Complication analysis in acute appendicitis, results from an international multicenter study.

PURPOSE: Acute appendicitis (AA) is frequent, its diagnosis is challenging, and the surgical intervention is not risk free. An accurate diagnosis will reduce unnecessary surgeries and associated risks. This study aimed to analyze the rate of appendectomies' postoperative complications. METHODS: Multicenter, prospective, observational study conducted at three large hospitals (Pisa University Hospital, Italy; Henri Mondor University Hospital, Paris, France; and Valencia University Hospital, Spain). RESULTS: A total of 3070 patients with a median age of 28 years (IQR 20-43) were enrolled. 1403 (45.7%) were females. Eight hundred ninety patients (29%) did not undergo preoperative imaging. Ultrasound and CT scans were performed in 1465 (47.7%) and 715 (23.3%) patients. Patients requiring CT scan were older [median 38 (IQR 26-53) vs. no imaging median 24 (IQR 16-35), Ultrasound median 28 (IQR 20-41); p < 0.0001]. Laparoscopic appendectomy was performed in 58.6%. Complications developed in 1279 (41.7%) patients: Clavien-Dindo grades I-II in 1126 (33.9%); Clavien-Dindo grades III-IV in 146 (5.2%). Overall mortality was 0.2%. Following resection of a normal appendix, 15% experienced major complications (Clavien-Dindo grades IIIb and above). Multivariable analysis revealed that age, Charlson comorbidity index, histopathology, and Alvarado score over 7 were associated with a higher risk of Clavien-Dindo complication grades IIIa and higher. CONCLUSION: Appendectomy may be associated with serious postoperative complications. Complications were associated with older age, Charlson comorbidity index, histopathology, and high Alvarado scores. The definition of accurate diagnostic and therapeutic pathways may improve results. The association between clinical scores and radiology is recommended.

Cardiocentrism in ancient medicines.

History of cardiology starts scientifically in 1628, when William Harvey (1578-1657) published his revolutionary book Extercitatio anatomica de motu cordis et sanguinis in animalibus, where he described "general" circulation, movements and functions of heart, heart valves, veins and arteries [1]. Consequently, all theories and practices of ancient medicines were reduced to superstitions. Historians relegated pre-Harveian cardiology to roughs notes, preventing a proper historical evaluation of many centuries of conceptions and practices. All the ancient civilizations shared the conviction that the heart was the biological and spiritual center of the body, the seat of emotions, mind, will, a vital energy produced by breathing and healing, and the soul. This cardiocentric view maintained a special role both in religion and in medicine across millennia from east to west, passing over cultural and scientific revolutions. Here, we will try to give a schematic account of medical beliefs on the heart from the most important pre-classic medicines. Some of them today show to have a kernel of truth. This demonstrates, at least, that history is a non-linear process and that intuitions or even truths, potentially useful for the present and scientific development, can re-emerge from the past.

Lodovico Brunetti, the Unknown Father of Modern Crematorium.

The cremation has been documented since prehistoric times and it was a common funerary custom until the advent of Catholicism. Falling into disuse, during XVII-XVIII centuries there were new movements to bring it back according to modern criteria, mainly due to hygienic reasons and cemeteries overcrowding. This also led to the prototyping of new crematory ovens to improve the ancient open-air pyre. Lodovico Brunetti was the first to carry out a crematory experimental research in the modern countries. Since Brunetti's studies were based on the study of ancient cremations, a comparison with a modern experience of reconstruction of archaeological cremation is presented to evaluate the validity of his crematorium oven. Furthermore, the social and religious aspects related to Brunetti's inventions and the revitalization of cremation shows how tools and technologies and also the cultural environment have evolved over the years, effectively accepting the cremation practice as an alternative to inhumation.

Paleopathology of the skull of Santorio Santorio, father of modern clinical experimental physiology.

The University of Padua (Italy) preserves the skull of Santorio Santorio, father of the modern clinical experimental physiology. A recent study performed with modern anthropological methods and medical instruments (CT scan) revealed the presence of a lobular formation in the left temporal bone, with an irregular morphology, internal bone sequestrum, a well-defined non-continuous sclerosis and both internal and external thinning of the cranial plate. Three oval depressions observed in the cranial vault, edentulism and moderate osteoarthritis of the temporomandibular joint were also investigated. The lobular formation was an epidermoid cyst and the oval depressions were the result of other cysts. The edentulism was consistent with some metabolic deficiency or disease, whilst the osteoarthritis appeared to be the result of antemortem tooth loss. This study allowed to investigate a complex and peculiar palaeopathological picture, linked to a piece of the history of the University of Padua.

Leonardo Botallo (1530-1587) and his pioneering contributions to traumatology, cardiology and deontology.

