bluuebunny/crossref_metadata_2025_split huggingface dataset:
464 Local Extension of a Solitary Extra Medullary Nasal Plasmacytoma into the Orbit
Authors: Sandhar P , Gill C , Khanna A 
Published: November 2022

Abstract

Aim
Extramedullary plasmacytoma are rare neoplasms, which mainly occur in the head and neck, the most common site being the nasal cavity or septum. Patients may present with epistaxis, nasal obstruction, or rhinorrhoea. Extension into the orbit is rare but can lead to visual disturbances.

Method
This case report pertains to a 69-year-old female patient who initially presented with a 6-week history of recurrent sinusitis, with left sided cheek pain and diplopia.

Results
A CT and MRI scan was performed, which showed opacification of the left maxillary, ethmoid and sphenoid sinuses with bony destruction of the medial and anterior maxillary walls and into the anterior soft tissues. The mass was completely obstructing the left nasal cavity extending into the inferomedial orbit. Staging CT scans also showed nodal disease in the neck.
Biopsy with histology was positive for CD138, with diffuse proliferation of plasma cells of varying maturity and atypia. Additionally, mono IgG kappa was also positive as was CD45 suggestive of a lymphoid neoplasm. Bone marrow biopsy and PET scan confirmed there was no systemic involvement.
Radiotherapy was initiated after the patient recovered from COVID -19. A repeat MRI scan 6 weeks post radiotherapy showed a partial response with reduction in the size of the tumour, resolution of the intra-orbital extension and disappearance of paraprotein.

Conclusions
This case report illustrates need for earlier consideration of EMP diagnostically to reduce the risk of conversion of the plasmacytoma to multiple myeloma, which is a known possibility and to ensure minimal delay in the commencement of treatment.
492 Calcific Tendonitis of the Longus Colli: A Rare Cause of Neck Pain
Authors: Bryce A , Douglas C , Williamson A 
Published: November 2022

Abstract
Cervical tendonitis of the Longus Colli muscle (CTLC) is a rare but clinically significant cause of neck pain. It can mimic other more serious pathologies in the retro-pharygneal area and requires sufficient investigation for diagnosis.
This case presented with a fit and well 54-year-old gentleman suffering from progressive left sided neck pain, stiffness, and odynophagia. His imaging demonstrated a prevertebral fluid collection of unclear aetiology and an area of calcification just below the anterior arch of C1. Along with the differential diagnosis of calcific tendonitis of longus colli, the fluid collecting inferior to C1 could have represented a retropharyngeal abscess - a potentially life-threatening infection. This patient required input from multiple specialities to safely reach diagnosis and exclude more significant pathology.
Although CTLC represents a benign and perhaps under-recognised condition, this case highlights the importance of considering other differential diagnoses and multidisciplinary management in a patient presenting with limited neck movements.
573 The Changing Microbiology of Paediatric Neck Abscesses: Implications for Antibiotic Therapy
Authors: Kawar L , Deshpande A , Kubba H 
Published: November 2022

Abstract

Aim
To provide an update on the microbiology, sensitivity rates and antibiotic prescribing patterns of drained superficial neck lymph node abscesses at Scotland's largest paediatric tertiary centre. Findings were compared to historical data from our institution. Analysis of the microbiology and epidemiological trends of paediatric neck abscesses is helpful for both antimicrobial stewardship purposes as well as to enhance the literature, given that paediatric-related conditions tend to be less well characterised when compared with adults.

Method
A retrospective case series of paediatric patients undergoing incision and drainage of a superficial neck lymph node abscess at the Royal Hospital for Children in Glasgow, 2018–2021. Patients were only included if they had culture and sensitivity testing performed on a sample obtained intra-operatively, were prescribed antibiotics, and were aged 16 years or younger.

Results
Thirty-nine abscesses were identified. Methicillin-susceptible Staphylococcus aureus remains the commonest organism (28%), followed by Streptococcus pyogenes (13%). Their prevalence is significantly lower in comparison to historical data. This was met by a shift towards a variety of rarer micro-organisms. 82% of patients were administered a drug regimen containing co-amoxiclav. Only 3 children required a change in their antibiotics.

