An Early Description of Using Oral Route for the Management of Cervical Vertebra Fracture by Ibn al-Quff in the Thirteenth Century.

OBJECTIVE: This study presents information regarding the treatment of fractures and dislocations of the vertebrae, including the use of the oral route for upper cervical fractures, presented in certain chapters of the book titled Kitab al-'Umda fi Sina'a al-Jiraha (Ibn al-Quff, thirteenth century ad). METHODS: A printed copy of the second volume of the book was studied. Chapters 22 ("On treatment of vertebral fractures") and 33 ("On treatment of vertebral dislocation") of the seventeenth treatise of this book were translated from Arabic into English. Each section is presented (in full text) in the Results section of this article. The findings were compared with the relevant literature and discussed to determine whether Ibn al-Quff presented novel information compared with that presented by his predecessors. RESULTS: The writings of Ibn al-Quff regarding vertebral dislocations seem to summarize information derived from his predecessors. Moreover, he modified certain approaches, previously described for vertebral dislocations, and used them for correcting vertebral fractures. Ibn al-Quff introduced the most novel use of a bridlelike instrument for anterior cervical fracture through the oral route. By introducing the device in the mouth, he described a pushing maneuver to the cervical vertebrae from the ventral site and a simultaneous pulling maneuver by cupping on the neck from the dorsal site. CONCLUSIONS: The use of the oral route introduced by Ibn al-Quff may be one of the earliest examples of novel, practical, and advanced treatment for cervical vertebral fracture.

One of the Earliest Accounts of Head Wounds in Firdaws al-Hikma by al-Tabari from the 9th Century.

OBJECTIVE: To present the first Arabic text on suturing scalp wounds. METHODS: A related section entitled "On the wounds in the head" from the book Firdaws al-Hikma (Paradise of the Wisdom) written by al-Tabari in the 9th century was identified and analyzed. This work was one of the earliest medical compendiums in the Islamic world during the medieval period. A printed copy of Firdaws al-Hikma edited by Muhammad Zubayr al-Siddiqi was examined, and findings were compared with relevant knowledge in the literature. RESULTS: A notable part of this text is based on appropriate closure of scalp wounds using sutures. Before this work, only the well-known Indian medical book Susruta-Samhita had mentioned closure of scalp wounds using sutures. In his work, al-Tabari recommended using materials made of silk or linen for suturing. He additionally proposed some recipes that have a coating feature that prevents bleeding from the wound after it was closed properly. He also dealt with persistent swelling and provided formulas for solving the problem with special compositions. CONCLUSIONS: Firdaws al-Hikma is a noteworthy work in the history of medicine, and it includes a unique chapter on head wounds. To the best of our knowledge, this is the first mention of suturing scalp cuts in Arabic literature and the second reference in medical literature after the Indian work Susruta-Samhita.

Medieval times' influencing figure Rhaze's approach to head injuries in Liber Almansoris.

OBJECTIVE: To present the chapter "On wound of the head and fracture of the head bone" of Kitab al-Mansuri / Liber Almansoris, which was one of the early works of Rhazes. METHODS: Both Arabic (Süleymaniye Manuscript Library, Ayasofya collection, Nr. 3751 and Millet Library, Feyzullah Efendi collection, Nr. 1327) and the Latin (Basileae, 1544) texts of Kitab al-Mansuri / Liber Almansoris were studied, and the 26th section of the 7th chapter, entitled "Fi al-shajja kasr al-'azm al-ra's / De plagis capitis et fractura cranei / On wound of the head and fracture of the head bone" was translated into English and English text created. RESULTS: Rhazes underlined removing bone fragments in depressed and separated fractures of cranium along with protection of the dura, but he did not describe any surgical technique in this chapter. CONCLUSIONS: Galen's contemplation for the care of the dura with its integrity and as well his proposal to remove the bone fragments for preventing the dura from injury were the golden standards at the time that Rhazes also followed in the treatment of skull fractures.

Peripheral nerve disorders and treatment strategies according to Avicenna in his medical treatise, Canon of medicine.

The written transmission of knowledge has played a great part in the advancement of medicine, and historical documents hold the key to a full exploration of the history of medicine. Some fields, including disciplines that deal with peripheral nerve disorders, have received little benefit from such valuable material. In particular, peripheral nerve surgery lacks perspectives from historical data. For many years, physicians have obtained positive results in the surgical treatment of peripheral nerve diseases. Relevant documents reveal that the first author who described the surgical repair of damaged peripheral nerves was Avicenna, a leading figure of the medieval era who lived in the Middle East. In his primary medical work, the Canon, he provides a description, albeit sketchy, of a suture procedure for peripheral nerve transection. This treatise influenced physicians for several centuries. In this presentation, we analyze excerpts from the Canon that concern peripheral nerve disorders and strategies for their management.

