Padua Medical School Research Articles

The role of the University of Padua medical school in the study of conjoined twins between 18th and early 19th century.

The Medical School of Padua (Italy) contributed profoundly to the study of teratology. Many famous physicians and professors of medicine, such as Liceti, Vallisneri, Morgagni, and Malacarne, have studied and investigated these anomalies to better understand the causes and to find a potential explanation, often preserving the specimens for future studies. The present study highlights some historical cases of conjoined twins and a conjoined triplet preserved at the Morgagni Museum of Human Anatomy to show the development of medical theories in the teratological field between the 18th and early 19th century. This approach will provide insights into different study methods and ideas of some of the most famous scholars working in Padua at that time. The current article focuses on rare cases, both human and animal, that were encountered by physicians who worked in the Veneto area in the late 18th and early 19th century. Their detailed descriptions are not only of historical but also of contemporary dysmorphological value.

Vincenzo Gallucci: Memories of a Surgeon, Scientist, and Teacher

Thirty years ago, Vincenzo Gallucci, MD, head of the Cardiovascular Surgery Institute of the University of Padua Medical School in Italy, died in a car accident at the age of 55 years. Vincenzo Gallucci was one of the most authoritative Italian cardiac surgeons, a fine, gentle, and extremely talented surgeon. He is credited with the first implant of a glutaraldehyde-fixed, stented porcine Hancock bioprosthesis in 1970 and with the first orthotopic heart transplantation performed in Italy in 1985. After 30 years, the memory of a great surgeon, scientist, and teacher is still alive, particularly in those who received his important heritage.

Exchanges and interactions between Padua and Vienna medical schools in the XIXcentury.

It is well known that Padua Medical School, Italy, played afundamental 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 ageneral 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.

Will We Have a Cohort of Healthcare Workers Full Vaccinated against Measles, Mumps, and Rubella?

Healthcare workers are a population exposed to several infectious diseases, and an immunization programme is essential for the maintenance of good vaccination coverage to protect workers and patients. A population of 10,653 students attending degree courses at Padua Medical School (medicine and surgery, dentistry and health professions) was screened for vaccination coverage and antibody titres against rubella, mumps, and measles. The students were subdivided into five age classes according to their date of birth: those born before 1980, between 1980 and 1985, between 1986 and 1990, between 1991 and 1995, and after 1995. Vaccination coverage was very low in students born before 1980, but the rate of positive antibody titre was high due to infection in infancy. Increasing date of birth showed increased vaccination coverage. In contrast, immune coverage was high for rubella (more than 90%) but not for mumps and measles (approximately 80%). An “anomaly” was observed for mumps and measles in the cohort born between 1991 and 1995, probably due to the trivalent vaccine formulation. Students born after 1990 showed vaccination coverage that exceeded 90%. It is therefore very likely that we will have a future generation of healthcare workers with optimal vaccination coverage.

Origin and development of modern medicine at the University of Padua and the role of the "Serenissima" Republic of Venice.

[first paragraph of article] The University of Padua Medical School played a fundamental role in the history of medicine. Padua is a very old town, probably one of the oldest in North Italy. Traditional legend tells that the Trojan prince Antenore founded Padua in 1183 BC. At the beginning of the Roman Empire, Padua was an important town, both for its strategic position as an ultimate defence point against barbarian populations of North Europe and for its famous horse breeding, which made it the main supplier of horses to the Roman army. In the late Middle Ages, even before the rule of Venice, Padua was a prosperous city state adhering to the values of tolerance, civilization and democracy. During that era, Padua was particularly famous for its school of civil and religious law, which was the cornerstone for the upcoming university.

