Large distal ureteric stone with high burden urothelial cancer of the entire ureter and renal pelvis: a dual pathology
Ann R Coll Surg Engl. 2021 Mar 5. doi: 10.1308/rcsann.2020.7047. Online ahead of print.ABSTRACTUpper-tract urothelial cancer comprises only 3% of all urothelial cancers. Risk factors include tobacco smoking, recurrent urinary infection, urolithiasis and analgesic abuse. Urolithiasis-induced chronic inflammation leads to urothelial proliferation and eventual malignant transformation. The most common association is reported with squamous cell cancer. A 54-year man under evaluation for right flank pain was diagnosed with a large distal ureteric stone and urothelial cancer of the entire right ureter and renal pelvis. The patie...
Source: Annals of the Royal College of Surgeons of England - March 5, 2021 Category: Surgery Authors: D Aggarwal K Parmar A K Yadav S Kumar B Naik N Banerjee Source Type: research

The changing face of rhinology in the NHS: a study of septoplasty, septorhinoplasty and rhinoplasty hospital episode statistics
CONCLUSIONS: We found an overall year-on-year reduction in the number of rhinology operations being performed in the NHS, but variation in trends between different clinical commissioning groups. A reduction in operative activity likely represents the effect of underlying restrictions on commissioning rather than reduced clinical need.PMID:33661043 | DOI:10.1308/rcsann.2020.7034 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 4, 2021 Category: Surgery Authors: E Balai K Jolly N Bhamra M S Osborne J Barraclough Source Type: research

Posterior urethral valves masquerading as neuropathic bladder following sacrococcygeal teratoma resection
This report highlights the crucial importance of being aware of the rare coexistence of lower urinary tract pathology in male babies with sacrococcygeal teratoma. Routine urodynamic assessment should be considered in all children following sacrococcygeal teratoma resection.PMID:33661045 | DOI:10.1308/rcsann.2020.7046 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 4, 2021 Category: Surgery Authors: P A Green Linda Hyde H J Corbett P D Losty Source Type: research

Two cases of non-parasitic splenic cysts and spleen-preserving therapy
Ann R Coll Surg Engl. 2021 Mar 4. doi: 10.1308/rcsann.2020.7043. Online ahead of print.ABSTRACTWe review two different presentations of non-parasitic splenic cysts, both of which are post-traumatic in aetiology. The first case was of slower onset and was managed electively. The second case was of acute onset and was managed as an emergency. Non-parasitic splenic cysts are uncommon and the optimal management strategy for them is not well defined. Historically, treatment has been with open splenectomy; however, infection rates following this surgery have been high, making it an unattractive management option. Both cases were...
Source: Annals of the Royal College of Surgeons of England - March 4, 2021 Category: Surgery Authors: S B Kumar J Richards K Butcher R Welbourn Source Type: research

The changing face of rhinology in the NHS: a study of septoplasty, septorhinoplasty and rhinoplasty hospital episode statistics
CONCLUSIONS: We found an overall year-on-year reduction in the number of rhinology operations being performed in the NHS, but variation in trends between different clinical commissioning groups. A reduction in operative activity likely represents the effect of underlying restrictions on commissioning rather than reduced clinical need.PMID:33661043 | DOI:10.1308/rcsann.2020.7034 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 4, 2021 Category: Surgery Authors: E Balai K Jolly N Bhamra M S Osborne J Barraclough Source Type: research

Posterior urethral valves masquerading as neuropathic bladder following sacrococcygeal teratoma resection
This report highlights the crucial importance of being aware of the rare coexistence of lower urinary tract pathology in male babies with sacrococcygeal teratoma. Routine urodynamic assessment should be considered in all children following sacrococcygeal teratoma resection.PMID:33661045 | DOI:10.1308/rcsann.2020.7046 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 4, 2021 Category: Surgery Authors: P A Green Linda Hyde H J Corbett P D Losty Source Type: research