Leonardo Botallo (1530-c. 1587) is widely known for the eponymous "foramen Botalli" and "ductus Botalli". The first, most commonly named "foramen ovale", allows blood in the fetal heart to enter the left atrium from the right atrium. The second, named "ductus arteriosus", consists of a blood vessel in the developing fetus connecting the trunk of the pulmonary artery to the proximal descending aorta. However, Botallo was a multifaceted figure who studied many aspects of human anatomy and physiology, also making important contributions to clinical and surgical practices. Moreover, as we will see in the last section of this paper, Botallo wrote a book on medical deontology having significant features in relationship to the history of medical ethics. Botallo's multidisciplinary approach is a typical characteristic of Renaissance physicians and scientists, who contributed to making this period a fundamental prelude to the scientific revolution of the 17th century.

When self-medication goes wrong: the case of argyria at the Padua Morgagni Museum of Pathology.

A unique specimen of argyria is preserved in the Morgagni Museum of Pathological Anatomy at the University of Padua (Italy). It is a stuffed head belonging to a man who decided to cure his syphilis by himself with the so-called infernal stone (silver nitrate) every day for years, thus developing argyria in the second half of the nineteenth century. Paleopathological and historical studies were performed on the specimen to confirm the diagnosis of argyria. Furthermore, a morphological investigation of the specimen was conducted with histological and ultrastructural investigations, including environmental scanning electron microscopy and electron dispersive x-ray spectroscopy, recording high presence of silver in the dermis and epidermis and also other chemical elements correlated to the "infernal stone." A comparison with actual cases may also lead to a common feature: a potential dependence on the perceived benefits brought by silver compound that may sustain a further prolonged intake.

The three fetal shunts: A story of wrong eponyms.

The fetal circulatory system bypasses the lungs and liver with three shunts. The foramen ovale allows the transfer of the blood from the right to the left atrium, and the ductus arteriosus permits the transfer of the blood from the pulmonary artery to the aorta. The ductus venosus is the continuation of the umbilical vein, allowing a large part of the oxygenated blood from the placenta to join the supradiaphragmatic inferior vena cava, bypassing the fetal liver and directly connecting the right atrium. These structures are named after the physicians who are thought to have discovered them. The foramen ovale and the ductus arteriosus are called the "foramen Botalli" and the "ductus Botalli," after Leonardo Botallo (1530-c. 1587). The ductus venosus is styled "ductus Arantii" after Giulio Cesare Arantius (1530-1589). However, these eponyms have been incorrectly applied as these structures were, in fact, discovered by others earlier. Indeed, the foramen ovale and the ductus arteriosus were described by Galen of Pergamon centuries earlier (c. 129-210 AD). He understood that these structures were peculiar to the fetal heart and that they undergo closure after birth. The ductus venosus was first described by Andreas Vesalius (1514-1564) 3 years before Arantius. Therefore, the current anatomical nomenclature of the fetal cardiac shunts is historically inappropriate.

Fabrici and the functional power of the image.

Hieronymus Fabricius ab Acquapendente, famous anatomist of the medical school of Padua, Italy, marked a further step not only in the morphological studies, but also in anatomical illustration and physiology. His researches were inspired by the work of Aristotle which was focused on the understanding of biological "functions" in an anatomo-comparative way. The anatomo-comparative approach of Fabrici allowed him to discover several specific features of human anatomy. His focusing on function marked the transition from a descriptive to a functional anatomy, paving the way to the birth of human physiology in the following century. To enhance the teaching and learning of anatomy, Fabrici realized the importance of the "dimension" and "color" of anatomical illustrations and introduced for first full-scale and colour painted plates. In this way, the images were closer to representing "living" parts, than previous black & white and low scale images. Moreover, Fabrici was the first to create an "anatomo-phisiological" image, namely the one representing the valves in the veins. His work was a fundamental inspiration for his students, in particular Gaspard Bauhin and William Harvey.

Exchanges and interactions between Padua and Vienna medical schools in the XIX century.

It is well known that Padua Medical School, Italy, played a fundamental role in shaping modern medicine. Its golden age lasted from the late XV to the late XVIII century, thanks in particular to its extraordinary anatomical school. One of the last fundamental achievements of the Padua Medical School was the founding of the anatomo-clinical method and organ pathology by Giovanni Battista Morgagni, Professor of Theoretical Medicine in Padua from 1711 and 1715 and of Anatomy from 1715 to his death. This method, which dramatically changed the course of medical diagnosis and therapy, was immediately developed by the so-called Anatomo-Clinical School of Paris. Figures such as Jean-Nicolas Corvisart and René Laennec improved this new approach in the clinical setting with the method of auscultation and the introduction of the stethoscope. However, organ pathology probably found its most important modern expression in the so-called Viennese School of Medicine, thanks to figures such as Karl von Rokitansky, Joseph Skoda and Theodor Billroth. In that period, this school was described by the anatomist Rudolf Virchow as "the Mecca of medicine." As is well known, Padua and Venice fell under the rule of the Austro-Hungarian Empire between the end of the XVIII and the beginning of the second half of the XIX century. The most important influences and changes at the University of Padua were introduced by the Viennese School during the so-called Third Austrian Domination (1813-1866), with improvements of medical curriculum, the founding of new specialist medical institutes and a general advancement of medical science, inspired by the technical-practical approach typical of this school. In particular, the new chair and Institute of Pathological Anatomy was founded by Lodovico Brunetti, pupil of Rokitansky, who influenced his appointment at Padua. In this way, we can advance that, at the end, the Morgagni method came back to Padua through the leading role of the Vienna Medical School, which deeply influenced the University of Padua during the different phases of Austrian domination in north Italy.

