Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

Jean-Louis Petit

Jean Louis Petit
(1674 – 1750)

French surgeon and anatomist, Jean Louis Petit was born in Paris in on March 13, 1674.  His family rented an apartment at his house to Alexis Littre (1658 – 1726), a French anatomist. Petit became an apprentice of Littre at seven years of age, helping him in the dissections for his lectures and at an early age became the assistant in charge of the anatomic amphitheater.

Because of Petit’s dedication to anatomy and medicine, in 1690 at the age of sixteen, became a disciple of a famous Paris surgeon, Castel.

In 1692, Petit entered the French army and performed surgery in two military campaigns. By 1693 he started delivering lectures and was accepted as a great surgeon, being invited to the most difficult operations.  In 1700 he was appointed Chief Surgeon of the Military School in Paris and in the same year he received the degree of Master of Surgery from the Faculty of Paris.

In 1715 he was made a member of the Royal Academy of Sciences and an honorary member of the Royal Society of London. He was appointed by the King as the first Director General of the Royal Academy of Surgery when it was founded in 1731.

Petit’s written works are of historical importance.  “Traite des Maladies des Os” ( A Treatise on Bone Diseases);  “Traite des Maladies Chirurgicales et des Operation” (A Treatise on Surgical Diseases and their Operations” This last book was published posthumously in 1774. He also published a monograph on hemorrhage, another on lachrymal fistula, and others.

He was one of the first to perform choIecystotomy and mastoidotomy. His original tourniquet design for amputations saved many in the battlefield and the design of the same surgical instrument today has not changed much since its invention by him.

His name is remembered in the lumbar triangle, also called the "triangle of Petit", and the abdominal hernia that can ensue through that area of weakness, the lumbar hernia or "Petit's hernia".

Sources:
1. “Jean Louis Petit – A Sketch of his Life, Character, and Writings” Hayne, AP San Fran Western Lancet 1875 4: 446-454
2. “Oeuvres compl?tes de Jean-Louis Petit” 1837 Imprimerie de F. Chapoulaud
3. Extraits de l'eloge de Jean-Louis Petit Ius dans Ia seance publique de I' Academie royale de chirurgie du 26 mai 1750” Louis A. Chirurgie 2001: 126 : 475- 81


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-oma

The suffix [-oma] means "tumor", "mass", or "growth". It should be noted that the word [tumor] is originally Latin, and means "swelling" or "bulging". Sometimes the plural form [-omata] can be used.

It is a general misconception that the suffix [-oma] or the term [tumor] are synonymous with "cancer". This is not so. [Tumor] only means a mass and the type of mass, benign or malignant is not implied in the term. A cancerous mass will be denoted by the addition of the root term [-carcin-] meaning "cancer" therefore the combined root and suffix will be [-carcinoma]. There are other root-suffix combinations that also mean "cancerous".

The suffix [-oma] can be found in many medical words, such as:

Hematoma: from the Greek root [-hem-] meaning "blood". A mass of blood
Myoma:  from the root [-my-] meaning "muscle". A mass, growth, or tumor of muscle.
Fibroma: from the root [-fibr-] meaning "fiber". A mass of fibers. 
Fibromyoma: the combining form of "muscle" is [myo-], therefore "a mass of fibers and muscle" (Pl. fibromyomata)
Adenoma: from the Greek [aden-] meaning "gland". A mass that has a glandular look to it or a mass in a gland 

Sources:
1. "The Language of Medicine" John H. Dirckx Pub: Harper & Row 1976
2. "Medical Meanings" Haubrich, William S. Am Coll Phys Philadelphia 1997
3. "The origin of Medical Terms" Skinner, AH, 1970

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Giovanni Battista Morgagni


This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.To search all the articles in this series, click here.

Giovanni Battista Morgagni (1682 - 1771). Italian anatomist, physician, and pathologist, Morgagni was born in the city of Forli. He started his medical studies at the University of Bologna, graduating in 1701 with a degree in Medicine and Philosophy. In 1712 he became a professor of anatomy at the University of Padua, Italy, 175 years after Andreas Vesalius. Morgagni was offered and accepted the Chair of Anatomy in 1715 at the University of Padua. Although Morgagni held a position at the anatomy department of the University of Padua, his name is associated mostly with his pathological studies.

