bluuebunny/crossref_metadata_2025_split huggingface dataset:
214 Laparoscopic Cholecystectomy: Most Primeval and Pervasive Yet Least Congruent
Authors: Kuzman M , Bhatti KM , Islam O 
Published: November 2022

Abstract

Aim
Laparoscopic Cholecystectomy is one of the commonest surgical procedures performed worldwide. However, there is considerable variation in laparoscopic cholecystectomy practice, and a lack of robust data on variations in practices.

Method
A 45-item electronic survey was designed to capture global variations in practice of laparoscopic cholecystectomy. The survey was disseminated to the global community of surgeons performing laparoscopic cholecystectomy through professional surgical and training organizations and social media.

Results
638 surgeons from 70 countries completed the survey. Pre-operatively 5.6% routinely performed an endoscopy to rule out peptic ulcer disease. Cholecystectomy theatre lists were provided acutely by 58.6%, with 61.2% (n=389) performing index admission cholecystectomy for gallstone pancreatitis. Peri-operative practice included the use of prophylactic antibiotics (n=362) and elastic compression stocking routinely by over half of the respondents. However, 69.7% do not use pharmacological DVT prophylaxis preoperatively.
Open juxta umbilical is the preferred method of pneumoperitoneum (n=410, 64.6%). The most common approach to difficult Calot's triangle is retrograde dissection from fundus (49.2%, n= 312). Transection of the gallbladder in the middle and retrograde dissection is practiced by about 18% of surgeons (n=114).
Local anesthetic is instilled into the gallbladder bed by 14.2% of surgeons. Half of the surgeons discharge their patients on the following day, while around 44% would discharge them on the same day.

Conclusions
This study highlights significant variations in practices concerning various aspects of laparoscopic cholecystectomy and stressed on the need for developing consensus guidelines.
265 Group and Saves for Laparoscopic Cholecystectomies: An Unnecessary Expense?
Authors: Cole K , Jamnadass E , Ward J , Hou D 
Published: November 2022

Abstract

Aim
The aim of this study was to analyse the necessity of routine group and saves (G+S) in patients undergoing laparoscopic cholecystectomies and to establish whether it would be safe to cease this practice. In doing so, we aim to reduce financial burden and workload, whilst maintaining safe clinical outcomes.

Method
This was a retrospective study into all consecutive patients that underwent an elective or emergency laparoscopic cholecystectomy in Royal Hampshire County Hospital (RHCH) from May 2019 - May 2021. IT systems and clinical notes were analysed to identify the quantity of pre-operative G+S samples sent, and the proportion of patients that required a postoperative blood transfusion.

Results
Over 24 months, 427 laparoscopic cholecystectomies were performed in RHCH, 70% of which were elective. In total, 682 G+S samples were processed (1.6/patient), resulting in a cost of £16504. Two patients received a postoperative blood transfusion (0.5%). One of these patients presented with an UGI bleed, whilst the other presented with a haemolytic crisis. They were therefore predictable, pre-operative conditions, for which a post-operative transfusion had been planned prior to surgery.

Conclusion
In conclusion, this study suggests that performing routine G+S for all laparoscopic cholecystectomy patients has created an unnecessary workload and financial burden on this small DGH. Furthermore, during this 24 month, this practice had no clinical advantage. We therefore advise that sending pre-operative G+S samples should be a clinical decision made on a case-by-case basis, rather than a default for all patients.
409 Evaluation of Advanced Bimanual Skills in Novices Using the Wrist-Like FlexDex™ Articulating Laparoscopic Needle Holder in 2D and 3D Vision: A Randomised Trial
Authors: Farzaneh SB , Motahariasl N , Motahariasl S , Kokotkin I , Sousi S , Zargaran A , Zargaran D , Patel B 
Published: November 2022

Abstract

Aim
The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDex™ laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems.

Method
In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDex™ and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves.

Results
The intervention group that used FlexDex™ and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDex™ with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P &lt; 0.001).

