Aristotle - Ἀριστοτέλης (ARISTOTÉLES, 384/3- 322/1 BCE) The revelation of tuberculosis in his zoological works.

One of the most challenging issues with the sources of ancient medicine is to be able to identify the correspondence between the diseases we know today and those reported in ancient medical texts. Ancient diseases' definitions rarely help us, and the symptoms described often correspond to more than one disease. This is especially true about tuberculosis, a disease that historians of medicine habitually associates with the Greek words phthi(n)o (φθίνω), verb, phthisis/phthoe (φθίσις/φθόη), noun, phthinodes/phthisikos (φθινώδης/φθισικός), adjective, all etymologically linked to an Indo-European root that expresses the idea of consumption in a broad sense. This article aims to analyze a group of Greek words, branchos/branchia (ßράγχος/ßράγχια), krauros/kraurao (κραῦρος/κραυράω), and katarreo (καταρρέω), that appear in nosological contexts very close to the infectious disease that today we call tuberculosis. Moreover, the paper aims to focus on the transmission pathways of TB being via animal-human contact and some ancient strategies to cure it. The symptoms, transmission pathways and therapeutic approach of tuberculosis belong to a homogeneous pathological picture that emerges from a set of texts that date back to the period between the fifth century BC and the second century AD.

Mythology and rational explanation in the history of medicine The case of molar pregnancy.

OBJECTIVE: To analyse own set of molar pregnancies and to develop clinically relevant procedures. TYPE OF STUDY: Historical article based on the analysis of Greek classic medicine. SETTINGS: History of Medicine Unit; Department of Medico-Surgical Sciences and Biotechnologies; Sapienza-University of Rome, Italy; Unit of Medical Humanities; Department of Cardiac, Thoracic, Vascular Sciences and Public Health; University of Padua, Italy. INTRODUCTION: Molar pregnancy is a specific kind of gestational trophoblastic disease which originates from the placenta. There are two types of molar pregnancy, complete and partial. Complete molar pregnancy derives from a defect in maternal eggs, while an incomplete one derives from a defecting fertilization by paternal sperm. Historical analysis: Molar pregnancy drawn the attention of ancient physicians from the classic period and they widely discussed maternal and paternal roles in causing this condition. Classic doctors drawn from mythology several suggestions and ideas, which indicates that the issue of normal and abnormal conception was a crucial problem since the most ancient past Conclusion: Current scientific studies on molar pregnancy are free from ancient prejudices about male and female “nature” and their reciprocal role in embryogenesis. However, an awareness of the cultural biases that could drive scientific researches, might be useful for scientists and physicians even today.

Tumour-specific induction of immune complexes: DCP-IgM in hepatocellular carcinoma.

BACKGROUND: In the sera of liver, colorectal and prostate cancer patients, several biomarkers may be detected as IgM immune complexes. To determine whether the presence of immune complexes was correlated to an increase of IgMs, we measured the IgM content in the sera of patients with hepatocellular carcinoma (HCC) and cirrhosis, and evaluated the occurrence of des-gamma-carboxy prothrombin (DCP) as immune complexes (DCP-IgM) compared to the levels of DCP and alpha-fetoprotein (AFP). PATIENTS AND METHODS: Serum samples from 31 patients with cirrhosis, 33 untreated HCC patients diagnosed by ultrasound, computed tomography and/or magnetic resonance and confirmed by histopathology, when indicated, and 30 healthy controls were analysed. Concentrations of IgM and DCP-IgM were determined by ELISAs. RESULTS: Circulating IgM in patients with HCC (median level = 1.79 mg mL(-1)) and cirrhosis (1.09 mg mL(-1)) were not significantly different (P = 0.1376) while DCP-IgM were significantly higher in HCC patients (median level = 2171.2 AU mL(-1)) than in those with cirrhosis (1152 AU mL(-1), P = 0.0047). No correlation was found between DCP-IgM and IgM in HCC (r = 0.227) and cirrhosis patients (r = 0.475). DPC-IgM was positive in 55% (18/33) of HCC patients and in 26% (8/31) of cirrhosis patients compared to 39% and 26% for DCP and 48% and 13% for AFP. DCP-IgM, DCP and AFP tests had 100% specificity in healthy controls. CONCLUSIONS: DCP-IgM in HCC patients was not associated with an increase in IgM concentration. DCP-IgM was more frequently detected in HCC patients than DCP and AFP, strengthening the diagnostic role of IgM immune complexes for liver cancer.

