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The Hippocratic Oath is one of the most known medical texts. Despite its importance, it was rarely used in art and music. There exist only two complex musical settings of the Hippocratic Oath: "SERMENT-ΟΡΚΟΣ pour chœur mixte" ("Oath for mixed chorus") by Iannis Xenakis (1922-2001) and "Der Eid des Hippokrates für Klavier zu 3 Händen" ("The Hippocratic Oath for piano three hands") by Mauricio Kagel (1931-2008). Both being among the most important composers of the 20th century: Xenakis attempted to apply stochastic processes to his compositional techniques and Kagel is considered a pioneer of instrumental theatre. Both musical settings of the Hippocratic Oath were commissioned by medical institutions: Xenakis composed the work "Serment" in 1981 as a commission for the 15th World Congress of the "International Society of Cardiovascular Surgery" in Athens. "Der Eid des Hippokrates" was composed by Kagel in 1984 on behalf of the German medical journal "Deutsches Ärzteblatt". Both works are therefore intended for medical practitioners and both are influenced by the pathography of the two composers. This article will present results of the analysis and interpretation from a medical-historical perspective.

Infective endocarditis (IE) is an increasingly prevalent condition with relatively high mortality, whose epidemiology has become more complex with an aging population, an increased number of comorbidities, and an increasing incidence of health-care associated IE. Epidemiological data on the causative microorganisms of IE, prevalence of involvement of the different cardiac valves, and IE-associated mortality are clinically relevant. Eligible studies were identified through a systematic search of PubMed/MEDLINE database from 2010 to 2020, and a random effects model meta-analysis was conducted. 133 studies comprising 132,584 patients from six continents were included in this systematic review. The most common causative agents were Staphylococci species in 36% of cases, followed by Streptococci species (26%) and Enterococci species (10%). Out of studies that provided further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans group Streptococcus (12%). The short-term mortality rate (defined as in-hospital or 30-day mortality) was 17%. The highest mortality was reported in studies from Latin America with a mean mortality rate of 33% and the lowest mortality was reported in studies from Oceania at 13%. The aortic valve was the most commonly affected valve (46%), followed closely by the mitral valve (43%). The prevalence of tricuspid valve IE was 7% and multivalvular IE occurred in 14% of cases. Our study highlights a shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE. PROTOCOL REGISTRATION: PROSPERO CRD42024602342.

Assessments in the German Public Health Service take place, among other things, in the recruitment and incapacity assessment of civil servants. This may lead to conflicts of values and norms for assessing doctors, as they have to make decisions that are not necessarily in the interests of the person being assessed. Legally, the expectations of assessing doctors in public administration are largely defined. For public health service physicians, individual normative role conflicts still appear, and questions arise as to whether conscientious decisions of physicians adhere to legal requirements. Begutachtungen im Öffentlichen Gesundheitsdienst (ÖGD) finden unter anderem in der Einstellungs- und Dienstunfähigkeitsbegutachtung von Beamten statt. Hier entstehen möglicherweise Werte- und Normkonflikte für begutachtende Ärzte, denn diese müssen Entscheidungen treffen, die nicht unbedingt im Interesse der zu begutachtenden Person liegen. Wie kann man die Begegnungen zwischen Ärzten und zu Begutachtenden normativ rekonstruieren und deuten? Juristisch sind die Erwartungen an begutachtenden Ärzte in der öffentlichen Verwaltung weitgehend definiert. In der amtsärztlichen Praxis erscheinen trotzdem individuelle normative Rollenkonflikte, es entstehen Gewissensentscheidungen, ob man sich an rechtliche Vorgaben hält.

