Suicide in ancient Greece.

The theme of suicide appears several times in ancient Greek literature. However, each such reference acquires special significance depending on the field from which it originates. Most of the information found in mythology, but the suicide in a mythological tale, although in terms of motivation and mental situation of heroes may be in imitation of similar incidents of real life, in fact is linked with the principles of the ancient Greek religion. In ancient drama and mainly in tragedies suicide conduces to the tragic hypostasis of the heroes and to the evolution of the plot and also is a tool in order to be presented the ideas of poets for the relations of the gods, the relation among gods and men and the relation among the men. In ancient Greek philosophy there were the deniers of suicide, who were more concerned about the impact of suicide on society and also these who accepted it, recognizing the right of the individual to put an end to his life, in order to avoid personal misfortunes. Real suicides will be found mostly from historical sources, but most of them concern leading figures of the ancient world. Closer to the problem of suicide in the everyday life of antiquity are ancient Greek medicines, who studied the phenomenon more general without references to specific incidents. Doctors did not approve in principal the suicide and dealt with it as insane behavior in the development of the mental diseases, of melancholia and mania. They considered that the discrepancy of humors in the organ of logic in the human body will cause malfunction, which will lead to the absurdity and consequently to suicide, either due to excessive concentration of black bile in melancholia or due to yellow bile in mania. They believed that greater risk to commit suicide had women, young people and the elderly. As therapy they used the drugs of their time with the intention to induce calm and repression in the ill person, therefore they mainly used mandragora. In general, we would say that there were many reasons to suicide someone in antiquity. Very important factor was to avoid captivity and the consequent overcrowding of indignity, especially for politicians and military leaders. Also intention in these circumstances was to avoid torture and the disgrace of rape. Strong grief is another reason, as in case of death of family members. The erotic disappointment had place in ancient suicides, which concerned both men and women, while there were also suicide for financial reasons. Especially for the elderly, the despair of the anility in conjunction with physical illness and cachexia, were important factors for these people to decide thee suicidal. Finally, the methods of suicide fitted their epoch, but bear resemblance to those of the modern time. Poisoning was very common to both men and women but equally popular in both sexes was also the hanging. It was not unusual to fall from a high in order to reach the death, while stabbing a sword in the body for self killing was widespread in men and soldiers.

Suicide in the Byzantine Empire.

Studying the suicide in the Byzantine Empire is difficult due to the limited number of references to it. Their number is greater in the early years of the Empire, mainly because of the persecution of Christians and gradually decreases. The attitude of the Church also gradually hardens, as well as the law. The law was strictly followed to the West, but as far as the Eastern Empire is concerned there are no references of punishment, confiscation of property or vandalism of dead bodies mentioned. Avoiding public humiliation after a public crime or a military defeat, religious redemption, emotional disturbance and debts, are the main cause of suicide. There are some references of mass suicides, while women suicides are relatively fewer, if the early Christian years are excluded. Suicide is more acceptable to the pagans because of their lifestyle. The therapeutic approach comes mainly through the treatment of depression. Aretaeus and Galen cite some ways to deal with the disturbance in the internal balance of black bile. Their view echoes through the centuries and the subsequent doctors embrace it. At least after the 9th century, more importance is given to the patient's bliss. Gemistus Pletho tried to revive the Platonic view of suicide shortly before the end of the Empire. The Church forbids Christian burial and troubled soul hovers in an intangible journey.

Lung compliance and chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease, namely, pulmonary emphysema and chronic bronchitis, is a chronic inflammatory response of the airways to noxious particles or gases, with resulting pathological and pathophysiological changes in the lung. The main pathophysiological aspects of the disease are airflow obstruction and hyperinflation. The mechanical properties of the respiratory system and its component parts are studied by determining the corresponding volume-pressure (P-V) relationships. The consequences of the inflammatory response on the lung structure and function are depicted on the volume-pressure relationships.

The "reversed halo" sign in pneumonococcal pneumonia: a review with a case report.

