Pathological Diseases

The Pathological diseases that are the responsibility of a Pathologist, constitute a wide range of Pathological conditions that concern many systems such as the Cardiovascular, Respiratory, Gastrointestinal, Renal, Urinary, Liver, Brain, Spine, Nervous system, Muscles and Joints. However, many diseases involve several organs. The Pathologist is specially trained to recognize and treat the wide range of symptoms from all systems in a holistic approach to the patient and their health problems. The pathologist is a valuable ally for the elderly who are more fragile in terms of health, since they are often suffering from chronic diseases but also for all those with the presence of multiple different diseases.

Pathologists are characterized by deep and broad knowledge of health issues and for this reason they are characterized as ¨Specialist Doctors¨. They monitor patients with chronic diseases, participate in the care of patients who need physical rehabilitation and reintegration. Finally, in our country there are two official specializations of Pathologists, Diabetology and Infectious Diseases, which require additional training and relevant examinations. Patients visit the Pathologist for various algae, but the Pathologist will examine the patient in detail and holistically without focusing only on the reported symptoms, will request a special laboratory test and, if deemed appropriate, the help of a colleague from another specialty. The training of a Medical Pathologist is five years in the field of Pathology and to obtain the title, special and even difficult exams (oral and written) are required.

To avoid confusion between the remit of a Pathologist and a GP, both of whom may see chronically ill patients, you should be aware that GPs only train for 10 months in pathology, 3 months in mental health, 3 months in general surgery, 4 months in gynecology - paediatrics, 2 months in the laboratory sector and 27 months in health centers and other primary and health care structures with the aim of informing them in a wide range of specialties. Next is for GPs to be able to attend to all members of a family regardless of age, pregnant mothers and undertake minor surgeries such as suturing skin wounds. On the contrary, the Pathologist does not have the corresponding training in these fields, but has deep knowledge of the pathological conditions and is the pillar of many other specialties by investigating the correct diagnosis and safe therapeutic management of the patient. The Pathologist therefore does not have the responsibilities of the family general practitioner who also examines small children, offers help to pregnant women and undertakes minor operations which are the objects of the general practitioner. Pathologists participate in prevention through vaccination or special instructions, they deal with skin lesions as well as ear inflammations. They examine patients older than 14 years and do not even undertake minor surgeries.

Then you can read a text by the late Professor K. Gardikas which is a timeless legacy of the great teacher of Pathology.

Konstantinos D. Gardikas. Shall We Abolish Pathology?

In my long medical life I have experienced the glory of Pathology, its gradual decline, and its present decline. So my medical autobiography is, in a way, also the story of the rapid impoverishment of Pathology.

Konstantinos D. Gardikas Professor Emeritus of Pathology

In December 1936, as soon as I finished my military service, I became an unpaid assistant at the Evangelism in the Pathology Clinic directed by D. Komnenos, an excellent clinician of his time. There, from 1936 to 1945, i.e. for 8 years, I was successively promoted from unpaid assistant to unpaid assistant with the duties of assistant, unpaid external assistant, paid medical assistant, internal assistant, unpaid medical assistant, paid medical assistant and finally, paid clinic assistant . Don't think that my progress was so slow that it was due only to my low IQ, but also to the narrowness of the seats.

