Five autopsy reports of rib fractures in the mental hospital of Reggio Emilia (1874-5): pathogenesis proposal in defence of the 'non-restraint' system.

At the end of the nineteenth century, recurrent cases of rib fractures were recorded in psychiatric asylums, opening a long chapter of discussions about the application of the 'non-restraint' system. Here we present a brief discussion of an article written by Enrico Morselli about five cases of rib fractures in the mental asylum of Reggio Emilia, in 1874-5. Morselli, a supporter of the ideas of 'non-restraint', suggested a common pathological cause. His analysis proposed the osteomalacic condition as the possible cause of fractured ribs, rejecting the accusations of violence by asylum attendants. The discussion also examines similar cases of the same period, making rib fractures the means through which the issue of management of the insane was addressed.

Co-morbidity with hypertrophic osteoarthropathy: A possible Iron Age Sarmatian case from the Volga steppe of Russia.

PURPOSE: Hypertrophic osteoarthropathy (HOA) is a condition that can be inherited or acquired. It causes diffuse periosteal new bone formation on the long bones, with a predilection for the appendicular skeleton. When acquired, it is a nonspecific indicator of systemic disease that arises following a primary condition. This paper reviews the palaeopathological literature associated with this rare condition. It also describes the first possible case of co-morbidity associated with hypertrophic osteoarthropathy in an adult skeleton (cal. BC 170 - 1 cal. AD) from the mobile pastoralist Sarmatian culture of the Volga steppes of Russia. METHODS: Macroscopic and radiological examination provide differential diagnoses of the lesions, while clinical and bioarchaeological analyses offer insights into the possible experience of disease and social implications of care among the nomadic populations of Iron Age Russia. RESULTS: The analysis of Sk. 6524.102 displays lesions that may be due to both hypertrophic osteoarthropathy and osteomalacia. The man was physically impaired and his participation in physically challenging activities would have been limited. CONCLUSIONS: The study stresses that co-morbidity is a key parameter when interpreting disease in past populations, particularly when the diagnosis involves hypertrophic osteoarthropathy. SIGNIFICANCE: This is the first case of hypertrophic osteoarthropathy identified in Eurasian prehistoric populations. The research emphasises the significance of co-morbidity in the past. LIMITATIONS: The diagnosis of co-morbid diseases in human remains is extremely complex and the conditions were identified as most probable by a process of elimination. SUGGESTIONS FOR FURTHER RESEARCH: Further studies should be dedicated to understanding co-morbidity in the past.

Analysis of patterning in the occurrence of skeletal lesions used as indicators of vitamin D deficiency in subadult and adult skeletal remains.

Paleopathological investigations of conditions linked to vitamin D deficiency have increased in the last twenty years, and a suite of skeletal lesions has been established to aid in the diagnosis of vitamin D deficiency disease in subadults and adults. This paper analyzes the occurrence of these lesions in a large skeletal series comprising 3541 Roman period individuals (1st-6th century AD). Sixteen lesions reported in rickets in subadults, and 13 associated with residual rickets and osteomalacia in adults, were analyzed. Among subadults, there were clear associations among post-cranial lesions. Porotic cranial changes were associated with each other, but not with post-cranial lesions. A range of conditions could have produced the cranial lesions. There was a general paucity of correlations between indicators found in adults, and the difficulty in recording bending deformities was clear. Pseudofractures appear to provide a useful means of investigating osteomalacia in adults. In general, a simple algorithmic approach using presence or absence of lesions is unlikely to provide an adequate means of diagnosing vitamin D deficiency in paleopathology. Knowledge and consideration of the underlying physiological mechanisms involved in lesion formation, combined with individual judgement, will be required to differentially diagnose cases.

Radiographically recognizable? An investigation into the appearance of osteomalacic pseudofractures.

Pseudofractures, lucent bands that occur due to a build-up of osteoid, are a key feature of osteomalacia. In paleopathology, pseudofractures are often marked by small, linear cracks in the cortex of the bone surrounded by irregular, bony spicule formation. Radiography can be used to help diagnose pseudofractures, both clinically and in paleopathology. A detailed understanding of the radiographic appearance of pseudofractures and their development is, therefore, necessary to aid a diagnosis of vitamin D deficiency. The present study examined the clinical literature to determine current ideas on the appearance of pseudofractures with the aim of applying this knowledge to paleopathology. A radiographic study of the characteristics of pseudofractures was performed on five individuals with clear skeletal features of osteomalacia from archaeological sites in Canada and the United Kingdom dating to the medieval period (5th to 15th centuries) and the 18th to 19th century. Results show that the radiographic appearance of pseudofractures could potentially reveal information about the cause of the deficiency and the chronicity of pseudofractures. This type of information has the potential to further our understanding of the lived experiences of archaeological individuals with osteomalacia.

Medical diagnostic methods applied to a medieval female with vitamin D deficiency from the north of Spain.

