The Countess of Chester is the main NHS hospital for Chester and its surrounding area. It currently has 625 beds, general medical departments and a 24-hour accident and emergency unit. It is managed by the Countess of Chester Hospital NHS Foundation Trust, one of the first Foundation Trusts in the UK, formed in 2004. Cardiac rehabilitation services at the hospital are provided by Cheshire and Wirral Partnership NHS Foundation Trust.
Giant cell arteritis (GCA) is a large vessel vasculitis classically presenting with headache, jaw claudication, visual disturbance, and raised inflammatory markers. However, atypical presentations occur, and a delay in recognition can lead to irreversible visual loss. We report a 75-year-old male with sequential ocular involvement in whom erythrocyte sedimentation rate and C-reactive protein remained within normal limits. Carotid/vertebrobasilar imaging showed atherosclerotic change without critical stenosis, and 18F-fluorodeoxyglucose PET demonstrated vertebral arterial uptake consistent with cranial GCA. High-dose corticosteroids were commenced with rheumatology input. Normal inflammatory indices do not exclude GCA. Clinicians should maintain a high index of suspicion when visual symptoms evolve and initiate treatment without delay where clinical probability is high.
This is an Opinion piece. Originally written as part of the ACPGBI undergraduate essay competition and adapted for this manuscript submission. This piece examines how AI and automation are reshaping colorectal surgical practice, arguing that safe integration requires preserving human competence, maintaining surgeon accountability and ensuring systems remain interpretable and readily overridable.
Incretins are gut hormones involved in maintaining metabolic homeostasis in the human body, and disorders of the incretin system are recognized as contributing to the pathobiology of metabolic dysfunction and obesity. Incretin polyagonists are transforming the landscape of obesity treatment by offering potent, non-surgical alternatives to bariatric procedures. Acting on multiple incretin and related receptors, these novel pharmacological agents harness the synergistic effects of gut hormones such as glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, and glucagon to achieve unprecedented weight loss and metabolic improvements. Recent clinical trials demonstrate that dual and triple agonists can produce weight reductions comparable to, or in some cases approaching, those seen with bariatric surgery, while simultaneously improving glycemic control, lipid profiles, liver fat, and cardiovascular risk factors. Unlike conventional monotherapies, these polyagonists address the complexity of energy homeostasis and metabolic dysfunction in obesity, with some agents displaying a favorable side effect profile and thereby enhancing patient tolerability. Practical considerations, such as ease of administration, cost, long-term safety, and accessibility, remain evolving challenges; yet, incretin polyagonists have rapidly gained prominence in clinical guidelines for the management of obesity and type 2 diabetes mellitus. As evidence mounts regarding their efficacy, safety, and potential to modify cardiometabolic disease risk, incretin polyagonists emerge as promising alternatives, especially for patients unable or unwilling to undergo bariatric surgery. Ongoing research will further define their long-term role, comparative effectiveness, and optimal integration into multidisciplinary obesity care. This review discusses the current evidence-base for optimal use of incretin polyagonists as an alternative to bariatric surgery.
Blunt splenic trauma is the most common solid organ injury in abdominal trauma, with high-grade (American Association for the Surgery of Trauma (AAST) III-V) injuries carrying increased risk of hemorrhage and failure of non-operative management (NOM). Splenic artery embolization (SAE) has emerged as a key adjunct for hemodynamically stable patients, aiming to achieve hemostasis while preserving splenic function. This systematic review evaluated SAE outcomes in high-grade blunt splenic trauma, focusing on technical success, splenic salvage, re-bleeding, complications, delayed splenectomy, and mortality. Five retrospective cohort studies, including 600 adults, were analyzed. SAE demonstrated high technical success (92-100%) and splenic salvage rates (>90%). Proximal and distal embolization achieved comparable salvage rates; distal embolization was associated with longer fluoroscopy times and occasional re-bleeding, while combined techniques showed higher abscess formation. Overall mortality was low, and SAE facilitated preservation of splenic function, reducing the need for delayed splenectomy. Limitations include retrospective design, moderate-to-serious risk of bias, and limited long-term immunologic data. SAE is a safe and effective adjunct to NOM in high-grade blunt splenic trauma, with technique selection influencing complication profiles. Prospective studies are needed to optimize embolization strategies and evaluate long-term outcomes.
