Spyridon Magginas (1839-1920) and One of the First Successful Radical Nephrectomies.

Spyridon Magginas was among the Greek doctors of the turn of the century who trained abroad with the hope of returning to their native country to offer their services. He became a professor in the "Othonion University" of Athens to promote surgery among young physicians. He was raised in an upper social class family and, reportedly, had an arrogant behaviour, which occasionally led him to have ineffective patient interactions. His patient, and an important Greek writer, Emmanuel Rhoides, nicknamed him the "surgeon beast" for neglecting his case. However, Magginas was an innovative surgeon and in 1902, completed the first successful radical nephrectomy in Greece, and possibly one of the first few globally of the 20th century. A key factor in his success was the prioritisation and application of strict antisepsis.

The Most Common Comorbidities in Dandy-Walker Syndrome Patients: A Systematic Review of Case Reports.

OBJECTIVE: Dandy-Walker syndrome (DWS) is a rare neurologic multi-entity malformation. This review aimed at reporting its main nonneurologic comorbidities. METHODS: Following PRISMA guidelines, search in Medline was conducted (2000-2014, keyword: dandy-walker). Age, sex, country, DWS type, consanguinity or siblings with DWS, and recorded coexistent conditions (by ICD10 category) were extracted for 187 patients (46.5% male, 43% from Asia) from 168 case reports. RESULTS: Diagnosis was most often set in <1 year old (40.6%) or >12 years old (27.8%). One-third of cases had a chromosomal abnormality or syndrome (n = 8 PHACE), 27% had a cardiovascular condition (n = 7 Patent Ductus Arteriosus), 24% had a disease of eye and ear (n = 9 cataract); most common malignancy was nephroblastoma (n = 8, all Asian). Almost one-fifth had a mental illness diagnosis; only 6.4% had mild or severe intellectual disability. CONCLUSION: The spread of comorbidities calls for early diagnosis and multidisciplinary research and practice, especially as many cases remain clinically asymptomatic for years.

Trepanation Practices in Asclepieia: Systematizing a Neurosurgical Innovation.

BACKGROUND: As ancient Greeks started looking for deities that could fulfill the pragmatic needs of common people, local heroes started being mythologized and worshipped through cults. METHODS: The most widespread such example was Asclepius, possibly a skilled war surgeon who followed military expeditions to Colchis and Troy. Our study investigates the possibility of the early neurosurgery to have been started inside Asclepieia by Asclepius and his followers. RESULTS: Asclepius was worshipped at religious temples called Asclepieia where certain specific medical and surgical techniques were followed. The most advanced technique was skull trepanation, which was most likely done as an acute operation to release intracranial pressure. The contemporary Hippocratic corpus provided extensive descriptions of the technique, and archaeologic evidence has shown that many patients survived the operation. CONCLUSIONS: Decompressive craniectomy techniques have been practiced for millennia but it is possible that they were first systematized as a neurosurgical innovation through the Ancient Greek religious cult followed in Asclepieia.

The Secondhand Smoke Exposure Scale (SHSES): A hair nicotine validated tool for assessing exposure to secondhand smoke among elderly adults in primary care.

INTRODUCTION: Accurate estimation of exposure to Secondhand Smoke (SHS) is important in both research and clinical practice. We aimed to develop, an easy to implement, biomarker validated scale to provide an estimation of adult exposure to SHS for use within primary health care or epidemiological research. METHODS: A pool of 26 baseline questions evaluating exposure to SHS was administered to 178 non-smoking adults (mean age 68.1 years), recruited from both urban and rural primary health care practices in Crete, Greece in November 2011, while concurrent hair samples were collected and nicotine concentrations were measured. To generate scores for each question item, we fitted a backward linear regression using the main predictors of SHS exposure selected from the initial pool of questions, weighted against each individuals biomarker evaluated exposure. RESULTS: Among the pool of participants and weighted according to hair nicotine levels, in descending order, the most important sources of SHS exposure were the home (5 points, ß=0.37), the family car (3 points, ß=0.20), public places (2 points, ß=0.15) and the workplace (1 point, ß=0.013), the relative weighting of which led to the development of an 11-point scale to assess exposure to SHS. For every unit increase in the score, there was an associated increase in mean hair nicotine concentrations by 1.35 ng/mg (95%CI: 1.25-1.45, p<0.0001). CONCLUSIONS: The SHS exposure score (SHSES) may be a useful tool in an estimating the level of the exposure to SHS among elderly adults and investigating the relationship between SHS exposure and potential health outcomes.

From the Classroom to Facebook: A Fresh Approach for Youth Tobacco Prevention.

