A case of secondary hypertrophic osteoarthropathy from medieval Tuscany (central Italy, 10th-12th centuries CE).

OBJECTIVES: This study aims to provide a detailed evaluation of a case of secondary hypertrophic osteoarthropathy (HOA) and to explore insights into the presence and consequences of disease in medieval rural Italy. MATERIALS: The skeleton of a male (US 4405) with an estimated age at death of 51-69 years excavated from the medieval rural site of Pieve di Pava (Siena, Italy). METHODS: Macroscopic and radiological (x-ray, CT) analyses were performed. RESULTS: Symmetrical extensive periosteal new bone formation on the diaphyseal and metaphyseal regions of this individual's long bones; the lower limbs were more extensively and severely affected than the upper limbs and the distal segments were more severely altered in comparison to the proximal ones. CONCLUSIONS: The macroscopic and radiological features are highly consistent with a diagnosis of secondary HOA. SIGNIFICANCE: The excellent state of preservation allowed the evaluation of rarely noted skeletal manifestations of HOA and provided insight into aspects of rural life in medieval Italy. LIMITATIONS: Molecular analysis was not successful in sequencing the aDNA of tuberculosis, therefore the underlying primary cause of secondary HOA, whether pulmonary or extrapulmonary, remains obscure in this case. SUGGESTION FOR THE FUTURE RESEARCH: It is advisable to regularly revisit the data available from osteoarchaeological collections in order to identify further cases of HOA, along with to further investigate the known cases to search for the underlying primary disease.

Contextualizing bilateral asymmetry and gender: A multivariate approach to femoral cross-sectional geometry at rural Medieval Pieve di Pava, Italy.

OBJECTIVES: Our objective was to identify the relationship between biocultural factors of sex-gender and age and patterns of femoral cross-sectional geometry with historical evidence about labor and activity from an archeological skeletal sample excavated from the rural Medieval site Pieve di Pava. MATERIALS AND METHODS: The study site, Pieve di Pava, was a rural parish cemetery in Tuscany with osteoarcheological remains from the 7th to 12th centuries. Cross-sectional geometric analysis of femora from 110 individuals dated to the 10th-12th centuries were used to examine trends in bone quantity, shape, and bending strength between age and sex groups, as well as in clusters identified through Hierarchical Cluster Analysis (HCA). RESULTS: Overall, our study sample showed remarkable heterogeneity and our cluster analysis revealed a complex underlying structure, indicating that divisions of labor did not follow a strict gender binary in our sample. We found high levels of bilateral asymmetry in our sample in multiple cross-sectional areas for a significant proportion of the population. We found minimal differences between age groups or sex. DISCUSSION: Our results suggest that males and females had varied experiences of labor and work during their lives that did not reflect the strict binary gender roles sometimes documented for medieval Europe. One important axis of difference is the direction and magnitude of bilateral asymmetry observed in our femur sample, which is associated with divergent trends in section moduli and bone area measures.

Computer tomography and magnetic resonance for multimodal imaging of fossils and mummies.

The study of fossils and mummies has largely benefited from the use of modern noninvasive and nondestructive imaging technologies and represents a fast developing area. In this review, we describe the emerging role of imaging based on Magnetic Resonance (MR) and Computer Tomography (CT) employed for the study of ancient remains and mummies. For each methodology, the state of the art in paleoradiology applications is described, by emphasizing new technologies developed in the field of both CT, such as micro- and nano-CT, dual-energy and multi-energy CT, and MR, with the description of novel dedicated sequences, radiofrequency coils and gradients. The complementarity of CT and MR in paleoradiology is also discussed, by pointing out what MR provides in addition to CT, with an overview on the state of the art of emerging strategies in the use of CT/MR combination for the study of a sample following a multimodal integrated approach.

Exploring activity-induced dental modifications in medieval Pieve di Pava (central Italy, 10th-12th centuries AD).

