Dry bone histology of bone tumours.

This article focuses on the application of dry bone histology in the diagnosis of a series of different bone tumours. It provides a short introduction on bone tumour classification and how tumours may affect the skeleton. To illustrate the value of dry bone histology in the diagnostic process we studied the 'fresh' and 'dry' bone histology of a series of well-documented, recent clinical cases of various benign and malignant bone tumours. We show that histology is a valuable instrument to assess bone tissue architecture, which provides information on the biological behaviour of a tumour. Though histology may reveal the specific 'tumorous' bone deposition of high-grade conventional osteosarcomas, all other bone tumours display common, unspecific features. This holds for the following tumours: osteochondroma, hyperostotic meningioma, high-grade angiosarcoma, grade 2 chondrosarcoma, myoepithelial carcinoma, high-grade osteosarcoma and four carcinoma metastases. We conclude that histology is useful in cases where the biological behaviour of a tumour is to be defined, and is particularly an aide in the diagnosis of high-grade conventional osteosarcomas. Nevertheless, the differential diagnosis on the bone tumours in our series should primarily be based on a combination of physical anthropological patient data (age, sex), gross anatomy (e.g. tumour morphology and location), and radiography.

An accessory skull suture mimicking a skull fracture.

This paper describes an investigation of the sudden and unexpected death of a five-and-a-half-month-old boy. As in every Dutch case of sudden unexpected death in infancy (SUDI), a multidisciplinary diagnostic approach was used. This included post-mortem radiography, showing a linear discontinuity of the parietal bone. Originally this was interpreted as a skull fracture, but autopsy indicated no signs of mechanical trauma. Instead the defect was defined as a unilateral accessory suture of the parietal bone. The initial erroneous diagnosis had severe adverse consequences and thus every health care professional or forensic specialist dealing with paediatric mechanical traumas should be cautious of this rare anomaly.

A review of the embryological development and associated developmental abnormalities of the sternum in the light of a rare palaeopathological case of sternal clefting.

A sternal cleft or bifid sternum is a rare anterior chest wall abnormality. Although several cases have been reported in clinical literature, very little reference has been made to this anomaly in palaeopathological texts. This paper presents a case of superior sternal clefting observed in a middle-aged female with concurrent Paget's disease and congenital hyperkyphosis excavated from a 19th century Dutch psychiatric asylum cemetery in Bloemendaal, The Netherlands. The embryological development of the sternum and associated developmental abnormalities are reviewed and a differential diagnosis is performed on the suite of observed skeletal anomalies. Goltz syndrome, congenital hypothyroidism, disruption of the Hoxb-4 gene, acute excessive maternal alcohol consumption during pregnancy, Coffin-Lowry syndrome and PHACES syndrome were considered as possible causative agents, with the latter two conditions determined to be the most likely. The psychiatric asylum context, from which the individual came, supports the differential diagnosis as neurological abnormalities are common in these two syndromes. This article demonstrates that the integration of embryology, modern clinical literature and palaeopathological principles is vital in the interpretation of developmental anomalies from an archaeological context.

The diagnostic value of microscopy in dry bone palaeopathology: A review.

Over recent decades histology has increasingly been used as a diagnostic tool in human dry bone palaeopathology. Still, the use of histology in human dry bone is associated with various problems, including a lack of pathognomonic histomorphology and a need for more experimental data. Consequently, the value of histology as diagnostic tool in human dry bone remains a subject for debate. Here we review all published palaeohistopathological research in human dry bone. A systematic search identified 3363 articles, with the 64 most relevant citations studied in depth. We specifically focused on the interpretation of histomorphological parameters and the use of comparative fresh bone tissue and/or experimental data. Our literature review shows that only a few disorders demonstrate a 'specific' histomorphology: Paget's disease, osteoporosis, hyperparathyroidism and possibly osteomalacia. In all other cases, histology may aid during the differential diagnostic process, but it is unable to confirm a definitive diagnosis. The histological diagnostic process and consequential recommendations for the use of histology are discussed per following disease categories: metabolic disease, neoplasm, infectious disease and trauma.

Diffuse idiopathic skeletal hyperostosis: diagnosis in a palaeopathological context.

