Case series and a systematic review concerning the level of the aortic bifurcation.

BACKGROUND: The aim of this study is to present the level of aortic bifurcation in a sample of Greek origin (case series) and to perform an up-to-date systematic review in the existing literature. MATERIALS AND METHODS: Seventy-six formalin-fixed adult cadavers were dissected and studied in order to research the level of aortic bifurcation. Additionally, PubMed and Google Scholar databases were searched for eligible articles concerning the level of aortic bifurcation for the period up to February 2020. RESULTS: The mean level of aortic bifurcation according to our case series was the lower third of the L4 vertebral body (21/76, 27.6%). The level of aortic bifurcation ranged between the lower third of the L3 vertebral body and the lower third of the L5 body. No statistically significant correlation was found between the two sexes. The systematic review of the literature revealed 31 articles which were considered eligible and a total number of 3537 specimens were retracted. According to the recorded findings the most common mean level of aortic bifurcation was the body of L4 vertebra (1495/3537 cases, 42.2%), while the range of aortic bifurcation was described to occur from upper third of L3 vertebrae to the upper third of the S1 vertebrae in the 52.8% of the cases (1866/3537). CONCLUSIONS: The mean level of AA corresponds to the body of L4 and presents a great range (form L3U to S1U). Knowledge of the mean level of aortic bifurcation and its probable ranges is of great significance for interventional radiologists and especially vascular surgeons that deal with aneurism proximal to the aortic bifurcation.

An aperture in the sagittal plane of the dorsal wall of the sacrum.

The dorsal wall of the sacrum presents various anatomical variations, while the dorsal bony wall of the sacral canal suffers more. We report a case of a sacrum with a series of variants in the midline due to abnormal ossification and a bizarre aperture on the sagittal plane between the 1st and the 2nd sacral spinous processes. A failure of the ossification patter during embryological life, or an ossification of the supraspinous ligament may result in such an aperture. Sacrum variety is of great importance for the daily proper medical practice.

An unusual case of asymmetrical combined variations of the subclavian and axillary artery with clinical significance.

In a Greek Caucasian male cadaver, a combination of the following arterial variations were observed: an aberrant right subclavian artery originating as a last branch of the aortic arch and coursed posterior to the oesophagus, a right non-recurrent laryngeal nerve, an atypical origin of the left suprascapular artery from the axillary artery, an unusual emersion of the lateral thoracic artery from the subscapular artery and a separate origin of the left thoracodorsal artery from the axillary artery. According to the available literature the corresponding incidences of the referred variants are: 0.7% for the aberrant right subclavian artery, 1.6-3.8% for the origin of the suprascapular artery from the axillary artery, 3% for the origin of the left thoracodorsal artery from the axillary artery and 30% for the origin of the lateral thoracic artery from the subscapular artery. Such unusual coexistence of arterial variations may developmentally be explained and has important clinical significance.

Hippocratic views in the treatment of rectal prolapse.

Known since antiquity, rectal prolapse was first studied systematically by Hippocrates (460-377 BC) who recognized the predisposing factors and proposed several therapeutic approaches such as defecation positions, manual retraction and specific herbal or mineral based anti-haemorrhagic and pain-killing poultices. Hippocratic medicine avoided invasive surgical procedures probably due to a lack of knowledge in human anatomy. However, Hippocrates' views astonishingly lasted in time, presenting similarities to current medical theories on rectal prolapse.

Mental health and sexual activity according to ancient Greek physicians.

The ancient Greek physicians have not failed in their studies to indicate the beneficial role of sexual activity in human health. They acknowledged that sex helps to maintain mental balance. Very interesting is their observation that sex may help mental patients to recover. Nevertheless they stressed emphatically that sex is beneficial only when there is a measure in it, so they believed that sexual abstinence or excessive sexual activity affect negatively the mental and physical health of man. Ancient Greek physicians reached this conclusion by empirical observation. They tried to justify the mental imbalance, as the potential physical problems, which probably will be listed today in the psychosomatic manifestations, of people with long-term sexual abstinence or hyperactivity, based on the theory of humors which was the main methodological tool of ancient Greek medicine. Their fundamental idea was that the four humors of the body (blood, phlegm, yellow and black bile) should be in balance. Therefore they believed that the loss and the exchange of bodily fluids during sex help body's humors to maintain their equilibrium which in turn will form the basis for the physical and mental health. Although in ancient medical texts the irrationality presented by people in the aforementioned conditions was not attributed in any of the major mental illnesses recognized in antiquity, as mania, melancholy and phrenitis, our belief is that their behavior is more suited to the characteristics of melancholy, while according to modern medicine it should be classified in the depressive disorders. We have come to this conclusion, because common characteristics of people who either did not have sexual life or was overactive, was sadness, lack of interest and hope, as well as paranoid thinking that can reach up to suicide. Regarding the psychosomatic problems, which could occur in these people, they were determined by the ancient Greek physicians in the following; continuous headaches and heaviness, dilatancy, pain, dysuria and fever. But all these symptoms would disappear when the man gained a measure sexual activity, as was categorically stated by Galen. It is striking that these ideas were maintained over time, starting already from the authors of the Hippocratic Corpus, from which the distinguished work De virginum morbis, refers indeed to women who reached the point of suicide due to the absence sexual life, hanging themselves or falling into wells and eventually passing to the works of Rufus of Ephesus, Soranus of Ephesus and Galen.

