IVTH MALTESE MEDICAL SCHOOL CONFERENCE MEDITERRANEAN CONFERENCE CENTRE torn TO 13rn MARCH 1999 Republic Hall Boffa Hall Wednesda~· 10th 1700 OPENING REMARKS Dr. Jose1>h L. Pace 1710 - 1900 I Biomedical Sciences I I Free Communications Coffee Break 1930- 2UO 2 Biomedical Sciences II 2 Family Practice Thursda~ 11th 0830 - I mo 3 Medicine I 3 Oncology Coffee Break 1100 - 1300 -1- Medicine II -1- UNAIDS I Lunch 1-1-30 - 1630 5 CardioYascular 5 UNAIDS II I63o - 1no 6 Health & Work 6 P<Jthology I 1830 OPENING CEREMONY 1930 RALPH ARRIGO LECTURE b~ PROF SIR ALFRED CUSCHIERI 2015 RECEPTION Frida~ 1ih 0830 - 1mo 7 Surger:- I 7 Obs & Gynae I Coffee Break 1100 1300 8 Surger:- II 8 Obs & Gynae II Lunch 1-1-30 - 1630 9 Psychiatr:- 9 Radiology 1630- 1no I (l Denna to-\ enereology I 0 Pathology II 1no - 1930 11 Health Care Priorities 11 Phannacy/Gencral Poster Session Saturda~ 13th 0830 - 1030 12 Paediatrics I 12 Medicine Ill Coffee Break I JOO - noo 13 Paediatrics II 13 Surgery III 2030 CONFERENCE DINNER Westin Dragonara Resort. St. Julians CONTENTS Forward Prof. M. Brincat, Dean Dr. J.L. Pace, Conference Chairman Front Cover Organising Committee Acknowledgements Programme Timetable .................................... 1 Abstracts Oral presentations .................................... 18 Posters ................................................. 100 Cover Christ - red chalk, 116 x 90 mm, National Museum of Fine Arts, Malta, inv. 313-4 by Mattia Preti. Mattia Preti ( 1619-1699) was Italian by birth but he spent the last forty years of his life in Malta as a knight of the order of St John. He spent most of this time embellishing the Cathedral, a masterpiece of Baroque art, but he also filled most of Malta's older churches and several other buildings with his magnificent art. The Fourth Maltese Medical School Conference is being held two months after the tercentenary of his death. This drawing was selected because this conference is being held two thousand years after the birth of Christ. The bright face of this young man seems filled with hope and light. It is a preparatory study of the figure of Christ in the Baptism in the vault of St John's Co-Cathedral in Valletta. Malta and Maltese medicine have very close links with the Roman Catholic church. The drawing was recently exhibited at the L 'Idea del soggetto exhibition and is reproduced with the kind permission of the curator of the Fine Arts Museum. Gordon Caruana-Dingli Foreword Dear colleagues, I would like to warmly welcome you all to the IV Maltese Medical School Conference. When these conferences were started some years ago, its founding fathers wanted us to have a local forum that would encourage the Maltese medical community to pool their resources in a great triennial jamboree. This meeting is the showpiece of our Medical School. We know how difficult it is to carry out research locally. We also know that our graduates and our fellow Maltese do well when they have the right opportunities and resources both locally and abroad. Malta has the advantage of having had a large number of medical personnel who have trained overseas for a long period of time. This has provided a large group of extremely well trained practitioners amd scientists who by coming back to Malta have had the vision to realise that good research can be carried out anywhere. A good brain with a good imagination can always be creative no matter what the facilities. Fr. John Fsadni OP, one of our theological scholars on the Island was asked how he reconciled his detailed research on philosophical matters with his best selling well researched book on the Maltese 'girna' (the local beehive stone hut of unknown antiquity). His answer was very clear. Once he had been endowed with an inquisitive mind and well trained in the descipline of research, research was research whatevu the subject, providing that this was looked at in depth and no short cuts were taken. I feel that this contained the essence of the discipline needed as a research worker. We have to aim to look into something in depth and be ready to train hard to learn the discipline of carrying out research. Without that discipline we cannot call ourselves professional. Even if we are not in a position to carry out such research ourselves, we have at least got to be able to analyse data, process information, even that given on Internet and evaluate that data in a scientific and professional manner. Without that discipline, one's opinion would be worthless, no more valid than idle gossip at a hairdresser's which as everyone knows is the alternative university. An exceptional number of papers was submitted to this meeting. If anything, it shows that despite an abject lack of resources, including that most precious one of all - time - there is a pool of talent