Donatella Lippi

Natural compounds for cancer treatment and prevention.

We describe here the main natural compounds used in cancer therapy and prevention, the historical aspects of their application and pharmacognosy. Two major applications of these compounds are described: as cancer therapeutics and as chemopreventive compounds. Both natural compounds, extracted from plants or animals or produced by microbes (antibiotics), and synthetic compounds, derived from natural prototype structures, are being used. We also focus on the molecular aspects of interactions with their recognized cellular targets, from DNA to microtubules. Some critical aspects of current cancer chemotherapy are also discussed, focusing on genetics and genomics, and the recent revolutionary theory of cancer: aneuploidy as the primum movens of cancer.

Chocolate and medicine: Dangerous liaisons?

According to ancient Mayan texts, cocoa is of divine origin and is considered a gift from the gods. In the Classic period of Mayan civilization (250-900 a.d.), ground cocoa seeds were mixed with seasonings to make a bitter, spicy drink that was believed to be a health-promoting elixir. The Aztecs believed that cocoa pods symbolized life and fertility, and that eating the fruit of the cocoa tree allowed them to acquire wisdom and power. Cocoa was said to have nourishing, fortifying, and aphrodisiac qualities. Pre-Columbian societies were known to use chocolate as medicine, too. The appreciation and popularity of chocolate fluctuated over the centuries since its introduction to Europe from the New World. Now, recent evidence has begun to erase the poor reputation that chocolate had acquired in the past few decades and is restoring its former status. Chocolate is no longer deemed a guilty pleasure, and it may have positive health benefits when eaten in moderation as part of a balanced diet.

Scenes from the Past: The Medici Project: Radiographic Survey

The remains of 12 members of the grand ducal (junior) branch of the Florentine Medici family were exhumed in 2003 as part of the Medici Project, a multidisciplinary study whose aim was to investigate the lifestyles, health status, and possible causes of death of members of one of the richest, most powerful families of the Italian Renaissance. Digital radiography and orthopantomography were performed on the skeletal remains of individuals who lived between 1562 and 1666. The observed bone malformations, deformities, and changes (degenerative, metabolic, and dental) challenge traditional views, based on portraits and historical accounts, about the appearance and lifestyle of some family members. Moreover, the occurrence of a constellation of bone changes related to diabetes (osteoporosis, osteoarthritis, diffuse idiopathic skeletal hyperostosis, cranial hyperostosis, and crystalline arthropathy) suggests that this metabolic disease was common in the grand ducal branch of the Medici family.

The ossification diathesis in the Medici family: DISH and other features.

The Medici family ruled Florence for most of the period from the 1430s to the 1730s, with the senior (primogenito) branch predominating until the line ended in the 1530s and the cadet (secondogenito) branch predominating thereafter. Recent studies have identified a familial syndrome consisting of cutaneous symptoms, peripheral arthropathy and spinal ankylosis in the primogenito branch of the family, and the presence of diffuse idiopathic skeletal hyperostosis (DISH) in two members of the secondogenito branch. These findings raise the question of whether DISH was also a component of the primogenito familial syndrome. The present study provides a further specification of the ossification diathesis in the familial syndrome of the primogenito branch of the Medici family. Recently discovered photographs of exhumed Medici skeletons from the primogenito line are examined, with a focus on spinal, sacro-iliac and peripheral ossifications. These observations are supplemented with published reports of radiological, histological and macroscopic studies of the skeletons. Our interpretations of the ossification data relating to the primogenito branch of the Medici family are supportive of a diagnosis of DISH. DISH was one component of the triple pathology identified as a syndrome in the fifteenth century primogenito Medici line. As a diagnosis of DISH has recently been proposed for two sixteenth century members of the secondogenito branch of the family, it appears that the same condition affected both branches of the Medici lineage, without excluding other forms of undifferentiated joint and spondylarthropathies.

The Medici syndrome: a medico-historical puzzle.

The historical significance of the Medici family of Florence is widely recognised, but the diseases which afflicted leading members of this family have only been scientifically studied in recent decades. Paleopathological findings on exhumed skeletons, supplemented by medical descriptions in historical documents, have permitted a retrospective diagnosis of a triple pathological syndrome in the senior branch of the Medici family. Peripheral joint and spinal conditions, with the presence of skin disease, are identified in several generations of the family in the 15th century and are presented as the ‘Medici syndrome’. Radiological findings are compared with macro‐ and microscopical descriptions in the diagnosis of the peripheral joint disease and spinal ankylosis/stenosis within the syndrome.

Longevity and Causes of Death of Adult Males in the Medici di Bicci Family

The Medici family was prominent in Europe between the fifteenth and eighteenth centuries. Their contributions to political, economic, and artistic life have remained persistent preoccupations for historians. The medical history of this family, however, was relatively neglected prior to the middle of the twentieth century, probably due to the scarcity of relevant information. Retrospective study of the diseases of the Medici has developed more intensely since World War II, when exhumation of the skeletons of family members became possible. The present researchers are engaged in a new assessment of the data now available, starting with an analysis of the longevity and causes of death of adult males in the family. Our findings show clear longevity trends in the two branches of the family. These trends cannot be explained on the basis of current knowledge, but recognition of their existence may help to orient future research.

