Fifty Years of Acute Ischemic Stroke Treatment: A Personal History.

BACKGROUND: It has been 50 years since the first explorations of the physiology of cerebral ischemia by measuring cerebral blood flow (CBF), and 25 years since the approval of tissue plasminogen activator for treating acute ischemic stroke. My personal career began and matured during those eras. Here, I provide my perspective on the evolution of acute stroke research and treatment from 1971 to the present, with some in-depth discussion of the National Institutes of Neurologic Disease and Stroke (NINDS) tissue-type plasminogen activator (tPA) stroke trial and development of mobile stroke units. SUMMARY: Studies of CBF and metabolism in acute stroke patients revealed graded tissue injury that was dependent on the duration of ischemia. Subsequent animal research unraveled the biochemical cascade of events occurring at the cellular level after cerebral ischemia. After a decade of failed translation, the development of a relatively safe thrombolytic allowed us to achieve reperfusion and apply the lessons from earlier research to achieve positive clinical results. The successful conduct of the NINDS tPA stroke study coupled with positive outcomes from companion tPA studies around the world created the specialty of vascular neurology. This was followed by an avalanche of research in imaging, a focus on enhancing reperfusion through thrombectomy, and improving delivery of faster treatment culminating in mobile stroke units. Key Messages: The last half century has seen the birth and evolution of successful acute stroke treatment. More research is needed in developing new drugs and catheters to build on the advances we have already made with reperfusion and also in evolving our systems of care to get more patients treated more quickly in the prehospital setting. The history of stroke treatment over the last 50 years exemplifies that medical "science" is an evolving discipline worth an entire career's dedication. What was impossible 50 years ago is today's standard of care, what we claim as dogma today will be laughed at a decade from now, and what appears currently impossible will be tomorrow's realities.

Tratamiento del pie zambo congénito a lo largo de la historia / Congenital clubfoot treatment throughout history

El tratamiento del pie zambo congénito ha evolucionado a lo largo de la historia. Desde la Antigüedad hasta finales de la Edad Media se utilizaron las manipulaciones e inmovilizaciones seriadas. Del Renacimiento al siglo XVII se crearon las primeras ortesis. En el siglo XVIII comenzó el uso de moldes de yeso y se desarrollaron ortesis y calzados complejos. El período del siglo XIX hasta la tercera década del XX, se caracterizó por la práctica de las tenotomías, siendo la cirugía el principal enfoque terapéutico. En el siglo XX, Joseph Kite e Ignacio Ponseti describieron su eficaz método no quirúrgico, lo que produjo el regreso a las manipulaciones e inmovilizaciones seriadas frente a la cirugía agresiva. Cuando se revisa la historia del tratamiento del pie zambo, sorprende ver que los médicos tratantes cometían los mismos errores una y otra vez, porque ignoraban constantemente lo que ya habían aprendido de sus antecesores y, en su lugar, a menudo se veían confundidos por las nuevas informaciones o tendencias. En el siglo XXI, los avances en biología celular, genética molecular, diagnóstico por la imagen, biomecánica y biomateriales hacen prever que se puedan diseñar tratamientos personalizados para los pacientes con pie zambo(AU)

Congenital clubfoot treatment has evolved throughout history. Serial manipulations and immobilizations were used from antiquity to the end of the Middle Ages. From the Renaissance to the 17th century the first orthotics were created. In the 18th century, the use of plaster casts began and complex orthotics and footwear developed. The period from 19th century until the third decade of the 20th century was characterized by the practice of tenotomies, with surgery being the main therapeutic approach. In the 20th century, Joseph Kite and Ignacio Ponseti described their effective non-surgical method, which led to the return to serial manipulations and immobilizations in the face of aggressive surgery. When reviewing the history of clubfoot treatment, it is surprising to see that the treating doctors made the same mistakes over and over again because they constantly ignored what they had already learned from their predecessors and, instead, were often confused by the new ones information or trends. In the 21st century, advances in cell biology, molecular genetics, diagnostic imaging, biomechanics and biomaterials suggest that personalized treatments can be designed for patients with clubfoot(AU)

Epilepsy in Hildegard of Bingen's writings: A comprehensive overview.

Hildegard of Bingen (1098-1179AD) is one of the most relevant figures of the Middle Ages. She wrote two medical books, Physica (Natural history) and Causae et curae (Causes and remedies). Our aim was to provide a comprehensive account of Hildegard of Bingen's conception of epilepsy, of the remedies proposed to treat it, and of the medical and physiological theories behind their use. We searched Hildegard of Bingen's entire body of writings to identify any possible reference to epilepsy or epileptic seizures. We reported the identified passages referring to epilepsy and discussed their content in light of medieval medical and physiological theories. Most references to epilepsy were found in Physica and Causae et curae. The suggested remedies against epilepsy range from herbal preparations to animal remedies and jewel therapy. Hildegard's conception of epilepsy gives the impression of an original revisitation of the traditional theory of humors, and carries strong moral connotations. Hildegard of Bingen's conception of epilepsy appears strongly rooted in medieval thinking and less in physiological theories. However, it differs in many respects to the traditional medieval beliefs and is a further proof of her unique personality. As living testimony of the past, Hildegard's writings enable us to shed a fascinating light on the beliefs concerning epilepsy in the middle ages.

John Brown's system of medicine and its introduction in Denmark around 1800.

