Aristidis Diamantis

Hallmarks in the history of epilepsy: Epilepsy in antiquity

The purpose of this article is to highlight the hallmarks of epilepsy as a disease and symptom during antiquity and especially during Ancient Greece and Rome. A thorough study of texts, medical books, and reports along with a review of the available literature in PubMed was undertaken. Observations on epilepsy date back to the medical texts of the Assyrians and Babylonians, almost 2000 years B.C. Considered initially as a divine malady or demonic possession, epilepsy was demythologized by the Father of Medicine, Hippocrates, who was the first to set in dispute its divine origin. Physicians in the early post-Hippocratic era did not make any important contribution regarding the mechanisms of epileptic convulsions, but contributed mainly in the field of nosology and systemization of symptoms.

Fine-needle aspiration (FNA) biopsy: historical aspects.

This study aims to present the origins and the historical evolution of fine-needle aspiration biopsy and to also underline its importance in the history of modern cytology. The article focuses on the advances made in the 20th century that have led to the modern techniques associated with the procedure. The authors conducted a thorough review of early reports on needle biopsy, particularly those published during 19th and 20th century, examining in brief also the origins of the needle biopsy. The first report on the use of needle puncture is referred in early writings of Arab medicine. In the early 20th century, Martin and Ellis are considered to be the founders of modern needle aspiration techniques. The German doctor Mannheim was the first to publish reports suggesting the use of fine needles with a small gauge. The establishment and world-wide expansion of FNA should be attributed to the representatives of the Swedish School of Cytopathology. The school embraced FNA in the second half of the 20th century while serving as a training ground for doctors around the world. The history of needle biopsy spans ten centuries. However, the development and establishment of the technique in its modern form took place primarily during the twentieth century. Today, FNA is considered an important cytologic technique with sufficient diagnostic accuracy, especially when applied in cases of lung and prostate cancer.

A brief history of apoptosis: from ancient to modern times.

The purpose of this article is to sketch the evolution of research on cell death and apoptosis from ancient to modern times. Early use of the term can be found in the texts of Hippocrates, whereas the first description of apoptotic cell death should be attributed to Rudolf Virchow. Glucksman, in 1951, rediscovered and reviewed cell death during embryonic development. Milestone discoveries in biology in the 20th century led biologists to the discovery of apoptotic mechanisms, soon after the definition of apoptosis by Kerr in 1972. The involvement of programmed cell death in the pathogenesis of various diseases and abnormalities gave a huge boost in the research of apoptosis. Nowadays, research is focused on the elucidation of apoptotic mechanisms, since the possibility of modulating cell death by targeting specific factors involved in the whole process could be the key for cure of diseases such as cancer, Alzheimer’s disease, and AIDS.

Epilepsy during the Middle Ages, the Renaissance and the Enlightenment

The purpose of this study was to pinpoint the views on epilepsy as a disease and symptom during medieval times and the Renaissance. A thorough study of texts, medical books and reports along with a review of the available literature in PubMed was undertaken. With the exception of some early Byzantine doctors in the East and some of the representatives of Arab medicine, scientific views and observations on epilepsy in the West were overrun by the domination of the Catholic Church. This led to the formulation of superstitious views of the disease; epileptics were considered possessed and, therefore, only religious methods could possibly cure it. Near the end of the fourteenth century, physicians were emancipated from Catholic intervention. The Renaissance is marked by a plethora of new treatises on epilepsy regarding the mechanisms of epileptic convulsions, the connection with various clinical conditions such as tumors and venereal diseases and the collection of interesting cases.

Highights in the History of Epilepsy: The Last 200 Years

The purpose of this study was to present the evolution of views on epilepsy as a disease and symptom during the 19th and the 20th century. A thorough study of texts, medical books, and reports along with a review of the available literature in PubMed was undertaken. The 19th century is marked by the works of the French medical school and of John Hughlings Jackson who set the research on epilepsy on a solid scientific basis. During the 20th century, the invention of EEG, the advance in neurosurgery, the discovery of antiepileptic drugs, and the delineation of underlying pathophysiological mechanisms, were the most significant advances in the field of research in epilepsy. Among the most prestigious physicians connected with epilepsy one can pinpoint the work of Henry Gastaut, Wilder Penfield, and Herbert Jasper. The most recent advances in the field of epilepsy include the development of advanced imaging techniques, the development of microsurgery, and the research on the connection between genetic factors and epileptic seizures.

Alfred Francois Donné (1801-78): a pioneer of microscopy, microbiology and haematology.

Alfred François Donné is widely known in the scientific community as the discoverer of Trichomonas vaginalis, since he was the first to illustrate the parasite that later was recognized to cause vaginal infections. However, his other, less-known findings are equally important: he was also the inventor of the photoelectric microscope, with the assistance of his student Léon Foucault, as well as the first to apply photography to microscopic preparations (Daguerreotype). His research in microscopy extended to almost all human fluids that could be investigated and culminated in his famous Atlas, which was illustrated with numerous photographs. Donné was also the first to describe the microscopic appearances of leukaemia based on blood preparations acquired from patients. Finally, his work in the hygiene of child upbringing and nutrition is very significant.

