Conclusion
The COVID-19 pandemic has negatively impacted the orthopaedic trauma theatre efficiency and training opportunities. Actions should be taken to improve the turnover time to maximise theatre efficiency while prioritizing training opportunities.
353 Patients with N2 Non-Small Cell Primary Lung Cancer, Does Surgery Offer an Advantage?
Authors: Jackson D , Badran A 
Published: November 2022

Abstract

Background
Non-small cell lung cancer (NSCLC) is one of two histological types of lung cancers. Evidence-based guidelines recommend radical resection in early-stage lung cancer, N2 disease is when there is moderately advanced lymph node spread of the cancer, recommendations for surgery at this stage are more contested.

Aim
This was a service evaluation of the management of patients with NSCLC N2 disease. We aimed to evaluate the management and outcomes of these patients to see whether surgery offers an advantage over other modalities.

Method
This was a retrospective cohort study reviewing patients treated at University Hospital Southampton (UHS) who were diagnosed with N2 NSCLC before the start of treatment from 2016–2018 and comparing survival of surgically managed patients with those treated in other ways.

Results
50 N2 patients were included, 32 had radical treatment and 11 of these underwent surgery. Kaplan-Meier survival analysis showed no significant statistical difference (Log rank = 2.342 p = 0.679) between surgery and other treatments, the survival plots showed a slightly better initial survival for chemoradiotherapy. Men were statistically more likely to have squamous cell carcinomas than women who had more adenocarcinomas. PS was shown to have significant effect on survival with higher PS having a worse survival.

Conclusions
We didn't find a statistically significant difference in the survival between patients managed surgically and other modalities. PS's effect on survival reiterates its importance when deciding on treatments to offer patients.
374 Thoracotomy vs Video-assisted Thoracoscopic Surgery in the Treatment of Vascular Rings
Authors: Campbell I , McCulla A 
Published: November 2022

Abstract

Aim
This review aims to investigate the procedure itself, post-operative complication rates and long-term outcomes of both VATS procedures and thoracotomy procedures in the treatment of VRs.

Method
A literature search of the MEDLINE and SCOPUS databases were performed at the projects inception to present. From the 361 articles retrieved, 271 were excluded. After applying the exclusion criteria and thorough manual screening, 14 studies were included in the review. 6 of these studies investigated the outcomes using thoracotomy, 3 case reports plus 2 studies that investigated the outcomes using VATS and 3 studies that directly compared the two procedures. All 11 studies were retrospectively performed with 4 studies collecting data for over 20 years, 2 studies over 10 years and the remaining studies collected data for 2–8 years.

Results
Overall, 590 cases in this review focused on using thoracotomy operations and 190 cases used VATS. The main themes from the results of the literature included: type of vascular ring identified, case and collection period of the studies, the surgical approach, post-operative complications, length of stay in hospital, symptom resolution, reoperation rates and mortality. In this review, VATS demonstrated reduced length of stay in hospital, lower reoperation rates and a lower mortality rate than the thoracotomy studies. The results indicated similar rates in operating time and rates of post-operative complications between the two procedures.

Conclusions
This review provides insight into the encouraging outcomes in the use of VATS compared to the thoracotomy cases which is the gold standard approach in vascular ring surgery.
420 Thoracic Physiotherapy Requirements in Anatomical Lung Resections
Authors: Lee A , Badran A , Alzetani A 
Published: November 2022

Abstract

Objective
Consideration of the effectiveness of thoracic physiotherapy interventions in anatomical lung resections.

Method
Prospective cohort of 119 anatomical lung resections and assessment of physiotherapy interventions in a busy teaching hospital over a 6-month period.

Results
119 patients were included, with median age of 69 (28–89). There was no obvious difference between genders (F: 52% vs M: 48%). 56% were assessed to be of performance status 0. Most were resections for adenocarcinoma (48%) and squamous cell carcinoma (10%). 61% were resected by VATS and 39% through other approaches (including open thoracotomies). A minority had no comorbidities (18%), with hypertension (41%) and previous solid tumours (33%) being most common. Average length of stay was 4 days for the cohort (3.4 for VATS and 4.9 for others). The average length of stay for patients who were seen day 1 post-op on a weekend is 4.4 (vs 5.1 if there were not seen on day 1). This is also in contrast with the average length of stay of 3.5 days if they were seen day 1 post-op on a weekday, as opposed to 4 days of average stay if they were not seen. The biggest barrier to closing this discrepancy remains weekend physiotherapy staffing.

