Qafzeh 9 mandible (ca 90-100 kyrs BP, Israel) revisited: µ-CT and 3D reveal new pathological conditions.

OBJECTIVE: The aim of this paper is to provide new insights into growth patterns and health of Mousterian hunter-gatherers dated to ca. 90-100 kyrs B.P. from the Qafzeh site. MATERIALS: An almost complete skeleton, including the mandible from the Qafzeh site (Qafzeh 9). METHODS: Micro-CT and medical imaging techniques are used to explore inaccessible inner structures and to assess the etiology of identified lesion. RESULTS: Mandibular and dental conditions appear to be growth-related skeletal disorders. CONCLUSION: To our knowledge, Qafzeh 9 offers the earliest evidence of associated mandibular and dental pathological conditions (i.e. non-ossifying fibroma of the mandible, pre-eruptive intracoronal resorption and osteochondritis dissecans of the temporomandibular joint) among early anatomically modern humans, and more generally among Middle Palaeolithic hominins in Southwestern Asia. The diagnoses can be added to other growth-related disorders of skulls previously documented from the Qafzeh site (Tillier, 1999; Tillier et al., 2001), suggesting a quite high and exceptional incidence of these conditions compared to those of Palaeolithic populations. SIGNIFICANCE: Identification of pathological conditions in subadults from Eurasia dated to the Middle Palaeolithic is documented less often than in adult skeletons. Hence, new results from immature fossil remains are particularly important to our understanding of the past. SUGGESTIONS FOR FURTHER RESEARCH: This research will be extended to the rest of the skeleton, then to all Qafzeh specimens in order to broaden our understanding of this anatomically modern group.

[Reliability of the Sauvegrain and Nahum method to assess bone age in a contemporary population]. / Fiabilité de la détermination de l'âge osseux par la méthode de Sauvegrain et Nahum.

PURPOSE: The Sauvegrain and Nahum method can be used to assess bone age in addition to methods based on hand and wrist radiographs in children between 9 and 15 years of age. The aim of this study was to evaluate the reliability of this method in a contemporary population. MATERIAL AND METHODS: Elbow radiographs taken for acute trauma in 106 patients (42 girls, 64 boys) aged from 9 to 15 years old were analyzed by four radiologists. Inclusion in the study required the absence of chronic disease and previous trauma as well as parental consent. RESULTS: There was no significant difference between the four observers. The differences between bone age (BA) and chronological age (CA) were 5+/-1 months for the study group, 3.5+/-9 months for the female group, and 6+/-12 months for the male group. Bone age was overestimated compared with chronological age. There was a good correlation between CA and BA (r = 0.84). CONCLUSION: The Sauvegrain and Nahum method seems to overestimate CA in a contemporary population.

Unusual spinal tuberculosis in an Avar Age skeleton (Csongrád-Felgyo, Ürmös-tanya, Hungary): A morphological and biomolecular study.

The paleopathological analysis of a well-preserved young adult female skeleton from the AD 7-8th century (Avar Age) in Hungary revealed multiple lytic lesions in all of the thoracic and lumbar vertebral bodies. The lesions were characterized by smooth marginal zones and space-occupying mass appearance. The considerable loss of spongy bone in the thoracolumbar vertebrae resulted in angular deformity and fusion, characteristic of the healing stage of TB. Osteolytic lesions were also observed on the vertebral processes, ribs and sternum. On the endocranial surface, abnormal blood vessel impressions were revealed, indicating some kind of meningitis. The X-ray and CT analysis of the affected bones detected abnormal structures and cystic zones of destruction. The lesions were however not always bordered by areas of increased density, which is typical in cystic TB. Vertebral remains were also subjected to biomolecular analysis in two different laboratories, which attested the presence of Mycobacterium tuberculosis complex (MTBC) DNA and supported the paleopathological diagnosis of TB. Spoligotyping analysis confirmed the presence of MTBC DNA and more specifically an infection caused by bacteria belonging to the M. tuberculosis lineage. This case study provides new data for the paleoepidemiology of TB in this geographical area and historical period, and draws attention to the great variability of TB lesions in the human skeleton.