Mechanical thrombectomy (MT) has become the standard of care for stroke patients. The majority of the clinical trials and publications analyzing the outcomes related to the procedures report interventional performance by experienced practitioners. However, few of them individualize their preliminary metrics according to the operator's experience. To summarize the literature and report safety and efficacy outcomes following MT procedures and correlate them with the operator's experience. Primary outcomes were successful recanalization, defined as modified thrombolysis in cerebral infarction greater or equal to 2b or 3, duration of the procedure measured in minutes, and serious adverse event. This systematic review was performed according to the PRISMA guidelines. The PubMed, Embase, and Cochrane databases were utilized. There were six studies comprising 9348 patients (mean age 69.8 years; 51.2% males), and 9361 MT procedures were included. Each publication used for this review used a different experience definition to report their data. Higher interventionists' experience demonstrated a positive relationship with the possibility of successful recanalization and an inverse relationship with the duration needed for the operation in almost all of the included studies. As for the complications, none of the authors reported a statistically significant risk reduction of an adverse event, except Olthuis et al. correlating increasing training with lower odds of stroke progression. A higher experience level is associated with better recanalization rates and shorter procedural duration in MT operations. Further studies are warranted to define the minimum required level of experience for operational autonomy.

Which theoretical and practical competences do the surgical case histories of the Hippocratic Corpus convey? The 431 Hippocratic case histories have been studied for reports and communication on diagnosis, therapy and prognosis of single persons and groups of patients suffering from surgical diseases. Within the 7 books of the Hippocratic "Epidemics", a total of 18 patients with general and visceral surgical diseases are described. The main signs of the disorders were fever, pain, looseness, constipation, colic, swelling and bleeding, the most common affections abscesses, ruptures, ulcers and necroses. In addition, breast cancer can be reliably identified. Seven men are facing six women. Moreover, four children and one group are described. The patients' information about the course of their disease is sparse. Diagnostics were limited to inspection and palpation. In many cases, the treating physician confined to conservative measures. Among the surgical interventions incision, cauterization and bloodletting dominated. 11 of 18 patients succumbed to their diseases. The Hippocratic doctor diagnosed and treated a limited number of general and visceral surgical diseases. The symptoms of inflammation and traumatic lesions are narrated in detail. The observer describes the bloody secretion in two women with breast cancer as briefly as impressively. In two thirds of the cases, neither conservative measures alone nor in combination with invasive treatment led to enduring success. Complete recovery is reported of only three persons. The unfavourable balance of treatment for the involved physicians is an important reason for the confidence of scientists in the credibility of the Hippocratic case histories. Fragestellung: Welche theoretische und praktische Fachkompetenz vermitteln die chirurgischen Kasuistiken des Corpus Hippocraticum? Die 431 hippokratischen Kasuistiken wurden auf Berichte und Kommentare zu Diagnostik, Therapie und Prognose von chirurgischen Erkrankungen bei Einzelpersonen und Gruppen von Patienten untersucht.Ergebnisse: In den sieben Büchern der hippokratischen „Epidemien“ werden 18 Fälle von allgemein- und viszeralchirurgischen Erkrankungen beschrieben. Die wesentlichen Krankheitszeichen waren Fieber, Schmerzen, Diarrhö, Obstipation, Koliken, Schwellungen und Blutungen, die häufigsten Erkrankungen Abszesse, Rupturen, Geschwüre und Nekrosen. Außerdem ist das Mammakarzinom sicher identifizierbar. Sieben Männern stehen sechs Frauen gegenüber. Daneben werden vier Kinder und eine Gruppe beschrieben. Die Angaben der Patienten zum Verlauf der Erkrankung sind spärlich. Die Diagnostik beschränkte sich auf Inspektion und Palpation. Vielfach ergriff der behandelnde Arzt nur konservative Maßnahmen. Unter den chirurgischen Interventionen dominierten Inzision, Kauterisation und Phlebotomie. Elf der 18 Patienten erlagen ihren Erkrankungen.Schlussfolgerungen: Der hippokratische Arzt hat eine Reihe von allgemein- und viszeralchirurgischen Erkrankungen diagnostiziert und behandelt. Die Symptome von Entzündungen und traumatischen Läsionen werden im Detail geschildert. Kurz, aber eindrücklich beschreibt der Beobachter die blutige Sekretion bei zwei Frauen mit Brustkrebs. In zwei Dritteln der Fälle führten weder konservative Maßnahmen allein noch in Kombination mit invasiver Behandlung zu dauerhaftem Erfolg. Nur von drei Patienten wird über vollständige Genesung berichtet. Die für die Ärzte ungünstige Behandlungsbilanz ist ein wichtiger Grund für das Vertrauen der Wissenschaft in die Glaubwürdigkeit der Kasuistiken des Hippokrates.Schlüsselwörter: Griechische Welt/Geschichte, Arzt-Patient-Beziehungen, Chirurgie, Fallbeschreibung, EpidemienEingereicht am 19. August 2024 - Revision akzeptiert am 30. September 2024.