Two cases of non-parasitic splenic cysts and spleen-preserving therapy
Ann R Coll Surg Engl. 2021 Mar 4. doi: 10.1308/rcsann.2020.7043. Online ahead of print.ABSTRACTWe review two different presentations of non-parasitic splenic cysts, both of which are post-traumatic in aetiology. The first case was of slower onset and was managed electively. The second case was of acute onset and was managed as an emergency. Non-parasitic splenic cysts are uncommon and the optimal management strategy for them is not well defined. Historically, treatment has been with open splenectomy; however, infection rates following this surgery have been high, making it an unattractive management option. Both cases were...
Source: Annals of the Royal College of Surgeons of England - March 4, 2021 Category: Surgery Authors: S B Kumar J Richards K Butcher R Welbourn Source Type: research

Locally advanced tongue squamous cell carcinoma in epidermolysis simplex bullosa patient: a therapeutic conundrum
Ann R Coll Surg Engl. 2021 Mar;103(3):e85-e87. doi: 10.1308/rcsann.2020.7080.ABSTRACTEpidermolysis bullosa simplex (EBS) is a debilitating condition affecting the skin and mucous membranes that is characterised by frequent ulceration and blistering on trivial trauma. In EBS, oral cavity mucosal injuries lead to a high propensity for developing squamous cell carcinomas. Locally advanced tongue carcinoma arising in this background presents a challenging therapeutic conundrum. To our knowledge, this is the first case of aggressive locally advanced tongue carcinoma that has developed sporadically in a patient with EBS and no f...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: W Al Shareef S Sayed S Kamel H Alkaf A Bahaj R Amin A Al Herabi Source Type: research

Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management
DISCUSSION: The rise in admissions for tonsillitis and its complications appears to correspond closely to the date of SIGN guidance and clinical commissioning group rationing of tonsillectomy and is on the background of a rise in the population of the UK. The move towards daycase tonsillectomy has reduced bed occupancy after surgery but this has been counteracted by an increase in admissions for tonsillitis and deep neck space infections, sometimes requiring lengthy intensive care stays and a protracted course of rehabilitation. The total cost of treating the complications of tonsillitis in England in 2017 is estimated to ...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: M Pankhania J Rees A Thompson S Richards Source Type: research

Novel skin graft donor site for the scalp transposition flap
Ann R Coll Surg Engl. 2021 Mar;103(3):e106-e108. doi: 10.1308/rcsann.2020.7041.ABSTRACTTransposition scalp flaps are a versatile solution for soft-tissue cover in a multitude of scalp defects. They are frequently used to reconstruct larger skin cancers that involve the outer table of the cranium in addition to covering neurosurgical bony defects and hardware. The transposition flap requires the donor site to be grafted using a split-thickness graft, which results in a secondary wound elsewhere on the body, commonly the lateral thigh. Although quite routine in such surgery, this procedure does require another body area to b...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: O Sawyer J Zakaraite Source Type: research

Haemorrhagic shock from solid tumours of the adrenal gland: a case of bleeding primary adrenal lymphoma
We present a novel case of primary adrenal lymphoma with adrenal haemorrhage in a middle-aged woman who presented with right-sided abdominal pain and class 1 haemorrhagic shock. She was found to have spontaneous unilateral adrenal gland haemorrhage in the absence of any underlying previous pathology. Presenting features, diagnosis and subsequent oncological management are reported.PMID:33645269 | DOI:10.1308/rcsann.2020.7040 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: P Bhattacharya R Zakaria S Stonelake B Butler D Sarma M Maheswari S Zaman Source Type: research

A huge abdominal mass revealing a depressive syndrome
We report the case of a giant gastric trichobezoar in a 21-year-old woman who presented with chronic abdominal pain, vomiting and weight loss. Abdominal examination revealed a large epigastric mass. Endoscopic and imaging findings were highly suggestive of a gastric trichobezoar. Surgical extraction of the huge hair mass was successfully performed through an open gastrotomy. Postoperatively, history of a neglected chronic depression with suicidal ideation was diagnosed. Consequently, the patient was referred to the psychiatric department for mental healthcare, to prevent trichobezoar recurrences.PMID:33645270 | DOI:10.1308...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: M Tarchouli B Ait Idir N Bouhabba S D El Jaouhari T Salaheddine Y Hnach A Zentar Source Type: research

