Galen: The First Cardiac Surgeon?

It is widely believed that the first and the second pericardium surgeries were done in the nineteenth century by Francisco Romero and Dominique Jean Larrey, respectively; however, Galen was the first surgeon who proceeded with pericardiectomy. This ancient case report of sternum osteomyelitis and pericardiectomy illuminates some dark part of the history of medicine and the ability of physicians in that era.

Dental pulp exposure, periapical inflammation and suppurative osteomyelitis of the jaws in juvenile Baltic grey seals (Halichoerus grypus grypus) from the late 19th century.

The systematic analysis of museum collections can provide important insights into the dental and skeletal pathology of wild mammals. Here we present a previously unreported type of dental defect and related skull pathology in five juvenile Baltic grey seals that had been collected in the course of a seal culling program along the Danish coast in 1889 and 1890. All five skulls exhibited openings into the pulp cavities at the crown tips of all (four animals) or two (one animal) canines as well as several incisors and (in one animal) also some anterior premolars. The affected teeth showed wide pulp cavities and thin dentin. Pulp exposure had caused infection, inflammation, and finally necrosis of the pulp. As was evidenced by the extensive radiolucency around the roots of the affected teeth, the inflammation had extended from the pulp into the periapical space, leading to apical periodontitis with extensive bone resorption. Further spreading of the inflammation into the surrounding bone regions had then caused suppurative osteomyelitis of the jaws. The postcanine teeth of the pathological individuals typically had dentin of normal thickness and, except for one specimen, did not exhibit pulp exposure. The condition may have been caused by a late onset of secondary and tertiary dentin formation that led to pulp exposure in anterior teeth exposed to intense wear. Future investigations could address a possible genetic causation of the condition in the studied grey seals.

Use of Computed Tomography scanning in a 'virtual' bioarchaeology of care analysis of a Central Coast Peruvian mummy bundle.

BACKGROUND: CT scanning was utilized to investigate an intact mummy bundle within the bioarchaeology of care framework. The project sought to ascertain whether a 'virtual' analysis was feasible, thereby avoiding physical disturbance to bundle structure and contents. METHODS: The bundle selected for this study contained an adult male (FA 54), Ichma culture, Peru, displaying evidence for two pathologies: chronic osteomyelitis of the right tibia, and cranial trauma. CT images provided the basis for bioarchaeology of care analysis, which followed Index of Care protocols. RESULTS: CT images enabled description and diagnosis of FA 54, and revealed human neonate remains and material artifacts within the bundle. Probable disease impacts were identified, and likely forms of care provided were inferred. CT scanning was of limited value in identifying characteristics of textile wrapping (a clue to cultural identity) and in resolving questions regarding funerary treatment (primary vs. secondary burial), and this constrained consideration of wider social implications of caregiving. CONCLUSION: 'Virtual' examination of FA 54 achieved an advanced stage of bioarchaeology of care analysis, but building on this would require physical examination of bundle elements. Further investigation of CT imaging potential for bioarchaeology of care research in mummy studies is recommended.

A possible case of mycosis in a post-classical burial from La Selvicciola (Italy).

An examination of an adult male buried from the post-classical necropolis of La Selvicciola (Viterbo, Latium, Italy; 4th-6th centuries AD) revealed a series of skeletal lesions. The lesions, both proliferative and lytic, ranging in size from small (around 0.01 mm) to extensive (up to 16.00 mm) pits, occurred at multiple sites. A holistic approach assessed lesion type, frequency and location in a differential diagnosis, which included myeloma, metastatic carcinoma, tuberculosis, leukemia, osteomyelitis, and mycoses. It was concluded that a mycosis, specifically Cryptococcosis, was the most likely cause of these lesions. Both macroscopic analyses and X-ray scans support our diagnosis. We also provide a methodological scheme as a model for examining unknown lesion patterns.

A palaeopathological analysis of skeletal remains from Bronze Age Mongolia.

Little is known about the lifeways of the people who inhabited the Mongolian steppe during the Bronze Age (c. 4450-2650 BP). Palaeopathological analysis allows us to draw inferences about the lifeways of past people from the indicators of health and lifestyle recorded in human remains. This paper presents results of analysis of the remains of 25 individuals excavated in northern Mongolia. Overall, the remains demonstrated very little pathology. In particular the lack of evidence for both infectious and non-communicable diseases, along with the patterns of dental pathology indicate a group of people who experienced few health insults and little stress. The types of trauma, Schmorl's nodes and patterns of degenerative joint disease present in the sample are suggestive of interpersonal violence and horse riding. The findings are consistent with a traditional pastoral lifeway where people live in small groups, rely on a protein-rich diet and use animals for transportation.