The "reversed halo" sign (RHS) is a distinct radiological sign representing a focal rounded area of ground-glass opacity surrounded by a more or less complete ring of consolidation. Initially, it was reported in two cases of cryptogenic organizing pneumonia and was considered to be relatively specific of the disease. Since then, it has been reported in a wide variety of clinical entities, thus reducing its specificity. We describe the reversed halo sign in a case of pneumonococcal pneumonia. To the best of our knowledge, this is the first report in English literature. The presence of the "reversed halo" sign during the resolution phase of pneumonococcal pneumonia has serious implications. First, it further reduces its specificity. Second, it opens new areas of research regarding its significance in cases of cryptogenic organizing pneumonia.

Tuberculous pericarditis: three cases and brief review.

Tuberculous pericarditis is a form of extrapulmonary tuberculosis that is considered unusual in western coun-tries. Diagnosis is often challenging, while proper treatment has a major impact on prognosis. We present three interesting cases, with complicated or unusual manifestations of tuberculous pericarditis: a patient with cardiac tamponade as the initial manifestation of tuberculosis; a patient progressing to constriction despite adequate treatment; and a patient receiving anti-TNFalpha, who developed pericarditis in the context of immune reconstitution inflammatory syndrome. We briefly review the clinical features of tuberculous pericarditis, whilst our main focus is on the available diagnostic techniques and treatment aspects. In conclusion, tuberculous pericarditis remains an active thread in the western world. A high index of suspicion combined with the use of all available diagnostic techniques are important to increase diagnostic yield. Prompt and effective treatment is essential to reduce morbidity and mortality.

Liposomal cisplatin combined with paclitaxel versus cisplatin and paclitaxel in non-small-cell lung cancer: a randomized phase III multicenter trial.

BACKGROUND: Liposomal cisplatin is a new formulation developed to reduce the systemic toxicity of cisplatin while simultaneously improving the targeting of the drug to the primary tumor and to metastases by increasing circulation time in the body fluids and tissues. The primary objectives were to determine nephrotoxicity, gastrointestinal side-effects, peripheral neuropathy and hematological toxicity and secondary objectives were to determine the response rate, time to tumor progression (TTP) and survival. PATIENTS AND METHODS: Two hundred and thirty-six chemotherapy-naive patients with inoperable non-small-cell lung cancer were randomly allocated to receive either 200 mg/m² of liposomal cisplatin and 135 mg/m² paclitaxel (arm A) or 75 mg/m² cisplatin and 135 mg/m² paclitaxel (arm B), once every 2 weeks on an outpatient basis. Two hundred and twenty-nine patients were assessable for toxicity, response rate and survival. Nine treatment cycles were planned. RESULTS: Arm A patients showed statistically significant lower nephrotoxicity, grade 3 and 4 leucopenia, grade 2 and 3 neuropathy, nausea, vomiting and fatigue. There was no significant difference in median and overall survival and TTP between the two arms; median survival was 9 and 10 months in arms A and B, respectively, and TTP was 6.5 and 6 months in arms A and B, respectively. CONCLUSIONS: Liposomal cisplatin in combination with paclitaxel has been shown to be much less toxic than the original cisplatin combined with paclitaxel. Nephrotoxicity in particular was negligible after liposomal cisplatin administration. TTP and survival were similar in both treatment arms.

Errors and difficulties in the diagnosis of bladder cancer in the 19th century: about an uncommon case reported by Professor Claude-François Lallemand (1790-1854).

Before the official foundation of the specialty of urology in 1870 from Félix Guyon, its exercise was in the hands of general surgeons. One of the most distinguished surgeons interested in urology was Claude-François Lallemand, Professor of Surgery in Montpellier. Despite his enormous experience in the diagnosis and treatment of urinary tract diseases as well as the invention of various surgical instruments for the lower urinary system, Lallemand, however, did not avoid serious diagnostic errors because of the lack of diagnostic tools. Characteristically in the present article we present a serious diagnostic mistake in a patient with bladder cancer with fatal outcome.

The role of Endothelin-1 in obstructive sleep apnea syndrome and pulmonary arterial hypertension: pathogenesis and Endothelin-1 antagonists.

