Journal of the Nuffield Department of Surgical Sciences最新文献

{"title":"‘You’re a girl, You’re Black, You’re poor’","authors":"Susannah M Black, Hibatullah Abuelgasim","doi":"10.37707/jnds.v2i3.165","DOIUrl":"https://doi.org/10.37707/jnds.v2i3.165","url":null,"abstract":"","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115667689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The chronic ear: A case report of bilateral cholesteatoma in a 10-year-old boy","authors":"Mate Naszai, J. Ramsden","doi":"10.37707/jnds.v2i3.152","DOIUrl":"https://doi.org/10.37707/jnds.v2i3.152","url":null,"abstract":"\u0000Cholesteatoma is a rare condition affecting 9-12.6 adults and 3-15 children per 100,000 per annum [1–4], with a more aggressive presentation in the paediatric population [5]. \u0000Intermittent otorrhea (ear discharge) is the presenting complaint in over half of cholesteatoma patients [6, 7]. The peak incidence of cholesteatoma is 5-15 years of age [8] which overlaps significantly with a period of high incidence in otitis media [9] and externa [10], diseases that often present the same way as cholesteatoma. This results in diagnosis that may take several years. \u0000Left untreated, cholesteatoma can cause significant lasting damage in the form of deafness, vertigo, facial paralysis, meningitis, and brain abscesses which may prove fatal [11]. \u0000Current treatment options are limited to surgical excision with the aim to establish a safe and manageable ear, while maintaining hearing is secondary. Improving surgical instrumentation has allowed a better success rate, however, revision surgeries remain a mainstay of practice. In practical terms, this means that those affected by bilateral disease often undergo surgery 4 or more times [12]. This represents a significant burden for patients. \u0000The decision about the exact surgical approach (canal wall up vs canal wall down) is a careful balancing act of safety versus functionality, and the pros and cons must be weighed in light of available evidence and the skill of the surgeon [13]. \u0000","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124482971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approaching academic writing as a medical student; tips and tricks","authors":"S. Black, Kwame Baffour-Awuah","doi":"10.37707/jnds.v2i3.171","DOIUrl":"https://doi.org/10.37707/jnds.v2i3.171","url":null,"abstract":"Approaching academic writing as a medical student; tips and tricks \u0000No abstract - Editorial","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131119034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Vascular Graft Infection","authors":"Harry Ward, D. Howard","doi":"10.37707/jnds.v1i3.78","DOIUrl":"https://doi.org/10.37707/jnds.v1i3.78","url":null,"abstract":"This case report focuses on the risk factors, diagnosis, and management of vascular graft infections. A complex and intriguing case is presented and the latest evidence on aetiology and management of this challenging condition are summarised. The contention regarding the diagnostic criteria for graft infection is addressed, and how different imaging modalities and genetic or systemic biomarkers could aid this diagnostic process. Key management challenges are also discussed. Firstly, the difficulties of penetration and efficacy of antimicrobials and the issues surrounding biofilm formation. Secondly, the different surgical options such as graft preservation with partial excision or muscle flap coverage, or excision and revascularisation. Further, the type of explant and the latest innovations in the field of biological grafts are considered. Overall, this case report brings to the fore the lack of structured guidelines and level 1 evidence for the diagnosis and management of vascular graft infection, and calls for a more structured, unified, multi-disciplinary approach.","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123605909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recombinant Nidogen-1 Significantly Improves Survival of Hypoxic Human Islets","authors":"D. Brandhorst","doi":"10.37707/jnds.v1i2.91","DOIUrl":"https://doi.org/10.37707/jnds.v1i2.91","url":null,"abstract":"Daniel Brandhorst,1,2 Heide Brandhorst,1,2 Samuel Acreman,1,2 Yukari Kimura,1,2 Shannon Layland,3 Katja Schenke-Layland,3 Paul R.V. Johnson1,2 \u00001 Research Group for Islet Transplantation, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom \u00002 Oxford Consortium for Islet Transplantation, Oxford Centre for Diabetes, Endocrinology, and Metabolism (OCDEM), Churchill Hospital, University of Oxford, Oxford, United Kingdom \u00003 Natural and Medical Sciences Institute, Eberhard Karls University, Tübingen, Germany \u0000Aim \u0000Islet isolation essentially requires dissociation of the islet basement membrane by collagenolytic enzymes. Basement membrane loss is associated with reduced islet function and viability. Previous studies demonstrated that individual extracellular matrix proteins (ECMPs) can increase islet survival pre- and post-transplant. In the present study, we tested our hypothesis, that the combination of different ECMPs, particularly those forming suprastructures, are more efficient than individual ECMPs to protect human islets from hypoxia-induced damage. In contrast to previous studies, we dissolved ECMPs in the media rather than to coat culture surfaces. \u0000Methods \u0000Islets, isolated from pancreases of 11 human DBD donors (50±2 years, 29.3±1.2 BMI, 5.7±0.3 hours CIT), were cultured for 3–4 days in 2% oxygen and suspended in CMRL 1066 (2% FCS) supplemented with either 40 µg/mL of dissolved collagen-IV, 10 µg/mL laminin-521 or 12.5 µg/mL nidogen-1 used individually or as combination. Sham-treated islets (STIs) cultured without ECMPs served as controls. Post-culture characterisation included IEQ yield or islet number (IN), viability (FDA-PI), early plus late apoptosis (annexin V-PI), glucose stimulation index (SI: 2 vs 20 mM) and reactive oxygen species production. Parameters were normalised to IEQ, related to pre-culture data if appropriate and presented as mean ± SEM. Statistical analysis was performed by Friedman test followed by Dunn’s multiple comparison. \u0000Results \u0000Compared with STI (41±7%), post-culture recovery was higher when hypoxic islets were treated with collagen-IV (64±7%, p<0.001), laminin-521 (57±6%, p<0.01) or nidogen-1 (65±6%, p<0.001) used individually or combined (61±7% p<0.001). This correlated with islet fragmentation (IN/IEQ ratio) that was lower when collagen-IV (116±13%, p<0.001), laminin-521 (114±12%, p<0.01), nidogen-1 (121±12%, p<0.01) or combined ECMPs (119±13%, p<0.001) were compared with STIs (155±16%). Reactive oxygen species production in STIs was substantially reduced by 71±6% (NS), 73±6% (p<0.05), 90±2% (p<0.001), and 87±4% (p<0.001) in presence of collagen-IV, laminin-521, nidogen-1 or combined ECMPs, respectively. This resulted in improved viability (83±7% [p<0.01], 79±9% [p<0.01], 84±7% [p<0.001], 83±8% [p<0.001]) compared with STIs (63±7%). While individual ECMPs stabilised or reduced pre-culture apoptosis (94±17% [p<0.05], 117±16% [p<0.05], 68±13% [p<0.001])","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114441003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ex Vivo Normothermic Perfusion, a Novel Method to Assess Pancreases after Preservation","authors":"Julien Branchereau, Etohan Ogbemudia","doi":"10.37707/jnds.v1i2.86","DOIUrl":"https://doi.org/10.37707/jnds.v1i2.86","url":null,"abstract":"Julien Branchereau1,2* and Etohan Ogbemudia1*, Kaithlyn Rozenberg1, Fungai Dengu1, Gabriella Hakim1, Flavia Neri1, Georg Ebeling1, Letizia Lo Faro1, James Hunter1, Rutger Ploeg1* and Peter Friend1* \u0000* \"Authors contributed equally to this work\" \u00001-Nuffield Department of Surgical Sciences - University of Oxford \u00002-Nantes Hospital University - France \u0000Introduction \u0000Static cold storage (SCS) of pancreases remains the current standard method for preservation prior to transplantation. Pulsatile hypothermic machine perfusion (HMP) is an emerging method that could potentially improve the preservation of pancreases to enhance graft function. This is based on personal extensive experience with HMP of pancreases in human, porcine allotransplantation and large non-human primate models. All models consistently showed preservation of pancreatic parenchyma on histological assessment for up to 24hours. To provide reassurance of organ viability prior to transplantation further investigations are necessary. We propose that normothermic perfusion (NMP) of pancreases after cold preservation allows necessary functional and physiological assessments. \u0000Method \u0000Porcine pancreases (3) were retrieved from the slaughterhouse after 30 minutes of warm ischaemia and were flushed. After 3 hours of cold ischaemia two pancreases were perfused by HMP (Wave machine; Waters Medical Systems) for 6 hours followed by 1 hour of NMP. One pancreas after 3 hours of CIT was placed on NMP for 2.5hours, this was the first pancreas NMP to assess feasibility of this technique.NMP was achieved by modification of the kidney assist device. Oxygenation was with 21% oxygen. The pancreases were cannulat