All right, so we're going back to Edinburgh Castle. So the other thing you don't realize is you have to sit through my travel sides with these talks. I've got a captive audience. All right, so there's the line going to Edinburgh Castle. And the nice thing is, as you go inside, you can pretty much go around every, of course, there's a line into everything, but you can pretty much go all the way through the castle. So that's kind of like the main heart of the castle. And on the top, you can imagine they had archers up there to try to defend it. And it's still the United Kingdom flag, although Scotland did have a referendum to secede from Great Britain, but it was voted down barely. And this is the chapel. There's a chapel on top here. And then this is the nice thing. These are the views. So this is the old city of Edinburgh. Looking at it, Edinburgh is right on an inlet from the, now, Edinburgh is on the far east side of Scotland. And so it's kind of the sea between Scotland and Europe there, but there's an inlet to the sea. And so Edinburgh actually has a port right there. As usual, it's gray. It's like gray there for 300 days of the year. It's kind of the opposite of Utah. So it's the usual gray that you see. All right, so we're going to talk about orbit a little bit. And we're talking about orbit. The first thing that we want to do is you always want to make sure that you know what the definition of the orbit is. And I thought this was a pointer. Well, unfortunately, the pointer is not pointing. I don't really see anything coming out of here. Sorry. So whenever we're talking about the orbit, you want to make sure that you understand what constitutes the orbit. And the first thing that when you're looking at the orbital path, you want to make sure that you understand what the bones are of the orbit. So always the first question we ask is, what are the orbital bones? So Julia, tell me what the orbital bones are. OK, that's seven, right? Well, lesser and greater are the same thing. So they just count as one. They just count as one. OK, the Palatine is what people always forget. So I didn't get you on that one. Usually it's the Palatine that people just completely forget about. But when you look at the orbit now, Maurice, the orbit is divided into three main areas. What are the three areas anatomically that we divide the orbit into? Well, that's where the lids, how about the orbit itself? OK, good. Yep. And again, one people forget about. Well, you can call periosteal, subperiosteal is a potential orbit. So when you divide the orbit, intraconal, what does intraconal mean? Inside the muscle cone. Exactly. So when you look at the muscles, the muscles have an intramuscular septum and they form a cone coming out from the apex of the orbit out to where the muscles insert. And so intraconal and then extraconal is what we really think about as the orbit. And then you could sometimes have where the periosteum is. There's a subperiosteal area there that, again, can be a potential space. So when we look at it here, we're looking at it in a little bit of a sagittal cut. Brian, tell me some of the structures that are intraconal, what are the most important structures intraconally? Good. Those are kind of the two important ones. Those are main ones. And we talked about optic nerve tumors last time. And so you can get tumors within the optic nerve intraconally. And then, of course, as you said, the ophthalmic artery goes in and then the various branches come out from the ophthalmic artery intraconally. Extraconally, there's a lot of fat and some septae and not a whole lot else going on extraconally. So we kind of look at it in an MRI. And again, you can see where the muscles are, denoting the intraconal from the extraconal space. What are we looking at here, I think? And what kind of gland is the lacrimal gland? Ecring gland. OK, so it's an ecring gland. It's a secretory gland, similar to sweat glands. And we kind of forget that the ecring gland is part of the orbit. Now, when we divide the lacrimal gland, what are the two major areas we divide it into? And what divides those two? Exactly. So the orbital lobe is what we think of as the lacrimal gland. But then when the orbital septum comes down anterior to that, there's a palpebral lobe, a small lobe of the lacrimal gland. And when you're inside the orbit, going ahead and trying to remove tumors and remove tissue, you can often disrupt that.  So see, the pattern of the lacrimal gland, it's like other ecring glands. It's like an assener pattern. So it's got a round gland that secretes into the center. And then it's got these little myoepithelial cells. And I wish I had a pointer to kind of surround the glands and have the little contractile elements that squeeze out the lacrimal secretion, if you will. So the problem with orbit is, when we look at the orbit, you can't often see anything from the outside. And that's the problem is, is we often don't know what's going on. We have to kind of infer it from other things. And so you thought you were going to get reprieved, because it's your first day. But at least looking at this picture, you can tell me which eye is abnormal. And how would you tell that? You don't even have to read to know this one. By looking at the two-eyed state of the patient, if there's a left eye, that looks like there's some discharge there, so maybe you have normality there. OK, now remember, what are we talking about today? What part of the orbit? Exactly. So look at the light reflex that's sitting on there. How is that light reflex different? Yeah, and not only that, but the left eye is lower. The light reflex is higher in the pupil. So it's as if something's above that left eye and kind of pushing it down and also pushing it in a little bit. So since we were just talking about this particular structure when we looked at it, we're looking at a scan here. Julia, what are we looking at here? All right, so we've got this lesion. It's kind of superior in temporal, which is where the lacrimal gland sits in its coin shape. Is that important? So what are the most common lesions that can affect the lacrimal gland? So in the olden days, like when I was a resident, we were taught the 50-50 rule, and that was that 50% of all lacrimal lesions were intrinsic tumors of the lacrimal gland, and then 50% of those were what we call these benign mixed or tumors that are arising from the lacrimal gland. But since people have really looked at lacrimal lesions and the shield's at Al, both of the shield's is plural, they looked at all of their lacrimal lesions that they had looked at at wills, and they found that about 80% of them are actually lymphoid in origin. And so the old 50-50 rule got chucked out. So really the most common lesion affecting the lacrimal gland is lymphoid, be it either benign lymphoid hyperplasia or a decryoadnitis or a lymphoma. But when you're looking at the actual epithelial lesions of the lacrimal gland, again, the 50-50 rule takes effect. So half of them are going to be the so-called benign mixed or pleomorphic adenomas, and these tend to have a round coin lesion when you look at them. And so when they grow, they don't have an actual capsule around them, but they do have a pseudo capsule.  So Rhys, what are the cellular components that make this up? It's still a glandular structure, she's telling me. OK, so this is one where the name describes it, which is really easy, because benign mixed. So mixed, meaning it's a mixture of proliferation of the glandular elements, but also those myoepithelial elements that we talked about. So you'll see kind of elongated, proliferative glandular elements, but in between them, you'll see the cellular proliferation of the myoepithelial cells that are there. So it's both of them. And they call it benign mixed, because it tends to be relatively benign, meaning that it doesn't send fingers out all over, it doesn't metastasize, it slowly grows with one caveat. The but is if you go in there to remove this and you just biopsy and you leave more in there and it kind of spills out in the orbit, these cells get ticked off at that and they start to become more nasty and grow a little bit more aggressive. So this is the one lesion where you definitely want to do an excisional biopsy. You want to remove it whole. You don't want to remove part of this behind. And here's a close-up. You can see the proliferation of the cord-like glandular elements that are in there. Now, sometimes if you take this out, you don't take it out completely. You just can't get it all out. It can grow back and it can actually start to change from what we call a benign mix to a malignant mix. Now, fortunately, malignant mix does not as common. And so this malignant mix, you start to look at it. They still got proliferation of both cellular elements, but they start to look atypical. They start to look dysplastic. So that's a malignant mix. And that's if you don't get the benign mixed out completely. And I know it's hard for you guys to see. I should have probably taken a higher power of this, but there are a little nucleoli in there. There's a little chromatone in there. And so these cells have become much more active and these can be a more aggressive tumor once they become a malignant mix. There's a close-up. That's a better picture. You can see the little nucleoli that are in there. You can see that these are just a little bit more aggressive. So Dr. Namas, that's the difference, then? It's just the activity of this. It's the activity. And also, once you've violated that capsule, you lose that pseudo-encapsulated look. So they start to grow more diffusely. All right, Brian, since you are up anyway, a little bit more obvious which eye is involved here when we look at it. Yeah, so the left eye, it looks like there's again some hypoglobus, inferior squaralum show. The eyelid has some probably mechanical ptosis and then some fullness of the left