George M. Weisz

Complex Regional Pain Syndrome Associated with Cervical Disc Protrusion and Foraminotomy

STUDY DESIGN Case report. OBJECTIVE To report a previously undescribed association between complex regional pain syndrome (CRPS) and surgery for cervical disc protrusion. SUMMARY OF BACKGROUND DATA Although CRPS has been associated with disc protrusion and lumbar spine surgery, there is no record in the literature of a similar association with cervical disc protrusion. METHODS Description of a clinical case. RESULTS A patient with radicular pain due to cervical disc protrusions underwent posterior foraminotomy, which did not relieve his pain. Within 3-4 weeks, he developed features of CRPS. Review at 16, 22, and 34 months revealed some, but limited, improvement. CONCLUSIONS This case provides circumstantial evidence of a hitherto undescribed association between CRPS and cervical disc protrusion. The mechanism is elusive, but may involve damage to small nerves in or near the intervertebral foramina.

The medico-artistic phenomenon and its implications for medical education

A better understanding of the relationship between medicine and art could have significant implications for the role of the creative arts in medical education. This study seeks to contribute to that understanding by providing an overview of the involvement of medical practitioners in artistic creation from the Renaissance to the present--based on historical material, statements published by medico-artists in professional journals, and an informal survey of members of a Medical Art Society. Our findings support the hypothesis that there are close links between medical practice and artistic creativity, and that individuals who engage in both forms of activity find the interaction beneficial. The implications of this hypothesis are that the inclusion of practical art training in the medical curriculum would not only enrich the experience of medical students during their education, but would also enhance their later wellbeing, both while they are engaged in medical practice and after they have retired. Although this study is preliminary, we believe that we have identified a consistent relationship which, if established, would have significant implications for medical education, and which therefore merits further investigation by psychological, sociological and educational researchers. The article concludes with some suggestions for further research.

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

Secondary Guilt Syndrome May Have Led Nazi-persecuted Jewish Writers to Suicide.

Feelings of guilt have tormented Holocaust survivors, ranging from immediately after the liberation to later in life, for shorter or longer periods, and persisting for some throughout their entire post-war lives. Descriptions of the guilt experienced by survivors of the Nazi camps occupy an impressive amount of literature: “Why me?” was the question, when a younger and more able family member perished; “Why me?” when more productive members of the community perished; “Why me?” when a million and a half children were deprived of their lives. Many found the answer by retelling their stories, witnesses of what happened. This type of guilt is much different from the recently described phenomenon of survivor syndrome, namely the secondary guilt felt by Nazi-persecuted Jewish writers. Despite successes in all aspects of their life, these writers developed a self-incriminating guilt due to their perceived inadequacy of communicating, particularly in light of the resurging anti-Semitism worldwide. This paper deals with the survival and suicides of Nazi-persecuted Jewish writers and offers a possible explanation for their late self-destructive acts.

Hunger Whilst "In Utero" Programming Adult Osteoporosis

The fetal “programming of adult diseases” has been previously reviewed. The descriptions were comprehensive, dealing with the effects of nutritional deprivation on the development of adult metabolic and cardiovascular diseases. During the past decade, research into this “programming” also expanded to the development of osteoporosis. The present review deals with the imbalance of bone mineral metabolism, “programmed” by maternal/fetal/infantile nutritional deprivation, and is illustrated with a family history from the Budapest Ghetto.

Comment on: The ‘gout’ of the Medici, Grand Dukes of Florence: a palaeopathological study

groups. We have investigated only one ELISA method that uses defined recombinant antigens and the results cannot be extrapolated to other ELISA methods, which may use different combinations of defined antigens or even simple undefined tissue extracts. We have shown that 1 year following ANA testing, patients who are ANA-ELISA-negative and ANA-IIF-positive are indistinguishable in symptoms related to SLE from patients who are negative for both ANA-ELISA and ANA-IIF. This suggests that the IIF-positive, ELISA-negative patients do not form a different patient group from those who are negative by both assays and therefore would warrant no difference in their management. Adoption of the ANA-ELISA would therefore reduce the number of patients who are referred for a rheumatological opinion and subjected to needless follow-up on the basis of a false positive ANA result.