The co effect of prophylaxis and radiosynovectomy on bleeding episodes in haemophilic synovitis.

Prophylactic substitution treatment and radiosynoviorthosis have a leading role in preventing irreversible haemophilic arthropathy. The aim of the study was to evaluate the effects of prophylaxis treatment and radiosynovectomy on the length of intervals between subsequent haemorrhages in haemophilic patients. Thirty-three joints were treated with radiosynovectomy in 28 patients with bleeding disorders. (90)Y colloid was used in knees and (186)Re colloid for elbows, shoulders and ankles. Twenty patients were on prophylaxis. Joint X-rays were evaluated on the Pettersson scale between 0 (normal) and 13 (severe joint destruction). During an observation period (range 6-44 months) bleeding episodes were recorded and data statistically analysed. Before radiosynovectomy, increasing intensity of the prophylaxis 10% lengthens intervals between two haemorrhages by 1% (P < 0.05). In patients with a Pettersson score higher than nine, intervals between bleedings are shorter by 73% (P < 0.05), in comparison with patients with lower Pettersson scores of 0-5. After radiosynovectomy, the length of the first non-bleeding interval increased by 120% (to 60 days) in comparison with the intervals before the procedure (P < 0.001). But, in the following year and half, every subsequent non-bleeding interval was 8% shorter (P < 0.1). In that period, prophylaxis shortened the non-bleeding interval by 1.7% (P < 0.05) per 10% increase of its intensity. Radiosynovectomy is more efficient in patients with less affected joints and is less efficient in younger patients. Prophylaxis reduced time between the bleedings episodes after isotope application. Before radiosynovectomy, prophylaxis reduces the number of haemorrhages. Our findings support data previously published by Rodriguez-Merchan et al. [J Thromb Haemost, 5 (2007) P-W-126].

Incidence of primary Sjogren's syndrome in Slovenia.

OBJECTIVE: To determine the annual incidence of primary Sjögren's syndrome (pSS) in Slovenia. METHODS: All patients admitted to our department of rheumatology or referred to our outpatient clinic between 1 January 2000 and 31 December 2002 owing to sicca symptoms or because of a suspicion of SS were examined. Our rheumatological department is the only tertiary referral centre for the Ljubljana region, which has a population of 599 895 Caucasian people. All patients were evaluated by the validated European criteria for SS. The exact 95% confidence interval (CI) based on binomial distribution was created for the incidence estimate. RESULTS: 248 patients were examined; 71 of them (28.6%; 65 women, 6 men) were diagnosed as having pSS. Their mean (SD) age was 51.3 (14.5) years (range 19-78). The average annual incidence for pSS in our study population was calculated as 3.9 cases per 100 000 inhabitants (95% CI 1.1 to 10.2). CONCLUSION: The estimated annual incidence of pSS in Slovenia is 3.9/100 000.

The importance of follow-up of children with vesicoureteral reflux grade 1.

AIM: The objectives of this study were, first, to determine the probability of detecting vesicoureteral reflux (VUR) into the renal collecting system (VUR grade 2 or higher) by follow-up cyclic radionuclide cystography (CRC) in children with VUR 1 on initial examination, and in children without VUR and with the same clinical history; and secondly, to find out whether dividing VUR 1 into three subclasses, including possible reflux into the ureter, reflux into the lower ureter, and reflux into the whole length of the ureter, enhances detection of higher grade reflux in these children. METHODS: 275 children with VUR 1 found on initial CRC, and 31 children without reflux and with the same clinical history were studied. In total, 414 renal units with VUR 1 of different subclasses and 198 renal units without reflux were evaluated. RESULTS: Follow-up CRC disclosed reflux into the renal collecting system in 20% of children with VUR 1 on initial investigation, and in 23% of children with no reflux at the time of initial investigation. The probability that follow-up examination would disclose VUR 2 in 3 in renal units with different subclasses of grade 1 reflux was 8-16%, and did not differ significantly from the probability for detecting reflux in kidneys with no reflux on initial examination. CONCLUSION: In the absence of recurrent urinary tract infection, the management of children with VUR 1 identified by CRC can be the same as in children without reflux. Yet, in children with no reflux or with VUR 1 detected after urinary tract infection, the probability that reflux reaching the pylon was missed should not be underestimated. Dividing VUR 1 into subclasses does not seem to be of diagnostic value.

[Definition of the real domain of the history of sciences and exploring the relationship with the philosophy of science]. / Définition du domaine propre de l'histoire des sciences et considérations sur ses rapports avec la philosophie des sciences.

The specific field of the history of science is the study and explanation of the origin and transformation of the structures of scientific knowledge. The historian of science should render understandable the reality of scientific research. The relationships between the history of science and the philosophy of science are examined stating that (1) the philosophical theories on the development of science have a scientific content only as much as they may be compared with the results of the history of science, and (2) the philosophy of science does not refer to an immediate historical reality but to an intellectual reconstruction of the past.

[The De fibra motrice et morbosa]. / IL de fibra motrice et morbosa di Giorgio Baglivi.

Baglivi published in Perugia, for the first time in 1700, his reflections about the fibers as fundamental parts of the living organisms. The text, conceived as a letter to Alessandro Pascoli, underlines the role of the cerebral membrane in physiological and pathlogical phenomena. The Specimen quatuor librorum de fibra motrice et morbosa has been printed in 1702 as an answer to the book of A. Pacchioni De durae matris fabrica et usu. Living fibres are the fundamental structural elements making up the human body and the living organisms, seats of the vital functions and main causes of diseases. In formulating the living fibers theory, Baglivi places himself as a first bridge between classical medicine and the reductionist method of natural sciences.