Conclusion
We found that elective thoracic patients are more likely to have a reduced length of stay when reviewed day 1 post-op. This highlights the need for potential service developments within our weekend and Level 2/3 elective thoracic caseloads to optimise our care.
454 Sinus of Valsalva Rupture
Authors: Kucheria A , Reddy A , Bahl R , Ahluwalia V , Sadighi A 
Published: November 2022

Abstract

Background
Sinus of Valsalva (SVA) rupture is a rare cardiac pathology which is important to recognise and diagnose early.

Case Summary
This case report details a 30-year-old gentleman who presented with a 3-day history of dyspnoea and palpitations on a background of previous congenital heart disease. The patient's examination highlighted a continuous harsh pan-systolic murmur as well as an ECG finding of sinus tachycardia. Transthoracic echocardiography identified a ruptured Sinus of Valsalva. The patient was transferred to a cardiothoracic surgery centre and definitively treated with an aortic root and ventricular septal defect repair.

Discussion
This case highlights the clinical findings of a patient with an acute left to right shunt and the importance of early diagnosis and urgent surgery. This case emphasises the factors required to decide which surgical approach is appropriate such as the presence of aortic valvular pathology size, size of Sinus of Valsalva aneurysm, any simultaneous cardiac anomaly and the cardiac chamber involved.

Learning Points
163 Anterior Sacral Meningocystocele Manifesting as Vague Gastrointestinal and Urinary Syndromes – Two Case Reports
Authors: Khan AA , Javed S , Yaqoob E , Wellington J 
Published: November 2022

Abstract

Aim
Anterior Sacral Meningocystocele (ASM) carries a unique place in the current literature regarding its rarity. The condition arises in association with a congenital defect of the sacrum and coccyx through which the caudal part of the meninges may herniate to form a cyst-like structure. The disorder derives from a genetic defect of the coccyx and sacrum of which some meningeal segments protrude or herniate, forming a cyst-like entity.

Method
We report two cases of ASM. The first is a 65-year-old male with active complaints of urinary retention and hesitancy for two weeks and chronic constipation associated with lower back pain. The second, a 17-year-old girl, was presenting with abdominal bloating, pain, and backache. Magnetic resonance imaging (MRI) of the pelvis and lumbosacral spine was conducted for both patients, respectively, each scan exhibiting evidence of ASM development. Surgical correction and closure of the ASM's were performed via a posterior midline approach, which successfully alleviated the symptoms presented clinically by both patients.

Conclusions
ASM may develop asymptomatically, often with incidental discovery. Although ASM is well-regarded as a rare anomaly, diagnosis of such a defect must always be kept pertinent when a cystic structure in the pelvis is unveiled on ultrasound or during surgery. Puncture or aspiration of the cyst should be avoided if the diagnosis is in doubt. A posterior midline approach with careful obliteration of the meningocele sac opening may be curative.
219 A Rare Case of Simple Appendiceal Mucocele
Authors: Gopikrishna D , Leong WJ , Paroan M , Chiphang M 
Published: November 2022

Abstract
An Appendiceal mucocele is described as a dilated and abnormal accumulation of mucin in the appendix, most commonly as a result of epithelial proliferation. However, it can also be caused by an obstruction or inflammation of the appendix. It is a rare disease and sometimes it can present like an acute appendicitis. Computed tomography should be used vastly to prevent serious complications such as pseudomyxoma peritonei, if underlying pathology is neoplasm, or ileocolic intussusception
We present here a case study on patient with an appendiceal mucocele, together with its radiological, endoscopic as well as histological features. 74-year-old gentlemen was referred for a colonoscopy due to symptom of anaemia. He had an incidental finding of abnormal appendix orifice bulging into the lumen for about 15mm with an appearance of submucosal cystic lesion. He subsequently had a CT thorax, abdomen and pelvis which showed a 7–8cm appendiceal mucocele with 1.8cm diameter. An urgent Laparoscopic Appendicectomy was performed, which revealed an intact but large distended appendix with 9cm in length. The appendiceal lumen was filled with mucus material. No polyps or tumour identified. Histological examination revealed that this was a simple appendiceal mucocele with no evidence of malignancy. The patient was well post-operatively with no complication noted.
396 A Rare Encounter of “Forgotten Disease”
Authors: Sengupta S , Bose S 
Published: November 2022

