bluuebunny/crossref_metadata_2025_split huggingface dataset:
787 Surgical Outcomes and Optimal Approach to Treatment of Aortic Valve Endocarditis with Aortic Root Abscess: Single-Centre Experience and Meta-Analysis
Authors: Harris W , Sinha S , Caputo M , Angelini G , Rajakaruna C , Benedetto U , Ahmed E , Vohra H 
Published: November 2022

Abstract

Aim
To evaluate the impact of aortic root abscess (ARA) on the postoperative outcomes of surgically managed infective endocarditis (IE) and to inform optimal surgical approach.

Method
Between 2009 and 2020, 143 consecutive patients who underwent surgical management for aortic-valve IE were included in a retrospective cohort study. Multivariate and propensity-weighted analyses were used to adjust for demographic imbalances between those without (n=93; Group NARA) and with ARA (n=50; Group ARA). These results were then included in a meta-analysis of existing data, performed following a literature search of Medline, Embase and the Cochrane library. Additionally, empirical subgroup analysis appraised the two most used surgical techniques; Patch Reconstruction (PR) and aortic root replacement (ARR).

Results
In-hospital mortality was 8% and 12% in Group NARA and ARA, respectively (p=0.38).
Six clinical studies were included in the meta-analysis. Group ARA was associated with an increased risk of in-hospital mortality (OR=1.74 96% CI: 1.18–2.56) and late mortality (HR=1.27 95% CI: 1.03–1.58). Our reoperation meta-analysis had high levels of heterogeneity (I2=59%) and found no significant differences in reoperation between group ARA and NARA (HR=1.48; 95% CI: 0.92–2.40). However, inconsistent reoperation figures could be explained by varying institutional preferences for surgical approach as our propensity-weighted analysis suggested that ARR is associated with an advantageous preoperative profile compared with PR.

Conclusions
The presence of an ARA in aortic valve endocarditis is associated with elevated early and late mortality despite modern standards of care. Additionally, we contend that ARR should be considered as best practice for IE cases complicated by ARA.
1035 Gender Equality in Heart Transplantation: A Single Centre Study
Authors: Surendran A , Mascaro J , Dumitriu I 
Published: November 2022

Abstract

Background
International Society for Heart and Lung Transplantation catergoirises female gender in donor/recipient, as a significant risk factor for mortality after heart transplantation. Further, donor-recipient gender mismatch is also reported to be a determinant of post-transplant morbidity/mortality. To examine the effect of gender in survival outcomes, we conducted a retrospective study.

Method
Population comprised of 298 patients undergoing heart transplantation from 2001 to 2021, divided into four groups on the basis of donor and recipient matching. Group A consisted of men who received male donor-hearts, group B of women who received female donor-hearts, group C of women who received male donor-hearts, and group D of men who received female donor-hearts. Standard heart transplantation protocols were applied to all patient groups for graft preservation, surgical technique, donor-recipient size matching, induction & immunosuppressive therapy.

Results
The study groups were found to be homogeneous to the major preoperative- risk- factors (aetiology, transplantation status, donor-recipient-age, total ischemic time). Donor gender, recipient gender and donor-recipient gender mismatching did not significantly modify the short and mid-term survivals, functional recovery, and primary graft dysfunction post-surgery.

Conclusions
Even though previous reports suggest that gender negatively affects survival, this proved to have no influence on the outcomes in our study. These results can be explained by a correct donor-recipient size matching. The well-documented female recipients’ tendency to more frequent and fatal rejection was not confirmed in our experience. The patient's age at transplantation, the routine use of induction therapy and an aggressive immunosuppressive regimen may be the substrate of these findings.
19 A Rare Case of Parapharyngeal Schwannoma Mimicking Peritonsillar Abscess in a Young Female Patient
Authors: Khan A , Rehman A , Omakobia E , Sood S , Khan S 
Published: November 2022

Abstract

Introduction
Parapharyngeal Space (PPS) tumours are responsible for 0.5% of head and neck cancers. Presenting features can mimic peritonsillar abscess. A differential diagnosis of PPS tumour should therefore be considered in young, systemically well patients with resistant peritonsillar masses.