Conclusion
Our case series highlights a fall in the yearly rate of drained neck abscesses. There was a significant change in causative micro-organisms, including a decrease in Staphylococcus aureus and an increase in the Streptococcus anginosus group. We recommend the use of co-amoxiclav empirically. In abscesses showing no clinical improvement, second-line options such as clindamycin, cefotaxime and vancomycin should be considered.
715 Implementation of Enhanced Recovery After Surgery (ERAS) in Total Laryngectomies
Authors: Lim KH , Dorris C , Thomson A , Ardis M , Devlin B , Gray G 
Published: November 2022

Abstract

Aim
The Enhanced Recovery After Surgery (ERAS) protocol for total laryngectomies was first implemented in our tertiary head and neck centre from November 2019. It includes pre-operative carbohydrate loading and an early swallow test which facilitates recommencement of oral intake to improve outcomes. Protocol adherence rate and patient outcomes were measured to determine the effectiveness and benefits of ERAS in laryngectomy patients.

Method
22 total laryngectomy patients from November 2019 to September 2021 were enrolled onto the ERAS protocol, 18 primary and 3 salvage cases. An analysis of the respective patient cohorts was performed to determine adherence to the ERAS protocol and outcomes such as complications and length of inpatient stay were measured.

Results
19 patients (86%) received pre-operative carbohydrate loading successfully, while 3 patients were contraindicated due to background of diabetes. Early swallow test was performed in 59% of patients. Potential reasons for delay were stoma dehiscence or clinical suspicion of neo-pharyngeal leak. 59% of primary cases were deemed medically fit for discharge within the target timeframe of 12–14 days whereas no target was set for salvage cases due to expected poor healing. Main complication in primary cases was neo-pharyngeal leak followed by stoma dehiscence with 28% and 11% respectively.

Conclusion
Limitations of our study include small sample size due to the COVID-19 pandemic. Despite its infancy, the ERAS protocol has achieved good outcomes in early recommencement of oral intake post-laryngectomy and encouraging early safe discharge from hospital. Future plans include establishment of Prehab Clinic and application of ERAS to neck dissection patients.
935 Case of Bad Breath in a Child
Authors: Bhatti D , Khan A 
Published: November 2022

Abstract
4-year-old girl with a two-year history of speech and language delay was referred to the Speech and Language Therapy Service by her health visitor. Additionally, she had a history of asthma, recurrent glue ears, head lice, poor dentition, a persistent malodorous nasal discharge, and halitosis. Her hyper-nasal speech sounds indicated soft palate dysfunction. Subsequent assessment in the cleft clinic resulted in a diagnosis of non-cleft velopharyngeal insufficiency. At the time of her elective pharyngoplasty, the anaesthetist and surgeon were overwhelmed by the foul smell emanating from her nose and mouth. As such, an intraoperative nasal endoscopy was undertaken to examine her vestibules. A calcified cigarette filter (Figure 1) was found impacted deep within the patient's right nostril and was removed prior to the pharyngoplasty. It was later discovered that the malodorous nasal discharge and halitosis had plagued the child since the age of 18 months. Moreover, she had undergone a number of clinical assessments within the primary care setting. However, the combination of head lice, foul smell, and her uncooperative demeanour made examination difficult, and her symptoms were inappropriately attributed to tooth decay and periodontal disease.
1010 Audit of Acute Management of Sudden Onset Sensorineural Hearing Loss and Streamlining of Local Management Pathway
Authors: Kruczynska A , Cordiner P , Maini S 
Published: November 2022

Abstract

Aim
Sudden onset sensorineural hearing loss (SSNHL) presents infrequently to ENT services in Aberdeen Royal Infirmary. Although ENT UK guidelines are in place for the management of SSNHL, the practicalities of organising these cases within our department can be challenging to junior staff leading to variation in time to review and timings of intervention. We Aimed to assessed current local practice in comparison compare it to national ENT UK guidelines

Method
Retrospective audit of 6 months data set recording management pathway of patients presenting with SSNHL to Rapid Access Clinic of Royal Aberdeen Infirmary Hospital. Electronic patient records were searched for: time of referral, duration of symptoms, times to first ENT review, intervention and audiogram, and timings and management during subsequent reviews.

