THE ST. LUKE'S HOSPITAL GAZETTE MALTA DECEMBER 1974 Vo!. IX No. 2 Published for the Consultant Staff Committee, St. Luke's Hospital, Malta, and the Medical and Dental Surgery Faculties of the Royal University of Malta. Editor: Dr. Emanuel Agius. Editorial Board: Dr. R. Attard, Prof. G.E, Camilleri, Dr. P. Cassar, Prof. F.F. Fenech, and Dr. L. Vassallo. CONTENTS ABOUT OURSELVES About Ourselves 103 With this issue "The St. Luke's Hos­ An I nternational Gathering 104 pital Gazette" concludes its ninth year of Surgery and Advanced Abdominal Malignancy - H. Ellis ... 105 existence. It has been by far the longest More about Weever Fish and their Toxic lived local medical periodical, it is in the Stings - L. Zammit 108 "World List of Medical Periodicals", it Dermatology and Surgery - R.O. Parnis 114 reaches every member of the medical and Parapharyngeal Chordoma - P.J, Damato and J. Pace-Balzan 116 the dental professions in Malta, those of Traumatic Air Embolism - N. Azzopardi 119 our colleagues abroad whose whereabouts Haemang'ioma al the Orbital Bones - F.J. we can trace, many other medical friends Damato 120 abroad and a large number of un;versities Ocular Onchocerciasis - J.A. Coleiro. 127 Determination of Serum Zinc Levels in Normal and learned societies. An initial fear that Maltese Adults - R. Ellul-Micallef, A. it might lack contributors has proved Galdes and F.F. Fenech. ... 128 groundless and in fact papers have been Anatomical' Distribution of Diverticula in the Large Intestine - Marie T. Podesta and of a consistently satisfactory level. The J. L. Pace. ... 133 editorial policy of accepting contributions An Hour for my Thoughts - E. Agius. ... 138 from whoever had anything interesting to Royal Operations. - H. Ellis. ...... ...... 144 say has also proved right and we have been Malta, Florence Nightingale and the Crimean War. - M. Galea ... 148 glad to publ;sh papers not only by doctors The Serpent of Aesculapius, the Confraternity and dental surgeons but also by a variety of SS. Comas and Damian and the of paramodical norsons and ev"'n bv noonle Bishop of Malta. - P. Cassar.... 156 completely outside medicine; it has also Economics of Medical Practice in Eighteenth Century Malta - P., Cassar.,... 166 fallen to us, sometimes, to return papers Hospital Services in Gozo at the Time of the which did not quite come up to the neces­ Knights. - J. Borg. ... ... 172 sary standard. A Note on Suicide 175 Throughout this period the "Gazette" The Nomenclature for Chronic Lung Diseases 175 has always come out at its appointed time Medical News. 176 Publications List. ... 178 and has published some fourteen hundred Obituarli Notices. ... 178 pages of text. Even from the financial Index to Volume IX 181 aspect conditions are excellent with a very 104 satisfactory bank balance and this is in Medicine recently held here was very spite of a possibly quixotic refusal to raise successful, the organ:sat~on being. excellent. the charge for advertisements, which has The Italian delegation was the largest, but remained unchanged since we started in Britain, France, Belgium, Canada and 1966. Possibly if others also did not raise other countries, including our own, were fees just because it seems the thing to do worthily represented. The Malta represen­ at the moment, inflation might not be such tatives who read papers were Doctors J. A. a grievous problem. Admittedly our finan­ Meilak, P. Cassar and J.L. Grech on ces, besides being on a minute stage, are "Seasonal variations in suicidal deaths in peculiar in other ways. We are some of Malta", Dr. V. Captur on "Traumatic the few who are not interested in making heart disease", Dr. P. Cassar on "The con­ money. This is possible because of consis­ cept of 'permanent' incapacity for work in tent support by our advertisers, of free psychiatric patients applying for an inva­ postal transmission, of the convenient lidity pension" and Dr. L. Vassallo on medical tradition of not paying our contri­ "Aspects relating to gas poisoning fr~m butors and of all staff work being on a water heaters in Malta". Since the fore­ completely voluntary basis. To can it all most representative in Malta of the special­ the periodical, each copy of whic-h costs ties dealt with at the meeting is Dr. J oseph something like forty cents, is distributed L. Grech the main burden of organising free. the meeting fell on him and he and the This state of affairs would appear to members of a special committee, whom he be optimal and so it is from certain points took good care to thank for their assis­ of view. Our relations with the profession tance, acquitted themselves very well. are perfect, but unfortunately conditions One wonders sometimes whether such in the wider spheres are far from being meetings are really worth while. Does one so. The general state of affairs is so bad learn or does one teach much