P-P54 Interpreting trends in post-operative drain fluid amylase according to type of anastomosis used to form a pancreaticojejunostomy

Background The formation of the pancreaticojejunostomy during pancreaticoduodenectomy is the most technically challenging aspect of the procedure, with its failure increasing rates of both morbidity and mortality significantly. Early identification and management of a clinically relevant post-operative pancreatic fistula (CR-POPF) can be critical in reducing the threat of potentially avoidable harm to the patient. The most used indicator for a CR-POPF is the level of drain fluid amylase. There are many different techniques for forming the anastomosis, with considerable analysis but no consensus on superiority. We aimed to look at our centres experience using different techniques and the trends we observed in drain amylases and clinical outcomes. Methods A prospective database of all patients in a single UK centre undergoing pancreatic or duodenal resection has been maintained. This includes patient demographics, diagnosis pre and post operatively, operative details and duration, complications, and outcomes. All patients undergoing a pancreaticoduodenectomy between 1st January 2020 and 31st July 2021 were identified and their data retrospectively analysed. Results Thirty-three patients underwent a pancreaticoduodenectomy during the study period. The pancreatojejunostomy was formed using a duct-to-mucosa anastomosis in twenty-eight patients and using a dunking technique in five patients. The mean of the highest drain fluid amylase on post-operative day one for the patients with a dunking anastomosis was 14804.8 (range 3643-43686), on day three 2376.12 (range 167-8008.6) and of the three patients whose drains were in situ at day 5 it was 522.2 (range 31 to 983. An 83.9% reduction in mean drain amylases was observed between Day One and Day Three, followed by a further 78% reduction between day 3 and day. One patient (20%) had a CR-POPF with a grade B fistula, two others had a biochemical leak. The mean Day One drain amylases for patients with a duct-to-mucosa anastomosis was 71% lower at 4274.5 (range 15.4 to 41755). However this increased by 11.5% by Day Three to 4766.4 (range 5 to 46300) before falling by 64.7% to 1681.9 (range 5 to 13015) on Day Five. Eight patients (28.6%) had a CR-POPF – 3 grade B and 5 grade C fistula - and three patients had a biochemical leak. Conclusions In our centre’s experience, the type of anastomosis used to perform the pancreatic reconstruction post pancreaticoduodenostomy significantly impacts the post-operative trend in drain fluid amylase. This is important for clinicians to appreciate in order to avoid premature suspicion of a CR-POPF and prevent potentially unnecessary intervention.

Adenolipoma of the Breast: A Case Report

Adenolipoma of the breast is a rare tumor classified as a hamartomatous lesion. It is a well-circumscribed lesion composed of adipocytes and other breast tissues. The characteristic feature is a well-circumscribed mass containing radiolucent fat admixed with dense fibrous connective tissue surrounded by a thin radiopaque pseudo capsule. Microscopically, there is a mixture of ducts and lobules with adipose tissue. Ductal hyperplasia, adenosis, calcification, and apocrine metaplasia may occur within the hamartoma. These are rarely associated with malignancies and excision is considered curative. If these lesions are not detected clinically or radiologically, these remain unrecognized. Awareness of this poorly recognized benign entity would help avoid an incorrect diagnosis and unnecessary intervention. Here we present a case of a 35-year-old female diagnosed histologically as adenolipoma of the breast.

1169Impact of sex-specific growth centiles in utero - a statewide population cohort study

Background Sex impacts birthweight, with male babies heavier on average. However, growth charts in pregnancy are often sex-neutral. Small babies (<10th centile) are at risk of adverse outcomes. We aimed to identify the impact of using sex-specific charts during pregnancy, and if this detected more babies at risk of stillbirth. Methods Retrospective cohort study including all infants born in Victoria from 2005-2015 (n = 529,261). We applied the same growth centiles, either adjusted or not adjusted for fetal sex. We compared overall <10th centile populations, populations of males considered small by sex-specific charts only, and populations of females considered small by sex-neutral charts only. Stillbirth risk was our primary outcome. Results Of those <10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of < 10th centile females were reclassified as > 10th centile using sex-specific charts. These females were not at increased risk of stillbirth or adverse outcomes compared with a healthy weight infant, but were at greater risk of being delivered by obstetricians on suspicion of growth restriction. A further 25.0% of male infants were reclassified as < 10th centile by sex-specific charts. These male newborns, compared to a healthy weight baby, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90) and other adverse outcomes. Conclusions Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as < 10th centile, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth. Key messages Male babies are heavier than female babies. Thus, ultrasound charts growth charts should be sex-specific.

