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The anticancer agent docetaxel and thalidomide shows significant inter- individual variation in their pharmacokinetic and toxicity profiles as well as wide pharmacological variations purchase viagra with amex erectile dysfunction fast treatment. Genetic poly- morphisms were analyzed for associations with clinical response and toxicity order 75mg viagra overnight delivery erectile dysfunction statistics. MenaCalc™ Prostate (MetaStat Inc) is a diagnostic for prostate cancer to help in informed decision about whether to undergo radical surgery and risk its dreaded side effects. Effects of Lifestyle Changes Shown by Gene Expression Studies Epidemiological and prospective studies indicate that comprehensive lifestyle changes may modify the progression of prostate cancer. A pilot study was con- ducted to examine changes in prostate gene expression in a unique population of men with low-risk prostate cancer who declined immediate surgery, hormonal ther- apy, or radiation and participated in an intensive nutrition and lifestyle intervention while undergoing careful surveillance for tumor progression (Ornish et al. Consistent with previous studies, significant improvements in weight, abdominal obesity, blood pressure, and lipid profile were observed. Two-class paired analysis of global gene expression using significance analysis of microarrays detected 48 up-regulated and 453 down-regulated tran- scripts after the intervention. Pathway analysis identified significant modulation of biological processes that have critical roles in tumorigenesis, including protein metabolism and modification, intracellular protein traffic, and protein phosphoryla- tion. Intensive nutrition and lifestyle changes may modulate gene expression in the prostate. Understanding the prostate molecular response to comprehensive lifestyle changes may strengthen efforts to develop effective prevention and treatment. The study not only provides insights into potential drug targets, but also suggests that lifestyle changes could produce benefits akin to therapeutic interventions. Use of the test in practice is likely to have an impact on the management in a signifi- cant portion of tested patients, particularly by shifting the trend towards more con- servative management. This could reduce overtreatment of patients with less aggressive disease, decreasing patient morbidity and costs for payers and the health- care system. Nevertheless the outcome can be optimized by individualization, of the extent of surgery, the dosage of 131I therapy and the use of levothyroxine therapy (Luster et al. Newer imaging techniques and targeted molecular therapies such as multi- targeted kinase inhibitors provide new options for the personalized care of patients with advanced disease for whom no effective therapies were available previously. Individualized therapies could reduce adverse effects, including the sometimes debilitating hypothyroidism that used to be required before initiation of 131I treat- ment, and major salivary gland damage, a common and unpleasant side effect of 131 I therapy. However, in spite of ongoing research, personalized thera- pies remain in their infancy. Future of Cancer Therapy There are now unprecedented opportunities for the development of improved drugs for cancer treatment. Most of the genes in the majority of common human cancers are expected to be defined over the next 5 years. This will provide the opportunity to develop a range of drugs targeted to the precise molecular abnormalities that Universal Free E-Book Store Future of Cancer Therapy 365 drive various human cancers and will open up the possibility of personalized thera- pies targeted to the molecular pathology and genomics of individual patients and their malignancies. The new molecular therapies should be more effective and have less-severe side effects than cytotoxic agents. To develop the new generation of molecular cancer therapeutics as rapidly as possible, it is essential to harness the power of a range of new technologies. Challenges for Developing Personalized Cancer Therapies Two major challenges to cancer drug discovery are: (1) the ability to convert potent and selective lead compounds with activity by the desired mechanism on tumor cells in culture into agents with robust, drug-like properties, particularly in terms of pharmacokinetic and metabolic properties; and (2) the development of validated pharmacodynamic endpoints and molecular markers of drug response, ideally using noninvasive imaging technologies. Many variables besides genotypes of patients would need to be considered in development of personalized therapies for cancer. The Pilot Project focuses on three types of cancers: brain (glioblastoma multiforme), lung (squamous Universal Free E-Book Store 366 10 Personalized Therapy of Cancer carcinoma), and ovarian (serous cystadenocarcinoma). There is a need for better description of the genetic damage that drives human cancers; this will form the basis for all future studies of cancer in the laboratory and the clinic and will provide immediate benefit for molecular diagnosis of human cancers as a basis for the development of personalized treatment of cancer. It is a 4-year program that has used comprehensive molecularly-annotated colon cancers to define specific biomarkers of response or resistance to signaling pathway agents. The consortium is open to any pharmaceutical developer who wishes to determine which patients are most likely to respond to their novel cancer therapy and perform rapid proof-of-concept clinical trials. These models will support drug discovery researchers to understand how complex genetic diseases manifest themselves in real patients and help rationalize many aspects of drug development, and therefore the cost of bringing to market new personalized therapies. They are using advanced computer and imaging technology to create a database where Universal Free E-Book Store Future of Cancer Therapy 367 physicians and scientists can compare patients’ tissues with digitally archived cancerous tissues for which genomic and proteomic data is available. This will not only lead to more personalized treatment, but will also enhance cell and radiological cancer studies. In the next phase, the project will expand into other types of cancer and also create a Center for High-Throughput Data Analysis for Cancer Research. The Center will rely on pattern recognition algorithms for developing diagnostic tools based on archived cancer specimens and radiology images. That information will be integrated with proteomic and genomic data to aid treatment recommendations. Several other institutions, including Rutgers University, Arizona State University, Ohio State University, and the University of Pennsylvania are involved in the project. Genomic Cancer Care Alliance Genomic Cancer Care Alliance – which currently involves founding organizations Fox Chase Cancer Center, Scripps Genomic Medicine, Omicia, El Camino Hospital, and the Translational Genomics Research Institute – launched a pilot study in 2010 to investigate the ability of whole-genome sequencing to guide treatment for patients who have responded poorly to initial therapy. A comprehensive picture of genetic alterations in human cancer should therefore include the integration of sequence- based alterations together with copy number gains and losses. Combining copy Universal Free E-Book Store 368 10 Personalized Therapy of Cancer number and sequence data also holds promise for determining whether particular point mutations have a functional effect, the researchers noted. For example, if a gene turns up with a deletion in one sample and a point mutation in another, it could indicate that that point mutation is inactivating. Incorporating information on other genome-wide changes such as translocations and epigenetic changes could provide even greater insight into cancer, as will trying to determine the timing with which genetic alterations occur in cells. These analyses could prove useful for cancer per- sonalizing diagnosis and therapy. For example, two-thirds of the breast and colorec- tal samples tested in the study contain alterations to four key signaling pathways, suggesting that drugs targeting these pathways could prove useful for treating both breast and colorectal cancers. Each project is expected to involve specimens from 500 patients and have an esti- mated cost of $20 million. Projects that are currently funded are examining tumors affecting: the biliary tract, bladder, blood, bone, brain, breast, cervix, colon, eye, head and neck, kidney, liver, lung, nasopharynx, oral cavity, ovary, pancreas, prostate, rectum, skin, soft tissues, stom- ach, thyroid and uterus. Universal Free E-Book Store 370 10 Personalized Therapy of Cancer • Use knowledge from genome-wide association studies and chromosomal instability to predict the progression from benign to malignant cancers and develop molecular tests to identify genes associated with risk progression in early lesions. These teams will use a range of omics approaches to characterize lesions at the molecular and cellular levels. They will also establish a biospecimen repository to house screen-detected lesions and interval cancers. Research is supported by a grant that Horizon Discovery is sharing with the University of Torino Medical School to develop models of inherited and somatic genetic variation for research into new drugs and diagnostics for cancer.