Vitamin D deficiency is a pathological condition that affects bone metabolism by preventing proper mineralization, which eventually leads to bone deformities and other pathological conditions such as osteoporosis, increased bone fragility and fractures. The aim of this study is to present a case of vitamin D deficiency, but also to note how the application of several complementary techniques is a fundamental step in the establishing an accurate diagnosis. These techniques range from classical palaeopathological analysis to modern clinical practice. After the macroscopic examination of a medieval female skeleton from Palencia (Spain), where various bone deformations were observed, a differential diagnosis could not establish a definitive cause. Radiological, bone density, and histological studies were carried out, finally allowing to confirm a vitamin D deficiency suffered in both childhood and adulthood. This is a clear example, with practical applications, of the importance of interdisciplinarity to reveal insights about the life history and physical health of ancient individuals.

Four possible cases of osteomalacia: The value of a multidisciplinary diagnostic approach.

Rickets and residual rickets are often encountered in Dutch archeological skeletal samples. However, no archeological Dutch paleopathological case of adult osteomalacia has been described in literature to date. This paper describes the first four archeological Dutch paleopathological cases of osteomalacia and assesses the value of the various modalities (macroscopic assessment, radiology and histology) that may be used for diagnosis. The skeletal remains investigated originate from the Meerenberg psychiatric hospital cemetery in Bloemendaal, the Netherlands, and date from 1891 - 1936. The remains of 69 adult individuals were inspected for macroscopic lesions which may be associated with osteomalacia. In cases suspect for osteomalacia, complimentary radiological and histological investigations (BSE-SEM and light microscopy) were performed. Macroscopically, four individuals presented with lesions (highly) suggestive of osteomalacia. Histological examination (both BSE-SEM and light microscopy) provided valuable information to come to an eventual diagnosis of osteomalacia in all four cases. Light microscopy proved to be an feasible alternative for BSE-SEM. The added value of radiological analyses was limited. The individuals identified were most likely patients in the psychiatric hospital, and the reason for their institutionalization and/or the regime in the institution may have played a role in the development of the osteomalacia observed.

Historical perspectives on cadmium toxicology.

The first health effects of cadmium (Cd) were reported already in 1858. Respiratory and gastrointestinal symptoms occurred among persons using Cd-containing polishing agent. The first experimental toxicological studies are from 1919. Bone effects and proteinuria in humans were reported in the 1940's. After World War II, a bone disease with fractures and severe pain, the itai-itai disease, a form of Cd-induced renal osteomalacia, was identified in Japan. Subsequently, the toxicokinetics and toxicodynamics of Cd were described including its binding to the protein metallothionein. International warnings of health risks from Cd-pollution were issued in the 1970's. Reproductive and carcinogenic effects were studied at an early stage, but a quantitative assessment of these effects in humans is still subject to considerable uncertainty. The World Health Organization in its International Program on Chemical Safety, WHO/IPCS (1992) (Cadmium. Environmental Health Criteria Document 134, IPCS. WHO, Geneva, 1-280.) identified renal dysfunction as the critical effect and a crude quantitative evaluation was presented. In the 1990's and 2000 several epidemiological studies have reported adverse health effects, sometimes at low environmental exposures to Cd, in population groups in Japan, China, Europe and USA (reviewed in other contributions to the present volume). The early identification of an important role of metallothionein in cadmium toxicology formed the basis for recent studies using biomarkers of susceptibility to development of Cd-related renal dysfunction such as gene expression of metallothionein in peripheral lymphocytes and autoantibodies against metallothionein in blood plasma. Findings in these studies indicate that very low exposure levels to cadmium may give rise to renal dysfunction among sensitive subgroups of human populations such as persons with diabetes.

"The English disease" or "Asian rickets"? Medical responses to postcolonial immigration.

Do the former colonizing powers, like their former colonies, have "postcolonial medicine," and if so, where does it take place, who practices it, and upon whom? How has British medicine in particular responded to the huge cultural shifts represented by the rise of the New Commonwealth and associated postcolonial immigration? I address these questions through a case study of the medical and political responses to vitamin D deficiency among Britain's South Asian communities since the 1960s. My research suggests that in these contexts, diet frequently became a proxy or shorthand for culture (and religion, and race), while disease justified pressure to assimilate.

