ABSTRACT
Chemotherapy stands today for cancer. In 1909, Paul Ehrlich (1854-1915) advocates the use of arsphenamine by infusion. So, he is considered as the father of chemotherapy. In fact, the first to have thought through chemotherapy was Sir Christopher Wren (1632-1723). In 1676, ideas and experiments on animals had sufficiently progressed to allow Michel Ettmuller (1644-1683) to publish the first edition of his book and several others were printed until 1753. In this book, he describes the first intravenous treatment, it sets the first indications, dosages and different products which can be used. However this method has been forgotten until the late 19th century.
Subject(s)
Antineoplastic Agents/history , Neoplasms/history , Administration, Intravenous , Animals , Antineoplastic Agents/administration & dosage , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , Humans , Neoplasms/drug therapyABSTRACT
The oil painting by Gervex Avant l'opération is analysed as far as art-history in general is concerned, and also for a more precise history of medical portraiture.
Subject(s)
History of Medicine , Medicine in the Arts , Paintings , History, 19th Century , History, 20th Century , Hospitals , ParisABSTRACT
OBJECTIVE: To retrospectively evaluate the feasibility of thoracoscopic removal of mediastinal parathyroids. SUMMARY BACKGROUND DATA: Mediastinal exploration to resect ectopic parathyroid(s) is needed in approximately 2% of cases in hyperparathyroidism. Recent advances in thoracoscopic surgery allow for a minimally invasive treatment. METHODS: From 1999 through 2007, 13 patients affected by primary hyperparathyroidism (11 females, mean age 60 years, range: 22-88) underwent thoracoscopic removal of mediastinal parathyroids. Scintigraphy produced positive results in 11 of 13 cases, computed tomography scan in 9 of 10, parathyroid hormone venous sampling in 10 of 10 patients, and magnetic resonance imaging in 5 of 7. Right thoracoscopic access was used in 9 patients, left in 4. Postoperative outcome was analyzed. RESULTS: Thoracoscopy enabled retrieval of mediastinal parathyroids in 10 of 13 (78%) cases. Mean operating time was 92 minutes (range: 50-240). One procedure (8%) was converted. No perioperative deaths/major complications occurred. Mild complications occurred in 2 of 13 (15%) patients (pneumothorax/pneumonia, transient recurrent nerve palsy). Mean hospital stay was 4.7 days (range: 2-15). At a mean follow-up of 73 months (range: 16-105), parathyroid hormone and calcium venous concentrations were high in 3 patients. Unsuccessful procedures were related to doubtful or non-concordant preoperative localization. CONCLUSIONS: The thoracoscopic approach for mediastinal parathyroidectomy is feasible and safe. An accurate preoperative work-up should be standardized to avoid useless procedures. In case of negative preoperative localization of the abnormal gland, thoracoscopy should not be adopted as a diagnostic tool.
Subject(s)
Choristoma/surgery , Hyperparathyroidism/surgery , Mediastinal Diseases/surgery , Parathyroid Glands , Parathyroidectomy/methods , Thoracoscopy/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
Petit-Saint-Antoine was for six centuries a Parisian hospital specialized in the treatment of the so-called "mal des ardents", or ergotism.
Subject(s)
Ergotism/history , Hospices/history , Ergotism/therapy , History, 15th Century , History, 16th Century , History, Medieval , ParisABSTRACT
Paré is well-known through many papers. His incomes allowed him to have a middle-class Parisian living. It is impossible to have an accurate knowledge of his fortune before his death but we have a good idea of his landed property. In fact as a Parishioner of Saint-Andre-des-Arts Church he probably was a landlord only in Paris and its vicinity with a building (rue de l'Hirondelle), two houses (rue Garancière), Meudon, Cormeille-en-Parisis and La-Ville-Du-Bois which the authors describe the present state of.
Subject(s)
Ownership/history , Architecture/history , History, 16th Century , Humans , Male , Ownership/statistics & numerical data , ParisABSTRACT
Lymphoepithelial cysts are rare lesions of the thyroid, with exceptional bilateral presentation. We report the case of a 62-year-old woman presenting with a multinodular goiter, without associated clinical or biological abnormality. Histological examination demonstrated multiple cysts lined by squamous or respiratory-type epithelium, associated with a dense lymphoid infiltrate. Chronic thyroiditis and numerous solid cell nests were also observed in the adjacent parenchyma. We briefly discuss differential diagnosis and current hypothesis concerning the pathogenesis of these peculiar lesions.
