[Medical practice in classical Greece : The neurological and psychiatric case reports of the Hippocratic Corpus]. / Medizinische Praxis im klassischen Griechenland : Die neurologischen und psychiatrischen Fallberichte des Corpus Hippocraticum.

OBJECTIVE: Which theoretical and practical competences do the neurological and psychiatric case histories of the Hippocratic Corpus convey? MATERIAL AND METHODS: The 431 Hippocratic case histories have been studied for reports and communication on the diagnostics, treatment and prognosis of single persons and groups of patients suffering from neurological and psychiatric diseases. RESULTS: In the 7 books of the Hippocratic Epidemics, a total of 128 patients with neurological and psychiatric symptoms are described. Epidemic fever and its variants were the leading predisposing conditions and the main symptoms were delirium, coma, insomnia, headache, speech disorders and convulsions. A number of patients with phrenitis and opisthotonos are also reported. The majority of the sick persons were male, were teenagers or adults and 47 of them are mentioned by name. The patient's information about the course is often just as informative as the doctor's observations. Treatment was limited to physical and dietary measures. DISCUSSION: The Hippocratic physician diagnosed and attempted to treat a large number of neurological and psychiatric diseases. The often almost continuous observations of the patients led to astonishingly precise predictions of the course and the prospects of recovery. Numerous symptoms described in the case studies, including carphologia and opisthotonus, have entered the neurological vocabulary. The retrospective etiological analysis of the reports leads to the almost explicit identification of neurosyphilis and encephalitis lethargica. The therapeutic measures described by the author were, as the changeable course of the diseases shows, only of limited effectiveness despite a very differentiated application over time, both against the underlying diseases and the neurological and psychiatric complications.

[The urological case reports of the Hippocratic Corpus : Medical practice in classical Greece]. / Die urologischen Fallberichte des Corpus Hippocraticum : Medizinische Praxis im klassischen Griechenland.

OBJECTIVE: Which theoretical and practical competences do the urologic case histories of the Hippocratic Corpus convey? MATERIALS AND METHODS: The 431 Hippocratic case histories have been studied for reports and communication on diagnostic methods, treatment, and prognosis related to urologic diseases. RESULTS: Within the seven books of the Hippocratic Epidemics, a total of 69 patients with urologic symptoms are described; in 21 cases the urologic disease is dominant. The leading clinical signs were urine discoloration and urinary sediment, polyuria, testicular swelling and pain, hematuria, stranguria, anuria, and renal pain, the most frequent diseases were nephritis and urolithiasis. Most patients were men in juvenile and adult age; 33 sick persons are named. The statements of patients regarding the course of their illness were often sparse. Diagnostic tests were restricted to inspection and palpation. Otherwise, treatment was confined to conservative measures. The dietary decisions for treatment of nephritis were differentiated but nonuniform. CONCLUSION: The Hippocratic physician diagnosed and treated diseases of the urinary tract. Inflammatory conditions and traumatic lesions are described in detail. Highest priority was awarded to uroscopy. Nephritis was a widespread disorder und usually associated with other symptoms, above all fever. The urinary tract was often regarded as an indicator of physical and mental health. Conservative treatment measures dominate in the case reports.

[Medical practice in classical Greece : The dermatological case reports in the Hippocratic Corpus]. / Medizinische Praxis im klassischen Griechenland : Die dermatologischen Fallberichte des Corpus Hippocraticum.

OBJECTIVES: Which theoretical and practical competences do the dermatological case histories of the Hippocratic Corpus convey? MATERIALS: The 431 Hippocratic case histories have been studied for reports and communication on diagnostics, therapy and prognosis of individuals and groups of patients suffering from skin diseases. RESULTS: Within the seven books of the Hippocratic 'Epidemics', a total of 49 patients with dermatological symptoms are described; in 20 of these, skin disease was the leading suffering. The essential clinical signs were itching, red spots, blisters, pustules, aphthae, lichen, dandruff and hair loss. Most patients were male; one of the four women was pregnant, among the two children was a baby whose skin disease ended fatally. Eight patients were named. In addition, five waves of disease are reported, in the course of which the shape of the skin played an important role. The diagnostic workup was limited to inspection and palpation, but included the determination of the level of suffering. The follow-up checks often extended over months. Mostly, plasters and compresses with grain flour were primarily used for treatment. CONCLUSION: The Hippocratic doctor observed and described a large number of skin lesions and attempted to classify them in the differential diagnosis. In addition to changes in the color and tension of the skin, numerous lesions-for which the names are still often used in modern dermatology-are also described in detail. The skin manifestations associated with fever and abdominal symptoms are counted among the epidemic diseases. The condition of the skin was often regarded as an indicator of general health. In the case reports, conservative treatment adapted to the development of the disease dominated. In desperate cases, bloodletting was chosen as a last resort.