Prevalence of Sjögren's syndrome in Slovenia.

OBJECTIVE: The aim of our study was to determine the prevalence of Sjögren's syndrome (SS) in Slovenia. METHODS: A total of 889 randomly selected adults were invited to take part in our study. The classification of SS was based on the validated criteria reported by a multicentre study performed in Europe. The participants were asked six simple questions for assessing both ocular and oral involvement. Information on co-morbidities and related treatment was collected at the same time. All participants were subjected to a Schirmer-I test, an unstimulated salivary flow test, as well as serological studies (rheumatoid factor, antinuclear antibodies, anti-Ro/SS-A and anti-La/SS-B antibodies). When indicated, Rose Bengal score, salivary scintigraphy and histopathological investigation of the minor salivary glands were carried out until three out of the six European classification criteria for SS were shown to be negative or until SS was diagnosed. RESULTS: Out of the 889 invited subjects, 332 (37.3%) participated in our study: 183 females, mean age (+/- S.D.) 52.2 +/- 13.7 yr (range 20-84) and 149 males, mean age (+/- S.D.) 56.3 +/- 12.9 yr (range 23-84). After the first visit, 244 of the 332 (73.5%) participants proved to be negative for three out of the six above-mentioned criteria, and were eliminated from further tests. The remaining 88 participants were consecutively subjected to Rose Bengal score, salivary scintigraphy and minor salivary gland biopsy. Fifteen participants refused to perform either one or more of the proposed tests at the second study stage. Two females of the 332 study participants [0.60% (exact 95% CI 0.07%, 2.16%)] fulfilled the criteria for primary SS. CONCLUSIONS: The estimated prevalence of definite SS in Slovenia is 0.60%.

[Claude Bernard and Daremberg father and son]. / Claude Bernard et les Daremberg.

Claude Bernard and Charles Daremberg were friends since youth. In a letter dated August 1, 1862, the medical historian tells the physiologist about Galen's experiments on nerves. Eighteen years later, Georges, Charles' son, writes a letter to Ernest Renan and congratulates him about his speech in honour of Claude Bernard, whom he succeeds at the Academie francaise.

[The decline and emergence of diseases]. / Déclin et émergence des maladies.

Presenting the various approaches that have so far been employed in the historical study of diseases, the author analyzes their characteristics, points to their limitations, and emphasizes their complementarity. In most cases historians restrict themselves to studying diseases separately, one by one, failing to bring to light reciprocal influences. After defining the concept of pathocenosis, the author examines some of the diseases prevalent in the pathocenoses of former days. He also describes the historical path taken in the conceptualization of diseases.

[The Zagreb Etruscan ceremonial fragment and an ancient Egyptian medical papyrus]. / Zagrebacki etruscanski obrednik i staroegipatski medicinski papirus.

The Archeological museum in Zagreb treasures the linen strips of an Egyptian mummy with inscriptions in Etruscan, and an Egyptian medical papyrus. The Etruscan text has been deciphered, but only a small part has been translated. This religious-magical ceremonial might be in relation with theurgical measures for health protection, promotion and restitution. The medical text on the papyrus is a hieratic script dating back to Pharaonic New Kingdom, probably a fragment of a medicine book similar to the Ebers papyrus. This article provides its transcription and translation. Three recipes for a powder and ointments which were used in the local treatment of inflammed moist skin lesions are presented.

[Ragusa (Dubrovnik) community physicians of the Middle Ages]. / Les médecins communaux de Raguse (Dubrovnik) au Moyen Age.

Several medieval cities on the eastern coast of the Adriatic Sea renewed the Byzantine tradition of hiring a public physician, thus offering their citizens the service of qualified doctors. The case of Ragusa is typical. The archives of this city-state have been preserved since the XIIIth century; the names, origins and professional titles of public physicians are well known. The conditions of their employment reveal not only their duties and the salary but also many aspects of communal hygiene and medical ethics.

[The iconography of consumption in the ancient world]. / Les représentations figurées de la consomption et du corps émacié dans l'antiquité.

There is in Delphi a votive statue - representing a man affected with phtisis - which is said to have been dedicated by Hippocrates himself. A little bronze found in Soissons could refer to the legend of Perdiccas' love sickness. We draw a parallel between Perdiccas' bronze and a mosaique in Lambiridi. Others representations (portraits, coins, statues of rickety children and iconographies of the Old Age) of weak and thin bodies are here studied following a medical approach.

-Malaria in the eastern Mediterranean in prehistory and antiquity-. / La malaria dans la Méditerranée orientale préhistorique et antique.

Paleopathological data support the hypothesis that malaria recrudescences in Greece occurred at the Mesolithic, at the top of the classic period and at the beginning of the Turkish conquest. Malaria due to Plasmodium falciparum did not appear until the 5th century B.C.

[The concept of emerging disease]. / Le concept de maladie émergente.

To avoid misinterpretations one should substitute the ambiguous notion of 'new disease' with 'emerging disease'. A disease can be classified emergent in at least five different historical situations; 1) it existed before it could be first identified but was overlooked from a medical point of view because it could not be conceptualized as a nosological entity; 2) it existed but was not noticed until a quantitative and/or qualitative change in its manifestations; 3) it did not exist in a particular region of the world before its introduction from other regions; 4) it never existed in a human population but only in an animal population; 5) it is completely new--the triggering germ and/or necessary environmental conditions did not exist prior to the first clinical manifestations. A series of historical examples illustrate this classification.