Possible bite-induced abscess and osteomyelitis in Lufengosaurus (Dinosauria: sauropodomorph) from the Lower Jurassic of the Yimen Basin, China.

We report an osseous abnormality on a specimen of the sauropod dinosaur Lufengosaurus huenei from the Fengjiahe Formation in Yuxi Basin, China. A gross pathological defect occurs on the right third rib, which was subjected to micro-computed tomographic imaging as an aid in diagnosis. The analysis of pathological characteristics and the shape of the abnormality is incompatible with impact or healed trauma, such as a common rib fracture, and instead suggests focal penetration of the rib, possibly due to a failed predator attack. The identification of characteristics based on gross morphology and internal micro-morphology presented by the specimen, suggests an abscess with osteomyelitis as the most parsimonious explanation. Osteomyelitis is a severe infection originating in the bone marrow, usually resulting from the introduction of pyogenic (pus-producing) bacteria into the bone. Micro-tomographic imaging of the lesion suggests a degree of healing and bone remodelling following post-traumatic wound infection with evidence of sclerotic bone formation at the site of pathological focus, indicating that L. huenei survived the initial trauma. However, as osteomyelitis can express through widespread systemic effects, including a lowering of immune response and overall condition, this disease may have been a contributing factor to the eventual death of the individual.

Pediatric chronic osteomyelitis in the outskirts of Al-Ushbuna (Carnide, Lisboa, Portugal).

The skeletal remains of seven individuals (five non-adults and two adults) were recovered during an archeological intervention in the township of Carnide (Lisbon, Portugal). Funerary anthropology strongly suggests that the sample is from the Medieval Islamic period (8th - 12th centuries AD). This report presents a case of chronic osteomyelitis in a non-adult individual. The diagnostic is substantiated by the presence of pathognomonic signs of osteomyelitis, including the presence of cloacae and a sequestrum in the left tibia. The bone infection is discussed in the context of inadequate socioeconomic conditions. This case from a relatively unfamiliar chronology and cultural context supplements the uncommon paleopathological descriptions of osteomyelitis in non-adults from historical populations.

Clinical and microbiological features associated with group B Streptococcus bone and joint infections, France 2004-2014.

This study describes the clinical and microbiological features associated with group B Streptococcus (GBS) bone and joint infections (BJIs). It was a retrospective analysis of adult cases of GBS BJIs reported to the French National Reference Center for Streptococci from January 2004 to December 2014. Clinical data and GBS molecular characteristics are reported. Strains were collected from 163 patients. The most frequent comorbidities were: solid organ cancer (n = 21, 21%) and diabetes mellitus (n = 20, 20%). The main infection sites were knee (47/155 = 30%) and hip (43/155 = 27%), and occurred on orthopedic devices in 71/148 cases (48%). CPS III (n = 47, 29%), Ia (n = 26, 16%) and V (n = 40, 25%) were predominant. Resistance to erythromycin, clindamycin and tetracycline was detected in 55/163 (34%), 35/163 (21%) and 132/163 (81%) strains, respectively. The most frequent sequence types were ST-1 (n = 21, 25%), ST-17 (n = 17, 20%) and ST-23 (n = 11, 13%). The rate of resistance to erythromycin was 0% for ST-17 strains, 52% (n = 11) for ST-1 and 44% (n = 7) for ST-23 (p < 0.001). GBS bone and joint infections predominantly occur in patients aged >50 years and/or with comorbidities such as cancer and diabetes mellitus. CPS type distribution and MLST are very similar to that of other adult GBS invasive infections.

The Cause of Death of a Child in the 18th Century Solved by Bone Microbiome Typing Using Laser Microdissection and Next Generation Sequencing.

The history of medicine abounds in cases of mysterious deaths, especially by infectious diseases, which were probably unresolved because of the lack of knowledge and of appropriate technology. The aim of this study was to exploit contemporary technologies to try to identify the cause of death of a young boy who died from a putative "infection" at the end of the 18th century, and for whom an extraordinarily well-preserved minute bone fragment was available. After confirming the nature of the sample, we used laser microdissection to select the most "informative" area to be examined. Tissue genotyping indicated male gender, thereby confirming the notary's report. 16S ribosomal RNA sequencing showed that Proteobacteria and Actinobacteria were more abundant than Firmicutes and Bacteroidetes, and that Pseudomonas was the most abundant bacterial genus in the Pseudomonadaceae family. These data suggest that the patient most likely died from Pseudomonas osteomyelitis. This case is an example of how new technological approaches, like laser microdissection and next-generation sequencing, can resolve ancient cases of uncertain etiopathology. Lastly, medical samples may contain a wealth of information that may not be accessible until more sophisticated technology becomes available. Therefore, one may envisage the possibility of systematically storing medical samples for evaluation by future generations.

