bluuebunny/crossref_metadata_2025_split huggingface dataset:
1040 Metabolite Quantification and Entity and Grade Characterisation of Gliomas via Single-Voxel Spectroscopy for Pre-Operative Radiological Diagnosis
Authors: Crispi V , Sanders K , Kenning L , Spink G 
Published: November 2022

Abstract

Aim
Brain tumours pose a diagnostic challenge, but single-voxel spectroscopy (SVS) provides a non-invasive tool to quantify brain metabolite variations reflective of neoplasia, such as NAA, choline (Cho), creatinine (Cr), lipids (Lip) and lactate (Lac). Inconsistency in spectroscopic research and time-patient pressures emphasises the need for reviewing SVS characterisation of gliomas for peri-operative decision-making.

Method
A single-centre, retrospective, observational study, including 93 SVS meaningfully interpretable examinations between 2012 and 2018 (PRESS, TE=35ms, 144ms). Spectroscopic diagnoses were compared to histopathologic reports for overall, entity and grade accuracy analysis. Metabolite ratios to Cr were recorded or obtained from peak area integrals.

Results
High accuracy of lesions discrimination was observed (83–98%). Significant metabolite variation for Cho/Cr (p=0.021) and Cho/NAA (p=0.013) was observed across grades (WHO Grade I-IV). Spectra of astrocytomas and oligodendrogliomas (grade II) were similarly characterised by high Cho, decreased NAA and Cr, and small-to-moderate Lac-Lip and mIns. In contrast, grade III anaplastic oligodendrogliomas (AO) were distinguished from anaplastic astrocytomas (AA) thanks to smaller Lac-Lip and mIns/Cr. Finally, glioblastoma multiforme (GBM, grade IV) displayed high Cho, decreased Cr, the lowest or virtually absent NAA, and the highest Lac-Lip. High-grade spectroscopy, such as enhanced Lac or Lac-Lip, may be an early indicator of grade transformation prior to reflection in histopathology in tumours, which were follow up prospectively.

Conclusion
This study enhanced spectral characterisation of gliomas and discrimination amongst low- and high-grade gliomas. Whilst these aid pre-operative radiological diagnoses, further research is required to investigate spectroscopy predictive of tumour genetics, now necessary for diagnosis.
38 Laparoscopic Surgery Versus Endoscopy in the Management Common Bile Duct Stones: Systematic Review and Meta-Analysis
Authors: Elhag HE , Eltayab O 
Published: November 2022

Abstract

Introduction
The objective of this study is to assess whether a 1 stage Laparoscopic Common Bile Duct Exploration (LCBDE) followed by Laparoscopic Cholecystectomy (LC) should be the gold standard in managing CBD stones by comparing the clearance rate of common bile duct stones, morbidity, mortality, and the duration of hospital stay with ERCP+LC.

Method
This systematic review with a meta-analysis included RCTs of patients who were treated by the LCBDE/LC versus ERCP+LC. RCTs were collected using PRISMA guidelines by 2 authors Independently from Cochrane central register of controlled trials, Medline and Embase. Review Manager was used for Statistical analysis using the Mantel–Haenszel method. The results were plotted on a Forest Plot diagram and then compared.

Results
849 patients from 7 RCTs were included in the study, 426 patients in the ERCP+LC arm and 423 in the LCBDE/LC arm. According to the Meta-analysis, Laparoscopic Common Bile Duct Exploration with Cholecystectomy was significantly superior to ERCP + LC in terms of successful Clearance of CBD stone, mortality rate and Acute Pancreatitis. but had significantly higher rates in biliary leakages. There were no significant differences in Surgical Site Infections, Haemorrhages, Acute Cholangitis, Perforations, or duration of hospital stay.

Conclusion
LCBDE/LC is superior in successful CBD stone clearance, mortality, and acute pancreatitis. Further RCTs will be needed to assess overall Morbidity, surgical site infections, Haemorrhages, Acute Cholangitis, perforations, or duration of hospital stay. Therefore, LCBDE/LC should be considered as the gold standard in clearing CBD stones.
355 Comparison of Outcomes in Surgical and Endoscopic Transgastric Cystgastrostomy for Severe Acute Pancreatitis
Authors: Mountjoy P , Latif J , Bandlamudi N , Austin A , Bhatti I , Awan A 
Published: November 2022

Abstract

Aim
The heterogeneous nature of severe acute pancreatitis (SAP) renders decisions related to complications challenging. A select group of patients may be suitable for surgical (S-CG), which can be performed open or laparoscopic, or endoscopic (E-CG) transgastric cystgastrostomy (TCG) of symptomatic or infected retrogastric pancreatic collections (walled-off pancreatic necrosis (WOPN) or pseudocyst). There is limited data comparing outcomes between these approaches.