Abstract
With the advent and prompt use of antibiotics after throat infections, the rare entity of Necrobacillosis has almost disappeared in clinical practice. Here we present a case of a fit and well 27-year-old lady who was brought into A&E with septic shock, DIC and MODS after initial diagnosis of a sore throat 4 days ago which was treated by oral antibiotics. She was found to have bilateral patchy consolidations which later became necrotic cavities, empyema thoracis, peritonitis and abscess cavities in abdomen with evolving splenic abscess, prolonged QT and ectopics and type 2 respiratory failure. She was resuscitated, intubated, and transferred to the ICU. With an isolate of Fusobacterium necrophorum from blood culture Meropenem, clindamycin and metronidazole were started. However, over the next few days of treatment, lack of clinical response prompted antibiotics changing, and surgical drainage of abscesses in chest and abdomen. Eventually after a considerable period of abdominal abscess drainage and about 3 weeks of metronidazole and other antibiotics followed by Piperacillin and tazobactam for another 3 weeks the patient recovered from sepsis and was stepped down to ward. This case though rare is a good example of the benefits of surgical drainage and prolonged antibiotics for septic patients with collections. A rapid weaning only results in re-collection and clinical deterioration, or recurrent collection as happened to this patient. This is a rare case of Lemierre's syndrome which depicts the surgical difficulties faced due to recurrent abscess cavities formed in this condition.
543 Bouveret Syndrome: A Rare Presentation of Gastric Outlet Obstruction
Authors: Peiris B , Elmasry M , Middleton S 
Published: November 2022

Abstract
A 76-year-old lady presented with a 5-day history of lower abdominal pain and vomiting. She had not opened her bowels for 3 days and 24 hours prior to admission had coffee ground vomitus. A CT abdomen and pelvis showed gastric outflow obstruction secondary to a large 3.5cm gallstone within the pylorus (Bouveret syndrome).
She was initially treated conservatively for bowel obstruction and underwent an OGD where attempts to retrieve the stone were unsuccessful. A subsequent laparoscopic gastrotomy revealed a large stone in the duodenum and was successfully removed.
This case highlights how this rare syndrome can present with non-specific symptoms, diagnosis can be challenging and relies on imaging, therefore patients should be worked up thoroughly to ensure a correct diagnosis. There are currently no standardised management guidelines for Bouveret syndrome, mainly due to its rare prevalence and this case demonstrates a variety of management options.
591 Abdominal Apoplexy – a Case of Spontaneous Haemoperitoneum from Pancreaticoduodenal Artery Bleed
Authors: Rizvi K , Beatson K , Lordan J , Moosvi R 
Published: November 2022

Abstract

Background
Inferior pancreaticoduodenal artery (IPDA) haemorrhages are extremely rare and often occur secondary to IPDA aneurysms. They can result in a spontaneous life-threatening bleed which requires urgent treatment via transcatheter arterial embolisation (TAE).

Case Summary
We report the case of an IPDA haemorrhage in a 52-year-old male who presented with a one-day history of severe worsening generalised abdominal pain. Although his initial blood pressure, heart rate and haemoglobin were within the normal range, he had a persistent metabolic acidosis with raised lactate. This prompted an urgent out-of-hours Computed Tomography (CT) scan. On return to the ward, he had a syncopal episode and was found to be in shock. An urgent venous blood gas revealed a substantial haemoglobin drop (133g/L to 88g/L) and review of his imaging identified intra-abdominal haemorrhage, confirmed by radiology to be an IPDA haemorrhage. The patient was managed according to the trust's major haemorrhage protocol and blue light transfer to a tertiary centre for embolisation by interventional radiology was arranged. He was transferred with ongoing resuscitation, and successfully underwent TAE of the IPDA. No aneurysm or other pathology was noted on angiography.

Conclusion
IPDA haemorrhages are uncommon. Physiological compensation may normalise initial observations and initial haemoglobin level may also be falsely reassuring. Therefore, it is important to monitor physiological indicators, such as pH and lactate, as real-time severity indicators to identify emergency pathology early.