in them? In and appears so hopeless that one person, fact the plain truth is that probably care­ at least, has had enough of it and ful reading of the specialised periodicals or the present editor bows out with this contributing to these would be just as or issue. Whilst one is willing to work for a even more effective so far as pure learning community he could like one does not or teaching is concerned. Still even scien~ feel ready to spend time and energy in tists are human and the actual meeting of supporting, however remotely, something persons who may have exchanged views or he detests. Certain people can command corresponded for years does amount to a anvthing except respect and liking. So, great deal. Besides if circumstances are saluting our colleagues and thanking our favourable, why not please oneself in such helpers, in bitterness and disgust, we bid a direction? our readers farewell until, if ever, condi­ We are indeed glad when such gather­ tions are such that return is possible. ing can take place in Malta and although playing host is often a formidable under­ taking, in the long run it is worth it. Only AN INTERNATIONAL the profession must remember to be grate­ G'ATHERING ful to those who take on such tasks, since on the principle of ars est celare artem The meeting of the International the more efficient the organisers the easier Academy of Legal Medicine and Social the work appears to have been. 105 SURGERY AND J\DVANCED ABDOMINAL MALIGNANCY HAROLD ELLIS D.M., M.Ch., F.R.C.S. Professor of Surgery We!stminster Hospital Medical School, London I am always amazed when I speak to tumour with reconstruction of the vascular doctors in many parts of the world by their trunk. Involvement of adjacent organs by pessimistic attitude towards their patients no means indicates inoperability and we with advanced malignant disease. The have described, for example, six patients same medical practitioners who are in whom the invaded duodenum was enthusiastic in trying every means at their resected together with a carcinoma of the disposal to palliate patients with incurable right side of the colon. cardiac or renal disease seem to give up The presence of secondary deposits, without a struggle when confronted by once considered complete contraindication advanced malignancy. While I agree that to curative surgery, is now no~ longer in many cases the situation is indeed grave, necessarily so and occasional long term I wish to show in this lecture that there survivals follow resection of solitary are some grounds for optimism. deposits in the right or left lobe. I freely The problem divides itself into two admit that the great majority of patients major parts. In the first, we have those with liver secondaries have multiple patients who present with fresh clinical deposits which are unsuitable for any form problems which at first appear to be hop2- of resection. Until recently, many surgeons lessly advanced abdominal cancer. In the taught that the presence of such secon­ second group are patients who have daries completely contraindicated resec­ already undergone what was hoped to have tion of the primary tumour. However, we been curative resection of an abdominal have recently reviewed our experience at cancer, but who now return with clinical Westminster Hospital and of 640 patients features which suggest recurrence of the with carcinoma of the large bowel submit­ disease. ted to laparotomy, 112 (18%) had liver metastasis. 6 had laparotomy only and all Primary Advanced Malignant Disease were dead within a few months. 19 had palliative colostomy or short circuit and The spectrum of what is now regarded 17 of these were dead within a year. Ho\\'­ as surgically removable is ever widening. ever, 32 of the 86 patients submitted t'l Thanks to improved anaesthesia, blood palliativ.e excision of the primary tumouc transfusion facilities and advances in sur­ lived for more than a year and 1 survive"l gical technique such as vascular recon­ for 5 years. We know, in addition, that structive surgery, we are now able to carry death from liver deposits is far kinder than out successful resection of cancer which the terminal illness of the primary cancer. only a few years ago would have been con­ Even when the local tumour itself is sidered totally inoperable. Age, for example, completely irremovable, we must always is now seldom a bar to surgery provided consider whether we can carry out some that the patient's general condition is useful short circuit operation or intubation satisfactory. Involvement of major blood using a plastic tube. The average length vessels by tumour does not necessarily of survival of patients after this procedure contra-indicate resection, since the involved is only in the region of 12 weeks and the vessels can be removed en bloc with the longest survival one can expect is about 106 1 year.