Craniofacial anthropometric analysis in patients with 22q11 microdeletion.

Microdeletions in the 22q11 region are associated with a wide range of overlapping phenotypes. The main manifestations of the syndrome include palatal anomalies such as cleft palate or velopharyngeal insufficiency, conotruncal heart defects, hypocalcemia, immune disorders, and minor facial anomalies. Because of the wide variability, facial changes appear to be the most constant manifestation of the syndrome and characteristic for informed physicians. The purpose of this study is to report the preliminary results of a detailed analysis of anthropometric data (35 measurements) in 15 patients (7 females and 8 males between 5 and 38 years of age, all white Europeans) with a 22q11 microdeletion. Objective anthropometric study showed that 19 measurements and 7 indexes were significantly different between 22q11 patients and normative database. The typical face showed a short forehead with an anterior vertical excess. Downslanting eyes and large binocular width were the most common anomalies in the orbital area. The nose showed anomalies with a large root, a short tip, and a narrow alar base. There was a narrowing of the mouth and thin lips. Ears were small and slightly disharmonic for the children. Statistical comparison between children (10 cases) and adults (5 cases) showed that craniofacial assessment was more demonstrative in children than in adults.

Limits of the Lamendin method in age determination.

This study shows that epithelial attachment level, used as age determination criterion in Lamendin's method, is not reliable for adults of either sex above the age of 49 years with periodontal diseases in any quadrant. The underestimation of calculated age increases from 7 to 19 years with chronological age. On the other hand, the present paper confirms the pertinence of dentin translucency as an age indicator in Lamendin's method.

Comparison between direct clinical and digital photogrammetric measurements in patients with 22q11 microdeletion.

Thanks to recent advances in imaging and computing technology, photoanthropometry has become an increasingly helpful adjunct to obtain objective clinical evidence of morphologic abnormalities in patients with dysmorphic syndromes. The aim of this study was to evaluate measurements made using a new two-dimensional digital photogrammetry technique by comparison with direct clinical measurements. A total of 14 patients with 22q11 microdeletion were included in this study. There were seven females and seven males between 5 and 38 years of age. Sixteen direct clinical measurements were performed using a graduated anthropometric sliding caliper and angle meter. Photogrammetric measurements were made on digital photographs using a commercially available software package. After calibration to one in situ reference on frontal and profile views, photogrammetric measurements were compared to a total of 14 direct clinical measurements made in the same patients. Findings showed that photogrammetric measurements calibrated to an in situ reference were reliable especially on profile views. No statistical difference was found between 10 of the 14 measurements (P> 0.05) including eight of the nine measurements on profile views and two of the five measurements on frontal views. This study indicates that digital photogrammetry is a useful tool but there is still no reliable standard photographic measurement technique.

Evidence of pin implantation as a means of verifying death during the Great Plague of Marseilles (1722).

The evidence obtained for the methods used in verification of death during the Great Plague of Marseilles in 1722 is presented here. This evidence was gathered during the excavation of a mass grave dating from this epidemic, and is based on two adjacent interments. The technique used at that time was the implantation of bronze pins into the toes. This method is precisely described in the medical treatises dating from this period, which list different death verification methods. The fear of "false death" and the burial of still living people characterized the end of the 17th and the 18th centuries. It should be noted that the main cause of apparent death is presented in the same medical treatises as the plague. This observation is the first anthropological evidence of the use of this forensic method to verify the fact of death.

Postmortem assessment of fetal diaphyseal femoral length: validation of a radiographic methodology.

