The importance of pathophysiology to the understanding of functional limitations in the bioarchaeology of care approach.

This article presents a partial bioarchaeology of care case study of a mummified adult female with chronic obstructive pulmonary disease (COPD) from late historic period United States. It examines likely clinical and functional impacts of disease and corresponding need for provision of care, stopping short of Stage 4 Interpretation/analysis. The case study illustrates and argues for the importance of an interdisciplinary research team for achieving a comprehensive understanding of disability and care. The article highlights the necessity of knowledge of pathophysiology for identifying the potential interventions (supports) dictated by the associated functional limitations. inter alia, this case is a powerful illustration of the way analysis of preserved soft tissue can provide insights into disease and likely care that are inaccessible using skeletal analysis alone. The article represents an interesting contribution to the theory and methodology of both the bioarchaeology of care approach and mummy studies.

α1-antitrypsin deficiency: what has it ever done for us?

The first five cases of α1-antitrypsin deficiency were originally published in 1963. This changed our whole concept about the pathophysiology of emphysema, including the role of inflammation and, in particular, the role of proteolytic enzymes. However, the observation also had a significant 50-year impact on many aspects of protein biochemistry, genetics, cell biology, and disease concepts outside the lung as well as the study of COPD in general.

What we owe to alpha(1)-antitrypsin and to Carl-Bertil Laurell.

The archetypal status of alpha(1)-antitrypsin in biology and medicine grew from the finding, thirty years ago, by Carl-Bertil Laurell, of the association of its deficiency with emphysema. In biology, alpha(1)-antitrypsin now provides the model for both the structure and the remarkable mechanism of the serpin protease inhibitors that control the key proteolytic pathways of the body. In medicine, the plasma deficiency of alpha(1)-antitrypsin has drawn attention to protease-antiprotease imbalance as a contributory cause of chronic obstructive pulmonary disease. But even more significantly, the finding that the common genetic deficiency of alpha(1)-antitrypsin was also associated with the development of liver cirrhosis introduced the new entity of the conformational diseases. The proposal that the same general mechanism was responsible for the best known of the conformational diseases, the common late-onset dementias, was controversial. It was vindicated however by the recent finding that a mutation, which results in the liver aggregation of alpha(1)-antitrypsin, also results in a typical late-onset dementia when it occurs in a brain-specific homologue of alpha(1)-antitrypsin. The extensive development of such diverse fields of studies, each based on alpha(1)-antitrypsin, is a measure of the encouragement Laurell gave to younger colleagues in the field. It also reflects the great advantage of linked contributions from clinical as well as basic sciences. Time after time, scientific controversies and deadlocks have been solved by landmark clinical cases, which have revealed unexpected findings and insights, within and beyond the fields of study.

[History of surgical treatment for emphysema].

Great efforts have been paid to the effective surgical managements of diffused emphysema in the past century, which can be grossly divided into three stages, namely, the early exploration, lung transplantation and lung volume reduction surgery. Lung transplantation, developed in the 80's, and especially lung volume reduction surgery, which was developed in the 90's, was recognized as the most effective therapy for terminal stage of emphysema, which offers a new approach for the victims of emphysema.

Convulsion of the lung: an historical analysis of the cause of Dr Johnson's fatal emphysema.

Of Johnson's fatal emphysema, it appears probable, on available historical and anatomic evidence, that it resulted from bronchiectasis, a diagnosis favoured by the pattern of illness: a protracted and severe respiratory infection succeeded by annual episodes of severe winter bronchitis, remitting in summer, and culminating in respiratory insufficiency; and by the findings of pleural adhesion and cor pulmonale at necropsy. That is resulted from chronic bronchitis is a proposition both plausible and irrefutable without the specimen.