Hinds, Fionnuala M.

Kasper, F. Kurtis

Mikos, Antonios G.

Shi, Meng

Spicer, Patrick

Wong, Mark E.

Elsevier - Publisher Connector 

Abstracts / International Journal of Surgery 9 (2011) 495–546 537
ABSTRACTS0461 DEVELOPMENT, CHARACTERISATION AND OPTIMISATION OF
POLY
(METHYLMETHACRYLATE) BONE CEMENT FORMULATIONS FOR APPLI-
CATION AS A SPACE MAINTAINER IN A STAGED STRATEGY FOR CRANIO-
FACIAL BONE REGENERATION
Fionnuala M. Hinds 1, Patrick Spicer 2, Meng Shi 2, Mark E. Wong 3,
F. Kurtis Kasper 2, Antonios G. Mikos 2. 1 School of Medicine, Dentistry and
Biomedical Sciences, Queens University Belfast, Belfast, Antrim, UK;
1Department of Bioengineering, Rice University, Houston, Texas, USA;
1Department of Oral and Maxillofacial Surgery, University of Texas Health
Science Center at Houston, Houston, Texas, USA
Delayed surgical reconstruction of craniofacial bony defects can lead to
secondary intention healing, defect volume loss and soft-tissue ﬁbrotic
contracture, giving poorer aesthetic and functional results. Utilising
temporary porous space maintainers, made by leaching porogens (pore
inducers) from curable matrices e.g. Poly (methylmethacrylate) (PMMA)
cement, limits aforementioned complications.
Carboxymethylcellulose (CMC) is a demonstrated, efﬁcacious porogen but is
unlicensed for interstitial use. Pre-existing licensed products may provide
alternatives (e.g. gelatin-based products), facilitating clinical application.
This project aims to investigate PMMA incorporating a gelatin-based
porogen and compare scaffold characteristics, e.g. interconnectivity,
porosity and porogen release, to PMMA-CMC.
PMMA-gelatin scaffolds of different weight percentages and yields (water/
unit of gelatin) were mould polymerised then lyophilised. Micro-
computed tomography analysis of scaffold porosity and interconnectivity
was performed pre/post gelatin leaching and gelatin releasewas measured
by microBSA protein assay.
PMMA-gelatin demonstrated lower porosity and pore interconnectivity
than PMMA-CMC of identical weight incorporation. Increasing yield and/
or weight incorporation increased porosity. Leaching was slow (mg/ml/
hr), with the majority of porogen still entrapped at three weeks
dissolution.
The gelatin-based product shows promise as a CMC alternative, consid-
ering initial results for porosity and interconnectivity indicate desirable
scaffold characteristics. Further work is warranted to fully characterise the
desired scaffold characteristics comparative to PMMA-CMC.
0463 HOSPITAL AT NIGHT PROTECTS DAYTIME SURGICAL TRAINING BY
REDUCING UNNECESSARY NIGHT–TIME CLINICAL ACTIVITY
Sukrti Nagpal, Sarvi Banisadr, Eamonn Coveney, Dermot O'Riordan. West
Suffolk Hospital, Bury St Edmunds, Suffolk, UK
Introduction: With junior doctors working reduced hours and stringent
EWTD laws, the impact of the Hospital at Night (HAN) Team in managing
out-of-hours medical activity and its implications for maintaining daytime
training has been questioned.We studied the outcome of HANwork on the
out-of-hours surgical workload.
Methods: All ward calls made since July 2007 to the HAN team were
recorded. The site clinical practitioners (SCP) triaged calls according to
urgency using a trafﬁc light system. These were allocated on clinical
priority. Data from July 2007 to July 2010 was analysed.
Results: Over 36 months 32,355 calls were made. The ﬁve most common
calls were for clinical skills (32%), medical review (27%), drug queries (15%),
ﬂuid balance (13%), and emergencies (4%). 54% of calls were managed by
the SCP. The remainder were managed by the medical SHO (22%), SPR (2%)
and surgical SHO (14%). Less than 1% of calls were referred to the surgical
registrar. The ﬁve main reasons requiring a doctor were for patient review,
clerking, catheter management, wound reviews and pain.
Conclusions: Using a strategic triage system, the HAN service facilitated
compliance with the surgical registrar non-resident on call rota with
resultant protection of daytime training hours.0464 ARE C-REACTIVE PROTEIN LEVELS NECESSARY IN THE DIAGNOSIS
OF ACUTE APPENDICITIS IN CHILDREN?
J.D. Hodgkinson, Z.N. Shukur, E. Tan, O.Warren, Q. Iqbal, S. Harris, Y. Mohsen,
A. Prabhudesai. Department of Colorectal Surgery, Hillingdon Hospital,
Uxbridge, Middlesex, London, UKBackground: Diagnosis of acute appendicitis is difﬁcult, particularly in