Division of the growing long bone into individual basic parts, that is, diaphysis, metaphysis, physes and epiphyses, has become generally accepted and used. However, the origin of these terms is almost unknown. Therefore, we have analyzed the literature in order to identify their sources. The terms epiphysis and apophysis have been used since the time of Hippokrates, although with different meanings. During the time of Galen, the term apophysis was used to describe all types of bone processes, and epiphyses denoted articular ends. The term diaphysis denoting the middle cylindrical part of the long bone was used for the first time by Heister in 1717. The first to use the term metaphysis was Theodor Kocher in his books on gunshot wounds and on bone inflammation of 1895. On the basis of Kocher's study, Lexer published a radiological study of the vascular supply to bones in which he defined metaphyseal blood vessels as a separate group supplying a particular part of the long bone. The epiphyseal growth plate had no particular name from the time of its first description in 1836. During the second half of 19th century, this structure acquired different names. The term "physis" was therefore introduced in 1964 by the American radiologist Rubin in order to label the growth structure between metaphysis and epiphysis clearly. One year later, the term physis also appeared in the radiological literature, and during the following decades it spread in the orthopedic literature.

Acute flaccid myelitis (AFM) is a rare disease that commonly affects young children. AFM's pathophysiology involves loss of lower motor neurons following a viral infection and induces acute asymmetric flaccid paralysis most commonly in the upper extremities. Nerve transfers have emerged as a treatment option for these patients with permanent motor deficits. To summarize the literature and report safety and efficacy outcomes following nerve transfers for recovery of shoulder abduction and external rotation, and elbow flexion and extension in pediatric patients with AFM. Recovery of at least antigravity function was defined as a successful outcome. This systematic review was performed according to the PRISMA guidelines. The PubMed, Embase and Cochrane databases were utilized. Five studies comprising 44 patients (median age 2.95 years; 71% male), and 93 upper extremity nerve transfers were included. Thirty-eight patients received 65 nerve transfer procedures aiming for recovery of shoulder abduction and/or external rotation with a transfer to the axillary and/or suprascapular nerve. The recovery of shoulder abduction and external rotation was achieved in 40.7% (n = 11/27) and 60% (n = 6/10) of patients, respectively. Time from injury to surgery showed an inverse relationship with the odds for successful recovery (OR: 0.81; 95% CI: 0.64-1.02; p = 0.07); however, statistical significance was not reached. Successful recovery of elbow flexion with a transfer to the musculocutaneous was reported at a rate of 92.3% (n = 12/13). Successful re-innervation of the radial nerve with recovery of elbow extension was found in 75% (n = 6/8) of patients. No complications were reported. Upper extremity nerve transfers appear to be promising and safe for AFM patients. Shoulder abduction is the most challenging upper extremity function to recover. Further studies are warranted to identify whether nerve transfers are associated with superior outcomes when performed earlier.