Who was Pontormo’s Halberdier? The evidence from pathology

The identity of the young man in Jacopo Pontormo’s Portrait of a Halberdier has long been disputed by art historians. Two probable candidates have been identified: Francesco Guardi, a Florentine nobleman, and Cosimo I de’ Medici, Duke of Florence from 1537 and Grand Duke of Tuscany from 1569. The present study is intended to help resolve this controversy by providing evidence, based on pathological criteria, for the identification of Pontormo’s Halberdier. Pathological anomalies of the finger joints in the left hand of the Halberdier are compared with those in three acknowledged portraits of Cosimo I de’ Medici. These three portraits show the hands of Cosimo in approximately the same position as the Halberdier’s hand, thus allowing a meaningful comparison. Detailed observation indicates that there is a close correspondence between the Halberdier’s hand deformity and that of Cosimo I in the comparison portraits. This deformity is also consistent with what is known about the medical history of Cosimo I and with the skeletal remains of his left hand. The pathological evidence supports the conclusion that Pontormo’s Halberdier is Cosimo I as a young man and that the painting was done around 1537 when Cosimo first became Duke.

Osteoarthritis in the hands of Michelangelo Buonarroti

Davide Lazzeri, Manuel Francisco Castello, Marco Matucci-Cerinic, Donatella Lippi and George M Weisz Plastic Reconstructive and Aesthetic Surgery, Villa Salaria Clinic, Rome, 00139 Italy Center for Medical Humanities, Department of Experimental and Clinical Medicine, University of Florence, 50134 Italy Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Italy School of Humanities, University of New South Wales, Sydney, 2052 Australia School of Humanities, University of New England, Armidale, 2351 Australia Corresponding author: Davide Lazzeri. Email: davidelazzeri@gmail.com

Goiter in portraits of Judith the Jewish heroine.

Judith was a legendary Hebrew heroine who beheaded the general Holofernes and saved the children of Israel from destruction by the Assyrian army. In the Book of Judith, which is still present in the Catholic and Orthodox Christian Bibles, Judith is presented as an illustrious woman who defeated the enemy using her virtue and fortitude. The present investigation has revealed 24 portraits in which Judith has been depicted with variable grades of thyroid gland enlargement on the scene where she decapitates Holofernes. There is no doubt that the integration of a slight thyroid enlargement in the paintings is a stylistic hallmark that portrays an idealized female beauty with a balanced neck and graceful body. The large extended goiter was probably depicted by the artists as a symbol of a powerful masculine body and her courage, and at the same time, it probably also reflects better anatomic accuracy and knowledge of artists from that period.

Complementary and alternative medicine: an academic view.

that it is fi rst necessary to escape a terminology that involves the concept of ‘alternative’: this defi nition, which has been used in recent years, considers the practice of CAM as optional, justifying its use when scientifi cally sanctioned treatment is not available, or has failed. In English, the terms ‘alternative’ and ‘complementary’ are mostly used, underlining a specifi c relationship with biomedicine. However, in France, CAM is known as ‘médecines parallèles’, with the precise intention of stressing the constant distance between orthodoxy and non-conventional medicine. Often, it is a negative defi nition such as ‘not orthodox’, ‘not offi cial’ that is used highlighting what these medicines are not. CAM treatments greatly differ from one another, but they have a common feature in that they often do not have their theoretical foundation in basic biological sciences. CAM therapies were very widely promoted in the late 19th and early 20th centuries in many western countries, particularly North America. In the western world, their use is currently on the increase, especially in Englishspeaking societies. Recent data from the National Health Interview Survey (USA) indicate that in the 12 months previous to the interview, 33.5% of American women used CAM. Caucasian, elderly and educated individuals were more likely to use CAM [3] . Other recent data point In the last 20 years international scientifi c literature has shown a steady increase in discussions concerning complementary and alternative medicine (CAM) [1] . When dealing with this subject, many issues arise. It is imperative to understand fi rstly the kind of medical reality concealed beyond the names of these practices and secondly, the problems posed to the medical profession by their increased therapeutic usage. Important questions further arise regarding the introduction of CAM therapies in medical curricula. The reconstruction of the cultural context within which CAM has developed cannot escape a historical and linguistic refl ection: a semantic analysis clearly indicates that this terminology is a well-defi ned historical product and conceals a specifi c conceptualisation that very often also involves a value judgement. In 2000, the British House of Lords, through a select committee, commissioned research to illuminate the then current status of ‘complementary therapies’, in an attempt to understand the CAM therapies that could be considered real medical treatments [2] . The Commission classifi ed therapies into three well-defi ned groups: Principle Disciplines, Complementary Treatments and Alternative Disciplines. The linguistic problem here revealed is substantial rather than formal. The Commission stated Received: September 10, 2004 Revised: March 14, 2005