Anemia or scurvy: A pilot study on differential diagnosis of porous and hyperostotic lesions using differential cranial vault thickness in subadult humans.

Metabolic disorders, such as scurvy, manifested in human skeletal remains provide insight into health, nutrition, and environmental quality in past populations. Porous cranial vault lesions are often used to diagnose metabolic conditions in subadult remains, but overlapping gross lesion expressions have led to over-diagnosis of anemia and under-diagnosis of scurvy. Studies by Ortner and colleagues have suggested that specific porous cranial lesions are pathognomonic of scurvy, but additional diagnostic tools are necessary. In this technical report, we offer a preliminary assessment of cranial vault thickness (CVT) at the site of porous lesions (sensu lato porotic hyperostosis, cribra orbitalia) as a method for distinguishing between scurvy and anemia in subadult crania. Computed Tomography (CT) was used to measure CVT at various landmarks associated with porotic hyperostosis and cribra orbitalia, complemented by lesion scores, from scorbutic (N=11), anemic (N=3), and non-pathological (N=28) subadult crania used as a control group. Results indicate that CVT consistently distinguishes scorbutic from non-pathological individuals, while anemic individuals overlap with both - likely a function of small sample size in this study. Despite current limitations, CVT has the potential to be an objective diagnostic tool for distinguishing scurvy and expanding reconstructions of nutritional adequacy over the life course in past populations.

Treponemal infection in Peru's Early Colonial period: A case of complex lesion patterning and unusual funerary treatment.

This study describes a series of skeletal lesions observed in a mid 16th century individual of an old adult female from the Early Colonial Period of northern coastal Peru. This fragmented skeleton revealed evidence of complex, active, and systemic chronic infection that included multiple pathological foci on the cranial vault, extensive pathological new bone formation in both arms, the sternum, ribs, left scapula, clavicles, femora, and fibulae, which was paralleled by extensive endosteal obliteration of affected long bone medullary cavities. Differential diagnosis included hematogenous osteomyelitis, Paget's disease, fluorosis, melorheostosis, endosteal hyperostosis, and hypertrophic osteoarthropathy. Simultaneous periosteal and endosteal bone deposition of the clavicles, in addition to patterns of florid bone deposition on long bones and superficial cavitation, point most directly to treponemal disease. Co-morbidity with a non-specified respiratory disease and well-healed fractures of the tibiae are also considered. We also relate this person's illness to the highly informal disposal of their body to underscore how social perceptions of disease may have shaped this unusual and informal funerary ritual. Ultimately, this research cautions against overly "tibia-centric" thinking regarding treponemal syndromes, raises questions regarding the history and nature of treponemal disease in Peru, and highlights cross-disciplinary connections between paleopathology and mortuary archaeology.

What skeletons tell us. The story of human paleopathology.

Human skeletal paleopathology provides important insight regarding the antiquity of some diseases and their distribution in past human groups. The history of human skeletal paleopathology extends back more than 150 years. Rudolf Virchow published reports on the subject, and research on paleopathology has provided critical data on important topics such as the origin of syphilis. With the development of powerful new research tools, human paleopathology will continue to be a source of data on the development of disease and its effect on human biological and cultural development.

Human skeletal paleopathology.

Human skeletal remains from archaeological contexts are the main source of data about the complex interaction between disease and humankind throughout the emergence of Homo sapiens. Past and current research on these remains has revealed the presence of many diseases that affect the skeleton today. There are, however, limitations in using data from such skeletal samples to reconstruct the health of past human groups. Recently developed diagnostic procedures and methods for extracting relevant data from skeletal tissue provide new options for exploring important questions and trying to clarify the role of disease in the evolutionary process that resulted in human societies today. These past histories hold important lessons for predicting future relationships between our species and its disease load.

Issues in paleopathology and possible strategies for dealing with them.

Human paleopathology has the potential of enriching what we can reconstruct about the lives of our recent and ancient ancestors. The development of remarkably sensitive analytical methods in chemistry and physics provides information that is still in the early stages of being used in research about human paleopathology. Research on mummy and skeletal tissues, both gross and histological, has vastly improved from the early studies in paleopathology. There are, however, nagging issues that have been identified as scientists attempt to conduct new research and interpret the research being done. These include the need for a greater emphasis on rigor in diagnosis of skeletal and soft tissue abnormalities; the establishment of additional research centers that recover and curate large, carefully documented archaeological samples of human remains; better integration between the medical fields of orthopaedic pathology and skeletal radiology with paleopathology; and improved design in the research conducted.

Skeletal manifestations of hypothyroidism from Switzerland.

Hypothyroidism is caused by a deficiency in the synthesis of thyroid hormone. Dwarfism is the most obvious skeletal manifestation, but most people with hypothyroidism do not have any skeletal evidence of the disease. When the skeleton is affected, the severity of this manifestation depends on the degree of the deficiency and age of onset. Endemic hypothyroidism typically is linked to specific ecological settings such as the high mountains where iodine is absent, or else it occurs with very low concentrations in water and soil. In these areas, the prevalence may be as high as 8%. The disease can be expected to occur in archaeological human skeletal samples from endemic regions. Sporadic hypothyroidism is caused by a deficiency in the thyroid gland itself, and is not linked to any specific environmental context. The disease may be the result of a genetic defect, but can also be caused by other pathological conditions that may affect the thyroid gland, including infection and cancer. The skeletal abnormalities of the two variants will be indistinguishable in archaeological human remains. In order to identify hypothyroidism in archaeological skeletal samples, one must be aware of the differences in pathological skeletal changes seen in hypothyroidism in comparison with other diseases, such as achondroplasia, that can cause similar abnormalities. Twelve clinically documented cases of hypothyroidism provide data for understanding the skeletal abnormalities associated with this disease. All 12 are modern documented cases from Switzerland, where endemic hypothyroidism occurred in the iodine-deficient Alpine regions. However, at least one case in the sample was caused by a defect in the thyroid gland itself.

Probable destructive meningioma in an archaeological adult male skull from Alaska.

Several intracranial pathological conditions can affect the bones of the skull. The most common cause of these conditions is tumor, but infection and other diseases are also known to affect the bones of the skull. Distinguishing between the various causes of intracranial skeletal pathology in archaeological human remains is usually a challenging exercise, and a specific diagnosis will often be impossible. Meningiomas are tumors that arise in arachnoid tissues embedded in the outer layer of the dura. Because of this association, they occur almost exclusively in the skull and vertebral column. Usually meningiomas are slow-growing tumors that do not metastasize to other organs and tissues of the body. However, rare cases can be malignant and, even when meningiomas are benign, their presence and growth can adversely affect the nervous and vascular supply to other tissues in the skull and vertebral column. Their effect on adjacent bone tissue varies from stimulating bone-forming lesions to causing highly destructive lesions. A few examples of meningioma have been described in the paleopathological literature. Most of these cases are bone-stimulating meningiomas. The case presented here is a probable example of a highly destructive meningioma of the skull base, with unilateral extension into the left side of the cranium. This case is compared with a modern clinical case of destructive intracranial meningioma that was documented both radiographically and pathologically. Destructive meningiomas can be confused with other pathological conditions, including benign and malignant tumors. Criteria for differentiating the diagnostic options are reviewed.