bluuebunny/crossref_metadata_2025_split huggingface dataset:
800 A Rare Cause of Unilateral Facial Palsy in an Adult Presenting to a Tertiary ENT Centre
Authors: Mehtani N , Navaratnam A , Rennie C 
Published: November 2022

Abstract

Introduction
Sinonasal inverted papilloma are benign tumors usually appearing in 5th decade of life. They are characterised by their recurrent nature with extensive local destruction and malignant potential.

Case Report
A 54-year-old male was referred to our tertiary centre for further management of recurring Inverted papillomas. On review in clinic, he was found to have right facial palsy- House Brackman (HB) grade V with extensive disease in nasal passages and external auditory canal (EAC) bilaterally. This was associated with reduced visual acuity (VA)- 6/12 and proptosis of the right eye.
CT Head was suggestive of a lesion involving the right mastoid, external and middle ear, extending into the right middle cranial fossa is likely to account for the right facial nerve palsy. The MRI scan showed multiple enhancing massess in the nasal cavity, the right mastoid and tympanic cavity, the left tympanic cavity with further possible disease in the oropharynx and nasopharynx.
He was admitted to hospital from clinic for surgical management and underwent Endoscopic debulking of nasal tumour + Biopsy of bilateral external auditory canals + biopsy of pharynx. The patient was discharged a day after undergoing the procedure and remained well on ENT follow-up visit. He was further referred to Oncology team once histology results were available which showed Nonkeratinising sinonasal carcinoma and is due to receive his first dose of chemotherapy shortly.

Conclusion
The study showcases the need for awareness in such conditions and potential complications that can arise due to disease progression.
804 Accessory Extensor Digitorum Brevis Manus Muscle Presenting as a Painful Dorsal Hand Swelling - a Case Report
Authors: Noton T , Magill H , Kazzazi F , Lumsdaine W , Bremner-Smith A 
Published: November 2022

Abstract
Hand and wrist pain are common presenting complaints in General Practice, Emergency Departments, and plastic surgery clinics across the UK.
We present the case of a 43-year-old male who initially presented to his General Practitioner with an 18-month history of progressive pain and intermittent swelling to the dorsum of his right hand and wrist. Magnetic resonance imaging (MRI) and ultrasound (US) performed privately, when his symptoms first presented, were inconclusive, demonstrating generalised tenosynovitis. The patient had previously tried local steroid injections and shockwave therapy prior to being referred, neither of which relieved his symptoms.
On examination in clinic, there was subtle fusiform prominence over the radio-dorsal aspect of his right hand, with tenderness on palpation and on extension of the wrist. An up-to-date MRI scan was performed which revealed an accessory extensor digitorum brevis manus (EDBM) muscle at the dorsal aspect of the right hand and wrist.
The patient opted for excision of the accessory EDBM muscle, which was performed without complication under general anaesthetic and regional block. He made an unremarkable recovery.
Whilst accessory extensor muscles in the hand are not unheard-of, variant EDBM muscles only account for around 1% of these, and only a handful have been documented in literature. When patients present with a painful swelling in the dorsum of the hand or wrist, which is exacerbated with repetitive use, a diagnosis of an accessory EDBM muscle should be considered a differential.
808 A Fascinating Case of Anosmia in an Adult: Benign Peripheral Nerve Sheath Tumour Managed at a Tertiary NHS Centre
Authors: Mehtani N , Acharya V , Rennie C 
Published: November 2022

Abstract

Introduction
A nerve sheath tumour is slow growing lesion in the myelinated connective tissue surrounding the nerve fibres. Paranasal schawannomas are rare and often clinically misdiagnosed.

Case Report
An 80-year-old male referred to us with suspected olfactory neuroblastoma. He initially presented to his local unit with anosmia, nasal blockage, and epistaxis. There was history of right temple skin cancer 20 years ago and he is being currently being treated for hypertension. The biopsy results from local hospital were S100 and CD56 positive and preliminarily suggestive of olfactory neuroblastoma or ancient schwannoma.
On review in clinic, he had a large left sided anterior sinonasal lesion obstructing the cavity. The patient was planned for elective endoscopic or open resection and underwent further imaging to aid surgical planning. The CT Head was suggestive of a large left anterior sinonasal tumour, abutting the cribriform plate which is thinned and possibly focally dehiscent. Abutment of the left lamina papyracea which is bowed and thinned.
The patient underwent Endoscopic resection of left sinonasal tumour and skull base repair with fat, fascia lata and septal flip flop flap. The patient recovered well postoperatively and was discharged home 5 days after his procedure. The histology confirmed benign peripheral nerve sheath tumour.