Anal cancer survival: a socioeconomic analysis
CONCLUSION: In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.PMID:33645271 | DOI:10.1308/rcsann.2020.7019 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: F Ali A E Ghareeb A Jha H Van der Voet D Garg M Jha Source Type: research

Introduction of a virtual trauma meeting in response to COVID-19
CONCLUSION: Trauma meetings can be safely conducted in a virtual environment with high standards of patient care maintained. Virtual trauma meeting offers service enhancements such as early subspecialty input and enhanced cross-site communication and rapid solution development to logistical difficulties. Adapting to conference call etiquette will enhance user experience and opportunity for training opportunities, but adequate investment in high-quality equipment is essential.PMID:33645272 | DOI:10.1308/rcsann.2020.7018 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: D Burchette C To H Willmott Source Type: research

Prophylactic antibiotic use in acellular dermal matrix-assisted implant-based breast reconstruction
CONCLUSION: The study demonstrated no difference in outcomes between different prophylactic antibiotic regimens in acellular dermal matrix-assisted implant-based breast reconstructions.PMID:33645273 | DOI:10.1308/rcsann.2020.7017 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: Fak Mazari G M Wattoo N H Kazzazi K M Kolar O O Olubowale C E Rogers I A Azmy Source Type: research

Clinical frailty and its effect on the septuagenarian population after emergency laparotomy
Ann R Coll Surg Engl. 2021 Mar;103(3):180-185. doi: 10.1308/rcsann.2020.7028.ABSTRACTINTRODUCTION: The UK has an ageing population with an increased prevalence of frailty in the over 70s. Emergency laparotomy for acute intra-abdominal pathology is increasingly offered to this population. This can challenge decision making and information given to patients should not only be based on mortality outcomes but on relative expected quality of life and change to frailty syndromes.MATERIALS AND METHODS: This was a single site National Emergency Laparotomy Audit (NELA)-based retrospective cohort audit for consecutive cases in the s...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: L Alder S J Mercer N C Carter S K Toh B C Knight Source Type: research

Gastrocnemius suture myodesis for skew flap amputations
Ann R Coll Surg Engl. 2021 Mar;103(3):1-2. doi: 10.1308/rcsann.2020.7056.NO ABSTRACTPMID:33645275 | DOI:10.1308/rcsann.2020.7056 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: A Tang I Massey D C Bosanquet Source Type: research

Hockey: a pain in the butt! Isolated superior gluteal artery rupture following blunt pelvic trauma - an unusual case
Ann R Coll Surg Engl. 2021 Mar;103(3):e91-e93. doi: 10.1308/rcsann.2020.7045.ABSTRACTSuperior gluteal artery rupture is a rare complication of trauma but a significant one with potential for substantial morbidity and mortality. This case demonstrates the importance of early diagnosis and treatment of this injury pattern. Endovascular embolisation has become the most effective treatment for pelvic haemorrhage. Acknowledgement of this rare injury as a differential diagnosis is vital to facilitate rapid diagnosis and appropriate treatment.PMID:33645276 | DOI:10.1308/rcsann.2020.7045 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: H Burton S Mossadegh R McCarthy Source Type: research

A single centre evaluation of risk prediction models and imaging modalities in acute appendicitis
CONCLUSIONS: This study suggests that risk prediction models may be useful in both women and men to identify appendicitis. Ultrasonography gave high rates of equivocal results and should not be relied on for the diagnosis of appendicitis. CT is a highly accurate diagnostic tool and could be considered in those at low risk where clinical suspicion remains to reduce negative appendicectomy rates.PMID:33645277 | DOI:10.1308/rcsann.2020.7033 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J Ashcroft A A Singh S Rooney J Bennett R J Davies Source Type: research

The hidden dangers of staying home: a London trauma unit experience of lockdown during the COVID-19 virus pandemic
CONCLUSION: Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.PMID:33645278 | DOI:10.1308/rcsann.2020.7066 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: L Oliver-Welsh C Richardson D A Ward Source Type: research