upper eyelid. All right, so you'd be, again, concerned of about kind of a superior temporal lesion in that area. And sure enough, when you do it, this is a coronal scan now. And sure enough, you can see that lesion up superior temporally. Now, this is a little bit different lesion. What is this one? That's the adenoid cystic. OK, so on this particular picture, this kind of denotes one of the propensities for this lesion to grow. What are we seeing on this picture where this lesion is growing? Exactly, it's going into the bone. And so these tend to be much more aggressive tumors. The problem is this is one of those tumors that's been described as, quote, disarmingly benign. And I'd said most times when we look at tumors, we can tell how aggressive they're going to be by how they look when you look at them. But this is one of the tumors. You look at the cellularity to it, and it looks pretty benign. And these can actually be very aggressive tumors. And so when you look at these, sometimes they can have a Swiss cheese or a cribriform pattern to them, where you see this little Swiss cheese effect. And there's a close up. But there's one particular subtype of these tumors that are alarming. And this is the one you'll need to know for boards. What does this denote? Exactly, basaloid or basilar type of proliferation. And when people have looked at these tumors, they've wanted to say, OK, these are really bad actors. These can metastasize. They can spread locally. But when they look at the subtype, it's this particular subtype that's the really nasty actor. And if you look at it, it almost kind of looks like a basal cell. And remember how basal cell, you had these nodules of really packed-in tumor cells. And so you can see here, it hasn't taken over the whole acromole gland, just part of it. And so this basaloid variety is the one that's a particularly bad actor. And these can actually metastasize. People can die from these. And so these are a particularly nasty one that you don't want to miss. All right, Eileen, we're looking at this patient here. So what would you be concerned about here? So that's always in your differential when you see that as a preceptal cellulitis, or what other things can look like this? And also what used to be called pseudotumor. Now they call that idiopathic orbital inflammation. That can be anterior, too, and look like this. But the interesting thing about this is if you look, it's kind of red and swollen. But you maybe have a little bit of redness underneath, but not the really hot look that you would see usually in a preceptal cellulitis. And when you look at this, you can see in this coronal view, what do you call that when you see it kind of going around and plastering itself around ocular structures? Exactly, so remember the coin lesion tended to grow in one area and then push against the eye? This tends to be really diffuse and mold around. Did you guys ever have silly putty when you were kids? Did that still exist? You know, silly putty molds around everything. Lesions like this tend to be lymphoid in origin, and they tend to mold around the ocular structures. And so don't forget what we said, the most common entity that affects the lacrimal gland is not so much the tumors that we had talked about, but this entity, and what do we see here? Yeah, so when you look at a lymphoma, it almost looks like someone took just a handful of lymphocytes and just smeared them across the slide. So there's just this diffuse infiltrator, these small blue lymphocytes. So don't forget lymphoma, but also you can have dachryoidinitis, you know, a benign proliferation affecting that. And here is an immunoperoxidase stain, and that's a way we can sometimes tell lymphoma from lymphoid proliferation as you look and see for clonality, and this particular lesion turned out to be a pure B-cell capa. So lymphomas can affect the lacrimal gland. All right, Julia, this is a familiar picture from last week, what are we showing here? And what are the carotid folds usually denote? All right, it's an intraconal mass. What's the most common cause for carotid folds? Exactly, so hyperopia with a flat posterior surface of the eye, so don't always jump in for tumors. And so if you're ever on boards, you wanna say exactly that answer, you wanna say, well, this is indicative, it could be indicative of a mass intraconally behind you, however, you know, when you look at series of these, the most common reason for this is just a hyperopic flat eye. So intraconal lesion, so we talked last week about some of the tumors that can affect the optic nerve, meningiomas, gliomas, even schwannomas, but there's another lesion that can affect that. Let's say this is a 28-year-old, vague symptoms of fullness around the eye, maybe a little bit of pain and you saw that, carotid folds, and then you do this scan and you see this lesion. What would you be concerned about here? Okay, so when you see this grape-like lesion intraconally, kind of slowly growing, you may have some subtle proptosis, some subtle symptoms, and so the most common lesion that affects that is a cavernous hemangioma. So when you look at these, again, just like the benign mix tumors of lachmoglobin, these tend to have a pseudocapsule around them. It's not a true capsule, but they grow really slowly and they've got this capsule surrounding them, so the nice thing is when you remove these, they tend to just come right out.  And the other thing is, is they have a very, very slow turnover of blood in there, so these don't bleed. These aren't like the cavernous, not like the capillary hemangiomas, I'm sorry, the lids that bleed like crazy. These usually don't bleed. And here's low power. You can see the pseudocapsule around it down here, and then you see it's characterized cavernous, big, you know, big vascular spaces with little fibrous septae between them, and how can we tell that the blood flow is slow through these? Yeah, so what is that that's layering? Yeah, so actually that's just serum separating from red blood cells, and so this is your, you know, hematocrit, you know, tube that you do.  I mean, that hematocrit's like 60, they're easy, so if you look at it when it's here.  So these tend to be benign, but because they're in that closed, intraconal space, they can grow when they can cause problems. And so you do want to get them out of there before they cause problems, because there's some kind of minorly important structures next to them like the optic nerve, you know, so you don't want to let them grow too big. All right, what are we seeing right here, Rhys? So there's some, yeah, when you have sclerosis, it's a sign that maybe that eye's coming out toward you. So, you know, again, first thing you want to do is say, gee, which eye's abnormal? And then what do we see in them? Because you really can't see the ore, but that's a nice thing about ophthalmology. It's a visual science. We can see what's going on in there, but orbit, you can't. And so you do have to jump to a scan, but Boopy will really pound you guys. You want to, you know, get as much history and as much physical exam as you can before you jump to that scan and try to figure out what you're looking for. And so this particular patient had a biopsy and this is what it looked like. So at low power, there's a certain pattern there I want you to look at. Yeah, it's kind of called a stag horn.   All right, so this is a vascular channel shaped like a stag horn, but if you look carefully, look, there's vascular channels all over the place in here, but there's a whole bunch of cells in between. What do you think this lesion could be? Now look up from that book, da, da, da, da, da, da, da. No, it's not, it's just working, you know. Okay. Would this one be like a hemangio perisatoma? Exactly, so this is a hemangio perisatoma. So not only a proliferation of vessels, but also the parasites around the vessels. So hemangio perisatoma, it's characterized by these classic stag horn appearance. The secret number one that you get. You can sometimes get stag horns in. Exactly, you can have big stag horns in the lymph angioma, so hold that thought. We'll get there, but yeah, you can. So it doesn't necessarily mean it, but the key that tells you it's hemangio perisatoma is it's packed with cells around those little stag horns. And so you can see each one of these little channels. Now this is a higher power.  Every one of these blood vessels is lined by these pump capillary channels, but in between you've got this proliferation of these perisites. So hemangio perisatoma. And this is just a closeup showing you these mini stag horn spaces, but a lot of vascular channels and blood. Now the thing with these hemangio perisatomas is we also try to classify them on how atypical they look. And so you can have benign, more of an intermediate, and then a more malignant variety. And if you look right here, look at the parasite cells. You see how they've got nucleoline in them? They've got clump chromatin. And so we really look hard pathologically and we say, okay, is this going to be aggressive or not? And is the pathology worrisome? And yet after all that, when people who see a lot of these have looked and said, okay, does the histopathological findings match with how aggressive they are? The answer is no. It's weird. There's some that look benign, that behave really aggressively. There's some that look more malignant and behave not so aggressively. So unfortunately that's one of the times where again this cellular makeup of the tumor is not really prognostic. The problem with these is they are not encapsulated. They're very hard to remove. And we've got a couple of patients that even started when Rick Anderson used to be here that then Bupi's taken over that.  