High serum levels of B-lymphocyte stimulator are associated with clinical-pathological features and outcome in classical Hodgkin lymphoma.

B-lymphocyte stimulator (BLyS) acts as survival factor for B lymphocytes. As Hodgkin and Reed-Sternberg (HRS) cells express receptors through which BLyS promotes their growth and chemotherapy resistance, we investgated whether this molecule was increased in sera from patients with classical Hodgkin lymphoma (cHL) and whether it correlates with clinical-pathological features and outcomes. Enzyme-linked immunosorbent assay was used to measure soluble BLyS (sBLyS) in sera from 87 patients and 33 donors; higher levels were detected in patients (mean +/- standard error 4493.9 +/- 264.9 pg/ml vs. 2687.0 +/- 200.9 pg/ml; P < 0.0001). Levels above the median value (4242.0 pg/ml) were associated with age > or = 45 years (P = 0.042), advanced stages of disease (P = 0.005), systemic symptoms (P = 0.014) and extranodal involvement (P = 0.009). Five-year failure-free survival (FFS) of patients with sBLyS below or equal to median levels was 88.6% as compared to 65.1% of those with levels above the median (P = 0.009). Statistical analyses confirmed the prognostic significance of sBLyS (P = 0.046). When patients were analysed according to variables associated with high levels, sBLyS showed an independent predictive power in terms of FFS. Our findings support the involvement of BLyS in cHL pathogenesis. The association between high serum levels and an inferior FFS indicates that sBLyS is a possible prognostic predictor with a potential significance as a therapeutic target.

Retroperitoneoscopic lumbar sympathectomy for nonreconstructable arterial occlusive disease.

AIM: The aim of this study was to present our experience with video-assisted lumbar sympathectomy for non-reconstructive arterial occlusive disease in a series of 23 consecutive patients whose predominant symptoms were unilateral rest pain, limited skin ulcerations or gangrene of the toes. METHODS: All the procedures were performed with retroperitoneal approach, dorsal position of the patient and simple digital dissection of the retroperitoneal space. RESULTS: The operations were successfully performed in all patients except for 2, who immediately underwent open conversion. A urinoma caused by ureteral lesion was the only severe complication in this series. The mean operative time of the procedure was 55 min and the hospital stay was 2 or 3 days. No parenteral analgesics were administered postoperatively. At 1 month from operation, 20 patients out of 23 had significant relief of rest pain and improvement of ischemic lesions. After a median follow-up of 36 months, 2 patients had died, 4 underwent some type of distal amputation, 1 had recurrent rest pain and the other 16 reported persistent improvement of pain or dystrophic changes. CONCLUSIONS: Retro-peritoneoscopic technique appears the modern and less invasive version of the lumbar surgical sympathectomy.

HIV risk-related behaviors among injection drug users in Rome: differences between 1990 and 1992.

Temporal differences in human immunodeficiency virus (HIV) risk-related behaviors among injection drug users in Rome, Italy, were analyzed in 487 drug users recruited in 1990 and 450 recruited in 1992. Sharing of syringes decreased among self-reported HIV-positive drug users between 1990 and 1992, but there was no change in their sexual behavior. Fewer HIV-seronegative drug users reported passing on used syringes in 1992 than in 1990; however, there was no change in the percentage of seronegative subjects using previously used syringes, and a reduction in condom use with primary partners. There still exists a great potential for transmission of HIV infection among injection drug users and from injection drug users to the general population.

Usefulness of CEA, TPA, GICA, CA 72.4, and CA 195 in the Diagnosis of primary colorectal cancer and at its relapse.

