Author: Jason Curtis

Spinal Motocross Injuries in the United Kingdom (2018)

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Type of publication:
Journal article

Author(s):
*Singh, Rohit; Bhalla, Amit; Ockendon, Matthew; *Hay, Stuart

Citation:
Orthopaedic journal of sports medicine; Jan 2018; vol. 6 (no. 1); p.

Abstract:
Background Motocross is a form of motorcycle racing held on established off-road circuits and has been a recreational and competitive sport across the world for >100 years. In the United Kingdom alone, motocross has grown into a phenomenally ambitious and popular franchise. There are >200 motocross clubs across the country, permitting >900 events annually.PurposeTo assess the current trend of spine-related motocross injuries over the past 5 years.Study DesignDescriptive epidemiology study.MethodsData were prospectively collected over 5 years (August 2010-August 2015) at our regional trauma and spine unit, regardless of whether the rider was performing the sport competitively or recreationally. Results During the study period, spine related injuries were identified for 174 patients (age range, 6-75 years) who were directly referred to our department following recreational or competitive motocross, with most injuries being sustained within the early spring and summer months, representing the start of the motocross season. A significant number of injuries were in males (n = 203, 94%), with the majority of injuries occurring within the 21- to 30-year-old age group. A total of 116 (54%) injuries required operative treatment. The most common spinal injury was thoracolumbar burst fracture (n = 95), followed by chance fractures (n = 26).ConclusionThis data series emphasizes the prevalence and devastation of motocross-related spinal injuries in the United Kingdom and may serve in administering sanctions and guidelines to governing bodies of motocross. The spinal injuries that occur during motocross have significant capital connotations for regional spinal centers. The recent surge in motocross popularity is correlated with the number of injuries, which have increased over the past 5 years by almost 500%.

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"Door to knife time" for emergency admissions (2017)

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Type of publication:
Conference abstract

Author(s):
*Quraishi M.; Tayyab M.; Badger I.

Citation:
International Journal of Surgery; Nov 2017; vol. 47

Abstract:
The NCEPOD has formed the foundation of local trust guidelines in the triage of surgical patients requiring surgery. Delays in surgical intervention lead to significant morbidity and mortality. Reviewing the reasons for delay to theatre is therefore important in improving service provision and patient outcomes. Method: A retrospective collection of data on 62 (eligible) from 90 consecutive patients that were taken to emergency theatre were reviewed in February 2016. Result: of 62 patients 44 were admitted under general surgery, 6 under urology and 14 under other specialities. There were 37 males and 26 females. Median age was 47 years. As per local guidelines, 3 patients belonged to category III(septic shock), 16 in category V(sepsis without organ dysfunction) and 43 in category VI(infected source without sepsis). This translates into three CEPOD 1 (immediate) and 59 CEPOD 2 (urgent) patients. Two delays were identified, a patient requiring cardiovascular stabilisation prior to surgical intervention and another patient due to lack of perioperative resources. Conclusion: This review has highlighted good compliance with local guidelines and, the importance of the need for clarification of categorisation of surgical urgency. Our local categorisation offers more detail on specific emergencies, but still has significant lapses.

Anaemia and upper GI bleeding: A local experience (2017)

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Type of publication:
Conference abstract

Author(s):
*Ding M.; *Prawiradiradja R.; *Arastu Z.; *Sabri H.; *Smith M.

Citation:
United European Gastroenterology Journal; Oct 2017; vol. 5 (no. 5)