Clinically, the presence of diffuse idiopathic skeletal hyperostosis (DISH) has been linked to a disturbance of glucose and insulin metabolism, hypertension, dyslipidemia and obesity associated with a rich diet. The prevalence of DISH in archaeological skeletal samples may therefore be a valuable indicator of their socio-economic status when compared to other contemporary groups. However, various methods are currently being used to diagnose DISH. The purpose of this study was therefore to assess the comparability of results obtained using four different diagnostic methods to estimate the prevalence of DISH in a skeletal sample, and to discuss the implications of the results in relation to palaeopathological health assessments. Four different diagnostic criteria were applied to 127 male and 113 female skeletons to diagnose DISH. Skeletal remains were obtained from two 16th century samples from Delft and one modern sample from the anatomy dissection hall of the Leiden University Medical Centre. The estimated prevalences were statistically compared. Special attention was also given to the distribution of extra-spinal enthesophytes described in diagnostic criteria, in order to assess their diagnostic value. The prevalence of DISH observed in the skeletal samples varied significantly depending on the criteria used for diagnosis. Furthermore, extra-spinal enthesophytes, suggested as being indicative of DISH, proved to be variable and unreliable. It was concluded that it is of great importance to explicitly state and adhere to criteria employed for diagnosing DISH in both palaeopathological and clinical investigations in order to ensure reliable comparisons between studies. Also, DISH cannot be positively diagnosed solely based on the presence of extra-spinal enthesophytes.

Diffuse idiopathic skeletal hyperostosis in ancient clergymen.

Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral enthesopathies are present. The etiology of DISH is unknown but previous studies have shown a strong association with obesity and insulin-independent diabetes mellitus. DISH can lead to back pain, dysphagia, myelopathy, musculoskeletal impairment and grossly unstable spine fractures after minor trauma. In archeological studies a high prevalence of DISH has been demonstrated in ancient clergymen. The present study describes the pathological changes of human remains excavated from the abbey court (Pandhof) in the city of Maastricht, The Netherlands. Human remains of 51 individuals buried between 275 and 1795 CE: were excavated and examined. The remains were investigated according to a standardized physical anthropological report and individuals demonstrating ossification of spinal ligaments and/or multiple peripheral enthesopathies were included in the study group. The authors reviewed all available material and after reaching consensus, each abnormality found was given a diagnosis and subsequently recorded. After examination, 28 individuals were considered to be adult males; 11 adult females; three adults of indeterminate sex and nine individuals were of sub adult age. The mean age at death for adults was 36.8 years. Seventeen adult individuals (40.4% of all adults), displayed ossifications of at least four contiguous spinal levels and/or multiple enthesopathies of the appendicular skeleton and were therefore, assigned the diagnosis DISH. The mean age of these individuals was 49.5 +/- 13.0 years. In at least three of these individuals, DISH had led to extensive ossification and subsequent ankylosis of axial and peripheral skeletal structures. In this population of (presumably) clergymen and high-ranking citizens, DISH was observed in unusual high numbers at a relatively young age. Some of the examined cases suggest that DISH may be a seriously incapacitating disorder when the more advanced stages of the disease have been reached. It is hypothesized that "a monastic way of life" can predispose to DISH. Present demographic trends in obesity and diabetes mellitus as potential co-factors for the development of DISH warrant further study to investigate its future prevalence.

Inter- and intra-individual variation in applied force when listening at a surface, and resulting variation in earprints.

We aimed to explore the level of inter- and intra-individual variation in applied force when listening at a surface, and assess the resulting variation in earprints. We further intended to identify possible sources of this variation. Forty subjects each listened twenty-four times at a surface while applied force was recorded. In between efforts the level and frequency of the target sound, and the level of ambient noise were varied. Each listening effort was characterized by two values: the mean of a series of force recordings ('functional force') and the highest force reading of the effort ('peak value'). A mixed model analysis of variance revealed that repetition during multiple efforts of listening and the level of the target sound significantly affected both values for applied force. The frequency of the target sound affected the peak value, but we assume this was due to confounding effects. The level of ambient noise did not affect applied force. To explore the correlation between values for applied force of various efforts by single ear, the intra-class correlation coefficient was calculated. For functional force it was 0.80; for the peak value it was 0.79. To study intra-individual variation in earprints, five prints from each ear were lifted and studied. Variation in prints is discussed.

Study of the relationship between a person's stature and the height of an ear imprint from the floor.

Occasionally ear prints are found at crime scenes. The height of the ear imprint may provide the police with information regarding the stature of the perpetrator and may therefore help to narrow down the number of suspects. The research provides calculations for the determination of stature from the height of the tragus imprint found at crime scenes. It takes into account various variables such as age, stature and gender.

The positioning and magnification of faces and skulls for photographic superimposition

In the identification of persons living or dead, or of skulls, the technique of photographic superimposition of laboratory images on existing original portraits has frequently been used. The applicability of the technique and the confidence in the results have always depended very much on the professional acceptance and experience of forensicspecialists. Defined preconditions, improved methods and clear-cut directions on how to posture the head or the skull and how to magnify its photographic laboratory image, not only help to standardize and simplify procedures, but also increase the accuracy and credibility of the resulting diagnoses (AU)