So these are, as Bupi would say, a real bugbear. Bugbear, take this out. So chap comes in with one of these, bugbear. So these are really difficult sometimes. And so remember, they can be more benign or they can be mixture or they can be more malignant looking. And here's one of the more malignant looking ones. Again, you can see how there's some pleomorphism, different sizes and shapes of the cells. Clumped chromatin, you know, some nucleoli in there. Now there's one special stain we can do that really helps us out and bonus points for knowing what this stain is. Reticulum stain, exactly. And what does that mean? Okay, technically that is a true answer, yes. I said it with conviction too. Yeah, you said it with conviction, very good. So basically you remember the pericytes are kind of the support cells around vessels. And so they do have this supporting network of connective tissue. And so when you do a reticulum stain, which is a silver stain.  And so you'll see this extensive reticular network around. So this is really helpful when you're looking at lesions like this to do the retic stain. All right, Brian, what are we seeing here? Exactly, so it's kind of multiloculated. And if you look at it, you see some, you know, it's not really uniform in terms of how it's showing up on the CT scan. And you can see there's areas where it looks lighter staining and darker staining and it's septated. And you've got a lot of proptosis here going on. So how do you think this patient is? Exactly, so this is like a 10-year-old kid. And this waxes and wanes. They'll get proptosis, then it settles down, then more proptosis, then it settles down. And so speaking of giant stag horns, you know, what is this lesion or what is this entity? This is a lymph angioma. And so people call it that because they think that these big spaces almost look like lymphatic channels rather than vessels. And so when you look at these large, you know, channels and they're lined by a flattened, kind of spindly and complete endothelial lining, much like a lymphatic channel would be. And so this is a lymph angioma. And then what are these down here? Lymphocytes. And so you really do get patches of lymphocytes around these channels. And when the kids get a viral infection, especially an upper respiratory or nasal viral infection, these can grow rapidly. And so these lymphocytes will proliferate, the cysts will get really big. The problem is when you're treating these, again, these are not encapsulated. And so you can cause more damage trying to take these things out. And sometimes when they'll get an explosive proptosis and it's due to a big cyst, people will actually go in with CT or ultrasound guided needles and actually drain the cysts without having to go in and do surgery. And so if you can get them through that acute period, these will often settle down again. And you can see a close-up of one. Now what has happened here, Eileen? Exactly. Let's say the resident didn't do the surgery here. And this is what it really looked like before they took it out. Yeah, so every once in a while, you get an explosive proptosis because you can get one of the small blood vessels that surround those big stancords will bleed into it. And then when that blood sits there for a while, it'll start to break down. And instead of being nice and red, it'll turn that brown chocolatey. And so they call these chocolate cysts. So when you get bleeding into these cysts, you can get an explosive proptosis. And then you see that eventually those blood cells will break down and they call it a chocolate cyst. There's a close-up. You can see the blood within this, the big staghorn spaces. But then again, you see these lymphocyte clump, lymphocyte groupings that are there kind of around the lesion. So lymph angioma. There's a close-up of the lymphocytes. Okay. God, we're down to, what is it? Is it, if I got bad breath this morning or something? It's like, geez, we're down to like two of you guys? I mean, I know it's, it was Valentine's Day, but gosh, Brian again, what are we seeing here? Is this a picture from? This was when I first came here as an attending. Yep. So, well, I'll tell you. So it's a horrible proptosis and hyperglobus on the right and the eyes deviated down. I would guess that it happened pretty quickly to get to the back form. It happened really quickly. And this was the actual scan on this kid. Because it's like we're a third world, you know, some slow room, I could do it. But here, yeah. This was really rapid. So the story is mom brings the kid in to primaries in explosive proptosis. We do a biopsy. We say it's a tumor. We tell the mom she needs chemotherapy. They start to give the kid chemo. The lesion starts to respond and the kid's hair starts to fall on. She gets sick, so mom immediately takes the kid and goes to Mexico for coffee enemas and leitral treatment. You guys don't remember leitral. It's the stuff that cured tumors. And so you'd go to these clinics in Mexico, Miracle Cure, and what they would do is they'd give you coffee enemas because the enema would remove bad tumors from your body. And so that would help to cure you. And then they'd give you leitral. And at the same time, they'd also give you something else with the leitral and this cocktail, i.e. steroid. And then the patients would say, wow, I feel better. And then they'd come back and tell all their friends, I went to Mexico.  Doctors just want to make money and control everything. Those good Mexican doctors treated me. And then they would come back feeling good afterwards. And then they'd keep taking the medicine and then they would die from complications, either of the tumor explosively re-growing or the steroids. And so basically dad, who was divorced from mom, hired a private detective, tracked mom down to this clinic in Mexico. Dad flew down there and kidnapped the kid and brought her back. By then the tumor had grown so much that the kid ended up having an ex-generation and her life was in jeopardy. So interesting, interesting story. Of course they were from Utah County, the home of homeopathy and, you know, magic cures. All right, so unfortunately my fellows took these beautiful pictures once for orbit conference and so they did put these nice legends on here. And so you can read that legend as well as I can. But, so this is a rhabdomyo sarcoma. So whenever you've got a child with explosive proptosis and rapid tumor growth, you want to worry about rhabdomyo sarcoma. And so there's a couple of types of rhabdomyo sarcomas that we see and we don't good, we don't say it on here. What are some of the different varieties of rhabdomyo sarcoma? Okay, so embryonal or embryonal, I don't know how the proper pronunciation is, but that's the most common type. And what you see is when you look in these, you'll see these kind of tadpole shaped cells. So you'll see these cells that'll have this cytoplasm with a lot of pink, eosinophilic, staining material that kind of look like those round tadpoles that you see before they come into, turn into frogs. But if you look at them, you can see that it's pretty aggressive looking. And so if these aren't treated, they can grow pretty rapidly. And one of the other characteristics that you can see in these embryo, what do you see in rhab? Here. Yeah, so this is a muscle derived tumor and so you can actually see cross striations on these if they're differentiated. And the embryo tend to be moderately differentiated. So you can sometimes see cross striations and if you do a special stain, a trichrome stain, it really does show them. And so you can see over there to the right in the middle there, you can see the cross striations real nicely. So you can see cross striations, muscle differentiation for the embryo variety. Here you can see again, a nice one. Now if they're poorly differentiated, it's often hard to tell what these cells are. And so you can do immunoperoxidase stains, which will show that it is muscle in origin. So there are muscle specific stains that you can do. So these are the stains. One of them is by Menten, Desmond, and you can see that the cells stain positively for these. So we know that they're muscle derived. All right, so what kind is this? You already alluded to it? Yeah, so you can see why they call it alveolar. It looks like lung tissue. So it looks like you're looking at alveoli with a bunch of cells in it. So this could be a patient with pneumonia. These are inflammatory cells in the lung, but it's not. This is the kid's orbit. So you can see it, alveolar means it looks like alveoli in the lung. So you get these little septi in these round spaces with tumor cells. Is this important prognostically? Yeah, it's really bad prognosis. Yeah, so this is the bad prognosis. And so not that there's any really good prognosis in Arabian myosarcoma, but this is a particularly bad prognosis when you see the alveolar variety. You can't really make out the striations. No, once it gets to the alveoli, you don't really see the prostrations. It's really pretty poorly differentiated. And then again, if it's really poorly differentiated and you can't tell what its origin is, you have to do some immunoperoxidase stains. You know, does mental stain, muscle specific actin. So you can do some various immunoperoxidase stains that let you know this is muscle derived. All right, welcome back. So you're seeing this child. What are we seeing here? What would you be concerned about here? It's a graftose. What are these little things you see right here? Have somebody just put a foreseeing in or something? Actually, that's just their little crusty. That's the little crusty yellow stuff that's on the lashes. So is it probably more infectious like a preceptual or something? Okay, so in this particular one, again, you always keep rabdo on the back of the mind. That's good. And so again, when you're at boards, you know, it's almost like saying herpes when they show you a corneal lesion. If they show you a kid with an orbital lesion, you want to say, well, of course, rabdo is on the differential diagnosis and we need to rule that