Day 2 :
Keynote Forum
Neringa Musteikaite
Lithuanian University of Health Sciences, Kaunas, Lithuania
Keynote: Pancreatitis, panniculitis, polyarthritis (PPP-) syndrome caused post-pancreatitis mesenteric vein necrosis. A case report
Biography:
Neringa Musteikaite has completed her medicine from Lithuanian university of Health Sciences and she is pursuing her Pathologist Resident from Lithuanian university of Health Sciences. She is the member of Lithuanian Society of Pathology. She has presented an oral report at the conference organised by Lithuanian Society of Pathology.
Abstract:
Pancreatic disease can rarely express itself by extra-abdominal pathological processes. The symptomatic triad of pancreatic disease, panniculitis and polyarthritis, also known as PPP syndrome, is characterized by severe chronic episodes and high mortality rate. The pathognomic hallmark of PPP syndrome is fat necrosis in affected tissues. It is essential to identify its indicators due to complicated diagnosis procedure as a result of absent or mild abdominal symptoms. We report a case of 58-year-old male with a history of acute pancreatitis 1 years ago, admitted to University Hospital because of progressing feet joint arthritis, panniculitis, and febrile fever with chills lasting for approximately 2 weeks. Significantly increased levels of plasma lipase and α-amylase with inflammatory changes of blood and ascitic fluid were identified by laboratory testing, although patient did not complain of pancreatitis clinical symptoms. Inflammatory features of joints and surrounding soft tissues were detected during palmar ultrasound. Skin biopsy was not informative. Ascites, excessive oedematous changes in multiple organs were identified, whereas no pancreatic parenchymal changes were observed. Patient did not respond to applied treatment, and he died. Predominate peripancreatic steatonecrosis, superior mesenterial vein necrosis with perforation complicated by extensive steatonecrosis at omentum, liver, colon, local lymph nodes, and subcutaneous tissues were identified during an autopsy. Finally, this condition was named as PPP syndrome. Knowledge of association between panniculitis and polyarthritis with acute pancreatic disease may lead to a prompt diagnosis and management. Histopathological features of skin lesions can be a valuable clue for focusing attention to a pancreatic disease.
Keynote Forum
Bishow Bekhyat Karki
University Hospitals of Leicester NHS Trust, UK
Keynote: Accuracy of documenting complications when consenting patients for Laparoscopic Appendectomy
Biography:
Bishow Bekhyat Karki is currently working as a General Surgeon from University Hospitals of Leicester NHS Trust, UK
Abstract:
Background: Correctly performed informed consent acts as a shield against complaints by patients and claims of malpractice against the doctors. Laparoscopic Appendectomy accounts for a significant portion of general surgical workload hence shows a difference in the patient consenting. The purpose of this study is to to compare the variations in consenting practice amongst Foundation Year 2 Doctor (FY2) , Core Surgical Trainees (CT) and Specialist Registrar(SpR) for Laparoscopic Appendectomy with specific reference to the documentation of significant risks of surgery.
Methodology: A proforma was devised which included information like significant and/or commonly recognised complications of Laparoscopic Appendectomy as well as grade of the consenting medical professional. The proforma containing 10 standard complications 5 major and 5 minor) was then cross-referenced with the consent forms of 38 patients and the documented risks in each form was noted.
Findings: The result showed a wide variation in the documentation of complications based on the grades of the medical professional. Out of 38 consent forms, 32 (84.21 %) were completed by Junior Grade Doctors out of which 15 by FY2 and 17 by Core Surgical Trainees and 6/38 (15.78 %) by SpR. Of the set standard 10 complications, FY2 documented an average of 4.2, Core Trainees documented 6.2 and ST3+ documented 8.16 complications.
Conclusion and Significance: There is a need of improvement in the documentation of complications especially among Junior Doctor which require proper intervention either by conducting a consenting workshop or using a Procedure specific consent (PSCF) which can significantly improve consenting practice for a standardised list of complications and act as a source of information for the patient and a prompt to discuss the risks.