Depending on the general condition of fetal remains, forensic specialists might face difficulties concerning age estimation. Reference tables and regression equations are helpful devices in this task, although they are generally applied for complete fetuses or fetal remains including soft tissues. However, the problem of age estimation stays for osseous remains, both for entire bones and ossified parts, since most of the reference tables come from ultrasonographic measurements, which are not easily reproducible on fetal osseous remains. Furthermore, the ultrasonographic measurements contain slight errors in comparison to the real anatomical ones. This study describes a radiographic protocol and a measurement technique that facilitate and improve bone measurements, and therefore, facilitate age estimation, too. A qualitative criterion, namely a clear-cut bony endplate, was defined and tested. Its reliability (repeatability and reproducibility) turned out to be good, showing nonsignificative differences to the threshold of 0.05, with average errors of 0.26 and 0.44 mm respectively. Moreover, concerning the test of eventual size differences between the right and left femurs showed a P value < 0.0001. The test of the qualitative criterion was based on the comparison of the radiographic in situ femur measurements and the radiographic measurements of the same bones after dissection. The results were satisfactory, since an average error of 0.58 mm was obtained, which did not give any significant differences to the threshold of 0.05. It was concluded that this methodology provides an easy and precise new measurement tool for forensic practice, and can allow us to establish some nonultrasonographic tables, which fit our population.

[Advanced-stage ankylosing spondylitis in a subject in the 8th century]. / Spondylarthrite ankylosante évoluée chez un sujet du VIIIe siècle.

Paleopathological study of an adult male skeleton, coming from a Hungarian archeological site from the 8th century, revealed lesions of the spine (ankylosing vertebral syndesmophytosis, costo-vertebral ankylosis, discal calcifications), of the sacro-iliacs (bilateral ankylosis) and several extraspinal changes (abnormalities of symphysis pubis, enthesopathies). Radiological and CT investigations confirmed the diagnosis of advanced stage ankylosing spondylitis.

[Sagittal equilibrium of the pelvis: analysis of the inclination of the ischio-pubic ramus from the horizontal]. / Equilibre sagittal du bassin : analyse de l'inclinaison de la branche ischio-pubienne par rapport à l'horizontale.

PURPOSE OF THE STUDY: The sagittal equilibrium of the spine and pelvis has been examined in numerous studies looking for the origin of certain posture disorders of the spine and the cause of lower back pain. Sagittal x-rays of the pelvis provide an analysis of the degree of inclination of the pelvis from the horizontal and the bi-coxo-femoral axis and information on the form of the sacrum. There is no radiographic parameter however which analyzes the transition between the pelvis-sacrum component and the femoral component, i.e. the periacetabular region. In the sagittal plane, a line tangent to the ischio-pubic ramus would appear to best reflect the orientation of the periacetabular region and the muscular forces applied to this region. The purpose of this work was to analyze the inclination of the ischio-pubic ramus from the horizontal and its relations with other sagittal radiographic parameters in a population of growing children with spinal disorders. MATERIALS AND METHOD: The study population included 100 children with spinal disorders who underwent a teleradiographic series with lateral view in the upright position. Most of the children had scoliosis (80 cases), 7 had kyphoscoliosis, 4 isthmic spondylolysis with spondylolisthesis, 1 spondylodiscitis and 4 lower back pain. Mean age was 13 years (range 2.5-22 years). We measured 7 radiographic parameters: lumbo-sacral angle, slope of the sacrum, pelvic version, incidence, thickness, overhang, and inclination of the ischio-pubic ramus from the horizontal. Data were analyzed to search for correlations between radiographic parameters and between radiographic parameters and clinical features. RESULTS: Mean inclination of the ischio-pubic ramus from the horizontal was 33.9 degrees (SD =5.9 degrees ). The only positive statistical correlation between the inclination of the ischio-pubic ramus and the clinical data was a relationship with the position of the arms compared with the horizontal (p =0.04). There was no correlation with age, sex, ethnic background, etiology. There was no correlation between the inclination of the ischio-pubic ramus and the other radiographic parameters (coefficient r ranging from 0.06 to 0.43). DISCUSSION: The interdependence of sagittal radiographic parameters of the pelvis and the spine have been largely demonstrated. Certain pathological situations (isthmic spondylolysis with spondylolisthesis, lower back pain, etc.) can be explained by the value of these parameters, particularly incidence. The inclination of the ischio-pubic ramus from the horizontal reflects the periacetabular region. When analyzed in the sagittal plane, it was found to be a more stable parameter, independent of most clinical criteria (particularly age, and etiology) and of the other radiographic parameters studied. The only determining factor appears to be acquisition of the upright position. The consistency of this parameter constrasts with the variability of the other radiographic parameters of the pelvis and the spine, particularly incidence, although the inclination of the ischio-pubis ramus is an expression of a region different than the pelvis. This study suggests that the periacetabular region plays a key role in acquisition of the upright position in humans. The periacetabular region would be a fixed point around which the lower limbs and spine describe varying orientations.

