Restorative proctocolectomy with ileal pouch reservoir in ulcerative colitis : the first series from Malta

Seventy five to eighty percent of patients with ulcerative colitis are more or less satisfactorily treated medically. Surgery cures the disease, but because proper surgical therapy has until recently necessitated a permanent ileostomy, physicians and patients are understandably reluctant to agree to definitive surgical treatment until absolutely necessary.peer-reviewe

Surgery and Ulcerative Colitis

The management of ulcerative colitis requires the collaboration of various teams looking after the patient and any decision regarding surgery should involve not only the patient and the surgeons but also various other professionals looking after the patient. Surgery may be needed in the acute setting or in patients with chronic disease and the management in these two scenarios is different. This article will look at the indications for surgery in patients with both acute and chronic colitis and the various options available, together with the results expected. We will also give an overview of the results on 27 cases of chronic colitis with restorative proctocolectomy operated on in our unit.peer-reviewe

Hilar Cholangiocarcinoma - Klatskin’s Tumour : review of the literature and report of first successfully resected case in Malta

Hepatic duct confluence sclerosing cholangiocarcinoma (Klatskin’s Tumour) is described as a small tumour in an inaccessible position, high up in the hilum of the liver. In the past the position of the tumour made it difficult to diagnose at operation, but nowadays with intelligent use of ultrasonography, percutaneous transhepatic cholangiography and digital subtraction angiography, pre-operative identification and localisation of this tumour is possible in a high percentage of cases. In this article the first case successfully treated by curative resection in Malta is presented after reviewing in detail the present international state of surgery for these tumours.peer-reviewe

Five years of peripheral percutaneous transluminal angioplasty : the St Luke’s Hospital experience

This article reviews the first series of 54 cases of Percutaneous Transluminal Angioplasty on the peripheral vasculature performed at the Radiological/Surgical Department at St. Luke’s Hospital, Malta, over a five year period. After describing in detail the technique used, the indications and the objective criteria utilised for assessment are reviewed and analysed. The two year patency rate for femoro-popliteal and iliac stenoses was 93% and 86% respectively, while for corresponding occlusions, the figures were 42% and 0% respectively. Thus, while the results were very encouraging for femoro-popliteal stenoses and occlusions, they were unacceptable for iliac occlusions. As expected the major risk factors were smoking, diabetes mellitus and associated ischaemic heart or cerebrovascular disease. This series had no mortality and there was minimal morbidity, mainly at the site of arterial access. Elective surgery for iliac re-stenosis was only required in one patient.peer-reviewe

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Laparoscopy in general surgery in Malta

A first series of fifty non-acute laparoscopies in general surgical practice in Malta are presented with particular reference to the indications for the procedure and its diagnostic yield. The series includes the first case of Curtis Fitz-Hugh syndrome to be diagnosed laparoscopically in Malta and the use of laparoscopy for splenic smear preparation under direct vision in visceral leishmaniasis (Kala-azar), a method not described previously. The series had a 100%, diagnostic yield in cases of hepatomegaly and abdominal mass but only a 60% yield in cases of splenomegaly. There were one major and one minor complications both occurring in the same patient.peer-reviewe

Surgery and Ulcerative Colitis Original Article

Abstract The management of ulcerative colitis requires the collaboration of various teams looking after the patient and any decision regarding surgery should involve not only the patient and the surgeons but also various other professionals looking after the patient. Surgery may be needed in the acute setting or in patients with chronic disease and the management in these two scenarios is different. This article will look at the indications for surgery in patients with both acute and chronic colitis and the various options available, together with the results expected. We will also give an overview of the results on 27 cases of chronic colitis with restorative proctocolectomy operated on in our unit