Conclusion
Combination of 3D visual systems and the FlexDex™ laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance.
916 The Use of Absorbable Suture Versus Staples Versus Tissue Glue in Laparoscopic Port Skin Closure. a Prospective, Randomised Control Trial. the STILS Trial
Authors: Ramjit SE , Donlon NE , Nugent T , Kelly M , Ravi N , Neary P , Donohoe C , Reynolds JV 
Published: November 2022

Abstract

Aim
The closure of surgical wounds following laparoscopic surgery is not currently standardised. The aim of this study was to compare the three main methods of closure – Stitches, Staples, and Tissue Glue to evaluate which of these produce optimum cosmetic outcomes, results in least wound complications and which is most cost-effective. This would enable the adoption of a standard protocol for closure of laparoscopic wound sites.

Method
This was a prospective, randomised controlled trial. Patients undergoing elective, laparoscopic surgeries were consented and randomised into one of the three treatment arms (Stitches–Subcuticular 4–0Monocryl;Skin Staples or Tissue Glue). Pre-defined, specific guidelines for each of the closure methods were followed. Data recorded at the time of surgery included: Number/Size of Port Sites, time taken and Quantity of closure material used. At an interval follow-up appointment, the wounds were evaluated using the ‘Patient and Observer Scar Assessment Scale’ (POSAS), wound complications recorded, and photographs taken to facilitate further evaluation by a third-party clinician.

Results
A total of 147 patients were recruited with 138 completing full follow-up. In the ‘Sutures’ arm the average Observer Scar Score(OSS) was 10.3;Patient Scar Score(PSS) was 12.6;Rate of wound closure(RWC) 4.3mm/min;Wound complication rate(WCR) 0.08%;Cost €4.22/patient. The ‘Staples’ arm demonstrated an average OSS-13.1;PSS-16.4;RWC-15.7mm/min;WCR-0.06%;Cost €21.97/patient(excluding labour for ROS). In the ‘Tissue Glue’ arm there was an average OSS-15.7;PSS-18.4;RWC-5.1mm/min;WCR-.19%; Cost €21.10/patient.

Conclusions
Laparoscopic port site closure with 4–0 Monocryl was most superior with regards to cosmetic outcome and cost-effectiveness. Staples was the fastest method of closure and lowest complication rate.
64 The Radial Forearm Free Flap Versus the Nasolabial Flap in Adults Having Reconstructive Surgery for Oral Cancer: A Comparison of Quality-of-Life Outcomes
Authors: White M 
Published: November 2022

Abstract

Background
The radial forearm free flap has classically been used in oral reconstructions, however, there has been research into an alternative option, the nasolabial flap. Surgical research is focussing more on quality-of-life outcomes to measure a successful recovery. Therefore, this review has a focus on QOL as well as functional outcomes.

Aim
To determine if there are better QOL outcomes between patients undergoing tongue reconstruction with the NLF or the RFFF. The quality and limitations of the included papers will be discussed.

Method
Four databases were searched using set search terms and inclusion/exclusion criteria. Fourteen final papers were assessed using a CASP checklist and a bias tool.

Results
Four papers lost patients to follow-up; one provided no information, and one excluded three patients from follow-up, leaving nine papers with complete follow-up data. Eight studies used subjective measurements for functional outcomes; two used objectives; three used both; and one study used objective measurements for speech, but no information was provided for swallowing. A variety of outcome measures were featured; despite this, all the papers found good functional and QOL results at follow-up. There were problems with bias throughout all the papers and several reoccurring limitations such as small sample size and the retrospective nature of all but one study.

Conclusions
Due to the significant amount of bias found, the low quality of literature available, and discrepancies between outcome measures, further research is needed in the form of a long-term prospective study with a larger cohort that includes some objective outcome measures.
390 Assessing Biocompatibility & Mechanical Testing of 3D-Printed PEEK Versus Milled PEEK in Maxillofacial Surgical Applications
Authors: Limaye N , Veschini L , Coward T 
Published: November 2022

Abstract

Aim
PEEK (poly-ether-ether-ketone) is an innovative thermoplastic polymeric biomaterial used in Maxillofacial Surgery. As opposed to metallic implants, PEEK implants can be 3D-printed specifically for patients and do not suffer stress shielding effects- a major cause of implant failure. This investigation aimed to compare mechanical integrity and biocompatibility of modern 3D-printed PEEK implants against traditionally produced Milled-PEEK implants and metallic biomaterials e.g., Titanium.