Method
Retrospective analysis of all patients that underwent S-CG or E-CG was performed from a single, high-volume benign pancreatic centre between 2012 – 2021 inclusive. Patient demographics, clinical characteristics, and outcomes of these 3 groups was compared. One-way analysis of variance tests was used to compare categorical data.

Results
47 patients underwent TCG: 20 S-CG (12 open and 8 laparoscopic), and 27 E-CG. There was no statistical difference between S-CG and E-CG for age, body mass index (BMI), aetiology, organ failure and type or position of collection. S-CG patients had less burden of pre-existing co-morbidities (APACHE-II and Charlson-Co-morbidity-Index (CCI)) (p&lt;0.05). S-CG patients had shorter length of stay, emergency readmission and reintervention (p&lt;0.05). Those who underwent E-CG had higher burden of intervention due to persistent/recurrent pancreatic collections, with 33% mortality rate (p &lt;0.05).

Conclusions
S-CG, in a select group of patients, provides a single-staged intervention for drainage of transgastric pancreatic collections, especially when they predominantly contain solid necrosis and patient is suitable for general anaesthetic. Outcomes are favourable for S-CG, but multidisciplinary approach is critical to delineate the most appropriate approach for each individual patient.
442 A Comparison of Short-Term Outcomes in Robotic and Laparoscopic Distal Pancreatectomy
Authors: Ding H , Kwaka M , Gall T , Hand F , Jiao L 
Published: November 2022

Abstract

Aim
Technical limitations of laparoscopic distal pancreatectomy (LDP) may translate to high conversion postoperative complications rates. Robotic distal pancreatectomy (RDP) can potentially allow for better visualisation and greater freedom of movement, improving surgical outcomes. The aim of this retrospective observational study is to compare short term outcomes between RDP and LDP.

Method
We retrospectively analysed all RDP and LDP procedures performed at our centre by a single surgeon between December 2009 and July 2021. We recorded demographic data for 62 consecutive LDP cases and 27 RDP cases and compared the perioperative outcomes, 90-day morbidity and mortality.

Results
Both groups were comparable with respect to baseline characteristics. The conversion to open rate was significantly higher in the laparoscopic group (21.0% vs. 3.7%, p = 0.04). Operative time (176.5 min RDP vs. 156.8 min LDP, p = 0.503) and number of operations with clinically significant estimated blood loss (&gt; 500ml) (1 RDP vs. 3 LDP, p = 0.998) was comparable in both groups. For the benign conditions, the spleen preservation rate showed no significant difference between the two groups (14.8 vs. 11.3%, p = 0.729). In both groups, three patients were readmitted within 90 days. There was no 90-day mortality in either group.

Conclusions
According to our results, RDP was equivalent to LDP in nearly all short-term operative outcomes and safety but significantly reduced the risk of conversion to open resection. However, the evidence is limited, and larger multi-centre randomised trials are needed to investigate the long-term outcomes.
525 A Review of Literature on Anatomical Variation of the Extrahepatic Biliary Tree Using Cadaveric Dissection and Imaging Modalities
Authors: Kettyle G , Abdel Meguid E 
Published: November 2022

Abstract

Aim
The aim of this project was to examine world literature to establish the various types and frequencies of anatomical variants within the extrahepatic biliary tree, thereby contributing to the body of information available to anatomists, surgeons, and radiologists. Knowledge of the notoriously variable anatomy of the extrahepatic biliary tree is of greater importance than ever, given the increased occurrence and complexity of hepatobiliary and laparoscopic surgeries.

Method
A database search of MEDLINE, EMBASE and PubMed was conducted in June 2021 and returned 3440 articles, of which 29 were deemed eligible for inclusion.