Overview of the 8th meeting of the European Forum on antiphospholipid antibodies

Summary The 8 th Meeting of the European Forum on Antiphospholipid Antibodies was an important setting for timely, in-depth discussions concerning the antiphospholipid syndrome (APS) and it provided an opportunity for European investigators to exchange information with colleagues from the USA who have taken important steps forward in this field. The future governance of the European Forum was also clearly outlined by the forum coordinator. During the first part of the meeting, the physiopathology of thrombotic and obstetric APS as well as the possible implications of adjuvant vaccines in the pathogenesis of APS were assessed and discussed. The ongoing and future projects of the forum as well as laboratory and clinical aspects of APS were also addressed. The program included two guided poster sessions and 11 oral presentations. A surprisingly large number of participants (n ¼ 271) joined from 23 different European and extra-European countries and an unexpected number of young researchers participated for the ‘young investigator awards’. A lecture on the University of Padua Medical School over the centuries and its role in the development of modern medicine along with a singular social program including a guided tour of Giotto’s Scrovegni Chapel gave the meeting an exceptionally wellrounded program. The forum was an important setting for timely discussions concerning latest developments with regards to APS. It also provided European investigators with an opportunity to exchange information with colleagues from the USA who have recently taken important steps forward in this field. The first two sections of the issue, in

P.48 Procoagulant phospholipids clotting time in normal pregnancy and preeclampsia

s / Thrombosis Research 127 (2011) S123–S150 S141 disease. Undifferentiated thrombocytopathy was diagnosed in 11 (15.7%) of women. In control group undifferentiated thrombocytopathy was found in 5 (3.8%) of women, von Willebrand’s disease was not detected < 0.05). – 23 (32.9%) of the women had a thrombophilia: genetic 18 (25.7%) or combined one (combination of genetic thrombophilia with AFA circulation) 5 (7.4%). In control group thrombophilia was found in 9 (6.9%) of women (p < 0.05). – The 26 (37.1%) of women had the thrombophilic disorders in combination with the defects of platelet function. There are no women in control group had combination of thrombophilic and haemorrhagical disorders (p < 0.05). 25 women evaluated prospectively received differentiated pathogenetic therapy and prophylaxis, according to the diagnosed condition. All women delivered live babies without any cases of obstetrical haemorrhage. Conclusion: the presence of undetectable haemostasis system defects such as thrombophilia, platelet function defects and their combination can essentially increase risk of severe haemorrhagical complication during pregnancy. P.48 Procoagulant phospholipids clotting time in normal pregnancy and preeclampsia L. Spiezia *, E. Campello, M. Bon, S. Gavasso, S. Visentin, E. Cosmi, B. Woodhams, P. Simioni. Department of Cardiologic, Thoracic, and Vascular Sciences, 2nd Chair of Internal Medicine, University of Padua Medical School, Padua, Gynaecological Science and Human Reproduction, Section of Maternal Foetal Medicine, University of Padua School of Medicine, Padua, Italy, R&D, Diagnostica Stago, Gennevilliers, France Background: We performed a case control study to evaluate the changes in procoagulant phospholipids depending clotting time (PPL-CT) during normal pregnancy and in preeclampsia. PPL activity was evaluated using a specific clotting assay designed to measure the influence of phospholipids on the activation of coagulation cascade. Patients and Methods: One hundred and ten women were enrolled: 25 non-pregnant women (control), 35 women in the first (T1, n = 10), second (T2, n = 10) and third (T3, n = 15) trimesters of pregnancy, 25 during labour (L) and 25 women with preeclampsia. After informed consent blood samples (1:10 dilution in 0.105M buffered Na-citrate) were collected and double centrifuged. The PPL-CT (STA Procoagulant PPL, Diagnostica Stago, France) is obtained by measuring the CT of the patient sample, diluted in phospholipid depleted substrate plasma, after activation by Factor Xa. A shortening CT of the sample compared with control values means an increase in PPL

Gastone Giovanni Nussdorfer

Gastone Giovanni Nussdorfer is no longer with us. Gastone completed his medical studies at the University of Padua Medical School, where he graduated magna cum laude in 1967. He then became a fellow at the Department of Anatomy of Padua University, where he was appointed full professor in 1975, one of the youngest professors of medicine in the country. For almost 4 decades, Gastone Nussdorfer has been a world-recognized leader in the field of cytophysiology of the adrenal gland. His outstanding research work has contributed enormously to the current understanding of the role of this gland in the regulation of blood pressure. It is difficult to describe the scientific contributions of Prof Nussdorfer on 1 page: he published more than 500 papers, almost exclusively in high-impact international journals, and numerous chapters in major international handbooks for some of which he acted as the editor or coeditor. Although he contributed importantly to the cytophysiology and pathophysiology of practically all …