Method
Fused-deposition-modelling and non-CNC Milling were used to produce ASTM/ISO-designed PEEK samples. Samples were designed and produced using the Apium P155 FDM-3D-printer, Fusion 360 and Simplify3D software. Fracture Toughness KIc, Tensile Strength, Vickers micro-hardness and 3-point flexural strength tests were performed. Cell adhesion on sandblasted 3D-printed PEEK was evaluated by culturing primary human endothelial cells and osteoblasts (HUVEC, HOBS) and evaluating cell growth.

Results
Milled PEEK had higher tensile strength (p=0.022), higher flexural strength (p&lt;0.0001) and higher fracture toughness (p=0.003) than FDM-printed PEEK. However, FDM-printed PEEK demonstrated higher microhardness than Milled PEEK (p=0.014). Both FDM and Milled PEEK showed mechanical strength values in normal ranges of cortical bone, and close to ranges of alternative bone-replacement biomaterials. Both HOBS and HUVEC demonstrated strong adhesion to PEEK with &gt;95% viability.

Conclusions
3D-printing of PEEK is an emerging technology with advantages over milling and metallic biomaterials in implant production. Nonetheless, this manufacturing modality may produce 3D-printed PEEK devices with lower mechanical resistance parameters compared to milled PEEK, but with values compatible with natural bone. Sandblasting is a modality to create uniform micro-rough surfaces potentially enhancing osseointegration of PEEK implants with host tissue.
537 Oro-Nasal Fistula: A Very Rare Complication Following Routine Palatal Biopsy
Authors: Yasen Z , Smith M , Mani R , Chung A 
Published: November 2022

Abstract
Biopsies of the palate are generally well-tolerated with known complications of pain, bleeding, or infection, that can usually be well-controlled. We report a case of a 63-year-old male who developed a rare complication following a biopsy of an ulcer on the junction between hard and soft palate. Despite an uneventful routine biopsy, the patient presented with an oro-nasal fistula and complaints of nasal discharge. The cause of the fistula was unclear, and the histopathology results excluded malignancy. The possible hypotheses considered for this very rare and unusual complication were infection, vascularity, and underlying systemic co-morbidities. We believe in this case that the cause of wound breakdown was secondary to loss of vascularity of the mucosa from his CPAP device. The patient has since been referred to a tertiary unit for consideration of surgical repair. To the author's knowledge, there are no similar published reports of such complications following routine palatal biopsy.
565 Gorlin Syndrome: A Case of Recurrence of Odontogenic Keratocysts
Authors: Quek J , Al-Gholmy M 
Published: November 2022

Abstract
Gorlin Syndrome (GS) is a rare condition with multisystemic manifestations. Known features include basal cell carcinomas, odontogenic keratocysts (OKCs), and skeletal abnormalities. Multidisciplinary involvement is paramount with surgical intervention as a common treatment modality. Multiple OKCs with recurrence is common in GS. However, limited up-to-date guidelines are available on the appropriate radiographic monitoring of such lesions, in the form of orthopantomogram, in these patients.
This is a case of a 12-year-old girl with GS and multiple episodes of OKCs. She is monitored regularly with the Oral and Maxillofacial team since the age of 3, after her dentist referred her due to her condition and its association with OKCs. A multidisciplinary approach with Dermatology, Pediatrics, Ophthalmology, Ear Nose and Throat, and Orthodontics and Restorative Dentistry within the dental specialty is undertaken to manage her condition.
Yearly clinical reviews of her mouth and radiographs biannually were done, with her first episode of OKCs presenting at 10 years old. Orthopantomogram and magnetic resonance imaging revealed 6 OKCs – 2 in the maxilla, 4 in the mandible. These were surgically enucleated with liquid nitrogen cryotherapy adjunct, alongside extractions of associated deciduous teeth. Eighteen months following this, her OPG showed 2 new OKCs – 1 in the maxilla, 1 in the mandible. These were removed successfully in a similar fashion and active monitoring is ongoing.
This case underscores the importance of regular clinical and radiographic follow-ups due to the frequency of multiple OKCs with recurrence in GS. Long-term multidisciplinary approach in this multisystemic syndrome is also paramount.
868 External Carotid Artery Pseudoaneurysm Following Penetrating Trauma Presenting as an Atypical Parotid Mass
Authors: Cairns M , Fernando S , Balasundaram I 
Published: November 2022

