Download studio paleopatologico dell`iperplasia prostatica in mummie italiane

A MULTIDISCIPLINARY APPROACH TO THE PALEOPATHOLOGIC STUDY OF RENAL
UROLITHIASIS IN ITALIAN MUMMIES
L. Ventura, L. Arrizza*, M. Capulli**, N. Rucci**, A. Teti**, V. Giuffra***, G. Fornaciari***
Unità Operativa Complessa di Anatomia Patologica, Ospedale San Salvatore, L’Aquila
*
Centro di Microscopie, Università di L’Aquila, Italy
**
Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università di L’Aquila
***
Divisione di Paleopatologia, Storia della Medicina e Bioetica, Dipartimento di Oncologia, Trapianti e delle Nuove
Tecnologie in Medicina, Università di Pisa
Urolithiasis is an ancient disease, with the first paleopathologic documentation dating back to the
Paleolithic. Two main forms (bladder and renal) of urinary calculosis recognise different causes,
chemical composition, and epidemiology. Bladder stone disease was more frequent in the past and
is still endemic in rural areas and developing countries. Renal stone disease appeared in more recent
times and is mainly an affliction of western industrialized countries, due to high animal protein and
refined sugars intake. We present the results of a multidisciplinary study of renal urolithiasis in the
mummies of two italian noblemen.
The renal stones found in the natural mummies of Pandolfo III Malatesta (1370-1427), Lord of
Fano and a leading Renaissance figure, and of an anonymous nobleman from Popoli (XVIII
century) were investigated using different techniques. In the first case, a stone was found at autopsy
in the left kidney region, whereas in the second case a left renal stone was removed using
radiography-guided endoscopic extraction.
Both specimens were examined with binocular stereomicroscopy (BSM), scanning electron
microscopy (SEM) also with energy dispersive X-ray analysis (EDX), and imaged with
microcomputed tomography (microCT). Tiny fragments from the surface and inner portions were
submitted to X-ray diffraction (XRD) analysis.
The stone from Pandolfo had a mulberry-like surface with honey brown colour and measured 12
mm in largest diameter. Along with the organic constituents (C, O, N), the following elements were
detected: K, S, Si, Cl, Ca, P, Na and Ba. The calculus was composed of ammonium acid urate
(95%) and calcium oxalate dihydrate (weddellite) (5%). Internal structure consisted of large
spheroidal crystals with different density values. In the Popoli case, the ovoidal mass with small
superficial buds measured 22x16x15 mm. Detected chemical elements were: C, O, N,Ca, P, K, S,
Cl, Na. The stone composition was calcium oxalate monohydrate (whewellite) (90%) and calcium
phosphate (hydroxylapatite) (10%). Internal structure detail revealed concentric laminations and
aggregates of similar density values.
The composition of the stones supported the hypothesis of high animal protein and sugar intake by
both subjects, confirming they belonged to high social classes. The presence of ammonium acid
urate, infrequently found in kidney stones, may indicate recurrent urinary tract infections in the case
of Pandolfo. The death of both subjects could be related to infectious complications of renal
urolithiasis.
Finally, we are able to propose a protocol for conservative examination of ancient stones. After
BSM observation, the specimen should be imaged with microCT, in order to trace a map of the
surface and the whole calculus and guide the following SEM-EDX measurements for elemental
analysis. Matching the results from these methods avoids destructive XRD analysis and may allow
to obtain an affordable evaluation of the entire stone composition.