Results
A rare malposition, the left-sided gallbladder, was observed in 0.04–0.60% across five studies. A normal cystic artery origin, that is, from the right hepatic artery was observed in 73.3–92% with variations being seen from the left hepatic artery (1–1.9%), gastroduodenal artery (1–7.5%) and the aberrant right hepatic artery (3–12.1%). It was also noted that in 3.6–32% of subjects the course of the cystic artery lay extraneous to Calot's triangle. Michels’ and Hiatt's classification systems were used to define the anatomical variations of the hepatic arteries: studies using Michels’ Type III reported a prevalence from 6.4–15%, Michels’ Type VI from 0.6–7% and Hiatt's Type III recorded an incidence ranging from 9.7–14.8%.

Conclusion
The most obvious finding to emerge from this project was the widely variable anatomy of the extrahepatic biliary tract and the contrasting reported data. Surgeons should therefore anticipate such complexities and adapt techniques to avoid biliary and arterial injuries and associated intra- and postoperative complications.
729 Endoluminal Vacuum Therapy in the Management of Boerhaave Syndrome: A Case Series
Authors: Soussi D , Helmi Ahmad Alharahsheh B , Stevens S , Boshier P , Karim S , Hoare J , Direkze N , Ekpe J , Peters C 
Published: November 2022

Abstract

Background
Boerhaave syndrome is a rare condition associated with poor prognosis: high morbidity and mortality. Prompt intervention greatly improves outcomes, with surgery being the mainstay of management. Recent advances in therapeutic endoscopy have led to increasing interest in endoluminal vacuum therapy (EVT). EVT is a minimally invasive technique, allowing wound debridement and drainage, and granulation tissue formation. EVT has been associated with excellent clinical outcomes, including lower mortality rates when compared to surgery and stenting. EVT has been adopted into practice across Europe, however, only two cases have been reported in the UK. We report three cases of Boerhaave syndrome, successfully managed with EVT, using the EsoSPONGE ® (B.Braun, Medical Ltd, Sheffield, UK).

Method
EVT involves the placement of a polyurethane sponge into the wound cavity. The cavity is initially assessed endoscopically before an overtube is introduced. The sponge is pushed into the cavity through the overtube, and the overtube is removed. Sponge position is confirmed and adjusted if necessary. The sponge is connected via a trans-nasal drain to continuous negative pressure suction and is changed every 3–5 days.

Results
Having been deemed surgically unfit, all three patients were referred for EVT, using the EsoSPONGE. All patients made excellent recovery and were discharged home.

Conclusions
EVT is an effective management strategy for surgically unfit Boerhaave syndrome patients. EsoSPONGE use aided drainage of the septic focus and closure of the defect, leading to complete recovery. Our findings support the existing evidence that EVT is a promising solution for Boerhaave syndrome.
398 Acute Paediatric Appendicitis (AA)- Decreasing the Negative Rate of Appendicectomy in a District General Hospital
Authors: Karagiannidis G , Youssef F 
Published: November 2022

Abstract

Aim
Globally Acute appendicitis (AA) is the most common general surgical emergency. A recent consensus study has proposed a negative appendicectomy rate of 10%. Our aim is to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow.

Method
Retrospective patient data collection via electronic sources (Evolve discharge summary, Operation notes) for all paediatric patients (0–16 years old) admitted with AA between March 23rd and October 31st, 2020.

Results
We separated our audit in three different periods of time. In the first period, 5 out 20 (25%) who underwent an appendicectomy had a normal appendix on histological analysis. In the second period (from June to August) we introduced a paediatric assessment workflow and managed to decrease the negative rate of appendicectomy from 25% to 19%. During the third period (from September to October 2020) the negative rate of appendicectomy decreased to 11%, 14% less than our initial result. More patients underwent an US prior CT as part of routine screening in order to avoid a negative appendicectomy. The initial percentage of US scanning was 72% and was increased to 90% after the end of the third period. Additionally, conservative management was 20% and was increased to 24% after the end of the third period.

Conclusions
Due to the results of this study, the paediatric appendicitis workflow in daily practice has resulted in more patients being treated conservatively.
628 A Rare Case of Bilateral Abdominoscrotal Hydrocoele in a 10-Month-Old Infant
Authors: Shkoukani ZW , Al-Taher RN , Naser S 
Published: November 2022