ed via the aorta with free drainage of perfusate from the portal vein. NMP parameters for all pancreases were a pressure of 40mmHg and temperature of 37C. Perfusate was composed of red blood cells, plasma to provide a haematocrit of 25%, with additives of co-amoxiclav and 25,000IU of heparin. During the perfusions we collected serial perfusate samples for blood gas analysis and for insulin enzyme-linked immunosorbent assay (ELISA). \u0000Results \u0000The macroscopic appearance of the pancreases and the attached duodenum at the end of NMP appeared viable. Average resistance index during NMP was 0.62 ru (range 0.30 to 0.90 ru). Average flow rate was 77mls/min (range 53 to 100 mls/min). Throughout, the duration of NMP in the two pancreases perfused for one-hour lactate remain stable with no increase from baseline. In the one pancreas perfused for 2.5hours lactate was also stable in the first hour then increased by 50% during the last 1.5hours of perfusion. ELISA confirmed the presence of insulin in the perfusate for all three perfusions. \u0000Conclusion \u0000Normothermic perfusion is a feasible method to allow physiological and functional assessment of pancreases after cold preservation techniques encouraging us to further develop this model. \u0000 ","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133861083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Welcome Letter from the Editor-in-Chief","authors":"A. Handa","doi":"10.37707/jnds.v1i1.66","DOIUrl":"https://doi.org/10.37707/jnds.v1i1.66","url":null,"abstract":"Welcome to the Inaugural Issue of Journal of Nuffield Department of Surgical Sciences!","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131665023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Challenges of Monitoring PTLD with focus on Renal Transplantation: A Case Report","authors":"Y. Shammoon, F. Dengu","doi":"10.37707/jnds.v2i3.80","DOIUrl":"https://doi.org/10.37707/jnds.v2i3.80","url":null,"abstract":"N/A - Surgical Case Study ","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128258183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Ominous Sign: Mucinous Ovarian Carcinoma with Sister Mary Joseph Nodule","authors":"A. Hunter, S. Addley","doi":"10.37707/jnds.v2i3.129","DOIUrl":"https://doi.org/10.37707/jnds.v2i3.129","url":null,"abstract":"Despite two centuries of progress in its surgical and oncological management, ovarian cancer remains the most lethal of the gynaecological cancers, claiming the lives of nearly 185,000 women globally each year. Historically considered a single disease, there is growing recognition that ovarian cancer is in fact a spectrum of malignancies with distinct cellular origins, molecular driver pathways and clinicopathological features. Mucinous ovarian carcinoma (mOC) is a rare histological subtype that presents a particular challenge in accurate diagnosis and management. Frequently confused with metastatic deposits from extra-ovarian mucinous tumours, the true incidence of primary mOC is estimated to be between 3-5%. Typically affecting younger women, prognosis for late-stage disease is abysmal with a median survival of <15 months. This case report describes a 38-year-old patient who presented with rapidly worsening abdominal distension. Subsequent debulking surgery removed a mass weighing 2.4kg, confirmed by histopathology as a high grade mucinous ovarian carcinoma with a mural nodule of anaplastic carcinoma. Evidence behind the current guidelines for management will be discussed, addressing our recent understanding of mOC as a separate disease from other histotypes and the consequent challenges in interpreting data from large multicentre trials in which patients with mOC are poorly represented. Moreover, using the Sister Mary Joseph nodule (SMJN) as an example, this case also highlights the importance of the physical examination and the value of subtle (and sometimes missed) clinical signs that provide important clues about the extent of a patient’s underlying disease and prognosis.","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"230 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115995659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Introduction to Surgical Prehabilitation","authors":"H. Cui, K. Fairer","doi":"10.37707/jnds.v2i3.168","DOIUrl":"https://doi.org/10.37707/jnds.v2i3.168","url":null,"abstract":"<jats:p>None</jats:p>","PeriodicalId":184356,"journal":{"name":"Journal of the Nuffield Department of Surgical Sciences","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127518431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}