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Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. We will post a workweek daily medical or surgical term, its 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

Thomas Willis, MD
Thomas Willis
(1621-1675)

An English physician and anatomist, Willis was born on his parents' farm in Great Bedwyn, Wiltshire, where his father held the stewardship of the Manor. He was a kinsman of the Willys baronets of Fen Ditton, Cambridgeshire. He graduated M.A. from Christ Church, Oxford in 1642. In the Civil War years he was a royalist, and was dispossessed of the family farm at North Hinksey by Parliamentary forces. In the 1640's Willis was one of the royal physicians to Charles I of England. He obtained his medical degree in 1646.

Thomas Willis might well be one of the greatest physicians of the 17th century.He is one of the founders of the Royal Society of London. He is remembered by his many publications, especially "Cerebri Anatome: Cui accessit Nervorum Descriptio et Usu", where he describes the arterial anastomoses at the base of the brain. This work is also the first detailed description of the vasculature of the brain. Willis described nine cranial nerves.

He is considered as the father of Neurology as a discipline. He used the term "neurology" for the first time in 1664. He described several neurological conditions

The Arterial Circle of Willis is a famous eponymous structure found at the base of the brain. It represents an anastomotic roundabout that connects the right and left sides as well as the carotid and vertebral arterial territories that supply the brain. Named after Thomas Willis, this structure was known well before him, but it was Willis who described its function.  If you click on the image or here, you will be redirected to a detailed description of this structure.

Sources:

1. "The legendary contributions of Thomas Willis (1621-1675): the arterial circle and beyond" Rengachary SS et al J Neurosurg. 2008 Oct;109(4):765-75
2. "Thomas Willis, a pioneer in translational research in anatomy (on the 350th anniversary of Cerebri anatome)" Arraez-AybarJournal of Anatomy, 03/2015, Volume 226, Issue 3
3. " The naming of the cranial nerves: A historical review" Davis, M Clinical Anatomy, 01/2014, Volume 27, Issue 1
4. "Observations on the history of the circle of Willis". Meyer A, Hieros, R.Med Hist 6:119–130, 1962


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Esophageal hiatus hernia surgery

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.

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

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.