Sigmoid volvulus: Surgical intervention or

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aims to improve awareness of organ donation and transplantation (ODT) at medical ... Methods: A 33-item online questionnaire was distributed to 957 medical.
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Abstracts / Annals of Medicine and Surgery 3 (2014) 47–50

incontinence. However, the significant difference in body image observed echoes findings in earlier studies. KNOWLEDGE AND ATTITUDES OF MEDICAL STUDENTS TOWARDS ORGAN DONATION AND TRANSPLANTATION K.K. Bedi*, A. Hakeem, R. Dave, K.R. Prasad, N. Ahmad. Leeds Aims: The shortage of organ donors is still a fundamental problem in the UK. Many strategies have been put forward to overcome this, one of which aims to improve awareness of organ donation and transplantation (ODT) at medical student level. This survey seeks to identify current knowledge and attitudes of medical students towards ODT. Methods: A 33-item online questionnaire was distributed to 957 medical students at the University of Leeds (October-December 2012). Results: There were 215 (22.5%) respondents. Students were aware of kidney, heart and liver transplantation (98.5%, 95.5% and 93.0%). Awareness of small intestine (39.5%) and limb (39.0%) transplants were poor. Students understood the term Brain Stem Death (BSD, 88.1%), however they lacked understanding of criteria used for BSD testing (59.2%). Despite 59.5% indicating they would feel comfortable addressing a patient's questions about ODT, 43.3% were unhappy with their current knowledge. 87.6% agree that ODT teaching should be included in the curriculum. 63.8% would select a topic of transplantation for their studentselected module. Conclusion: Students have basic understanding of ODT but they lack detailed knowledge. They accept its importance and desire further teaching to supplement their current knowledge in order to be able to truly understand the issues related to ODT. VILLUS MORPHOGENESIS DURING INTESTINAL DEVELOPMENT: A PROXIMAL-DISTAL SIGNALLING CASCADE OR INTRINSIC TRIGGERING? G. Deehan*, R.W. Partridge, J.A. Davies. Edinburgh Aims: Villus morphogenesis is the process by which the luminal epithelium of the intestine changes from being a flat surface to having crypts and villi. In mammalian development, villi form in proximal bowel first and subsequently spread distally in a wave of morphogenesis. Better understanding the factors controlling the development and maintenance of villi may help guide therapies for patients suffering post-bowel resection intestinal failure. It is not known whether the propagation of villus morphogenesis occurs as a result of a proximal–distal signaling cascade, or by intrinsic factors which trigger villus growth at predetermined timepoints. An embryonic mouse tissue culture model was used to explore this. Method: Embryonic mouse small intestine was dissected at day 11.5 and cultured in a low volume of media. Four groups were established: (1) control - intestine cultured intact; (2) divided one third of the way along and reapposed at same position; (3) middle third removed (proximal third apposed to the distal third); (4) middle third reversed and re-inserted. Villus morphogenesis was assessed using brightfield microscopy, timelapse in-incubator microscopy, histology and immunohistochemistry. Results: Embryonic mouse intestine was successfully cultured in vitro for 5-7 days. During this time it elongated, commenced rhythmical peristaltic contractions and develop villi. The wave of villus morphogenesis was not affected by dissecting and reapposing in-situ. A delay was seen at the join when the middle third of the gut was removed. When the middle third was reversed, villi developed distally prior to proximally. Conclusion: Our findings suggest that villus morphogenesis occurs due to location-specific intrinsic factors, rather than a proximal to distal signalling cascade. Further work is required to quantify villus growth and explore candidate triggering factors. PATI: PATIENT ACCESSED TAILORED INFORMATION N.M. Foley*, G. Connolly, S. Tabirca, B. Maher, T. Cil, M.A. Corrigan. Cork Aims: Gaining empowerment through knowledge is a common theme among breast cancer patients. Information gathering can reduce feelings of uncertainty and produce feelings of hope and being in control. We have