[The Galenic case reports on inflammatory diseases of the musculoskeletal system]. / Die Fallberichte des Galen von Pergamon über entzündliche Erkrankungen des Bewegungsapparats.

BACKGROUND: The case histories in the writings of the Greco-Roman physician Galen of Pergamum have so far been interpreted primarily in literary and socio-historic terms. Analysis focused on the medical aspects is still incomplete. QUESTION: Which competence for the treatment of inflammatory diseases of the musculoskeletal system do the Galenic case reports communicate? STUDY DESIGN AND RESEARCH METHODS: The 358 Galenic case histories were studied for anamnestic, clinical, therapeutic, and epidemiological statements on inflammatory diseases of the musculoskeletal system. RESULTS: Eight case reports could be identified in which inflammatory diseases of the musculoskeletal system are discussed. The descriptions are found in the writings On the Powers and Mixtures of Simple Drugs (n = 3), On the Composition of Drugs according to Kind (n = 2), Therapeutics to Glaucon (n = 1), How to detect Malingerers (n = 1) and On Hippocrates' 'Aphorisms' (n = 1). Seven male individuals and one group of patients are described; in one case a proper name is given. The descriptions do not follow a fixed structure. The texts are dominated by information on the anamnesis and catamnesis, the results of the physical examination and the choice of therapy. The author has repeatedly combined the case description with theoretical explanations. The most common inflammatory diseases of the musculoskeletal system that Galen was confronted with were soft tissue swelling without/with associated skin symptoms, gout, arthritis and sciatica. Knees and feet were affected more frequently than the hands. Galen himself was always the observing and treating physician. Therapy was dominated by ointments, fats and oils that should lead to the distraction or drying out of pathogenic juices. The statements on the prognosis were mostly favourable. DISCUSSION: The case reports illustrate the range of inflammatory diseases of the musculoskeletal system without being able to reliably identify individual nosological entities retrospectively. Equating 'arthritis' with chronic polyarthritis and 'podagra' with gout is also not undisputed. The doctor-patient-conversations are the most original element in terms of content and style. The explanations for the choice of therapy show that the numerous mixed agents disposable for the treatment of patients with inflammatory diseases of the musculoskeletal system were prescribed after critically weighing the advantages against the disadvantages.

Interpretation and Diplomacy Aspects of Authority and Care in Imaging Reports.

Whereas the creativity and intellectual power of the radiologist are measured against his/her written report, the value of the message will not only be judged by the precision of the medical statement. The same result can be attributed to different words. Numerous common and accidental factors exert influence on the decision on what is said and what is not said, how it is assessed and what is ignored. The less certain a diagnosis is and the less favourable its possible consequences are, the more subtleties and periphrases are to be expected within the report. The decision on the nature and the volume of the written report will not only be taken by the time of recording, but is likewise prepared by the knowledge of the patient's history and symptoms, the personal relationship to him/her as well as by a set of conditions throughout the inspection of the images. The intuition that accompanies the information transfer in imaging diagnostics does not only explain the differences in volume and depth of diagnosis and differential diagnosis, but also the range of diagnostic and therapeutic recommendations.

The "creeping fat sign"-really diagnostic for Crohn's disease?

BACKGROUND: Focal or regionally prominent mesenteric fat adjacent to wall-thickened bowel loops can be readily identified by computed tomography. The so-called creeping fat of the right lower quadrant is usually considered to be an important clue for diagnosing Crohn's disease. However, when the sign is isolated, indistinct, and not set in the proper clinical context, the radiologist should consider other inflammatory conditions of the bowel and its appendages. CONCLUSION: Controlled studies are needed to confirm the diagnostic use of the "creeping fat sign" in clinical practice.