paediatric patients, where clinical signs maybe harder to elicit. Tradi-
tionally, history and clinical signs combined with leukocyte count (WCC)
have been used to aid diagnosis. Over recent years, C-reactive protein
(CRP) is also being measured routinely. We aimed to evaluate whether CRP
improves diagnostic accuracy of acute appendicitis in children.
Methods: 16-month retrospective study of 92 consecutive paediatric
patients undergoing appendicectomy for suspected appendicitis. CRP and
WCC on presentation were compared with histological ﬁndings.
Results: 65.2% (60) of patients had a histologically conﬁrmed diagnosis of
acute appendicitis. Use in isolation WCC >17 yielded: sensitivity ¼0.25;
speciﬁcity¼0.94; PPV¼0.88. Used in isolation CRP>20 yielded: sensitivity
¼0.52; speciﬁcity ¼0.91; PPV ¼0.91. Combined WCC >17 and CRP >20
(sensitivity ¼0.13; speciﬁcity ¼1.00; PPV ¼1.00) did not signiﬁcantly
improve PPV or speciﬁcity compared with WCC alone.
Conclusions: When used in isolation, WCC is more useful in predicting
acute appendicitis at histology than CRP. Combining both markers has no
impact on the likelihood of a correct diagnosis when compared with WCC
>17 alone. Measuring CRP levels in suspected acute appendicitis, in chil-
dren, doesn't improve diagnostic accuracy and therefore cannot be
ﬁnancially or clinically justiﬁed.0466 LOCAL ANAESTHETIC HERNIA REPAIR IS A SAFE THERAPEUTIC
OPTION IN OVERWEIGHT PATIENTS
Sarvi Banisadr, Balendra Kumar, Eamonn Coveney. West Suffolk Hospital,
London, UK
Aims: Inguinal hernia repair performed under general anaesthesia (GA) is
currently the preferred approach in themajority of surgical units in the UK.
This reservation to use local anaesthesia (LA) may in part be due to
a reluctance to operate on overweight or obese patients because of
potential technical challenges or toxicity concerns. The aim of this study
was to examine the impact of the use of local anaesthetic hernia repair
(LAHR) on surgical outcomes in overweight patients (BMI25).
Methods: In 2010, data on BMI, local anaesthetic use, operative time, pain
scores and patient satisfaction rates was prospectively recorded in 75
consecutive patients undergoing LAHR.
Results: Number: BMI<25(meanSD) 32 / BMI25 (meanSD) 43 /(P
value); Local anaesthetic (mls): 40.4  18 /43.4  16 /(0.37*); Operative
time (min): 51.7 14 /56.316 /(0.29*); Pain score (1-100): 22.419 /21.8
 15 /(0.79*); Patient satisfaction (1-100): 95.2  6 /94.7  5 /(0.41*);
(*Mann Whitney test).
Conclusions: When compared to normal weight patients, local anaes-
thetic hernia repair in the overweight is comparable, safe and well toler-
ated. Use of LAHR should be considered as a viable alternative approach to
managing the overweight patient.0469 TOTAL NEOPHARYNGEAL STENOSIS FOLLOWING
PHARYNGOLARYNGO-OESOPHAGECTOMY WITH GASTRIC
INTERPOSITION – SUCCESSFUL RECANALISATION USING
A TRANSCERVICAL RADIOLOGICALLY GUIDED TECHNIQUE
Mark Wilkie 1, Iain Hawthorne 2, Andrew Evans 2. 1Department of
Otorhinolaryngology Royal Liverpool University Teaching Hospital,
Liverpool, UK; 1Department of Otorhinolaryngology St. John's Hospital,
Livingston, UK
Aims: To present a novel therapeutic strategy for managing total neo-
pharyngeal stenosis following surgical treatment of hypopharyngeal
cancer. To discuss how this simple technique adds to currently employed
methods of managing pharyngo-oesophageal stricturing following both
non-surgical organ preservation and surgical treatment of head and neck
cancers.
Methods:We report the case of a 71-year-old female who developed total
neopharyngeal stricturing following pharyngolaryngo-oesophagectomy
and gastric interposition for squamous cell carcinoma of the proximal
cervical oesophagus/post-cricoid. A transcervical, radiologically guided,
combined antegrade/retrograde procedure was performed to restore
luminal patency.


Development, characterisation and optimisation of poly(methylmethacrylate) bone cement formulations for appli-cation as a space maintainer in a staged strategy for cranio-facial bone regeneration 

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Development, characterisation and optimisation of poly(methylmethacrylate) bone cement formulations for appli-cation as a space maintainer in a staged strategy for cranio-facial bone regeneration

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