out, but it's more likely this. Always include that in a kid. But so this looks more like something that's pretty acute and possibly infectious. And so what kind of infections can look like this? A preceptual cellulose. Okay. Now, is it important to differentiate preceptual cellulitis from a regular cellulitis? Like an orbital cellulitis? Exactly. And so that's a key thing. So you probably want to do a scan because you're going to treat a true orbital cellulitis a lot more aggressively than you would a preceptual cellulitis and you don't want to miss that, you know, miss an orbital cellulitis. And so sure enough, this is the biopsy that was done and you can see this inflammatory reaction here where you've got a mixture of acute and chronic inflammatory cells that are pretty much diffused through the tissue. And here you see a close-up of these. Now, in addition to an acute cellulitis, what other lesions can you get that can look a lot like this, but not be infectious? Okay. What do we call the entity? We mentioned that just briefly before. The idiopathic orbital. Exactly. So we used to call it pseudotumor of the orbit, but people don't like the term pseudotumor. And I call it idiopathic inflammation of the orbit. And so it's the same thing. It's a lymphoid type proliferation. And so we want to talk a little bit right now about how you separate lymphoma from a benign, you know, idiopathic orbital inflammation. And again, this tends to be more on the side of the orbital inflammation. Now, when you are looking at idiopathic orbital inflammation here and you're looking at lymphoma over here, there's a few things you can do to differentiate it. First of all, on the benign proliferation side, the idiopathic orbital inflammation, you see lymphocytes, but you also see plasma cells. And you can see vessels growing through there. And you can see follicles in there. And so those tend to be on the benign side. Now on the malignant side, you have just a sheet of lymphocytes, no plasma cells. You usually don't have follicles. You usually don't have a lot of blood vessels through there. What's the one test we can do if we had to do one test to tell, you know, lymphoma from an idiopathic orbital inflammation? Clonality, exactly. So if you look at the lymphoma, they are monoclonal where the others are polyclonal. Now we can do that now on formalin fixed tissue. And so you can do immunoproxidase stains. You can say, okay, is it T cell or B cell? Is it, you know, Kappa, Lambda, et cetera? Now if we were gonna look at orbital lymphomas, what's the most common type of orbital lymphoma? B cell. B cell, okay. And know your characterization. Know the classifications of them. Because, you know, they've changed in my career three times now, the classifications.  So I have to look them up every time. But the most common now is what they call a mantle zone B cell, small cell lymphoma. So that's the most common one of the, but this particular one tends to be inflammatory. And if you don't treat an inflammatory orbital lesion like this properly, this can happen. Eileen, what's happened here? No, no, that could be the same thing. It can, scures just mean scarred, scarred in. Exactly.  And so once you get that inflammation, eventually calmed down, it can lead to scarring, fibrosis. You can even get a frozen orbit. In the days before they had steroids, these patients would go on and their orbit would just get sucked in completely with this fibrous, skierous scarring material. So you want to treat the pseudo tumor lesion before it gets to this point. And then of course, here's our young man with, you know, similar things. You look at it, you can't really tell what's going on. And here again, if you look at the scan, you see this diffuse infiltrative lesion of the orbit and we see this. Now how is this different from the previous ones we've seen? Yeah, so you see a sheet of these medium sized lymphocytes when you're looking at them here. And then we do immunoperoxidase stain. And again, these were all B cell lymphocytes. And then when you substained them, you could tell which they're from. Now you can also, if you get fresh tissue, do flow cytometry, which you need fresh tissue for that. If the tissue is fixed in formalin, though, you can still do staining for clonality, but it's immunoperoxidase stains. And so some of the people over at the main hospital like the flow cytometry better, others say none of the immunoperoxidase is fine. So if you can get your hands on fresh tissue, they can do the flow cytometry and they'll give you exactly what percentages of what type of cell. So you can see, okay, it's 80% B cells and such percent T cells and so much of this and so much of that. So the clonality that's done with flow cytometry gives you a little bit more precise information, but even on formalin fixed tissue, you can tell lymphoma versus the idiopathic orbital inflammation. Now there's a continuum in between. It's not just there's one here and one here. The hard part is in between, there is a lesion that's characterized by proliferation of mostly lymphocytes, but it's not monoflonal. And so this is called an atypical lymphoid infiltrate and those are really tricky because they almost look like lymphomas. And so we spent a lot of time trying to subdivide these. Again, I'm not sure if it makes that much difference. 10 years later, a lot of these do go on, even if they're not quite lymphomas at the time go on and become lymphomas. And the longer you follow these, the more chance you have for systemic involvement of lymphoma. And Fred Jacobiak when he was in New York had a bunch of people who had just orbital lymphoma and when he followed them at five, 10 and 15 years out, by 15 years almost 75% of them had developed systemic lymphoma. So it's interesting at 10 years it was about 50%, at five years about 25%. And so the longer you follow them, the more chance they had to develop systemic lymphoma. So you really gotta keep a close eye on these patients. All right, I'm just gonna show you a couple of ugly orbital lesions here, tumors that can't involve the orbit.  So you can get primary tumors of the orbit which we talked about, but you can also get tumors from elsewhere invading the orbit. So Brian, where can you get other tumors that can affect the orbit? They said you can get them from the eyelids or the conch or from the sinuses. Exactly, so you can actually get tumors invading from the lid. So any of the lid tumors can be back into the orbit. Any of the tumors growing from the sinuses can go into the orbit. And then lastly, you can actually get metastases to the orbit too. And so this is an exenteration where you remove the entire orbital contents because of the tumor. And the reason I'm trying to show it to you is look at the color up above there and that's real color here. What kind of color are you seeing here?  What would you be concerned about if it's a really dark lesion? So yeah, just talking about the lead lesions, the lesions from the front, they were worried about the melanoma. Yeah, so this particular patient had actually a conch melanoma that invaded into the orbit and required an exenteration. You can also get other tumors that grow from the lids. And those now basal cells usually don't invade unless you let them go for a long, long, long time. But squamous cells can invade into the orbit and so you can get lid tumors that can invade into the orbit. And you can get, this is a squamous cell that invaded into the orbit from the lids. This was a melanoma. So you see these bizarre, big melanoma cells. So you can get secondary invasion into the orbit from the lids. Now, you can also get distant metastases and so it's indicative of the most common tumors. And so in women, if you're thinking of metastatic tumors, you think of breasts. Men, you think of lung, exactly. And so although that may be changing and keep an eye on that because when cigarette commercials used to be allowed on TV, they had one that was for this company.  So you see this really sophisticated, sleek-looking woman with a cigarette. And this was her brand and she was making it in business. And so their slogan was, you've come a long way, baby. Seriously, that was the slogan in the 60s. And so that's true now. And so women have come a long way. They smoke just like men now so they can get metastatic tumors from their lungs just like men do.  And so you're seeing the lung almost even with breasts when you look at metastatic. All right, back to Reese since we got to make up for when you were gone. So this is what Reese looks like when I just ask him this question again. This is you on oral boards. So what are we seeing here? The injection where it's low-key. It's almost kind of here where the rectus muscle's insert. So what would this be? I'd be worried about thyroid, IVs. So what's the most common cause of bilateral proptosis in an adult? Thyroid disease. What's the most common cause of unilateral proptosis in an adult? Thyroid disease. Good, so you guys have listened at one time. So pound that in there. All right, thyroid disease. And so this is classic Graves picture. Now, in this particular scan, is this a worrisome scan if this were that patient? Exactly. So when you get, you know, the muscles will swell in thyroid disease. When you get this swelling posteriorly where it's very crowded at the orbital apex, you can actually get an optic neuropathy from compression.  