[Anatomic study of the anterior patellar groove in the fetal period]. / Etude anatomique du creusement de la trochlée fémorale chez le foetus.

PURPOSE OF THE STUDY: We performed a biometric analysis of the femoral trochlea in the fetus and compared our findings with those observed in adults in order to search for correlations with other biometric parameters of the femur. MATERIAL AND METHOD: Twenty-two fetuses (44 knees) conserved in formol and free of known orthopedic disease were studied. Fetal age ranged from 26 to 40 weeks. After anatomic dissection, digitalized images were used to obtain angle measurements with a dedicated software. Measurements made on the distal epiphyseal view were: anteroposterior dimension of the condyles, medial and lateral protrusion of the trochlear borders, difference in condyle height, length of the trochleal borders, alpha angle of the trochlear groove, trochlear slope. Measurements made on the AP femoral view were: femoral anteversion, length of the femoral neck, neck-shaft angle. Spearman's test was used to search for correlations. Results were compared with measurements obtained under the same conditions in a series of 32 adult knees published by Wanner. RESULTS: The trochlear alpha angle was 148 degrees (coefficient of variation 4%). The angle was greater than 150 degrees for 18 trochleae. The lateral border of the trochela was higher than the medial border in 37 of the 44 knees. There was no correlation with age and gender. Femoral anteversion was 27.01 degrees, with a high coefficient of variation (46%), and no correlation with the trochlear alpha angle. Comparison with measurements made on the adult knees revealed no significant difference. DISCUSSION: This is the first report of statistically significant biometric data of the fetal trochlea. The morphology of the lower femur observed during the third trimester of fetal live is the same as observed in adults. Morphological changes in the proximal femur occurring during growth do not appear to modify the morphology of the distal femur. The asymmetrical ingression of the patella into the trochlea, characteristic of modern man, is considered to result from bipedalism. Our study would suggest that the anatomic characteristics of the trochlea could have been integrated into the genoma during the course of evolution. This would be in favor of a genetic origin of trochlear dysplasia.

[Epidemic recrudescence of the Great Plague in Marseille (May-July 1722): excavation of a mass grave]. / La rechute épidémique de la Grande Peste de Marseille [Mai-Juillet 1722]: le charnier de l'Observance.

The return of some infectious disease has stimulated specialists to study historical aspects of human infections. A major model for this study is Yersinia pestis which has had a great impact on human demography due to the fact that it is highly contagious and has a high mortality rate similar to that of the most lethal viral pathogenic agents. We carried out excavation of a mass grave containing the bodies of victims of an outbreak of bubonic plague that occurred in Marseille from 1720 to 1722. More than 200 skeletons were uncovered from the grave known as the Observance (second district in Marseille). In conjunction with laboratory testing, archival records were studied to determine the conditions and dates surrounding the use of this mass grave and to explain certain findings made at the site. This multidisciplinary approach revealed previously unknown facts concerning the Great Plague and provided new insight into recrudescence of the epidemic in 1722.

Differential diagnosis of carpal and tarsal ankylosis on dry bones: Example from the catacomb of Saints Peter and Marcellinus (Rome, 1st-3rd century AD).