HELLP syndrome and HELLP-like syndrome in pregnancies with covid-19 – case reports

Summary: Objective: We present two case reports of severe course of covid-19 in pregnancy demonstrating similarity between covid-19 and HELLP syndrome. Case report: The fi rst case report describes an asymptomatic course of covid-19 accompanied by elevation of liver enzymes and lactate dehydrogenase but low ratio of angiogenic bio markers. No severe pregnancy complication occurred. All laboratory results had normalized after recovering from covid-19. The second case report describes a patient with elevated liver enzymes and lactate dehydrogenase which preceded a respiratory failure. Furthermore, one of the most feared complication of pregnancy occurred, namely hepatic rupture. After a delivery, the condition of the patient had been improving only slowly. It is not clear whether this condition represented a severe course of covid-19 or a concurrence of covid-19 and HELLP syndrome. Conclusion: A severe course of covid-19 in pregnancy may cause a diagnostic dilemma for its similarity between covid-19 and a specific complication of pregnancy – HELLP syndrome. This might lead to an unnecessary intervention and iatrogenic prematurity or underestimation of symptoms and delayed diagnosis of HELLP syndrome.

A STUDY OF ASSOCIATION OF THYROID DISORDERS IN PATIENTS WITH ABNORMAL UTERINE BLEEDING

Introduction: The aim of the study was to determine the association between menstrual disturbances and thyroid dysfunction, to analyze the pattern of menstrual dysfunctions among women with thyroid disorder and to estimate the prevalence of subclinical thyroid diseases among women in the reproductive age group with abnormal uterine bleeding, Materials And Methods: This was an observational study conducted in the department of Obstetrics and Gynaecology, Institute of Post Graduate Medical Education & Research, SSKM Hospital, Kolkata from March 2019 to August 2020. Inclusion criteria were patients attending OPD with age group of 18-45 years, women with any of the following menstrual disturbances- menorrhagia, oligomenorrhoea, hypomenorrhea, polymenorrhoea, amenorrhoea with no pelvic pathology and USG showing normal uterus and ovaries. Conclusion: From our study, it may be concluded that there is a strong correlation of thyroid dysfunction with abnormal uterine bleeding. In the patients with abnormal uterine bleeding, if thyroid disorders are timely diagnosed and treated, the menstrual irregularities settle, and unnecessary intervention like hormonal treatment and surgery like hysterectomy can be avoided. Since thyroid dysfunction is an important treatable cause of abnormal uterine bleeding, estimation of thyroid status should be a part of the battery of investigations being done in the patients of abnormal uterine bleeding.

Fifteen-minute consultation: A structured approach to a child with primary spontaneous pneumothorax

Primary spontaneous pneumothorax (PSP) is an uncommon presentation in children but may occur at any age and occurs in patients with no pre-existing lung disease. Management aims are to re-expand the collapsed lung, relieve pressure in the intrapleural space and avoid a tension pneumothorax. Correct management of PSP will avoid unnecessary intervention, reduce length of hospital stay and also reduce the risk of recurrence. There are no established guidelines for treating PSP in children and there is significant variation in management among centres and clinicians. This article provides a clear, evidence-based and structured approach to assessment and management of PSP in children and young people.

Pneumopericardium after Laparoscopic Hernia Repair Presents with ST-segment Changes: A Case Report

Introduction: Although rare, iatrogenic cases of pneumopericardium have been documented following laparoscopic surgery and mechanical ventilation. Electrocardiogram (ECG) changes, including ST-segment depressions and T-wave inversions, have been documented in cases of pneumopericardium, and can mimic more concerning causes of chest pain including myocardial ischemia or pulmonary embolism. Case Report: This unique case describes a patient who presented with chest pain and ST-segment changes on ECG hours after a laparoscopic inguinal hernia repair and who was found to have pneumopericardium. Conclusion: While iatrogenic pneumopericardium is often self-limiting and rarely requires intervention, it is critical to differentiate pneumopericardium from other etiologies of chest pain, including myocardial ischemia and pulmonary embolism, to prevent unnecessary intervention.

Boosting the Network Performance using Two Security Measure Scenarios for Service Provider Network

Network security is defined as a set of policies and actions taken by a network administrator in order to prevent unauthorized access, penetrated the defenses and infiltrated the network from unnecessary intervention. The network security also involves granting access to data using a pre-defined policy. A network firewall, on the other hand, is a network appliance that controls incoming and outgoing traffic by examining the traffic flowing through the network. This security measure establishes a secure wall [firewall] between a trusted internal network and the outside world were a security threat in shape of a hacker or a virus might have existed

Fibromatosis colli leading to positional plagiocephaly with gross anatomical and sonographic correlation

Fibromatosis colli, also known as ‘sternocleidomastoid tumour of infancy’ or ‘pseudotumour of infancy’, is a rare condition involving fibrosis and swelling, or ‘tumour’ of the sternocleidomastoid muscle in newborns that typically occurs after a traumatic delivery. Although usually self-limited, fibromatosis colli can lead to congenital muscular torticollis and positional plagiocephaly due to uneven forces on the neonatal skull. Ultrasound is the diagnostic imaging modality of choice and can prevent additional imaging and unnecessary intervention.