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Prediction of Recurrence in Breast Cancer for Personalizing Therapy To tailor local treatment in breast cancer patients there is a need for predicting ipsi- lateral recurrences after breast-conserving therapy 25 mg viagra with amex what age does erectile dysfunction happen. After adequate treatment (exci- sion with free margins and radiotherapy) cheap viagra 25mg erectile dysfunction medication new, young age and incompletely excised extensive intraductal component are predictors for local recurrence. Gene expres- sion profiling (wound-response signature, 70-gene prognosis profile (Agendia’s MammaPrint test) and hypoxia-induced profile) can identify subgroups of patients at increased risk of developing a local recurrence after breast-conserving therapy. Lymph node status at the time of diagnosis of breast cancer is considered to be the most important measure for future recurrence and overall survival. It is an imperfect method because a third of patients with no detectable lymph-node involve- ment will develop recurrent disease within 10 years. The poor prognosis signature consists of genes regulating cell cycle, invasion, metastasis and angiogenesis. This gene expression profile will be superior to currently used clinical parameters in predicting disease outcome and selection of patients who would benefit from adju- vant therapy. The ability to accurately predict long-term recurrence with microar- rays, however, might prove very important if subsets of patients who will not relapse can be spared the toxicity of adjuvant chemotherapy. Prosigna Breast Cancer Prognostic Gene Signature Assay (NanoString) pro- vides digital readout of expression of 50 genes implicated in the growth and spread of cancer. The score is used to estimate the chance that cancer may recur after hor- mone therapy. The microarray assay looks at what specific genes are expressed in a patient’s tumor. When compared to clinical factors currently used by physicians in the prognosis of breast cancer such as age, tumor size, lymph-node status, tumor grade and estrogen receptor status, the MammaPrint test has shown to provide the best single prognostic information concerning the development of dis- tant metastases. Large-scale prospective clinical trials of the breast cancer prognosis test have been carried out. MammaPrint test outperformed the clinicopathologic risk assessment in predicting all endpoints and adds independent prognostic infor- mation to clinicopathologic risk assessment for patients with early breast cancer as well. To facilitate its use in a diagnostic setting, the 70-gene prognosis profile was translated into a customized MammaPrint containing a reduced set of 1,900 probes suitable for high throughput processing. Classification results obtained from the original analysis, when compared to those generated using the algorithms based on the custom mini-array, show a high correlation of prognosis prediction. Therefore, the array is an excellent tool for predicting outcome of disease in breast cancer. This is of paramount importance in planning treatment of breast cancer patients after surgery and assists physicians and patients in making informed treatment decisions. Changes in this gene in breast cancer cells can be used to predict likelihood of tumor recurrence or long-term survival of a patient. The test was studied Universal Free E-Book Store 310 10 Personalized Therapy of Cancer in Danish patients who were treated with chemotherapy after removal of breast cancer tumors. That study used data from tumor samples and clinical data from 767 patients with high-risk tumors, and it confirmed that the test was useful in estimat- ing recurrence and survival in women who had received chemotherapy. Findings of this study may form a foundation for the growing body of knowledge explaining the outcome differences in treatment of patients with metastatic breast cancer, potentially helping to create tailored counseling and personalized treatment approaches for this vulnerable group. Prognostic testing of all patients prior to treatment aligns with standard medical practice to distinguish patients by hormone status. This information also enables pharmaceutical companies to clearly define patient stratification for improving clin- ical trial timelines and outcomes. These two biomarkers serve are the foundation of the AviaraDx Breast Cancer Profiling Technology. Other genes that determine cell fate- are being exam- ined in an attempt to identify new therapeutics for breast cancer and metastasis. It may prove to be a useful biomarker for predicting, which patients have the greatest risk of breast cancer recurrence, so their physicians can offer the most appropriate treatment plan. This gene might not only be an important biomarker for metastasis but a possible target for novel therapies for patients with metastatic breast cancer. Multi-gene Expression Prognostic Constellation (Celera) The prognostic con- stellation provides information that is distinct from that predicted by routine clini- cal assessment tools, such as tumor grade, and can quantify risk for metastasis for variable time periods rather than only categorically for 5 or 10 years. A previously Universal Free E-Book Store 312 10 Personalized Therapy of Cancer developed 14-gene metastasis score that predicts distant metastasis in breast cancer research subjects without systemic treatment has now been applied to Tamoxifen- treated research subjects. The absence of the estrogen receptor gene in the constellation increases