bluuebunny/crossref_metadata_2025_split huggingface dataset:
262 Abdominal Hernia Mesh Repair in Patients with Inflammatory Bowel Disease: A Systematic Review
Authors: El Boghdady M , Ewalds-Kvist B , Laliotis A 
Published: November 2022

Abstract

Aim
Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons’ decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications.

Method
A systematic review was done in compliance with the PRISMA guidelines. A search was carried out on PubMed and ScienceDirect databases. English language articles published from inception to October 2021 were included in this study. MERSQI scores were applied along with evidence grades in agreement with GRADE's recommendations. The research protocol was registered with PROSPERO (CRD42021247185).

Results
The present systematic search resulted in 11243 citations with a final inclusion of 10 citations. One paper reached high and 4 moderate qualities. Patients with IBD exhibit about 27% recurrence after hernia repair. Risk factors for overall abdominal septic morbidity in Crohn's disease comprised enteroprosthetic fistula, mesh withdrawals, surgery duration, malnutrition, midline incision site of hernia, biological mesh, and digestive concomitant procedure.

Conclusions
Patients with IBD were subject, more so than controls, to postoperative complications and hernia recurrence. The use of a diversity of mesh types, a variety of position techniques and several surgical choices in the citations left room for less explicit and more implicit inferences as regards best surgical option for hernia repair in patients with IBD.
953 Amyand's Hernia: The Fortuitous Intraoperative Diagnosis – a Case Report
Authors: Adepoju O , Rahman A , Aladesawe O , Elemile P , Adepoju J 
Published: November 2022

Abstract

Introduction
Amyand's hernia is a very rare form of inguinal hernia, in which the vermiform appendix is in the inguinal canal/hernia sac. Its incidence is less than 1% of groin hernias and is complicated by appendicitis in about 0.1% of cases. It is commoner in males, on the right side and has a bimodal age distribution – neonates and the elderly.
We present the case of an elderly gentleman with amyand's hernia diagnosed intraoperatively.

Case Presentation
A 78-year-old male with a background of systemic hypertension presented to the clinic with an 18-month history of painless right groin swelling. Physical examination revealed a full, non-tender abdomen. He had a 4cm soft, reducible right groin swelling, with visible and palpable cough impulse. A diagnosis of right inguinal hernia was made. Baseline blood workup and ECG were unremarkable. He was listed for a day case open hernia repair.
Intra-operatively, the right indirect hernia sac contained a grossly uninflamed appendix lying freely within it. Figure 1.
Appendicectomy was performed and a tension-free repair was done.
The post-operative period was uneventful. Histology of the excised appendix revealed reactive lymphoid hyperplasia and submucosal fibrosis.

Conclusion
As only about 1 in 60 cases of Amyand's hernia are diagnosed pre-operatively, usually as an incidental finding on imaging; the overwhelming majority are intra-operative findings.
Although rare, the vermiform appendix remains a possible content of the inguinal hernia sac, and it is important to be aware of likely complications and options of repair.
207 Accuracy of Reviewing NELA Operation Data Entry in Emergency Laparotomy
Authors: Cirocchi N , Lee KM , Ahmed S , Brown K 
Published: November 2022

Abstract

Aim
The National Emergency Laparotomy Audit (NELA) is part of the National Clinical Audit and data can often be submitted by a non-surgical clinician who do not perform the procedure, whereas operating notes are written mostly by the primary surgeon. A concern for possible discrepancies prompted a comparison between the operation notes and the NELA audit data, to assess for accuracy and understanding of the NELA inclusion/exclusion criteria.

Method
Operation data was collected retrospectively from the NELA database from January to December 2020. The surgeon's operation notes were reviewed and compared. Main parameters compared included ‘indication of surgery’, ‘main operation procedure’, ‘operative findings', ‘peritoneal contamination’ and ‘level of contamination’. The inclusion and exclusion criteria for NELA audit was also assessed and compared. A further questionnaire survey was performed to review the understanding of the procedure

Results
Total of 171 data was retrieved from the NELA database from the selected time-period.
Out of these, 4.6% fulfilled the exclusion criteria. ‘Indication of operation’ were not consistent in 14 entries while in Operation procedure 4.9%. ‘Main operative findings’ were inconsistent in 11% cases. The Survey showed surgical difference in reviewing the operation notes.