Results
Seven patients meeting the inclusion criteria were identified and included in the audit. Average times from referral were calculated including time from referral to intervention (1.47 days), from referral to first ENT review (3.82 days), from referral to first audiogram (4.43 says). Average time from presentation to starting oral steroids was very efficient of just 0.33 days and average time from symptom onset to oral steroids initiation was 7.5 days suggesting late patient presentation.

Conclusions
The data gather helped our department to reinforce management pathway of SSNHL as per ENT UK guidelines and improved the way urgent audiograms are organised in the hospital. It also emphasised the importance of performing tuning fork test to determine the nature of hearing loss when audiogram is not immediately available.
1031 Survival Outcomes for Larynx-Preserving Therapy Compared to Total Laryngectomy in Advanced Laryngeal Tumour: A North-East of Scotland Cohort
Authors: Ahmeidat A , Shakeel M 
Published: November 2022

Abstract

Aim
Advanced laryngeal tumours (stage III and IV) management remains uncertain. This study aims to investigate whether choice of organ-preservation treatment (radiotherapy or radiochemotherapy) or surgical intervention (total laryngectomy with/without adjuvant therapy) affects survival in the North-east of Scotland cohort.

Method
Laryngeal cancer data was prospectively collected and maintained at a tertiary care centre at NHS Grampian Scotland. This data was retrospectively analysed for overall and disease specific survival. Death from laryngeal cancer was recorded from death certificates. Statistical analysis with Cox regression was used to estimate hazard ratios for sex, smoking status, age, staging, tumour site, and treatment choice in the advanced laryngeal cancer cohort.

Results
A total of 311 laryngeal cancer patients were identified. 49 patients were stage III and of which 35 (71%) received organ-preserving treatment and 14(29%) underwent total laryngectomy. The corresponding numbers for 65 stage IV patients were 13 (20%) and 52 (80%) respectively. On cox regression for overall survival, reduced survival was associated (p&lt;0.05) with choice of organ preservation and stage IV disease, fully adjusted HRs (95%CI) were 2.57 (1.42–4.66) and 3.00(1.08–8.34) respectively. For disease specific survival, no variables were found to be significant. Median follow up time from date of diagnosis to death was 1.56 years.

Conclusions
Organ preserving intervention was associated with a worsened overall survival in the advanced laryngeal cancer cohort. This study suggests that primary surgical intervention remains a key element in the treatment of advanced laryngeal cancer and future bigger cohort studies may be needed to evaluate this relationship.
347 Management of Acute Sigmoid Volvulus in NHS Grampian
Authors: May V , Drever K , Ramsay G 
Published: November 2022

Abstract

Aim
The Emergency General Surgery guidelines from the ACPGBI were recently published and recommend that definitive management should be planned on index admission with sigmoid volvulus. However, the evidence base for these recommendations was low. We aim assess the current practice of Sigmoid Volvulus (SV) in a Single Scottish Health board.

Method
A retrospective review of patients with acute SV managed at two hospitals between 2011 and 2021 was conducted. Individuals were identified through inpatient coding and case notes reviewed electronically. Operative intervention, colonoscopic decompression and short- and long-term outcomes were noted.

Results
Of 105 patients treated, 41 were female. The mean age at presentation was 73.2 (range: 38–94 years). In total, 70 patients (66.7%) underwent decompression alone and 35 (33.3%) were treated with surgical intervention. There was no difference in mean age, number of co-morbidities and number of previous operations between the two groups. Of the decompression group, 35 (50%) presented on a single occasion. However, the mean number of re-presentations was 3.3 (range 2–29) and the mean time to re-presentation was 136.5 days (range 5–1224 days). There were no recorded inpatient deaths following surgical intervention.