Evangelismos, in its glory at the time, had 4 pathology clinics. The First Pathological Clinic was directed by P. Vatsineas who was a Pathologist - cardiologist. That's why his clinic had 3 curators instead of two. The third was a supervisor of a Cardiology laboratory whose equipment was limited to a 3-lead EKG. The 4th Pathological Clinic was directed by the blessed N. Tsamboulas. She also had 3 curators. C' was responsible for the laboratory of exchange of matter, which had only one basic metabolism determination machine. Pathology subspecialty clinics did not exist, although each Pathology clinic usually had a particularly popular topic. B', in which I served, had Hematology as such a subject. Specialty clinics e.g. Cardiology, Rheumatology, Endocrinology, etc. They did not exist. We as pathologists dealt with everything, and with the data of the time I would say successfully. Mortality in the pathology clinics was about 8%. I imagine that will be enough now. At that time the Pathologist was the Grand Archon, the Patriarch and Pope of Medicine, the father of a uniform and indivisible medicine. Everyone, society and colleagues, bowed before him. In the Dowry Exchange of that time, the highest transactions recorded were related to Pathologists. In 1945, a few months after liberation, on a British Council scholarship, I went to England. The blessed Komnenos, saying goodbye, advised me "To acquire a balanced and symmetrical knowledge in all the chapters of Internal Pathology". I promised I wouldn't forget his advice. Of course, promising that you won't forget something does not necessarily mean that you will implement it. In September 1945, after a two-day air journey in an ancient military Dakota I landed in London. My scholarship was for 8 months. I stayed 8 years. It didn't take me long to realize that I was waking up from a deep sleep. It didn't take me long to realize that I was in the middle of a new medical revolution, which still has no intention of settling down. One progress followed another. No one could breathe between them. My first surprise was penicillin. In the 8 years of Evangelism, a diagnosis of infectious endocarditis was equivalent to a death sentence. And one might say, ironically perhaps, that as soon as I got there I was seconded to a unit at the MRC where they were studying the value of penicillin in infective endocarditis. We granted 500,000 units. every 6 hours intramuscularly, for 3 weeks. 75% of patients left-cured. Unbelievable. That is, those with the more than 20 million you are giving now, often in combination with another antibiotic. The Center where I worked was mainly Hematology. The material is abundant. However, I did not like the exclusive involvement with a single chapter of Pathology. She seemed unwell to me. After all, I did not forget the promise I had made to the blessed Komnenos. So I didn't neglect the other specialties. I started in Cardiology. I met some of the Holy Monsters of modern Cardiology, Mc Michel, who introduced cardiac catheterization into practice, the great clinical cardiologists like ParkinSon, Cambell, Evans and the then rising star Paul Wood, who died prematurely. In the darkened fluoroscopy room, I saw the charming dance of portals in atrial communication and the coeur en sabot of tetralogy of Fallot. I palpated the pulsating spinal arteries in isthmic stenosis of the aorta and saw the magnificent radiographic picture of trigeminal atresia. There I first heard the charming torrential blow of the open pore. At St Thomas' in London I spent many hours of the night in the Department of Angiography with its unique collection, the keys of which were entrusted to me. In the outpatient clinic of the pioneering rheumatologist Kellgren, I entered the meaning of the classification of arthropathies, felt the signs of rheumatoid arthritis and learned the characteristics of ankylosing spondylitis General Pathology so that he was subsequently appointed Director of the Pathology Clinic. As I said, the explosive increase in knowledge of that time, which concerned all chapters of Internal Pathology, resulted in the creation of specialties. These were completely separated from the main body of Pathology and since then each one has followed its own path independently. Besides Cardiology, I mention Hematology, Rheumatology, Endocrinology, Gastroenterology, Pulmonology, Oncology and so on. But the development did not stop there. Many subspecialties of Pathology were again divided into subspecialties. Another hematologist deals with malignant blood diseases, another with congenital hemolytic anemias. One cardiologist deals with heart disease in adults and another with heart disease in infants and toddlers. Another is an expert in reading ultrasound and another only in reading coronary angiograms. One endocrinologist is a specialist in thyroid diseases, the other in adrenal diseases, and so on. And it is not about the research aspect of the matter, because the research must necessarily concern a very limited area as a rule, but the clinical practice. In addition to the vertical division, the horizontal division also followed. This is how Gerontology was added and finally Adolescence and Andrology or Sexology. As soon as men start to feel a decline, they rush to the andrological-sexological centers and there they hope to get their acne with the injections of the forgotten papaverine. Freud used to say that anyone who dreams of Zaepelin (airplanes didn't exist then) desires a penis, because only these two do not follow the laws of gravity. Now the papaverine must be added to the Zaepelin. And most sexologists forget that sexual stimulation with its prolonged effects can, in people with an intact myocardium, have a fatal outcome due to the great increase in cardiac work. Of course, I had not forgotten Comnenus's recommendation for symmetrical and balanced knowledge in all chapters of Internal Pathology and I tried to follow it, although of course this was not easy... Finally in '52 I returned to Greece. Although Hematology was my great lover, I preferred to be called Pathologist, I even remember, some time after my return, a lady to whom I was introduced, asked me: What specialty do you have, Mr. Gardikas? When I answered Pathologist, she looked at me with wonder and perhaps contempt, saying: Strange, I too had heard that you are a good doctor. In a strange way I preferred to remain a Pathologist. That's why – it might seem strange to you – I never went to ask for the specialty of Hematology, which we old-timers used to get like that, without exams. Little by little the prestige of the Pathologists was diminishing, while the prestige of the Specialists was increasing. The Specialist became synonymous with a good doctor. The dowries of Pathologists were continually declining in the stock market, but in the meantime dowries were also abolished. Doctors no longer get their money from daughters-in-law and in-laws, but they make it many times over from their clients. Despite the fact that eminent specialists had already settled in Greece, pathologists had not yet lost their prestige. At least for 10 years after my return, that is until 1963, I continued to see cardiac patients in my practice, to be called to medical councils for cardiac cases and to treat cardiac patients in Evangelism. Besides, in the evening gatherings that I established in Evangelismos, two series were particularly popular: that of hematological preparations and that of electrocardiograms. It is not an exaggeration to add that I am one of the first to teach modern electrocardiography in Greece, and several of today's eminent cardiologists, before moving for specialization abroad, were introduced to electrocardiography by me. Today that might sound brazen.. I met Hench with the dreaded cleft lip and palate, who pioneered cortisone in rheumatoid arthritis. In endocrinology I learned about the variety of syndromes and saw the legendary Albright up close with advanced Parkinson's. I attended the Neurology clinic every Monday for 8 years. Symons' take on the background was real lace. He knew so well