Aim
To report a rare case of parapharyngeal schwannoma in a fit and well adult female with a focus on investigations and optimal management.

Method
A 29-year-old, Caucasian female presented with a three-week history of a right sided oropharyngeal mass, odynophagia, and dysphonia. A stagnant clinical picture prompted further investigation with Magnetic Resonance Imaging (MRI). This demonstrated a 7cm right sided PPS mass arising from the deep lobe of the right parotid gland. Mass excision and partial, ipsilateral parotidectomy confirmed Schwannoma (neurilemoma).

Results & Discussion
Schwannomas account for a third of PPS tumours. Arising from neurological Schwann cells, they are often encapsulated, benign tumours which are characterised by slow and asymptomatic growth. Presentation often follows mass effects leading to dysphagia, odynophagia, and dysphonia. MRI and FNAC remain the gold standard in confirmation of diagnosis. Insensitivity to radiotherapy ensures that surgical resection is the mainstay of treatment and may utilise the transcervical, transparotid or transmandibular approach.

Conclusion
There is a significant degree of overlap in the epidemiology and presenting features of peritonsillar abscess and PPS tumours. In cases of treatment resistant, chronic peritonsillar masses a differential diagnosis of PPS tumour must therefore be excluded.
20 A Novel Case of Metastatic Hypopharyngeal Carcinoma Without Nodal Involvement
Authors: Khan A , Taylor R , Omakobia E , Glore RJ 
Published: November 2022

Abstract

Introduction
In the UK, patients with hypopharyngeal carcinoma are managed via a multidisciplinary team approach based on UK National MDT Guidelines. Hypopharyngeal cancer often presents late, 80% of patients presenting with Stage III or IV disease, with PET-CT recommended for these patients to assess for metastases.

Aim
To report a novel case of an elderly ex-smoker with hypopharyngeal carcinoma without nodal involvement.

Method
An 86-year-old ex-smoker presented to the otolaryngology department with a T2N0 hypopharyngeal carcinoma, which was later upstaged to T3N0M1 following a PET-CT scan.

Results & Conclusions
This case highlights discrepancies between the MDT Guidelines and NICE guidance over when to perform staging scans. NICE recommends PET-CT for T4 or N3 disease compared to Stage III or IV disease in the National MDT guidelines. Our patient would not have qualified for PET-CT under NICE guidance and his metastatic disease would have been undiagnosed. This case highlights that lack of nodal involvement does not exclude metastases and there should be a low index of suspicion for distant metastases in patients with significant systemic symptoms.
25 The Trapped Twin Within: A Rare Case Report of Fetus in Fetu
Authors: Jadhav P , Vaze D , Shimpi A , Hegde A , Anne D , Viswambharan V 
Published: November 2022

Abstract

Introduction
Fetus in fetu is an uncommon congenital anomaly in which the malformed monochorionic diamniotic twin is entrapped within the body of the host twin, due to embryogenic defects or arrest of blood supply. Differentiation from teratomas is done by the evidence of budding vertebral column and limbs in radiological investigations.
Fetus in fetu has an incidence of 1 in 500,000 births with less than 200 cases reported. Herein,we present a case of 1 year old male infant brought with a growing abdominal mass.

Case report
A 12-month-old male child was brought by the mother with a growing abdominal mass in right lower quadrant and failure to thrive. Tumor markers were negative and radiological investigations confirmed a huge retroperitoneal 12 *10 cm fetus in fetu compressing the inferior vena cava. Transverse laparotomy and in-toto excision following meticulous dissection was done. Histopathology confirmed the diagnosis of fetus in fetu.