If the muscles are more anteriorly and the patient has a lot of proptosis, you worry actually a little bit less about those because it's automatically decompressing outward rather than, you know, compressing on the optic nerve inward. And so this is a autopsy eye that I got ahold of a picture of. And look at the swelling of the muscle. Now, how do we tell the difference when you look at a muscle that's involved with the inflammation from thyroid as opposed to an inflammatory myositis? Exactly. If you look at this picture, here's the tendon, tendon is spared. Here's the muscle itself diffusely involved. And so if you have a myositis, it can go all the way to where it inserts into the glow. But if you've got thyroid, it tends to spare the tendon. So you can see it sparing that. Acutely, you tend to get swelling of the nerves. And so you get lymphocytes in there. You get this myxoid pattern. They get really acutely swollen. And then just like pseudotumor of the orbit, kind of in thyroid, if you don't control it well, you can eventually get scarring. So you can get scarring of those muscles. They can contract and you can get significant problems with trabismus. All right, last little lesion here. Let's see. I guess we did, Eileen. You got a short one, but we'll go back to you because that last one was short. This is from a young child. This was fortunately taken out of their orbit hole. And I'm trying to show in this picture that we're trying to shine a light through there. And when you shine a light on there, it almost lights up like it transilluminates. A cyst, okay? And a big cyst. And we look at that cyst and what do we see here? And when you cut it, this yellowish material is really disgusting and smelling too. So what do you think this could be? Okay, so this could be a dermoid cyst of the orbit and it's filled with, what is this yellow material? It's keratin. Keratin. So when we look at the lining of a dermoid cyst, what is the epithelial lining? Okay, and what else is here? Yeah, so there's some hair follicles, there's some sebaceous glands, and so the key is the dermoid cysts of the orbit tend to have not only epithelium, but epithelial appendages. Hair, sebaceous glands, things like that, even sweat glands sometimes. And so dermoid cysts in kids, usually we think it's some kind of a congenital remnant where superficial epithelium gets pinched off at the area of one of the sutures, suture lines of the bones, and then grows in the orbit. Now, these again will push out and form a pseudo capsule. So if you get these out whole, it's curative. If it breaks when you go to take it out, keratin is really inflammatory, and so you can get some raging inflammation if these things break up when you try to take them out. So you gotta be really careful that you take these out whole. Then we say goodbye, looking out toward the port in the old city of Edinburgh. So I think next week you get a time off from me, but then it's like March 1st is tumors. And so not only are we gonna do tumors in adults, we're gonna do tumors of children and we're gonna do the differential diagnosis of leukocoria. So know that, okay? All right.


So, good evening everybody. The second life in this moment is a way also to escape from a rather green reality here. And I am afraid in Italy we are experiencing something which will become sadly familiar to all of you in the coming months. I mean, it's... This pandemic is spreading to the speed of the light. It's really one of the most unpleasant time in my personal life, I would say. In any case, it's a pleasure to be here. And I hope that... Well, I mean, at the end if you wish I can give you more detail on what's happening here in Italy, but the situation is really unpleasant. And we took all the needed measures well in advance, but not much to say. Ok, can you see the slides? Because I see them in a quite confused way. Ok, good. So, nice to be back. Thank you for inviting me again. It is always a pleasure to be in second life. Even though, as you can see from the bed shape of my avatar, I am not anymore as a frequent customer as I was in the past, but I even forgot how to assemble some details of my avatar. Must work with it. Ok, tonight I am going to speak about something completely different from what are my normal research interests. And therefore, this is not really a seminar, it's just a set of thoughts. Thoughts on which I and some friends from the philosophy department at the University are beginning to put together. And everything starts from our deep belief that even though methods and goals are often different, there is a substantial uniqueness in the way human brain, humans react to internal stimuli. And therefore, there is a very strict link, a very close link between arts, physics, biology, all sorts of sciences and human discipline. But the topic is incredibly large. We focus on two aspects, which I think are particularly interesting, because they also give very clear examples of what we mean in a unique framework in which the human being develops. Basically, these two contexts are painting and physics. But the same type of thoughts, which I will expose tonight, can be formulated, can be developed in each field. It doesn't matter whether it is literature or painting or sculpture or music. Basically, the same consideration all through in all cases. So, let's start. Let's see if everything works fine. Yes, but basically the tonight thoughts will focus on these four different points. As science influenced arts, but also as art influenced science. Usually, there is a clear cut answer to the first question and it is obviously yes, because artists use a lot of technological developments, they use new type of materials for colors, they use new type of materials for expressing themselves. They use perspective, which is based on geometry. Many artists also use math. Therefore, there is no doubt that in some sense science is influenced arts. And also, the second question, as art influenced science, is something which is a little less obvious, but the answer is yes, because science has been inspired by many needs in the fields of architecture, in the fields of music. These are trivial questions, which basically do not deserve much of your time and of my time. The second set of questions is art to art and science possible outside of a culture in the anthropological sense. And I will try to show that it is, the answer is somewhere in the middle between yes and no. Here as culture we mean what defines a culture, like the Inuit in the Arctic regions or the Native Americans in their culture. Here a set of behaviors and traditions or myths or legends, which define a culture. And so, in the same equation, which is does it make sense to keep parts and sciences separate, if so, what is the criteria to separate them? And the answer is obviously not. But not so obviously, I would say, because many people keep claiming that there is a sort of distinction. I mean, I'm sure that many of you have heard people who say, well, you know, I have an artistic temperament. I understand nothing about mathematics. Like they are two different things.   Of course, we cannot control all of it because we are limited in the capability of our brain. But the intermingling of different disciplines is so strong that there is no way to separate sides from art or from any other form or from any other intellectual process. But this is a frame, the general context of the framework. Let's go to some more detailed thing. In the relationship between art and science, let's focus on some similarities which you can find in the way professionals describe their work. I mean, therefore, in the way artists define art and in the way scientists define science. Both of them are organized perception of reality. On this, there is no doubt. No one of us doubts that an artist try to represent something accordingly to some paradigm in which he developed in his brain and that this paradigm is strongly influenced by everything that artist in his life, the way he grew up, what he started. Therefore, Roy Lichtenstein is a famous artist of the 60s, he said that organized perception is what art is. Hugo Genn said something which is very familiar to what we claim in science that there are only two types of artists, revolutionaries and plagiarists. Reiner Maria Lirk, the famous writer, says that arts is an explosion of clarity. So basically it's the eureka moment. You suddenly understand something that you have never understood before. In the means of law, who is a very famous Italo-German writer, also say that art is nature as perceived to a temperament, because basically it's the same thing which Roy Lichtenstein and he are lepers. And now about science. Well, there is no art without facts and no science without facts. This is again a writer Vladimir Nabokov, but Thomas Kuhn, who is one of the most famous philosophers of science, one of the most famous epistemologists, says that there is a revolutionary science and paradigmatic one, exactly like an art. Mike Norton says that dreams are what the guy does and art is what defines us, math is what makes it all possible and love is what lights up our way. And finally, the more famous than anyone else, René Descartes says, is with me everything turns into mathematics. Philosophical issues related to scientific discovery arise about the nature of human creativity, specifically about whether the eureka moment can be analysed and about whether there are rules, algorithms, guidelines, heuristics, according to which such a novel, let's add, can be same for the encyclopedia of philosophy. Ok, so basically both fields, if we want to separate them into fields, give more or less the same description of what they are doing and what their goal methods can be different, but the final goals and the purpose is the same, the description of light. And I also would like to point out this statement from Jean Lepierge. I don't know whether you ever heard of him, I'm quite sure you have. He is one of the most outstanding figures in the field of children's psychology, basically. He has been studying the way human beings develop consciousness and thought, since more than 40 years, and most of what we know nowadays comes from his research. And he says also that human knowledge is based on vision, from vision we derive abstractions. This is true for artists, this is true for scientists, this is true for everyone