The changing epidemiology of bacteraemic osteoarticular infections in the early 21st century.

Osteoarticular infections (OAI), which are often associated with bacteraemia, seem to be increasing. We studied all patients with bacteraemia and concomitant OAI: septic arthritis (SA), vertebral osteomyelitis (VOM) or peripheral osteomyelitis (POM), which were seen at our institution (1985-2011). Data were extracted from a prospective protocol of bacteraemia cases recorded. Trends in main findings were considered in five periods. Major antibiotic resistance patterns were studied. A total of 601 cases of bacteraemic OAI, accounting for 1.8% of total bactaeremias, were studied: SA (48%), VOM (40%) and POM (17%). When comparing the 1985-91 and 2007-11 periods, the incidence of bacteraemic OAI increased from 2.34 to 5.78 episodes/100 000 inhabitants per year (p <0.001); and nosocomial and healthcare-related cases increased from 18% to 30% (p <0.001) and from 10% to 25% (p <0.001), respectively. Also, there was an increase of age (median, from 49 to 65 years, p <0.001), patients with comorbidities (23% to 59%, p <0.001), and device-related OAI (7% to 28%, p <0.001). Patterns of OAI were changing over time. Compared with younger patients, older adults (≥ 65 years) had more VOM, prosthetic-joint infections and enterococcal OAI. The percentage of OAI caused by methicillin-susceptible Staphylococcus aureus decreased, while those caused by methicillin-resistant S. aureus, streptococci, enterococci, and Gram-negative bacilli increased. There was a link between certain microorganisms with specific OAI and age of patients. Over the past three decades, bacteraemic OAI increased in association with aging and use of orthopaedic devices. Nosocomial and healthcare-related OAI increased, with a rise in multidrug-resistant bacteria. These trends should be considered when planning diagnostic and therapeutic guidelines for OAI.

Childhood bone tuberculosis from Roman Pécs, Hungary.

A child from a Roman necropolis in Pécs, Hungary (4th century CE) was initially diagnosed with severe spinal osteomyelitis. The post-cranial skeleton displayed bone alterations in the lower thoracic and upper lumbar segments, including vertebral body destruction, collapse and sharp kyphosis, and additional multiple rib lesions, suggesting a most likely diagnosis of pulmonary and spinal tuberculosis. This study discusses a number of selected diagnoses in the context of our pathological findings, complementing the macroscopic examination with radiological and biomolecular analyses.

[A birth with fatal outcome in 1866]. / En fatalt forløbende fødsel i 1866. En kasuistik med illustrationer.

A birth with fatal outcome for both the mother and the foetus was reported in the Danish medical journal, Bibliothek for Læger in 1868. Here, the article with its two illustrations is summarised because of the vivid description of the course together with the therapeutic considerations expressed by the obstetrician. Due to an earlier osteomyelitis the pregnant woman's spine was deformed and her pelvis was narrowed. The birth came to a standstill, and it became necessary to reduce the circumference of the foetus' cranium by perforation, after which the dead foetus could be delivered. The woman died of infection some days later. Afterwards her deformed lumbar spine and pelvis was removed, preserved and depicted in two lithographs. The preserved pelvis is still extant in the Saxtorphian obstetric collection in Medical Museion, Copenhagen.

The classic: The treatment of chronic osteomyelitis with the maggot (larva of the blow fly). 1931.

This Classic article is a reprint of the original work by William S. Baer, MD, The Treatment of Chronic Osteomyelitis With the Maggot (Larva of the Blow Fly). An accompanying biographical sketch on William Baer, is available at DOI 10.1007/s11999-010-1415-4 . The Classic Article is ©1931 by the Journal of Bone and Joint Surgery, Inc. and is reprinted with permission from Baer WS. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly). J Bone Joint Surg Am. 1931;13:438-475.

Biographical sketch: William S. Baer (1872-1931).

This biographical sketch on William S. Baer corresponds to the historic text, The Classic: The Treatment of Chronic Osteomyelitis With the Maggot (Larva of the Blow Fly), available at DOI 10.1007/s11999-010-1416-3.