Conclusion
Though a rare entity, fetus in fetu warrants a suspicion in a pediatric abdominal lump and special focus to differentiate from teratoma is recommended. Surgical excision is curative.
26 Case Report of a Pseudoaneurysm from Distal Anastomosis of Open AAA 32 Years Previously, Contained Within Original Aortic Sac
Authors: Clelland A , Sravanam S , Chatha S , Metcalfe M 
Published: November 2022

Abstract
An 86-year-old gentleman attended hospital with confusion following collapse at home. On examination the abdomen was soft, non-tender and distended with an expansile mass. He underwent elective open repair of a 7cm AAA 32 years prior to current presentation. His past medical history included severe aortic stenosis and atrial fibrillation for which he was anticoagulated with warfarin.
CT imaging of head for intracranial pathology. Triple phase contrast CT studies to assess possible aortic pathology.
CT brain excluded intracranial pathology as cause of collapse. CT triple phase aortogram demonstrated an 8.4cm infrarenal abdominal aortic aneurysm. Arterial phased images show contrast in the previous aortic repair, however delayed images showed extravasation of contrast from a potential leak at the distal suture line, with blood filling the original aortic sac, outside the aortic surgical graft. No retroperitoneal leak was identified.
This presentation was amenable to relining of the aorta with an EVAR however given the patient was asymptomatic and had significant comorbidities, no further intervention was undertaken. The patient and family agreed with this plan of action, and the patient died 3 weeks later. The duration of this contained leak was unknown.
101 A Case Report on Persistent Mullerian Duct Syndrome Presenting as Obstructed Inguinalhernia in an Adult Male
Authors: Somasekhar K , Bangalore Mahalinga D 
Published: November 2022

Abstract
Persistent Mullerian Duct Syndrome (PMDS) is defined as the presence of müllerian derivatives, uterus, and Fallopian tubes in otherwise normally masculinized 46, XY subjects. It's more common in children with cryptorchidism and is a rare finding during hernia surgery among adults with a risk of malignant degeneration. Here we present the case of a 34-year-old adult male with a history of irreducible swelling in the right groin for 1 day and with a past surgical history of left sided hernia repair 10 years back. On examination a tender, irreducible swelling was noted in the right inguinoscrotal region, opposite side and groin area appeared normal with normal male pattern virilisation. A clinical diagnosis of irreducible right inguinal hernia was made, and the patient was taken up for surgery under spinal anaesthesia. Intraoperatively, right sided sliding hernia with an indirect hernia sac was noted with the contents being degenerated uterus, right fallopian tube connecting to the cornua of uterus along with right gonadal tissue at the fimbrial end within the broad ligament. Consent was taken and hernioplasty was performed after excision of the gonadal tissue along with the fallopian tube. On histopathological examination the gonadal tissue was found to be of testicular origin with fibrosis and degeneration. The diagnosis of persistent Müllerian duct syndrome was confirmed. This case report adds on to the current literature on incidence and presentation of PMDS amongst adults and highlights the importance of knowing the pattern of occurrence of this rare condition.
107 A Rare Presentation of a Giant, Multi-Compartmental Lipoma of the Hand Causing Median Nerve Compression
Authors: Shah R , Rahman S , Pywell M , Ibanez J 
Published: November 2022

Abstract
Lipomas are the commonest benign tumour, made up exclusively of adipose tissue, and can arise anywhere in the body. However, giant lipomas of the hand, defined as greater than 5cm in diameter, are rare. They have the potential to invade and cause a multitude of symptoms due to the compression and proximity of underlying structures.
We describe a case of a 64-year-old woman who presents with a swelling of the left thenar eminence, associated with numbness and tingling in all fingers.
MRI and nerve conduction studies confirmed the diagnosis of a lipoma causing median nerve compression. The patient underwent elective surgical excision using a volar approach, with good postoperative recovery. The excised lesion, measuring 12x7x2.4cm, is the largest giant lipoma of the hand reported in literature, and the first to demonstrate invasion from the mid palmar space into both the dorsal sub-aponeurotic space and carpal tunnel.
Space occupying lesions, such as giant lipomas of the hand, are a rare but important secondary cause of compression neuropathies of the upper extremity and must be suspected when these neuropathies present with atypical symptomatology. Any patient presenting with a soft-tissue lesion of the hand demonstrating rapid growth, pain or large size must be thoroughly investigated to rule out malignancy. MRI forms an essential part of the workup in such cases due to its high diagnostic accuracy. Malignant transformation of giant lipomas of the hand is extremely rare, and such lesions can be removed by en bloc marginal resection with excellent postoperative results.
115 Management of Femoral Non-Union with Post-Traumatic Bone Defect Using Second-Generation PRECICE® Nail - a Case Report
Authors: Lu V , Zhang J , Krkovic M 
Published: November 2022