else. Our paradigm, our perception of the world, our perception of society, depends on vision. If you think about it, almost all the concepts we use are based on some visual perception. Even in geometry we need to visualize vision, only in very high level, very high level mathematics, you stop visualizing things because you start understanding formulas, but all the rest is based basically on vision. And vision is what defines basically what we are in the end. I am not going to give much detail about this because that is a different topic, but nowadays it is also clear that by understanding vision we are capable to understand human intelligence and also to build the foundation for the artificial intelligence to come, which is basically the... Sorry, this is the slide which I presented in my other talks, one about the work I do, which is the way humans develop their knowledge. I mean, when a baby is born, he starts building categories on the basic... He is an empty tablet. He has no a priori knowledge. He has just very sophisticated software inside it. And by being exposed to thousands of sounds of images and so on, he trains his neural networks. And for instance, from the vision of several tens or hundreds of bottles, it defines an idea of a bottlehood which he will keep for all his life and which will allow him to recognize a bottlehood along with it. This is true for the idea of space, for the idea of time, for everything, for the idea of dog. All concepts we have in our mind are the results of a similar process where basically our brain gathers examples from external stimuli and converts them into abstract concepts. How can this help us in what we want to talk? I mean, we have to make choices in what we are going to discuss because arts and science have been around for more than a few thousand years. We have very well defined epochs in which both of them had quite a strong person. We could focus on classic Greece, we could focus on Egypt, on science and art, or we could move to renaissance. Or we could go to the later renaissance to the work by Galileo. But what I think is more useful is to focus on the most reason of this revolutionary period in which things began to change. Therefore, we shall focus mainly on the relationship between painting and physics at the beginning of last century. I want to emphasize this sentence by Pablo Picasso because it's exactly in the same line of what we are saying. I mean, many people believe that art is talent and science is a study. It's absolutely not true. Art, everything, to achieve excellence in any field you need to study a lot.   Art is a serious business, exactly like science, like mathematics, like physics, like biology. You can be an amateur, but if you want to be a professional, you need to be. To spend, let's say, your proper share of years studying what has been done before and where you are now. Because if you don't do this, you never do anything really original. OK. Please look carefully at these two paintings. I think they are the best simplification of what we are going to say. I am not going to tell you for the moment the name of the painter, but it's just to prove what I am saying, that basically an artist is not someone, a real artist, is not someone like, you know, a romantic creature, you know, and just as a talent and from one day to the other starts doing master. And remember these two paintings, please. It will be a surprise. To give you an example, I already showed this slide in my astronomical paintings and to tell you the truth, this is also where my interest in the relationship between paintings and science began. I mean, many years ago in Madrid, and there so this wonderful painting of Paul Rubens. Rubens was one of the best painters of the 17th century, which depicts Saturn devoring his children. It's fantastic. One thing, originally I was an astronomer and therefore one thing caught my attention and there are those three stars which are in the ellipses, which are above the god. Why? And this is a proof of how cultured, how deep was the culture of Paul Rubens. Look at the date, 1636. At that time there were no professional journals, there was obviously no internet and neither telephone or things like this. And the news spread of scientific discoveries and so on spread across Europe at a very low speed. To go from Florence to Paris could take even more than two weeks, four weeks of travel. Therefore, try to imagine how much time it would have taken for renews to spread across Europe. Years. Okay. Why there are these those three stars above Saturn? This planetation is quite intriguing. In, sorry, let me make the same mistake. Okay. It's quite intriguing. In 1610 Galileo Galilei sent a strange anagram to some of his courtes parlor. You know, before scientific journals were established, scientific anagrams were used to claim a priority when you had discovered something but you were not so sure about its interpretation.  Galileo, Kepler, many others, use Christian elegans and so on. Used to say that this letter where they made anagrams which contained the discovery but were not easy to be understood. And this anagram meant something very simple. Altissimum in Latin Altissimum planetan tergeminum observati which translated it how you observe the highest and more distant planet as a triple star. When Galileo pointed this telescope to Saturn, he saw it as a triple star just because his telescope and this is something which should be remembered when we discuss Galileo, his telescope was very bad, terrible quality, terrible glass, terrible aberration and we could not see the rings which we know around Saturn. But this the planet as it is depicted on the first image on the upper left corner of the slide like a main central body with two smaller bodies on the side. The other drawings represent the way the other astronomers you see there on the right side have observed the planet. The first one to realize in 1651 that what they were observing was not you know a triple body or renown for our things ladies but the planet with the ring was Christian Eugen John Domenico Cassini sort of in 1650. No, Christian Eugen it was much time later. What does he mean? That for Rubens it was a painter who was informed on the most advanced discoveries in the field of astronomy. Rubens was working in Spain at the time I am quite sure. Galileo was in Italy communication was very slow took place through very informal very strange channels but already 20 years later Rubens was aware of the discovery of Galileo of Saturn as a triple star and when he painted the Saturn the god Saturn there in his children he also wanted to celebrate the discovery by Galileo by putting those three stars on the top of the pit. Ok. This is a typical example. Examples like this are low rover the history of science in the history of picture you can find them everywhere from the Neolithic paintings through the whole history of modern art and science. The two communities have always been very well informed of what the others were doing but the main thesis behind these the behind these presentation is another one in and let me first present the thesis and then to give some evidence about that I think we will write at the end of the longer fort we will try to write something about that but this is very useful human culture is one the social paradigm changes because of modification in environment changes in the social culture and so on and the perception that humans as a collective entity have of this change in paradigm changes and our way of representing this change obliged us to make deep changes in all fields so we have just one adjustment of the cultural paradigm to an evolving reality and this adjustment takes place in all fields arts, music, history, whatever science and in some cases artists come before scientists and in other cases science anticipate art so basically we find that in the same period there are incredible revolutions in arts incredible revolutions in science focusing on the same topics and that these revolutions sometimes take place first in arts and sometimes they take place in science but it's matter of years not all decades it's just in few years one comes slightly before the other and the fantastic example is what happened at the beginning of the 20th centuries that has been one of the most prolific, most creative moment in the human history on one end art was completely revolutionized by what we shall see in few seconds basically we left realism to move to post impressions to move to something completely different which is art and in science we moved from classical mechanics to special relativity general relativity from classical physics to quantum mechanics and in both cases the the key factors was a different perception of space and time and of light and this is quite amazing because both communities were conscious that they had to change the way they were understanding the main concept of space, time light and matter at the same moment and they did it in two completely different way at the same time in some cases physics was first and some cases art was first and I think this is the best proof that there is a hidden engine in human culture which pushes forward and with no clear cut distinction between fields and something which we used to organize our knowledge not exist at all just a few words about the starting point which is primitive art and it's very well it's believed nowadays and I think most of us agree with that that primitive art and also tribal art and most of oriental art have a completely different understanding of space and time with what respect with what we do nowadays because if you look at work of art from very early age or from farist you find that the artist does not depict the object as it is in a realistic approach but basically they try to represent what the artist feels about that object so basically these feelings these interpretation