Bone ankylosis is a pathological feature that may occur in many chronic diseases involving joints. In paleopathology, it is therefore challenging to attribute such a change to a specific condition. Here, we illustrate the differential diagnosis by discussing the lesions observed on an incomplete skeleton from the Roman period, recovered from the catacomb of Saints Peter and Marcellinus (Rome, Italy). The skeleton exhibits several bone changes, including ankylosis on both feet and the left hand. The right tarsal fusion is accompanied by soft tissue ossifications involving the plantar aponeurosis and the tendinous structures connecting the great toe's proximal phalanx and sesamoid bones. The lesions recorded suggest that a spondyloarthropathy is the most likely cause of these extensive fusions.

Ramadan fasting with diabetes: an interview study of inpatients' and general practitioners' attitudes in the South of France.

AIM: The aim of this study was to evaluate attitudes in hospital inpatients and physicians towards Ramadan fasting and diabetes in Marseille. METHODOLOGY: This cross-sectional study was conducted during the three months prior to the month of Ramadan. A total of 101 patients (age: 57±17 years) and 101 general practitioners (GPs) were recruited into the study. RESULTS: The patients had low levels of education (52% illiteracy). Of the 101 patients, 52 continued to fast during Ramadan, and only 65 patients had discussed the matter with their GP. Of these, 36 were told that fasting was forbidden, but more than half (n=19) fasted despite the medical advice. Six patients thus experienced daily hypoglycaemia because they had continued to take their hypoglycaemic agent or insulin analogue at noon. Both inadequate education and religious attitudes were found to endanger patients during the fast: 15 patients skipped the meal scheduled before dawn, five of whom persisted in taking their sulphonylurea. Also, 27% of patients refused, in spite of daytime hypoglycaemia, to ingest anything orally to avoid breaking their fast. Among the GP population, medical knowledge of Ramadan fasting with diabetes was low, leading to medically unjustified negative advice for fasting and a lack of patient education on adjusting treatments. This particular situation weakened the patient-physician relationship. CONCLUSION: This study confirms the importance of Ramadan fasting for Muslim patients, and reveals a wide cross-cultural gap between GPs and their patients. Systematic advice on treatment adjustment needs to be given. For this reason, we encourage more sensitive care of these patients and more medical training for physicians.

An anthropometric study of relationships between the clival angle and craniofacial measurements in adult human skulls.

UNLABELLED: STATING BACKGROUND: The clival angle, between the ethmoidal plane and the clival plane, measures the cranial base angulation. Relations between cranial base angulation and facial patterns have been discussed and present contradictory evidence. The aim of this study is to determine whether correlations could be found between the clival angle and craniofacial measurements. METHODS: This study was carried out on a sample of 235 human skulls. Twenty landmarks were marked. The clival angle and 16 other variables were measured and compared using analysis of variance. RESULTS: Statistical analysis showed a relationship between the clival angle and six measurements (P < 0.05). There was a positive correlation between the clival angle and the cranial lengths, the nasomaxillary sagittal measurements and palatal length but the width of the foramen magnum had a negative correlation. No significant relationship was found between the clival angle and the cranial height and widths, the palatal width, the length of the foramen magnum and the mandibular measurements. CONCLUSIONS: The trends found in this study with regard to the craniofacial lengths show that the nasomaxillary complex in humans has a stable position lying beneath the anterior cranial base. Transversal, vertical and mandibular variables have a more independent relationship.

Relationship between formation of the femoral bicondylar angle and trochlear shape: independence of diaphyseal and epiphyseal growth.