PURPOSE: The explosive rise in Internet use calls for effective ways to utilize new forms of social media to enhance school smoking prevention programs. We attempted to design and test an educational intervention for youth tobacco prevention. DESIGN: Intervention design and posttest pilot implementation. SETTING: A single high school in Athens, Greece. SUBJECTS: Two hundred twenty-five students (aged 15-18 years). INTERVENTION: A Facebook-integrated educational intervention in six simple steps was designed and tested during an ad hoc smoking prevention lecture to high school students in Greece in order to stimulate social mobilization in online networks. MEASURES: Number of students with an active Facebook account, percentage posting antismoking messages within a 72-hour period, number of Facebook friends reached. ANALYSIS: Descriptive statistics. RESULTS: Assessed 3 days after the lecture, 15.9% of students had posted a smoking-related sentence in their Facebook account, a take-home message that was spread as a note on their wall via news feed to their 20,095 cumulative Facebook friends. CONCLUSION: One smoking-related take-home message can spread virally to a large number of adolescents through their Facebook friends. This intervention provides insight into a novel way of providing health information to youth, a hard-to-reach and vulnerable population.

A Palpable Painless Axillary Mass as the Clinical Manifestation of Castleman's Disease in a Patient with Hepatitis C Disease.

Introduction. Castleman's disease (CD) is a rare lymphoproliferative disorder. CD is divided into two clinical subtypes: the most common unicentric and the less usual multicentric subtype. The majority of unicentric CD affects the mediastinum, while neck, abdomen, and axilla are less common locations. Case Presentation. Herein, we describe a rare case of unicentric CD in the right axilla in a 36-year-old white male with a medical history of hepatitis C virus infection admitted to our hospital due to palpation of a painless mass in the right axilla. Complete excision of the lesion was performed and, one year after the diagnosis, patient was free of the disease. Conclusions. Although infrequent, it is important to include CD in the differential diagnosis when evaluating axillary lymphadenopathy particularly in young patients with a low-grade inflammation process and chronic disease even in the absence of an abnormal blood picture or organomegaly.

Joseph Gensoul and the earliest illustrated operations for maxillary sinus carcinoma.

Surgery has evolved along with anatomical illustrations through the ages. Joseph Gensoul (1797-1858), an important figure of the great Lyonnaise medical tradition of the 19th century, was occupied with many different surgical diseases, mostly diseases of the face. Apart from his many contributions stand various techniques on ophthalmological, otorhinolaryngological and oral and maxillofacial surgery. In this context, two rare illustrations depicting an innovative facial surgical operation performed by the great surgeon Joseph Gensoul are thoroughly analyzed. The two illustrations represent the "before" and "after" phases of Gensoul's most eminent operation, most probably practiced for a maxillary sinus carcinoma. This surgical operation is probably the earliest recorded of its kind in the history of surgery, even though the development of maxillary surgery is connected with the practice of Irwin Moure, who also practiced a type of lateral rhinotomy about a century later than Gensoul. Surgical illustrations are closely related to the history of surgery in every corner of the world.

Paleopathological findings in radiographs of ancient and modern Greek skulls.

OBJECTIVE: The skull, when portrayed radiologically, can be a useful tool in detecting signs of systemic diseases and results of pathological growth mechanisms. The aim of this study was therefore to examine, compare, and classify findings in cranial configuration of pathological origin, in modern and ancient skulls. MATERIALS AND METHODS: The material consists of 240 modern and 141 ancient dry skulls. Three radiographs for each skull (lateral, anteroposterior, basilar) provide enough evidence for differential diagnoses. RESULTS: Cases of osteoporosis are among the interesting pathological findings. A prevalence of female modern skulls in those determined as osteoporotic skulls is noted. Special interest is placed on the area of the sella turcica and many variations, regarding the shape and texture, are recognized both in ancient and modern skulls. Malignancies and important causes of cranial destruction are identified in both skull collections. Diploid thickening and osteolytic areas appear commonly among ancient remains. Moreover, from the ancient skull collection, one case possibly recognizable as fibrous dysplasia is noted while another case with an unusual exostosis gives rise to many questions. CONCLUSIONS: Interpreted with caution, the results of the present study, which can serve as an approach of paleopathology and paleoradiology, indicate similarity trends in cranial configuration of pathologic origin in modern and ancient people. Radiography and cephalometry were the main diagnostic tools used to gather evidence and are evaluated as a quite appropriate method to examine anthropological material and assess the internal structure of skeletal remains since they are non-destructive techniques.

Imperforate anus and perianal fistula in Ancient Greek medical writings.

Anorectal malformations remain a challenging topic in pediatric surgery, known since antiquity. In our paper we expose the main descriptions and therapeutic approaches of imperforate anus and perianal fistula through the works of the ancient Greek and Byzantine physicians.