MEDICINSKA SKRB U SLOBODNOM OPKOLJENOM MISSOLONGIJU (1822.–1826.). JOHANN JACOB MEYER I PRVA VOJNA BOLNICA

During the siege of Missolonghi by the Ottomans the conditions of hygiene living, clothing and feeding of the vast majority of enslaved Greeks could be assessed as deprived and miserable. The humid climate and geophysical environment favored the outbreak of epidemics that further darkened an already unfavorable situation of the fighters and their families. Necessarily, the priority was to meet the military and economic needs and secondarily tackling public health issues, health care and medicine - social welfare. The inadequate infrastructure of nursing care, the limited number of health personnel and serious shortages into pharmaceutical material revealed the resolution of those doctors who provided their services during the siege. Johann Jacob Meyer, a famous Swiss philhellene, a man known as the first journalist in Greece, along with his Greek wife, contributed to the founding and organization of the first military hospital and to the improvement of the general health care during the siege of Missolonghi (1822-1826).Tijekom otomanske okupacije Missolonghija higijenski se uvjeti življenja, odijevanja i ishrane za većinu zarobljenih Grka mogu opisati oskudnima i bijednima. Vlažna klima i geofizički okoliš pogodovali su izbijanju epidemija koje su pogoršavale ionako nepovoljan položaj boraca i njihovih obitelji. Neadekvatna infrastruktura njege, ograničen broj medicinskog osoblja i ozbiljan nedostatak farmaceutskog materijala otkrivaju odlučnost liječnika koji su pružali svoje usluge tijekom okupacije. Prioritet je nužno bio zadovoljiti vojne i ekonomske potrebe, a potom riješiti problem javnog zdravlja, zdravstvene skrbi i medicine – društvenog blagostanja. Johann Jacob Meyer, glasoviti švicarski helenofil, poznat kao prvi novinar u Grčkoj, sa svojom suprugom pridonio je osnivanju i organizaciji prve vojne bolnice i poboljšanju opće zdravstvene skrbi tijekom opsade Missolonghija (1822.–1826)

John C. Carapanayiotis (1909. – 1999.): grčki radiolog i pionir fizijatrije u Grčkoj

John C. Carapanayiotis was specialized in physical medicine and rehabilitation in the USA in 1948, at a time when the medical world in post-war Greece was ignorant of this specific medical specialty, and the political, economic and social backdrop was incapable of accepting and understanding the wealth of scientific knowledge that he was trying to introduce. At this point it should be noted that the specialty of Physical Medicine and Rehabilitation was established in Greece in 1973. John C. Carapanayiotis was a member of the American Congress of Physical Medicine during the 1950’s. In the same period, he expressed interest, on behalf of the New York University, in the establishment of a Physical Therapy Clinic in Greece, which would be granted unlimited funding by the Marshal Plan. His efforts clashed constantly with the backward mentality of his time, with the entrenched conservatism and with the bureaucratic red tape. Unfortunately, he was far ahead of his time and was condemned to the same fate as all other visionaries and pioneers in the way that his knowledge and scientific background were not put into practice for decades to come.John C. Carapanayiotis specijalizirao je fizikalnu medicine i rehabilitaciju 1948. u SAD-u, u vrijeme kada medicinski svijet u poslijeratnoj Grčkoj još nije bio upoznat s ovom specifičnom medicinskom specijalizacijom, a politička, ekonomska i društvena pozadina nije bila spremna prihvatiti bogatstvo znanstvenih spoznaja koje je pokušavao uvesti. Specijalizacija fizikalne medicine i rehabilitacije u Grčkoj je osnovana 1973. godine. John C. Carapanayiotis bio je član Američkog kongresa fizikalne medicine tijekom 1950-ih. U istom je razdoblju izrazio zainteresiranost, u ime Sveučilišta u New Yorku, za osnivanje Klinike za fizikalnu terapiju u Grčkoj, kojoj bi Marshallovim planom bilo odobreno neograničeno financiranje. Njegovi su se napori stalno sukobljavali s nazadnim mentalitetom njegova vremena, s ukorijenjenim konzervativizmom i birokracijom. Bio je daleko ispred svoga vremena, osuđen na sudbinu svih ostalih vizionara i pionira kojima se znanje i znanstvena pozadina nisu primjenjivali još desetljećima

Computed Tomography-Guided Interstitial High-Dose-Rate Brachytherapy in the Local Treatment of Primary and Secondary Intrathoracic Malignancies