Abstract
Pseudoaneurysm (PSA) of the external carotid artery (ECA) is a rare but potentially lethal clinical entity, with mortality as high as 30%. PSA of the external carotid artery branch vasculature are found consequent to penetrating trauma; infection; vasculitis; iatrogenic injury; radiation therapy and idiopathic causes. Adequate clinical intervention is warranted to prevent rupture and the subsequent neurologic sequelae or death. Management strategies for head and neck PSA have included open vessel ligation, open direct vessel repair, endovascular embolization of the parent vessel or the pseudoaneurysm itself. While surgery was once the standard treatment for PSA, later endovascular approaches have become effective alternatives with minimal morbidity and high success rates.
Here we present a complex case of 37yo man who presented with an atypical parotid mass to the emergency department. History revealed several attendances to the primary care, and the emergency department, due to painful enlargements of the mass. Imaging later identified the mass as a PSA secondary to historical penetrating trauma of the left neck. The clinical presentation and diagnosis of this condition is explored. We discuss the initial unsuccessful endovascular embolization and stenting of the ECA, and the subsequent multi-disciplinary decision for surgical excision months later. This case highlights the importance of obtaining an appropriate history; clinical exam; special investigations to consider the differential diagnoses of parotid mass and specifically the management of PSA in the Head & Neck.
932 The Use of Medical & Dental Clinical Healthcare Apps by Dental Core Trainee Groups in Scotland
Authors: Cairns M 
Published: November 2022

Abstract

Introduction
The development of healthcare applications and their use has increased significantly in clinical practice. A variety of different applications are available covering clinical guidelines, prescribing advice and productivity. These applications may aid clinical decision making and improve patient care

Aim
This survey aimed to determine the use of the medical & dental healthcare applications within the Dental Core Trainee group (DCT) and describe the demographics of the population using them.

Method
An electronic questionnaire was distributed to DCT groups in Scotland between May and July 2018. The questionnaire collected demographic data and type of application used. Trainees also provided comments on their experiences.

Results
49 responses were received with 14 different apps described. SDCEP(89%) and BNF(63%) apps were used most commonly. 22% of respondents describe using apps daily with 73% reporting at least monthly. The average app use was 2 per person. SDCEP(89%) and BNF(63%) apps were most common. DCTs in OMFS (36%) use more apps (4) and do so more frequently. This may reflect the nature of the work undertaken. 66% were using Apple i0S devices. 51 comments were obtained about the perceived advantages and disadvantages of apps. Respondents praised the benefits of app updates, but report concerns about the reliability and quality assurance. The use of mobile phones in clinical settings also generated contrasting responses. App use does not appear age or sex linked.

Conclusion
Applications are used regularly within the DCT group but questions about their quality and appropriateness in the clinical setting remain.
337 Comparison of Outcomes, Signs, and Symptoms of Traumatic Posterior Fossa Epidural Hematoma (PFEDH) Patients Who Managed Surgically Versus Conservatively: A Systematic Review and Meta-Analysis
Authors: Aljabali A , Altal M , Jbarah O 
Published: November 2022

Abstract

Aim
To compare patients with PFEDH who managed surgically versus conservatively in terms of signs and symptoms at admission and outcomes at follow-up.

Method
This systematic review was performed according to PRISMA guidelines on four databases: PubMed, Scopus, EBSCO, and Cochrane central up to December 20th, 2021.