Abstract:
Introduction: There has been significant research recently on the use of blood transfusions in upper GI bleeding (UGIB) [1] with recent evidence advocating a restrictive approach to blood transfusions as well as the use of iron therapy[2] for anaemia post UGIB. Our team conducted a local retrospective analysis on patients admitted with UGIB over a six month period and analysed the use of blood transfusions at our trust which consists of two District General Hospitals. Patient data over a period of up to 12 months post discharge was collected to monitor their anaemia. Aims & Methods: Our aim was to monitor the appropriateness of transfusions in Upper GI Bleeding as well as monitoring the response to iron therapy following discharge. All inpatients that had an Upper GI endoscopy for UGIB were analysed. Electronic patient records were obtained from our endoscopy software and hospital database. Patients were selected over a time period of six months from 1/ 6/2015 to 31/12/2015. A Student's T-Test was used to compare the average increase in haemoglobin (Hb) for patients discharged with iron therapy against those who were not. Results: There were 148 patients, 81 male and 67 female. The mean age was 69.3, minimum 20 and maximum of 98. The average Hb on admission was 103 g/L (min=32 g/L, max=178 g/L). 78 out of 148 (52.7%) patients presenting with UGIB received a blood transfusion. The mean amount of blood received for those transfused was 3.7 units. 48 out of 78 (61.5%) of blood transfusions were given when Hb was below 70 g/L. 30 of 78 (38.5%) were transfused above a Hb of 70 g/L. (36.7%, n=11) of those who were transfused with Hb above 70 had cardiac risk factors. The mortality rate in those transfused above Hb of 70 was 13.3% (n=4) vs 10.4% (n=5) 41.5% (n=44) patients who were anaemic post-UGIB were discharged with iron therapy. The average rise in Hb was 26.5% for those discharged on iron vs 12.1% for those who did not. There was a statistically significant rise in Hb for those discharged with iron therapy (p<0.005) on follow-up versus those who did not receive it (n=62). The anaemia related readmission rates were similar for patients discharged on iron or not (9.1% n=4 vs 9.7% n=6). Conclusion: The data obtained supports a restrictive transfusion policy (mortality rate of 13.3% vs 10.4%). 58.5% of patients who were anaemic on discharge did not receive any iron therapy. On follow up, there was a statistically significant rise in Hb level in the group discharged on iron. Our data affirms recent evidence favouring iron therapy post UGIB. Further education is needed to improve outcome in patients presented with GI bleed.

An audit of 'real world' systemic chemotherapy in breast cancer patients over the age of 70 in one U.K. Cancer Centre (2018)

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Type of publication:
Conference abstract

Author(s):
*Choudhary Y.; *Pettit L.; *Khanduri S.

Citation:
European Journal of Surgical Oncology; Mar 2018; vol. 44

Abstract:
Background: Breast cancer incidence among the over 70's is increasing. Trial data from this age group is not as extensive when compared with younger patients. Co-morbidities are common and may lead to poor tolerance of chemotherapy. Cytotoxic chemotherapy usage in patients over 70 was audited to record toxicity and tolerability.Method: Patients aged >70 years, diagnosed with invasive breast cancer between 01/01/2015 and 31/12/2015 treated with cytotoxic chemotherapy at the Shrewsbury and Telford Hospital NHS Trust were identified from the Somerset database. Clinical information was obtained from an electronic portal. Data collected: demographics, performance status, tumour characteristics, ER/PR and HER2 status, chemotherapy regimen, treatment intent, number of chemotherapy cycles planned, number given, toxicities, and hospital admissions. Data was collected on an excel database.Results: Thirty patients were identified, all female. 26 were between 71 and 75, 2 were between 76 and 80, 2 > 80 years. 20 patients (67%) ER/PR receptor positive. 15 (50%) HER2 positive. The majority 29 (97%) had a performance status of 0/1. Cardiovascular co-morbidities were the most common (57% pre-existing cardiovascular disease). 25 (83%) were treated with adjuvant intent. 15 (50%) were admitted to hospital, 6 (20%) with neutropenic sepsis. 12 (40%) had dose reductions. 21 (70%) completed their planned number of cycles. Chemotherapy was discontinued in 7 (23%) due to toxicity and 1 patient remains on treatment at the time of this audit. There were no patient deaths within 30 days of commencing chemotherapy.Conclusion: Chemotherapy usage in the >70's was associated with higher risk breast cancer. Despite good baseline performance status, 50% of patients required hospital admission and 27% discontinued treatment due to toxicity. The decision to use chemotherapy must also account for potential toxicities and impact on quality of life. Increased contact with health professionals including tele-consults and increased specialist nurse support, will help to predict and manage toxicity and reduce admissions.

Suture-assisted punctoplasty (2017)

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Type of publication:
Journal article

Author(s):
*Sachdev A.; *Sagili S.R.

Citation:
Digital journal of ophthalmology : DJO; 2017; vol. 23 (no. 3); p. 60-62

Abstract:
Purpose: To describe a surgical technique in which a suture, instead of forceps, is used to improve access for the introduction of scissors and more easily achieve an appropriately-sized punctoplasty.Materials and Methods: In this technique, a new modification of the 2-snip punctoplasty, a 6-0 polyglactin 910 suture is passed through the posterior wall of the punctum to apply traction. A video of the technique is provided.Results: This technique improves the surgical field of view and eases access for introduction of Vannas scissors into the punctum to perform the punctoplasty.Conclusions: This simple and practical modification of the 2-snip punctoplasty improves instrument access so that an appropriately-sized punctoplasty can be performed with ease.

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A rare mandibular presentation in multiple myeloma (2017)

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Type of publication:
Conference abstract

Author(s):
*Mihalache G.; *MacBean A.; *Bhatia S.