Profunda femoris pseudoaneurysm rupture post dynamic hip screw fixation after physiotherapy
Ann R Coll Surg Engl. 2021 Mar;103(3):e81-e84. doi: 10.1308/rcsann.2020.7076.ABSTRACTThis case discusses an elderly female who presented acutely with compromised profunda femoris pseudoaneurysm and massive haematoma five weeks after dynamic hip screw insertion for a left neck of femur fracture. The only precipitating factor leading to this presentation was ongoing physiotherapy. She was referred from a rehabilitation hospital to the nearest vascular surgical unit for acute and definitive surgical intervention. Post-operatively, she fared incredibly well, regaining her baseline level of functioning. History taking is comple...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: K A Hamdulay T P Beresford Source Type: research

The possible effect of different types of ventilation on reducing operation theatre infections: a meta-analysis
CONCLUSIONS: Based on this meta-analysis, operating under laminar airflow or conventional ventilation may have no independent relationship with the risk of surgical site infection. This relationship forces us not to recommend the use of laminar airflow ventilation since it has a much higher cost compared with conventional ventilation.PMID:33645280 | DOI:10.1308/rcsann.2020.7021 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: Q Lv Y Lu H Wang X Li W Zhang Mea Abdelrahim L Wang Source Type: research

Out of hours magnetic resonance imaging for suspected cauda equina syndrome: lessons from a comparative study across two centres
CONCLUSIONS: Over 95% of patients who were transferred for imaging did not undergo emergency decompression. The authors propose a greater role for the provision of out of hours magnetic resonance imaging in all hospitals admitting emergency patients to streamline management.PMID:33645281 | DOI:10.1308/rcsann.2020.7086 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: A Silva B Sachdev M Kostusiak Mubarak Yousif G Flint J Dhir N Furtado R Laing Source Type: research

Penile fracture associated with complete urethra and bilateral corpora cavernosa transection
We describe a case of 36-year-old man who presented to the emergency department with penile fracture during sexual intercourse associated with blood at the meatus and voiding difficulty. On surgical exploration, complete bilateral corpora cavernosa tear and penile urethral transection was noted. The patient was successfully managed with timely repair. This case highlights the need for suspicion of an associated urethral injury in patients of penile fracture with blood at the meatus.PMID:33645282 | DOI:10.1308/rcsann.2020.7042 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J Mathew K Parmar A Chandna S Kumar Source Type: research

Palliative gastrojejunostomy in unresectable cancer and gastric outlet obstruction: a retrospective cohort study
This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre.METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival.RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit fast...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J I Rodr íguez M Kutscher M Lemus F Crovari F Pimentel E Brice ño Source Type: research

A new clinical presentation: breast implant pneumocapsule and pneumothorax following penetrating chest wall trauma
Ann R Coll Surg Engl. 2021 Mar;103(3):e98-e100. doi: 10.1308/rcsann.2020.7038.ABSTRACTPneumothorax resulting from traumatic thoracic injury is a potentially life-threatening emergency requiring prompt recognition and management with an intercostal drain. A 34-year-old woman was brought into the emergency department after sustaining a stab injury to the right upper outer quadrant of the right breast. She described noticing a jelly-like substance from her wound, on the background of a prior cosmetic breast augmentation. On examination, it was noted that the right breast was significantly swollen. Computed tomography demonstr...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J Ashcroft S Murphy T A Laing A J Durrani A Roshan Source Type: research

Isolated brachial artery aneurysm: a rare presentation of paediatric Beh çet's disease
Ann R Coll Surg Engl. 2021 Mar;103(3):e94-e97. doi: 10.1308/rcsann.2020.7037.ABSTRACTBehçet's disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet's disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment inv...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: A L Naik A Savlania A Gupta P Rastogi A Singh Source Type: research

Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19)
We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU.METHODS: We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann-Whitney and Fisher Exact tests were used to test the statistical significance of data.RESULTS: A total of 1,147 patients were seen, with peak attendances between 11am and 2pm...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J W Lim H Rehman S Gaba H Sargeant I M Stevenson D E Boddie Source Type: research