OBJECTIVE: This study aims to investigate the following aspects: i) presence of activity-induced dental modifications (AIDMs) in a medieval population from Pieve di Pava (Siena, central Italy); ii) sex-specific and age-specific distribution of AIDMs in the sample; iii) potential correlations between AIDMs and the tradi tional activities and cultural habits of rural communities in medieval Italy. DESIGN: The permanent teeth of 204 individuals buried at Pieve di Pava (10th-12th centuries AD) were systematically examined in order to assess the distribution of five types of AIDM, i.e. lingual surface attrition of the maxillary anterior teeth (LSAMAT), excessive occlusal load, grooving, notching, and chipping. RESULTS: Prevalence rates of LSAMAT, excessive occlusal load and grooving were low, whereas higher frequencies were recorded for the other types of AIDMs. Prevalence was higher in the male subsample for all the modifications recorded. Overall, the frequencies of AIDMs increased with age. CONCLUSIONS: The very low prevalence of LSAMAT was thought to be connected to leatherworking in the sample under study, while excessive occlusal load was interpreted as evidence that hard materials requiring preliminary chewing and softening were not regularly processed with teeth. The unique case of interproximal grooving in an old male individual may reflect the use of a toothpick for therapeutic purpose. Conversely, the very high prevalence of notching and chipping was taken as indicative of the processing of wool fibers. The sex-specific distribution of these AIDMs suggests that males performed activities involving the use of teeth more frequently than females.

Paleopathology of Endocranial Lesions: A Possible Case of a Middle Meningeal Artery Aneurysm in an Etruscan Child from Pontecagnano (Southern Italy).

A middle meningeal artery (MMA) aneurysm is a type of intracranial aneurysm that has been rarely documented and is not completely understood in clinical medicine and especially in pediatrics, because juvenile cases have been extremely uncommon. Vascular conditions have occasionally been diagnosed in osteoarchaeological remains, providing evidence of their occurrence in previous eras. In the present report, we have described a lesion that was highly consistent with a case of an MMA aneurysm observed in an Etruscan child, whose remains had been exhumed during archaeological excavations in the necropolis of Pontecagnano (Salerno, southern Italy). The remains date back to the seventh to sixth century BC. Macroscopic and radiological examinations revealed an oval depression in the endocranial area corresponding to the parietal branch of the right MMA. The localized thinning of the bone and the absence of a bone reaction were compatible with a long-lasting compression of vascular origin highly consistent with an MMA aneurysm. Primary malignant bone tumors, bone metastasis, benign neoplastic conditions, and other non-neoplastic conditions, including calvarial venous malformations, eosinophilic granuloma, and sarcoidosis, could be excluded from the differential diagnosis, although the occurrence of other pathologies, such as dural arteriovenous fistulas, could not be rejected. Although it was not possible to definitely establish whether the MMA aneurysm was symptomatic, it could not be ruled out that rupture and subsequent extradural hemorrhage and/or intracranial hemorrhage could have caused the death of the child. From a paleopathological viewpoint, the case illustrated provides an interesting historical perspective on a rare neurovascular disorder that continues to be debated in modern clinical research.

Maxillary sinusitis as a respiratory health indicator: a bioarchaeological investigation into medieval central Italy.

OBJECTIVE: This study aims to assess chronic maxillary sinusitis in an osteoarchaeological sample from the medieval rural site of Pieve di Pava (central Italy), to investigate triggers responsible for sinus inflammation, and to compare prevalence rates with coeval European rural sites. MATERIALS: The analysis focused on 145 10th-12th-century adults with at least one preserved maxillary sinus. METHODS: Sinusitis-related lesions were observed macroscopically and microscopically. Alveolar pathologies of the maxillary posterior dentition were recorded to investigate the impact of odontogenic sinusitis. RESULTS: Maxillary sinusitis was observed in 23.4% of the individuals (n = 34), with similar frequencies in both sexes and bilateral sinusitis appearing more frequently than unilateral sinusitis. An association of alveolar lesions with sinusitis was found in 38.2% of cases. CONCLUSIONS: Compared to coeval rural sites in Northern Europe, Pieve di Pava shows the lowest prevalence of maxillary sinusitis, likely reflecting a greater amount of time spent outdoors. Despite the small size of the sample, odontogenic sinusitis cannot be ruled out. SIGNIFICANCE: This is the first Italian study to investigate maxillary sinusitis and to focus on the Mediterranean area, contributing to the understanding of this condition as a health indicator in ancient populations. LIMITATIONS: Research limitations include preservation issues affecting the number of observable sinuses, the non-homogenous age distribution of the sample, and the impact of inclusion and methodological criteria on the comparability of results. SUGGESTIONS FOR FURTHER RESEARCH: Further investigations into odontogenic sinusitis and the microscopic examination of dental calculus may provide new data on the pathogenesis of sinusitis.