Introduction:Image-guided interstitial (IRT) brachytherapy (BRT) is an effective treatment option as part of a multimodal approach to the treatment of isolated lung tumors. In this study, we report our results of computed tomography-guided IRT high-dose-rate (HDR) BRT in the local treatment of inoperable primary and secondary intrathoracic malignancies.Methods:Between 1997 and 2007, 55 patients underwent a total of 68 interventional procedures for a total of 60 lung lesions. The median tumor volume was 160 cm3 (range, 24–583 cm3). Thirty-seven patients were men and 18 were women, with a median age of 64 years (range, 31–93 years). The IRT-HDR-BRT delivered a median dose of 25.0 Gy (range, 10.0–32.0 Gy) in twice-daily fractions of 4.0 to 15.0 Gy in 27 patients and 10.0 Gy (range, 7.0–32.0 Gy) in once-daily fractions of 4.0 to 20.0 Gy in 28 patients.Results:The median follow-up was 14 months (range, 1–49 months). The overall survival rate was 63% at 1 year, 26% at 2 years, and 7% at 3 years. The local control rate for metastatic tumors was 93%, 82%, and 82% and for primary intrathoracic cancers 86%, 79%, and 73% at 1, 2, and 3 years, respectively. Pneumothoraces occurred in 11.7% of interventional procedures, necessitating postprocedural drainage in one (1.8%) patient.Conclusions:In patients with inoperable intrathoracic malignancies, computed tomography-guided IRT-HDR-BRT is a safe and effective alternative to other locally ablative techniques

Focal hepatic lesion ultrasound-guided biopsies

Abstract Purpose: To compare the results of pathologic and cytologic reports of specimens acquired from focal liver lesions using ultrasound-guided biopsy and to evaluate the necessity of performing both techniques in the same patient. Materials and methods: 21 patients were eligible for enrollment in the study. Specimens for both pathologic and cytologic examination were obtained from 16 lesions using a 17G needle guide in a single puncture attempt. In 2 cases the diagnosis was based on cytologic smears. In 3 cases only histologic sections were acquired. The needle was introduced under continuous ultrasonographic control using a freehand technique. A cytologist was present at all times. Results: The diagnostic sensitivity of cytologic examination was 83.33% and that of histologic examination was 94.74%. Histology diagnosed all cases of benign lesions and was proved inconclusive in 1 patient. The diagnostic sensitivity and accuracy of both methods combined reached 100%. In 94.4% malignancy was immediately diagnosed by cytology. Conclusions: Combination of both methods should increase the sensitivity and accuracy in diagnosing focal liver lesions performing a safe minimally invasive technique. Keywords: focal liver lesions, ultrasound-guided biopsy, pathologic and cytologic examination Rezumat Scopul lucrării: de a compara rezultatele examenelor anatomopatologic şi citologic ale probelor obţinute prin puncţie hepatică ghidată ecografic din leziuni hepatice focale şi de a evalua necesitatea efectuării ambelor tehnici la acelaşi pacient. Material şi metodă: în studiu au fost incluşi 21 de pacienţi. Din 16 leziuni s-au obţinut probe atât pentru examenul anatomopatologic, cât şi pentru cel citologic, folosind un ac de ghidaj de 17G prin efectuarea unei singure puncţii. În 2 cazuri diagnosticul a fost bazat pe probele citologice. În 3 cazuri s-au obţinut doar secţiuni histologice. Acul a fost introdus sub control ultrasonografic continuu folosind tehnica freehand. Medicul citolog a fost prezent în toate cazurile. Rezultate: Diagnosticul citologic are o sensibilitate de 83,33%, iar cel histologic de 94,74%. Examenul histopatologic a diagnosticat toate cazurile de leziuni benigne, într-un caz diagnosticul s-a dovedit neconclusiv. Sensibilitatea şi acurateţea ambelor metode combinate ajunge la 100%. În 94,4% malignitatea a fost imediat diagnosticată citologic. Concluzii: Asocierea celor două metode creşte sensibilitatea şi acurateţea diagnosticului leziunilor hepatice focale utilizându-se o metodă sigură şi puţin invazivă. Cuvinte cheie: leziuni hepatice focale, biopsie ghidată ultrasonografic, examen histologic şi citologi

Sequential treatment with teriparatide and strontium ranelate in a postmenopausal woman with atypical femoral fractures after long-term bisphosphonate administration

AbstrAct ObJEctIVE: Despite the existence of numerous case series, no evidenced-based medical management for atypical fractures associated with bisphosphonate (bP) treatment has been established. DEsIGN: We report the outcome of teriparatide (trP) administration followed by strontium ranelate (sr) in a woman with a complete and an incomplete contralateral atypical fracture of the femoral diaphysis (AFF) associated with bP treatment. the spontaneous complete AFF was managed with intramedullary nailing, discontinuation of bP and initiation trP. rEsULts: Eleven months later, she suffered a contralateral incomplete AFF. At the completion of the trP treatment, she had only slight discomfort in the femur with the incomplete AFF. bMD testing revealed increase of 7.61% at the lumbar spine (Ls) and 0.8% at the hip. Following trP, 1-year sr treatment resulted in further bMD increase of 9.2% at the Ls and 1.4% in the hip, while she does not report any pain. bone markers remain within the normal range. cONcLUsION: Our case indicates that sequential therapy with trP and sr in cases of AFF might be a rational treatment option. However, there is a need for additional information concerning the effect of trP and sr, given alone or sequentially, in these patients in order to incorporate these drugs into the management of AFF