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For the past fifteen years the author has been collecting photografic documentation of works of figurative arts (graffiti, mosiac, engravings, paintings and sculptures) made at different times and places, in which he found mostly unintentional display of diseases or deformities that would be clearly identified in nosography in the light of today's knowledge. In this study the author intends to illustrate briefly different cases on endemic goitre - whose representation is particularly frequent in figurative arts - in chronological order, beginning with the most ancient ones and focussing on Italian portraying of the Nativity and the Passion of Christ, where the most striking infirmities and disabilities were mirrored and commonly accepted. This study whose interest lies between a scientific and a humanistic one has also importance in the field of art, and especially in relevant philological research which is of particular importance to us pathologists. At last it contribute to establish the epidemiology of some diseases and the knowledge of historical and geographical pathology.

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This study is interested in figurative works of the past in which the artist had seemingly no purpose to illustrate pathological manifestations and their display was merely casual. It deals with both scientific and humanistic aspects and is of relevance to pathologists, in that it provides further insights into the epidemiology of some disease. Also, it contributes to an ever increasing progress of knowledge of historical and geographical pathology. The author has been carrying out this study without following a definite pattern, guided only by chance and curiosity, and discovering that artists could sometimes portray to perfection malformations and morbid conditions which would later be identified and classified in medicine, thus anticipating and even emphasizing the expressiveness of descriptions in scientific works. In his study, referring to paleopathology (therefore, not necessarily only very ancient), the author intends to illustrate briefly different cases found and to dwell in particular on two conditions, dwarfishness and endemic goitre, whose representation is particularly frequent in figurative arts. Representations of dwarfishness, in several of their genotypic and phenotypic variations, exist particularly in ancient Egyptian, Assyrian, Greek, Roman and, in the American continent, pre-columbian art; and then, again in Europe, mostly in 15th and 16th century art, but also in the following centuries, in which statues of dwarfs and malformed people were placed even in public and private gardens as ornaments. There are mainly representations of primary digenetic dwarfishness (total or partial chondrodysplasia, Lobstein type osteopsathyrosis, Hurler and Morquio diseases and other thesaurismoses), but also secondary (dysendocrinous-hipopituitaric and hypothyroid-, and due to different types of rickets and to vertebral tuberculosis of Pott). Representations of dwarfs of different types are shown and commented, from the most ancient, through the masterpiece portraits of Spanish 17th century, up to modern times. As to the goitre, a set of its most significant portrayals in figurative arts is presented in chronological order beginning with the most ancient ones and focussing on Italian representations of the Nativity and the Passion of Christ, where the most striking infirmities and disabilities were mirrored and commonly accepted. As far as pathology is concerned, it is pointed out how, for a long time in the past, the goitre appears frequent and widespread. This condition reached such an extent that it could almost represent another type of people, playing at times the main characters not only, as said, in Christian iconography, which for many centuries was almost the only one to exist, but also in every day life.

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The term of pathophysiognomy is to describe the conditioning exercised by the structure, position, and function of an organ on the characteristic configuration of a pathological process and, as the case may be, even upon the possibility of its development.

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Cystic adventitial disease is a rare vascular pathology mostly affecting the popliteal artery in disease is a rare vascular pathology mostly affecting the popliteal artery in men. An unusual case, located in the ilio-femoral region of a young woman, is reported. The authors claim that the cystic adventitial formations are similar to the ganglia that originate from tendon-sheaths, as structure, configuration and, probably, histogenesis are concerned. Moreover the authors suggest that cystic adventitial disease can be located among "histogenic dystrophic arteriopathies" in the pathokinetic classification of angiopathies.

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After a brief philologic introduction on some correlated concepts of pathogenesis we suggest the concept of pathological physiognomy of the organs. This concept express the conditioning that the peculiar structure, topography and function of an organ exercise on the characteristic configuration (and sometimes even on the possibility) of a pathological process in it. As fondament of this concept we report several examples of pathology.

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Our studies on pathology of AIDS point to four major conclusions. 1) The brain is often directly affected by the HIV infection (with the characteristics of subacute microglial encephalitis with pathognomonic multinucleated giant cells) and then by opportunistic infections such as Cytomegalovirus, Herpes-virus, Papova-virus JC (with progressive multifocal leucoencephalopathy), Mycobacterium tuberculosis, Toxoplasma gondii, Cryptococcus neoformans, Candida albicans and Aspergillus fumigatus; opportunistic neoplasms (i.e. B cell lymphoma mostly pluricentric) could also developed. 2) The heart is frequently involved as well; perivascular sclerosis and myocytolysis are the hallmarks of a peculiar cardiomyopathy. 3) In the lung viral, bacterial, fungal an protozoan severe infections are frequently present: common are those caused by Cytomegalovirus and Pneumocystis carinii. Frequently thin fibrotic interalveolar septa are observed (with consequent alteration of hematosis). 4) Adrenal (most frequently) and pituitary may display necrotic-hemorragic areas (in adrenals chiefly due to Cytomegalovirus). These may be extensive enough to explain the occurrence of clinical syndromes of endocrine insufficiency.

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We have previously described a few peculiar myocardial abnormalities occurring in AIDS patients. In this report we have extended out observations on twenty-eight additional cases where the presence of perivessel fibrosclerosis and sclerosis mostly of intramural arteries, as well focal myocytolysis were confirmed at the autopsy.