Abstract
Abdominoscrotal hydrocoeles (ASH) are an increasingly rare form of hydrocoeles. Reported incidence rates are currently estimated between 0.18–3% of all hydrocoele cases. They can present in any age group, however they are more commonly reported amongst the paediatric population. Although not yet confirmed, the aetiology of ASH has been under scrutiny for the past two centuries, and scarcity of reported cases hinders this process. Clinical examination is oftentimes sufficient to make the diagnosis, however confirmatory ultrasonography is recommended. Although old reports favoured a more conservative approach with watchful waiting, the risk of serious secondary complications is high, and surgical intervention is hence considered standard of care. Different approaches have been described, each with their own benefits, with minimally invasive surgery becoming more prevalent as of late. In this case report a 10-month-old boy with bilateral abdominoscrotal hydrocoeles is presented. Overall, the surgical procedure is considered to be a difficult one, due to the fact that in many cases the hydrocoele attaches itself to the cord structures along with a thickened tunica vaginalis which can be difficult to access regardless of technique. Aspiration of the fluid prior to dissection of the membrane can thus help facilitate easier access. The use of laparoscopy in the treatment of ASH is becoming commonplace, with the added benefit of a confirmatory as well as a therapeutic role. Laparoscopic approach was employed in our case and had satisfactory results with no signs of recurrence on follow-up.
764 Paediatric Emergency Appendicectomy in a District General Hospital: A Review of Current Practice
Authors: Armstrong L , Ali T 
Published: November 2022

Abstract

Aim
Appendicitis is one of the most common surgical pathologies amongst children, with approximately 80% in the UK admitted and managed in district general hospitals. The Royal college of Surgeons paediatric emergency appendicectomy commissioning guidelines state a negative appendicectomy rate should be &lt;15% and &lt;1% should be admitted following a prior discharge with no intervention. We aimed to review current practice and adherence to guidelines.

Method
A retrospective review was carried out of all paediatric patients admitted with suspected appendicitis, in a single centre over a 1-year period. Demographics, pre-operative investigations, technique, histology, length of stay, readmissions, complications, and transfers to tertiary centres were recorded.

Results
Total of 101 patients admitted within audit window with a median age of 9.5 years, 50.5% male. Average length of stay was 2 days. Total of 30 appendicectomies performed (63.3% laparoscopic). Negative appendicectomy rate 23.3% (n=7). Seventeen underwent a pre-operative ultrasound, 2 of which confirmed appendicitis and proceeded to an appendicectomy. The remaining 15 were successfully discharged. 28-day readmission rate returned at 5.94%. 1 (0.99%) patient was readmitted following a prior discharge with no intervention and subsequently underwent an appendicectomy, revealing acute appendicitis. No patients were transferred to a tertiary centre.

Conclusions
Overall, favourable comparison to published guidelines, however higher than optimal negative appendicectomy rate. Utilisation of preoperative ultrasound may aid towards the reduction of this figure. Guideline also states patients should be taken to theatre within 12 hours of decision to operate. Further review of patient's notes should be performed to determine this.
788 Caecal Duplication Cyst: An Unexpected Cause of Bowel Obstruction in a 12-Year-Old
Authors: Dale J , Mclean E , Gupta T , Healy C 
Published: November 2022

Abstract
We report the case of a rare cause of bowel obstruction in a 12-year-old girl who presented with a short history of abdominal distension and vomiting after a month of unexplained urinary frequency and weight loss. Abdominal radiographs demonstrated small bowel obstruction with an unknown pelvic mass. A raised CA125 suggested a possible ovarian lesion and a magnetic resonance scan was interpreted as supportive of this pathology. Intra-operatively a 120x90x70mm cystic mass was found attached to the caecal serosa, immediately adjacent to the ileocaecal valve. There was an associated 180-degree twist of the terminal ileum and ascending colon. A limited right hemicolectomy was performed, and histopathology confirmed the diagnosis of a caecal intestinal duplication cyst. Post-operatively she has recovered well, with resolution of her obstructive and urinary symptoms. Given the unusual age of presentation, uncommon location of the cyst and the diagnostic challenges incurred, the authors wish to share their experience of managing an atypical duplication cyst.
240 Flexor Digitorum Profundus Tendon Segment Length Estimation via Measurement of Adjacent Landmarks in the Secondary Repair of Jersey Finger
Authors: Sehmbi A , Syed M , Shah S , Parry D 
Published: November 2022

Abstract

Aim
Jersey finger describes injury involving the rupture of a Flexor Digitorum Profundus (FDP) tendon. The rupture occurs at its point of insertion, at the base of the distal phalanx. Cause of injury is forced hyperextension of FDP. Correct tendon tensioning correlates with tendon length during repair and is vital to optimise restoration of function. No evidence-based approach to tendon tensioning exists hitherto. We used cadaveric dissection to measure anatomical landmarks associated with the FDP tendon and assess whether these can be used to estimate the length of the adjacent tendon segments.