Keynote Forum
Bishow Bekhyat Karki
University Hospitals of Leicester NHS Trust, UK
Keynote: Prevalence of SARS-COVID-19 serum IgG antibodies amongst staff on an acute surgical unit
Time : 11:30-12:00
Biography:
Bishow Bekhyat Karki is currently working as a General Surgeon from University Hospitals of Leicester NHS Trust, UK
Abstract:
Background: The United Kingdom now has one of the highest death rates from COVID 19, with over 40,000 deaths (1). It has been posited that the identification of care workers with immunity or increased resistance could be important in developing future strategies.
Methods: This was a retrospectively conducted survey of general surgical staff at a tertiary surgical unit.
Results: We surveyed 215 staff that had undergone antibody testing. Of the: 175/215 who reported contact with COVID-19 positive patients, 6/215 had a positive PCR result and 15/215 reported a positive antibody test. Only 3/6 that had a positive PCR test demonstrated antibodies.
Conclusion: Our “immunity” rate of 7% is extremely low and is concerning especially in respect of the anticipated “herd immunity” which would mitigate many of the issues presently being confronted and it is likely to be many months at least before this makes a realistic contribution. Continued testing for the presence of COVID-19 antibodies will contribute to crucial sero prevalence data that can be used by public health bodies whose advice will necessarily evolve as increasing data sets become available.
- Session Introduction
Session Introduction
Rahul Hajare
Indian Council of Medical Research, New Delhi, India
Title: The first experiment of woman aroused transiting of morphine smell can detecting approach sex
Biography:
Rahul Hajare was fortunate enough to be recognized for hard work with scholarships from India Council of Medical Research Ministry of Health Research New Delhi scholarship including a centenary post doc National AIDS Research Institute Pune that is presented by Respected Dr. R.S.Paranjape, Immunologist and World Renowned Scientist., Retired Director & Scientist ‘G’ National AIDS Research Institute Pune. His initial journey was a quest to heal with a different kind of highly education and did a sponsorship at the Ana Laboratory in Mumbai. After completing his training, he was privileged to practice in KLE College of Pharmacy Bangalore as a board certified Secretary KLE society Belgavi, .he was work to formerly reputed Pune University and services to be recognized by special Investigation team (SIT) for work in education.
Abstract:
A female mind reacts much more and is more stimulated than a male one when aroused. Turns out, a woman's mind is much more complex than a male's when it comes to intimacy. According to a recent Pune University study, a female mind reacts much more and is more stimulated than a male one when transition of morphine to functional morphine. In the study conducted on 20 men and 20 women, each of the individuals was shown erotic film clips while their brain vitals were scanned by two scanners. One of the scanners was an MRI machine that tracked stimulation in their brains. The other was a heat-seeking camera that measured levels of arousal through participant's genitals. While not massive, the recorded difference between stimulation levels between male and female brains highlighted the consistent disparity between the two counterparts. There were no brain regions in men with stronger brain-genital correlations than in women", the study stated, according to the Independent. While interesting, the sample size for the study was too small, according to researcher Pune University. He further added that more detailed research would be required to draw such certain conclusions. However, he did not deny the complexity of female arousal.
Benjamin Schapira
University College London, London, UK
Title: Necrotizing enterocolitis in a patient post Roux-En-Y gastric bypass
Biography:
Benjamin Schapira graduated from UCL in 2020 with an MBBS and BSc in medical sciences. He is a young researcher working with a team of surgeons at the Whittington Hospital lead by Mr Hassan Mukhtar. Hasan Mukhtar completed his MBBS in 1989 at Punjab University, Pakistan followed by advanced surgical training at Oxford Deanery and West from where he was appointed as consultant colorectal and general surgeon at the Whittington Hospital in 2001. He is an Honorary Clinical Associate Professor of Surgery at UCL and has presented and published over 100 publications in national and international meetings and peer-reviewed journals.