Hand surgery is a combination of microsurgery, osteosynthesis, nerve and tendon surgery focusing on the most essential organ in daily life and in societal interactions: the human hand. A discipline as important and highly specialized as hand surgery must be based on scientific studies and milestones from the past. Our work accompanies the video with english subtitles that was displayed in part during the opening ceremony of the 58th Congress of the Deutsche Gesellschaft für Handchirurgie (DGH, German Society of Hand Surgery) in Munich (President of the conference, Univ.-Prof. Dr. R. Giunta). This paper presents the development of hand surgery from its historical origins, focusing on and introducing important characters from the times of Hippokrates, the Middle Ages, the Renaissance, the 18th and 19th centuries, as well as the two World Wars. In summary, progress of hand surgery is linked to the advances in anatomy, tendon surgery, nerve surgery and closely connected to the necessity of specialized care for upper limb injuries during and after World War II. A well-founded understanding of history and an insight into the development of our specialization underlines the importance of our daily work as hand surgeons and creates new incentives for the future development of hand surgery.This contribution is published in honor of Ulrich Lanz on occasion of his 80th birthday in november 2020. Die Handchirurgie vereint Kompetenzen der Mikrochirurgie, Frakturheilkunde, Nerven- und Sehnenchirurgie und widmet sich dem im Alltag so essentiellen Funktionsorgan: der Hand. Ein so hochspezielles und bedeutsames Fach fußt auf den Wurzeln wissenschaftlicher Arbeiten und Meilensteinen aus der Vergangenheit. Als Nachtrag zum 58. Kongress der Deutschen Gesellschaft für Handchirurgie (DGH) in München (Tagungspräsident: Univ.-Prof. Dr. R. Giunta), soll dieser kurzgefasste Beitrag gemeinsam mit dem bei der Kongresseröffnung in Ausschnitten gezeigten Video die Entstehung der Handchirurgie von ihren Ursprüngen über Hippokrates, das Mittelalter, die Renaissance, das 18. und 19. Jahrhundert, sowie die zwei Weltkriege zusammenfassen. Bedeutende Persönlichkeiten der jeweiligen zeitlichen Perioden werden dabei vorgestellt. Zusammenfassend entwickelte sich die Handchirurgie aus Fortschritten in der Anatomie, der Sehnenchirurgie, der Nervenchirurgie, und vor allem auch durch die Notwendigkeit einer spezialisierten Versorgung von Verletzungen der oberen Extremität während und nach dem 2. Weltkrieg. Ein fundiertes Verständnis der Geschichte und der Einblick in die Entstehung unseres Faches unterstreicht die Bedeutung unserer täglichen Arbeit als Handchirurgen und schafft neue Anreize für die Weiterentwicklung der Handchirurgie in der Zukunft.Dieser Beitrag erscheint zum 80. Geburtstag von Ulrich Lanz im November 2020.

Mechanical thrombectomy (MT) for anterior circulation stroke has been proven to be highly effective. In comparison, MT for basilar artery occlusion (BAO) continues to lack definitive evidence of efficacy. The main MT modalities are stent retriever (SR) and direct aspiration (DA). Several studies have been published comparing the 2 approaches. We sought to directly compare and synthesize safety and efficacy outcomes with SR versus DA for acute BAO. A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Overall, 8 studies comprising 693 patients with BAO were included (SR: 457; DA: 236). The SR group was associated with statistically significant lower odds of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.31-0.94) and mTICI3 (OR: 0.47; 95% CI: 0.23-0.95) compared with DA. Favorable outcome rates were similar between the 2 groups (OR: 0.83; 95% CI: 0.60-1.16). The rates of symptomatic intracerebral hemorrhage (OR: 3.57; 95% CI: 0.75-16.95), subarachnoid hemorrhage (SAH) (OR: 4.71; 95% CI: 0.82-26.90), and vessel perforation (OR: 2.64; 95% CI: 0.43-16.33) were higher in the SR group, but statistical significance was not reached. The rates of 90-day mortality were similar between the 2 groups (OR: 1.07; 95% CI: 0.67-1.70). Procedure duration was significantly shorter when DA was used compared with SR (weighted mean difference: 26.10 minutes; 95% CI: 13.28-38.92). SR is associated with statistically significant lower odds of mTICI 2b/3 and mTICI 3 recanalization rates compared with DA. SR appears to be associated with a higher complication rate, but significance was not reached.

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This article deals with the history of medicine in the ancient Greece; from the cult of the God Asklepios, to the founder of the scientific rational medicine, Hippokrates. The humoral theory of Hippokrates is explained (the human body consists from four liquids) and his ideal of a physician's approach to a patient is emphasized. In the Hellenistic period the medical development continued in the Alexandria Medical School (Herofilos and Erasistratos). At first, not much attention was given to medicine and scientific health prevention in ancient Rome. Only 293 AD have physicians from Greece first been invited to Rome--e.g. Asklepiades. During the reign of C. lulius Caesar, foreigners, who engaged in medical practice, were granted Roman citizenship and thanks to a number of benefits the medical condition in Roman Empire blossomed. Medical clinics (iatreia), infirmaries (valetudinaria) and, under the influence of Christianity, hospitals were established. In the 2nd century AD ancient medicine reached its climax with physician Galenos, who created the entire system of medical science and became the most significant, but also last medical figure of ancient Rome.

