Milestones in the evolution of pathology in Malta

This book offers a brief sketch of events in chronological sequence that mark the rise of the science of pathology in Malta over the past three hundred years. This development cannot be adequately appreciated without a backward glance over a stretch of time when morbid anatomy and clinical medicine were still interpreted in terms of the ancient theory of the four humours - blood, phlegm, yellow bile and black bile - according to which an imbalance of these humours was considered to be the root cause of disease. In fact it was not until after 1858 when Rudolf Virchow (1821-1902), Professor of Pathology at Wursburg University, brought out his concept of Cellular Pathology that the humoral theory was abandoned. In fact Virchow pointed out that the cell was the centre of all bodily activity and changes and ultimately the seat of disease. Going through these pages the reader will note the great impact that European medical literature and advances have exercised on the development of pathology in Malta. This is to be expected as Malta, in its central geographical location in the Mediterranean at the southernmost point of Europe has, since ancient times, been a hub in the main stream of the political, maritime, cultural and medical evolution of that continent.peer-reviewe

High-grade vaginal intraepithelial neoplasia and risk of progression to vaginal cancer. a multicentre study of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV)

OBJECTIVE: The aim of this study was to analyse the women with high grade vaginal intraepithelial neoplasia (HG-VaIN), in order to identify a subset of women at higher risk of progression to invasive vaginal cancer. MATERIALS AND METHODS: The medical records of all the women diagnosed with HG-VaIN, and subsequently treated, from January 1995 to December 2013 were analyzed in a multicentre retrospective case series. The rate of progression to invasive vaginal cancer and the potential risk factors were evaluated. RESULTS: 205 women with biopsy diagnosis of HG-VaIN were considered, with a mean follow up of 57 months (range 4-254 months). 12 cases of progression to vaginal squamocellular cancer were observed (5.8%), with a mean time interval from treatment to progression of 54.6 months (range 4-146 months). The rate of progression was significantly higher in women diagnosed with VaIN3 compared with VaIN2 (15.4% vs. 1.4%, p < 0.0001). Women with HG-VaIN and with previous hysterectomy showed a significantly higher rate of progression to invasive vaginal cancer compared to non-hysterectomised women (16.7% vs. 1.4%, p < 0.0001). A higher risk of progression for women with VaIN3 and for women with previous hysterectomy for cervical HPV-related disease was confirmed by multivariable logistic regression analysis. CONCLUSIONS: A higher rate of progression to vaginal cancer was reported in women diagnosed with VaIN3 on biopsy and in women with previous hysterectomy for HPV-related cervical disease. These patients should be considered at higher risk, thus a long lasting and accurate follow up is recommended

The Expression of p21 Marker in Bladder Urethral Tumor and its Association with Histopathologic Characteristicslogic charactristics

Background: In addition to clinical and histologic factors that are able to differentiate between low and high grades of bladder's urethral tumor from each other, there are a number of biomarkers that may be helpful in evaluating the degree, outcome, and prognosis of the tumor. The aim of this study was to investigate the relationship between overexpression of p21 marker and histologic status, prognosis, and recurrence of urethral carcinoma of the bladder. Methods: In this cross-sectional study, the paraffin wax blocks of 356 patients were gathered. Tumor points of the tissue were selected from the main block and mounted on the tissue microarray (TMA) of receptor block. Immunohistochemical staining was performed for the p21 marker. The intensity and extent of staining for this marker were determined by two pathologists using the combined and semi-quantitative method [Histochemical Score (H-Score)]. Results: The expression of p21 marker was significantly different in the high- and low-grade tumors. On the basis of H-Score, and in the high-grade tumor group, this expression was significantly higher than the low-grade (153.85 ± 91.06 versus 130.01 ± 82.20). Using the receiver operating characteristic (ROC) curve analysis, the p21 marker (based on the H-Score) had a high degree of precision in distinguishing high-grade items from the low-grade (ROC = 0.596, P = 0.002). Accordingly, the best cut-off value for the marker in differentiation of two grades was 92.5%, at which, the sensitivity and specificity were 67.7% and 44.7%, respectively. Regarding the results of multivariate logistic regression analysis, in the evaluation of factors related to tumor recurrence, the presence of non-papillary pattern predicted the recurrence (likelihood ratio: 6.363, P = 0.001). Conclusion: By determining the H-Score of p21 marker, the high- and low-grade tumors can be discriminated with an acceptable sensitivity and specificity. The presence of non-papillary pattern has a high predictive value for tumor recurrence

The benefits of a 5-day dysphagia intensive placement

Finding practical dysphagia opportunities for students pre-qualification is challenging. Discussions with clinicians led to the development of a new placement model. The placement was just five days and had an accompanying workbook. The current study aimed to evaluate the benefits of the placement. Data were analysed from 40 students who attended an adult dysphagia placement and 13 who attended a paediatric dysphagia placement. Measures included a pre and post self-rating questionnaire, qualitative feedback from clinical educators and students and a pre and post measure of knowledge using concept maps. Student self-rating data indicated gains in experience, awareness, knowledge, clinical skills, competence, confidence and interest in dysphagia. Clinical educators and students also reported a range of benefits from this placement. Students who undertook a placement that focused on adult dysphagia significantly increased their knowledge of adult dysphagia, but this did not generalize to paediatric dysphagia. Despite reporting that they felt they had gained in knowledge of dysphagia, the students who did a paediatric dysphagia placement did not significantly increase their knowledge of dysphagia. The study raises a number of important considerations when designing placements including length, timing, intensity, how best to encourage generalization of knowledge, and how best to measure learning