Hippocratic concepts of acute and urgent respiratory diseases still relevant to contemporary medical thinking and practice: a scoping review.

BACKGROUND: The collected works of Hippocrates were searched for concepts on the diagnosis, prognosis, and treatment of acute and urgent respiratory diseases, with the objective to trace their origins in the Hippocratic Collection. METHODS: A scoping review was performed to map out key concepts of acute and severe respiratory diseases in the entire Hippocratic Collection. The digital library Thesaurus Lingua Graeca (TLG) was researched for references in the entire Hippocratic Collection regarding the epidemiology, pathophysiology, prognosis, diagnosis and treatment of acute respiratory diseases; then, the relevant texts were studied in their English translation by the Loeb Classical Library. RESULTS: Hippocratic physicians followed principles of treatment for pneumonia and pleurisy, still relevant, such as hydration, expectoration, analgesia and prompt mobilisation. Other approaches, including the inhalation of "vapours through tubes" in angina, can be considered as forerunners of modern medical practice. Thoracic empyema was diagnosed by shaking the patient and direct chest auscultation after "applying your ear to his sides". In case of an emergency from upper airway obstruction, urgent insertion of primitive airway equipment, such as a small pharyngeal tube, was applied. CONCLUSIONS: The main Hippocratic concepts on four still common acute and urgent respiratory diseases -pneumonia, pleurisy, thoracic empyema and upper airway obstruction- were identified and most of them were found to be in agreement with contemporary medical thinking and practice.

Hippocrates (ca 460-375 bc), Introducing Thoracotomy Combined With a Tracheal Intubation for the Parapneumonic Pleural Effusions and Empyema Thoracis.

Hippocrates was the first physician to describe in accuracy pleural effusion and pneumonia. To treat empyema thoracis he had introduced a combined method of tracheal intubation with a simultaneously thoracotomy. The surgical incision was used for the pus to be progressively drainaged. If the patient was too weak to eat, he had suggested for nutritional mixtures to be administered through an oral-gastric tube. Thus Hippocrates composed in his operating theatre, an icon similar to modern surgical operations.

Parapneumonic empyema deaths during past century, Utah.

Bacterial pneumonia with empyema is a serious complication of influenza and commonly resulted in death during the 1918 influenza pandemic. We hypothesize that deaths caused by parapneumonic empyema are increasing in Utah once again despite advances in critical care and the availability of antimicrobial drugs and new vaccines. In this study, we analyzed the historical relationship between deaths caused by empyema and influenza pandemics by using 100 years of data from Utah. Deaths caused by empyema have indeed increased from 2000-2004 when compared with the historic low death rates of 1950-1975. Vaccine strategies and antimicrobial drug stockpiling to control empyema will be important as we prepare for the next influenza pandemic.

[Pleural empyema, chirurgeons and Auenbrugger's Inventum novum]. / Pleura-empyeem, chirurgijns en Auenbruggers Inventum novum.

In the past while the diagnosis was primarily made by the physician, the treatment of thoracic empyema was a surgeon's job. Carrying out this treatment was something of a hit and miss affair. With the change from belief in the Hippocratic principles ofhumours towards organs and tissues being the cause of disease, the way diagnoses were made also changed. The technique of percussing the thorax developed by Auenbrugger two centuries ago, was the beginning of diagnosing based on meticulous physical examination. Chirurgeons were expected to treat thoracic empyema adequately and by employing this technique, were able to make a more exact diagnosis and consequently provide better treatment. Modern imaging techniques have rendered manual thoracic percussion less often necessary. Percussion is now carried out much more often by pulmonologists than by surgeons. Nevertheless, Auenbrugger's 'inventum novum' will continue to be a gratefully employed technique.

'Tell Brother Regius...' Clifford Allbutt's correspondence with Archibald Malloch during Osler's final illness.

A very close friendship developed between Sir Clifford Allbutt (1836-1925) and Sir William Osler (1849-1919) after they became regius professors at the universities of Cambridge and Oxford, respectively. In 1919, Osler contracted influenza during the 1918-19 pandemic. The disease developed into serious pneumonia and empyema and was the cause of his death. One of his attending physicians in his final illness was Dr T Archibald Malloch (1887-1953) with whom Allbutt began to correspond. Allbutt's letters to Malloch are presented here. Allbutt was an exemplary physician. His handwriting, however, left much to be desired. Transcription of these letters was no mean feat.

Pyothorax-associated lymphoma.

In Japan, EBV positive rate in immunocompetent patients with nodal lymphomas is less than 10% in B-cell and 20-50% in T cell lymphoma. Among extranodal lymphomas, EBV positive rate is higher in pyothorax-associated lymphoma (PAL), nasal NK/T-cell lymphoma, and adrenal lymphoma. PAL is non-Hodgkin's lymphoma that develops from chronic pyothorax resulted from artificial pneumothorax for the treatment of lung tuberculosis or tuberculous pleuritis. This disease was originally described by Dr. Aozasa as a distinctive clinicopathologic entity in 1987, and now listed as the disease entity in the WHO classification of Tumours, Pathology & Genetics, Tumours of the Lung, Pleura, Thymus and Heart (2004).

Thoracoscopic approach to the management of empyema thoracis. Indications and results.

The optimal management of empyema thoracis demands a fundamental knowledge of the pace and timing of the illness. Early free-flowing empyema should be drained by as dependent a drain as possible, while antibiotics directed against the underlying pneumonia are delivered. Late chronic empyema characterized by a constrictive rind intimately fused with the visceral pleura is best managed with an open decortication. Controversy exists when addressing the needs of the patient with a multiloculated acute empyema. Lengthy hospitalizations with prolonged chest tube drainage and administration of antibiotics likely will prove fruitless and culminate in open thoracotomy. The key to successful therapy lies in effective pleural evacuation and re-expansion of the lung. Intrapleural fibrinolytic therapy has been reported to produce excellent results in some centers and is a therapeutic option. Patients undergoing fibrinolytic therapy should be subjected to surgical drainage and debridement if significant improvement is not appreciated within 3 to 5 days. Early limited thoracotomy and thoracoscopic debridement theoretically accomplish the same end result. The advantages of thoracoscopy over limited thoracotomy are enhanced visualization of the pleural cavity and less postoperative pain and dysfunction.

The history of surgery of empyema, thoracoplasty, Eloesser flap, and muscle flap transposition.

This article discusses the surgical history of empyema, thoracoplasty, the Eloesser flap, and muscle flap transfer. Little has changed in the 2000 years since the treatment of empyema was originally described by Hippocrates. The basic concepts of drainage of the infected empyema and obliteration of the space by allowing the lung to come up to the chest wall, taking the chest wall down to the lung, or by using muscle flaps or antibiotic solution remain the stabilizing forces in the treatment of postresection or postinfectious empyemas.

Radiologic evaluation and intervention for empyema thoracis.

Empyema thoracis has changed little in its presentation and etiology since first described. Surgical intervention, simply put, is "drainage of pus." The introduction of computed tomography and catheter drainage of empyema is the first technologically driven advancement for the management of empyema. The use of various radiologic procedures for characterization and treatment of empyema is described.