The fascinating story of urine examination: From uroscopy to the era of microscopy and beyond.

The purpose of this study was to present the evolution of ideas on the examination of urine from antiquity till our days. A thorough study of texts, medical books from antiquity till twentieth century along with a thorough review of the available literature in PubMed was conducted. The first observation on urine examination can be traced back to the Babylonian and Sumerian texts. Almost all physicians in antiquity including Hippocrates referred to the value of urine examination in the diagnosis and prognosis of diseases. The construction of first compound microscope lead to the examination of urine sediment and the development of Urine Cytology which was revolutionized during the twentieth century with the studies of important cytologists such as George Papanicolaou, Geoffrey Krabbe, and Leopold Koss. The introduction of molecular tests in the diagnosis of urothelial cancer inaugurated a new era in the study of urine cytology. The history of urine examination spans a period of 6,000 years. The application of microscope in the examination of urine sediment during the nineteenth century established urine analysis as an important diagnostic tool in clinical practice. Diagn. Cytopathol. 2015;43:1020–1036.

Milestones in the History of Research on Cardiac Energy Metabolism

The present study summarizes the history of research on cardiac metabolism from antiquity till the 21st century. It describes important landmarks regarding the discovery of oxygen and of the 3 steps of cellular respiration, as well as major research on cardiac energy metabolism. For this purpose, we conducted a thorough search of original manuscripts, books, and contemporary reviews published in PubMed. The first views and concepts about the hearts function appear in Greek philosophic manuscripts of 2500 years ago. According to Aristotle, the heart is responsible for heat production, which is essential for life. The understanding of cardiac metabolism awaited new discoveries. The discovery of oxygen during the 18th century, along with the idea of energy conservation, or what is now known as one of the first versions of the first law of thermodynamics, played an important role in initiating the study of energy metabolism in general and heart metabolism later. The discovery of glycolysis, of the Krebs cycle, and of adenosine triphosphate offered a better understanding of cellular respiration, necessary for later research. Indeed, many researchers dedicated their studies to energy metabolism, but Richard John Bing, the renowned German research cardiologist, is the one who guided the exploration of cardiac metabolism, and he is therefore considered to be the father of cardiac energy metabolism. Since then, encouraging new research has been taking place, offering important clinical applications for heart patients.

Different strokes: Pap-test and Babes method are not one and the same

We would like to thank Dr. Pampuccian for his challenging criticism on our article, and must acknowledge that Dr. Aurel Babes did indeed make an important contribution to the methodology of his times while researching cervical cancer. However, we are not fully convinced that Aurel Babes should be credited along with George Papanicolaou in the development of the Pap-test. As Dr. Pampuccian states, techniques for studying cells from imprints and secretions had already been described before Babes and Papanicolaou’s publications on cervical cytological preparations. For that reason, Babes’ technique was not innovative in relation to his era’s previously published studies. On the contrary, Papanicolaou’s method was indeed innovative. It concerned a palpably different approach based not on scrapings but on smears from aspiration of vaginal fluid. The method initially aimed at the dating of the female hormonal cycle and later for the diagnosis cervical lesions and for the screening of cervical precancer and cancer lesions. The technique suggested by Ayre was not an abrasive method and does not involve scraping of visible lesions, as it was the method suggested by Aurel Babes who used clearly a platinum loop. For the aforementioned reasons, such an abrasive method that Babes and Daniel suggested could never be used as a screening method for cervical cancer. Dr. Pampuccian compares the two papers of George Papanicolaou and Aurel Babes. We believe that Dr. Pampuccian make some unfortunate comments regarding Dr. Papanicolaou’s paper. The quality and importance of the study is not always connected with the journal in which it is published or whether it contains grammar and spelling errors. By 1928, Dr. Papanicolaou had already published three major papers in prestigious journals such as Science and the American Journal of Anatomy. Also, Dr. Pampuccian assumes that the sample size presented by George Papanicolaou is very small, although there is no support for that argument. On the contrary, Dr. Papanicolaou made it clear in his Battle Creek presentation the extensiveness of his work on vaginal smears: ‘‘I studied smears from various pathological cases, including all kinds of infections staphylococcus, streptococcus, gonococcus, various inflammatory conditions of the vagina, of the uterus, of the tubes, cases of tubercle abscesses, cases of ovarian cysts and other conditions of the ovaries, and also cases of pregnancy and of tubal pregnancy, of abortions and finally cases of benign and malignant tumor.’’ Dr. Papanicolaou extended his studies beyond diagnosed cases of cancer to other non-malignant cases showing that he already confirmed that his method successfully screened of asymptomatic cases. Moreover, Papanicolaou worked on vaginal smears for almost a decade before presenting his results in the Battle Creek conference, as we prove below, and from 1923 already with human vaginal smears. To dismiss his paper because of an supposedly small sample size is a curious historical interpretation. A careful study of Papanicolaou’s papers proves that he started working on vaginal smears long before Aurel Babes. Babes presented his findings on 20 cases in Romania in a local conference of the Bucharest Gynecological Society in 1927 and published 20 cases in Presse Medicale in 1928, 3 months after the presentation of Papanicolaou’s paper in the Battle Creek conference. (The proceedings of the 1927 Bucharest conference were not widely disseminated.) In addition, Papanicolaou had been working with and on his method for more than 10 years. His first two publications with Stockard in 1917, entitled ‘‘The existence of a typical oestrous cycle in the guinea pig: with a study of its histological and physiological changes’’ and ‘‘A rhythmical ‘heat period’ in the guinea pig,’’ involved the use of vaginal smears for the study of the oestrous cycle in guinea pigs. Unlike Babes’ work, Papanicolaou efforts on vaginal smears shows a remarkable continuum. In 1923, Papanicolaou told an incredulous audience of physicians about the technique of gathering cellular debris from the lining of the vaginal tract *Correspondence to: E. Magiorkinis, B.Sc., M.D., Ph.D., L. Aianteiou 3-PB 1541, Salamina 18900, Greece. E-mail: mayiork@med.uoa.gr Received 17 December 2009; Accepted 28 December 2009 DOI 10.1002/dc.21347 Published online 6 May 2010 in Wiley Online Library (wileyonlinelibrary.com).

