History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century.

Breast cancer is the most common forms of cancer and a leading cause of mortality in women. Early and correct diagnosis is, therefore, essential to save lives. The development of diagnostic imaging applied to the breast has been impressive in recent years and the most used diagnostic test in the world is mammography, a low-dose X-ray technique used for imaging the breast. In the first half of the 20th century, the diagnosis was in practice only clinical, with consequent diagnostic delay and an unfavorable prognosis in the short term. The rise of organized mammography screening has led to a remarkable reduction in mortality through the early detection of breast malignancies. This historical review aims to offer a complete panorama of the development of mammography and breast imaging during the last century. Through this study, we want to understand the foundations of the pillar of radiology applied to the breast through to the most modern applications such as contrast-enhanced mammography (CEM), artificial intelligence, and radiomics. Understanding the history of the development of diagnostic imaging applied to the breast can help us understand how to better direct our efforts toward an increasingly personalized and effective diagnostic approach. The ultimate goal of imaging applied to the detection of breast malignancies should be to reduce mortality from this type of disease as much as possible. With this paper, we want to provide detailed documentation of the main steps in the evolution of breast imaging for the diagnosis of breast neoplasms; we also want to open up new scenarios where the possible current and future applications of imaging are aimed at being more precise and personalized.

Pietro Pacifico Gamondi (1914-1993), tropical physician and ethnologist. A protagonist of medical research in the middle of the 20th century.

Pietro Pacifico Gamondi was a tropical physician, who was one of the main protagonists of medical research during the 20th century. His training as a doctor first saw him in Rome following doctor Aldo Castellani. Gamondi then left for Lisbon, London, and the extra-European countries that have characterized his path as a doctor and as a man. In fact, he traveled to Indonesia and Africa, where took care of the population, combining European and local medicine. In this contribution, we wanted to remember the figure of a man who dedicates his life to tropical medicine and to the care of others.

Accessory sacroiliac joints and the iliosacral complex: two case studies from a medieval and post-medieval cemetery in northern Italy.

The detection of parturition markers on archaeological pelvic bones is relevant for the reconstruction of the biological profiles of female individuals, in whose life history pregnancy represents a crucial biological event. During a preliminary study on a sample of 18 individuals from the medieval and post-medieval cemetery of San Biagio in Cittiglio (northern Italy), two skeletons exhibited evidence of noteworthy bony projections at the sacroiliac level. In clinical studies, these occurrences can be connected to several biological variables such as age, obesity, and multiple births, suggesting that they are a possible consequence of weight-bearing stresses. Here, we address two cases of accessory sacroiliac joints and the iliosacral complex found in two female individuals. The study is part of the anthropological analysis of the sample from the cemetery of Cittiglio (78 individuals have been investigated to date) and, in particular, of the examination of female and male pelves in order to highlight the expression and aspect of pelvic features in both sexes.

Analysis of the corrosive effects of hydrochloric acid (HCl) on human bone: Preliminary microscopic study and observations for forensic purposes.

The destruction of a corpse in caustic acid can cause complex forensic scenarios to deal with. Furthermore, the literature on the subject is poor, having been the few studies carried out only on animal bones. We carried out an experimental analysis on human cranial, ribs, vertebrae, and femur bone fragments. These samples were sent for dissolution by hydrochloric acid (HCl) at two different concentrations in the lab: 10% and 37%. We have performed macroscopic and microscopic histological and cytological observations at set time intervals: 3, 4, 19, 24, 48, and 72 h of immersion in acids. The purpose of the study was threefold: to investigate the temporal evolution of bone dissolution, evaluate the destructive effect of the two hydrochloric acids, and establish whether or not the human pattern of histological structure could be recognized. A more significant destructive action of HCl at 37% has been observed. In the 10% acid, the bone nature of the samples was demonstrable up to 24 h of immersion, but the human pattern of histological structure was already compromised at 19 h, being lost at 24 h. Instead, in the 37% acid, the bone nature of the sample was demonstrable only within 4 h of immersion, and the human pattern of histological structure was markedly compromised within 3 h. At 19 h of immersion, neither the recognition of the bone nor its human nature was feasible. These preliminary findings and observations may be of practical use in forensic investigations of bodies found in acidic substances, for which there is no scientific evidence to refer.