Conclusion
Peripheral nerve sheath tumours can present with various unusual symptoms and may prove difficult to diagnose. Hence a multidisciplinary approach is beneficial to guide management in such complex cases.
811 Dermal Fillers and Delayed Hypersensitivity Following Influenza Vaccine: A Case Report
Authors: Magill H , Ioannidi L , Collier J 
Published: November 2022

Abstract

Background
Dermal fillers can be used to improve cosmetic appearance of facial soft tissue in patients with Human Immunodeficiency Virus (HIV) associated lipodystrophy. There are documented cases of delayed hypersensitivity reaction to dermal fillers following influenza-like illness, and similarly following coronavirus vaccination, however none following the influenza vaccine.

Case
A 52-year-old female was treated with dermal filler injections to her zygomatic and buccal regions for lipoatrophy secondary to HIV treatment. Her HIV was well controlled with a low viral load. Six months following dermal filler treatment she presented with periorbital and zygomatic arch swellings one week after vaccination for influenza. The swelling was initially treated as periorbital cellulitis with antibiotics; however, it did not resolve. The swelling was in the same distribution as her filler and as it did not appear to be an infection but rather a delayed hypersensitivity reaction, it was treated with prednisolone for one week. There was further reduction in nodules following intralesional triamcinolone injections and following weaning of prednisolone there was no recurrence of swelling.

Discussion
To our knowledge this is the first case of its type to be described; literature searching does not retrieve any reports to date of adverse events related to the influenza vaccine following the use of dermal fillers. This is an important consideration in terms of the risks posed by this treatment in immunocompromised patients, and detailed informed consent is an important component of treatment.
827 Unusual Presentation of Missed Appendicitis
Authors: Khitab N 
Published: November 2022

Abstract
I present the case of old age man, who presented with pain right side of the abdomen with huge anterior abdominal wall swelling, along with loose motion in one of the hospitals in an Asian country. His inflammatory markers were unremarkable, and his ultrasound showed fluid-filled bowel loops, with no ascitic fluid. The appendix could not be visualised. On examination, he had tender and distended abdomen and bowel sounds were exaggerated. Laparotomy was performed and it came out to be missed appendicitis which buried into the abdominal wall and caused the pus track down anteriorly to appear as anterior abdominal wall abscess as one of its rare complications. Appendectomy was done alongside abdominal wall exploration. Pus was drained. The patient improved and went home in the second post-operative week.
883 Clinical Case Report: Recurrent Non-Tuberculous Psoas Abscess with Associated Discitis
Authors: Palepa A , Morrison TEM , Suresh S , Arulampalam T 
Published: November 2022

Abstract

Introduction
Following the discovery of modern anti-tuberculosis treatments, psoas abscesses secondary to Pott's disease of the spine rarely occur in developed countries. We present a case of a recurrent non-tuberculous psoas abscess communicating with the spine and pleural cavity, presenting as an abdominal mass.

Case
A 72-year-old man presented with a left upper quadrant mass, pain, abdominal distension and raised inflammatory markers. Cross-sectional imaging with CT and MRI revealed a large left-sided psoas abscess with a pleural effusion tracking to the retroperitoneum and associated recurrent discitis. The patient was commenced on intra-venous antibiotics and the collection was accessed via a radiologically placed drain to the retroperitoneum.

Discussion
Spinal infections may present with a lump below the inguinal ligament due to pus tracking down the psoas tendon sheath. Irritation of the psoas muscle may also present with pain on hip extension due to muscular spasm. The most common causative agent of primary psoas abscesses is Staphylococcus Aureus. Discitis is more common in men and shows a bimodal age distribution in presentation, predominantly affecting children and then those in the 6th-7th decade of life.