the confi- dence that this information complements routinely assayed estrogen receptor lev- els determined by immunohistochemistry. The test can be used as a predictor of distant metastasis in Tamoxifen®-treated breast cancer patients. A key finding is the calculation of a Metastasis Score for breast cancer that predicts a 3. The information is then combined with a proprietary algorithm to produce a risk score that assists pathologists and oncologists in clinical decision-making. Clarient con- ducted an independent study using a set of breast cancer patients from the Royal Perth Hospital in Western Australia to clinically validate the Clarient Insight Mammostrat™. In the study, high- and low-risk patients were identified using the Clarient Insight Mammostrat™. This is equivalent to a negative predictive value of about 97 %, and the corresponding positive predictive value was 39 %. MetaStat™ Breast Cancer Test Scientists at MetaStat Inc have discovered the micro-anatomical site in breast cancer by direct visual observation, the MetaSite, the window in the blood vessels through which the metastatic cells squeeze through Universal Free E-Book Store Personalized Management of Cancers of Various Organs 313 to enter the blood stream to begin their deadly journey. The number of these “win- dows” correlated to the probability of distant site metastases. MetaStat™ Breast Cancer Test uses conventional staining techniques to count these windows, and the count correlates to the risk of metastasis. In clinical trials, the high-risk cohort proved to be 22 times as likely to experience metastasis as the low. The test is inex- pensive and fast because archived human tissue samples are used accompanied by their corresponding medical records. The predictions are compared to known out- comes in the corresponding medical records. The basal-like breast cancer subtype was more prevalent among premenopausal African American women (39 %) compared with postmenopausal African American women (14 %) and non– African American women (16 %) of any age (Carey et al. Although breast cancer is less common in blacks than whites, when black women do develop the disease, they are more likely to die from it, especially if they are under 50. Among those younger women, the breast cancer death rate in blacks is 11 per 100,000, compared with only 6. A higher prevalence of basal-like breast tumors and a lower prevalence of luminal A tumors could contribute to the poor prognosis of young African American women with breast cancer. The finding has no immedi- ate effect on treatment, because there is no treatment that specifically concentrates on basal-like cancer.

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Neurologically generic 25mg viagra with mastercard erectile dysfunction of diabetes, the patient presents paraparesis with tive care adapted enabled good functional recovery after 6 months discount viagra express erectile dysfunction doctors in colorado. Cu- taneo abdominal refexes are present and musculoskeletal refexes are abolished in the lower limbs. However, at the urinary level, it has conducted to North Staffordshire Rehabilitation Centre, Physical Rehabilitation 2 bladder drainage by intermittent self-catheterization. Conclusion: Medicine, Stoke-on-Trent, United Kingdom; North Staffordshire The main vertebral deformities in achondroplastic patient are the Rehabilitation Centre, Physcial Rehabilitation Medicine, Stoke-on- magnum foramen narrows and spinal stenosis. If symptomatic, pa- Trent, United Kingdom tient will present with neurological signs of myelopathy or equina Introduction/Background: Transient bone barrow oedema is a rare, cauda syndrome, as a function of the compression seat. The aim of this study is to ences of neurological signs indicate a decompression surgery. Material and 315 Methods: This is a retrospective descriptive study from the data collected through our bespoke database. Blood parameters including 1Boo-Ali hospital -Islamic Azad university of Medical Sciences infammatory markers were normal. Sayilir 1Muğla Sıtkı Koçman University- Faculty of Medicine, Physical disease that have great effect on quality of life. Material and Methods: genital anomaly characterized by variable degree of defciency In this quasi-experimental clinical trial, postmenopausal women en- along the radial (or preaxial) side of the limb. In this report, we pre- tered the study and randomized into case and control group. Case group also performed back ex- 42-year-old man with right radial bone dysgenesia applied to our tensor strengthening exercises at home. Concerning radial bone dysgenesia, he has 6 months after entering the study in both case and control groups any rehabilitation programs or surgical treatments. The medical history was otherwise non- except for role emotional as a subscale of mental health. On physical examination, right elbow was found to be trol group-, only some physical health dimensions including bodily fxed in extended and right hand fxed in fexion position. He had pain, role physical and vitality and mental health status as a mental minimal motor functions of fngers. Conclusion: In conclusion, performing as taking objects, holding or clutching at the right hand. Right elbow back exercises had major impact on improving physical and most and wrist joint showed severe degenerations. He was recommended of the mental aspects of quality of life in patients with osteoporosis for a rehabilitation program including; improving hand functions, and could be considered in routine management in these patients. Material