[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.

[Surgical case reports in the Corpus Galenicum]. / Chirurgische Fallbeschreibungen im Corpus Galenicum.

BACKGROUND: The case histories in the writings of the Greco-Roman physician Galen of Pergamum have so far been interpreted primarily in literary and sociohistoric terms. Analysis focused on the medical aspects is still incomplete. QUESTION: Which surgical competences do the Galenic case reports communicate? MATERIAL AND METHOD: The 358 Galenic case histories were studied for anamnestic, diagnostic, therapeutic, and prognostic statements on surgical diseases. RESULTS: In 38 case reports surgical disorders are presented. Most of the histories are found in the works On the composition of drugs according to kind (12), On the affected parts (5) and On anatomical procedures (3). Both individual persons, including many children and several women, and groups of patients are reported. The descriptions do not follow a fixed structure. The texts are governed by information on the anamnesis and catamnesis, the results of the physical examination and the description of the chosen intervention. The author has repeatedly combined the description of an individual case with theoretical remarks. The majority of the reports come from wound, visceral and thoracic surgery. The most common surgical diseases Galen encountered were soft tissue injuries of the extremities, traumatic thoracic and abdominal lesions, abscesses, peripheral nerve lesions, dislocations and tumors of the female breast. Gladiator wounds played an important role. In most cases, Galen was the attending physician. Second-hand medical histories are also told. Surgical interventions were regularly combined with conservative treatment methods, albeit in varying orders. DISCUSSION: The case reports cover much of the spectrum of surgical diseases mentioned by Galen. The differential diagnostic and differential therapeutic reflections are the most original element in terms of content. The remarks on the choice of treatment show that to care for surgical diseases the physician of antiquity sometimes used subtle interventions on the chest and abdominal wall, on the extremities and on the vessels. The accompanying drug treatment is described in great detail.

[Between anatomy and pathology : The dissection reports of Galen of Pergamum]. / Zwischen Anatomie und Pathologie : Die Sektionsberichte des Galen von Pergamon.

BACKGROUND: The autopsy protocols in the work of the Greco-Roman physician Galen of Pergamum have so far primarily been examined from a literary and socio-historic point of view. An analysis focused on the medical aspects is still incomplete. OBJECTIVES: Which pathologic-anatomic competence do the Galenic section reports convey? MATERIALS: The approximately 400 Galenic case histories were examined for anatomic and pathologic statements obtained during dissections of animals and men. RESULTS: In 29 reports, anatomy and pathology issues are addressed. Most section reports can be found in the work On anatomical procedures (De anatomicis administrationibus). The texts do not follow a fixed structure. Galen is always the leading actor, observer, and analyst. Many interventions were performed in front of an audience. Monkeys were by far the most commonly dissected animals. Galen stayed away from little animals, because in his opinion their anatomy was not sufficiently similar to that of men. The post-mortem examination of human corpses with scientific intent was limited to victims of epidemics, armed conflicts, and accidents. CONCLUSIONS: The dissection reports cover only part of Galen's pathologic expertise. The attractive public opening of animals earned him a large part of his reputation as a scientifically oriented physician. The dissection reports are an essential part of the collection of Galen's case histories and provide important detailed information on the history of anatomy and pathology in late antiquity.

[The Greek-Roman physician Galen of Pergamum and his neurological case histories]. / Der griechisch-römische Arzt Galen von Pergamon und seine neurologischen Fallberichte.

BACKGROUND: The case histories in the writings of Galen of Pergamum have so far been interpreted primarily in literary and socio-historic terms. The analysis focused on the medical aspects is still incomplete. QUESTION: Which neurological competences do the galenic case reports communicate? MATERIAL AND METHODS: The 400 galenic case histories were studied for anamnestic, clinical, therapeutic, and prognostic statements on neurological and psychiatric diseases. RESULTS: In about every tenth case report, neurological and/or psychiatric disorders are discussed. Most of them are found in the works Anatomical procedures, On the affected parts and Method of Healing. Both individual patients and patient groups are reported. The author calls prominent patients by name. The descriptions do not follow a fixed structure. The texts are governed by information on the anamnesis and catamnesis and the results of the physical examination. The author has repeatedly combined the description of the individual cases with theoretical remarks. The most common diseases of the nervous system Galen encountered were traumatic palsy, paresthesia, incontinence, rabies, epilepsy, depression and insanity. Symptoms associated with fever and epidemics also played an important role. In most cases, Galen was the attending physician. Secondhand medical histories are also told. The most invasive treatment procedure was trepanation. DISCUSSION: The case reports cover much of the spectrum of diseases of the nervous system mentioned by Galen. The doctor-patient tales are the most ingenious element in terms of style and content. The often sparse statements on the choice of treatment show that the ancient doctor hardly had any specific measures available for patients suffering from neurologic diseases with the exception of the rarely indicated and practiced surgical interventions.