Conclusion
The most common method of acute SV management has been decompression on its own. There were no differences observed in patient demographics between the intervention groups, suggesting that there are no set criteria to determine method of intervention. However, representation remains commonplace and operative intervention had few complications indicating a likely required increase in definitive surgical approaches.
367 Can We Justify Routine Group & Screen Testing Prior to Appendicectomies? - A Single Centre Analysis
Authors: Deb R , Deb G , Pore N , Sheth H , Raje D 
Published: November 2022

Abstract

Aim
Numerous sources have suggested that routine preoperative Group & Screen (G&S) testing prior to cholecystectomies1–4, breast surgery5 and gynaecological procedures including Caesarean sections6 may be unnecessary because perioperative blood transfusion incidence remains low.
This project aimed to understand whether routine pre-appendicectomy G&S testing can be justified by analysing blood transfusion incidence for appendicectomies completed at our hospital. To further comment on their relevance to clinical practice, we also aimed to investigate any potential delay to surgery that G&S tests may pose, and their cost implications.

Method
For all appendicectomies undertaken at our hospital from 2018 to 2021 (n = 257), we noted if the patient received a blood transfusion anytime during their admission. The date and time of G&S sample collection and of the surgery were recorded, including any documentation of delays to surgery.

Results
0% of appendicectomies between 2018 – 2021 required a blood transfusion during the admission. On average, 3.9% of appendicectomies per year were delayed due to preoperative G&S testing with an average delay to surgery of 78.71 minutes.
The total cost of G&S tests undertaken for appendicectomy patients between 2018 – 2021 was £5768.03.

Conclusions
It is difficult to justify routine pre-appendicectomy G&S testing when our data suggests such a low risk of blood loss necessitating transfusion, and that these tests delay treatment. This may warrant pre-appendicectomy risk stratification to streamline G&S testing. Additionally, should an emergency occur, uncrossmatched blood is readily accessible and poses minimal risk to patients7.
474 Should We Be Concerned of Oesophageal Injury in Traumatic Pneumomediastinum? – A Review of the Past 11 Years in an UGI Specialist Centre
Authors: Shehata Z , Shetty V 
Published: November 2022

Abstract

Aim
Pneumomediastinum is a known radiological finding after major trauma, however its significance and required investigative workup is not standardized. Furthermore, there is little evidence to suggest that traumatic pneumomediastinum is indicative of oesophageal injury. Our study set out to investigate the rate of oesophageal injury for these patients at our centre, and the relevant investigative work up that is required.

Method
Medical records were retrieved our trust (Major Trauma Centre 2012 – present, UGI Centre 2009 - present) to include trauma patients with radiological pneumomediastinum admitted between 2010–2021. Demographics, mechanism of injury, length of stay, and other significant findings were collected retrospectively using the electronic patient record.

Results
The data search retrieved 38 patients with traumatic pneumomediastinum. 1 patient was excluded due to incomplete records. Road traffic collisions were the most common presentation (18 patients), followed by falls (13 patients), penetrating trauma (3 patients), assault (2 patients), and workplace injury (1 patient). The median length of stay was 6 days, with 2 inpatient deaths. 1 patient had a confirmed tracheobronchial injury on initial imaging which was managed conservatively in a cardiothoracic centre, while 6 other patients underwent further oral contrast CT for suspected oesophageal injury. No patients in our dataset had a confirmed oesophageal injury.

Conclusions
Oesophageal injury is rarely seen in traumatic pneumomediastinum and is usually secondary to other chest injuries causing air leak into the mediastinum. Oral contrast CT is the recommended investigation to exclude oesophageal injury.
482 Spontaneous Pneumomediastinum Case Series: Lessons Learnt in Assessment and Management
Authors: Manku B , Krishnamoorthy A , Thomson L , McLaughlin E 
Published: November 2022

Abstract

Aim
Spontaneous pneumomediastinum (SPM) is usually a self-limiting condition in clinically stable patients with no obvious causative factor. SPM can be difficult to distinguish from important secondary causes such as tracheobronchial injury or oesophageal perforation. Therefore, thorough clinical history and examination is of paramount importance. We aim to highlight lessons learnt from our experience to improve rapid diagnosis and clinical management of these patients.