Conclusions
There were significant portion of discrepancies between the surgical operating notes and NELA data entry when compared, due to retrospective entry and two different clinicians. There is a lack of clear understanding for the inclusion/exclusion criteria. We would like to recommend that the primary surgeon who performs the procedure records both the operating notes and the NELA data entry.
929 The Incidence and Outcomes of Delayed Laparoscopic Cholecystectomy and Bile Duct Exploration on a Unit Adopting Index Admission Surgery for All Comers. a Review of 5750 Patients
Authors: Welsh S , Sallam M , Nassar A 
Published: November 2022

Abstract

Aim
The timing of laparoscopic cholecystectomy (LC) for emergency biliary admissions remains inconsistent with national and international guidelines. The perception that LC is difficult in acute cholecystitis and the popularity of the two-session approach to pancreatitis and suspected choledocholithiasis result in delayed management.

Method
Analysis of prospectively maintained data in a unit adopting “intention to treat” during the index admission. The aim was to study the incidence of previous biliary admissions and compare the operative difficulty, complications, and postoperative outcomes with index admission LC.

Results
Of 5750 LC performed 20.8% had previous biliary admissions; one in 93% and two or more in 7%. Most presented with biliary colic (39.6%) and acute cholecystitis (27.6%). A previous biliary history was associated with increased operative difficulty (p&lt;0.001), longer operating times (86.9 v 68.1 minutes, p&lt;0.001), more post-operative complications (7.5% v 5.2%, p=0.002) and longer hospital stay (8.1 v 5.5 days, p&lt;0.001). However, conversion and mortality rates showed no significant differences.

Conclusion
Index admission LC is superior to interval cholecystectomy and should be offered to all patients fit for general anaesthesia regardless of presenting complaints. Subspecialisation should be encouraged as a major factor in optimising resource utilisation and post-operative outcomes of biliary emergencies.
508 Are Omega 3 Nutraceuticals Effective in Temporomandibular Joint Disorder
Authors: Yaqoob O , Perretti M 
Published: November 2022

Abstract

Aim
Temporomandibular Joint (TMJ) osteoarthritis (OA) is a common type of arthritis that affects all ages. Currently conservative treatment is 1st line for osteoarthritis in the TMJ and surgical treatment should only be considered as a last resort. This study aims to assess whether nutraceuticals can provide any symptomatic relief to TMJ OA.

Method
A total of 10 studies were identified using electronic databases, no exclusion criteria were applied. Inclusion criteria consisted of studies investigating the effects of Omega 3 nutraceuticals and their benefit in their role regulating the inflammatory pathways in TMJ osteoarthritis. We considered randomised controlled trials, systematic reviews, and meta-analyses.

Results
Polysaturated fatty acids have a role in inflammation due to their unique pro-resolving properties. The studies are clear in highlighting that omega 3 supplementation in patients suffering from TMJ OA will have symptomatic benefit. EPA seems to be the most powerful modality in achieving this and there was an inverse dose response relationship when investigating pain scores and eicosapentaenoic acid (EPA) concentration.

Conclusions
Omega-3 is an inexpensive conservative treatment option to have and should be offered to the majority of patients suffering from symptomatic OA. It can be used in conjunction with analgesics and possibly help reduce the dose of these. Based on the available literature and extrapolating data and results from similar inflammatory disorders and studies, it would be reasonable to suggest that a daily dose of 3g omega 3 for 12 weeks would be effective in TMJ arthritis.
780 Are E-Scooters Safe for Widespread Public Use? A Case Series Examining Severe Facial Injuries Secondary to E-Scooter Accidents
Authors: Noton T , Armes H , Mistry R , Tam A , Collier J , Greaney L 
Published: November 2022

