Του Πασχάλη Γαβριηλίδη, MD, MSc, PhD, pgavrielidis@yahoo.com
Presentation by Paschalis Gavriilidis MD, MSc, PhD
in Hospital Universitari Vall d’Hebron,
Barcelona 08035, Spain
Μια από τις πλέον ενδιαφέρουσες παραγράφους αναφέρεται
στη επινόηση και εισαγωγή από τον Σκώτο καθηγητή κλασσικών σπουδών στο
πανεπιστήμιο του Aberdeen, James Gomrack της λέξεως απόπτωσις. Όλως παροδόξως αυτή η νεκρή γλώσσα έχει τη
δυνατότητα να γεννά ακόμη. Τρεις παθολόγο-ανατόμοι του εζήτησαν να επινοήσει
μια λέξη που να περιγράφει επακριβώς το φαινόμενο του προγραμματισμένου
κυτταρικού θανάτου στην καρκινογένεση και ο James Gomrack εμπνεόμενος από το Όμηρο τους πρότεινε την λέξη απόπτωσις
και όχι απόπτωση!!!
Υπάρχει σαφής υπόμνηση ότι ανήκει στη τρίτη κλίση της Ελληνικής γλώσσης και ότι αυτή είναι η σωστή ορθογραφία.
PS: Although they used three Greek words "programmed cell death" asked James Gomrack to coin a new Greek word "APOPTOSIS".
The interest of the present study triggered after the proposal by
Dr Ernest Hidalgo MD, PhD to make a presentation on the study by Tiniakos D, et
al on the publication Tityus: a forgotten myth of liver regeneration. [1].
First of all, it will be of the great importance to inform the audience
that the word mythos (ΜΥΘΟΣ) does not has the similar
meaning in the ancient Greek language compared to the meaning in the
contemporary languages.
Aristotle used the word mythos to designate the plot of play. In the
ancient Greece it was recognised that were two distinct ways of thinking and
acquiring knowledge. One was “mythos”, which relied upon narrative and folk
knowledge, and the other the “logos”, which referred to logical and rational
analysis of the phenomena in question.
The audience will further understand the meaning of the word “mythos” if
present to them the etymology of the names Prometheus and Epimetheus. Both of
them constructed on the word ‘mythos”.
Károly Kerényi a scholar in classical studies and one of the founders of
modern studies of Greek mythology in his books “The Mythology of the Greeks”
and “Prometheus: Archetypal image of the Human existence” referred to the
meaning of the words “Prometheus, Προμηθεύς, and Επιμηθεύς”, “Epimetheus”. Epimetheus means
“hindsight”, literally “after-thinker” was the brother of Prometheus which
means “foresight” literally “fore-thinker”.
By presenting this quote by Antishenes we would like to underline that words matter.
Furthermore, we would like to draw the attention of the audience by underlining
the meaning of the word “etymon=true, actual, clear” which in combination with
logos produce the word etymology.
Slide No 4, communicates one the core messages of the Hippocratic
medicine first do not harm «ΩΦΕΛΕΕΙΝ Ή ΜΗ ΒΛΑΠΤΕΙΝ» “Primum non Nocere”
The messages of this slide can be used as an argument against
the “blame culture” in medicine. Medicine as any other art (techne, τέχνη) has both good and bad practitioners. Of note, the treatment of the sick
is not a matter of chance, but requires skill, experience and expertise.
Interestingly, in this slide will be presented concepts in evidence-based
medicine conceived by Hippocrates 2.500 years before
the contemporary era. In particular, the concept of the “opinion-based
medicine” could be better understand if you reflect over the Hippocratic quotes
which describes how treacherous is the experience. Evidence based medicine
comes to deal with all the caveats of the opinion-based medicine and with the
bias that produced from unchecked experience.
Refers to the contribution of the Hippocratic physicians in
natural sciences. In particular, similar to Milesian philosophers from the
Minor Asia (Thales, Anaximander, et al) who rejected the divine interference in
meteorology and astronomy, so Hippocrates did in medicine. He for the first
time stated “disease is a natural phenomenon the effect of natural causes”
Notably, according to Hippocratic principles the course of the
disease can be summarised on the following three concepts. First, disease is
determined by critical days. Second, there are as many different diseases as
there are patients, and third, many physicians confuse what is coincidental to
the disease with its cause. Of note, in the following slide we are going to
present contemporary studies that based on the concept of critical days in the
disease.