Abstract

Introduction
The management of post-traumatic bone defects with non-union remains a surgical challenge. Common limb length discrepancy (LLD) procedures involve Masquelet technique, vascularised bone grafts, distraction osteogenesis using external fixators, yet they pose a functional and economical challenge for patients, given high complication rates and need for revision surgery. Magnetically driven PRECICE nails are self-lengthening internal devices activated via an external controller. We present one patient with post-traumatic femoral non-union with concomitant bone defect, using second-generation PRECICE nail.

Case Study
One 57-year-old gentlemen suffered open femoral fracture after a motorcycle accident. Having previously undergone open reduction internal fixation, he presented to us with atrophic non-union and bone defect, which were simultaneously treated with a second-generation PRECICE nail. Our treatment protocol was based on the strain theory and involved initial distraction by ∼5mm at non-union site, at a rate of 1mm per day, to decrease strain on bone graft cells and promote callus formation. One week later, the non-union site was compressed to close the gap completely. After another four weeks, distraction using the PRECICE nail started, in increments of 0.25mm, four times a day, until the desired length was achieved. The patient achieved union and the initially planned limb lengthening regime was achieved with minimal complications.

Conclusions
By initially distracting the bone defect by ∼5mm, then compressing the gap, before distraction started, strain on bone graft cells was minimised, allowing robust callus and regenerate growth. Self-lengthening, magnetically driven PRECICE nails can successfully restore union and manage limb length discrepancies with reasonable patient satisfaction and minimal complications.
118 A Case Report on Mucinous Adenocarcinoma Colon in a 14-Year-Old
Authors: Diwakar G , Govindraja E , Bangalore Mahalinga D 
Published: November 2022

Abstract
Pediatric colorectal cancers are rare tumours that carry poor prognosis but none the less the incidence of these tumours is on the rise. Here we present a case of a 14-year-old boy who complained of vague abdominal pain, altered bowel habits and unintentional weight loss for 1 month. On examination a fixed hard mass was palpable on the left side of abdomen and had elevated CEA levels. Open biopsy and immunochemistry confirmed the tumour to be adenocarcinoma of colorectal origin. Patient and guardians denied surgery initially and one month later presented with obstructive symptoms for which left hemicolectomy was done and on histopathological examination mucinous adenocarcinoma stage- T3d N1 M0 was confirmed, the patient was later referred for chemotherapy. The patient showed transient improvement but succumbed to the disease 10 months after the diagnosis. This case highlights the importance of early detection of colorectal malignancy in children by raising awareness of its occurrence and by considering malignancy as a part of the differential diagnosis in pediatric cases with vague GI complaints. Currently colorectal carcinomas in children are being managed in line with the adults due to lack of sufficient evidence and data despite its aggressive nature in the younger age group.
134 Case Report and Review of Literature: Advanced Sino-Nasal Adenoid Cystic Carcinoma with Intracranial and Intradural Extension
Authors: Rassam J , Sood T 
Published: November 2022

Abstract

Introduction
Adenoid cystic carcinoma (ACC) is a rare cancer of the head and neck that primarily occurs in the salivary glands. Sino-nasal ACC (SNACC) is a much rarer entity; this paper presents an exceedingly rare case of SNACC with both intracranial and intradural extension. In addition to this, a review of the literature has been performed.

Case Study
Our case describes the diagnosis of SNACC with both intracranial and intradural extension in a 55yr old female which was subsequently managed with palliative radiotherapy.