Morgagni was interested in the works of Theophile Boneti (1620 - 1689), who started analyzing the correlation between post-mortem anatomical findings and diseases. He tried to establish a relation between the disease and the cause of death. In 1761 Morgagni published his most influential work "De Sedibus et Causis Morburum Per Anatomen Indagatis"  (On the Sites and Causes of Diseases, Investigated by Dissection). His work was essential for pathological anatomy to be recognized as a science in itself.

Giovanni Batista Morgagni
Morgagni was elected to become a member of several Academies of Science and Surgery: The Royal Society of London, The Academy of Science in Paris, The Berlin Academy of Science, and the Imperial Academy of Saint Petersburg in Russia. He is remembered today by several eponyms in anatomy and pathology:

• Morgagni's caruncle or lobe, referring to the miidle lobe of the prostate
• Morgagni's columns: the anal (or anorectal) colums
• Morgagni's concha, referring to the superior nasal concha
• Morgagni's foramina: two hiatuses in the respiratory diaphragm allowing for passage of the superior epigastric vessels
 Morgagni's hernia: an hiatal hernia through Morgagni's foramen, in the respiratory diaphragm
• Morgagni's ventricle: an internal pouch or dilation between the true and false vocal cords in the larynx
• Morgagni's nodules: the nodules at the point of coaptation of the leaflets (cusps) of the pulmonary valve. Erroneously called the "nodules of Arantius", which are only found in the aortic valve

Sources:
1. "A Note From History:The First Printed Case Reports of Cancer" Hadju, S.I. Cancer 2010;116:2493–8
2. "Giovanni Battista Morgagni" Klotz, O. Can Med Assoc J 1932 27:3 298-303
3. "Morgagni (1682 -1771)" JAMA 1964 187:12 948-950
Original imagecourtesy of National Institutes of Health.

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Lumen

The term [lumen] is Latin and means "light". It is an international measure of light intensity. The plural form is either [lumens] or the Latin version [lumina].

The question is how did this term end up meaning the "internal opening or cavity of a hollow organ"? Dr. J. Dirckx (1976) explains that the term [lumen] in gastrointestinal anatomy was not used until the late 19th century, but it was initially used by microscopists looking at cross sections of small vessels. Since the empty interior of the vessel was represented on the histological slide as a clear, lighted region, they started calling that the "light" of the vessel, or [lumen].

The root term for [lumen] is [-lumin-] and can be found in over 30 words in English and related to light, such as luminosity, luminaria, luminescent, luminous, illumination,  illuminator, intraluminal, transluminal, endoluminal, etc.

The correct adjective form for [lumen] is [luminal], as stated by Haubrich (1997). The point is that the use of the term "lumenal" as an adjective form for lumen is not correct. This term can be seen in many textbooks today. The proper form for the NOTES acronym should be "Natural Orifice Transluminal Endoscopic Surgery" and not "translumenal". 

See how you can "illuminate" this article by hovering your cursor over the light bulb!

Sources:
1. "The Language of Medicine" John H. Dirckx Pub: Harper & Row 1976
2. "Medical Meanings" Haubrich, William S. Am Coll Phys Philadelphia 1997
3. "The origin of Medical Terms" Skinner, AH, 1970

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Esophageal hiatus hernia surgery

Nissen fundoplication (www.en.wikipedia.org)
Original image courtesy of Wikipedia.org

An esophageal hiatus hernia (also known as a hiatal hernia) eventually may require surgery. In this case, the objective is three-fold: To bring the abdominal viscera to its proper intraabdominal position (reduction) , to create a pseudovalve to prevent gastroesophageal reflux, and to prevent a recurrence of the herniation.

There have been different  procedures developed to this effect. One of the most popular has been the Nissen fundoplication either trough the open surgery approach or by way of a minimally invasive laparoscopic procedure.