History of peripheral nerve repair: may the procedure have been practiced in Hippocratic School?

BACKGROUND: The literature regarding the history of the peripheral nerve repair is fairly scant. In the past, few physicians dealt with the topic and made prominent contributions. These works certainly eased the way to the modern concept of surgery of peripheral nerves. During the period between 7th and 17th centuries, Paulus Aeginatus, Avicenna, Roger of Salerno, Guglielmo da Saliceto, Guido Lanfranchi, and Gabriele Ferrara, who are universally accepted as the pioneers in this field, introduced the notion of nerve repair. The central predecessor of all these authors and as well as the founder of modern medicine, Hippocrates, also had reliable interest on peripheral nerve injuries; nevertheless, his written works do not include any section concerning peripheral nerve repair. An exciting document from Ottoman era challenges this issue by citing Hippocrates' nerve repair description. In this report, we present this account with a brief history of nerve repair. METHODS: The relevant section of an early 16th century Ottoman surgical treatise was examined in detail. RESULTS: The chapter regarding the treatments of acute wounds includes an anecdotal case report of nerve repair which is attributed to Hippocrates. CONCLUSIONS: Although attainable works of Hippocrates do not contain nerve repair procedures this Ottoman era medical book suggest that Hippocrates or his pupils may have practiced surgical treatment of nerve injury.

Hydrocephalus and its management in Avicenna's Canon of Medicine.

Hydrocephalus and macrocrania in children have been regarded as amazing disorders throughout the history of medicine. Although the main underlying causes and pathophysiology of hydrocephalus were not understood until the middle of the 18th century, early physicians had made important contributions to this field with their careful observations, management protocols, and anatomical studies. Among these pioneering physicians was Avicenna, widely accepted as an influential and leading scientific figure of the medieval ages. Avicenna was interested in the study of hydrocephalus, and in his principal medical book, the Canon of Medicine, he devoted a large section to this topic. In this paper, a short excerpt concerning hydrocephalus is presented from Avicenna's Canon.

A pioneer from the Islamic Golden Age: Haly Abbas and spinal traumas in his principal work, The Royal Book.

Spinal diseases have attracted medical scientists throughout the history of medicine, probably because they are relatively easy to diagnose and fairly simple to treat. Physicians who made great progress in medicine during the glorious Islamic civilizations also enthusiastically dealt with spine-related problems. More than a thousand years ago Persia was a cradle of medical learning, and Islamic medicine and other sciences spread westward from that center. A leading figure during this period was Haly Abbas, who created an excellent and compact medical encyclopedia, The Royal Book. Sadly, this book has rarely been cited in the literature. The subject of the present vignette is Abbas' work regarding spinal trauma.

Selective intraarterial nimodipine treatment in an experimental subarachnoid hemorrhage model.

BACKGROUND AND PURPOSE: Cerebral vasospasm secondary to subarachnoid hemorrhage (SAH) has been a serious clinical problem. The aim of the present study is to evaluate the efficacy of selective intraarterial (IA) nimodipine treatment in a rabbit model of chronic cerebral vasospasm. METHODS: Twenty-two adult New-Zealand rabbits of either sex, weighing 2500-3800 g were used for this study. Following a control angiography, all animals received 1 mL of fresh unheparinized autologuous arterial blood into the cisterna magna. Three days later, the presence of vasospasm was demonstrated angiographically by selective vertebral artery injection. The experimental design was as follows: separate groups of animals (n = 5, in each group) received nimodipine (0.05 mg/kg), papaverine (6 mg/kg), or vehicle intraarterially, after placement of a microcatheter into the vertebral artery. Another group (n = 5) received nimodipine (0.05 mg/kg) directly into the cisterna magna, and vehicle injection was made into cisterna magna in two other animals. Thirty minutes after treatment, angiographies were repeated and changes in arterial diameter were expressed as percentages of control. RESULTS: IA nimodipine and IA papaverine were effective in relieving veretebral and basilary vasospasm (P < .05). IA nimodipine was more effective than IA papaverine (P < .05). IA nimodipine was not more effective than intrathecal (IT) nimodipine in relieving vertebral artery vasospasm, although it was more effective than IT nimodipine in basilar artery. Vehicle injections (IA or IT) failed to reverse the vasospasm induced by autologuous blood injection. CONCLUSION: This study showed that selective IA nimodipine treatment may be considered as an alternative in the treatment of chronic vasospasm following SAH.