Method
Eight cadaveric hands were dissected (four fresh-frozen and four formalin-fixed). Lumbrical muscles, A1 pulley and distal FDP insertion for digits II-IV were identified. Lengths between the most distal point of the lumbrical origin; proximal and distal ends of the A1 pulley and FDP insertion were recorded.

Results
Measurements involving the A1 pulley showed a great degree of variation and no clear trend across the digits studied. Conversely, lumbrical origin to FDP insertion lengths were consistent relative to the adjacent digit measurements across all cadavers for digits II, II and IV. This was confirmed by a linear regression analysis (R2 &gt;0.97).

Conclusions
This study demonstrates how distal lumbrical origin to FDP tendon insertion measurements in digit III can be used to estimate the length of the tendon graft required in digit II or IV, during repair. This injury manifests most commonly in digit IV. Therefore, our finding furthers surgical knowledge and is likely to improve patient outcomes.
294 Stem Cell Enriched Fat Grafts Versus Autologous Fat Grafts for Facial Reconstruction: A Systematic Review and Meta-Analysis
Authors: Karam M , Abul A , Kahlar N , Naik A , Tay J , Rahman S , Matteucci P 
Published: November 2022

Abstract

Aim
To compare the results of stem cell-enhanced fat grafting to autologous fat grafting for face reconstruction.

Method
A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was carried out to identify all Randomised Controlled Trials (RCTs), case control studies, and cohort studies comparing the outcomes of stem cell-enrichment fat grafting versus routine fat grafting for facial reconstruction. The primary outcome measures were volume retention and infection rate. Secondary outcome measures included post-surgery patient satisfaction, redness and swelling, fat necrosis, cysts, and operation time. For the analysis, fixed and random effects modelling were utilised.

Results
Eight studies with a total of 275 participants were assessed. In terms of mean volume retention, there was a significant difference between the stem cell-enrichment fat grafting and routine grafting groups (standardised Mean Difference [MD] = 2.49, P 0.00001). However, there was no significant difference in infection rates between the two groups (OR = 0.36, P = 0.30). Except for the operation duration, which was shorter in the latter, the intervention group had similar results to the control group for all secondary outcomes.

Conclusions
When compared to conventional fat grafting, stem cell-enriched fat grafting is a better alternative for facial reconstruction surgery since it enhances mean volume retention and does not worsen patient satisfaction or surgical complications.
305 Improving Clinic DNA Rates with a Patient Initiated Follow Up Pathway: A Cohort Study
Authors: Katsura C , Tomouk T , Gathura E , Miranda BH , Zweifel CJ 
Published: November 2022

Abstract

Introduction
A Patient Initiated Follow-Up (PIFU) pathway was implemented in 2019; this enabled patients with specific plastic surgery trauma diagnoses to request a consultant clinic review within 3 months, without a routine follow-up appointment being made. PIFU aims to reduce ‘did not attend' (DNA) rates in line with the Royal College of Surgeons of England Outpatient Clinics Guide.

Aim
To assess the impact of PIFU on DNA rates of plastic surgery trauma clinics.

Method
A prospective cohort study of plastic surgery PIFU outpatient clinic DNA rates was undertaken (1st January–31st October 2021) and compared to data held for pre-PIFU pathway DNA rates (1st January–30th June 2018); inclusion dates for 2021 were extended to achieve comparable sample sizes for patient numbers routinely booked into clinics. DNA rates were collected from the hospital clinic database. Data were analysed using IBM®SPSS®. The Kolmogorov-Smirnov test was performed to assess sample population distribution, and the Chi2 test was used to compare categorical data.

Results
A total of 1702 patients were included in the study. Pre-PIFU, there was an 18% (149/823) DNA rate for patients (31.4 years ± 18.45 years) (mean age ± SD) booked into routine Consultant clinic follow-up. Post-PIFU, there was a 9% (77/879) DNA rate for patients (31.1 years ± 20.77 years) booked into routine Consultant clinic follow-up. This represents a significant reduction in DNA rates by 9% (Chi2=7.49, p&lt;0.01); non-operatively managed hand fracture patients were the most frequent non-attenders.

Conclusions
The PIFU pathway has significantly reduced trauma clinic DNA rates.