A possible case of juvenile idiopathic arthritis from Renaissance Lucca (Tuscany, central Italy).

OBJECTIVE: The skeletal remains of a young individual (Guinigi US 1278) are described and a differential diagnosis is performed to determine the potential etiology of bone alterations. MATERIALS: Archaeological excavations conducted at the private funerary chapel of the upper class members of the Guinigi family (14th-17th centuries AD) of Lucca (Tuscany, central Italy) brought to light the fragmented human skeletal remains of a young individual (Guinigi US 1278) with pathological osseous modifications. METHODS: Morphological and radiological analyses were followed by differential diagnosis. RESULTS: Guinigi US 1278 was a non-adult aged 16-20 years, who exhibited florid skeletal alterations in the form of vertebral fusion and extensive subchondral bone changes of the small and large joints of the appendicular skeleton. The severity of the resorptive process in the peripheral joints, as well as vertebral fusion, indicates a long-standing inflammatory process. CONCLUSIONS: The features and the distribution of the skeletal lesions of Guinigi US 1278 are highly consistent with a form of juvenile idiopathic arthritis (JIA), leading to irreversible phenomena such as subchondral erosive lesions and axial ankylosis, with impairment of the gait and neck movements. SIGNIFICANCE: While abundant clinical literature on JIA is available, paleopathological studies are scarce. The possible case of JIA from Lucca provides a direct opportunity to examine the chronic course of rheumatic disease in young individuals in the absence of appropriate medical therapies in the antiquity. SUGGESTIONS FOR FURTHER RESEARCH: Future molecular analyses might be able to identify specific alleles of the HLA region responsible for JIA subtypes.

Dental health in adults and subadults from the 16th-century plague cemetery of Alghero (Sardinia, Italy).

OBJECTIVE: The aim of this study is to examine a set of dental health indicators, including caries, periodontal disease, abscesses, ante-mortem tooth loss, calculus, and tooth wear of a 16th-century population from the city of Alghero, Sardinia (Italy), in order to evaluate the state of dental health and the diet. DESIGN: The cemetery is referable to the plague outbreak that ravaged the city in 1582-1583. A total of 160 individuals (81 adults and 79 subadults) were suitable for dental examination. RESULTS: The oral conditions of the urban population of Alghero are characterised by high frequency of carious lesions, periodontal disease, ante mortem tooth loss, and calculus, but a low prevalence of abscesses and moderate tooth wear are recorded. In general, no statistically significant sexual differences are observed, suggesting a uniform scenario for diet access and oral health. The subadult subsample shows moderate rates of caries and is affected by calculus. The results suggest that the diet was rich in soft and refined food, with a prevalence of carbohydrates and cariogenic aliments; the effects of the diet are associated with a lack of oral hygiene. CONCLUSIONS: The patterns of dental health observed in the Alghero population fit with the data observed in other Modern Age samples, reflecting increased prevalence of dentoalveolar diseases resulting from a less abrasive diet and an increase in carbohydrate consumption, as documented during the transition from the Middle Ages to the Modern period.

Identification of Italian Renaissance noble women through a bioarchaeological study of skeletal remains.

Three female skeletons, dated back to the beginning of the 15th century were recovered during an archaeological excavation in the Guinigi Chapel in Lucca (Italy). Archaeological and historical sources indicated that the remains might be those of Paolo Guinigi's wives. At the beginning of the 15th century Paolo Guinigi ruled Lucca for nearly 30 years (1400-1429), providing a long period of wealth and peace to the city. In those years of power Paolo Guinigi married four women from different countries. This study is aimed at identifying the three skeletons of Paolo's wives found in the Guinigi Chapel. The three skeletons were identified using a multidisciplinary approach, by integrating historical, archaeological, anthropological, and isotopic data. The anthropological studies evidenced the biological profile of two adult women and of one adolescent female, in agreement with the historical descriptions of three of the four wives of Paolo Guinigi. The isotopic analysis supported the identification of each individual.