and Methods: Forty-fve women with postmenopausal osteoporosis who were started medical Medicine and Rehabilitation Department, Ankara, Turkey treatment were prospectively included. Medications included alen- Introduction/Background: Avascular necrosis is the death of bone dronate, zoledronic acid, risedronate or ibandronic acid along with tissue due to a lack of blood supply. Also called osteonecrosis, a low or high dose of calcium plus vitamin D supplements. Patient was diagnosed with malign melanoma vitamin-D supplementation tended to have a greater improvement on right sacral region. Conclusion: Cognitive functions of women with these combination therapy patient experienced right hip pain and postmenopausal osteoporosis remained unaltered, whereas bone limitations. Higher doses of calcium vitamin d supplements were likely treated with 30 session hyperbaric oxygen treatment which did not to have better cognitive effects compared to lower doses. Patient addmited to our rehabilitation J Rehabil Med Suppl 55 Poster Abstracts 97 center for his joint pain and limitations with wheel chair dependent hadaye Tajrish Hospital from Apr 2009 to Apr 2010. Results: After 1 month, both the physiotherapy the patients general health condition and disabilities before treating and dry needling groups had decreased resting, night, and activ- with radiotherapy and chemotherapy. Yahyazadeh3 diology, Adana, Turkey 1Shiraz University of Medical sciences, Physical Medicine & Reha- bilitation- Geriatric Research Center, Shiraz, Iran; 2Shiraz Univer- Introduction/Background: The aim of this prospective pre-study sity of Medical Sciences, Physical Medicine & Rehabilitation- Shi- was to evaluate the effects of lidocaine injections to the trigger 3 points in the trapezius muscle on pain and disability in patients raz Burn Research Center, Shiraz, Iran; Farhangian University, with myofascial pain syndrome. Material and Methods: 20 patients Department of Languages, Shiraz, Iran (15 women and 5 men) with myofascial trigger points in the trape- Introduction/Background: Carpal tunnel syndrome is the most com- zius muscle were included in the study, and clinical examinations mon neurological entrapment in upper extremity and peripheral were used for the diagnosis. It was compared the Shear Wave Velocities (Vs) of the physical examination in diagnostic approach. Shear study was to compare some of these tests in diagnosis of mild carpal Wave Vs of the lesions were analyzed. All patients were treated with a 1 ml% Some different electrodiagnostic methods such as: Interpolation, 10 lidocaine injections to the trigger points by the same physiatrist. Results: The mean age method was sensory part of interpolation (sensitivity: 96% and speci- of the study population was found 43. After the lidocain injection sensitive method to detect mild cases of carpal tunnel syndrome. Conclusion: In patients with myofascial trigger points in the trapezius muscle, lidocain injec- 320 tions effectively improved the disability, and pain. Toshikazu1 prevalence of myofascial pain syndrome and lack of consensus in 1Kyoto Prefectural University of Medicine, Orthopaedics, Kyoto, the best treatment choice, we conducted this study to compare the Japan, 2Kyoto Prefectural University of Medicine, Rehabilitation effectiveness of physiotherapy with dry needling. The diagnosis is clinical and imaging is needed radical neck dissection with preservation of the accessory nerve, in- to confrm the diagnosis and to decide on the appropriate treatment cluding twenty-six men and four women with a mean age of 60. Results: At the time of rehabilitation starting after tion was entered in to the study. The correlation between different clinical tests and ultrasonographic fndings were assessed statistically. Results: Ultrasonographic fndings showed good correlation with clinical 323 fndings. We recommend its use in regular practice because it is Kashf3 user friendly and free from the risk of radiation. Ultrasound helps 1University of Social Welfare and Rehabilitation Sciences, Physi- in reaching at a correct diagnosis because many a times the clinical cal Therapy Department, Tehran, Iran, 2University of Social Wel- features may not give the accurate picture even in best hands. Thus the aim of this study was to evaluate the effect of 6 weeks shoulder girdle muscle exercises on the subacromial Introduction/Background: The aim of this study was to evaluate space and scapulohumeral rhythm in the subjects with scapular the coexistence of C5 and/or C6 root compression with rotator cuff dyskinesis. Material and Methods: Twenty subjects with obvious pathologies and its effect on pain and disability with clinical signs scapular dyskinesis were participated in the study. Material and Methods: The study with ter 6 weeks exercise program any alteration of scapular orientation 65 patients who fulflled the inclusion and exclusion criteria of the was assessed obviously by scapular dyskinesis test also the anterior study and who applied to our outpatient clinic with pain radiating outlet of subacromial space was measured via the acromiuhumeral from neck to shoulder. Exercise program consisted of stretch- were separated into two groups as patients with and without upper ing, strengthening and postural correction. These groups were compared in were given information about the anatomy and the importance regard to impingement grades, rotator cuff and bicipital muscle pa- of scapular position in shoulder kinematics. The pain domain of research needed to investigate the infuence of internal factors.