Human papillomaviruses (HPVs) infection and HPVs-associated lesions, including skin warts in children and adults and cervical neoplasia in women, have been excessively studied since ancient years. In our article, we present briefly four major researchers from the HPVs pre-vaccination historic period: Hippokrates the Asclepiad, Domenico Antonio Rigoni-Stern, George N. Papanicolaou and Harald zur Hausen.

The Hippokrates Exchange programme (HEP) is designed to give early career General Practitioners (Associates in Training (AITs)/First5s) first-hand experience into concepts of a primary healthcare system outside of their host country. The aim is to improve GP knowledge and skills, inspire professional development and promote a global approach to primary care. Although an increasing number are taking up this opportunity, their views and experiences of international exchanges are not well described. The aim of the study was to explore the experiences of AITs/First5s following their HEP exchanges. This qualitative study analysed 16 post-exchange reports of UK participants visiting 10 European countries via the HEP, using a thematic approach. Participants were unanimously positive about their exchange experiences. The themes that emerged were (1) Comparison of primary care practice (2) Infrastructure of host primary care (3) Motivation and experience of exchanges and (4) Learning and reflection. Participants displayed considerable benefits from these exchanges by broadening their experience in different primary care systems and identifying improvements to be incorporated into their UK practice.

Considering the morphological findings in egyptian mummies at the beginning of the 20th century, atherosclerotic lesions were also apparent in pharaoh mummies more than 3500 years ago. Hippokrates (469-377 b.c.) described the sudden (cardiac) death, whereas Erasistratos had documented the typical claudication intermittens symptoms of peripheral arterial disease approximately 300 b.c. Later on in 1575, Fallopius observed severe pathological findings in arteries which he has characterized as a 'degeneration to bones', suggesting the presence of calcified atherosclerotic lesions. The relation between coronary lesions and the symptoms of angina pectoris was postulated in 1799 by Parry, however, only more than 80 years later angina pectoris was interpreted as a result of myocardial ischemia by Potain. During that time, the term 'arteriosclerosis' was firstly created by Lobstein in his 'Lehrbuch der pathologischen Anatomie', published in 1835. With the beginning of the last century, the pathophysiological aspects of plaque development were investigated in more detail by a number of researchers. In this context, people such as Saltykow, Chalatow and Anitschkow are important to notice. In 1914, Anitschkow firstly described the role of cholesterol accumulation in the vessel wall for the development of atherosclerosis. He used a cholesterol-fed rabbit model, which is the most important model of experimental atherosclerosis up to now. He also firstly described the 'Cholesterinesterphagozyten', which today commonly are known as foam cells, derived from macrophages. Using the cholesterol-fed rabbit model as well, already in 1942, Ludden et al. could demonstrate the atheroprotective effect of estrogen experimentally, a finding, which got later confirmed in the primate model and epidemiological studies. In the last three decades our knowledge has expanded by a large number of findings, based on morphological, immunohistological and molecular methods. In this context, one major contribution was the discovery of the LDL-receptor and its importance for the development of atherosclerosis by Brown and Goldstein, and the setting up of the 'response to injury hypothesis' by Ross and Glomset. At the present, we understand atherosclerosis as a complex (and at least in part as a physiological) phenomenon, beginning in the early childhood. The pathological aspect, making it to a disease, is depending on individual growth dynamics and plaque localization. The following key processes during the development of atherosclerosis are identified: 1) Endothelial injury, 2) intimal cholesterol accumulation and monocyte invasion with subsequent foam cell formation, 3) migration and proliferation of smooth muscle cells with expression of extracellular matrix 4) local thrombus formation with secondary organization 5) calcification and/or plaque rupture 6) final occlusion due to plaque rupture/thrombus formation. The classical concept of cardiovascular risk factors does only partially explain the origin of atherosclerosis. For the future, further mechanism(s) need to be identified and studied (genomic pathways, hormonal aspects, infective components, etc.) probably opening an effective therapeutical strategy to prevent and treat atherosclerotic diseases.