Bedford Hospital NHS Trust

We aim to describe our centre's one-year experience after establishing our robotic programme for colorectal surgery. Demographic, peri-operative, and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic-assisted colorectal procedures carried out at our centre. All robotic colorectal resections were completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform. Fifty-eight robotic colorectal resections were compared to 58 from the laparoscopic cohort, all indicated for malignancy. No statistical difference was observed between the demographics of the two cohorts regarding sex, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) grade. 33/58 (56.9%) robotic resections were left-sided compared to 36/58 (62.1%) laparoscopic resections. One robotic case was converted to open (1.7%), with four (6.9%) in the laparoscopic group converted to open. Laparoscopic procedures were shorter (median operative time 282min compared to 384min, p<0.001, Wilcoxon rank-sum). Subgroup analysis for patients with ASA grades 1&2 showed shorter operative times in the laparoscopic cohort compared to the robotic cohort (p=0.003, Wilcoxon rank-sum). The median length of stay was five days for both cohorts. Significant postoperative complications (Clavien-Dindo ≥3) occurred in 3.45% (n=2/58) vs. 10.3% (n=6/58), which was not significantly different statistically. No mortalities were recorded within 90 days of the procedures in both cohorts, but at one-year follow-up, we observed one mortality in each cohort. Other than longer operative times for ASA grades 1/2 patients, robotic colorectal resection outcomes in a small district hospital setting are comparable to laparoscopic resections.

Fixation of the Felix IV tibial fractures after total knee arthroplasty is complicated. Additionally, the rarity of this type of injury further complicates the situation due to the lack of established fixation techniques, in contrast to other periprosthetic knee fractures. Artificial ligaments are currently used in a wide range of orthopedic procedures, from anterior cruciate ligament reconstruction to tendon and ligament augmentation in different joints. Using artificial ligaments for these specific types of fractures may offer an advantage.A lady in her late 70s presented with a Felix IV fracture, ongoing knee pain, and distal wound dehiscence following a twisting knee injury on postoperative day 14 after her complex primary total knee replacement, where a rotating hinge implant was used. In this particular case, fixation with plates and screws was not possible due to poor bone quality and the nature of the implant. Therefore, fixation was performed using Ortho-tape, a polyethylene terephthalate (polyester) (Neoligaments, Leeds, United Kingdom), along with FiberWire (Ethicon, Raritan, New Jersey, United States) to manage her injury.The aim of this report is to introduce a novel surgical technique employing artificial ligaments, specifically Ortho-tape, a polyethylene terephthalate (polyester) material (Neoligaments), and FiberWire (Ethicon), without the use of metal components. Positive clinical and radiographic outcomes at the 18-month follow-up demonstrate that this method is effective in restoring knee joint extension, minimizing disabilities, and alleviating pain associated with periprosthetic Felix IV fractures.