History of use and abuse of X-ray: the early 20th century Italian pediatrics school.

In our paper we report a brief history of the X-rays discovery and discuss the implications of their use and abuse in the Italian pedriatic schools of the early 20th century. Indeed, history of the X-ray treatment in the Italian Pediatric School has not yet been well studied. Even if the scientific experience of many physicians is well known in literature, a summary was missing. In Italy, in 1900, exposure to Röntgenand ultraviolet radiation or to large amounts of solar rays was a widespread medical practice, especially in several pediatric schools. During those years, diagnosis and treatment of childhood pathologies underwent considerable changes, especially after the twenties, when scientists developed an unquestionable trust in the therapeutic properties of radiation, considered harmless at that time. We report the main steps of the scientific research of the early 20th century in Italy.

Lithographic lecture notes. A tool of forensic medicine teaching. Observation on the lessons of Paolo Pellacani (1884-1885), forensic physician at the University of Pavia.

We focus our attention on the use of lithographed lecture notes written by professors, or more often by students, in the teaching of medicine and surgery courses, between the late 19th and early 20th centuries, a period in which, to better understand the phenomena underlying life and death, collaboration between medical professionals and natural science researchers was intense (1). In particular, we analyzed the lithographed lecture notes of Professor Paolo Pellacani at the University of Pavia for the course of legal medicine.

Osteological evidence of metabolic diseases from a post medieval North Italy archaeological site.

Skeletal lesions related to metabolic diseases in children have been systematically investigated in paleopathological literature only in recent years. This work presents an infant pathological specimen from the post-medieval cemetery of the St. Mary's Nativity church (15th-18th centuries, Segno, Trento, Trentino, Northeast Italy). The bones belonged to an individual of 9 ± 3 months of age, estimated upon an assessment of the stage of dental eruption. Metabolic diseases were diagnosed with paleopathological criteria according to previous literature. Differential diagnosis of the osteological evidence indicates a disease that might be caused by the lack of vitamin D or C. Comorbidity of vitamin C and D deficiency has been widely studied in clinical literature, particularly in children between 3 months and 5 years of age. The study of ancient osteoarchaeological materials allows us to improve our knowledge on diseases' effects on bone development in children and, in this case, it represents additional evidence of the presence of metabolic diseases in a rural contest of the Italian post-medieval period.

The Acetylcholine Therapy in the Treatment of Schizophrenia - The Experience of Mario Fiamberti in the Hospital of Varese (1937)

In the first half of the 20th century, in most European countries, it was thought that cholinesterase and other drugs that counteract acetylcholine should reduce the manifestations of schizophrenia. In 1937, Fiamberti (1894-1970) introduced the transorbital method of lobotomy which established the use of acetylcholine shock treatment for curing the disturbances of schizophrenia. Accepting the idea that the psychic alterations of schizophrenia were caused by a pathological interruption of nerve conduction at a presumably cortical level, Fiamberti thought he could apply this to the clinical field using the properties of acetylcholine, an acetic ester of choline. Here, we examined, in detail, the contribution of Mario Fiamberti to acetylcholine therapy.

Osteoarchaeology and the History of Medicine in our experience.

The encounter between archaeology and medicine is no longer the result of sporadic or intermittent research. Stemming from different areas of expertise and training, as well as historical sciences, archaeology, biology and medicine, common investigative objectives must come together in a coordinated manner. However, defining the boundaries of different areas of work, collaboration, interferences and interconnections is not an easy task.

Olive oil in pharmacological and cosmetic traditions.

Among the numerous natural substances used in medical remedies, oil certainly plays an important role and, over the centuries, there have been many functions and properties attributed to it. We present the processes that have seen it as protagonist in the pharmacological field and in the cosmetic field.

Some observations on the signs of certain death in the 18th century.