Abstract
E-scooter use is becoming commonplace across the UK as an increasing number of towns and cities launch trials with pay-as-you-go e-scooter companies. In addition, e-scooters are cheap method of transport, easily available for an individual to purchase online, without restriction. We present two cases of patients having suffered complex facial injuries secondary to e-scooter accidents.
The first is a 38-year-old male, who was thrown from an e-scooter and had associated loss of consciousness. CT facial bones demonstrated extensive fractures to the bilateral maxillary and frontal sinuses, nasal bones, bilateral orbital floors, and mandible. The Le Fort II and mandibular fractures were fixed in two procedures. The patient has ongoing neuropathic pain around the right mandibular condyle and is receiving input from orthognathic specialists.
The second patient is a 60-year-old male, who collided with the rear of a car and was thrown forward, hitting his face on the tarmac. CT facial bones showed a Le Fort II fracture pattern and a fractured left inferior orbital rim, with extensive surgical emphysema of the face. He underwent plating of the bilateral Le Fort II fractures and application of intermaxillary fixation wires.
With little to no enforcement of personal protective equipment use and safety advice whilst utilising e-scooter services, the number of people suffering serious injuries from using such equipment is set to skyrocket. Increased awareness and education around the danger of e-scooters needs to be addressed and should be prioritised by local authorities and public health services.
73 The Digital Cullen Chart: An App to Assess the Visual Field in the Context of Sellar/parasellar Tumours
Authors: Keenlyside A , Hughes M , Ho JW , Sieradzki J 
Published: November 2022

Abstract

Aim
30 years ago, Cullen1 (a neuro-ophthalmologist) developed and validated a simple paper chart for evaluation of the central 25 degrees of the visual field. We re-developed this concept in digital form (as a smartphone application) and sought to assess its sensitivity and specificity in detecting field loss, through comparison with formal machine-based perimetry.

Method
A case series pilot study was performed to test the app-based Cullen chart for concordance with formal machine-based perimetry (Humphrey and Octopus). 18 patients with a range of sellar/parasellar tumours (pituitary adenoma, craniopharyngioma, and meningioma) being managed in a single neurosurgical centre were involved in this study. Patients underwent formal visual field perimetry as part of standard care. They also underwent assessment using the smartphone-based Cullen chart as part of routine outpatient assessment. 37 eye episodes were assessed, incorporating pre- and post- treatment assessment for a range of potentially compressive pathologies.

Results
The digital Cullen chart had a sensitivity of 75% and specificity of 98% compared with machine-based perimeters. The positive predictive value was 93% and negative predictive value was 92%.

Conclusions
In the context of visual field assessment for patients with sellar/parasellar tumours, this smartphone-based chart shows strong concordance with machine-based perimeters. It is therefore an accessible visual field screening and monitoring tool for clinicians. With further study, there is also potential for approval as a remote patient-led visual field monitoring method.
228 Idiopathic Intracranial Hypertension and Pregnancy: A Comprehensive Review of Management
Authors: Scott C , Kaliaperumal C 
Published: November 2022

Abstract

Aim
To investigate idiopathic intracranial hypertension (IIH) and its management during pregnancy.

Method
PubMed and Embase databases were searched for studies on pregnancy and IIH, with the most recent search in July 2021. Mesh terms used were “idiopathic intracranial hypertension” or “pseudotumor cerebri” AND “pregnancy”. Papers were limited to studies with human subjects and written in the English language. There were no restrictions in study design or date of publication. The reference lists of all retrieved articles were reviewed for further identification of potentially relevant publications.

Results
Management of IIH during pregnancy is similar to those who are non-pregnant. It is recommended that pregnant women with IIH are treated in health care settings that have access to multi-specialty input. Management depends on disease severity and includes conservative management, the use of medication such as steroids and diuretics, lumbar punctures, and surgical management.
An indication for surgical management includes worsening visual deterioration despite initial management with medication or serial lumbar punctures. Surgical management includes cerebral spinal fluid diversion procedures and optic nerve sheath fenestration. These operations can be performed in all three trimesters of pregnancy.
IIH in pregnancy does not increase morbidity or mortality in the newborn and method of delivery should be based on obstetrical indication.