Multiple osteomata from medieval Tuscany, Italy (ca. 10th-12th AD).

OBJECTIVE: To explore the possible etiology of multiple osteomata on a skull and long bones from an individual from a medieval site in Tuscany, Italy. MATERIALS: Human skeletal remains dating to the 10th-12th century AD from the parish church of S. Pietro in Pava, in the province of Siena (Tuscany, Central Italy). METHODS: Macroscopic and imaging analyses (Cone Beam Computed Tomography). RESULTS: Nine round-shaped new bone formations are observed on a female individual aged 40-50 years. The lesions have a smooth surface and range from 2.2-6 mm in diameter. CONCLUSIONS: Cone Beam Computed Tomography confirmed that the lesions were composed of compact bone. Macroscopic and radiological features suggest the presence of nonsyndromic multiple osteomata. SIGNIFICANCE: Single cranial osteomata are commonly observed in osteoarchaeological remains, but multiple osteomata are rare and might assist in our understanding of neoplastic conditions in the past. LIMITATIONS: The lack of soft tissues prevents the diagnosis of complex disorders, such as the Gardner syndrome, which is characterised by multiple osteomata and polyposis of the colon. SUGGESTIONS FOR FURTHER RESEARCH: Careful investigation and reporting of all neoplastic lesions in ancient human remains in order to increase our knowledge about the etiology in past human populations.

Metastatic Prostate Carcinoma from Imperial Rome (1st to 2nd Centuries AD).

OBJECTIVE: This study describes and discusses a rare case of metastatic carcinoma that affected the skeleton of an adult male recovered in the necropolis of Casal Bertone in Rome (Italy). The necropolis, which dates back to the Imperial Age (1st to 2nd century AD), is located near some residential structures and a large place identified as a fullery (fullonica). METHODS: Anthropological and paleopathological studies of the skeletal remains were performed via careful macroscopic, microscopic, radiological (X-ray and CT scan), and histological investigation. RESULTS: The skeleton displayed mixed osteoclastic and osteoblastic lesions that mainly involved the axial bones, in particular the sternum, the ribs, the spine, and the scapular and pelvic girdles. The anatomical distribution and the destructive and proliferative nature of the lesions suggested diffuse metastases arising from a soft-tissue primary cancer. The age and sex of the individual, as well as radiographic and histological pictures, allowed diagnosis of an advanced prostate cancer with extensively diffused bone metastases. CONCLUSION: At present, this is the only case of prostate cancer from the Imperial Age recovered in Rome.

Linear Cutting Trepanation in Italy: A Unique Case from Hellenistic Sicily (Third Century BC).

During the archaeological excavations conducted in the Hellenistic necropolis discovered in Messina (Sicily, Italy) dating back to the 3rd century BC., a skeleton showing evidence of cranial traumas and surgical intervention was found. The skull, belonging to a young adult male, presented signs of 4 head injuries produced by both blunt and sharp-edged instruments. The first 2 lesions, located on the frontal bone, were produced by blunt blows and showed signs of long-term survival. The third lesion, located on the inferior portion of the right parietal, suggests a perimortem nonpenetrating linear cut likely caused by a blade instrument. Finally, a rectangular bone loss is visible on the left parietal bone, involving the full cranial thickness with well-delimited cutting edges and no sign of a reparative process. This injury can be interpreted as the result of a trepanation, performed with the technique defined as "linear cutting" and obtained through 4 linear incisions in parallel pairs intersecting at the right angles. The trepanation is likely related to the multiple head injuries exhibited by the patient, who unfortunately did not survive the surgical intervention. Trepanation in Italy has been largely attested since Prehistoric times, but the case from Messina represents the first evidence of neurosurgical intervention performed through the linear cutting technique in the Italian context and the second case in the whole of Europe. This technique might have been imported in Sicily during the Hellenistic period from the Near East, where it is clearly attested.

Paleopathological evidence of paranasal lesions: Two cases of frontal sinus osteomata from Imperial Rome.