of the objects represented on pottery ropes, fabrics simple geometrical forms and each one of these forms is usually charged with symbolic meaning also what you see is that perception of space and time both primitive and oriental culture is not Newtonian at all we shall be more clear about these in a few seconds here for instance you see these fantastic drawings by Chinese painters early painters of the century where you see the immortal spluttered ink on the left which I think is fantastic something which in the west we began to see only very recently in the last 50-60 years so you know the primordial chaos which reminds us of a fractal structure you know on the right side but also if you go and see what the anthropologist say about these tribal artists see that basically they do not have a perception of reality organized in strict concepts of space and time as we do and for instance deignuit from the no-artic circle is that they don't perceive the space as static space I mean they live in an environment where there are no reference points and they do not have a well defined set of measure for space and they have no uniform division for time they basically perceive space and time which is ruled by nature and in their artworks you have something asher-like basically the object feels the space and this is really completely the opposite of what was taking place in the western art in the late 19th century let's say till the beginning of the 20th century when something happened in the west in sorry this is has nothing to do with it ok so remember this primitive art is a non-Newtonian non-Euclidean perception of space and time and space and time depend on the observer depend on the observer and are not defined in an absolute way on the other side before 1905 in physics I mean the paradigm was ruled by Newton where time and space were something completely different and it was the absolute true mathematical time basically it was a time which was defined independently of the observer outside of the observer which existed in spite of the observer and this suddenly changed in physics let's see first what happened in physics and then we go ahead in 19 blank realize that light is not a continuous but it's basically an ensemble of particles and start and basically changes the nature of light in 1905 Einstein demonstrates that this light is has also the property of a physical body and not a wave in 1905 again Einstein reformulate the concepts of space and time with special relativity saying that the space and time are no longer absolute but they depend on the relative state of motion of the observer and of the observer the main basically there is a contraction of space time depending on the speed in which two objects are moving relative to one another so basically space and time became no longer absolute but relative there was a lot you know so this understanding about the meaning of this relativity but it was a momentous development but it was not at the end of the story because in physics in the coming years there were other revolutions the Broly the Broly demonstrated that in 1924 light was both wave and particles and that particles were both wave and solid matter so basically there was no longer a clear cut distinction between particles of matter and particles of light they basically were different when shared many properties in common this led the year after the birth of quantum mechanics in by Heisenberg's Schrodinger and where the main idea is there is no longer clear cut separation between observer and observer so basically nature does not exist by itself by what we perceive of nature is affected by the observer but also nature itself is affected observer of entities and observers intrinsically coupled so this was an incredible change in the way in the way space, time, light matter had been consumed in the preceding years ok, let's see what happened in art before 1905 many things had already began happening in the field of revising the general idea of space and time but the struggle reached the peak in the years between 1905 and 1908 especially in France Germany, Italy, Netherlands and Russia where basically it became clear that the impressionist approach was over and that double perspective geometric construction which was at the base of the impressionist did not reflect anymore the needs of the current paradigm and they also realized that art reached the limit and they had to move out of the two dimensional limitation posed by the canvas and very nice thing so let me go back today to two paintings if you don't check on internet or if you don't know before can you guess who painted these two paintings I'm looking at the chat who is the painter don't check on internet what do you think it's Picasso Pablo Picasso before 1905 this is what I was telling you Picasso before revolutionizing modern art had studied for many, many years he was a fantastic painter also by himself he was also a fantastic painter by let's say classical standards he knew everything he had to know about painting he knew everything about what but at some point he felt the exception of reality he had was no longer matched by the current artistic paradigm and where was the breakpoint the breakpoint let me move my mouse ok, here 1907 two years after the Einstein paper which remember did not become very popular until many years later, let's say in 1910 at the Museum of Trocadero in Paris there was an exhibit of African masks in Minecraft which really shocked the artistic world because for the first time artists who were looking to a new way of expression this is before what had been missing in art at that point and in that art had missing what was missing was exactly the same thing which was missing in physics before 1905 a coherent representation of space, time, light and matter look at that in this, the second one is 1895 in two years later Picasso was painting the De Mausel de Vignon which is completely different what is the meaning of this revolution Picasso had been shocked by the discovery of the non-euclidean geometry of the breaking in planes and of the different perception of space and time which was present in primitive art and you can see on the right side you see the right corner of the painting you see there is the face of Mademoiselle which is identical to an African mask it took inspiration from this new understanding of and he decided together with many other painters that what was missing painting was the perception of space and perception of time and that space and time depended on the observer exactly as it was being discovered in physics let me show you a few examples Cubism basically what Picasso started was Cubism this is fantastic painting by George Brack who is depicting a village and you can see objects are composed in visual fragments you don't have anymore the house as a unique piece you decompose the house in many pieces these are redistributed over the canvas in such a way that there is no the observer there is no 3D anymore in a sequence and all fragments which compose the image are perceived simultaneously as Gertrude Stein said there is no there basically there is you are delocalized in the observer even more fascinating is this violin and candle on the left side where you can see the violin for all possible perspectives this is a way instead of rotating the object instead of looking at the object in a temporal sequence from different angles you see all angles simultaneously and you live to your brain the task of reconstructing the object look also on the right side the Diego Rivera where the gate the painting of Zapata where you see all the items all together and you have this fragmented perception of reality this was one way to react to the stimuli but there are many others let's forget this one because otherwise we run very long another one was the surrealism and relativistic distortion which was introduced by many people but mainly by Savo Tordali Savo Tordali was also depicting very clearly the disruption of time in painting here you see these clocks slowly melting down slowly adapting to the environment it was a realistic representation of what was taking place in art and that these people knew a lot about science you can also prove in this coming fantastic painting which is corpus hypercubus by Savo Tordali where the cross is transformed in a tesseract and all mathematicians in the audience know that the tesseract is a 3D dimension the 3 dimensional projection the 4 dimensional hypercube again Tordali is putting the element of perception of space and perception of time into a painting which only in appearance looks realistic just because you can recognize the bodies but the hidden meaning is very strong I mean here you have dimensionality of the image which just projects in one moment so it's really yeah it's like breaking boundaries between space and time I absolutely I read the comment in the art nouveau again starts at the international exposition in Paris, well before the physics revolution 1900 and this is absolutely transversals in architecture, painting, design and it was dictated as a reaction to the industrial revolution and it deeply changed the way things were perceived. Look at this in that period before it happened in physics remember 1900 the work by Max Planck arts had realized that the perception of light was right and they moved from impressionism to post impressionism where basically light was reproduced by colors no longer with the details but just like globes of colors very strong colors this was called fulvism fulvism it's basically that I was from beast from savage and it was a very short period but basically it was a moment where the impressionist movement ended because it had exhausted its possibility to represent the light and the artists had discovered the light at much more in need and in that time and I think this fantastic painting Matisse is really one of the left side