In the study by Vigano, et al the aim was to identify the
predictive factors of conservative management failure of bile leak after
hepatectomy to avoid useless long waiting time and to perform early
interventional procedures. Bile leakage was defined any drainage of 50 ml or
more of bile from the drain, or from drainage of an abdominal collection.
Drainage outputs on days 1, 3, 5, 7, and 10 from bile leakage diagnosis were
considered. They concluded that for patients with bile drainage output of more
than 100 ml on the 10th day post leakage diagnosis, interventional
procedures should be considered because of their high risk of conservative
management failure [2].
Balzan et al, reported that the conjunction of PT < 50% and
serum bilirubin more than 50 μmol/L on the 5th postoperative day is a
strong predictive factor of mortality [3].
Gyoeri et al. investigated the role of CRP and antithrombin III (ATIII)
as predictive factors of postoperative hepatic failure and mortality. They
concluded that values of CRP 3mg/dl and for ATIII 60% on POD 1 are significant
predictors of increased posthepatectomy failure and mortality. Therefore,
adjustment of patients’ management should be considered [4].
In 1999 Brian Hurwitz published an article describing how
Plato explored the difference between skills grounded in practical expertise
and those based solely on following instructions or obeying the rules [5].
Plato in his work “Statesman” using the physician as model
describes the following thought experiment: Doctors would be stripped of their
clinical freedom- “no longer allowed unchecked authority”- but would form
themselves into councils to determine majority views about how to practise
medicine in all situations” [6].
In Plato’s view major caveats of application of guidelines
could be considered first that the knowledge used for the creation of
guidelines are not rooted in the mental processes of the Clinician Doctors but
in the minds of guidelines developers distant from the consultation and notably
the guidelines refer to the average patient. However, the Physician treats the
particular patient. The intrinsic value of this message will be further
increased if we simultaneously reflect on the Hippocratic quotes first, that
there are as many different diseases as there are patient, and second it is far
more important to know what person the disease has than what disease the person
has.
Plato considered that the qualities of expertise such as
flexible responsiveness and improvisatory ability could be endangered by blind
application of guidelines. Notably contemporary legal systems on the role of
guidelines in court consider that guidelines could be introduced to a court by
an expert witness as evidence of accepted and customary standards of care, but
they cannot be introduced as a substitute for expert testimony.
It presents works of Gavriilidis P et al., that assess
methodological quality of clinical practice guidelines using AGREE II tool.
It presents Greek cities in the Iberian peninsula. Question to
the audience “ Does somebody know the etymology of the word Iberia? Notably,
there is a myth that refers Hercules as a founder of the city of Barcelona. During the fourth of his labours, Hercules joined Argonauts
in the travel across the Mediterranean in the nine ships. The flagship of this
float is called Ago. One of the ships is lost in a storm off the Catalan coast
and the Hercules sets out to locate it. He finds it wrecked by a small hill,
but with the crew saved. Hercules was so taken by the beauty of the location
that he founded a city with the name “Barca Nona” “Ninth ship”
The message of this slide can be further appreciated if it is
combined with the following Hippocratic quote “ wherever the art of Medicine is
loved, there is a love of humanity”.
References
Tiniakos DG, Kandilis A, Geller SA. Tityus: a forgotten myth of liver regeneration. J Hepatology 2010; 53: 357-61.
Viganò L, Ferrero A, Sgotto E, Tesoriere RL, Calgaro M, Capussotti L. Bile leak after hepatectomy: predictive factors of spontaneous healing. Am J Surg 2008; 196: 195-200.
Balzan S, Belghiti J, Farges O, et al. The “50-50” Criteria on Postoperative day 5. An accurate predictor of liver failure and death after hepatectomy. Ann Surg 2005; 242: 824-829.
Gyoeri GP, Pereyra D, Braunwarth E, et al. The 3-60 criteria challenge established predictors of postoperative mortality and enable timely therapeutic intervention after liver resection. HepatoBiliary Surg Nutr 2019; 8:111-124.
Hurwitz B. Legal and political considerations of clinical practice guidelines. BMJ 1999; 318: 661-4.
Plato. Statesman. Annas J, Waterfield R, eds. Cambridge: Cambridge University Press, 1995 xvi-xvii, 60-1
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