Conclusion
This review highlights the role of multi-disciplinary approach in the management of IIH during pregnancy.
414 Are Lumbar Drains Necessary in Endoscopic Transellar Surgery with an Intraoperative High Flow Leak? a Systematic Review
Authors: Pak HYV , Hayhurst C , Taylor P 
Published: November 2022

Abstract

Aim
Perioperative lumbar drains have been used to facilitate healing of the dura and prevent postoperative cerebrospinal fluid (CSF) leaks. However, the use of perioperative lumbar drains is controversial and has primarily been left to the surgeon's preferences. Through the use of meta-analysis, we aim to find out whether lumbar drains effectively reduce the risk of postoperative CSF leak in the context of a high flow intraoperative leak.

Method
A systematic review was conducted using PRISMA guidelines. Databases used in literature searching include PubMed, Ovid (including Embase and Medline), Scopus and Cochrane Library. Articles published in 2006 or later were searched. The random-effects model was used in statistical analysis.

Results
A total of 2623 articles were identified. After screening and full-text reviews, 21 studies were included. From the quantitative data analysis, lumbar drains did not significantly lower the rates of postoperative CSF leaks. In addition, lumbar drains were associated with complications as well as a lengthier hospital stay.

Conclusions
Modern and rigorous repair techniques after endoscopic transsellar surgery are sufficient, and the use of lumbar drains is not necessary.
867 Transcranial Doppler Ultrasound for the Diagnosis of Cerebral Vasospasm After Aneurysmal Subarachnoid Haemorrhage
Authors: Masala I 
Published: November 2022

Abstract

Aim
This study aims to review the literature regarding the utility and accuracy of transcranial toppler (TCD) ultrasound in the diagnosis of cerebral vasospasm (CV) following aneurysmal subarachnoid haemorrhage (aSAH).

Method
A systematic review of the literature was conducted following the PRISMA guidelines. Pubmed and Google Scholar online databases were searched using the following designated MeSH search terms: “subarachnoid haemorrhage” AND “aneurysm” AND “aneurysmal” AND “cerebral vasospasm” AND “vasospasm” AND “transcranial Doppler” AND “TCD”. Results were limited to publications not older than 10 years prior this research (May-June 2020) and restricted to English language. All the articles found through the search were screened through their titles, then through the abstract and finally from reading in full. The remaining articles were then screened by the previously set inclusion and exclusion criteria. Finally, a further cross-reference search was completed in order to include articles missed in the database research.

Results
The database research yielded 1378 results. Of these, following the screening process, 6 papers were included in the study. A total of 403 patients was extracted from the data. Of these, the total number of reported diagnoses of CV was 172. The percentage of patients with CV was calculated for each study and overall, for an average of 42.68% of patients diagnosed with CV. TCD showed to have an average sensitivity and specificity of 68% and 74%, respectively and 71% accuracy.

Conclusion
TCD is a useful diagnostic tool that could help predicting and early diagnosing the occurrence of CV, with good sensitivity, specificity, and accuracy.
1041 Impact of Spectral Contamination and Anatomical Location on Diagnostic Accuracy of Single-Voxel Spectroscopy in Pre-Operative Glioma Characterisation
Authors: Crispi V , Sanders K , Kenning L , Spink G 
Published: November 2022

Abstract

Aim
Single-voxel spectroscopy (SVS) discriminates amongst brain tumours by measuring metabolite variations reflective of malignant transformation. However, spectral contamination may affect diagnostic accuracy, impacting radiological opinion of regions of interest (ROI) required to determine extent of surgical resection.

Method
A single-centre, retrospective, observational study, including 93 SVS meaningfully interpretable examinations between 2012 and 2018. Accuracy of lesion classification was assessed by comparison of histological diagnosis as reference standards against discrimination between entities and tumour grades by SVS, with consideration for voxel location, volume, and proximity to the calvaria or ventricular system. Quantification of metabolites was recorded as ratios, and visual inspection, qualitative and descriptive analysis were undertaken.