Immunity Against Infectious Diseases Predictive Value of Self-Reported History of Vaccination and Disease

To determine whether self-reported history of disease and/or vaccination is predictive of immunity against hepatitis B, varicella, rubella, mumps, and measles. The seroprevalence of viral antibodies and the predictive value of a self-report questionnaire were determined for 616 paramedical students who matriculated into Padua Medical School (Padua, Italy) during 2003-2005. The majority of subjects (86.9%) remembered being vaccinated against hepatitis B but had no recollection of disease. Among vaccinees, 1.5% showed markers of previous infection, 6.7% tested negative for anti-hepatitis B virus surface antigen (anti-HBsAg) antibodies, and 91.8% tested positive for anti-HBsAg. Self-reported vaccination history had a positive predictive value of 93.2% for test results positive for immunity against hepatitis B. Immunity against varicella (93.7% of subjects) and rubella (95.5%) was high, compared with immunity against mumps (79.9%) and measles (83.1%). In addition, results of tests for detection of immunity against mumps and measles were equivocal for more than 7% of subjects, probably because their vaccination regimen was not completed. Self-reported histories of varicella disease and rubella disease and vaccination had high positive predictive values (greater than 98% each) for testing positive for antiviral antibodies, compared with self-reported histories of mumps disease and vaccination and measles disease and vaccination; however, high positive predictive values were observed for self-reported histories of mumps only (92.0%) and measles only (94.7%). The self-report questionnaire used in this study did not accurately predict immunity against 5 transmittable but vaccine-preventable diseases. A complete serological evaluation of healthcare workers, followed by vaccination of those with negative or equivocal results of serological tests, is an appropriate measure to decrease the risk of infection in this population.

Antiphospholipid syndrome and right atrial mass

Clinical Summary A 43-year-old woman was urgently admitted to the hospital because of a syncopal episode. In the past she had had repeated spontaneous abortions, venous thrombotic events during pregnancy, and thrombocytopenia associated with lupus anticoagulant positivity. A diagnosis of antiphospholipid syndrome (APS) had been suggested 14 years earlier. Results of cardiac physical examination and a 12-lead electrocardiogram were unremarkable. Two-dimensional transthoracic and transesophageal echocardiography showed ventricular and left atrial chambers normal in size and function, whereas a polypus, mobile mass attached to the free wall was visualized in the right atrium (Figure 1, A and B ). Semilunar and atrioventricular valves were normal, without any evidence of vegetations. The patient underwent surgical removal of the mass, and pathologic examination ruled out a neoplastic or infective nature, by showing a fibrin network entrapping blood cells with calcific deposits at its implantation base (Figure 2). The histologic features were in keeping with an organized thrombosis, and a diagnosis of nonbacterial thrombotic endocarditis of the right atrial endocardium in the setting of APS was suggested. At 6 months’ follow-up, the patient is doing well with long-term anticoagulant therapy. She has no evidence of intracardiac mass recurrence on 2-dimensional echocardiography (Figure 1, C ). From the Institutes of Pathological Anatomy, Cardiovascular Surgery, and Rheumatology, University of Padua Medical School, Padua, Italy.

Mild factor VII deficiency due to heterozygosis is not associated with a bleeding tendency

University of Padua Medical School, Department of Medical and Surgical Sciences, Padua, Italy Received 20 April, 2005 Accepted 11 May, 2005 Correspondence and requests for reprints to A. Girolami, University of Padua Medical School, Department of Medical and Surgical Sciences, Via Ospedale 105, Padua, Italy. Tel: +39 49 821 2650; fax: +39 49 657 391; e-mail: [email protected]

Padua, the cradle of modern medicine: Bernardino Ramazzini (1633–1714) on headaches

A prominent historian of Medicine, Henry Sigerist, quoted the Padua Medical School as “the cradle of modern medicine”. This opinion is currently accepted worldwide. A short outline on the contribution of the Padua Medical School to the development of medical knowledge in its “golden age” is given. In this context, the work of a prominent figure of the 17th century Padua University and the founder of Occupational Medicine, Bernardino Ramazzini, is considered, with focus on his interest in headache.

