Cervical cancer screening : an update

In many countries cervical cancer is the commonest gynaecological cancer. In Malta and in the United States, it is the third most common gynaecological cancer. Countries which introduced organised cervical screening programmes saw a dramatic decrease in incidence and mortality from this cancer.1 In Malta however, its incidence and mortality has remained relatively constant in the last few decades, in keeping with the fact that we lack a national organised call and re-call cervical screening programme.2 Our cervical screening is largely opportunistic and most of it is carried out in the private sector. Although incidence and mortality has not decreased, our present imperfect screening must however have prevented a significant rise in incidence and mortality, because the detection (and treatment) of premalignant cervical lesions has risen over recent decades, in keeping with increased sexual promiscuity.peer-reviewe

Cholesterol & Statins : the controversy continues

A recent widely publicised Lancet review of statin efficacy and safety data generated more controversy than it resolved. Led by Professor Rory Collins of Oxford University, the review claimed that the benefits of statins have been underestimated and the risks exaggerated. Claims of statin intolerance in up to 20% of patients, the review argues, are not supported by largescale evidence from randomised trials. In fact, Collins et al. claim that statin therapy is no less well tolerated than placebo. Collins further claimed that the controversy about statin intolerance and myopathy rates emerged only in the past 2 or 3 years as manufacturers began marketing newer and “very expensive” cholesterol-lowering agents, such as, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors for patients classified as statin intolerant. He also pointed out that industry has funded reports on statin intolerance, as in the case of the European Atherosclerosis Society’s report2 which, not only had funding from makers of PCSK9 inhibitors, but also had its meetings coordinated by a commercial entity funded by the manufacturers.peer-reviewe

Is this disseminated ovarian cancer or not?

This is now the second half of the 1980s, I’ve been a consultant surgical pathologist at the Royal Hampshire County Hospital in Winchester since 1980, and I get a phone call from a friend in Malta who says his wife has just been diagnosed with ovarian cancer and asking me whether I would mind reviewing the histological slides before she starts chemotherapy. No problem – confirming ovarian cancer should be straightforward. This lady was around 50 years old and had consulted her doctor, and then a gynaecologist, because of some pain and redness around her umbilicus. A right ovarian mass was diagnosed and she underwent a bilateral oophorectomy and total hysterectomy. At operation, besides the right ovarian mass and some fluid in the pelvic cavity, a portion of omentum was found stuck in a small umbilical hernia, was extracted from the hernia sac, excised and also sent for pathological examination.peer-reviewe

Is lymphoma curable?

This is early 1980s, a few years after I took up a consultant surgical pathologist post at the Royal Hampshire County Hospital in Winchester. I get a call from Dr Anthony Galea- Debono who is now a physician and neurologist in private practice in Malta. In the late 1970s, Tony and I used to meet often over lunch because we worked not far from each other in London, him at Queen’s Square and I at The Middlesex in Mortimer Street. The call from Galea-Debono is about a young woman in her early thirties who has been referred to him for management of a diagnosis of tuberculosis following an excision biopsy of an enlarged neck lymph node, and wishes the histology reviewed before he starts anti-tuberculous therapy. The lymph node histology, in fact, shows what I thought was a high grade large cell lymphoma with necrosis, the latter feature having been misinterpreted as tuberculous necrosis. The patient also complained of retrosternal pain on ingesting alcohol. I confirm the lymphoma diagnosis with Professor Dennis Wright, at the time a world figure in lymphoid pathology, and conveniently located in Southampton, just down the road from Winchester.peer-reviewe

The cholesterol controversy : the series

In the previous instalment we learnt how Ronald Krauss, one of the most respected nutrition researchers, had worked out that LDL-cholesterol consisted of two sub-fractions, one with large soft particles and the other with small dense particles, and that the small dense particle sub-fraction was the one linked to atherosclerosis and not the other. He also noted that saturated fats increased the “good” sub-fraction and lowered the “bad” sub-fraction, and that carbohydrates did the opposite. This suggested that carbohydrates were implicated in atherosclerosis rather than saturated fat.peer-reviewe

The pitfalls of immunohistochemistry

This is 1996. I had returned to a consultant histopathologist’s post at St Luke’s Hospital the year before, and had become acquainted socially with a Maltese commercial lawyer and his ex-pat wife. Shortly afterwards, he informed me that his wife hasn’t been well and that Dr Mario Vassallo had just performed a private gastroscopy, was worried she had something serious and whether I would mind looking at the biopsy material. Mario Vassallo found a large gastric ulcer with rolled edges, practically diagnostic of a carcinoma. Fortunately the histology showed a low grade lymphoma of “mucosa-associated lymphoid tissue” (MALT) type, which carried a far better prognosis.peer-reviewe

It's not just about the corpses

Semi-retired pathologist Professor Albert Cilia-Vincenti speaks to The Synapse about his work, his experience and the changes he has witnessed in pathology over time.peer-reviewe

The slippery slope of modern medical reporting : part 2

Part 1 and part 3 of this article can be found through these links: https://www.um.edu.mt/library/oar//handle/123456789/13974 https://www.um.edu.mt/library/oar//handle/123456789/13998Part 2 of the article. Medical literature is littered with words like “may”, “possibly”, “associated with” and “could”. These words allow indefinite conclusions, exceptions and failures, so that no one is ever “wrong”. Nutritional and conventional medicine, and the pharmaceutical industry, have a long history of issuing recommendations that are later found to be incorrect and have to be amended. Information is widely disseminated as fact, when in reality it is little more than a guess. Unproven theories are then incorporated into people’s lives under the guise of “practicing good health”. It can take decades for false information to be purged out from the “common knowledge” that is tainted with it.peer-reviewe

Is anti-ageing therapy medical fiction?

The quest for an immortality elixir has been around for centuries. Is anti-ageing, regenerative medical intervention, still in the realm of science fiction? We’re not talking of cosmetic surgery here, obviously. Some scientists believe that human immortality is possible in the future. If all our tissues have stem cells for replacement of worn out ones, why do we age and die? Even if immortality is not ultimately possible, are there any recent advances in understanding ageing and deteriorating function at cellular level? Extending useful, healthy life without added strains on health systems, would be a significant medical advance.peer-reviewe

‘Surgical pathology’ : what’s in a name?

The Synapse is pleased to introduce a new series consisting of ‘Medical Anecdotes’ … short accounts of interesting cases, some medical disasters, involving pathology and clinical practice, from the recollection of Prof. Albert Cilia-Vincenti.peer-reviewe