Theatre ventilation
We present an overview of operating theatre ventilation systems and the respective evidence with relation to surgical site infection (SSI) and airborne pathogen transmission in light of COVID-19.METHODS: A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Search terms included "COVID-19", "theatre ventilation", "laminar", "turbulent" and "negative pressure".FINDINGS: Evidence for laminar flow ventilation in reducing the rate of SSI in orthopaedic surgery is widely documented. There is little evidence to support its use in general surg...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: C Theodorou G S Simpson C J Walsh Source Type: research

The significance of Hashimoto's thyroiditis for postoperative complications of thyroid surgery: a systematic review and meta-analysis
CONCLUSIONS: The meta-analysis showed that HT only increased the risk of the postoperative complication THC compared to BN. Understanding the significance of HT in postoperative hypoparathyroidism after thyroid surgery would help clinicians perform sufficient preoperative (and postoperative) assessments and to optimise surgical planning.PMID:33645288 | DOI:10.1308/rcsann.2020.7013 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: X Gan J Feng X Deng F Shen J Lu Q Liu W Cai Z Chen M Guo B Xu Source Type: research

Locally advanced tongue squamous cell carcinoma in epidermolysis simplex bullosa patient: a therapeutic conundrum
Ann R Coll Surg Engl. 2021 Mar;103(3):e85-e87. doi: 10.1308/rcsann.2020.7080.ABSTRACTEpidermolysis bullosa simplex (EBS) is a debilitating condition affecting the skin and mucous membranes that is characterised by frequent ulceration and blistering on trivial trauma. In EBS, oral cavity mucosal injuries lead to a high propensity for developing squamous cell carcinomas. Locally advanced tongue carcinoma arising in this background presents a challenging therapeutic conundrum. To our knowledge, this is the first case of aggressive locally advanced tongue carcinoma that has developed sporadically in a patient with EBS and no f...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: W Al Shareef S Sayed S Kamel H Alkaf A Bahaj R Amin A Al Herabi Source Type: research

Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management
DISCUSSION: The rise in admissions for tonsillitis and its complications appears to correspond closely to the date of SIGN guidance and clinical commissioning group rationing of tonsillectomy and is on the background of a rise in the population of the UK. The move towards daycase tonsillectomy has reduced bed occupancy after surgery but this has been counteracted by an increase in admissions for tonsillitis and deep neck space infections, sometimes requiring lengthy intensive care stays and a protracted course of rehabilitation. The total cost of treating the complications of tonsillitis in England in 2017 is estimated to ...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: M Pankhania J Rees A Thompson S Richards Source Type: research

Novel skin graft donor site for the scalp transposition flap
Ann R Coll Surg Engl. 2021 Mar;103(3):e106-e108. doi: 10.1308/rcsann.2020.7041.ABSTRACTTransposition scalp flaps are a versatile solution for soft-tissue cover in a multitude of scalp defects. They are frequently used to reconstruct larger skin cancers that involve the outer table of the cranium in addition to covering neurosurgical bony defects and hardware. The transposition flap requires the donor site to be grafted using a split-thickness graft, which results in a secondary wound elsewhere on the body, commonly the lateral thigh. Although quite routine in such surgery, this procedure does require another body area to b...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: O Sawyer J Zakaraite Source Type: research

Haemorrhagic shock from solid tumours of the adrenal gland: a case of bleeding primary adrenal lymphoma
We present a novel case of primary adrenal lymphoma with adrenal haemorrhage in a middle-aged woman who presented with right-sided abdominal pain and class 1 haemorrhagic shock. She was found to have spontaneous unilateral adrenal gland haemorrhage in the absence of any underlying previous pathology. Presenting features, diagnosis and subsequent oncological management are reported.PMID:33645269 | DOI:10.1308/rcsann.2020.7040 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: P Bhattacharya R Zakaria S Stonelake B Butler D Sarma M Maheswari S Zaman Source Type: research

A huge abdominal mass revealing a depressive syndrome
We report the case of a giant gastric trichobezoar in a 21-year-old woman who presented with chronic abdominal pain, vomiting and weight loss. Abdominal examination revealed a large epigastric mass. Endoscopic and imaging findings were highly suggestive of a gastric trichobezoar. Surgical extraction of the huge hair mass was successfully performed through an open gastrotomy. Postoperatively, history of a neglected chronic depression with suicidal ideation was diagnosed. Consequently, the patient was referred to the psychiatric department for mental healthcare, to prevent trichobezoar recurrences.PMID:33645270 | DOI:10.1308...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: M Tarchouli B Ait Idir N Bouhabba S D El Jaouhari T Salaheddine Y Hnach A Zentar Source Type: research