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In a previous chapter he employed an empirical argument to support his conviction that the disease is caused by an accumulation of phlegm in or around the brain buy generic viagra online erectile dysfunction caused by stroke. He claimed that if one were to open the skull of a goat that died as a result of an epileptic fit generic viagra 75 mg without prescription impotence problems, one would find a large amount of fluid (phlegm) around the brain. In this context phronesis¯ clearly means more than ‘thinking’ or ‘intelligence’, as the word is commonly translated. It means ‘having one’s senses together’ and refers to a universal force by which a living being can focus on its surroundings and can un- dertake activities; it also implies perception and movement. Another thing that is striking is that the author is of the opinion that the brain is also the source of feeling – although he admits that the heart and diaphragm take part in this as well. A text in which mental phenomena are even more clearly classified as a separate category is the Hippocratic writing On Regimen. As to the question whether this indeed concerns an experiment in the modern sense of the word, see Lloyd (1979) 23–4. There is a dispute about the date of this work: most scholars date it to the beginning of the fourth century bce, but some argue in favour of a much later date (second half of the fourth century bce). The soul consists of wa- ter and fire (the elements which, according to this author, have the greatest influence on the constitution of the human body), which stand in a certain proportion to each other. Fluctuations in this proportion result in differ- ences between individual people’s cognitive skills, such as acuteness, a good memory, precision of the senses and proneness to certain emotions (1. When the balance between these two elements is seriously disturbed, it will give rise to psychological disorders, but these can be cured by changing eat- ing and drinking habits and adopting a certain lifestyle (1. According to this author, the soul is therefore a material entity, yet it does not have a fixed location: it moves through the body via ‘passages’ (poroi ). The condition of these passages (for instance their width or narrowness) is a further influential factor in someone’s mental functioning. In the state of wakefulness, the soul distributes itself over the entire body and carries out certain tasks ‘for the benefit of the body’, including hearing, seeing, touching and movement. During sleep, or rather ‘when the body is asleep’, the soul remains awake and withdraws in its own ‘home’ (oikos), where it carries out the activities of the body independently. These include seeing, hearing, walking, touching, grieving, thinking: they are called enhupnia or ‘dreams’. Yet the author does not venture an opinion on the location of the soul and its ‘home’. A presentation like this shows how inadequate terms like ‘materialism’ and ‘dualism’ are to describe ancient theories on body and mind. The author of On Regimen may be called a materialist to the extent that he holds an entirely material view on the soul; yet at the same time he assumes two separate entities which may normally co-operate and mutually influence each other, yet one of them (the ‘soul’) can also function independently, as, for instance, in sleep. He expresses the view that the ‘soul’ is not a separate entity, which might exist independently of the body: ‘soul’ to Aristotle is ‘the form of the body’, that which causes a body to live, which gives it structure and enables it to exercise its faculties. For other attempts to reformulate Aristotle’s view on the mind–body debate in modern terms see the volume by Nussbaum and Rorty (1992), with comprehensive bibliography. Heart, brain, blood, pneuma 129 does not prevent him from repeatedly speaking of ‘experiences typical to the soul’, activities a human being carries out ‘with his soul’, or perceptions which ‘penetrate the soul’. According to Aristotle, the functioning of the dual entity that body and soul constitute is governed by a large number of organs and material factors. The heart is assigned the role of ‘beginning’ or ‘origin’ (arche¯), both as a source of essential bodily heat (required among other things for the digestion of food) and as the seat of the central sense organ, which is connected with the limbs and the separate sense organs and co-ordinates the data it receives from them. He assumes interaction between the heart (to him the real seat of the mind), the brain (which plays a pivotal role in sense perception) and the so-called ‘psychic pneuma’, a delicate substance that is responsible for transmitting sensory and motor signals. Organs for