Learning points
Retroperitoneal disease should be considered in a patient who presents with an abdominal mass. In patients who present with a psoas abscess or an empyema communicating with the retroperitoneum, a spinal source should be considered. Crohn's disease is a common cause of secondary psoas abscesses and should also be considered. Cultures for mycobacteria should be obtained to exclude Tuberculosis as an underlying cause.
915 Duodenojejunal Intussusception Caused by a Solitary Peutz-Jeghers-Type Polyp
Authors: Nazir S , Merchant A , Borscheid R , Wedgwood K 
Published: November 2022

Abstract
A solitary Peutz-Jeghers (SPJ) type polyp is a rare hamartomatous polyp that shares similar histological features to polyps found in typical Peutz-Jeghers syndrome (PJS), without the associated mucocutaneous pigmentation or family history. Intussusception is rare in adults and of the six previous reports of intussusception caused by a SPJ type polyp, only two occurred in adults.
A 59-year-old female presented with recurrent episodes of colicky abdominal pain lasting a few hours. These episodes were followed by abdominal bloating and belching, but no vomiting. A CT scan of the abdomen and pelvis suggested intussusception of the fourth part of duodenum (D4) into the jejunum and a small bowel mass with D4 involvement. Physical examination did not reveal the associated signs of PJS.
Multi-disciplinary team (MDT) recommendation was to resect the area in question. An exploratory laparotomy found a small bowel intussusception. Enterectomy of D4 and proximal jejunum was performed, with primary side to end anastomosis. Macroscopically, the specimen showed intussusception of the distal duodenum into the proximal jejunum, associated with a large duodenal polyp measuring 5×3 x 2 cm. microscopic examination revealed hamartomatous changes suggestive of a Peutz-Jeghers polyp. The resection margin showed normal small bowel tissue with no evidence of dysplasia. A colonoscopy to rule out additional polyps was negative, and the patient recovered well from surgery.
This rare case highlights the non-specific presentation of intussusception, shows the need for methodical evaluation of the patient's history, examination, and investigations, and queries the requirement for surveillance and screening.
934 Chemical Burns and the Use of High-Strength Topical Lidocaine Cream in Tattooing - a Case Report
Authors: Noton T , Burke-Smith A , Jones I 
Published: November 2022

Abstract
Topical anaesthetics have long been used for their ease of use and short duration to provide local anaesthetic prior to procedures such as cannulation and tattooing.
We present the case of a 26-year-old tattoo artist sustaining a chemical burn and resulting infection from a high-strength topical lidocaine cream. The patient presented to the emergency department 5-days following application of the cream. The topical preparation was sourced online, came in a nondescript white tube, and was marketed as having a 50% lidocaine content with no information regarding its constitution. For comparison, EMLA cream (lidocaine/prilocaine) commonly used in hospitals, is a 5% preparation. Following application, the patient proceeded to self-tattoo his left lower leg, in a ‘blackout’ style.
On presentation, a 2.5% TBSA area was blistered, with areas of denuded skin, in keeping with a deep dermal burn. Much of the lower leg was actively discharging yellow-stained serous fluid. In addition, there was tracking erythema around the demarcated area, and the left foot was grossly oedematous. Blood tests revealed CRP of 103 and WCC of 11.4.
The patient was commenced on intravenous flucloxacillin. Wound swab results showed significant growth of Pseudomonas aeruginosa. Following stepdown to oral antibiotics and careful wound management with dressings such as Flaminal and then honey-based dressings, the patient made a full recovery, avoiding the requirement for surgical intervention.
This case highlights the difficulty when assessing burns in heavily tattooed skin. Additionally, unregulated topical anaesthetics must be avoided by the public, due to infection risk and unknown ingredients.
954 Sarcoidosis Mimicking Progression of Melanoma: A Case Report
Authors: Quigley A , Al-Khattab M , Kennedy S , Kelly J 
Published: November 2022