Obstructive Sleep Apnea Syndrome (OSAS) is a recognized risk factor for cardiovascular disorders and in some cases is complicated with Pulmonary Arterial Hypertension (PAH), as the endothelium is affected. Recent studies provide strong evidence for endothelial dysfunction in obstructive sleep apnea. The resultant vasoconstriction, abnormal cell proliferation and hyper-coagulability may lead to the initiation or progression of atherosclerotic cardiovascular and cerebrovascular disorders, which are frequently encountered in OSA patients. While the currently available therapies for OSAS, such as Continuous Positive Airway Pressure therapy (CPAP therapy), improve endothelial dysfunction, they are not well-tolerated by patients. CPAP therapy can reduce nocturnal hypoxemias and decrease noradrenaline circulating levels, but does not affect ET-1 plasma levels. Potent and selective Endothelin-1 receptor antagonists have been developed and have shown promising results in the treatment of cardiovascular diseases such as pulmonary arterial hypertension, acute and chronic heart failure, hypertension, renal failure, and atherosclerosis. However, results are often contrasting and complicated because of the tissue-specific vasoconstrictor actions of Endothelin-B receptors and the fact that endothelin is an autocrine and paracrine factor whose activity is difficult to measure in vivo.

A rare cause of dysphagia--aberrant right subclavian artery (ARSA).

Aberrant Right Subclavian Artery (ARSA) is a rare vascular anomaly. It is though the most frequent anomaly involving the aortic arch, being present in about 1% of the general population. We present a case of a 71 year old male with symptoms of chronic cough and dysphagia. He was referred to our clinic for further evaluation of a mediastinal mass. A second Computed Tomography of the thorax was performed, this time with the use of i.v. contrast. The latter examination confirmed the diagnosis (ARSA), sparing the patient of invasive and potentially life threatening diagnostic procedures (invasive angiography, mediastinoscopy). This case highlights the significant pitfalls regarding the mediastinal evaluation, especially when i.v. contrast is not used. The majority of the mediastinal structures are vessels. Vessels abnormalities should be included in the differential diagnosis of a mediastinal mass.

A 77 year old male with peripheral eosinophilia, pulmonary infiltrates and a small pleural effusion.

The presence of peripheral eosinophilia with lung infiltrates poses a diagnostic challenge for the clinician. The differential diagnosis includes a wide spectrum of diseases. In some of them (for example vasculitis, lymphoma) eosinophilic pneumonia represents just another "symptom" and not the final diagnosis. A thorough diagnostic procedure is required to examine all related clinical entities in order to establish a firm diagnosis. In particular, Idiopathic Chronic Eosinophilic Pneumonia (ICEP) is a rare disorder. In the majority of cases, it is characterized by peripheral eosinophilia, lung infiltrates, bronchoalveolar lavage eosinophilia (above 25%), exclusion of other possible causes and last but not least an impressive improvement under steroid therapy. Relapses are common but they do not seem to be related with ICEP associated mortality.

Determinants of specific sensitization in flour allergens in workers in bakeries with use of skin prick tests.

Baker's asthma, like other forms of occupational asthma is probably the most serious manifestation of occupational allergy among bakery workers. It is caused by immunologic sensitization and subsequent allergic reactions in the airways to occupational specific airborne allergens. Skin Prick Tests (SPTs) play an important role in the diagnosis of baker's asthma and epidemiological field studies on frequencies of sensitization to flour. This paper presents a review of the available literature on prevalence of flours sensitization in bakery workers. Atopy and level of exposure appears to be a very strong determinant for sensitization to flour allergens. Prevention strategies and standard setting are discussed.

Human genes in TB infection: their role in immune response.

Tuberculosis (TB) caused by the human pathogen Mycobacterium tuberculosis, is the leading cause of morbidity and mortality caused by infectious agents worldwide. Recently, there has been an ongoing concern about the clarification of the role of specific human genes and their polymorphisms involved in TB infection. In the vast majority of individuals, innate immune pathways and T-helper 1 (Th1) cell mediated immunity are activated resulting in the lysis of the bacterium. Firstly, PTPN22 R620W polymorphism is involved in the response to cases of infection. The Arg753Gln polymorphism in TLR-2 leads to a weaker response against the M. tuberculosis. The gene of the vitamin D receptor (VDR) has a few polymorphisms (BsmI, ApaI, Taq1, FokI) whose mixed genotypes alter the immune response. Solute carrier family 11 member (SLC11A1) is a proton/divalent cation antiporter that is more familiar by its former name NRAMP1 (natural resistance associated macrophage protein 1) and can affect M. tuberculosis growth. Polymorphisms of cytokines such as IL-10, IL-6, IFN-g, TNF-a, TGF-b1 can affect the immune response in various ways. Finally, a major role is played by M. tuberculosis antigens and the Ras-associated small GTP-ase 33A. As far as we know this is the first review that collates all these polymorphisms in order to give a comprehensive image of the field, which is currently evolving.