Abstract Background The AI-based CariHeart Risk calculator has been developed using cardiac CT angiography (CCTA) assessment of the peri-coronary artery inflammation (FAI) and conventional cardiovascular risk factors to predict 8 years fatal and non-fatal cardiovascular events. As one of the 5 chosen Hospitals in the United Kingdom we have performed and interim analysis to assess the impact of the proposed new chest pain pathway on the risk stratification of patients referred for suspected angina to the Rapid Access Chest Pain Clinic (RACPC). Objective We set out to investigate the interaction (risk stratification predictive power) between the degree of coronary artery disease (CAD), the FAI risk score and the AI-based CariHeart Risk score. Methods 135 consecutive patients referred to the RACPC are part of this analysis. 2 patients had no contrast CCTA images at patient request and were excluded. Risk stratification was defined as no or mild CAD (&amp;lt;50% stenosis), moderate, (50-69% stenosis), severe (&amp;gt;70% stenosis) based on the degree or coronary artery luminal stenosis, low FAI score defined less then 50 percentile for any coronary artery, intermediate FAI score defined 50-75 percentile for LAD/RCA or 50-90 percentile for LCX, and high FAI score defined &amp;gt;75 percentile for LAD/RCA and &amp;gt;90 percentile for LCX. Low AI- CariHeart risk score was defined &amp;lt;1% 8 years CV mortality, intermediate risk 1-5% CV mortality, and high risk if &amp;gt;5% CV mortality. Results We found that patients with No or mild atherosclerotic CAD had a low FAI score in 4/114 (3.5%), intermediate score in 16/114 (14%), and high score in 94/114 (82%), (p&amp;lt;0.00001). Low CariHeart risk score was found in 4 (3.6%), intermediate risk score in 47 (41%), and high-risk score in 63 (55%) (p&amp;lt;0.0001). In No-or mild CAD patients the FAI score identified larger number of patients then CariHeart risk score as high risk 82% vs 55%, p&amp;lt;0.0001. However, merging the intermediate and high FAI score patients and compare it with the merged intermediate and high CariHeart risk score patients the two scores identified the same proportion of patients 97%. The 13 patients with moderate CAD on CCTA, low FAI score was found in none, intermediate score in 38%, and high score in 62%, (p=0.025). Low CariHeart risk score was found in none, intermediate risk score in 8%, and high-risk score in 92%, (p&amp;lt;0.007). High FAI score was found in all 3 cases whereas high CariHeart score in 2 cases and intermediate in 1 with severe CAD on CCTA. Conclusion The AI-based new chest pain pathway utilising CCTA images has identified higher proportion of at-risk patients particularly those with non-obstructive CAD. FAI score and CariHeart risk score seems to perform similarly in the aggregate intermediate and high-risk groups. To assess the value of the NP on real world outcome and the effect of new and conventional cardiovascular preventative therapy is warranted.

BackgroundDeep vein thrombosis (DVT) is a known postoperative complication associated with morbidity and mortality. Colorectal cancer patients have a higher risk of developing postoperative DVT, considering the long duration of surgery, positioning during surgery, pelvic dissection, and neoadjuvant chemoradiotherapy. For them, current guidelines recommend a protocol of 28-day postoperative pharmacological thromboprophylaxis with low-molecular-weight heparin (LMWH), unfractionated heparin, or fondaparinux, along with mechanical thromboprophylaxis like graduated compression stockings (GCS). However, most patients receive only in-hospital thromboprophylaxis. The aim of this study was to estimate the frequency of DVT in patients undergoing curative intent surgery for colorectal cancer, followed by postoperative thromboprophylaxis with GCS during their in-hospital stay in the Indian population.MethodsPatients undergoing curative intent surgery for colorectal cancer were screened for occult pre-operative DVT including a duplex ultrasound. All patients received in-hospital thromboprophylaxis with LMWH and GCS and were followed up for 28 days to six months after surgery to screen for symptomatic and asymptomatic DVT during their follow-up.ResultsOf the 42 patients recruited to the study, 13 were followed up with Doppler ultrasonography and 29 were followed for symptoms of DVT telephonically. No asymptomatic DVT or symptomatic DVT was detected during the follow-up. There was no significant difference in the risk factors between those who underwent follow-up Doppler ultrasonography and those who did not, except that those who did have follow-up Doppler ultrasonography had a greater exposure to neoadjuvant and/or adjuvant therapy.ConclusionsOur study suggests that thromboprophylaxis during the in-hospital postoperative period along with GCS was sufficient for preventing symptomatic or asymptomatic postoperative DVT in patients undergoing curative-intent surgery for colorectal cancer. However, a study with a larger sample size is required to recommend this for thromboprophylaxis in patients undergoing surgery for colorectal cancer in India.