is a clear sign that perception is a change another example we are slowly running toward the end also because it's running late I want to tell you about fulvism fulvism was a movement which started in Italy but had a huge impact all across Europe which was started by a crazy guy Filippo Tomasi Marinetti very intelligent, very smart very brilliant but completely weird who basically was impressed by the industrial revolution was impressed by the speed of the modern world by and he realized that time was crucial in art but time means movement so he represented the time not as the cubist but trying to put the movement into the painting and some of his paintings like this one by Umberto Bočoni was a famous, sorry I didn't translate it it's a famous Italian painter of the futurist movement he tried to show here the growing city and basically structure here are blurred out by the movement you don't have anymore a single object but you have just object which are evolving across the canvas here this is a cyclist by a Russian futurist painter Natalia Doncharova where you see that basically she's decomposing the cyclist in different frames like in a picture, like in a film and this is showing frame after frame so you have this tribal image so again time becomes a crucial aspect of the paintings and its relation with the observable this is something which you find nowadays everywhere I cannot see this painting very well, must be very heavy let's see the bargain while I cannot see the image but what you are saying is it's crucial the most shown lines were the the starting point of the futurism of the futurist paintings they really called them dynamic lines they called them evolution lines and they were really driving their the construction of their paintings so, sorry can you see this painting because I cannot see it very well on my PC so I think I must move to the other one it is not loading properly ok now I don't know how to load the video into the into the second life but if you click to this link the one which you see here if you wish I can try to put it in the shot it's this is a subsequent evolution of the relationship between work of art and observer this goes more on the quantum mechanics perception and this also took place more or less simultaneously where basically the work of art was not uniquely depended on the position of the observer so let me see if I if I can copy it for you in just a second I'm trying to do it ok I'm trying to find it in the original and I'll put it on the shot ok ok I think ok so ok I think you should be able to to open it from there and this is one of the many examples now we have in modern art where basically the perception of an object is not unique it depends on the observer it changes as a function of the position of the observer of the time in which it is observed and so on so it's an attempt to bring subjective perception into art and I can show you another example here this is a fantastic piece of work by Shigeo Fukuda I don't know whether why the image doesn't show you properly but please google up this guy and look at this work of art this is basically a conglomerate of works and spoons but when you lighten it from different perspective it forms different objects I'm sorry you cannot see on this image but this is really a let me see if it is in the next one I have a problem with my ah, here we are if you put the lighting in a proper place for instance it becomes a motorcycle that one, the shadow that structure becomes a motorcycle and so on and modern art is full of these things where basically it is trying to reproduce the relation between observer and the observer, look at this fantastic modern sculpture ok, what is it really, I'm not kidding I'm asking you, writing on is a piano, yeah if you look at it from a specific position that one is a mirror it's a perfect piano quite impressive isn't it and playing with perspective but something more than that and so on creating that feeling ok, so let's try to sum up something about this original this initial thoughts about something it's the idea our understanding part of the one of which we are working now it's that when society confronts with the new stimuli the interaction with the new types of images, new types of concepts which for instance arise from a huge shift in technology or a huge shift in societal structure need to be reorganized just it's a sort of compression algorithm we need to reorganize our way of perceiving reality to be able to handle it and revolutionaries doesn't matter whether they are artists or scientists create symbolic language which basically are able to express these new ideas much before words can do it and so it's a sort of preverbal state of human knowledge where images come first in words second and this applies to all field of human knowledge and just focusing but you can find similar stories in music in in everything the reflections and conclusions humans are social animals and they participated in the golden perception paradigm but when we say social paradigm there is something deeper than what we usually mean with this humans are no longer Darwinian animals you know that evolution rules the world but evolution for humans has assumed a completely different meaning because when you deal with Darwin evolution you are saying that basically if there is a change in the environment that by genetic modification the species adapt to the changing environment since we have discovered the fire it is no longer like that human beings react to a changing environment by cultural evolution so the fact that we are social animals social animals with the technology has changed deeply the way we adapt to our environment in other words if it gets cold we do not grow here we start the fire and this is really the main thing behind it as a species we need to react to a changing cultural and changing natural environment and basically the cultural environment is what matters more until we survive if the environment kills us it is a different story but as long as we can survive into the environment I mean the cultural environment is what shapes us and this forces us to go through a cultural adjustment which takes place across all boundaries of human knowledge there is a reflection there is nothing more conformist than the so-called anti-conformist because basically the anti-conformists usually are people who just are adopting a new paradigm but basically from the anthropological point of view it's nice okay exactly we are still evolving but I am very fast I am afraid I don't know what will come out of this coronavirus business because this is really going to change a lot our society okay okay so basically here I am just repeating what I was saying and I just want to show you a book which is where all these things started usually if you can find it read it it is very interesting there is a proof of what I am saying it was not written by either by an artist or by a physicist it was written by a cardiologist it's really fantastic book where some of the things I will be mentioning you can find them there but there is much more to say so thank you very much for listening and as I said you I mean this is just working progress I am done thank you questions? thank you thank you very much if you have any question I guess the other 5 minutes before my dinner time oh about the situation totally rude it's now it's bound to improve for the simple reason that we adopted the containment procedure basically we are isolated in the house you are not allowed to walk outside of your house in many parts of Italy for instance in Naples where I am I am teaching classes online I am doing exams online basically you can go out or buying essential food or drugs but you cannot walk all shops are closed with the exception of pharmacies and a few grocery stores but life is quite orderly even in Naples it's incredible the community is reacting in a wonderful way and I am afraid that there is no safe place in fact to tell you that I am scared by the level of I am Italian but I spent so much time it's a little bit at least as much as I follow news in Italy and I am really astonished by the level of incompetence of it, I mean I know it's not political correct not Trump he's been acting like there was no real danger of the virus spread all across the so I mean I'm afraid that you will lead to the same problems we are having here in Italy but don't be scared I mean just follow the rules he's isolated in the first time and life will slowly go back to a different normality because I think this pandemic is going to teach us a lot it has been changing the way we live in Italy and that is something that we never expected to tell you the truth because Italians are deeply rooted into the if the test changed our way only it can change the way of living of everyone else in the world it's it's something to be extremely careful with but for the rest I mean life is normal just social life has disappeared you know it's one advantage here in Italy is that we have a strong public health system huge I mean even if you are anomalous you are hospitalized for free and everything you get everything for free and you get fantastic treatment if you are poor and I am afraid that in reality this is not true I mean this is going to hit very badly on the poorest and on the less rich layers of the population I mean it's and I think that this pandemic will be over the intelligent people in the world should be able to rethink many their beliefs yeah people in camps in Greece agree so my friends thank you very much for being with me, thank you for giving me the opportunity to present my ideas now I must end because otherwise my wife is going to kill me because they are waiting for me for dinner thank you very much it's always a pleasure to be I hope to see all of you soon and be safe worry a little about these things make all precautions and be safe bye to everybody goodbye