The Pathologist within the suffocating cord of specialties has now shrunk, almost disappeared. In fact, after the detachment of Infectious Diseases as a separate specialty, the occupation of pathologists was almost limited to fever of unknown etiology. And because thanks to the new diagnostic methods the cause of the fever can be found in most cases, cases of fever of unknown etiology have become rare. Despite this, pathology clinics still exist in hospitals and will continue to exist. But they do not have their old prestige. They are intended for the remnants of the specialists, for the incidents that are no longer of interest to them, for the emergencies of the on-call (a kind of mountain surgery), as well as for the sick under deportation, which, however, is delayed for technical reasons. Thus, when an elderly woman has been discharged, she is transferred to a pathology clinic, until there is a route to take her to Folegandros or Astypalaia. Pathological clinics also receive all remains in a semi-vegetative or fully vegetative state, because no one else takes them. Because of the wretchedness of pathology clinics, few young doctors become pathologists. Perhaps if something is not done, in a few years there won't be a good new general practitioner. Have you ever thought that if you are asked about a good GP in London, you won't find anyone to recommend? Beware, you may be the last generation of pathologists. If you pay attention, you will notice that the specialist rarely takes a complete history. He is mainly based in his laboratories. He has more confidence in them. The expert does not speak, is usually sullen and always in a hurry. He ignores that talking to the sick person is not only one of the three elements of treatment (along with medicine and the knife), but also the only one that is provided free of charge. They forget that a good history gives the diagnosis in 80% of cases. Of course, the patient is more impressed by isolation in the MRI oven than by taking a good history. Last year I read in the J. of the Royal Society of Medicine the following case: An Englishman at the age of 6 had been examined by his local doctor, who had told him that he had an innocent murmur in the heart, and when in future he was examined by a doctor not to he fails to mention it to them. At the age of 50 he decided to visit a specialist cardiologist in London. At the time of the rendez-vous he went to the doctor's office. As soon as he entered he was received by a girl who did an EKG. Then someone else took him in for an x-ray. A third gave him an ultrasound. Finishing, she told him to wait to see Mr. Professor. After 1/2 hour the door opened and the professor appeared, who said to him: I studied the saw data. Your heart is healthy. You can go. On his way out, he was received by another. This was the professor's secretary. He presented him with an account, which in scientific language is called sad. It was quite salty. I do not think there can be a greater debasement of the art and science of medicine. The isolation, independence and sealing off of each specialty is artificial and unnatural. The various organs of the human body cannot be sealed and independent compartments. Interdependence and interaction between them would be surprising if it did not exist. Here are some examples: The increased morbidity and mortality from coronary disease in psychopaths. Mental factors contribute to heart attack. Many cardiologists are unaware that hyperventilation with accompanying hypocapnia, which was once considered completely innocent under the label of hysterical dyspnea, can result in angina pectoris and sometimes dangerous ventricular arrhythmia. And who can fail to see the interdependence of the nervous system and the heart in the now well-known dementia cordis? And isn't there an interconnection of these two systems in cardiac dysfunctions during epileptic seizures, which although it was first described in 1939 is not sufficiently known? A small increase in the dose of the antiepileptic eliminates the risk of dangerous ventricular arrhythmias, even ventricular fibrillation. In particular, epileptogenic areas such as the insula, which has strong interconnections with the cingulate system, hypothalamus and other areas, have been implicated. On the other hand, the experience gained in recent years on silent anginal attacks has shown that in such attacks one should not limit oneself only to the search for lesions of the coronary arteries. Shouldn't the cardiologist know that today the leading cause of death in Cooley patients is heart failure from myocardial hemoironization? I shall never forget the case of persistent persistent angina pectoris which did not respond to any anti-anginal medicine and which was immediately