Better a Broader Diagnosis Than a Misdiagnosis: The Study of a Neoplastic Condition in a Male Individual who Died in Early 20th Century (Coimbra,Portugal)

The paleopathological record of neoplastic conditions in the past is considered scarce. The detection of tumours in ancient populations is hindered by the quality and quantity of signs visible on the skeleton, the methodological approach, the preservation of remains, and by difficulties of differential diagnosis. The aims of this paper are to report the extensive and multiple osteolytic lesions observed in an adult male and to discuss the possible etiology of these lesions. The individual, a 71‐year‐old male who died in 1932, is part of the Coimbra Identified Skeletal Collection. Records indicate that he died of a ‘heart lesion’. The present study used macroscopic, radiological, and computerized tomography examinations to analyse the skeletal remains of the individual number 439. The type and pattern of the lesions detected, which were most prominent on the skull, were compared with both clinical and paleopathological diagnostic criteria for different nosologic groups. The differential diagnosis addresses problems expressed both in clinical and in paleopathological literature with regard to the difficulties in distinguishing metastatic tumours from multiple myeloma. The nature of the lesions represented by this individual precludes an exact diagnosis. Therefore, we employed a broader category, neoplastic condition, instead of choosing a more specific diagnosis that would likely have resulted in a misdiagnosis due to overlapping features on this individual's condition. Further investigations are necessary to establish more replicable indicators and to improve confidence in retrospective diagnosis of these types of conditions. Copyright © 2011 John Wiley & Sons, Ltd.     

Cribra orbitalia and porotic hyperostosis in a Greek colonial population (5th to 3rd centuries BC) from the Black Sea

Cribra orbitalia and porotic hyperostosis in Greek skeletal remains have typically been attributed to a genetic anaemia, most notably thalassemia due to the presence of endemic malaria in the Mediterranean region. This paper reports the results of an analysis of cribra orbitalia and porotic hyperostosis in a Greek colonial population (5th to 3rd centuries BC) from the Black Sea. Archaeological evidence, stable isotopic data, and other skeletal indicators of physiological stress are examined to determine the most likely cause(s) of these lesions. While the possibility that some of the colonists of Apollonia suffered from thalassemia cannot be entirely discounted, the skeletal evidence examined in this study is not consistent with a diagnosis of thalassemia. We must therefore be cautious in assuming that cribra orbitalia and porotic hyperostosis in Greek skeletal remains, and indeed skeletal remains from any region where malaria was endemic in the past, is always indicative of this condition. Nutritional deficiencies and exposure to infectious diseases probably played an equally, if not more, important role in the development of these lesions. Copyright © 2006 John Wiley & Sons, Ltd.     

Clay‐shoveler's fracture: an uncommon diagnosis in palaeopathology

An archaeological case of clay‐shoveler's fracture was observed in an adult male exhumed from a Roman necropolis dated to the 1st–3rd century AD and located in the city of Barcelona, Spain. Clay‐shoveler's fracture is a breakage of a lower cervical or upper thoracic spinous process as a result of mechanical stress. Different mechanisms have been related to this injury, generally in labour‐related contexts. This paper reviews the literature concerning this uncommon finding, focusing especially on its mechanism and on activity‐related lesions. Copyright © 2006 John Wiley & Sons, Ltd.     

Trauma in the Crusader period city of Caesarea: a major port in the medieval eastern Mediterranean

Caesarea is the first fortified city to undergo palaeopathological analysis of its Crusader period inhabitants. This study of the 12th and 13th century population aims to determine the major types of trauma present, whether from weapon injuries or accidents. Since the Crusades were known for the significant number of battles and raids that took place, weapon injuries were expected to be common. Thirteen cases of trauma are described and a highly unexpected pattern has come to light. These cases do not include one single example of weapon‐related trauma. Every fracture is of a type expected from accidents or interpersonal violence without weapons. Possible explanations include the location of the city deep within Frankish territory and the robust city walls giving effective protection to the inhabitants, and also that the population were involved in activities that left them prone to accidents but not weapon injuries. The other important finding from this study was that the cases of lower limb long bone spiral fractures had healed in a near‐anatomical alignment. This is not what we would expect, as a proportion of these injuries would normally have been unstable and tend to heal poorly aligned. The good position could have resulted from surgeons' use of splints to immobilise the bones while they healed. This suggestion is supported by laws of the kingdom of Jerusalem, which stated that surgeons were to be punished if they allowed such fractures to heal at an angle. Copyright © 2006 John Wiley & Sons, Ltd.     

Dental trauma and antemortem tooth loss in prehistoric Canary Islanders: prevalence and contributing factors