[Forecasts from the retort. A Greek gift of artificial intelligence : Interdisciplinary data analysis in preoperative imaging diagnostics]. / Prognosen aus der Retorte. Ein Danaergeschenk der künstlichen Intelligenz : Interdisziplinäre Datenanalyse in der präoperativen bildgebenden Diagnostik.

The growing influence of artificial intelligence on radiology not only leads to a fundamental change in the way diagnoses are made but also creates a wealth of additional information. Many programs correlate the parameters of image evaluation with the results of histological, molecular biological and genetic examinations and from these they derive therapeutic and prognostic statements that are intended to serve the planning of individual precision medicine. This information is included in the findings report and is therefore also fully available to the patient; however, the information takes no account of influencing factors, such as the time lag between diagnosis and start of treatment, comorbidities as well as the availability and tolerability of drugs. It is foreseeable that the supplementary statements of the expert systems will considerably influence the discourse between doctor and patient.

[Ganglion: a bundle of meanings : The history of development of a multifaceted medical term]. / Ganglion: Ein Bündel von Bedeutungen : Zur Entwicklungsgeschichte eines facettenreichen medizinischen Terminus.

The variety of meanings of the term ganglion have their origins in the Greco-Roman antiquity. The first clue can be found in the works of Hippocrates who speaks of ganglionic tendon swellings. Later, Galen of Pergamum referred to the nodules of the prevertebral nerve cords discovered by him as ganglia. Therefore, the term was known in pathology for a longer time than in anatomy. From the eighteenth century onwards, ganglion has also been used to denote central nervous structures.

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.

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

Whereas the creative performance of the physician for nuclear medicine is 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 habitual 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 favorable its possible consequences are, the more subtleties and paraphrases should 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 the way is 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 intuitiveness accompanying 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.

[Organopathy: dealing with an interdisciplinary pathological term from the radiologist's point of view]. / Organopathie: Vom Umgang mit einem interdisziplinären Terminus aus radiologischer Sicht.

Organopathy is a common pathological term used by diagnostic radiologists. More than 100 different examples of organopathy can be found in the literature. The appellations are highly esteemed for their role as connecting links between the path anatomical substrate and the clinical symptoms in many frequent disorders. However, the radiological diagnosis of an organopathy is not generally equivalent to the same statement made by pathologists or clinicians. Its accuracy depends on the organ involved as well as the origin, the symptoms, and the histological substrate of the disorder. Moreover, the imaging technique applied does exert some influence. So, a classification of the terms according to the importance of imaging for the diagnosis of the respective diseases seems to be useful. On the basis of that criterion, six different groups can be established. The 1st group is formed by disorders not identifiable with the aid of imaging techniques, the organs involved essentially being detectable (e. g. neuropathy). The majority of organopathies of the 2nd group can be recognized by radiologists because of gross morphologic criteria, but differential diagnosis is not feasible (e. g. myopathy). By contrast, the organopathies of the 3rd group can be differentiated by means of x-ray and allied techniques basically (e. g. encephalopathy), while those of the 4th group to a high degree (e. g. arthropathy). The 5th group is made up of organopathies whose clinical and radiological diagnoses correspond or are at least almost identical (e. g. endocrine orbitopathy). The organopathies of the 6th group are completely defined by imaging characteristics, that is, the terms possess a specific radiologic autonomy (e. g. pulmonary hypertrophic osteoarthropathy). In the future, some disorders that are at present still referred to as organopathies, may be renamed because of a better understanding of their nature.