Abstract
A 78-year-old lady with a history of malignant melanoma on the dorsal aspect of her left foot, presented with a new fluorodeoxyglucose positron emission tomography (FDG-PET) avid lesion in her left fibular head.
The patient had been diagnosed eight months previously with a 5.1mm Breslow thickness invasive melanoma. Following initial diagnosis, she underwent a wide local excision and sentinel lymph node biopsy (SLN). The melanoma was completely excised and SLN was negative for malignancy.
Postoperatively, she underwent radiological staging with computed tomography scans (CT) of her thorax, abdomen, and pelvis. This showed scattered pulmonary nodules, and multiple indeterminate liver lesions. A PET scan was then performed, which showed an expansile, FDG-avid, lytic lesion in the left fibular head, suspicious for bone metastasis. Following discussion at the multidisciplinary team meeting, the patient underwent an open biopsy of the fibular head. Histology revealed non-necrotising epitheloid granulomata without evidence of malignancy. Ziehl-Neelsen and periodic acid Schiff stains were negative. The findings were suggestive of sarcoidosis.
The patient revealed she had a previous diagnosis of pulmonary sarcoidosis 25 years prior, however, had no known extrapulmonary disease and was not attending a specialist. The pulmonary findings on CT were consistent with sarcoidosis.
Sarcoidosis is a systemic inflammatory disease characterised by the development of non-caseating granulomata which typically affect the lungs and lymph nodes but can affect multiple organ systems. This case highlights the diagnostic uncertainty of an FDG-avid lesion on PET, necessitating diagnostic biopsy. Sarcoidosis is an uncommon but possible differential in this setting.
961 Surgery for Stage IVA Metastatic Thymoma Found Incidentally Post-COVID-19
Authors: Ajdarpasic D , Weaver H , Hawari M 
Published: November 2022

Abstract

Background
Thymic epithelial tumours (TET) are rare thoracic cancers with reported annual incidence of 1.3–3.2 per million. TETs are histologically classified as thymomas or thymic carcinomas. Thymomas are slow-growing tumours that comprise the majority of lesions found in the anterior mediastinum. They can be associated with autoimmune disorders such as Myasthenia Gravis.
Contrast CT is the standard for diagnosis. Surgery is treatment of choice depending on resectability of the tumour. The Masaoka-Koga staging system is correlated with overall survival and is utilised post-surgical resection to guide adjuvant treatment.

Case Presentation
A 50-year-old male presented with cough, shortness of breath, myalgia, sore throat, and reduced sense of smell that was diagnosed as COVID-19. CT chest and abdomen showed a large heterogeneous mediastinal mass (11cm) invading the innominate vein and left upper lobe with two left pleural deposits, and diaphragmatic disease. CT biopsy confirmed thymoma. MDT recommended surgery due to patient age and resectability of tumour with post-operative chemotherapy. The sites of disease necessitated a left thoracotomy and median sternotomy. The pleural and diaphragmatic deposits were resected, followed by left upper lobe anatomical dissection enbloc with invaded pericardium, phrenic and vagus nerve, followed by median sternotomy to resect the thymic mass along with the innominate vein. Final staging was stage IVA thymoma (B2 and B3) (T3N0M1aR0). A CT scan at 1 year showed no recurrence despite patient declining adjuvant chemotherapy.

Conclusion
Surgical resection is a viable treatment option for patients with stage IVA thymoma who present with resectable primary and metastatic disease.
982 Embolisation of Iatrogenic Lumbar Artery Bleed Causing Psoas Haematoma Following Elective Lumbar Puncture
Authors: Oladeji E , Rati K , Rakhimova K , Day N 
Published: November 2022