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More than 50% of AIDS patients show adrenal compromise. The major pathological findings include inflammatory changes of both the cortical and medullary portion with necrosis and haemorrhage. The principal determinant of these abnormalities appears to be CMV infection. We also report the occurrence of focal or subtotal hypophyseal necrosis in the setting of AIDS. These alterations of endocrine glands may deserve attention in the management of the patients.

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A new case of malignant atrophic papulosis (Köhlmeier-Degos disease) is reported. Vascular symptoms began at 17 months of age with cerebral ischaemia and progressive involvement of fingers and toes with torpid ulcers and apical necrotic amputations. At 6 years of age he developed chronic intestinal ischaemia with malabsorption and a new cerebral attack; in spite of anti-aggregant therapy the disease progressed and he died 7 months after diagnosis from a third cerebral ictus. Since the typical skin lesions of the disease were absent, the diagnosis was made on the basis of a pathological pattern of an occluded biopsied artery. The elder brother presents clinical and instrumental vascular involvement without cutaneous lesions and could be slightly affected.

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Lesions of the central nervous system were seen in 13/22 autopsies of Italian subjects affected by the acquired immune deficiency syndrome and including 19 intravenous drug addicts. Multinucleated cells similar to those originally described by Sharer et al. [1985] in response to direct central nervous system lesions by the human immune deficiency virus were seen in five subjects. Isolated or multiple opportunistic infections of the brain including cerebral toxoplasmosis (7 cases), progressive multifocal leukoencephalopathy (4), cytomegalovirus encephalitis (3), and tuberculous meningoencephalitis (2) were recognized. Finally, three cases of primitive cerebral lymphoma of large round cells were found. The central nervous system is a target, like the lymphoid tissue, of direct damage for the human immune deficiency virus, and it is frequently affected by opportunistic infections due to the immunological impairment sustained by the acquired immune deficiency syndrome.

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The keratinization process of tonsillary epithelium in patients with different age, who underwent surgery because of chronic inflammatory processes, has been studied by employing low (40 KD), medium (52-56-58 KD), high (56-64 and 68 KD) as well as broad spectrum antikeratin antibodies. The findings thus obtained outline the various keratin patterns of the tonsil in the outer covering and, even more, in the crypt labyrinth wall. These findings have been compared with those obtained by histochemical reactions for acid phosphatase and non-specific esterase activities (Favrz et al. 1986 II). In crypt epithelium keratinization, 56-64 KD keratins are involved in cells where also high enzymic activities are taking place, namely 1. in those elements delimiting the lumen as well as in those belonging to the reticulum mesh which are nearest to it and host lymphoid elements active in immunity reactions; 2. in elements at the bottom of small and large crypts, where excavation continues into the lymphoid tissue and interfollicular spaces. 68 KD keratin, although present in lower amounts, is synthesized almost everywhere, but only irregularly. It marks surface epithelium surrounding some dermal papillae, some meshes of the crypt reticulum, the "gallery" bottom as well as elements of interfollicular proliferation developing in the lymphoid tissue like arborescence. The path of congested blood vessels in the crypt wall towards the surface is marked by keratinized epitheliocytes. 56-64 KD keratin is present in the most superficial elements and is generally accompanied by the wall growing thinner, its blistering and breaking. The most frequent pathologic alterations of the epithelium (like cellular hypertrophy) involve variations in cytoplasm keratin pattern, in still un-flattened polyhedral elements of the intermediate layers.

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Pathologic findings in 25 autopsies of AIDS. The common and severe changes of the central nervous system, lungs, adrenals, heart, kidneys and gonads are reviewed in a series of autopsies of AIDS. In the brain, HIV infection induces directly inflammatory infiltrates including the typical multinucleated giant cells described by Sharer. In addition, primary lymphomas are seen as well as reactive and inflammatory lesions that are caused by opportunistic infections, such as those of poliomavirus, Cytomegalovirus and Toxoplasma gondii. In the lung, interstitial inflammation prevails, which may be related to direct HIV infection and include rare multinucleated giant cells like the ones described by Sharer. Opportunistic infections are often associated, and are commonly sustained by Cytomegalovirus and Pneumocystis carinii. A peculiar findings is the evolution from septal inflammation to fine fibrosis and hyaline degeneration, either focal or diffuse. We believe that the severe respiratory insufficiency that is commonly seen in the advanced stages of AIDS could be related to the interstitial damage. In the adrenal gland, the most common change is Cytomegalovirus infection affecting both the cortex and the medulla, and inducing massive necrosis in the cortex with little or no reaction. Again, adrenal involvement should be related to adrenal functional insufficiency, which may be over-looked clinically because of the preponderant lesions of other sites. In the heart, myocarditis is often discrete, and may be complicated by perivascular fibrosis and rare foci of myocytolysis; in some cases primary lymphomas may also develop. In the kidney, several histological lesions are found, including glomerular damage with segmental necrosis, cortical areas of hyporeactive necrosis, and mild interstitial inflammation. In the gonads, the changes are partly induced by drug abuse, and consist of atrophy with secondary hypoplasia of the germ cells and interstitial fibrosis. In conclusion, the most important abnormalities consist of opportunistic infections, hyporeactive necrosis, fibrotic evolution of the inflammatory infiltrates and neoplasias (Kaposi's sarcoma and lymphomas). In this work, the changes of the lymphoid organs are only mentioned, for they have been widely reviewed elsewhere.

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Physical appearances of goitrous people as they appear in figurative sacral arts of Italy are documented and discussed. The investigation is a contribution to historical pathology.

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