Urinothorax: an unexpected cause of pleural effusion in a patient with non-Hodgkin lymphoma.

Urinothorax is a rather rare cause of pleural effusion and its potential mechanism is urinary tract obstruction or trauma that results in urine leakage and accumulation inside the pleural space. Patients with non-Hodgkin lymphoma could present with pleural effusion due to mediastinal lymphadenopathy or extrathoracic manifestation such as urinary tract obstruction, the latter described in our case report. Physicians must be aware even of the more occult mechanisms of pleural fluid accumulations which could point to extrathoracic manifestations of involvement.

Efficacy and tolerance of roxithromycin versus clarithromycin in the treatment of lower respiratory tract infections.

In an open, randomized, parallel group study, the efficacy and tolerance of roxithromycin 300 mg po od was compared with clarithromycin 500 mg po bd in the treatment of 60 patients with lower respiratory tract infections (LRTI). The two groups were well-matched demographically. Fifty patients (25 per group) were clinically evaluable at the end of the study and a satisfactory response was found in 88% of those given roxithromycin and 80% of those given clarithromycin. All had received treatment for a minimum of 3 days. Only one (3.3%) of 30 patients in the roxithromycin group reported adverse events compared with seven (23.3%) of 30 in the clarithromycin group. Thus both roxithromycin and clarithromycin are effective in the treatment of LRTI but roxithromycin is better tolerated (P < 0.05) with the advantage of a once-daily dose.

Clinical and microbiological evaluation of pefloxacin in lower respiratory tract infections.

Patients with Gram-negative lower respiratory tract infections (acute exacerbation of chronic bronchitis (n = 23), pneumonia (n = 4), and bronchiectasis (n = 5) were treated with pefloxacin, 400 mg twice daily, given either intravenously or orally. Symptoms, signs and sputum volume and colour were monitored daily. Chest X-rays, sputum culture and Gram-stain examinations were carried out on days 1 and 5, and immediately after the end of the treatment. There was a clinical improvement, as indicated by the incidence of cough, dyspnoea and rales, and by sputum volume and colour in 31 patients (97%). Microbiological improvement, as indicated by the complete elimination of sputum pathogens and pus cells, was achieved in 28 of the patients (88%). In one patient, an adverse effect, renal failure, occurred. These results suggest that pefloxacin is both clinically and microbiologically effective for the treatment of Gram-negative lower respiratory tract infections.

Bioavailability of a new sustained-release anhydrous theophylline product.

The bioavailability of a new sustained-release anhydrous theophylline product (Theophylline Lavipharm) was evaluated and compared with the bioavailability of a well-established product, Theodur. Two groups of 12 healthy non-smokers were given single doses of 200 or 300 mg of each product and two groups of 12 patients with asthma or chronic obstructive lung disease were given doses of 200 or 300 mg of each product every 12 h for 5-day periods. The values of the area under the plasma theophylline concentration against time curve (AUC), the maximum plasma theophylline concentration (Cmax) and the time taken to reach Cmax (Tmax) for the two products did not differ significantly in the healthy groups or in the patients. The minimum and the average plasma theophylline concentrations and the fluctuation index were also calculated for the patients and there were no significant differences between the values for the two products. The new anhydrous theophylline product, Theophylline Lavipharm, appears to show very similar bioavailability to Theodur. No adverse reactions to the new product were reported.

Post-prandial serum bile acid concentrations and ammonia tolerance in Maltese dogs with and without hepatic vascular anomalies.