Abstract:
Necrotizing enterocolitis (NEC) carries one of the highest mortality rates of all gastrointestinal disorders. Both its pathogenesis and aetiology remain enigmatic in adult patients. We report on the first known case of NEC following Roux-en-Y Gastric Bypass (RYGB) long-term. A 42-year-old female patient (BMI 51.2) underwent RYGB. At 12 months follow-up she presented with diarrhoea, vomiting, tachypnoea and hypotension. She was severely acidotic (pH 6.9), white cell count (24x109/L) and lactate (7.3U/L). CT presented dilated bowel most prominently at the upper jejunum and she subsequently underwent laparotomy for small-bowel resection, subtotal colectomy and end ileostomy. Intraoperatively, patchy necrotic segments of colon were noted. Postoperatively, her lactate increased to 10U/L, necessitating relook laparotomy for further bowel resection. Caecal and ascending colon samples showed ischaemic and necrotic areas with transmural inflammation and marked bacterial overgrowth with no evidence of vascular compromise. These features resembled acute NEC. Clostridium, Campylobacter, Salmonella, Shigella and vasculitis screening were negative. She had a slow recovery, requiring total parenteral nutrition and at 36 months follow-up she is making good progress. We believe an episode of binge eating led to gastrointestinal dilatation as seen in anorexia nervosa following rapid diet change. Such dilatation would diminish blood flow and damage mucosal integrity through ischaemia, permitting invasion of pathogenic gas-forming bacteria. With no specific diagnostic criteria; delayed diagnosis, time to surgery and failure to resect all necrotic tissue exemplify the challenges in management. We believe it’s important to highlight this case to raise awareness of similar presentations in post-bariatric surgery patients.
Mohammed Basamh
Leicester General Hospital, Leicester, UK
Title: Primary bowel de-differentiated liposarcoma with concurrent kidney nodule: A case report
Biography:
Mohammed Basamh completed his medical school degree at the University of Warmia and Mazury in Olsztyn,Poland with a final score of 4.5/5. He has received much recognition in his achievements including but not limited to a certificate of distinction in physiology. He has also gone on to study a post graduate certificate in Translational Cardiovascular Medicine and the University of Bristol, England. He is currently working as a Junior Doctor with the University Hospitals of Leicester working in the department of General Surgery at the Leicester General Hospital. He has so far published 1 publication in the British Journal of Surgery.
Abstract:
Abstract: Colorectal cancer is one of the of most common cancers in the western world and cause of mortality. In the UK, it is the 3rd most commonly diagnosed cancer with incidence rates highest amongst those between the ages of 85-89 and a tendency to involve the rectum Primary colonic liposarcoma is quite rare with less than 10 cases reported so far. We are presenting a case of de-differentiated liposarcoma of the colon with a concurrent lesion in the right kidney.
Our patient, a 64 year old male was referred from his GP to the colorectal clinic on a 2 week wait pathway for symptoms of rectal bleeding. His Past medical history includes hypertension, atrial fibrillation multiple cardioversions and ablation, Obstructive Sleep Apnea on home CPAP and a BMI of 36. Routine blood tests were unremarkable. With the COVID protocols, the patient’s symptoms were investigated with CT rather than a flexible sigmoidoscopy which has shown a large polypoid tumour lesion in the distal ascending colon with several enlarged adjacent lymph nodes and suspicion of liver infiltration. The preoperative staging was T3/4, possible N1 due to the suspected liver involvement and M 0. Further MRI scan of the liver showed that the liver lesions were in keeping with simple hepatic cysts. The patient underwent a right hemicolectomy which was an R 0 resection. The patient had an initial histopathological diagnosis of Inflammatory Myofibroblastic Tumour however on further MDT discussions and further staining, the diagnosis was changed to de-differentiated liposarcoma. A right kidney nodule was also further identified.
Conclusion: There is no standardised protocol for treatment of primary colonic liposarcoma as only a few cases have been reported. Previous studies have treated this with complete wide excision. A surgical resection was the treatment of choice. Although primary bowel liposarcoma is rare in itself, it would be wise to consider this as one of the differentials while working up a colorectal malignancy as it may have an impact on the outcome and mode of surgery.