Are percutaneous coronary interventions changing our coronary surgery practice?

Aim: The aim of this retrospective study was to assess the impact of a growing percutaneous coronary intervention (PCI) program on our coronary artery bypass graft (CABG) practice. Method: The data were collected from 300 consecutive surgical patients from January 2000 (early series) and from a similar number from July 2008 (recent series). Results: Our recent series presented an increased risk (mean Parsonnet scores rose from 5.5 to 7.3, mean euroSCORE rose from 2.4 to 3.1). The mean age increased from 60.3 to 63.8 years, with the percentage of patients over 70 rising from 14.3 to 29.1%. The proportion of females increased from 15.1 to 18.6%. Mean number of vessels grafted diminished from 3.24 to 3.02 per case. Fewer coronary arteries over 3mm diameter were grafted and more advanced atheroma was encountered at the site of grafting in the recent series. Conclusion: The rise in PCI was associated with a smaller surgical population presenting an increased risk and challenge to the cardiac surgical team.peer-reviewe

Coronary artery fistulae : 4 cases repaired surgically

Coronary artery fistulae involve a communication between a coronary artery and a heart chamber or part of the pulmonary circulation. Most are asymptomatic and discovered incidentally, whilst larger ones may cause coronary steal syndrome. Fistulae may produce continuous murmurs and are diagnosed at echocardiography or angiography. Treatment is by percutaneous coil embolisation or open surgery. This article reviews four cases treated with surgical closure. All patients were asymptomatic and diagnosed incidentally at angiography. One case involved a failed attempt at percutaneous coil embolization requiring immediate open surgery. The other three cases required other operative procedures and the fistulae were oversutured during the same procedure.peer-reviewe

Chest wall reconstruction following a speedboat propeller injury

Propeller blade injuries to the chest are uncommon but can result in devastating injuries. We describe a case of a 44 year-old male scuba diver who was dragged by sea currents into the propeller of a speedboat. He suffered extensive chest wall trauma but narrowly escaped damage to major organs and vessels. He was admitted directly to the operating theatre. There was significant loss of bone from the manubrium, costal cartilages, overlying skin and muscle which were stripped off in 3 horizontal bands. During reconstruction the bony fragments were anchored to the nearest stable sternal or costal cartilage entities using steel wires, to achieve stability. The overlying muscle and skin were sutured directly to its opposite edge in layers and in an interdigitating fashion following the shape of the propeller blade lacerations. The patient remained intubated for 3 days in ITU and was transported back to his home country. He required a small skin graft to one area of necrosis but eventually made a full recovery with only his scars as a reminder of his accident. There have been other cases of propeller injuries in Malta but this is unique in being a severe injury to the chest, in which the patient made a full recovery. This report highlights the importance of legislation in preventing propeller injuries by restricting swimmer zones and introducing propeller guards or jet drive systems.peer-reviewe

Epidemiology and seasonal variation of state hospital admissions for bronchiolitis among children in Malta

Bronchiolitis is a seasonal viral illness characterised by breathing difficulties, cough, poor feeding, irritability and lethargy and, in the very young, apnoea. General Practitioners (GPs) often encounter children with bronchiolitis and as GPs working in Malta, there was the notice of certain patterns of infection, such as the young age of this patient group, the increased frequency of occurrence in the winter months and a commonly reported history of Neonatal Intensive Care admission. There was the look for published local literature to determine the local epidemiology of this illness and found none. Review of the international literature led to an understanding of the existence of a specific seasonality of bronchiolitis in the northern hemisphere, with more admissions being recorded in the winter months. Particular trends in the demographics of admitted children were noted in the literature, specifically with younger patients, as well as children with previous Neonatal and Paediatric Intensive Care admission being more frequently admitted. This retrospective study was undertaken in order to establish whether there is any seasonal variation in the rate of hospitalization for bronchiolitis, what observations could be made about epidemiological factors describing these admissions and their radiographic and microbiological investigation in secondary care.peer-reviewe

Traumatic rupture of the aorta : a case report and discussion of clinical features

A young female patient was involved in a head-on collision and sustained a rupture of the aortic isthmus. She underwent emergency surgical repair of an aortic pseudo-aneurysm with an interposition graft. She made a good post-operative recovery and represents the first such case in Malta.peer-reviewe

The Maltese version of the DN4 questionnaire : initial validation to assess neuropathic pain in patients with chronic spinal or spinal-radicular pain