During hominin evolution, an increase in the femoral bicondylar angle was the initial change that led to selection for protuberance of the lateral trochlear lip and the elliptical profile of the lateral condyle. No correlation is found during ontogeny between the degree of femoral obliquity and of the prominence of the lateral trochlear lip. Might there be a relationship with the elliptical profile of the lateral condyle? On intact femoral diaphyses of juvenile humans and great apes, we compared the anteroposterior length of the lateral and medial sides of the distal metaphysis. The two diaphyseal pillars remain equal during postnatal growth in great apes, while the growth of the lateral pillar far exceeds that of the medial pillar in humans. Increase in bicondylar angle is correlated with disproportionate anteroposterior lengthening of the lateral pillar. The increased anteroposterior length of the lateral side of the metaphysis would contribute to increasing the radius of the curvature of the lateral condyle, but not to the projection of the lateral trochlear lip. The similar neonatal and adult femoro-patellar joint shape in humans prompted an assessment of the similarity during growth of the entire neonatal and adult epiphyses. We showed that the entire epiphysis undergoes drastic changes in proportions during postnatal growth. Finally, we emphasize the need to distinguish the cartilaginous phenotype and the ossified phenotype of the distal femoral epiphysis (and of any epiphysis) during postnatal growth. This crucial distinction applies to most postcranial bones, for they almost all develop following the process of endochondral ossification.

Distribution of the C282Y and H63D polymorphisms in hereditary hemochromatosis patients from the French Basque Country.

The distribution of HFE mutations was studied in patients from the French Basque Country with hereditary hemochromatosis (HH). The C282Y mutation was underrepresented but H63D seemed to demonstrate the highest prevalence when compared with other European countries. In addition, symptomatic HH was rarer in autochthonous Basques. This profile is interesting to consider in view of population genetics and should be associated with the search for non-HFE mutations.

Enthesopathies (lesions of muscular insertions) as indicators of the activities of neolithic Saharan populations.

Enthesopathies are bony lesions involving the sites of insertion of muscles or ligaments. Those caused by hyperactivity of the relevant muscles may be distinguished clearly from those of metabolic or inflammatory origin. Observations from sporting and occupational medicine indicate that specific enthesopathies are correlated with different activities. Examination of the enthesopathies present on two groups of well-preserved neolithic skeletons from separate regions of the Sahara with different paleoenvironments show that overall 20% of the skeletons presented lesions. Three different forms of enthesopathy involved the arm, principally the elbow, and may be tentatively correlated with javelin throwing, wood cutting, and archery. Two types of lesion involving the foot were observed in skeletons from a hunter-gatherer population and may be correlated with much walking or running over hard ground. I suggest that the analysis of such lesions on ancient skeletons may, in concert with other archaeological data, throw light on the activities of ancient people.

[Bilateral SLAC (scapholunate advanced collapse) wrist: an unusual entity. Apropos of a 7000-year-old prehistoric case]. / SLAC wrist bilatéral: une entité à part. A propos d'un cas préhistorique de 7,000 ans.

SLAC (Scapho-Lunate Advanced Collapse) wrist is the most common form of osteoarthritis of the wrist. The main aetiology is ligamentous rotary subluxation of the scaphoid. The authors report on a case of bilateral SLAC wrist, identified on a prehistoric skeleton derived from the Hassi-el-Abiod site in the malian Sahara (Dutour, 1989). The paleopathological study consisted of macroscopic examination and radiological examination. Radiocarbon dating situated this human occupation to 7 thousand years ago. The diseases observed included bilateral radiocarpal lesions in an adult male individual. The degree of preservation of the carpal skeleton was 90%. Lesions were bilateral, but predominantly affected the right side. The radial styloid processes presented a lateral osteophytic cuff, giving a tapered "pen-nib" appearance. The scaphoid has a normal shape, but presented posterior and lateral osteophytes. The scaphoid surfaces of the two distal extremities of the radius and the corresponding parts of the scaphoid showed characteristic polishing. X-rays showed a band of condensation corresponding to the ivory region on the articular surfaces. In this case, the bilateral nature and the absence of any obvious macrotraumatic aetiology suggest that the only aetiology was progressive and bilateral ligamentous distension, due to repeated microtrauma analogous to that observed in sports disease (volley-ball) or in occupational diseases (jackhammer). The manufacture of stone tools (carved or polished) can be incriminated in the pathogenesis of these lesions. These lesions are therefore useful markers of repeated microtraumatic activities or "activity markers". The is the first paleopathological description and the oldest known case of bilateral SLAC wrist.