Method
Patients were identified through hospital records between October 2019 – December 2021. Data was collected on clinical presentation, precipitating events, radiological confirmation of SPM and compared with current reported literature.

Results
11 patients were identified, 8 males (72.7%), 3 females (27.3%) with a mean age of 29 + 17 years. The most frequent symptom was retrosternal chest pain 27.3%; and vomiting the most common precipitating event (54.5%). Mean white cell count was 14×109/l on admission. All patients underwent plain film chest radiography, and subsequent computerised tomography of thorax, abdomen and pelvis. Patients underwent gastroscopy selectively, showing no acute pathology. Mean length of stay was 4.6 days. No patients required operative intervention or any other intervention beyond antibiotics. No complications or recurrence were found in patients at follow up.

Conclusion
SPM is a self-limiting condition with low morbidity and mortality. If life-threatening causes have been excluded, SPM can safely be managed expectantly at a local level, without the need of transfer to tertiary centres and prolonged hospital admission. We propose a structured approach to aid in the management of SPM and help address these challenges.
651 Timeliness of Ultrasound Investigation in Patients Presenting with Acute Abdominal Pain – Single-Centre Audit
Authors: Hakeem A , Mateescu D , Chedid Y , Chattopadhyay D 
Published: November 2022

Abstract

Aim
To identify patients delays in ultrasound investigation in patients who present with acute abdominal pain; patients who require ultrasound investigation to decide if they require admission or can be safely discharged home.

Method
Patients who presented to Bedford Hospital Accident and Emergency department with acute abdominal pain and an ultrasound was requested were included in the analysis. The indication was divided into 3 main categories (Upper abdominal pain, post-cholecystectomy, and other pathology). Data were analysed in relation to admission and discharge. Patients who had outpatient ultrasounds were excluded from the study. Mean and standard deviations were used for the delays.

Results
A total of 322 patients were included in the study, 160 (49.7%) patients were due to cholelithiasis or upper abdominal pain, 158 (49.1%) were due to other pathologies, 4 (1%) were post-cholecystectomy ultrasounds. The mean admission to ultrasound request was 1.77 (±5.48) with 290 (90.1%) being requested within 2 days of admission. Mean days from request to ultrasound being performed was 1.37 (±4.04) with 299 (93.1%) performed within 2 days.

Conclusions
The study concluded that the average time from ultrasound being requested to being performed in patients with acute abdominal pain was 0–2 days, this shows that the ultrasound is performed appropriately and there are minimal delays.
687 How Effective Is the ‘HOT Laparoscopic Cholecystectomy Pathway’ in Reducing Time to Surgery?
Authors: Sutharsan G , Chandra S , Said A , Dighe S 
Published: November 2022

Abstract

Aim
To evaluate whether the introduced ‘HOT laparoscopic cholecystectomy (LC) pathway’ has been effective in reducing outpatient (OP) time to surgery.

Method
All patients (March-October 2021) who had a LC at either Darent Valley Hospital or Queen Mary's Sidcup were identified via an extensive database search. Patient demographics, clinical diagnosis, number of presentations, in-patient (IP) vs OP LC and days to surgery were recorded. The results were descriptively analysed and compared to findings of the audit in 2020.

Results
During the study, 216 LCs were recorded, of which 31% took place as an IP and 69% occurred as an OP. Amongst the CEPOD list, 80% had a LC within 8 days of admission, in accordance with NICE guidance. 139 OP LC requests were noted, 75% included “HOT LC” in the ‘to come in” (TCI) request, with an average time to OP LC of 35 days, compared to 54 days for requests which did not include “HOT LC” in the request. This was significantly quicker than the wait time of 84 days in 2019, prior to the implementation of the pathway.

Conclusions
Introduction of the ‘HOT LC pathway’ in conjunction with greater operative capacity across 2 hospitals has resulted in earlier management of gallbladder disease and subsequently reduced length of hospital admission. Furthermore, inclusion of “HOT LC” in the TCI request significantly reduces delay in OP LC. In light of these findings, the use of the pathway should be encouraged with emphasis on the inclusion of “HOT LC” in the TCI request.