here that can perform and indeed at times does exceptionally well and achieves high standards. Add to this, the superb number of overseas colleagues that have come to join us and to share the most recent information and trends in their subspeciality and we have what we hope will be a perfect mix. We look forward to having a valuable meeting that should help us all and give us the confidence to keep on building our Medical School in the future. I am grateful to all our distinguished overseas guests for coming to Malta to join this family reunion. I would also like to welcome the not insignificant group of overseas Maltese who have decided to join us at this particular time. This is reminiscent of the 'gathering' that the Knights of St. John used to have from time to time when in answer to a summons, Knights would come from all over Europe to Malta. Our Medical School owes a deep gratitude to the Knights of St. John and this is one tradition that we are only too happy to imitate. Maltese doctors have always travelled extensively. I sincerely hope that this tradition will continue, and I am happy to say that it shows no sign of abatement. Anybody who knows us knows that despite being an Island, the Maltese Medical Profession is the best travelled and the most outward looking profession on the Island I wish you all a happy and successful conference Professor MP Brincat, PhD(Lond), FRCOG Dean, Faculty of Medicine & Surgery University of Malta Medical School Dear colleagues, It is with the greatest of pleasure that I welcome all participants to the IV Maltese Medical School Conference. In the ten years since the milestone I Maltese Medical School Conference in 1988, much has changed in Medicine generally and in Maltese medicine in particular. Prof Fenech, our Dean and Professor of Medicine seemingly for ever has left the driver's seat with Prof Brincat bringing a new era of endless energy and innovation. For the first time a substantial number of overseas students mostly from Norway are here for more than the weather and their presence enriches our school and spurs us to new heights. Technical achievements such as coronary bypass surgery, renal transplantation, laser surgery, and joint replacement have become commonplace procedures giving excellent results and well within the expectations of our people. In common with every advanced society, Malta is feeling the need to offer its citizens the fruit of medical achievements as soon as possible after they occur but at the same time keeping an eye on an ever expanding health budget attributed chiefly to the success of medicine in keeping us alive longer and longer. As in all other European countries, manpower problems in both medical and nursing fields are proving difficult to remedy satisfactorily despite serious and valid attempts in this direction with the seemingly endless vicious circle of progress-good results-more staff and resources-more patients appearing insurmountable. Indeed Setting Health Priorities was identified as of greatest importance in his inaugural editorial in the Journal of the Royal College of Physicians of London by a great friend of Malta and a participant at a past Medical School Conference, Dr Peter Watkins. Thus, Priorities of Health Care will figure in a session in its own right at a time when here too an on-going national debate is starting to take place. It is good that such discussion about Priorities takes place with the involvement of ALL concerned since not to do so will result in rationing declared or otherwise, a measure which has rightly been termed unethical by the World Medical Association. With the restrictions of living on a small island, Malta's doctors have since time immemorial found it profitable to spend periods of time abroad usually coming back to the lure of family and weather but sometimes, like Barth earlier and Cuschieri later, settling down to a chequered career in distant lands. With Europe beckoning, it is very important that our medical standards are and remain comparable to the best in the continent. To that end many of us have worked hard and diligently to ensure that we are represented at the various fora both purely academic such as the UEMS and specialist societies, and also medico-political such the Standing Committee of Doctors of the EU. Through personal sacrifice and often personal funding an increasing number of us are well in touch with medical Europe and others have ventured beyond. This must be encouraged across the board by those who have the interest of the profession at heart. The Malta session of the MRCP Part I and Australian College of Pathologists may soon be joined by the FRCS examination and we augur that discussions that will take place concurrently with this meeting achieve a fruitful outcome .