Historia de los mecanismos fisiológicos y bioquímicos de la vitamina D / History of physiological and biochemical mechanisms of vitamin D

La historia moderna en relación con los mecanismos fisiológicos y bioquímicos de la hormona D se inicia con los trabajos del bioquímico de origen noruego, R. Nicolaysen, quien, influido por los trabajos de las dietas en los diferentes animales, concluye que la captación del calcio es guiada por un factor desconocido que alerta al intestino a las necesidades del calcio y termina con los estudios del investigador sueco Arvid Carlsson, premio nobel de medicina por sus hallazgos en las señales de transducción a nivel del sistema nervioso central; además realiza varios trabajos con la Vitamina D que demuestran las mismas ideas de Nicolaysen. En estos 60 años se narra la historia de la hormona D, se describen los estudios de Wasserman y los grandes trabajos de Héctor De Luca, descubridor de la 25 hidroxivitamina D, y Fraser y Kodiecek, el calcitriol. Se describe a la vez el conocimiento de la adaptación intestinal, la fotobiología de la vitamina D, los otros metabolitos de la vitamina D, los análogos de los hormona D, el sistema enzimático CYP, el receptor de la vitamina D, la transcaltaquia y los nuevos mecanismos de la hormona D. Faltando por descubrir muchos efectos de esta hormona y que le brindaron un futuro más halagüeño

Estudio de la osteomalacia y raquitismo en diferentes períodos históricos en colombia / Study of osteomalacia in diferent historical periods in Colombia

Dividimos el trabajo en tres etapas. En la primera buscamos la recopilación de la información sobre raquitismo y osteomalacia desde finales del siglo XIX hasta 1960. En la segunda etapa revisamos los archivos estadísticos de la Unidad de Reumatología del Hospital San Juan de Dios desde su creación en 1967, y los pacientes que se consultaban desde esa época. La tercera etapa fue dividida en dos sub-etapas, la primera sub-etapa se refiere al estudio prospectivo del foco de raquitismo en el municipio de Suárez en 1991, y la segunda sub-etapa trata sobre los casos prospectivos desde 1984 hasta Marzo del 2000 en la Clínica de Fracturas de Barranquilla, el Hospital San Juan de Dios de Bogotá, y los casos remitidos a uno de los investigadores. En la primera etapa sólo encontramos la tesis del Dr. Francisco Sorzano, publicada en 1899. Estudió 6 casos de raquitismo secundario, hipovitaminosis D y de desnutrición proteico calórica. Se utilizan por primera vez el aceite de hígado de bacalao y sales de calcio y fosfatos. A partir de 1960 se estudian 7 familias y se describen por primera vez en Colombia el raquitismo hipofosfatémico ligado al cromosoma X, es el caso de cuatro familias con raquitismo hipofosfatémico y dos familias con raquitismo hipocalcémico. En 1991 describimos el clúster más grande del mundo, aproximadamente 400 pacientes, pero sólo informamos sobre 64 pacientes. Demostramos qué es un raquitismo dependiente de vitamina D tipo IIB; es estudiado con más detenimiento el receptor de la vitamina D, el cual fue encontrado normal, aunque el defecto se encuentra a nivel posttranslacional. De forma prospectiva, a partir de 1984 estudiamos 19 pacientes con raquitismo y osteomalacia, asociadas a diferentes etiologías e introducimos los estudios de desintometría ósea, los niveles polares de vitamina D, hormona paratiroidea (PTH), y las iso-enzimas de la fosfatasa alcalina (AU)

Osteomalacia y raquitismo. análisis y estudio en diferentes períodos históricos en colombia / Osteomalacia and riketts. Analysis and study of different historic periods in Colombia

No disponible

Reflections on Dr Henderson of Perth's case of impracticable labour: an early case (1820) in which the caesarean operation was performed.

The rediscovery of a female pelvis with features characteristic of osteomalacia stimulated an enquiry into the clinical history of the woman involved. It was established that she died in 1820, aged 30. Despite being severely debilitated and confined to bed for some years with increasing skeletal deformities, she became pregnant, and in due course laboured unsuccessfully for about 102 hours. An elective caesarean section was performed, but she died some hours later, though her daughter survived and was appropriately christened Caesar Anna. This represents one of the earliest cases in which the caesarean operation was performed where the full obstetric history was carefully recorded by the obstetrician involved, Dr. Henderson of Perth. The case was clearly considered important, and in 1836 engravings of this pelvis were used to illustrate Professor Hamilton's "Practical Observations of Various Subjects Related to Midwifery". Such cases are now of great rarity in the developed world.

[Could the Czech King Ladislav Pohrobek have had hypophosphatemic osteomalacia caused by a neoplastic disease?]. / Mohl ceský král Ladislav Pohrobek trpet hypofosfatemickou osteomalácií vyvolanou nádorovým onemocnením?

Histological examination of undecalcified specimens from different parts of skeletal remnants of king Ladislaus revealed a considerable degree of demineralization of a similar type as found in osteomalacia. This fact along with the finding of multiple osteolytic foci in different parts of the skeleton, and consistent with reports of the clinical picture of the disease made the authors present the hypothesis according to which the king may have suffered from so-called oncogenic osteomalacia. This bone disease may develop as a complication of some neoplastic disease incl. haemoblastoses and haemoblastomas. The authors think that with regard to the age of the king, historical reports and the multiplicity of osteolytic lesions that the most plausible hypothesis is that of oncogenic osteomalacia associated with some type of malignant non-Hodgkin lymphoma.