Journal of the Nuffield Department of Surgical Sciences

First, do no harm: surgical management of von Hippel Lindau syndrome

Hannah Farley — 2023-08-06

Von Hippel Lindau (VHL) syndrome is an inherited condition that is associated with retinal and central nervous system haemangioblastomas, as well as renal and pancreatic cysts (Varshney et al., 2017). The renal cysts have a significant likelihood of neoplastic change, and act as a pre-malignant pathological finding prior to the development of clear cell renal carcinoma.

Evaluating the decision to use Fenestrated EVAR for the elective treatment of a complex AAA

Georgina Loncarevic Whitaker — 2023-08-06

An aneurysm is defined as a focal dilatation of all three walls of an artery wall. This can occur at any point in the arterial tree but most commonly presents as an abdominal aortic aneurysm (AAA), with a diameter of 50% greater than its normal size. The prevalence of AAAs is estimated to be between 1.2-7.6% in over 50 year olds in the UK, and it is sevenfold higher for men compared with women1. There is approximately a 1% mortality from ruptured AAAs, and as such current NHS guidelines recommend that all men over 65 are screened annually, a precedent supported by the Multicentre Aneurysm Screening Study (MASS)2. AAAs reaching 5.5cm in diameter require elective surgical repair, which can take the form of endovascular aneurysm repair (EVAR) or open surgical repair.

Paediatric Renal Failure- A Lifelong Battle Requiring Multiple Transplantations

Luiza Farache Trajano — 2023-08-06

Kidney transplants are the most common form of transplant surgery performed in the UK - both in adults and in children. In 2019-20, 3190 adult1 and 112 paediatric2 kidney transplants were carried out in the UK. Importantly, in paediatric renal transplantation, the recipient often outlives their graft and therefore require multiple transplantations throughout their lifetime. This report focuses on patient ZG, a 32-year-old female undergoing her third renal transplantation. Patient ZG had her first transplant, aged 16 months, following a diagnosis of bilateral dysplastic kidneys, a subsequent transplantation 18 years later and a third transplant in 2021.

Carotid Artery Web: A rare cause of recurrent ischemic stroke

Katerina Dangas — 2023-08-06

Carotid artery web is a focal form of fibromuscular dysplasia characterised by an abnormal shelf-like projection of fibrous tissue into the lumen of the carotid artery. It is a rare but important cause of recurrent ischemic stroke particularly in younger patients with few traditional risk factors. Despite that it may cause up to 37% of cryptogenic strokes, an optimal evidenced-based management strategy has not been developed. This case report provides us with the opportunity to highlight this under-recognised cause of recurrent stroke and synthesize the current evidence for its diagnosis and management.

Post-ERCP acute infected necrotising pancreatitis in a patient with Cushing’s disease

Piero Alberti — 2023-08-06

This report discusses the case of patient KT, who suffered from acute necrotising pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) for treatment of common bile duct (CBD) calculi. After a summary of KT’s complex medical history, the epidemiology and pathophysiology of post-ERCP pancreatitis (PEP) are discussed. Finally, recent research on treatment of severe necrotising pancreatitis is reviewed, focussing on strategies to reduce morbidity and mortality from this devastating complication of a common procedure like ERCP.

Global Surgery, Universal Health Coverage & the Spirit of Ubuntu

Shobhana Nagraj — 2023-08-06

This editorial on global surgery provides an overview of this rapidly developing field, its origins, and its links to the discourse on universal health coverage.

Surgery in Oxford: A History

David Cranston — 2023-08-06

Obituary: Professor Sir Peter Morris

David Cranston — 2023-08-06

Surgeon Profile Series: Professor Meghana Pandit

Zara Small — 2023-08-06

Foreword

Ashok Handa — 2023-08-06