Subject(s)
Lymphocele/pathology , Thyroid Diseases/pathology , Thyroiditis, Autoimmune/complications , Chronic Disease , Diagnosis, Differential , Female , Goiter, Nodular/complications , Goiter, Nodular/surgery , Humans , Lymphocele/diagnosis , Lymphocele/etiology , Middle Aged , Models, Biological , Thyroid Diseases/diagnosis , Thyroid Diseases/etiology , Thyroidectomy , Thyroiditis, Autoimmune/pathologyABSTRACT
Henri IV, King of France, was killed on Friday, May 14th, 1610 in Paris, inside his partially open coach. The autopsy was performed the following day by Jacques Guillemeau, whose report was published in 1612. The murderer's position was deduced from the direction of the lethal second wound. We suppose that Ravaillac used his left hand (he was an ambidexter) hitting Henri IV under the left arm; the King was bent on his right side after the first wound, a superficial one. Ravaillac jumped up on a post by his left foot, then on the nave of the left-back wheel with his right foot and turning, gripped something high on the coach and hit with his long knife the left side of the king's chest. The direction of the wound was 40 degrees posterior and 30 degrees ascending. The pulmonary perforation involved a haemoptysis, an inability to speak and a bilateral pulmonary inundation. The left haemothorax was very probably associated to an haemopericardium and an haemomediastinum leading to a rapid collapse with a loss of consciousness which could not last than ten or fifteen minutes before death.
Subject(s)
Autopsy/history , Famous Persons , Homicide/history , Cause of Death , France , History, 17th Century , Humans , MaleABSTRACT
Surgery was practised at home for a long time during the first half of the XXth century. The improvement of anaesthesia and of the structures of cares provoked the progressive disappearing of these practices after the WWII. Although modern techniques were currently used in the Hospitals of the Universities the conditions of practising remained the same in some countries at the beginning of the century. At the beginning of the 50s before the growing transports surgical emergencies could be taken in charge at home in some areas uneasy to reach.
Subject(s)
Anesthesia, General/history , Emergency Treatment/history , General Surgery/history , Home Care Services/history , Appendicitis/history , Appendicitis/surgery , Female , France , General Surgery/methods , History, 20th Century , Hospitals, University/history , Humans , Ileus/history , Ileus/surgery , Pregnancy , Pregnancy, Ectopic/history , Pregnancy, Ectopic/surgeryABSTRACT
In general the shape of an organ is studied before its function except for the liver whose function has been studied at first and studying progresses during three millenniums led to the modern knowledge. Seven chapters: Before Hippocrates or the deified Liver. The metabolic Liver or the Liver regarded as sacred. The Liver on the wane or the forgotten Liver. The renewed Liver or the operated Liver. The bird of the Modern Liver surgery or the updated Liver. The planned Hepatectomies or the mastered Liver. The Changing or the transplanted Liver. The role of USA was preponderant in the XXth century.
Subject(s)
General Surgery/history , Liver/surgery , Digestive System Surgical Procedures/history , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, Ancient , History, Medieval , Humans , Liver/anatomy & histologyABSTRACT
The subject concerns the unrecognised European Bulgaria whose the alone museum of History of Medicine is worth of seeing. The 1869 building is of an ancient hospital which reminds of the hundred-year-old history of the modern Bulgaria. The miscellance of the objects, the strictness and the clearness of the show afford to follow through five rooms the development of Medicine as practice, art and science from Antiquity till the Second World War. The interest stemming from the general character of the museum is underlined by the constant references to the evolution of the Bulgarian Medicine. Then the local specific characteristics could totally integrate into the evolution of European Medicine. The role of France in the education of the first Bulgarian practitioners is worth reminding. The visitors get out of the museum through a delightful garden rich in Medicinal plants.
Subject(s)
History of Medicine , Museums/history , Bulgaria , Facility Design and Construction/history , History, 19th Century , Hospitals/historyABSTRACT
We diagnosed transient left ventricular apical wall motion abnormalities after surgery in a patient presenting with a clinical and electrocardiographic picture of acute myocardial infarction in the absence of significant coronary disease. These angiographic, clinical, and electrocardiographic features satisfied the criteria of the recently described tako-tsubo-like left ventricular dysfunction.
Subject(s)
Coronary Angiography/methods , Electrocardiography/methods , Magnetic Resonance Imaging/methods , Myocardial Infarction/diagnosis , Ventricular Dysfunction, Left/diagnosis , Female , Heart Ventricles/pathology , Humans , Middle Aged , Myocardial Infarction/pathology , Postoperative Period , Thyroidectomy/adverse effectsABSTRACT
In 1850 Sir Richard Owen discovered the parathyroid glands in rhinoceros. After they have been discovered in man in 1880 their history spread all along the 20th century. The history started from the descriptive anatomy and the clinical pictures of their illness to the trouble of their functioning. The hormone was studied while the surgeons began to cure adenoma, hyperplasia and cancers.
