The physician: From certainty to complexity

There is no doubt that during the nineteenth and the first half of the twentieth century physicians were considered less as simple prescribers of medicaments and a source of ready cash, and more as the bearers of a precious patrimony of science and wisdom destined to be passed on to others and further enriched over time. Such figures are becoming extinct. Their epigones (by now considered old-fashioned) are going through a profound crisis which reflects the status of the medical world as a whole. The rapid growth of social needs seems to parallel the disappearance of the very foundations onwhich this kind of doctor based his existence, but the intricate and intriguing historical regression of clinical medicine, and the disordered rhythm of its scientific revolutions, can also be identified as significant epistemiological and ethical elements.An analysis exploring the decline of this typology of physician is not easy because the number of intelligible real facts exceeds the cognitive and organisational capacities of a single human mind. This obliges us to gather causes and connections, and bring different events together into ad hoc historical units. A criterion for ordering the set of  events concerning the evolution of the physician figure can be the concept of complexity,which has shaken the certainties of the logical bases of traditional medicine. In the light of this concept, the course of the development of medicine can be divided into three epochs:- the first epoch is characterised by the episteme of the certainty derived from transcendental faith;- the second, which began in the Baroque age, by an episteme based on the certainties deriving from faith in scientific research;Paper partially sponsorized by: Fondazione Michele Rodriguez - Scientific Foundation for Quantitative Measurements in Medicine, Milan Italy and Quantitative Measurements Centre, Scientific Department, Istituto Clinico Humanitas, Rozzano Milan Italy.- the third and present epoch is increasingly characterised by an episteme whose essence lies in uncertainty due to the complexity highlighted by technology

Sperm protein 17 is expressed in human nervous system tumours

BACKGROUND: Human sperm protein 17 (Sp17) is a highly conserved protein that was originally isolated from a rabbit epididymal sperm membrane and testis membrane pellet. It has recently been included in the cancer/testis (CT) antigen family, and shown to be expressed in multiple myeloma and ovarian cancer. We investigated its immunolocalisation in specimens of nervous system (NS) malignancies, in order to establish its usefulness as a target for tumour-vaccine strategies. METHODS: The expression of Sp17 was assessed by means of a standardised immunohistochemical procedure [(mAb/antigen) MF1/Sp17] in formalin-fixed and paraffin embedded surgical specimens of NS malignancies, including 28 neuroectodermal primary tumours (6 astrocytomas, 16 glioblastoma multiforme, 5 oligodendrogliomas, and 1 ependymoma), 25 meningeal tumours, and five peripheral nerve sheath tumours (4 schwannomas, and 1 neurofibroma),. RESULTS: A number of neuroectodermal (21%) and meningeal tumours (4%) were found heterogeneously immunopositive for Sp17. None of the peripheral nerve sheath tumours was immunopositive for Sp17. The expression pattern was heterogeneous in all of the positive samples, and did not correlate with the degree of malignancy. CONCLUSION: The frequency of expression and non-uniform cell distribution of Sp17 suggest that it cannot be used as a unique immunotherapeutic target in NS cancer. However, our results do show the immunolocalisation of Sp17 in a proportion of NS tumour cells, but not in their non-pathological counterparts. The emerging complex function of Sp17 makes further studies necessary to clarify the link between it and immunopositive cells

© 2008 The WJG Press. All rights reserved. VIRAL HEPATITIS Metrically measuring liver biopsy: A chronic hepatitis B and C computer-aided morphologic description

doi:10.3748/wjg.14.733

Metrically measuring liver biopsy: A chronic hepatitis B and C computer-aided morphologic description

AIM: To describe a quantitative analysis method for liver biopsy sections with a machine that we have named “Dioguardi Histological Metriser” which automatically measures the residual hepatocyte mass (including hepatocytes vacuolization), inflammation, fibrosis and the loss of liver tissue tectonics