Abstract Re-expansion pulmonary oedema (REPE) is a rare but potentially fatal complication following rapid re-expansion of a collapsed lung, typically after treatment for pneumothorax or pleural effusion. We report the case of a 32-year-old male who developed REPE following chest tube drainage for a large left-sided spontaneous pneumothorax. Initial chest radiographs confirmed the pneumothorax, and subsequent imaging revealed progressive unilateral alveolar infiltrates. High-resolution computed tomography (HRCT) demonstrated diffuse ground-glass opacities and consolidation in the re-expanded lung, consistent with REPE. The patient was managed conservatively with high-flow oxygen, noninvasive ventilation, intravenous diuretics, and corticosteroids, leading to full recovery. This case underscores the importance of recognizing imaging features of REPE and implementing preventive strategies, such as controlled drainage and pleural pressure monitoring, to mitigate risk.

Abstract Background Stress echocardiography (SE) had been recommended by the professional Societies in assessing patients with suspected angina. SE protocols are variable across hospitals and countries in the recommendation of the cessation of rate controlling medication (RCMx) prior to SE. Some expert opinion paper recommends the cessation of beta-receptor blockers (BB) and rate controlling calcium channel blockers 48 hrs prior to SE to improve diagnostic accuracy of the test. This can impact on the efficient management of SE waiting list in addition can result in haemodynamic rebound effect leading to accelerated angina or hypertension. Objective To investigate the efficacy of Dobutamine SE in a cohort of patients where the cessation of rate controlling medication has not been mandated, we reviewed our results over one year period in patients investigated for suspected coronary artery disease (CAD). Method Two hundred and twenty-seven consecutive patients underwent Dobutamine SE between January 2022 and January 2023 in a single centre. In addition to dobutamine the protocol allowed the administration of intravenous Atropine (maximum dose of 1.2mg), and "top up" handgrip exercise at the discretion of the performing cardiologist. We assessed the DSE outcome (positive vs negative), target (85% of maximum age predicted) heart rate (THR) and the achieved peak HR, in the two groups with RCMx and without (No-RCMx). We analysed the patients’ characteristics and 12 months outcome of a combined MACE of death, non-fatal MI, stroke, admission with angina, unplanned revascularisation. Results Of the 227 patients 59% were on No-RCMx (male 49%). 88% of the patients in the RCMx group were on BB and 12 % on other RCMx. The THR was achieved in 74% of the RCMx and 90% in No-RCMx groups p=0.001. Positive Dobutamine SE was observed in 49% (46/93) of patients on RCMx vs 28% (38/134) on No-RCMx (p=0.001). Patients who did not reach THR 41% (15/37) had positive Dobutamine SE compared to 36% (69/190) who reached THR (p=0.626). There was no difference between groups in the peak WMSI. Logistic regression analysis showed that THR is not an independent determinant of positive Dobutamine SE (OR: 1.3, 95% CI 0.47-3.59, p=0.611), but being on RCMx was (OR 2.03, 95% CI 1.06-3.91, p=0.034). The MACE rate was higher in patients where the THR was not achieved (10/37, 27.0%) vs those with THR achieved (12/190, 6.3%) p&amp;lt;0.0001; in both the RCMx (8/24, 33% vs 8/69, 12%, p=0.015) and No-RCMx (2/12, 15% vs 4/121, 3%; p=0.045) groups respectively. RCMx was a determinant of MACE (OR 3.67, 95% CI 1.04-13.02, p=0.043) Conclusion This retrospective analysis of Dobutamine SE data proved same efficacy in patients with and without RCMx investigated for suspected CAD. The use of RCMx proved to be a predictor of both SE and MACE outcome irrespective the achieved THR. Our data show that patients referred for Dobutamine SE on RCMx can continue without impact on the test accuracy.

Gallbladder cancer frequently leads to the replacement or damage of the gallbladder, with both focal and diffuse wall thickening being common findings. Hypo-isoenhancement was the most prevalent imaging pattern, while hyperenhancement was less common. Although intraluminal polypoidal growth did not significantly correlate with metastasis, wall thickening was significantly associated. These results emphasize the importance of specific imaging patterns in assessing the severity of gallbladder cancer and informing treatment strategies.