Torbay Hospital is South Devon's main hospital. It is managed by the Torbay and South Devon NHS Foundation Trust.
OBJECTIVE:Aim: This narrative review aims to critically evaluate current evidence comparing surgical and non-surgical management strategies for acute cholelithiasis in elderly patients, focusing on outcomes, risks, and decision-making factors unique to this population. PATIENTS AND METHODS:Materials and Methods: A comprehensive literature search was performed in MEDLINER, Embase™, PubMedR, and Google Scholar™ using the terms: "acute cholecystitis," "cholelithiasis," "elderly," "surgical management," "laparoscopic cholecystectomy," "non-surgical," and "percutaneous cholecystostomy." Studies published between 2005 and 2025 were included if they evaluated outcomes such as morbidity, mortality, recurrence, and hospital stay in elderly patients. Both surgical and non-operative management strategies were compared, including antibiotic therapy and cholecystostomy. Articles were selected in accordance with PRISMA principles. CONCLUSION:Conclusions: Laparoscopic cholecystectomy remains the gold standard for acute gallstone disease but carries higher morbidity and mortality in elderly patients due to comorbidities and frailty. Non-operative approaches such as percutaneous cholecystostomy, or antibiotic therapy may reduce immediate surgical risk but are associated with higher recurrence and readmission rates. Optimal management requires an individualised, multidisciplinary approach considering physiological reserve, inflammatory markers, and patient preference. More prospective studies are needed to standardise risk stratification and management pathways specific to geriatric patients with acute cholelithiasis.
BACKGROUND:Total ankle arthroplasty (TAA) is increasingly used for end-stage ankle arthritis, with modern fixed-bearing designs demonstrating improved survivorship. The Canadian Orthopaedic Foot and Ankle Society (COFAS) classification stratifies patients by intra-articular and extra-articular deformity and adjacent joint arthritis. However, limited evidence exists on the impact of COFAS grade on mid-term TAA outcomes. This study reports the minimum 5-year outcomes of the Infinity fixed-bearing TAA and examines whether COFAS grade influences survivorship (defined as freedom from revision), complications, reoperations, revisions, radiographic findings, or patient-reported outcomes (PROMs). METHODS:A prospective, multi-center observational study included 502 ankles in 496 patients who underwent primary Infinity TAA across 11 UK centers. Patients were stratified by preoperative COFAS grade. Outcomes included implant survivorship, complications, reoperations, revisions, radiographic assessment of radiolucencies, and PROMs (the Manchester-Oxford Foot Questionnaire; the Ankle Osteoarthritis Scale [AOS]; and the EuroQol 5-dimension, 5-level index) collected preoperatively and at 2 and 5 years postoperatively. Patient-specific instrumentation (PSI) use was also recorded. RESULTS:Five-year implant survivorship was 98.2%, and reoperation without revision was 5.8%. There was no significant association between COFAS grade and revision or reoperation rates. Radiographic analysis demonstrated 5.7% linear radiolucencies >2 mm and 10.9% cystic radiolucencies >5 mm, with no correlation to COFAS grade. PROMs improved significantly across all domains from baseline to 5 years, with no differences between COFAS grades. PSI, used in 20.1% of cases, was associated with improved AOS scores at 5 years, though PSI and site effects could not be fully disentangled, and did not influence complication, revision, or radiographic outcomes. CONCLUSION:In this large multicenter cohort, higher COFAS grades were not associated with inferior outcomes in patients undergoing Infinity fixed-bearing TAA. Survivorship, complications, reoperations, radiographic outcomes, and PROMs were not statistically different across all grades. In this cohort, Infinity TAA was associated with favorable outcomes across all COFAS grades, including those with complex deformity or adjacent joint disease. LEVEL OF EVIDENCE:Level II, prospective cohort study.
Background:International guidelines recommend screening of first-degree relatives of patients with abdominal aortic aneurysm (AAA). However, the prevalence of AAA amongst screened relatives is uncertain. Methods:Medline, Embase, and the Cochrane Library were searched from inception to 4 March 2026 for studies screening relatives of patients with AAA. Data were analysed using a random-effects model meta-analysis in Stata. Risk of bias was assessed using a validated tool for prevalence studies. Evidence quality was assessed using GRADE. Aims and analyses to be performed were pre-specified and recorded with PROSPERO: CRD42024566370. Findings:Twenty-six studies were included with 4166 AAA index patients and 4530 screened relatives, providing moderate-certainty evidence. The prevalence of AAA amongst relatives overall was 14.4% (95% CI 10.7%-18.4%) (24 studies), 21.9% (95% CI 15.9%-28.6%) in male relatives (19 studies), and 6.3% (95% CI 3.6%-9.5%) in female relatives (17 studies). The prevalence of familial AAA, where AAA index patients had at least one affected relative, was 16.9% (95% CI 12.7%-21.6%) (13 studies). The odds of finding an AAA amongst male relatives was about 4 times greater than in female relatives (OR 3.69, 95% CI 2.89-4.71). Screened female relatives had a 5 times greater risk of having AAA compared to age- and sex-matched controls, whereas the comparable figure for male relatives was about 3. The risk of bias was low for all studies. Interpretation:Relatives of patients with AAA are a highly enriched population for AAA, occurring in 1 in 5 males and 1 in 16 females, with 1 in 6 AAA index patients having at least one affected relative. These findings support screening strategies that encompass all first-degree relatives, both male and female, irrespective of reported family history in the AAA index patient. Funding:None.
We report a case of a woman in her 60s who initially presented with typical symptoms of multiple myeloma, including fatigue, muscle cramps, lower back pain, hypercalcaemia, renal impairment and anaemia. Laboratory testing revealed elevated free light chains and M protein bands. Treatment was initiated for a working diagnosis of multiple myeloma. However, bone marrow assessment did not find plasma cells, instead revealing that the malignant clonal cells were of B-cell origin. Treatment was subsequently changed to a chemotherapy regimen for diffuse large B-cell lymphoma. After a suboptimal response, the patient received further treatment with a new regimen, resulting in a good response with no signs of active disease. Over 1 year after completing treatment, the patient remains well.