Review of literature and Conclusions
Currently, there are only few larger studies that have been conducted on SNACC and only isolated case reports of SNACC with intracranial extension. Aggregated data suggests that SNACC tends to present late at T3-T4 stage, has a 5-year survival of 60% and holds the best prognosis when surgical resection is feasible.
From our case and the four other cases published on SNACC with intracranial extension it can be seen there is a clear distinction with management of patients with or without intradural extension. Intradural extension is a contraindication to surgical resection and once found deems the disease stage as primarily palliative.
The focus for treatment of SNACC particularly with intracranial extension should catch disease early and prevent intradural spread. This maximises the number of patients who can undergo surgical resection and improves prognosis.
148 Migrated Esophageal Stent Causing Imminent Ischemia. a Case Report
Authors: Atif QAA , Raza M , Essiet E , Ahmed K 
Published: November 2022

Abstract

Introduction
Esophageal stents are being used more frequently for maintaining esophageal lumen patency in benign as well as malignant conditions. But the stents do not come without complications. The most common complication is stent migration. It can go unnoticed in asymptomatic individuals whereas timely exclusion of more urgent complications associated with migration is necessary to avoid morbidity and mortality.

Case presentation
We present the case of a 58-year-old patient with inoperable esophageal cancer. He underwent esophageal stenting twice, for palliation, and on both occasions, the stents did not maintain its position. He presented with abdominal pain, abdomen was peritonitic on examination and computerised tomography (CT) scan showed that the esophageal stent had migrated into his ileum. Upon laparoscopy, stent was found lodged in distal ileum causing ischemia and imminent perforation. We found the radiology and per-operative images interesting and are sharing herewith.

Conclusion
With the growing use of esophageal stents, it is important to recognize the possible immediate and delayed complications to manage them effectively. Surgeons need to be aware of the possible complications and have a high index of suspicion to diagnose and treat these.
166 Management Dilemma in an Unusual Presentation of Acalculous Acute Cholecystitis
Authors: Bose S , Alasmar M , Doran H 
Published: November 2022

Abstract
Acute acalculous cholecystitis is a recognised but seldom encountered entity except in immunocompromised and critically ill patients. Epstein-Barr virus infection, on the other hand, is a common viral illness throughout the world, mostly in the younger age groups. However acute cholecystitis due to EBV infection is very rare to occur and can be difficult to diagnose. Here we present a case of a middle-aged adult who presented with upper abdominal pain and non-specific viral illness-like symptoms. LFTs were of a mixed picture, and she had marginally raised inflammatory markers. Standard imaging studies excluded gallstones, but she had thickened gallbladder wall with pericholecystic oedema and some fat stranding, but normal intra hepatic biliary tree and CBD. Strikingly there were sizable lymph nodes in abdomen and thorax. Suspecting viral aetiology, a viral screen was performed which gave a positive EBV result. However, on daily clinical examination she kept on worsening symptomatically and a decision to operate was made following discussion with gastroenterologists and the patient. To note, EBV result was delayed and arrived after she had the operation. This case gives an example of a rare surgical case which may create a diagnostic dilemma amongst clinicians. Whilst understanding that management of acalculous cholecystitis is usually conservative, but in a clinically deteriorating young patient like this there may be a case for cholecystectomy or cholecystostomy. Here the learning point should be to think of other possible diagnoses and consider viral aetiologies earlier which may avoid a procedure on a patient.
222 Bilateral Patellar Tendon Rupture Following Low-Energy Trauma in a Young Patient Without Predisposing Risk Factors
Authors: Murphy S , McAleese T , Elghobashy O , Walsh J 
Published: November 2022

Abstract
We describe the case of a 25-year-old male who presented with a bilateral patellar tendon rupture without any of the identified risk factors for tendon injuries. Our patient is the youngest adult reported to date with confirmed bilateral, unprovoked, patellar tendon ruptures. We accompany our case with an up-to-date literature review on this topic. A degree of clinical suspicion is required for emergency room physicians as well as orthopaedic surgeons assessing such patients to avoid missing bilateral injuries. Point of care ultrasound may be utilised when there is doubt regarding the diagnosis. Prompt surgical management and a specific rehabilitation programme are both required to ensure maximum recovery of these patients.