Differential diagnosis of the aetiology of antemortem tooth loss (AMTL) may yield important insights regarding patterns of behaviour in prehistoric peoples. Variation in the consistency of food due to its toughness and to food preparation methods is a primary factor in AMTL, with dental wear or caries a significant precipitating factor. Nutritional deficiency diseases, dental ablation for aesthetic or ritual reasons, and traumatic injury may also contribute to the frequency of AMTL. Systematic observations of dental pathology were conducted on crania and mandibles at the Museo Arqueologico de Tenerife. Observations of AMTL revealed elevated frequencies and remarkable aspects of tooth crown evulsion. This report documents a 9.0% overall rate of AMTL among the ancient inhabitants of the island of Tenerife in the Canary Archipelago. Sex‐specific tooth count rates of AMTL are 9.8% for males and 8.1% for females, and maxillary AMTL rates (10.2%) are higher than mandibular tooth loss rates (7.8%) Dental trauma makes a small but noticeable contribution to tooth loss among the Guanches, especially among males. In several cases of tooth crown evulsion, the dental root was retained in the alveolus, without periapical infection, and alveolar bone was in the initial stages of sequestering the dental root. In Tenerife, antemortem loss of maxillary anterior teeth is consistent with two potential causal factors: (a) accidental falls while traversing volcanic terrain; and (b) interpersonal combat, including traditional wrestling, stick‐fighting and ritual combat. Steep‐walled valleys (barrancos) and lava fields (malpaís) required agile locomotion and occasional vaulting with the aid of a wooden staff. Accidental falls involving facial injury may have contributed to AMTL. Traditional conflict resolution involved competitive wrestling (lucha canaria), stick‐fighting (juego del palo), and ritualised contests involving manual combat. These activities made a small but recognisable impact on anterior dental trauma and tooth loss. Inter‐personal behaviours of such intensity leave their mark on skeletal and dental remains, thereby providing insight into the lives and cultural traditions of the ancient Guanches. Copyright © 2006 John Wiley & Sons, Ltd.     

Trepanation in the Chachapoya region of northern Perú

This paper discusses trepanation frequency data from the Chachapoya region of the northern highlands of Perú. New data from three skeletal samples are presented: Kuelap, Laguna Huayabamba, and Los Pinchudos, as well as isolated crania housed at the Chachapoya Museo Instituto Nacional de Cultura. The vast majority of the trepanations are circular in shape, except for one individual exhibiting as many as three roughly square trepanations. Evidence for healing is prevalent, with examples of both associated periosteal reaction of nearby outer table bone, as well as for healing of the insult itself. Only one case demonstrates a clear association between a traumatic injury and a trepanation event. The purpose or function of the remaining cases of trepanation, however, remains elusive. Copyright © 2006 John Wiley & Sons, Ltd.     

Lysis at the anterior vertebral body margin: evidence for brucellar spondylitis?

Recently, palaeopathologists have begun to diagnose brucellosis in skeletal remains from minor lytic lesions located on the anterior margins of one or some few vertebral bodies, taking these lesions to represent brucellar epiphysitis. However, review of the literature indicates that these lesions have been sporadically noted for some time by palaeopathologists and various different interpretations have been placed upon them. In view of this, a study of these vertebral marginal lesions (VML) was undertaken in a large series of archaeological skeletons from England, with the aim of characterising their morphology and frequency and shedding light upon their causes. In the study material, VML were found only in the lumbar spine, where they occurred with a prevalence of approximately 4%. It was argued that VML are consistent with two principal alternative diagnoses: brucellosis and traumatic anterior disc herniation. Differentiating these possibilities for the VML in the study material was difficult, but the balance of the evidence seemed to favour traumatic anterior disc herniation as the more likely cause. It is concluded that VML should not be used to identify the presence of brucellosis in skeletal remains unless there is further evidence, in the form of additional skeletal lesions or biomolecular evidence for residual brucella bacterial DNA, to support such a diagnosis. Copyright © 2007 John Wiley & Sons, Ltd.     

Thalassemia: macroscopic and radiological study of a case

Differentiation of the genetic and the acquired anaemias, particularly in areas of the world where they may co‐exist, has been a challenge for palaeopathologists for over 100 years. In this paper we present macroscopic and radiographic skeletal lesions that are associated with the thalassemias in a 14‐year‐old girl from a modern reference collection of the University of Athens. This individual is of known sex, age, cause of death, place and dates of birth and death. The case is examined in terms of epidemiology, growth, distribution and severity of lesions and differential diagnosis. The entire skeleton is affected by marrow hyperplasia: lesions of the axial skeleton are extreme, and the appendicular skeleton is severely affected as well. The odontofacial manifestations that are diagnostic of thalassemia and differentiate it from other anaemias are present and include: maxillary and mandibular hyperplasia, reduced sinuses, displacement of maxillary dental structures, overbite, and generalised osteopenia. The development of extreme bone lesions and the ‘advanced’ age‐at‐death of this individual is explained as either the result of thalassemia major under a low transfusion regimen that was the norm during her lifetime, or to a form of thalassemia intermedia that allows survival to later life at the expense of gross skeletal alterations. The present status of skeletal studies in Greece does not support the identification of a genetic anaemia in past populations. The potential contribution of the current analysis in differentiating the anaemias in antiquity is evaluated. Copyright © 2006 John Wiley & Sons, Ltd.     

Probable early presence of leprosy in Europe in a Celtic skeleton of the 4th–3rd century BC (Casalecchio di Reno,Bologna, Italy)

Examination of the skeleton of an adult male from the Celtic necropolis of Casalecchio di Reno (Bologna, Italy; 4th–3rd century BC) revealed some lesions on the feet, especially bilateral acro‐osteolysis of the metatarsals, and on the tibia, fibula and hand. The morphological and radiographic characteristics of the bones are consistent with a diagnosis of leprosy. Other features of the rhinomaxillary region support this diagnosis. As far as we know, this case could represent the oldest skeletal evidence of leprosy in Europe, indicating the early spread of this disease toward the Western world. Copyright © 2005 John Wiley & Sons, Ltd.