The archaeological excavations carried out in 1999 in the Collatina necropolis of the Roman Imperial Age (1st-3rd centuries AD) (Rome, Italy) discovered the skeletal remains of two adult males with evidence of paranasal lesions. Both individuals showed postmortem damage in the frontal bone, through which it was possible to macroscopically detect an oblong new bone formation. In both specimens, radiological examination of the defects' morphology showed new pediculated-based bone formations. Radiology also confirmed the presence of benign osseous masses arising from the right frontal sinus and interpreted as osteomata. Their dimensions did not exceed 10 mm, so that mechanical complications and compression of the adjacent structures could be ruled out. The osteomata of paranasal sinuses are rarely reported in paleopathology, since they can be discovered only incidental to bone breakage or radiography. Hence, the evaluation of their occurrence in past populations represents an important challenge. The two cases presented here show direct and rare evidence of frontal sinus osteomata dating back to the Roman Imperial Age.

On the history of gout: paleopathological evidence from the Medici family of Florence.

OBJECTIVES: Throughout history, gout has been referred to as the "disease of the kings", and has been clearly associated with the lifestyle of the aristocratic social classes. According to the written sources, several members of the famous Medici family of Florence suffered from an arthritic disease that contemporary physicians called "gout". A paleopathological study carried out on the skeletal remains of some members of the family, exhumed from their tombs in the Church of San Lorenzo in Florence, offered a unique opportunity to directly investigate the evidence of the arthritic diseases affecting this elite group. METHODS: The skeletal remains of several members of the family were examined macroscopically and submitted to x-ray investigation. RESULTS: The results of the study allowed us to ascertain that the so-called "gout of the Medici" should be considered the clinical manifestation of three different joint conditions: diffuse idiopathic skeletal hyperostosis, rheumatoid arthritis and uratic gout. In particular, uric acid gout was diagnosed in the Grand Duke Ferdinand I (1549-1609). Recently, a new case of this disease was diagnosed in Anton Francesco Maria (1618-1659), a probable illegitimate member of the family. CONCLUSIONS: With this new case, uratic gout was observed in 2 out of 9 adult males, leading to suppose that the disease should have been a common health problem within the family. The aetiology of the disease has to be searched in environmental factors, since both historical and paleonutritional studies demonstrated that the diet of this aristocratic court was rich in meat and wine.

A Dental Prosthesis from the Early Modern Age in Tuscany (Italy).

BACKGROUND: During archaeological excavation, carried out in the S. Francesco Monastery at Lucca (Tuscany, Italy), a golden dental appliance was discovered. The prosthesis was found, together with commingled human remains, in the collective tomb of the aristocratic family of the Guinigi, a powerful family who governed Lucca from 1392 until 1429. The exact archaeological dating of the prosthesis was not possible, but some elements suggest a dating to the beginning of the 17th century. PURPOSE: Aim of the paper is to study and describe the dental appliance trough a multidisciplinary approach. MATERIALS AND METHODS: Macroscopical and micro-CT examinations were performed to investigate the technics used for the realization of the dental prosthesis. SEM analysis was performed to study alloy composition of the metallic fixing lamina and microstructure of the deposits on the dental surface. RESULTS: The dental prosthesis consists in five mandibular teeth: three central incisors and two lateral canines linked together by a golden band inserted into the dental roots to replace the anterior arch of the jaw. Micro-CT scan revealed the presence of two small golden pins inserted into each tooth crossing the root and fixing the teeth to the internal gold band. SEM examination of the lamina indicated a homogeneous composition, with average contents of 73 wt% gold, 15.6 wt% Ag, and 11.4 wt% Cu. Apposition of dental calculus on the teeth indicated that the prosthesis had been worn for a long period. CONCLUSIONS: This dental prosthesis provides a unique finding of technologically advanced dentistry in this period. In fact, during the Early Modern Age, some authors described gold band technology for the replacement of missing teeth; nevertheless, no direct evidences of these devices have been brought to light up so far.

Autoptic practices in 16th-18th century Florence: Skeletal evidences from the Medici family.