Citation:
British Journal of Oral and Maxillofacial Surgery; Dec 2017; vol. 55 (no. 10)

Abstract:
Introduction: Multiple myeloma(MM)is a relatively rare malignant haematological disease, a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions in the vertebrae, ribs, pelvic bone, skull and jaw. This rare disease develops mainly in men aged 50 to 80 years (mean age, 60 years). Materials: We report on a clinical case of a 45-year-old female patient who presented with spinal and long bones pain to the hospital and she was diagnosed with multiple myeloma. In order to start her treatment (radiotherapy/ chemotherapy/ bisphosphonates) conform our hospital protocol, she came for a full oral and dental assessment. No intraorally abnormalities were seen. However the orthopantomogram showed multiple rounded lesions of various sizes which have little, if any, circumferential osteosclerotic bone reaction. Results: Patient was diagnosed with multiple myeloma with mandibular involvement. She will be followed up by our team and her dentist for monitoring the oral health. Conclusions: The clear and rare multilocular image of myeloma on the orthopantomogram makes our case unique. Knowledge about the maxillofacial manifestations of multiple myeloma is important for the diagnosis of the disease and treatment, also the follow up of these patients regarding their oral manifestations. In the clinical case presented here, we highlight the interdisciplinarity needed to obtain a diagnosis and treatment of multiple myeloma.

Recurrent laryngeal nerve function after central neck dissection (2017)

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Type of publication:
Conference abstract

Author(s):
*Fussey J.; *El-Shunnar S.; *Spinou C.; *Hughes R.; *Ahsan F.

Citation:
European Journal of Surgical Oncology; Dec 2017; vol. 43 (no. 12); p. 2388-2389

Abstract:
It is generally accepted that central compartment neck dissection (CCND) improves locoregional recurrence rates in cases of known central compartment lymph node involvement, however the practice of prophylactic CCND is somewhat more controversial. It is often quoted anecdotally that the risk of damage to the recurrent laryngeal nerve is higher during CND than in thyroidectomy only. The aim of this study was to evaluate recurrent laryngeal nerve injury rates following CND in thyroid cancer patients. Prospectively collected data from three head and neck cancer centres was retrospectively analysed to identify patients who underwent CND with or without concurrent thyroid surgery over a three-year period. Fifty-eight patients underwent CND, 35 of which were bilateral. There were therefore 92 recurrent laryngeal nerves at risk. The temporary recurrent laryngeal nerve palsy rate was 2.2%, and the permanent palsy rate was 3.3%. All cases of permanent recurrent laryngeal palsy occurred in patients undergoing CND and total thyroidectomy for pT4 disease. Many factors can affect recurrent laryngeal nerve palsy rate following CND, including surgeon experience, tumour characteristics and extent of dissection. Our experience suggests that the risk to the nerve in CND is no higher than in standard thyroid surgery.

Incidence of recurrent laryngeal nerve palsy and hypocalcaemia following thyroidectomy in a district general hospital setting by a single surgeon (2017)

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Type of publication:
Conference abstract

Author(s):
*McNamara K.; *Albuidair A.; *Ahsan F.

Citation:
European Journal of Surgical Oncology; Dec 2017; vol. 43 (no. 12); p. 2389

Abstract:
Background: The British Association of Endocrine and Thyroid Surgeons' (BAETS) set a standard of permanent recurrent laryngeal nerve (RLN) palsy of 1-2% and risk of permanent hypocalcaemia of 5-10%. Aim: To establish ates of permanent recurrent laryngeal nerve palsy and post-operative hypocalcaemia from thyroidectomy by a single surgeon in a District General Hospital Setting. Methods: Patient demographics, rates of permanent recurrent laryngeal nerve palsy and postoperative hypocalcaemia were obtained from all hemithyroidectomy, completion thyroidectomy and total thyroidectomy procedures performed between June 2012 and January 2017. Data was collected from the online Clinical Portal. All cases of RLN palsy and hypocalcaemia had been documented in patient's clinical letters. Results: 245 thyroidectomy procedures were performed during this time. This included 179 hemithyroidectomy, 41 completion thyroidectomy and 16 total thyroidectomy procedures. 1/245 (0.4%) patient suffered with permanent recurrent laryngeal nerve palsy in this patient group. 1/57 patients (2%) developed postoperative hypocalcaemia following completion or total thyroidectomy. Conclusion: This study reveals a lower incidence of RLN palsy and hypocalcaemia than is set by standards. Careful preoperative evaluation helps in achieving a satisfactory outcome in thyroid surgery. Thyroid surgery is safe to be done in a District General Hospital in the hands of a Head and Neck surgeon with a subspecialist fellowship training in thyroid.