developed a mobile application that is not only educational but also supports early discharge and remote monitoring of post operative patients, independent of geographical location. Methods: Developed over 6 months, the app contains patient tailored content, including information on patient specific surgery as well as general breast cancer related information. Patients update drain output and pain scores daily; information which is directly relayed to the phone of the relevant breast care nurse and surgeon. Additionally patients can communicate anonymously with other study participants through a moderated ‘whiteboard’. Direct patient video/audio education is delivered on drain and wound care, along with physiotherapy and past patients delivering frequently asked questions. Results: Adhering to eMedical developmental protocols and in partnership with NALA (national adult literacy agency) the application is now available on iPads used by participating breast cancer patients. The study is at the accrual stage with data collected on knowledge acquisition, anxiety and technology familiarity. In tandem qualitative and quantitative assessment of use of the app is also collected. Conclusions: This project reflects the initial stages in the development of online patient pathways for breast cancer care. PATI will empower patients and primary care, shifting the care paradigm away from tertiary centres and towards the community. PROGRESSION OF OPEN APPENDECTOMIES DURING ST3 R. Fernandes*, P.S. Basnyat. Ashford Aims: The purpose of the study was to assess the performance of a first year surgical registrar to perform an Appendicectomy. Duration of the operation, length of stay post-surgery, readmission, complications and analgesic requirements following surgery were evaluated. Methods: Data was collected prospectively between September 2012September 2013 on all appendicectomies done by a single surgical trainee in a District General Hospital. Results: 82 Appendicectomies (Open) were performed during the year. Intra-operative TEP blocks were given to all patients. There was no significant difference in ASA status between groups of patients in each quarter. The number of operations in each quarter was identified; 17, 22, 23 and 20 respectively. The mean duration of the operation shortened from 78 minutes in the first quarter to 41 minutes in the final quarter. The post operative length of hospital stay also shortened from a mean 1.8 days in the first quarter to 1.1 days in the final quarter. 17% of patients operated during the first quarter required opiates on day 1 post operation whilst only 5% of patients operated on in the final quarter required such analgesia. There were 3 cases of readmission. Two patients had histology of neoplasia requiring further surgery and one patient had a collection which was treated conservatively with antibiotics. Conclusions: The results show that as a trainee builds experience their performance and operative outcomes also improve. The District General Hospital setting provides good exposure and encourages performance to improve from the given caseload. This is within the current climate of the European Working Time Directive and a consequentially reduction in trainee operating time. SIGMOID VOLVULUS: SURGICAL INTERVENTION OR CONSERVATIVE MANAGEMENT? N. Heywood*, W. Chu, M. Wilkinson. Morecambe Bay Aims: Sigmoid Volvulus is the most common form of volvulus of the gastrointestinal tract and accounts for 8% of intestinal obstruction. There are no specific guidelines and non-definitive management has high recurrence rates. Our aim was to review current practice over a 5 year period. Methods: 20 patients were identified through clinical coding to have a diagnosis of sigmoid volvulus (age range 48-97 years). Each underwent restrospective review of management. Results: 14 (70%) were treated conservatively with either flatus tube insertion or flexible sigmoidoscopy. 6 (30%) underwent definitive surgical intervention (2 with primary anastomosis, 3 end colostomy, 1 loop colostomy). Mean survival in those treated conservatively (age range 76-97)

Abstracts / Annals of Medicine and Surgery 3 (2014) 47–50

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was 363 days (30%). 4 patients died on 1st admission, 6 patients died on subsequent admissions. Of those who died, 6 (60%) had a diagnosis of dementia, one which had treatment with recurrent sigmoidoscopy over a course of 22 months. Of those treated by surgical intervention (age range 48-86), survival was 100% based on mean survival of 630 days at time of review, none of which had readmission after surgery. Conclusion: There is an urgent need for guidelines for management of patients with sigmoid volvulus, however, surgical intervention should be preferred choice of definitive management. Yassaie et al recently showed high recurrence rate in conservative treatment, and favours the role of surgery. It is unclear of the role of repeat endoscopic decompression, and its role is one to be considered in patients who may not be suitable for surgery or in those who may not be able to manage a stoma.

(OR 95%CI) for ethnicity and baseline characteristics. IMT was greater in Group B with a mean of 0.101mm0.031 (SD) compared with 0.0790.031 (p¼0.04). Group B had more plaque present (p¼0.009). There was no difference in surface morphology or degree of stenosis. However, the median age for soft homogenous plaque was higher (p¼0.016). Conclusion: This study demonstrated encouraging preliminary results that octogenarians-plus should be assessed for vulnerable plaque compared with younger adults. The data from this study may help to improve the management of patients with potential risk of stroke.

THE GLYCOLYTIC SWITCH IN THE DEVELOPMENT AND PROGRESSION OF COLORECTAL CANCER

J. Clark, R. Wong, A. Richardson, J. Vatish*, A. Haque, A. Bello, D. AlMusawi. Epsom

V. Cubas*, J.W. Taanman, O. Obunbiyi, B. Fuller, B. Davidson, S.N. Dijk. London

Aims: The laparoscopic inguinal hernia repair has gained significant interest over the years as an alternative to the conventional open technique as a result of its faster recovery time, reduced postoperative pain and numbness. Recurrence occurs either caudal to the fold created in the mesh once in-situ or lateral to the border of the mesh. This technique aims to address both these areas of concern using an additional strip of mesh across the centre to brace the mesh and create a bolster to maintain mesh stability. Method: The technique involves cutting a 2cm strip from the 15x15cm mesh which is laid lengthways over the remaining 13x15cm mesh, keeping the longest dimension in the medial to lateral plane, and loosely tacked (Figure). The strip over hangs the lateral border of the mesh to control the lateral space. Recurrence rates were evaluated from a prospectively collected data series as well as outcomes collected from a questionnaire over a 10 year period between January 2001 and October 2011. Primary outcomes were confirmed hernia recurrence requiring surgical repair. Results: 491 patients underwent laparoscopic TEP hernia repair with outcomes including recurrence rates were retrospectively examined through a prospectively collected database. Subsequently 400 patients were sent a validated questionnaire. 246 responded (62% response rate). One recurrence (0.3%), which occurred 4 years after the original laparoscopic repair, was described across the series. Conclusion: The use of the additional mesh strip potentially reduces TEP hernia recurrence rates beyond simply the benefits of the learning curve. Although, questionnaires are notoriously inaccurate, the value and consistency between both evaluation techniques suggests that this level of reduction is significant to warrant further prospective trials.

