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Transcript of 2 P.G. Chrousos - Hist of Peds.Thermisia · Stress-induced hypogonadism, male sterility from...
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Pediatrics in Greece
Thermisia, Greece
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Introduction
George P. Chrousos, MDProfessor and Chairman
First Department of Pediatrics
(Founded 1855)
Athens University Medical School
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Doctor and Patient
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WESTERN MEDICINE
ANCIENT GREEK MEDICINE (< 500 BCE)Asklepios- The Asklepeia as Healing Places
CLASSIC GREEK MEDICINE (500- 200 BCE)Hippocrates- Evidence based-Medicine
HELLENISTIC MEDICINE (200 BCE-400 CE)Erasistratos, Herophilos , Galen, Aretaeos, Soranos
BYZANTINE (EASTERN ROMAN) MEDICINE (400-1400 CE)First modern hospital in Constantinople (430 CE)
MODERN MEDICINE (1400- present)Judaic-Arabic Medicine
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Medication= Pharma-con, Pharma-cy Pharmaco-poieia, Pharmaco-logy
Pharma or Varma from the GreekVarao= I knock or hit the demon
causing the disease
Target Therapy= Knocks out the defective substance, ie. gene, protein,
enzyme etc.
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Σιτία, ποτά, ύπνος και αφροδίσια, πάντα ταύτα
µέτρια. Το δε περισσόν νούσων ποιεί
Food, drink, sleep and sex, all these
should be in moderation. Excess causes
disease
Pythagoras
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A BASIC PRINCIPLE OF NATURE
Balance
Equilibrium
Harmony
Counteracting
Reestablishing
Disturbing
Forces
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General Stress Syndrome Diseases of Adaptation
Disturbing
Forces
HarmonyEquilibrium
Balance
Isonomia
Counteracting
ReestablishingForces
IIII
II
Stressors HomeostasisAdaptiveResponses
(Physical,
Emotional)
Specific Nonspecific
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Hippocrates of Cos
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”The three branches of Medicine are Physics, Surgery and Dietetics "
Hippocrates
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«Παχέες ταχυθάνατοι µάλλον των ισχνών»
“Obese people die earlier than thin ones”
Hippocrates
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Mentor and Mentee
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Aristotle of Stageira
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The constituents of Man:
Physis, Ethos, Logos
Aristotle
(384-322 BCE)
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«Συµπάσχει η ψυχή τω σώµατι νοσούντι καιτεµνοµένω, το δε σώµα τη ψυχή»
“The soul suffers when the body is diseased
or traumatized, while the body suffers when
the soul is ailing”
Aristotle
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BASIC CONCEPTS
Pythagoras The brain is the site of the intellect(580-489 BCE)Alkmaion Health is the equipose of opposing forces: isonomia(c. 500 BCE)Hippocrates A harmonious balance of the elements and qualities of life (460-375 BCE) is health- Dysharmony is disease
Νούσων φύσεις ιητροί =Vis medicatrix naturaeStress-induced hypogonadism, male sterility from orchitisObesity as a health problem
Aristotle Embryology, ovariotomy, semen(384-322 BCE)Soranos Menarche, menstrual disorders, eating disorders, anorexia nervosa(98-138 CE)Galen The hypophysis or pituitary gland(129-201 CE)Aretaeus Diabetes mellitus vs. insipidus, seminarche(c. 200 CE) Major depression
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Hippocrates as a Church Figure
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Νοσοκοµείο Παίδων η Αγία Σοφία
CHILDRENS’ HOSPITAL AGHIA SOPHIA
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“ The improvement of our children’s health depends on research and the provision of care requires a culture that
constantly asks and questions”
A. Aynsley-Green, Arch. Dis. Child . 78: 101, 1998
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70-75
Life Expectancy (1998)
75-80
65-7060-6555-60under 55NA
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Homo erectus Homo sapiens Homo fatuous
-----------------5 miilion y-------------- 150.000 y------------- 10.000 y
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TRADITION
versus
GLOBALISATION
The case of the Greek diet
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"Let food be thy medicine
and
medicine be thy food"
Hippocrates
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'Positive health requires a knowledge of man's primary constitution (which today we call genetics) and of the
powers of various foods, both those natural to them and those resulting from human skill (today's processed
food). But eating alone is not enough for health. There must also be exercise, of which the effects must likewise be known. The combination of these two things makes
regimen, when proper attention is given to the season of the year, the changes of the winds, the age of the
individual and the situation of his home. If there is any deficiency in food or exercise the body will fall sick.'
Hippocrates 480 BC
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That as you ought not to attempt to cure the eyes
without the head, or the head without the body, so neither ought you to attempt to cure the body
without the soul; and this, he said (Socrates), is the reason why the cure of many diseases is unknown to
the physicians of Hellas, because they are ignorant
of the whole, which ought to the studied also; for the part can never be well unless the whole is well.