Anal cancer survival: a socioeconomic analysis
CONCLUSION: In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.PMID:33645271 | DOI:10.1308/rcsann.2020.7019 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: F Ali A E Ghareeb A Jha H Van der Voet D Garg M Jha Source Type: research

Introduction of a virtual trauma meeting in response to COVID-19
CONCLUSION: Trauma meetings can be safely conducted in a virtual environment with high standards of patient care maintained. Virtual trauma meeting offers service enhancements such as early subspecialty input and enhanced cross-site communication and rapid solution development to logistical difficulties. Adapting to conference call etiquette will enhance user experience and opportunity for training opportunities, but adequate investment in high-quality equipment is essential.PMID:33645272 | DOI:10.1308/rcsann.2020.7018 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: D Burchette C To H Willmott Source Type: research

Prophylactic antibiotic use in acellular dermal matrix-assisted implant-based breast reconstruction
CONCLUSION: The study demonstrated no difference in outcomes between different prophylactic antibiotic regimens in acellular dermal matrix-assisted implant-based breast reconstructions.PMID:33645273 | DOI:10.1308/rcsann.2020.7017 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: Fak Mazari G M Wattoo N H Kazzazi K M Kolar O O Olubowale C E Rogers I A Azmy Source Type: research

Clinical frailty and its effect on the septuagenarian population after emergency laparotomy
Ann R Coll Surg Engl. 2021 Mar;103(3):180-185. doi: 10.1308/rcsann.2020.7028.ABSTRACTINTRODUCTION: The UK has an ageing population with an increased prevalence of frailty in the over 70s. Emergency laparotomy for acute intra-abdominal pathology is increasingly offered to this population. This can challenge decision making and information given to patients should not only be based on mortality outcomes but on relative expected quality of life and change to frailty syndromes.MATERIALS AND METHODS: This was a single site National Emergency Laparotomy Audit (NELA)-based retrospective cohort audit for consecutive cases in the s...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: L Alder S J Mercer N C Carter S K Toh B C Knight Source Type: research

Gastrocnemius suture myodesis for skew flap amputations
Ann R Coll Surg Engl. 2021 Mar;103(3):1-2. doi: 10.1308/rcsann.2020.7056.NO ABSTRACTPMID:33645275 | DOI:10.1308/rcsann.2020.7056 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: A Tang I Massey D C Bosanquet Source Type: research

Hockey: a pain in the butt! Isolated superior gluteal artery rupture following blunt pelvic trauma - an unusual case
Ann R Coll Surg Engl. 2021 Mar;103(3):e91-e93. doi: 10.1308/rcsann.2020.7045.ABSTRACTSuperior gluteal artery rupture is a rare complication of trauma but a significant one with potential for substantial morbidity and mortality. This case demonstrates the importance of early diagnosis and treatment of this injury pattern. Endovascular embolisation has become the most effective treatment for pelvic haemorrhage. Acknowledgement of this rare injury as a differential diagnosis is vital to facilitate rapid diagnosis and appropriate treatment.PMID:33645276 | DOI:10.1308/rcsann.2020.7045 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: H Burton S Mossadegh R McCarthy Source Type: research

A single centre evaluation of risk prediction models and imaging modalities in acute appendicitis
CONCLUSIONS: This study suggests that risk prediction models may be useful in both women and men to identify appendicitis. Ultrasonography gave high rates of equivocal results and should not be relied on for the diagnosis of appendicitis. CT is a highly accurate diagnostic tool and could be considered in those at low risk where clinical suspicion remains to reduce negative appendicectomy rates.PMID:33645277 | DOI:10.1308/rcsann.2020.7033 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J Ashcroft A A Singh S Rooney J Bennett R J Davies Source Type: research