Abstract
The case of a 59-year-old female patient presenting as a surgical emergency with abdominal pain and a positive Obraztsova's sign. Seven days prior to the presentation, she had attended her General Practice (GP) complaining of sudden onset severe occipital headache associated with photophobia, vertigo, and paraesthesia. Due to a family history of cerebral aneurysms, her GP urgently transferred her to an emergency department, where she was subsequently admitted under the acute medical team. A lumbar puncture (LP) had been performed to exclude a subarachnoid haemorrhage. The patient was investigated with a Computerised Tomography abdomen and pelvis with contrast and was subsequently found to have an acute lumbar arterial bleed causing haemodynamic instability and a psoas haematoma. An emergency lumbar artery embolisation procedure was performed by the interventional radiology department in order to stabilise the bleed. The patient made a full recovery prior to discharge. This rare case exemplifies the value of obtaining adequate history in arriving at a diagnosis. In the appropriate clinical context, a contrast-enhanced CT scan of the abdomen and pelvis should be obtained to exclude this treatable condition. Also, measures to minimize the risk of complications and make lumbar puncture safer should be incorporated into guidelines, including methods to ensure that the correct position of L3/L4 or L4/L5 is found prior to performing the procedure, use of atraumatic spinal needles and performing the procedure under ultrasound guidance.
1021 Spontaneous Rupture of Haemorrhagic Pancreatic Pseduocyst – Case Report
Authors: Lakshmipathy G 
Published: November 2022

Abstract

Case Study
A 67-year-old male presented to the emergency department with sudden onset of diffuse abdominal pain, nausea, and vomiting.

Relevant surgical history
He has a history of choledocholithiasis, and he was treated for an episode of acute gallstone related pancreatitis twelve months ago. He underwent ERCP in the admission. He subsequently developed a pancreatic pseudocyst which was managed conservatively through watchful waiting.

Examination
He was particularly tender in the epigastric region. He was mildly tachycardic and normotensive.

Imaging
CT Abdomen and Pelvis demonstrated a significantly enlarged pseudocyst which is closely applied to multiple branches of the coeliac axis. Haematoma within the left upper quadrant was compatible with recent haemorrhage.

Management
The patient was initially managed with IV fluids, broad spectrum IV antibiotics, analgesia, and anti-emetics. He needed emergency surgery for definitive management. Central pancreatectomy and peritoneal toilet were carried out. Pancreatic bed drains were left in-situ for two weeks. Patients need to spend one day in Intensive care. He was fed through TPN initially before switching to nasogastric feeding. Patient was discharged two weeks post-op with Octreotide and fortisips.

Discussion
Pancreatic pseudocyst is a common complication of pancreatitis. Spontaneous rupture of a pseudocyst is rare occurrence as a result it appears sporadically in the medical literature. However, it can be a potentially serious leading to severe peritonitis and needs emergency surgical exploration as highlighted in this case. Prompt surgery combined with extensive lavage was life saving for this patient.
1052 Intussusception of the Appendix in a Young Adult with Cystic Fibrosis: An Important Differential Diagnosis of Abdominal Pain in Cystic Fibrosis Patients?
Authors: Venkatasami M , Cobby E 
Published: November 2022

Abstract

Background
Cystic fibrosis (CF) is commonly associated with gastrointestinal manifestations from infancy to adulthood. Intussusception in the paediatric CF population is widely reported, whereas in the adult, distal intestinal obstruction syndrome (DIOS) is common affecting 20%, of which, intussusception is rare and appendiceal intussusception is rarer, affecting 1%.

Case-Description
A 20-year-old male with CF presented with 3 days of right iliac fossa pain and diarrhoea. On admission, he was hypotensive and afebrile. Clinical examination revealed tenderness of the right flank with a palpable mass in the right iliac fossa.
Serum investigations showed mildly raised inflammatory markers.
Contrast CT of the abdomen-pelvis confirmed intussusception of the appendix into the ascending colon.
Histological analysis of the appendix further demonstrated intussusception, with intraluminal mucinous material. Fascinatingly, no transmural inflammation was present.
The patient underwent a laparotomy-open appendicectomy. Interestingly, intraoperative findings showed the intussusception resolved, no longer requiring surgical reduction.
Patient postoperative recovery was complicated by pneumonia for which he was transferred for specialist CF respiratory care and thereafter, discharged.

Discussion
Literature review highlighted a paucity of data, with 10 reported cases of appendiceal intussusception in adult CF patients.
Interestingly, we report the intussusception had reduced by the time of operation. This is in-keeping with previous case reports of transient intussusception which spontaneously resolved.

Conclusion
From this rare case presentation, we have learnt it is imperative to carry a high index of suspicion for gastrointestinal manifestations in CF patients where acute appendicitis is seen less often and differential diagnoses like DIOS and intussusception should be considered.