A protocol with tumor markers as guidelines to follow up colorectal cancer patients was designed using criteria other than those commonly reported. They included combination of several markers and their dynamic evaluation of three different levels of increase: isolated elevated value (IEV), constant level of elevation (CE), and progressive increase (PI). In a total of 90 patients, the levels of combined serum CEA-TPA and GICA were serially measured, and in 71 of them, CA 72.4 and CA 195 levels were also determined. The tumor markers were measured during the first few months after surgery, and the usefulness of combined CEA-TPA-GICA and other, possibly more favorable combinations was determined in relation to "early" detection of recurrence and development of metastases. In addition the usefulness of conventional radiologic examinations and the impact on patients survival following "early" diagnosis was evaluated. A positive correlation was found between elevated preoperative serum tumor marker levels and the stage of disease. The postoperative variation of high serum CEA values was useful in identifying micrometastases after primary tumor resection. In the "early" diagnosed 14 patients with recurrence during the postoperative follow-up period, the highest sensitivity was found for TPA (87%) and, of the marker combinations, TPA-GICA (93%) with a lead time of 4.6 +/- 5.6 and 5.4 +/- 7.8 months (mean +/- SD) respectively. In nonrelapsed patients, falsely positive results of TPA-GICA (25%) were fewer than those for TPA-CA 195 (31%) and TPA-GICA-CA72-4 (35%). However, TPA-CA 195 and TPA-GICA-CA72-4, based upon their high sensitivity in patients with metastases, seemed in keeping with the effectiveness of TPA-GICA for monitoring of postoperative patients with colorectal cancer. In patients who developed recurrences, PI was more frequently present than IEV. In patients without recurrence, the opposite occurred. CE had less frequently discriminatory capability between these two groups than IEV and PI. Routine radiographic studies were ineffective whereas liver echography with its high sensitivity revealed the first sign of recurrence. Eight (50%) of the 16 relapses (two patients relapsed twice) were suitable for surgery because only one organ with a single metastasis was involved. Three (75%) of the 4 patients with "early" diagnosis of recurrence are alive without evidence of disease 5, 18, and 20 months after the last surgery. The results of this study revealed the importance of "early" diagnosis of recurrence for improved survival of patients with colorectal cancer.

[Behavior associated with HIV-1 infection in drug addicts in Rome, 1990-1992]. / Comportamenti associati ad infezione da HIV-1 nei tossicodipendenti a Roma, 1990-1992.

Two cross-sectional surveys have been conducted in Rome in 1990 and 1992 to investigate prevalence and temporal differences of risk behaviours among drug injectors. A total of 487 drug injectors in 1990, and 450 in 1992 have been interviewed both in the street and in treatment services. Twenty-four percent of the subjects interviewed in 1990 reported having used second-hand syringes in the preceding 6 months, as compared to 14% in 1992; in the two years 29% and 13%, respectively, reported having passed a second-hand syringe to other drug injectors. Fifty-six percent (46% in 1992) of primary partners of drug injectors interviewed were not drug users themselves, while the prevalence of non drug using occasional partners was 34% and 43% in the two surveys. In 1990 condom use with primary partner was reported by 48% of drug injectors, and by 41% in 1992; condom use with occasional partners was 56% and 64% in the two years. The differences in sharing behaviours were observed for HIV-1 positive subjects, while HIV-1 negatives reported the same prevalence of use of second-hand syringes in 1990 and 1992; no statistically significant differences have been found for sexual behaviours among the HIV-1 positives, while the HIV-1 negatives reported a lower prevalence of condom use with primary partner. The observed differences in the two years remain also adjusting for the socio-demographic characteristics of the two populations in a multiple logistic regression model. Prevalence of HIV-1 related risk behaviours among drug injectors is still too high.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis A, B, C and D in a community in Italy of immigrants from NE Africa.

A total of 213 subjects from a community in Italy of immigrants from Somalia and other NE African countries were enrolled in this study to evaluate the prevalence of HAV, HBV, HCV and HDV infections and to assess their possible risk factors. Of the subjects, 45 per cent (96) were female and 24 per cent (52) were under 12 years old. The age range was from 1 to 67 years and the mean age was 24 years. Eighty-three per cent (177 subjects) were born in Somalia, 10 per cent (21 subjects) in Ethiopia, and the rest in Djibouti, Egypt or Saudi Arabia. The 213 subjects were administered a questionnaire which covered socio-demographic characteristics and risk factors resulting from Western medical practice, traditional medicine, personal behaviour and living conditions. Blood was drawn from 209 subjects to ascertain the presence of HbsAg, HBeAg, anti-HAV, anti-HBc, anti-HBs, anti-HCV and anti-HDV. The results of this study show an HAV prevalence of 96 per cent (an 87.5 per cent prevalence in children under 12), and an HBV prevalence of 32 per cent (a 3.3 per cent prevalence of HBsAg carriers). No subject under 11 was HBV positive and no woman tested positive for HBeAg, confirming the extreme unlikelihood of vertical transmission of HBV. The prevalence of HBV is closely correlated with age (ranging from 2 per cent in those under 12 to 59 per cent in subjects over 39).(ABSTRACT TRUNCATED AT 250 WORDS)