The hidden dangers of staying home: a London trauma unit experience of lockdown during the COVID-19 virus pandemic
CONCLUSION: Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.PMID:33645278 | DOI:10.1308/rcsann.2020.7066 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: L Oliver-Welsh C Richardson D A Ward Source Type: research

Profunda femoris pseudoaneurysm rupture post dynamic hip screw fixation after physiotherapy
Ann R Coll Surg Engl. 2021 Mar;103(3):e81-e84. doi: 10.1308/rcsann.2020.7076.ABSTRACTThis case discusses an elderly female who presented acutely with compromised profunda femoris pseudoaneurysm and massive haematoma five weeks after dynamic hip screw insertion for a left neck of femur fracture. The only precipitating factor leading to this presentation was ongoing physiotherapy. She was referred from a rehabilitation hospital to the nearest vascular surgical unit for acute and definitive surgical intervention. Post-operatively, she fared incredibly well, regaining her baseline level of functioning. History taking is comple...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: K A Hamdulay T P Beresford Source Type: research

The possible effect of different types of ventilation on reducing operation theatre infections: a meta-analysis
CONCLUSIONS: Based on this meta-analysis, operating under laminar airflow or conventional ventilation may have no independent relationship with the risk of surgical site infection. This relationship forces us not to recommend the use of laminar airflow ventilation since it has a much higher cost compared with conventional ventilation.PMID:33645280 | DOI:10.1308/rcsann.2020.7021 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: Q Lv Y Lu H Wang X Li W Zhang Mea Abdelrahim L Wang Source Type: research

Out of hours magnetic resonance imaging for suspected cauda equina syndrome: lessons from a comparative study across two centres
CONCLUSIONS: Over 95% of patients who were transferred for imaging did not undergo emergency decompression. The authors propose a greater role for the provision of out of hours magnetic resonance imaging in all hospitals admitting emergency patients to streamline management.PMID:33645281 | DOI:10.1308/rcsann.2020.7086 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: A Silva B Sachdev M Kostusiak Mubarak Yousif G Flint J Dhir N Furtado R Laing Source Type: research

Penile fracture associated with complete urethra and bilateral corpora cavernosa transection
We describe a case of 36-year-old man who presented to the emergency department with penile fracture during sexual intercourse associated with blood at the meatus and voiding difficulty. On surgical exploration, complete bilateral corpora cavernosa tear and penile urethral transection was noted. The patient was successfully managed with timely repair. This case highlights the need for suspicion of an associated urethral injury in patients of penile fracture with blood at the meatus.PMID:33645282 | DOI:10.1308/rcsann.2020.7042 (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J Mathew K Parmar A Chandna S Kumar Source Type: research

Palliative gastrojejunostomy in unresectable cancer and gastric outlet obstruction: a retrospective cohort study
This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre.METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival.RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit fast...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J I Rodr íguez M Kutscher M Lemus F Crovari F Pimentel E Brice ño Source Type: research

A new clinical presentation: breast implant pneumocapsule and pneumothorax following penetrating chest wall trauma
Ann R Coll Surg Engl. 2021 Mar;103(3):e98-e100. doi: 10.1308/rcsann.2020.7038.ABSTRACTPneumothorax resulting from traumatic thoracic injury is a potentially life-threatening emergency requiring prompt recognition and management with an intercostal drain. A 34-year-old woman was brought into the emergency department after sustaining a stab injury to the right upper outer quadrant of the right breast. She described noticing a jelly-like substance from her wound, on the background of a prior cosmetic breast augmentation. On examination, it was noted that the right breast was significantly swollen. Computed tomography demonstr...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: J Ashcroft S Murphy T A Laing A J Durrani A Roshan Source Type: research

Isolated brachial artery aneurysm: a rare presentation of paediatric Beh çet's disease
Ann R Coll Surg Engl. 2021 Mar;103(3):e94-e97. doi: 10.1308/rcsann.2020.7037.ABSTRACTBehçet's disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet's disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment inv...
Source: Annals of the Royal College of Surgeons of England - March 1, 2021 Category: Surgery Authors: A L Naik A Savlania A Gupta P Rastogi A Singh Source Type: research