Background: Neuropathic pain is frequently encountered in patients with spinal and spinal-related pain which needs specific treatment. Therefore, the objective of this study was to do an initial linguistic translation and validation of the Maltese DN4 questionnaire to diagnose neuropathic pain in this population. Methods: The study was designed as a single-blinded, observational, prospective collected data and retrospective analysis. The English and French DN4 questionnaires underwent forward and backward translation, literal assessment and adaptation of the semantic equivalence into the Maltese language, followed by assessment of the Maltese DN4 during the initial patient assessment in patients who met the inclusion criteria. Results: The total Maltese DN4 score obtained a Cronbach’s alpha of 0.735 therefore having satisfactory internal consistency. Test-retest using the Intraclass Correlation Coefficient (95% CI) ranged from 0.975 to 0.991 (p=0.000), while inter-rater agreement using Intraclass Correlation Coefficient (95% CI) ranged from 0.986 to 0.995 (p=0.000). Test-retest reliability yielded an intraclass correlation coefficient (95% CI) ranging from 0.975 to 0.991 (p < 0.001), while inter-rater reliability yielded an intraclass correlation coefficient (95% CI) ranging from 0.986 to 0.995 (p < 0.001). Both the English and the Maltese DN4 questionnaires obtained the same sensitivity and specificity values of 0.422 and 0.941 respectively, and a positive likehood ratio of 7.153 and a negative likehood ratio of 0.614, at a cutoff score of 4. Conclusion: The results of this study support the transcultural internal consistency, inter-rater, test-retest reliability, validity of the Maltese DN4 questionnaire to differentiate between neuropathic and nociceptive pain in patients with chronic spinal and spinal-radicular pain. Therefore, this simple tool can be used both in daily clinical practice but also in the clinical research setting to quickly screen for neuropathic pain.peer-reviewe

Audit on follow-up of patients with primary Osteoporosis

Aim: To document the frequency of Dual-energy X- ray absorptiometry (DEXA) scanning and Rheumatology clinic follow-up visits of patients with primary osteoporosis, and compare these with recommended guidelines. Method: Medical notes of all primary osteoporotic patients attending a hospital Rheumatology clinic were reviewed over a period of four months. Data was collected on age, gender, frequency of follow up visits, frequency of DEXA scanning, osteoporosis treatment, any changes in such treatment during the last visit, and comparison of the last two DEXA scan results. Frequency of follow up DEXA scans was compared to Group Health Osteoporosis Screening Diagnosis and Treatment guidelines.1 Results: Eighty-two patients were included, 6 males (7.3%) and 76 females (92.7%). The age range was 35-87 years (mean age was 68.6 years). In total, 42.7% of all the patients were on combined calcium and vitamin D, with added Bisphosphonates, Strontium ranelate, or Denosumab. During their last clinic visit, 61% showed improvement in T score since their previous result, and 64.6% of patients had no change in treatment. In this audit, 29.3% were being followed up on a 13 monthly basis, and 72% had annual bone mineral density scans or more frequently Conclusion: According to the guidelines, none of the patients included in this audit should have had a repeat DEXA scan within less than two years. Patients attending the clinic have too frequent DEXA scans and therefore, too frequent follow up appointments.peer-reviewe

Sternal vascularity after harvesting of the internal thoracic artery

Reply to "Assessment of Sternal Vascularity With Single Photon Emission Computed Tomography After Harvesting of the Internal Thoracic Artery" by Cohen et al.peer-reviewe

Contributions to the Maltese flora

This work is intended to give further contributions to the Maltese Flora, including the sighting of Brassica tournefortii near Ghadira s-Safra, a plant first recorded in 1874 and thought to be extinct, the confirmation of the Aeluropus lagopoides population at Dwejra, Gozo, and about 5 other uncommon species of flora including the first record of naturalized Pennisetum villosum in a rural environment.peer-reviewe

Contemporary eden: the transmigration of paradise tales, into edenic architectures today

This document proceeds from the research for my doctoral thesis titled This thesis is about the subject of Eden or paradise in architecture, to understand its concepts and be able to generate a general model to generate architecture that places us in a virtual way in paradisiacal places, in holidays as well as in daily life. It also seeks to build a system of measure to be used to turn into Eden the previously non “Edenic”. A comparative measuring system to know where we are in relation to how much Eden is present in places to intervene, or project. Eden; Tale, Image and Project. The zones of the thesis that are related to this congress are those related to the use of this tale, idea and image of the collective unconscious, when it comes to projecting a place that locates us physically, mentally and in our mood in paradise.Peer Reviewe