Subject(s)
Parathyroid Diseases/history , Parathyroid Glands/surgery , Animals , History, 19th Century , History, 20th Century , History, 21st Century , Humans , Parathyroid Diseases/surgery , Parathyroid Glands/anatomy & histology , Parathyroid Glands/physiologyABSTRACT
BACKGROUND: With the current aging of the world's population, diagnosis of primary hyperparathyroidism is being reported in increasingly older patients, with the associated functional symptomatology exacerbating the vicissitudes of age. This retrospective study was designed to establish functional improvements in older patients following parathyroid adenomectomy under local anesthesia as outpatient surgery. MATERIALS AND METHODS: Data were collected from 53 patients aged 80 years or older who underwent a minimally invasive parathyroid adenomectomy. All patients underwent a preoperative ultrasound, scintigraphy, and were monitored for the effectiveness of the procedure according to intra- and postdosage of parathyroid hormone (PTH) at 5min, 2h and 4h. RESULTS: Mean preoperative serum calcium level was 2.8mmol/L (112mg/L) and mean PTH was 180pg/ml. Thirty-eight patients were operated under local anesthesia using minimally invasive surgery and 18 patients were operated under general anesthesia. In 26 cases, the procedure was planned on an outpatient basis but could only be carried out in 21 patients. Fifty-one patients had normal serum calcium and PTH levels during the immediate postoperative period. Two patients were reoperated under general anesthesia, since immediate postoperative PTH did not return to normal. Four patients died due to reasons unrelated to hyperparathyroidism. Five patients were lost to follow-up six months to two years postsurgery. Of the 44 patients (83%) with long-term monitoring for PTH, none had recurrence of biological hyperparathyroidism. Excluding the three asymptomatic patients, 38 of the 41 symptomatic patients (93%) with long-term follow-up were considering themselves as "improved" or "strongly improved" after the intervention, notably with respect to fatigue, muscle and bone pain. Two patients (4.9%) reported no difference and one patient (2.4%) said her condition had worsened and regretted having undergone surgery. CONCLUSION: In patients 80 years or older, minimally invasive surgery as an outpatient under local anesthesia offered an excellent risk/benefit ratio given its many advantages: simplicity, speed, absence of general anesthesia, ease of monitoring, direct voice control intraoperatively, very low morbidity, effectiveness in treating primary hyperparathyroidism in more than 95% of first intention patients, and the possibility of immediate or delayed recovery in the event of multiglandular disease going unnoticed.
Subject(s)
Ambulatory Care/methods , Anesthesia, Local , Hyperparathyroidism, Primary/surgery , Minimally Invasive Surgical Procedures/methods , Parathyroidectomy/methods , Adenoma/complications , Adenoma/mortality , Adenoma/surgery , Aged, 80 and over , Contraindications , Female , Geriatric Assessment/methods , Humans , Hyperparathyroidism, Primary/etiology , Hyperparathyroidism, Primary/mortality , Male , Minimally Invasive Surgical Procedures/mortality , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/mortality , Parathyroid Neoplasms/surgery , Parathyroidectomy/mortality , Postoperative Complications/etiology , Postoperative Complications/mortality , Retrospective Studies , Risk Assessment , Treatment OutcomeABSTRACT
OBJECTIVES: To examine the cost-effectiveness of strategies for management of primary asymptomatic hyperparathyroidism: surgical strategies and medical follow-up versus surgery. DESIGN: We used a Markov state-transition decision-analytic model for an hypothetical cohort of 55-year-old women to compare with a lifetime horizon costs and effectiveness of bilateral neck exploration (BNE), unilateral neck exploration (UNE), video-assisted parathyroidectomy (VAP) and lifelong medical follow-up shifting for either BNE or UNE in case of disease progression. METHODS: Data on localization tests, complications and treatment efficacies were derived from a systematic review of the literature. Outcomes were expressed as quality-adjusted life years (QALY). Costs (2002 Euro) discounted at 3% yearly were estimated from the health care system perspective. RESULTS: In the base-case analysis, VAP strategy (VAPS) was the most effective and BNE strategy (BNES) was the least costly. UNE strategy (UNES) had an incremental cost-effectiveness ratio of 2688 Euro/QALY versus BNES and VAPS of 17,250 Euro/QALY in comparison with UNES. Surgical management was more effective than medical follow-up with acceptable incremental cost-effectiveness ratios. VAPS became less effective than UNES over 71 years. Differences between UNES and VAPS were sensitive to success and complication rates, quality-of-life weights and procedural costs. Medical follow-up strategies became the most effective if quality-of-life weight for this condition was higher than 0.99. CONCLUSIONS: Surgery is more effective than medical follow-up at a reasonable cost and can be preferred except in patients choosing medical follow-up. Minimally invasive surgery is cost-effective compared to the traditional surgical approach.
Subject(s)
Decision Support Techniques , Hyperparathyroidism, Primary/surgery , Hyperparathyroidism, Primary/therapy , Cost-Benefit Analysis , Female , Follow-Up Studies , Humans , Middle Aged , Parathyroidectomy , Quality of LifeABSTRACT
IMPLICATIONS: Anesthesia may acutely reveal angle-closure glaucoma. This complication is an ophthalmologic emergency. However, symptoms of acute glaucoma may be overlooked or misinterpreted in a sedated or comatose patient, and this may result in delayed treatment. Immediate diagnosis and appropriate treatment should be done to prevent visual loss.