perception, limbs and other parts of the body are assumed to be connected to each other and to a centre via cer- tain ‘passages’ (poroi, phlebes, neura). The assumption of the existence of this network of passages and the ideas about their course and ramifications are highly speculative and hardly based on what we would 21 On Youth and Old Age (De iuventute et senectute, De iuv. Yet the fact that this obser- vation was known both to the author of the Hippocratic work On Fleshes and to Aristotle, who nevertheless do not attribute any significant role in cognition to the brain, proves that it might equally give rise to other interpretations. The authors mentioned do in fact employ rather sophisticated termi- nology for what we would call psychological, mental or spiritual faculties, but they assume a close connection between these faculties and anatomical and physiological factors. When speaking about exercising these faculties, they virtually always do so in terms of certain substances (such as blood, air or water) or qualities (hot, cold, dry, wet) and of processes such as flowing and distributing or, in case the psychic faculties have been disturbed, of stagnation, constipation, blockage, and so on. Another recurring element is the emphasis on balance (isonomia, summetria, eukrasia) and on the risk of an excess or shortage of a certain substance or quality. An exception to this rule is Aristotle’s idea that the highest cognitive faculty, thought, is not bound to a physical substrate. It is a kind of epiphe- nomenon that, although it is unable to function without sense perception (and therefore without physiological processes), cannot be located in a par- ticular place of the body. The author of this presumably post-Aristotelian writing claims that gnome¯ ¯ (‘mind’, ‘insight’) has its seat in the left ventricle of the heart, from where it issues its decrees about ‘the other (part of the) soul’ (alle¯ psuche¯), which is situated in the rest of the body. To prove his stance, the author argues that if autopsy were carried out on a body of a living being that had just been killed, the aorta would still contain blood, but the left 28 See Lloyd (1979) 146–9; for views on the vascular system see the studies mentioned in Harris (1973) and Duminil (1983). As stated above, the heart is given a leading role in co-ordinating perception, movement and nutrition (see Part. For the problems raised by Aristotle’s view see Barnes (1971–2) 110–12, reprinted in Barnes, Schofield and Sorabji, vol. Heart, brain, blood, pneuma 131 ventricle would not;31 this maintains contact with the blood by means of a process of ‘evaporation’ and ‘radiation’. As we have seen before, the medical authors of the period we are discussing do not consider the question of the seat of the mind an isolated issue, but a matter that becomes relevant when treating diseases which, although they have a somatic cause like other diseases, also manifest themselves in psychic disor- ders. Of the four classic psychosomatic diseases, mania (a chronic disorder), phrenitis, melancholia and epilepsy, epilepsy was by far the most dreaded. It was also known as ‘the big disease’ or ‘the sacred disease’; possession by the gods seemed the obvious explanation, but at the same time the physical aspects of the disease were so prominent that there could be no doubt as to its pathological status (as opposed to mania and melancholia, which were considered to manifest themselves in positive forms as well). After a long philippic against those adhering to this view he expounds his own theory. Epilepsy is the result of an accumu- lation of phlegm (phlegma) in the passages that divide themselves from the brain throughout the body and enable the distribution of the vital pneuma (this air is indispensable for the functioning of the various organs). This accumulation is a result of insufficient prenatal or postnatal ‘purifi- cation’ (katharsis) of phlegm in the brain – according to the author this is a hereditary phenomenon. This obstruction can occur in different places in the body and, accordingly, manifest itself in different symptoms. Near the heart, it will result in palpitations and asthmatic complaints; in the abdomen, in diarrhoea; in the ‘veins’, in foaming at the mouth, grinding of teeth, clenched hands, rolling eyes, disorders in consciousness, and a lack of bowel control. This way the author explains the various symptoms that can present themselves during epileptic fits and which he describes in considerable detail in chapter 7 of the treatise. The brain is the ‘cause’ (aitios)of the disease, and its condition can be influenced by a number of external causal factors (prophaseis) such as age, climate, season, the right or left side of the body, and the like.