Tullio Terni (1888-1946): The life of a neurocardioanatomist with a tragic epilogue.

Tullio Terni (1888-1946) was a pioneer of neuroanatomy at the University of Padua. He gave milestone contributions in the knowledge of cardiac innervation with the discovery of the "Terni column", a preganglionic autonomous nervous center. Due to "racial laws" introduced in Italy in 1938 by the Fascist government, he, being Jewish, was expelled from the University of Padua like many others from Italian universities. At the end of the 2nd World War, he was reinstated to his chair of Anatomy, however, having belonged to the Fascist party, he was dismissed from the Lincei Academy. It was a paradox that deteriorated his depression up to the suicide.

Correction to: Did Antonio Vallisneri (1661-1730) really describe frontal sinus osteoma? Unexpected insights for paleo-neuroparasitology.

The third sentence from the beginning in our article.

New technique in facial reconstruction: the case of Giovanni Battista Morgagni.

ABSTRACT: Morgagni is considered the father of pathological anatomy. He died in 1771, 89 years old, and was buried in Saint Maxim church in Padua, where his wife and five of his 15 children were already buried. In 2011, an anthropological analysis confirmed that one of the skulls belonged to the oldest individuals among those found in Morgagni's tomb. A genetic analysis proved a kinship between this skull and the fragments of young individuals (one male and two females), supporting the hypothesis that they were Morgagni and his children. Thanks to the interaction between historical studies, anthropological research, and molecular analysis we can assume that the skull belongs to Giovanni Battista Morgagni and the skull fragments came from his children. Having obtained the identification of Morgagni, we performed a forensic facial reconstruction with new 3D technology. We compared the facial reconstruction with Morgagni's portraits done when he was living and near to his death, as to be closest to his real resemblances. Finally, we performed a superimposition test with busts and portraits, as to achieve a further confirmation of the molecular identification.

Vincenzo Malacarne (1744-1816) and the First Description of the Human Cerebellum.

Vincenzo Malacarne, professor of medicine, surgery, and obstetrics in Turin, Pavia, and Padua, Italy, represented a perfect example of an eighteenth century "letterato", combining interests in humanities, sciences, and politics, embodying the ideal of an encyclopedic and universal culture. He made important contributions in anatomy and surgery, teratology, obstetrics, neurology, and history of medicine, adopting a interdisciplinary approach based on the correlation between anatomy, surgery, and clinics. He deserves a special place in the history of neurology because of the first complete description of the human cerebellum. He quantified the units of the cerebellar internal structures, the lamellae being numbered for a systematic description of the human cerebellum. He thought the mental faculties depended on their number, considering a relation between the number of cerebellar lamellae and the expression of intellectual faculties. In this way, he made first statistics on human faculties. He advanced the concept that the number of cerebellar folia was influenced by the environment, thus providing the first nature-nurture hypothesis made on the basis of observations, and the concept of neuroplasticity in the scientific literature. Finally, he also contributed to the emergence of a new science, namely electrophysiology, because he laid down experimental foundations of a project on the recording of brain electricity, comparing the structure of the human brain with Volta's galvanic pillar.

Did Antonio Vallisneri (1661-1730) really describe frontal sinus osteoma? Unexpected insights for paleo-neuroparasitology.

It has been believed for a long time that the Paduan scholar Antonio Vallisneri (1661-1730) described the second historical case of the frontal sinus osteoma in 1733. By historico-medically reexamining this case, we conclude that the brain concretions he described were not a case of frontal sinus osteoma, while they appear to have been pathological outcomes of neurocysticercosis, whose larval stages would only be described by Johann Goeze (1731-1793) later, in 1784. Thus, this case becomes relevant for the history of neuroparasitology.

Ophthalmologic wax models as an educational tool for 18th-century vision scientists.

The Medical Faculties of the University of Padua (Italy) and the University of Vienna (Austria) preserved two series of wax models, made by the Austrian Johann Nepomuk Hoffmayr at the beginning of the 19th century. These models were created in a period of evolution of both medical specialties and organ pathology, which brought morbid organs at the centre of medical investigation. Ceroplastic was considered a useful tool for didactic and research, as it provided a three-dimensional realistically coloured reproduction of organic lesions. The models represent the typical eye diseases of the period, in particular those affecting external parts, which could be investigated without the need for specific instruments devised for the observation of the inner and posterior anatomy of the eye, at that time not yet available. Even if the nosological categories then employed by Hoffmayr were different from those currently used, it has been possible to find a correspondence thanks to the ophthalmological literature of his period. Ceroplastic started to decline at the end of 19th century, substituted by the much less expensive method of preservation of morbid organs in formalin and by new techniques of investigation of the inner body, such as X-ray.