Comments on the history of needle and fine-needle aspiration.

Dear Dr. Bedrossian: We enjoyed reading the extremely interesting article by Marilin Rosa published in Diagnostic Cytopathology in the November 2008 issue. Although Dr Rosa’s article is concise and informative, important issues regarding the history of the development of fine-needle aspiration biopsy are not discussed. Dr. Rosa dates the use of needles for aspiration of liquids back to the 15th century; however, the use of such equipment can be traced back much further to the 10th and 11th centuries. Around 1000 A.D., the Arab doctor, Albucasis, known in Arabic as Abu alQasim Khalaf ibn al-Abbas Al-Zahrawi, the court physician to the caliph of the Andalusia Al-Hakim II wrote about a process resembling aspiration biopsy in his treatise, Kitab al-Tasrif (The Method of Medicine), the most influential book of Arab Medieval Medicine. Albucasis described for the first time therapeutic punctures of the thyroid gland, using instruments resembling modern aspiration needles. The Arab physician’s description resembles a modern FNA of the thyroid gland: ‘‘This tumor, which is called ‘Elephant of the throat,’ is a large tumor which has the color of the body; This type of tumor commonly occurs in women. It is of two kinds, congenital, and acquired. There is no treatment for the congenital type. The acquired type consists of two kinds: one resembles a sebaceous cyst, while the other resembles a tumor arising from an arterial aneurysm. The latter is dangerous to incise, so never you apply a knife to the latter kind unless the tumor is very small. If you try to explore them with a probe and find they are like sebaceous cysts and not attached to any blood vessel, then immediately cut down upon them as you would a cyst and remove them with whatever capsule may surround them, as long as they are contained within a capsule. If not, dissect away the whole accurately; then treat the place with suitable remedies.’’ Dr. Rosa also refers to the work of Skey, Paget and Erichsen, and Pritchard and Leyden during the 19th century as far as techniques of needle aspiration are concerned. However, the work of other authors who also conducted needle aspiration biopsies with needles of ordinary diameter should be mentioned. Physicians who equally contributed in the field include Baron Dupuytren in 1833, Stanley in 1833, Pravaz and Gabriel in 1853, as referred by Fragkakis, Zagarolas in 1865, Ménétrier in 1886, and Krönig in 1887. Baron Dupuytren published in Lancet an article about the microscopic diagnosis of an echinococcus cyst case by the use of puncture aspiration which followed a similar publication by Stanley. Pravaz and Gabriel designed a special metal needle which was used in the therapeutic approach of aneurysms or other vascular diseases and later for subcutaneous injections. The Greek surgeon, G. Zagarolas (1838–1898), Head of the Greek Hospital ‘‘Agios Sofronios’’ in Iskenderun (Aleksandria) Egypt, performed for the first time liver punctures during his study on liver abscesses and announced his results in 1872 in the Surgeon’s Society in Paris under the title ‘‘About The Free-of-Risk Procedure of Liver Puncture.’’ Ménétrier in 1886 and Krönig in 1887 were the first to diagnose malignant lung tumors by needle biopsy. Dr. Rosa mentioned the work of Greig and Gray in the early 20th century. In addition to their contributions, other physicians also employed needle aspiration techniques using needles of ordinary diameter including as Proscher as referred by Bennington, in 1907, Horder in 1909, Chatard and Guthrie on trypanosomiasis in 1914, Aravandinos in 1916 on spleen puncturing and Deelman in 1918. Proscher in 1907 employed the same technique with Greig and Gray, in order to diagnose syphilis identifying spirochetes in lymph node cellular *Correspondence to: Emmanouil Magiorkinis, M.D., B.Sc., L. Aianteiou 3, PB 1541, 18900, Salamina, Greece. E-mail: mayiork@med.uoa.gr Received 22 February 2009; Accepted 31 March 2009 DOI 10.1002/dc.21105 Published online 12 June 2009 in Wiley InterScience (www. interscience.wiley.com).