Ophthalmic malignancies in antiquity as depicted in two terracotta figurines.

Ocular and orbital wall cancers were recognized by the physicians of the antiquity as incurable, lethal, and non-operable malignant entities. Paul of Aegina (7(th)c AD) was the first to refer to this type of cancer and proposed only some palliative measures, while the same approach was also preserved by Theophanes Nonnus (10(th)c AD). However, two terracotta figurines of the Hellenistic period (323-30 BC) which depicted tumorous malformations in the eye area, raise a scientific debate on the matter. Hellenic art, once more contributed in a didactic way to preserve medical knowledge of the past, and served as an auxiliary tool in order to facilitate medical study.

The medical-religious practice of votive offerings and the representation of a unique pathognomonic one inside the asclepieion of corinth.

Votive offerings to the healing gods were a common religious custom for the ill believers to achieve the expected cure. The dedication of votive offerings began in Prehistoric Crete and continued during the Classical Period, mainly connected with the god Asclepius. Most offerings presented healthy members, while in some rare cases a disease had been displayed. A unique votive offering, found in the Asclepieion of Corinth, presented an anomaly, bringing to light the religious beliefs of the era. The custom of votive offerings was absorbed by the Orthodox Christians and still remains a common practice.

The fascinating germ theories on cancer pathogenesis.

For more than 100 years, the germ theory of cancer, proposing that microorganisms were at the origin of the disease, dominated medicine. Several eminent scientists like Etienne Burnet, Mikhail Stepanovich Voronin, Charles-Louis Malassez, and Francis-Peyton Rous argued on the pathogenesis presenting their theories that implicated cocci, fungi and parasites. The impact of these theories was culminated by the Nobel Prize in 1926 that was attributed to the Danish scientist Johannes Fibiger for his work on the nematode Spiroptera as a causative agent in cancer. Even if those theories were the result of fantasy and misinterpretation, they paved the way for the scientific research in oncology.

Aretaeus of Cappadocia and the first accurate description of uterine carcinoma.

In our article we present the work on uterine cancer of the distinguished physician Aretaeus of Cappadocia. Uterine cancer was known since antiquity and its presence is testified in ancient Egyptian and Greek medical writings. However in the 2nd century AD Aretaeus provided the first accurate description of uterine cancer, dividing it in two forms, an ulcerated and a non ulcerated, both painful and fatal.

The distinguished surgeon Bertrand Bécane (1728-1802?) and the syphilitic theory of cancer.

Bertrand Bécane, Professor of surgery in Toulouse Medical School, is considered an eminent precursor of oncology, influencing the 18th century medicine with his syphilitic theory of cancer.

The quarrel between iatromechanists and animists about the cause of cancer: lymph's role in oncogenesis.

In the 17th century, iatromechanists based to the solidist theory for the lymphatic system and lymph established a new speculation for the essential role of lymph in oncogenesis, while animists gave their own views in relation to the cause of cancer. Gradually, with the rise of pathological anatomy, new more rational theories have emerged.

The hygienist and sociologist Louis-René Villermé (1782-1863): a pioneer of occupational medicine.

BACKGROUND: Louis-René Villermé's work and research have ranked him among the most important figures in the history of occupational medicine. OBJECTIVES: The aims of this article were to objectively record the influence and the impact of Villermé's life and work on the establishment of occupational medicine. METHODS: A thorough analysis of scientific and historical literature on the subject was conducted. The authors paid special attention to primary French sources. RESULTS: Louis-René Villermé was born in Paris in 10 March 1782. Taking advantage of his good fortune and financial prosperity, due to the recognition of his initial work, he progressed efficiently and with decision towards a new way of thinking. He stressed the importance of observation of the social environment, the role of investigations on lack of hygiene, the significance of statistical recording and the study of demographic statistics, and devoted himself to the labour force's health problems. He died in his homestead on 16 November 1863. CONCLUSIONS: Villermé lived an intense life full of activity, social work and travel. His support of the working classes' rights, his opposition to child labour and gender inequality, and his fight for humane conditions in prisons remain diachronic ideals. He provided a reference model for socio-medical research and contributed to the establishment of the new scientific discipline, Occupational Medicine.

Joseph Gensoul's operation for sarcoma of the maxillary antrum, one century before Moore.

Joseph Gensoul is considered an important figure of the 19th century Lyonnais Medical School. His contribution to maxillofacial surgery and his legendary abilities secured him a place in the history of Medicine.

Hippocratic views on Paediatric Dentistry and Ancient Greek origins of Orthodontics.

Hippocrates, the father of medicine, expressed some very interesting ideas on dentistry. His remarks on paediatric dentistry and orthodontics are quite impressive and influenced its practice in ancient Greece. Here we examine his writings in order to find the most important dental references.