Results
SVS demonstrated high entity accuracy (100%) but lower grade accuracy (87%), ranging from periventricular (73%) vs non-periventricular (90%), and subcalvarial (86%) vs subcortical (88%) voxels. CSF contamination caused metabolite dilution and/or enhanced lactate signals from sub-arachnoid or ventricular CSF, especially in areas of increased brain-skull distance; lipid contamination from peri-calvarial fat and subcutaneous tissue resulted in enhanced lipid signals neighbouring areas of increased brain-scalp distance. Misclassified lesions were located regions of increased cranial concavity, reduced cerebral cortical thickness and inappropriate outer volume suppression (OVS). Voxel volume variation had no impact across cerebral coordinates (p=0.605), calvaria proximity (p=0.127) or ventricular proximity (p=0.367).

Conclusion
Spectral contamination significantly impacted grade accuracy, with metabolite dilution and enhance lactate and lipids signals leading to radiological under- and overestimation of glioma grade, respectively, thus indicating that avoidance of contaminating tissues and OVS are pivotal to adequate spectral quality for diagnostic accuracy.
82 Acute Acalculous Cholecystitis Caused by Epstein–Barr Virus Infection: Cohort Study of Literature
Authors: Latif S , Hajibandeh S 
Published: November 2022

Abstract

Aim
To perform a cohort study of literature to provide the best available evidence on clinical features and management of acute acalculous cholecystitis (AAC) caused by acute Epstein-Barr virus (EBV) infection

Method
A comprehensive search of electronic information sources was performed to identify all reported cases in the literature comprising patients of any age or gender who were found to have AAC due to acute EBV infection. Simple descriptive statistics were applied to present outcome data.

Results
Overall, 42 eligible patients were identified. The mean age of the included population was 17; 83% were female and 17% were male. Overall, 62% were from Europe; 21% from North America, 17% from Asia. Abdominal pain was present in all patients; sore throat in 62%; pharyngitis or tonsillitis in 50%; cervical lymphadenopathy in 62%; jaundice in 36%, hepatosplenomegaly in 60%; positive Murphy's sign in 69%. All patients had gallbladder wall thickening on imaging. Overall, 98% of patients were treated conservatively. Among those who were treated conservatively, all recovered with conservative management. The patient's preference was the reason for surgery in the patient who was not treated conservatively. As part of conservative management, antibiotics were used in 48% of patients. The mean length of hospital stay was 10 days

Conclusions
AAC caused by EBV infection is a rare condition that occurs in young patients and is more common in females and in European countries. EBV-associated AAC has a very good clinical prognosis and can be treated conservatively without a need for antibiotics or surgical intervention.
512 Megaoesophagus Presenting as Stridor: A Case Report and Review of Literature
Authors: Drever SKM , Thirumal V , Rogers MJC 
Published: November 2022

Abstract

Introduction
Megaoesophagus, dilatation of the oesophagus, is a recognised late complication of achalasia cardia, Chagas disease and, less commonly, dysmotility disorders. Megaoesophagus often presents with dysphagia, regurgitation of food and chest pain. Here, we describe a case of a patient presenting with stridor secondary to chronic dysmotility in the absence of dysphagia.

Case Report
An 85-year-old female presented to the Emergency Department with stridor, and a history of breathlessness and intermittent coughing episodes. Flexible laryngoscopy revealed the larynx to be rotated to the right, corresponding with a palpable swelling of the left neck. A chest X-ray showed a markedly dilated oesophagus. Computed tomography revealed severe oesophageal dilatation causing compression of the tracheobronchial tree and larynx. The patient received nebulised adrenaline and intravenous dexamethasone, resulting in resolution of her stridor. A barium swallow demonstrated marked cricopharyngeal spasm causing significant luminal narrowing but no holdup of barium. The remainder of the oesophagus was chronically dilated to the gastro-oesophageal junction and appeared atonic. The findings were atypical of achalasia, there were no obstructing lesions identified and chronic dysmotility was considered most likely, which was subsequently confirmed by a gastroenterology opinion.

Discussion
Megaoesophagus is rare, most frequently presents with dysphagia and regurgitation of food and is most commonly caused by achalasia. A literature search identified only one previous case of obstructing megaoesophagus secondary to idiopathic dysmotility disorder; however, this case revealed the stridor to be secondary to an impacted food bolus, whereas our case did not demonstrate any obstructing lesions.