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The Department of Surgery currently has several research groups working on various projects in different fields of surgery. Some of the ongoing or recently completed projects are listed below:

Osteoporosis/Osteopoenia in Crohn's disease patients expressing the atg16L1 variant

Researcher: Dr Neville Azzopardi M.D., M.R.C.P.(UK)

In this research project, the incidence of the rs2241880 mutation in the atg16l1 gene among Crohn's disease patients is being assessed. The atg16l1 gene is associated with autophagy and is believed to have a role in small bowel Crohn's disease. Samples of blood from the subjects is withdrawn and DNA is extracted from the core blood. The rs2241880 mutation is then identified using both qtPCR - HRM and enzyme digest of the PCR product. All subjects are also requested to undergo a Bone Mineral Density (as recommended by the ECCO guidelines) and the bone densities of patients having the rs2241880 mutation are compared with patients not expressing this mutation. The incidence of the rs2241880 mutation in Crohn's disease patients is also compared with the normal (non-Crohn's disease) population.

Does oral Pindolol improve clinical efficacy of amitriptyline in midfacial pain-serial measurement of plasma serotonin marker
Researcher: Mr Adrian M. Agius

This work centres on patients that present with chronic facial pain incorrectly labeled as ‘sinus pain’, which is a very common condition. These patients are thought to have tension-type facial pain or facial migraine. Tension-type facial pain is thought to be due to dysfunction of descending pain-modulationg serotonergic pathways. A cohort of over 200 patients is being followed up for at least 3 years to determine the long-term course of this condition and response to conventional treatment. Ninety patients with tension-type facial pain are entering a clinical trial which compares pain frequency and intensity scores of three groups having different treatment for eight weeks: placebo, amitriptyline, and amitriptyline with pindolol. Pindolol is a beta-blocker which blocks serotonin receptors. Serial serotonin levels are being taken in all three patient groups to determine whether clinical efficacy is reflected by a change in blood serotonin, which reflects intraneuronal serotonin.

A population based study on the epidemiology and aetiology of thyroid cancer in Malta
Researcher: Ms Angela Sultana M.D., F.R.C.S. 

Currently no local data about the demographics of patients suffering from thyroid cancer, definition of the prevalent types of thyroid cancer, treatment modalities and treatment outcomes are available. In 2002, 19,034 new cases of thyroid cancer were diagnosed in the European Union. The highest incidence rate was in Malta. The female rate in Malta was seven times higher than the rate of the lowest ranking country ie: Bulgaria (12.6 versus 1.7 per 100,000 females).

The aim of this project is to establish the local prevalence, incidence and geographical distribution of thyroid cancer. Subsequently a number of oligoelements and primary environmental thyroid disruptors will be analysed to establish any association between these and the local incidence of thyroid cancer as well as to identify any clustering of thyroid cancer and any of the proposed aetiological agents.

Barrett’s Oesophagus – Towards Improving Surveillance
Researcher: Mr Jo Etienne Abela M.D., M.R.C.S., F.R.C.S., F.E.B.S.

In this project surveillance of Barrett’s Oesophagus was researched from the screening and therapeutic perspectives in the following studies. A systematic review of published series was undertaken which suggested that careful white-light endoscopy with multilevel mucosal biopsies from the four quadrants was likely to yield more cases of high-grade dysplasia and early cancer. In contrast a random biopsy technique or no surveillance at all were associated with the development of invasive cancer. This observation was tested and confirmed in a comparative cohort study in Glasgow. With a total of 362 patients this is one of the largest studies of its type. In a proof of concept clinical experiment exhaled breath ethane was tested as a marker of oxidative stress in gastro-oesophageal cancer in a case-control. No useful association was found and therefore, this technique cannot be recommended for screening purposes. Treatment of high-grade dysplasia and early cancer with endoscopic mucosal resection (EMR) and Nd:YAG laser was assessed in a cohort study (n=30) which suggests that this modality is effective and safe. The former group of patients had similar survival statistics to age- and stage-matched patients (n=8) treated with oesophagectomy. More recently, the cutting edge modality of mucosal radiofrequency ablation was assessed in the treatment of high-grade dysplasia and early cancer in another cohort study (n=58,). In this series resolution of neoplasia and metaplasia was achieved in 90% and 70%, respectively.

This project suggests that careful endoscopy with a meticulous biopsy technique is likely to yield early neoplastic lesions which may be treated with endoscopic mucosal ablation. This practice may obviate the emergence of invasive cancer which carries a poor prognosis even when treated with oesophagectomy.

Remote Ischaemic Preconditioning in an Atrial Myocardial Cell line

Researcher: Mr Kevin Schembri M.D., F.R.C.S.

This study will look at genes that are expressed during Remote ischaemic preconditioning (RIPC) in an in vitro model using an atrial myocardial cell line and in vivo using atrial myocardial biopsies taken from coronary artery bypass patients with a special emphasis on the possible role of clock genes.


NEW Master in Laparoscopic Surgery

To be offered in February 2017

Last Updated: 30 March 2012

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