assigned as a general practitioner visited the patient, saw at once the intense pallor of the face, elicited from the patient the information that he was losing profuse blood from haemorrhoids, gave him Fe_ and the anginal attacks subsided spectacularly. The examples are endless. After all, according to traditional cardiology, heart failure was attributed only to the ventricles not being able to pump enough blood to the peripheral organs. Today we know that this is not right. In several there is sufficient myocardial damage to adversely affect systolic or diastolic function, without heart failure, because neurohormonal compensatory mechanisms intervene. Heart failure occurs not only when the myocardium is diseased, but usually when these neurohormonal mechanisms break down or become exhausted. Eminent gastroenterologist attended patient with persistent constipation, subjected him to rectosigmoidoscopy, torturous colonoscopy and various other tests. Good pathologist called by chance, immediately diagnosed hypothyroidism from the patient's appearance. After all, his history was typical: cold intolerance, plenty of blankets at night, and so on. But I cannot resist the temptation to mention the following case: A colleague complained of hot flashes and heat intolerance. The endocrinologist he consulted submitted him, and rightly so, to a full hormonal laboratory test. This was repeatedly negative. He was at a loss. A general practitioner visited the sick colleague at his home. There he discovered that he did not suffer from hyperthyroidism, but his wife from hypothyroidism. Because of the many blankets, the high temperature she kept in the house, the ill-fated doctor felt hot flushes and had profuse sweats. Cure the wife's hypothyroidism, cure the husband's hyperthyroidism! After gaining their autonomy, endocrinologists felt overjoyed. They had at their disposal a charming orchestra with a fine conductor, the pituitary gland, and several noble instruments that functioned disciplinedly under the conductor. At the same time, they developed sophisticated laboratory methods for assessing their function by determining the level of various hormones in the blood, although the various kits, which made these determinations, were a kind of blindfold. But the happiness of endocrinologists did not last long. Their conductor was humiliated. Above him sprang a pea-sized supermaestro, the hypothalamus. A little later the brain emerged with the demands of a supreme staff hormone-producing organ. But the brain is not only a hormone-producing organ, but is also influenced by various other hormones. The kidney and liver were challenged to be included in the endocrine-producing organs, and a strong exocrine-endocrine-pancreas relationship was discovered, a love-hate relationship according to Henderson. And how can one not comment on the knowledge that second-class tissues such as skin, fat, muscles, etc. do they produce testosterone? The isolation of Endocrinology was, as I said, artificial and could not last long, because the various systems of the human body cannot be independent and separated into watertight compartments. The endocrinologist should be familiar with psychiatry and the psychiatrist with endocrinology. How many patients with pheochromocytoma, Cushing's disease etc. are they not inmates of mental hospitals? I will add that the first case of insulinoma that I diagnosed in Greece involved a young woman confined in a psychiatric hospital for schizophrenia. I was called to explain why the patient was not reacting to the insulin shock. And shouldn't the psychiatrist know hematology, when patients with vitamin B12 deficiency may only present mental phenomena, without anemia? But also much more generally. Today, serious scientists accept that even the boundaries between physical and mental illnesses are not clear, while it has been proven that mental illnesses cause physical disorders and vice versa. And what will we say if tomorrow the disease melancholia is replaced by the term serotonin receptor disease? And then what diseases are due to receptor disorder? With the above do not imagine that I am so unreasonable as to propose the abolition of specialties. Graphic and laboratory methods of each specialty have become so complex and bloodless operations, e.g. colonoscopy or kidney biopsy, so specialized that only a Pathology superman could attempt them, nor would you assign an Artificial Kidney Unit to a Pathologist. On the other hand, I maintain that an experienced pathologist can successfully diagnose and treat 80% cases of any specialty. I believe that over 90% of endocrinopathy are diabetics, thyroids and addisons. That above the 80% of gastroenterologists, e.g. with stomach ulcer, irritable bowel, colitis, etc. can