This procedure was pioneered by Dr. Rudolf Nissen (1896 - 1981) in 1955.  After reducing the hiatal hernia and repairing the dilated esophageal hiatus, the surgeon creates a gastric wrap around the abdominal esophagus by bringing the fundus of the stomach through a retroesophageal passage, and suturing the fundus to the stomach. (see image). One of the concerns of the procedure is the ligation and transection of the short gastric vessels that pass within the gastrosplenic ligament to allow greater mobility of the gastric fundus and prevent potential avulsion of the short gastric vessels.

Since the introduction of this open procedure in 1955 there have been several variations, such as the "Nissen-Rosetti" procedure, a "loose" fundoplication; the "Toupet" procedure, an "incomplete" fundic wrap, and others, including laparoscopic procedures.

The advent of NOTES (Natural Orifice Transluminal Endoscopic Surgery) has brought a new procedure: Transoral Incisionless fundoplication (TIF), where a pseudovalve is created using an endoscope inserted into the esophagus and stomach through the oral cavity without abdominal  incisions or trocar ports. For more information on this procedure, click here. Clicking on the inferior image will start a six-minute video of the TIF procedure and the EsophX device.


Hiatus

The term [hiatus] derives from the Latin word [hiare], meaning to "gape" or to "yawn". In human anatomy this term is used to mean an "opening" or a "defect". It must be pointed out that in anatomy (and surgery) the term "defect" does not necessarily mean "defective". In most cases a "defect" is a normal opening in a structure, such as the esophageal hiatus. The plural form is either [hiatus] or [hiatuses].

There are many hiatuses in the human body, such as:

• Hiatus semilunaris: a crescent-shape opening in the lateral aspect of the nasal wall
• Esophageal hiatus: an opening in the muscular posterior aspect of the respiratory diaphragm, bound by two muscular crura
• Aortic hiatus: an opening in the posterior aspect of the respiratory diaphragm, bound by two tendinous crura
• Hiatus Fallopii: the entrance to the facial canal, an opening in the temporal bone allowing for passage of the facial nerve (CN V). Named after Gabrielle Fallopius


Respiratory Diaphragm

Respiratory diaphragm. Public domain
Respiratory diaphragm

The respiratory diaphragm is a musculotendinous dome-shaped shelf that divides the thoracic cavity from the abdominal cavity. It is one of the four named diaphragms in human anatomy. This is why it is proper to call it the "respiratory diaphragm" instead of just "diaphragm".

The name comes from the Greek, where the prefix [dia-] means "complete" or "through" and [phragm] means "a partition". In Latin, Celsus called it the "septum transversum", meaning "the transverse partition". The root term for [diaphragm] is [-phren-], as in phrenic nerves and cardiacophrenic vessels.

The respiratory diaphragm has a club-shaped central tendon (as in a card suit) which has a large hiatus for the inferior vena cava. The muscular portion is formed by skeletal (voluntary) muscle and descends skirt-like to attach to the internal aspect of the sternum and ribs anterolaterally, and a complex system of lumbocostal tendinous arches posteriorly.

It receives its blood supply through branches of the intercostal arteries, the musculophrenic artery, and the pericardiacophrenic arteries. It is innervated by the phrenic nerves, which descend through the mediastinum in relation to the pericardium.

The respiratory diaphragm has not one, but seven openings (hiatuses) to allow for passageway of many structures:

• Esophageal hiatus
• Aortic hiatus
• Inferior vena cava hiatus
• Hiatuses (2) for the superior epigastric vessels, which are the inferior continuation of the internal thoracic (mammary) vessels. Also known as the hiatuses of Morgagni.
• Hiatuses (2) for the splanchnic nerves

The most common site for an internal abdominothoracic herniation is the esophageal hiatus, but there are other respiratory diaphragm hernias, including the retrosternal hernia of Morgagni (through the superior epigastric hiatus), and the hernia of Bochdalek (a congenital hernia through an incomplete central tendon of the respiratory diaphragm).

Sources:
1 "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. "Anatomy of the Human Body" Henry Gray 1918. Philadelphia: Lea & Febiger Image modified by CAA, Inc. Original image by Henry Vandyke Carter, MD., courtesy of bartleby.com