The spectrum of factor VII deficiencies and abnormalities.

University of Padua Medical School, Padua, Italy. Correspondence and requests for reprints to Prof. Antonio Girolami, University of Padua Medical School, Second Chair of Medicine, Padua, Italy. Tel: +39 49 8212650; fax: +39 49 657391; e-mail: [email protected] Received 29 August 2003 Accepted 21 November 2003

Giuseppe Sterzi (1876-1919) of the University of Cagliari: a brilliant neuroanatomist and medical historian.

irst of all, let me explain why weare now writing about Sterzi.Approximately two years ago I(A.R.) received a message from Prof.Colin Wendell Smith, the secretary ofthe FCAT, who happens to live in theantipodal (for me) island of Tasma-nia, asking me if I could find him thearticle on subcutaneous tissue writtenby an Italian professor named Sterzi.This article had been mentioned byProf. DiDio during one FCAT meetingand Prof. Wendell Smith had alreadyunsuccessfully tried to obtain it viathe usual library system. Since I wasaware that Sterzi had been one of mypredecessors in the Anatomy Chair inCagliari, it was easy for me to send acopy of the article to Prof. WendellSmith, who was surprised to hear thatSterzi had been working in the antip-odal (for him) island of Sardinia andso was indirectly associated with me.In order to provide him with an En-glish summary, I had to read the 172-page article myself. I was greatly im-pressed by the rigorous discussion ofprevious reports and by the amount ofnew findings obtained also through acomparative anatomical/embryologi-cal approach. Prompted by this, webecame interested in Sterzi’s life andscientific achievements, being mani-fest that the studies on the subcutane-ous tissue and some others such asthat on the endolymphatic sac,though important and superbly car-ried out, had been just a parenthesisin his production devoted almost ex-clusively to neuroanatomy and thehistory of anatomy. Favaro (1921)maintains, in fact, that Sterzi madethem mainly to show his critics thathis production was not monothe-matic.

Frequent association of factor VII defects with other clotting disorders

University of Padua Medical School, Institute of Medical Semeiotics, IV Chair of Internal Medicine, Via Ospedale Civile 105, Padua, Italy.

Amino acid imbalance and hepatic encephalopathy.

Hepatic encephalopathy is one of the most frequent terminal episodes of primary liver disease. It was already known at the time of Hippocrates, and it was well described by Johanne Baptista Margagni, teacher at the Padua Medical School, in the 18th century. Hepatic encephalopathy is a neuropsychiatric syndrome seen in the pres­ ence of hepatic functional impairment secondary to acute liver failure or chronic parenchymal liver disease with or without spontaneous or surgi­ cally induced portalsystemic shunting of portal blood. The neuropsychiatric symptoms of liver failure are varied and range from subtle alterations, including mild personality change and disturbance in sleep rhythm, to confusion, drowsiness, stupor, and finally deep coma. In acute liver failure the progression of events may be extremely rapid, taking place in only a few hours. In chronic encephalopathy, in contrast, consciousness may be slowly altered over months, and may occasionally present as progressive and irre­ versible neurological symptomatology with dementia, parkinsonism, or other extrapyramidal signs suggesting involvement of the cerebellum or basal ganglia (170). Most often in the chronic situation, however, episodes of mental impairment are episodic, the result of defined stresses, and recov­ ery to the premorbid state is the rule. Other symptoms of hepatic encephalopathy are not specific for liver disease. Asterixis (flapping tremor of the extremities) is probably the most characteristic neurological sign of hepatic encephalopathy, is more common