During the late Middle Ages and the Renaissance autopsy started to be practised for medico-legal purposes in order to investigate the causes of death. The other reason for dissecting a body was embalming, a diffused custom typical of the elitarian classes. The exploration of the Medici tombs in the Basilica of San Lorenzo in Florence offered the opportunity to investigate the practice of autopsy on these aristocratic personages of the Renaissance and Early Modern Age. A total of 25 currently skeletonized individuals, almost all of whom formerly artificial mummies, were exhumed. Accurate examination of the skeletons revealed evident signs of autoptic practices such as horizontal and oblique craniotomies, longitudinal and transversal cuts of the sternum, and sectioning of the sternal extremities of the ribs. In this group, women were treated differently to men at autopsy, as only men underwent craniotomy; autopsy and embalming were carried out also for the illegitimate members of the family and for subaldults. The extremely rich documentary archives of the Medici family confirm that the corpses were in several cases submitted to autopsy. The present study offers important direct information on the 16-18th century autoptic practices that the court surgeons in Florence performed on the members of the elite class.

[PALEOPATHOLOGY OF HUMAN REMAINS]. / PALEOPATOLOGIA DEI RESTI UMANI.

Many diseases induce alterations in the human skeleton, leaving traces of their presence in ancient remains. Paleopathological examination of human remains not only allows the study of the history and evolution of the disease, but also the reconstruction of health conditions in the past populations. This paper describes the most interesting diseases observed in skeletal samples from the Roman Imperial Age necropoles found in urban and suburban areas of Rome during archaeological excavations in the last decades. The diseases observed were grouped into the following categories: articular diseases, traumas, infections, metabolic or nutritional diseases, congenital diseases and tumours, and some examples are reported for each group. Although extensive epidemiological investigation in ancient skeletal records is impossible, the palaeopathological study allowed to highlight the spread of numerous illnesses, many of which can be related to the life and health conditions of the Roman population.

Bone deformities and skeletal malformations in the Roman Imperial Age.

This paper describes some cases of individuals affected by skeletal deformities resulting in "freak" appearance. The skeletal remains were found during large archaeological excavations in the Roman territory, carried out by the Special Superintendence to the Archeological Heritage of Rome in the last years, dated back to the Imperial Age. The first cases reported are referred to two growth disorders with opposite effects: a case of dwarfism and another of gigantism. The former concerns a young man from the Collatina necropolis with very short and malformed limbs, which allowed a diagnosis of acondroplasic dwarfism, a rare congenital disorder that limits height below 130 cm. The latter case comes from the necropolis of Torre Serpentana in Fidenae, and is instead referred to a young person of very high stature, about 204 cm, suffering from Gigantism, a rare condition which in this case seems to have been linked to a hormonal dysfunction due to a pituitary adenoma. A third case regards a joint disease affecting the vertebral column and causing severe deformities. The skeleton was found in the Collatina necropolis and belongs to an old woman, suffering from ankylosing spondylitis. Finally, the last and very peculiar case is related to an individual recovered in the necropolis of Castel Malnome. The skeletal remains belong to an adult man with a complete fusion of the temporo-mandibular joint, which compromised mastication and caused severe deformation of the maxillofacial complex. These cases are described in detail together with the possible implications that these deformities could have on in the social context.

Osteobiography of a 19th century elderly woman with pertrochanteric fracture and osteoporosis: a multidisciplinary approach.

In this paper the osteobiography of an elderly woman recovered from a cemetery tomb where she was buried in 1850, affected by hip fracture and osteoporosis, is described. The overall anthropological characteristics of the individual have been investigated. Macroscopic, radiographic, tomographic, microscopic, and chemical and structural examinations have been performed to give a detailed account of the condition of the skeleton. A non-union pertrochanteric fracture not surgically treated and probably due to senile osteoporosis was diagnosed. The consequences of the fracture to the bones show that this individual likely survived several years following the injury. The osseous features we describe (remodelled bone at the fracture site, asymmetry of entheseal changes likely related to the particular walking pattern of the individual) may be useful in personal identification of skeletons of legal interest. Regarding the recognition of osteoporosis in unearthed skeletons, our study underlines that the cortical thickness, microscopic features, degree of crystallinity and Ca/P ratio represent more useful elements than the mean bone density, mineral/matrix ratio and mineral maturity, which are more sensitive to diagenetic changes that affect the mineral phase post-mortem.