In 1783, the work of Ferdinand de la Boissiere, Letters above the certainty of death signs with various observations and experiences over the drowned, was published in Rome. Manuscript is a translation of the French work of Antoine Louis, Lettres sur la certitude des signes de la mort, printed in France in 1752 and in which the surgeon discussed on the certain diagnosis of death. The Louis's work represented an important contribute of medicine especially because in the 18th century only the appearance of the first putrefactive processes was recognized as the indisputable sign of death. In the debate of the time, the treaty of Antoine Louis (1723-1792) overtaken the believed that the only indisputable sign of death was the appearance the first putrefaction processes. Our paper is limit to offering some author's account around the characteristic signs of death, which dispense from putrefaction of the bodies or the rigidity of the limbs and the collapse and softness of the eye. The book boasted a great meaning in the medical association of the time, especially because it discussed with contemporary criteria the signs of certain death.

The Italian law on informed consent and advance directives: New rules of conduct for the autonomy of doctors and patients in end-of-life care.

PURPOSE: Italy has long lacked a law regulating patients' informed consent and advance directives (ADs). All previous attempts to introduce a law on this matter failed to reach positive outcomes, and aroused heated ideological debate over the exact meaning of life and death. We report on the new law on informed consent and ADs approved by the Italian Parliament on 14th December 2017. MATERIALS AND METHODS: We analyse the new law and discuss the main ethical points connected with it, in the Italian context and in comparison with the international situation. RESULTS: The law provides for fundamental ethical principles and important guidelines: respect for patients' self-determination in all phases of life, option to refuse or interrupt life-sustaining treatments, including artificial nutrition and hydration, the legitimacy of end-of-life decisions, and the implementation of palliative care to ease suffering and pain. CONCLUSIONS: The effects of the new law must be tested in the field. Its objectives will be achieved if, in clinical practice, ADs are able to satisfactorily represent informed personal preferences through patients' relationships with their physicians, as part of personalized advance care planning. Future studies are necessary to assess the impact of the new law in Italy.

[New italian law about end of life: self-determination and shared care pathway.] / La nuova normativa italiana sul fine vita: l'autodeterminazione e la condivisione del percorso di cura.

The Italian Parliament has recently approved the Law n. 219/2017 concerning "Rules on informed consent and advance directives". The manuscript points out the main key points of the new law, in order to clarify the role of the advance directives and to provide clear operational guidelines for healthcare personnel. Taking into consideration the Italian deontological and juridical context, along with the main jurisprudential judgements, the law has been analysed. The Authors discussed the new rules and the bioethical issues also in relation to the provisions stated by the Convention on Human Rights and Biomedicine (Convention of Oviedo). The new law deals with relevant issues that were confined to jurisprudential rulings so far, such as the informed consent, the withdrawal/withholding of medical treatment (including artificial nutrition and hydration), the content of medical information, including the modalities, the medical responsibility and, finally, the value of advance directives. In the Authors' opinion this law provides essential rules to expressly strengthen the patients' autonomy, eliminating the juridical uncertainty on many central issues (such us, for example, the refusal of life-sustainment treatments) that have been the subject of contradictory judgments ruled by the Italian Courts. Nevertheless, advance directives should be regarded as a dynamic tools of relationship between physicians and assisted person and, thus, as an essential integrant part of the advance care planning. The education of health professionals and citizens about end of life issues is the basis for the successful implementation of this legislation.

An Osteological Museum inside the Varese Medical School? A proposal from the Medical, Antropological and Paleopatological point of view.

Not available.

[Ethical aspects of medical thought on the madness in the enlightenment]. / Aspetti etici del pensiero medico sulla folia il epoca illuministica.

The seventeenth century is a period of transition from religious views that are not authentic but dogmatic about demonic influences to the application of scientific and methodological criteria in science. During Enlightenment there was an approach heavily influenced by ethical issues. In this context, there is a rational recognition of the value of man free from the teleological type references. Mental illnesses are treated using scientific criteria. During the seventeenth century clinical interest is also extended to psychosis and not only to neurosis. There are several significant changes in the care of psychiatric patient, and healthcare institutions are improved and increased. Many behaviors are inspired by the values of philanthropy.

[Angelo de Vincenti and the history of neurology]. / Il neurologo Angelo de Vincenti e le terme di salice.

Angelo De Vincenti was been considered are of the pioneers of neurology in Italy. He left few printed works and of testimonies of his clinical and managerial activity; this article deals in particular with De Vincenti's fundamental promoting the therapeutical role in value of Terme di Salice in the first years of xx XIX century.