Notes

Factors From the Work Productiveness associated with Western Functioning Women that are pregnant: The Cross-Sectional Review.
Three open fractures and two polytrauma cases were seen that would have normally been managed at the local major trauma centre.

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.
Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. see more 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.
Patients with suspected appendicitis remain a diagnostic challenge. The aim of this study was to validate risk prediction models, and to investigate diagnostic accuracy of ultrasonography and computed tomography (CT) in adults undergoing appendicectomy.

A retrospective case review was performed of patients aged 16-45 years having an appendicectomy between January 2019 and January 2020 at a tertiary referral centre. Primary outcomes were the accuracy of a high risk appendicitis risk score and ultrasonography and CT imaging modalities compared with histological reports following appendicectomy.

A total of 206 patients (52% female) were included in the study. Removal of a histologically normal appendix was equally likely in men and women (13.1% vs 11.2% respectively, relative risk 1.17, 95% confidence interval 0.56-2.44,
=0.674). A high risk appendicitis score correctly identified 84.0% (79/94) of cases in men and 85.9% (67/78) of cases in women. Ultrasonography was reported as equivocal in 85.7% (18/21) of low risk women and 59.0% (23/39) of high risk women. CT correctly detected or excluded appendicitis in 75.0% (6/8) of low risk women and 88.5% (23/26) of high risk women.

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.
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.Superior 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.
The UK has an ageing population with an increased prevalence of frailty in the over 70s. link2 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.

This was a single site National Emergency Laparotomy Audit (NELA)-based retrospective cohort audit for consecutive cases in the septuagenarian population assessing mortality, length of stay outcome and subjective postoperative functioning. Follow-up was conducted between one and two years postoperatively to determine this.

Some 153 patients were identified throughout the single site NELA database. Median age was 79 years with a ratio of 1.7 men to women. Median rate of all-cause mortality was 35.3% at the median follow-up of 19 months. Median time from admission to death was 120 days. Of those who had died by the time of follow-upoperative rehabilitation and careful recovery is paramount. Where possible, during the counselling and consent for emergency laparotomy, significant postoperative long-term deterioration in physical, emotional and social function should be considered.
Prophylactic antibiotics are used in acellular dermal matrix-assisted implant-based breast reconstructions. However, there are no universally accepted guidelines regarding the best regimen. This retrospective, multicentre study was designed to compare the different prophylactic antibiotic regimens in these patients in three hospitals across two NHS trusts over a five-year period.

Case notes and electronic records were reviewed for all patients undergoing acellular dermal matrix-assisted implant-based breast reconstructions between January 2010 and December 2014. Prophylactic antibiotic regimens, duration of use, wound infection, implant loss, seroma and therapeutic antibiotic use was recorded. Patients were divided into groups based on prophylactic antibiotic regimen and actual duration of use. Intergroup analysis was performed using Stata 13.0. Implant loss due to infection was the primary outcome measure.

A total of 105 patients had 122 breast reconstructions performed over the study period. Four propstructions.
The COVID-19 pandemic has had a huge impact on all our lives, both personally and professionally, and in many ways has been a catalyst for change. Limitations on social gathering have called the wisdom of a conventional trauma meeting into question. We have initiated our virtual trauma meeting and report our early results.

Daily morning trauma meetings are now conducted online. Following instigation, we collated the results of a feedback form completed online to assess the relative merits of a virtual trauma meeting.

There were 27 responses received to the electronically administered virtual trauma meeting evaluation survey, from a range of trauma and orthopaedic department personnel. There were no concerns regarding patient safety or decision making and, apart from the quality of the audio (63% dissatisfied or very dissatisfied) positive feedback outweighed negative feedback in every category. At 74%, the majority of respondents were satisfied or very satisfied overall with the virtual trauma meeting.

Trauma meetings can be safely conducted in a virtual environment with high standards of patient care maintained. link3 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.
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.
Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre.

All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan-Meier analysis and Cox regression was used to investigate the effect of different factors on ovee between socioeconomic groups.
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.Trichobezoar is a rare condition that occurs mostly in young women with psychiatric disorders such as trichotillomania and trichophagia. 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.Suprarenal or adrenal gland haemorrhage is an uncommon but potentially lethal condition if unrecognised. Adrenal masses rarely present with haemorrhage, but they remain an important differential aetiology for adrenal bleeding. 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.Transposition 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 be prepared and draped. We sought to streamline this procedure with an adjustment to the location of the donor site. In harvesting the graft from the skin of the flap itself, we localised all surgery to one area, which has a number of logistical and patient-care advantages. Our experience has shown significant benefits from this technique and this is now our chosen and recommended donor site for these reconstructions.
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