be successfully treated by the general practitioner as well as the 80% of pulmonologists. The same applies to almost all specialties. I am often taken by acquaintances and instead of asking if I know any good internists, they ask me if I know any good gastroenterologists, and to the question, what does your patient have, the answer is bulbar ulcer. Now let's make a bold assumption. Let's imagine that a crazy dictator decided to kill all the doctors or all the specialists. Who would it be better for the sick person to let live? The pathologists or the specialists? Difficult question. What would you answer? Don't rush. I'll get back to you tomorrow. In my opinion, the pathologist is superior to the specialists for the following reasons: a) The possibility that something important escapes from the specialist out of his system, as I mentioned above with examples. b) The general pathologist makes a systematic history taking and a careful objective examination of the patient, while as a rule the specialists are sparing in both, because they usually turn quickly to the Laboratory that is most favorable to them. And the most important thing: c) The pathologist talks, chats with the patient. The expert. he is a technocrat, he does not speak, he does not listen, he is always in a hurry. And we know, as I said, how valuable a therapeutic weapon is the conversation with the sick person, which let's not forget is also provided free of charge. But for the sad situation we have reached, the Pathologists themselves have an important responsibility. They need to read more and not leave the field without a fight. I have in mind e.g. that even until the 80's there were several strong pathologists who knew electrocardiography very well. Now, of course, the percentage is smaller and is getting smaller. Maybe we deserve our luck. We must also remember the general family doctor, who is basically a pathologist, but charged, in addition to purely individual medicine, with the preventive medicine of individuals and groups, as well as the social medicine that deals with the health of the population. The family doctor has followed the family. So when e.g. a young man presents with strange neurological phenomena, he makes the diagnosis of Huntington's chorea, because he knows that the patient's father and an uncle had died in an asylum some years ago from this disease, which the patient probably would not have mentioned when taking the history to another foreign doctor. So expensive techniques, e.g. looking for the abnormality in part of chromosome 4 is avoided. Finally, isn't the ICU physician well versed in multisystem disease? On the other hand, according to Thompson (1992), people over 70 suffer from 86% of 8 diseases: Obesity, hypertension, atherosclerosis, type II diabetes, cancer, immune deficiency, endogenous depression or autoimmune disease. But what is even more important is that each of these elderly patients suffers from not just one of the above diseases, but from 32 diseases. So what will happen to them? Will each patient be monitored by 32 specialists? It's time to understand that man is not divided, and to remember Aristotle's theory of wholeness: "For the whole is necessary before the part, since the whole is negated, there is no food, no hand." The parts are subordinate to the whole. Let's also remember Aristotle Wertheimer, pioneer of the Gestalt theory: What happens in the whole does not come from the composition of the parts, but conversely what happens in a part of it, is defined by the internal constitution of the whole. The homeopathic doctors seemed smarter than us traditional medicine doctors. They managed, with little resistance, to monopolize the term holistic medicine, as if we orthodox doctors do not examine the whole. And by monopolizing everything they do golden business. More and more sick people are turning to them. And we haven't figured it out yet. So let us pathologists try with better practice, more effort and more self-confidence to regain some of our lost prestige. And this not for us, but for the good of medicine, for the good of the sick. I imagine that most, if not all, of you will perceive that there is no trace of personal ulterior motive in what I have said. I'm not looking for an appointment, nor do I see myself in any position. I do not have the required qualifications for promotion. There is no future for me in medicine. So I'm limited to tending to my remaining coronarys and reading about Salvation Sinners. If I was a bit sharp and perhaps displeased expert friends, please forgive me. They know how much I hold them in high esteem. But when one makes propaganda, a few exaggerations are forgiven.

I had him as a professor as a student

SOURCE: Health Inspection January February 1993