Aims: In cancer tissue, mitochondrial respiration is reduced, mitochondrial cristae are smaller and there are fewer mitochondria per cell. Conversely, markers of glycolysis are increased. These observations suggest a shift in glucose metabolism away from oxidative phosphorylation. The aim of this study was to assess the extent of the glycolytic switch in human primary colorectal carcinoma and liver metastatic tissue by measuring the activity of the mitochondrial oxidative phosphorylation enzyme cytochrome-c oxidase. Methods: Surgical specimens of patients undergoing resection of primary colon tumours (n¼10) and liver metastases resection (n¼18) were collected. Malignant and metastatic tissues were matched with normal tissue. Mitochondrial fractions were isolated and the activity of cytochrome-c oxidase was measured. In addition, the mitochondrial citric acid enzyme citrate synthase was measured to correct for differences in mitochondrial enrichment of the samples. Results: The relative cytochrome-c oxidase activity was 3.6-fold lower in colorectal carcinoma compared to the matched normal colorectal tissue, whereas the activity was 2.8-fold lower in metastatic tissue compared to the matched normal liver. . Conclusion: The glycolytic as well as the oxidative phosphorylation pathway may potentially serve as a target in cancer therapy. The results of this study help to define the extent of the glycolytic switch during malignant transformation of colorectal cancer and suggest that the glycolytic switch is larger in primary tumour than in metastatic tissue. Our work suggests that glycolysis is a potential target at the early stage of the disease, whereas mitochondria are a potential target at the late stage. A PRELIMINARY COMPARATIVE CROSS-SECTIONAL ANALYSIS PLAQUE MORPHOLOGY AND CAROTID ATHEROSCLEROSIS OCTOGENARIANS PLUS AND A YOUNGER COHORT

OF IN

L.S. Alder*, M. Aslam, N.J. Standfield. London Aims: Significant symptomatic carotid stenosis can be treated by carotid endarterectomy, furthermore features of plaque stability can predict risk of symptoms of transient ischaemic attack, stroke and amaurosis fugax. In the UK the octogenarians plus population will reach 8 million by 2050, subgroup assessment for carotid plaque morphology may define altered features of stability in this group. This study aimed to assess differences in carotid artery stenosis, and plaque morphology between a group aged over 80 and those aged less than 80. Method: A preliminary retrospective sample of patients (n¼44) who presented with symptoms of suspected carotid disease to a vascular investigation clinic from 2009-2013 were reviewed. Co-morbidities and measurements for intima media thickness (IMT), carotid stenosis and plaque characteristic were categorised. Comparative assessment of two groups those under 80 (Group A, n¼19) and those 80 and over (Group B, n¼25). Results: The median age in Group A was 66(interquartile range 51.9-69.1) compared with 84(IQR 81.3-87.3), Group B had more females (p¼0.079) but no statistically difference in odds ratio with 95% confidence interval

AN ADDITIONAL STRIP OF MESH MINIMISES HERNIA RECURRENCE AFTER LAPAROSCOPIC TOTALLY EXTRAPERITONEAL (TEP) INGUINAL HERNIA REPAIR; AN ANALYSIS OF 490 CASES OVER 10 YEARS

DIRECT FRACTURE RESISTANCE TESTING OF BONE IN CHILDREN USING THE RPI INSTRUMENT S. Foster*, L. Forestier-Zhang, P. Grabowski, O. Gallagher, S. Madan, P. Arundel, N. Bishop. Sheffield Aims: There is currently no clinical investigation to measure the mechanical properties of bone which contribute to whole bone strength. The Biodent Reference Point Indentation (RPI) instrument directly measures how mechanical properties of bone influence its fracture resistance. The greater the indentation distance of the RPI test probe into the cortex, the lower the fracture resistance. RPI is superior to DEXA in identifying patients with a previous fracture. Although uncommon, the morbidity, mortality and financial burden of paediatric bone diseases are substantial. This project aims to validate the use of the RPI instrument as a predictive tool for bone fragility in children and develop a safe, practicable and clinically effective ex vivo testing protocol. The ultimate goal would be a handheld tool for in vivo outpatient testing. Methods: Femoral osteotomy samples from 12 paediatric patients aged 015 years were collected alongside preoperative blood samples for Vitamin D, Parathyroid Hormone (PTH) and Calcium. RPI was carried out for all samples with 5 indentation cycles at 2N indentation force and 6 different sites were indented per sample. Scanning electron microscopy (SEM) assessed if RPI microindentation had damaged samples. Results: There was a weak statistically significant correlation between the 25(OH)D status and the indentation distance increase (IDI) parameter (P-