Plato
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STRESS AS A CONCEPT
Pythagoras The intellect is based in the brain
(580-489 BC)
Alkmaion Health is the equipose of opposing forces isonomia
(c. 500 BC)
EmpedoclesMatter consists of essential elements and qualities in
(500-430 BC) opposition or alliance to one another
Hippocrates A harmonious balance of the elements and qualities of life
(460-375 BC) is health- Dysharmony is disease
Νούσων φύσεις ιητροί =Vis medicatrix naturae
Epicurus Ataraxia (imperturbability of mind) as a superior pleasure
(341-270 BC)
Thomas Sydenham Symptoms and signs of a disease arise also from the reaction of the
(AD 1624-1689 patients system
Claude Bernard The milieu interieur
(1813-1878)
Walter Cannon Homeostasis
(1871-1945) Bodily responses to emotions
Fight or flight (or freeze) reaction
Hans Selye The general adaptation syndrome(the stress syndrome)
(1907-1982) Diseases of adaptation
Distress vs. eustress
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STRESS AS A CONCEPT
Empedocles Matter consists of essential elements and qualities in
(500-430 BC) opposition or alliance to one another
Hippocrates A harmonious balance of the elements and qualities of life
(460-375 BC) is health-Dysharmony is disease
Νούσων φύσεις ιητροί =Vis medicatrix naturae
Epicurus Ataraxia (imperturbability of mind) as a superior pleasure
(341-270 BC)
Thomas Sydenham Symptoms and signs of a disease arise also from the reaction of the
(AD 1624-1689 patients system
Claude Bernard The milieu interieur
(1813-1878)
Walter Cannon Homeostasis
(1871-1945) Bodily responses to emotions
Fight or flight (or freeze) reaction
Hans Selye The general adaptation syndrome(the stress syndrome)
(1907-1982) Diseases of adaptation
Distress vs. eustress
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STRESS AS A CONCEPT
Pythagoras The intellect is based in the brain(580-489 BC)Alkmaion Health is the equipose of opposing forces:isonomia(c. 500 BC)Empedocles Matter consists of essential elements and qualities in
(500-430 BC) opposition or alliance to one anotherHippocrates A harmonious balance of the elements and qualities of life (460-375 BC) is health- Dysharmony is disease
Νούσων φύσεις ιητροί =Vis medicatrix naturaeEpicurus Ataraxia (imperturbability of mind) as a superior pleasure(341-270 BC)
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92 Successful Inventions
• 1900: portable camera
• 1900: paper clip
• 1902: dog biscuits
• 1902: teddy bear
• 1902: vacuum cleaner
• 1903: safety razor
• 1907: baking powder
• 1908: model T ford,(first mass-
produced car)
• 1910: electric stove
• 1910: washing machine (with crank)
• 1912: luminous advertising
• 1912:vitamins discovered
• 1913:zipper
• 1914: bra
• 1916: tennis shoes
• 1916:loudspeaker
• 1919:electric toaster
• 1920: paper handkerchiefs
• 1920: sliced bead
• 1921: insulin
• 1921: band-aids
• 1928:peanut butter
• 1926: refrigerator
• 1928: adhesive tape
• 1928: penicillin
• 1928: ready-made baby food
• 1928: air conditioning
• 1929: TV set
• 1930: transparent tape
• 1930: flashlight
• 1931:Alkaseltzer• 1931: hair colour to use at
home
• 1931: electric shaver• 1931: stereo amplifier
• 1931: tampons• 1931:tape record ( invented
by AEG, Germany)• 1931:LP record
• 1933:laundry powder
• 1935:colour film• 1935: garbage disposal
• 1937: electric blender• 1938: Teflon
• 1938: photocopier
• 1939: nylon stockings• 1937: jet-propelled aircraft
• 1940: electric kettle• 1941: elastic
• 1941: wrinkle-free textiles• 1942:cake mixes
• 1944: ballpoint pen
• 1946: Tupperware• 1946: electric washing
machine• 1947: instamatic camera
• 1947: microwave oven
• 1948: electric guitar• 1949: disposable diapers
• 1950: cortisol• 1951: first home computer
• 1953: colour TV• 1953: cling film
• 1954: domestic dishwasher
Inventions are made every day, but not all of them meet with theInventions are made every day, but not all of them meet with the same sweeping success as the following :same sweeping success as the following :
•1954: Domestic dishwasher•1954: Frozen food•1955: Vaccine for polio•1955: Transistor radio•1956: Correction fluid•1957: Frisbee•1958: Hula Hoop•1959: Barbie doll•1960: Pantyhose•1960: Tylenol (painkiller)•1960: The Pill•1961: Soft contact lenses•1963: Cassette recorder•1963: Canned Coca-Cola•1963: Touch-dial telephone•1963: Metal tennis racket•1964: Fax machine•1969: Quartz wristwatch•1970: Skateboard•1972: Pocket calculator•1973: Food processor•1973: Cellular phone•1978: Snowboard•1979: Walkman•1980: Pacman, the first video game•1980: Post-its•1980: Inline Skates•1980: CD•1981: Goretex•1984: Macintosh computer•1988: Prozac•1993: Internet Navigator
Sources: "Bild Zeitung"/" The people's Almanac Presents the 20th Century"
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Depression is ancient:
Aretaeus of Capadocia (150-200 AD):
“The patients are dull or stern:
dejected or unreasonably torpid,
without any manifest cause…”
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«Παχέες ταχυθάνατοι µάλλον τωνισχνών»
“Obese people die earlier than thin ones”
Hippocrates
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Target Therapy= Specifically directed against the defective substance, ie. gene, protein, enzyme, etc. correcting loss of
function or excess function
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Load
Elastic region
Deformation
Plastic region
Yield point
Fracture point
Load deformation curve
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«Σιτία, ποτά, ύπνος και αφροδίσια, πάντα
ταύτα µέτρια. Το δε περισσόν νούσων ποιεί»
“Food, drink, sleep and sex, all these
should be in moderation. Excess causes
disease”
Pythagoras
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Pyramid of Progress
Therapeutic AgentWorks
Clinical Trial
Clinical RelevantPreclinical Trials
Phase I Animal Trials
Focused In Vitro/In Vivo Studies
BasicSciences
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Target Therapy= Specifically directed against the defective substance, ie. gene, protein, enzyme, etc. correcting loss of
function or excess function