At the end of the eighteenth century a scientific basis for medicine was called for. The Scottish physician John Brown proposed an all-comprising medical system in 1780. A surplus or lack of stimulating factors, the prime movers of life according to Brown, was supposed to explain all diseases and indicate their treatment. Individuals only subjected to a small degree of stimulation became affected by "asthenic diseases" which were the most frequent diseases. They should be treated with abundant food and wine, supplemented with camphor, opium, or other drugs considered to be stimulating. Conversely, individuals with "sthenic diseases" should reduce their intake of food and beverage. Brown's system was received with transient approval by some Danish physicians from the late 1790s. But it soon proved to be of no value in medical practice, and its success dwindled within academic medicine around 1814. On the other hand, it seemed to generate new ideas. It became linked with the German Romantic Movement and "Naturphilosophie." The widespread use of camphor and opium in both academic and folk medicine, continued throughout the nine- teenth century and into the twentieth century.

Historical survey of the internal use of unprocessed amber.

The organic mineraloid gemstone, amber, a fossilized resin collected from Eocene deposits laid down around 44 million years old on the Baltic coast, has been an important geopharmaceutical in the western materia medica since classical times. Once rendered into powdered form, it could be delivered into the body using a wide range of vehicles including lozenges, pills, tablets, troches, electuaries, solutions and lohochs (lick-pots), and with toast and poached eggs. Acting either alone or in combination with a wide range of botanical, zoological and other geological ingredients, it was employed in the treatment of a huge range of diseases. Most prominent among these were various vascular disorders (e.g. haemoptysis, haemorrhage, excessive menstrual bleeding), problems with the urogenital system (e.g. tendency towards miscarriage, impotence, venereal diseases, strangury, dysuria and bladder stones) and alimentary conditions, particularly dysentery. A variety of infectious diseases, including plague, gonorrhoea, measles and fevers could be targeted with amber-containing preparations, as could epilepsy, melancholy and the ravages of old age. Rather more unusual applications included its use in the treatment of impotence, halitosis, drunkenness and a weak back.

[E.S.BOTKIN, A SPECIMEN OF FIDELITY TO PROFESSIONAL DUTY AND OATH OF LOYALTY, AN EXAMPLE OF COURAGE AND HONOUR OF THE RUSSIAN DOCTOR].

Evgeny Sergeevch Botkin, son of the legendary Russian internist Sergey Petrovich Botkin, was a court physician for Tsar Nikolai II. After Nikolai abdicated the throne on 15 March (2 March in the Julian calendar) 1917, E.S. Botkin felt it was his duty to accompany the Romanovs into exile to Siberia and continued to selflessly treat the crown prince Aleksey, other members of the Romanov family and all those who applied for his advice. He was shot together with the Romanovs in the basement room of the Ipatiev house, Ekaterinburg, remaining loyal to professional duty and the word given to the Emperor.

Cuantificación oracional en prospectos de enfermedades cardiovasculares crónicas: implicaciones para la literacidad en salud / Sentence quantification in leaflets of chronic cardiovascular diseases: implications for health literacy

Los prospectos médicos, en cuanto a folletos destinados al paciente, presentan lo que debiese ser información necesaria para el tratamiento del paciente. La información entregada, sin embargo, no siempre se presenta de manera clara y adecuada respecto a la literacidad del destinatario. Esa complejidad puede verse en diversos factores como la gramática, que será el centro de esta investigación, aplicada a folletos de enfermedades cardiovasculares crónicas. OBJETIVO: Observar la complejidad gramatical dentro de un apartado de los prospectos medicamentosos para revisar cuantitativamente las estructuras gramaticales, considerando que una mayor complejidad gramatical implica una mayor dificultad de lectura y comprensión. METODOLOGÍA: Para la investigación se extrae un apartado específico de los prospectos, el cual es común a todos los prospectos analizados. Tras la recolección del corpus y el análisis del mismo, se revisan las oraciones para cada muestra y desde la información recolectada se comienza el trabajo cuantitativo, para, finalmente, extraer resultados y conclusiones. RESULTADOS: Se presenta en los prospectos una alta densidad oracional, lo que implica una gran cantidad de información en una cantidad baja de estructuras, lo que tiene implicancias en la legibilidad y comprensión de los medicamentos. CONCLUSIONES: La alta cantidad de oraciones implica una baja legibilidad y una baja comprensión, lo que significa una baja aprehensión de la información por parte de los destinatarios más aún en casos como el deterioro psicoorgánico, lo que repercute en la literacidad en salud de los destinatarios.

Leaflets, as text destined to medical patients, show the information that should be necessary for the right treatment of the patients. The information given, otherwise, is not always displayed clearly and appropriate respecting the literacy of the receiver. That complexity could be seen in diferent factors as grammar, and this point will be the main objective of this investigation, applied to chronic cardiovascular diseases leaflets. OBJECTIVE: Leaflets, as text destined to medical patients, shows the information that should be necessary for the right treatment of the patients. The information given, otherwise, is not always displayed clearly and appropriate respecting the literacy of the receiver. That complexity could be seen in diferent factors as grammar, and this point will be the main objective of this investigation, applied to chronic cardiovascular diseases leaflets. METHODS: To this investigation, a section of the leaflets is extracted, common to every leaflet analyzed. After recollection of the corpus and his analysis, the sentences from every samples are reviewed and from the collected information the quantitative work starts, to, finally, extract the results and conclusions. RESULTS: Sentence high density is presented in the leaflets, which involves a lot of information in a small amount of structures, which have implications for readability and understanding of medicines. CONCLUSIONS: The high number of sentences implies a low readability and low understanding, which means a low seizure of information by recipients, especially in cases like the psycho-organic deterioration, which affects the health literacy of recipients.