Post-prandial serum bile acid concentrations were measured in 200 Maltese dogs in an attempt to identify those with subclinical portosystemic shunts. Five of these were later shown to have hepatic pathology or abnormal liver function. In the other 195 Maltese, bile acid concentrations ranged from 1 to 362 mumol.L-1 (mean +/- SD, 70 +/- 50 mumol.L-1; median, 65.0 mumol.L-1). Of these, 79% were above the reference range (0 to 31 mumol.L-1) established from 23 mixed-breed control dogs. It was therefore not possible to determine the prevalence of subclinical portosystemic shunts on the basis of bile acid determinations. Further investigation of liver function was performed to investigate why bile acid concentrations were increased in these dogs. Rectal ammonia tolerance tests were normal in 102 of 106 Maltese tested and liver samples (11 dogs) and plasma biochemistry profiles (9 dogs) demonstrated no significant hepatic disease or dysfunction. Of 2 Maltese with hyperammonaemia after administration of ammonium chloride, one had a large congenital portosystemic shunt that was confirmed at surgery. In the other there were no macroscopic portosystemic communications, but a liver biopsy showed histological changes consistent with microscopic portovascular dysplasia. Total serum bile acid concentrations were consistently lower when assessed by high-performance liquid chromatography than by an enzymatic spectrophotometric method. This discrepancy was substantially larger in Maltese than in control dogs, suggesting the presence of an additional reacting substance in the serum of Maltese dogs.

Respiratory muscle strength during continuous ambulatory peritoneal dialysis (CAPD).

The purpose of this study was to investigate the effect of chronic renal failure (CRF) and continuous ambulatory peritoneal dialysis (CAPD) on respiratory muscle function. Global respiratory muscle strength was assessed by measuring mouth pressures during maximum static inspiration (PIMAX) near residual volume (RV) and expiration (PEMAX) near total lung capacity (TLC), in 26 patients. Maximum pressures, spirometry and lung volumes were measured before dialysis, 4 h after the administration of 2 l of dialysate into the peritoneal cavity, and just after the next drainage. In addition, biochemical indices (urea, creatinine, sodium, potassium, calcium and phosphorus) and haematological indices (haemoglobin (Hb) and haematocrit (Hct)) were measured once before the treatment. The results showed that mean PIMAX and PEMAX were normal, with a very wide range between patients, before CAPD. However, seven patients (27%) showed a PIMAX of < 75% predicted (pred) and eight (31%) a PEMAX < 75% pred. Maximal pressures decreased significantly during CAPD and increased again after the drainage of fluid. Similarly, lung volumes were within the normal range before and decreased significantly during CAPD. The forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio did not change. We conclude that respiratory muscle strength was preserved in the majority of the patients with chronic renal failure treated with CAPD. During CAPD, lung volumes and respiratory muscle function were decreased, demonstrating an effect of the abdominal cavity on the mechanics of the respiratory system. However, the decrease in the maximum pressures was less than 20%, indicating that CAPD is a safe procedure in patients without pre-existing pulmonary disease or uraemic pulmonary complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiographic determination of total lung capacity in patients with acromegaly.

Total lung capacity (TLC) was measured from posteroanterior and lateral chest radiographs by the ellipsoid (TLCE) and planimetric (TLCp) radiographic methods in 16 acromegalic patients. These measurements were compared to the TLC measured by body plethysmography (TLCBP) in order to investigate the accuracy of the two radiographic methods. Our results showed that the mean value of TLCBP was 6.52 +/- 1.51 litres (mean +/- SD) or 120 +/- 13.3% of predicted values, statistically significantly increased from normal values (P less than 0.001). The mean value of TLCE was 7.09 +/- 1.8 litres and did not differ from the mean value of TLCBP (P greater than 0.125). The mean value of TLCP was 7.74 +/- 1.20 litres, statistically significantly increased from TLCBP (P less than 0.005). A statistically highly significant linear relationship was found between TLCE and TLCBP (r = 0.867, P less than 0.001) identical to the line of identity. Similarly a highly significant linear relationship was found between TLCP and TLCBP (r = 0.793, P less than 0.001) but to the left of the line of identity. It is concluded that both the ellipsoid and planimetric radiographic methods could be used to measure TLC in acromegalic patients but the planimetric method needed the appropriate correction.