Result
Eighteen observational studies including 713 patients were assessed quantitatively. The proportion of patients achieved a Glasgow Outcome Scale (GOS) score of 5 was higher in the conservative group (Odds Ratio [OR] = 3.588, p &lt; 0.001) and odds of mortality were lower in the same group (OR = 0.210, P = 0.010). Surgical groups were more likely to have vomiting (OR = 3.316, P = 0.049), loss of consciousness (LOC) (OR = 4.584, P = 0.039), and bone fractures (cranial or facial) (OR = 3.223, P = 0.045), but less likely to have headache (OR = 0.342, P =0.032) at the admission time. There was higher proportion of males in the surgical group (proportion in surgical = 71%, p &lt; 0.001 versus proportion in conservative = 54%, p &lt; 0.001).

Conclusion
The initial presentation and overall outcomes of PFEDH patients who managed conservatively usually are better than those who managed surgically. This doesn't indicate that conservative management is used all time, as the treatment option should be in accordance with Brain Trauma Foundation's Guidelines in 2006, that surgical intervention is still the mainstay treatment and conservative management is used upon neurosurgeon's discretion depending on admission neurological status and other many criteria.
637 Choroid Plexus Tumours in the Paediatric Population - a Five Year Review
Authors: O'Kane R 
Published: November 2022

Abstract

Aim
A systematic, qualitative review of the literature available on choroid plexus tumours (CPTs) in the paediatric population, published within the last 5 years.

Method
Medline and Embase databases were used to identify suitable papers, and 70 papers were eligible for inclusion. Inclusion criteria: (1) Paediatric population, (2) Choroid plexus lesions of any grade, (3) Human subjects, (4) Abstract available, (5) Author name available, (6) Abstract in English.

Results
Choroid plexus tumours are rare neuroepithelial tumours. It was found that 74% of CPTs present within the first decade of life. They have a slight male predilection, with a male to female ratio of 1.2:1. The most frequent symptoms found in this study included headache, vomiting, and motor weakness. Both CT and MRI images of CPTs usually demonstrate densely enhancing, multilobulated, intraventricular masses. Choroid plexus tumours can be divided into three histological grades and have been subdivided into 3 methylation groups, which is proposed to be a more accurate classification than histological information alone. The review found that management is one of the most controversial aspects of CPT's. Treatment options include surgical resection, traditional chemotherapy, marrow ablative chemotherapy, and radiotherapy, depending on the case.

Conclusions
Larger cohorts are necessary for prospective, randomised studies are needed to develop a standardised treatment for paediatric patients with CPTs and improve outcomes. As with many low incidence conditions, there appears to be a vicious cycle of low incidences and poor outcomes, which perpetuate limited research into the area alongside a clinical need for better management.
930 Cauda Equina Syndrome Referrals: A Single Centre Experience
Authors: Parwez R , Baig A , Giakoumettis D , Sadek AR 
Published: November 2022

Abstract

Aim
Cauda Equina Syndrome (CES)is a neurosurgical emergency that requires prompt surgical intervention. History and examination performed by referring departments play an imperative role in the triaging of these patients for onward radiological investigation. We aimed to compare radiologically confirmed cauda equina syndrome to the CES referrals to our tertiary unit to elucidate the true regional incidence of CES.

Method
All CES referrals over a 4 year period (2018–2021) made using the electronic patient referral portal, referapatient.orgtm, were collated. The incidence of radiological confirmed CES was identified.

Results
2018: 231 CES referrals of which 26 were radiological CES and accepted (14 female and 12 male).
2019: 151 referrals of which 20 were radiological CES and accepted (14 female and 6 male).
2020: 257 referrals of which 28 were radiological CES accepted (16 female and 12 male).
2021 (first 6 months): 89 referrals of which 16 were radiological CES and accepted (7 female and 9 male).

Conclusions
In 2018–2021 we received 728 CES referrals of which 90 were radiologically CES and required surgical management. There were 51 female and 39 male patients.
211 referrals were from our own Hospital (Hub) while 517 referrals were from 6 other (Spoke) Hospitals. 12.36% had radiological CES.
This represents just over 1 in 10 referrals from secondary care facilities. A greater understanding of the condition via the utilisation of large electronic datasets may facilitate the formulation of novel scoring systems to more accurately appraise cases of putative CES to avoid unnecessary transfers to tertiary centres.