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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 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

Antoine Louis
(1723–1792)

French surgeon, anatomist, and physiologist. Following his medical studies and a long career as a physiologist, Antoine Louis was named Permanent Secretary of the Royal French Academy of Surgery. His other titles were those of Professor of the Royal Academy, Consultant Surgeon of the Armies of the King, member of the Royal Society of Sciences of Montpellier, Inspector of the Royal Military Hospitals, and Doctor in Law of the University of Paris. As a member of these academies Louis was instrumental in the design and construction of the guillotine. Initially called the "Louisette", this device was later named after another French physician in the same committee, Dr. Joseph-Ignace Guillotin.

Antoine Louis' name is better know to history as the eponymic origin of the "sternal angle" also know as the "Angle of Louis" and synonymously (probably by misspelling or translation) the "angle of Lewis", and "angle of Ludwig". This anatomical landmark is extremely important as it serves as a superficial landmark for important anatomical occurrences (click here).

As a point of controversy, there are some that contest the history of this eponym adjudicating it to Pierre Charles Alexander Louis (1787-1872), another French physician dedicated to the study of tuberculosis.

Sources:
1. Srickland, N; Strickland A Angle of Louis, More Than Meets the Eye. MedTalks:
2. Ramana, R. K., Sanagala, T. and Lichtenberg, R. (2006), A New Angle on the Angle of Louis. Congestive Heart Failure, 12: 197–199
3
. "The origin of Medical Terms" Skinner, HA; 1970


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Deltoid muscle

The deltoid or deltoideus (Latin) is a large, thick, triangular muscle, which covers the glenohumeral joint anteriorly, superiorly, and posteriorly.  It can be described as having three components or segments, anterior, middle, and posterior. The anterior portion originates from the lateral third of the clavicle, on the clavicle’s superior border. The middle portion originates from the lateral border of the scapula’s acromion, and the posterior portion originates from the spine of the scapula. All three portions insert laterally by means of a thick tendon on the deltoid tuberosity of the humerus. At its insertion the muscle gives off an thick connective tissue expansion to the deep fascia of the arm.

The three portions of the deltoid muscle are usually well defined. As an anatomical variation, the clavicular or the acromial portion of the muscle may be absent.

This muscle is innervated by the axillary nerve (C5, C6), a branch of the brachial plexus, and supplied by the posterior circumflex humeral artery and the deltoid branch of the thoracoacromial artery.

The word deltoid is derivates from the Greek word [δελτοειδής] which is itself formed by the terms [δέλτα] (délta), referring to the triangular shape of the letter delta (uppercase Δ, lowercase δ or ????) and [-οειδής] (-oeidís), a the Greek suffix meaning “similar to”. Delt-oid then would mean “similar to a Δ (delta)".

Deltoid muscle - Image modified from the original by Henry VanDyke Carter, MD. Public domain
Deltoid muscle.
Click on the image for a larger depiction 
Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015

Image modified from the original by Henry VanDyke Carter, MD. Public domain


Pectoralis major

The pectoralis major muscle is the largest muscle in the anterior aspect of the thorax. It is thick and fan-shaped.  It attaches superiorly to the medial half of the clavicle, and medially to the anterior aspect of the sternum and cartilage of the first to sixth or seventh rib, extending inferiorly to attach to the aponeurosis of the external oblique muscle. Laterally, this muscle attaches to the lateral lip of the intertubercular groove (bicipital groove) of the humerus by a two-layered tendon which inserts each of the two heads of the muscle.

The superficial tendon attaches the clavicular head (red in the accompanying image), which extends between the intertubercular groove of the humerus and the clavicle. The deep tendon attaches the sternocostal head (purple in the accompanying image), which extends between the humeral intertubercular groove and the attachments in the sternum, costal cartilages, and the aponeurosis of the external oblique muscle. There is usually a well-defined interval between the two heads of the pectoralis major.

The pectoralis major is innervated by the medial (C8-T1) and lateral pectoral nerves (C5-C7).

This muscle is covered by the pectoral fascia which extends in different directions. An extension of this fascia is the clavipectoral fascia. In both male and female, the mammary gland is situated anterior to and anchors in the pectoral fascia.

Pectoralis major muscle - Red: clavicular head. Purple: Sternocostal head - Image modified from the original by Henry VanDyke Carter, MD. Public domain
Pectoralis major muscle - Red: clavicular head. Purple: Sternocostal head
Click on the image for a larger depiction 
The word pectoral arises from the Latin term "pectum" meaning "chest, breast". In its true meaning, pectoral or pectoralis refers to a "chest plate" or an "adornment of the chest".

Sources:
1. “Gray’s Anatomy” Henry Gray, 1918
2. "Tratado de Anatomia Humana" Testut et Latarjet 8th Ed. 1931 Salvat Editores, Spain
3. "Gray's Anatomy" 38th British Ed. Churchill Livingstone 1995
4. “An Illustrated Atlas of the Skeletal Muscles” Bowden, B. 4th Ed. Morton Publishing. 2015

Image modified from the original by Henry VanDyke Carter, MD. Public domain


Dr. Elizabeth Murray Honored with American Academy of Forensic Sciences Award

We are proud to announce that our own contributor and associate Dr. Elizabeth Murray, Ph.D., has been awarded the Anthropology Section's 2018 "T. Dale Stewart Award" at the American Academy of Forensic Sciences (AAFS) 71st Annual Scientific Meeting in late February.

Dr. Murray's involvement with AAFS has included chairing the Academy-wide annual meeting as well as committee-level service in long-term planning, Board of Trustees, and the Student Academy.

Well-known and respected as a forensic anthropologist, Dr. Murray teaches at the University of Mount St. Joseph courses in anatomy and physiology, gross anatomy, and forensic science for the Department of Biology. Her most recent book, published in 2019, is "The Dozier School for Boys: Forensics, Survivors, and a Painful Past."

Our congratulations to her for yet another incredible achievement in her illustrious career. We are glad to count her as a friend and as a contributor to "Medical Terminology Daily" and Clinical Anatomy Associates, Inc.

Click here for Dr. Murray's Facebook page.


Holly leaf sign

The Holly is a tree/shrub of the genus Ilex , with perhaps the most well know being Ilex aquifolium. The plant has shiny prickly evergreen leaves and bright red berries. Cut branches of Holly are widely used as a traditionally Christmas decoration especially in wreaths and Christmas cards as illustrations. “The Holly and the Ivy” is a popular traditional English Christmas carol.

The [Holly leaf sign] refers to the appearance of calcified pleural plaques seen on chest radiographs. Pleural plaques are common in patients who have been exposed to asbestos, are asymptomatic and are most useful as a marker of asbestos exposure or asbestosis. They can be identified in 3-14% of dockyard workers and in 58% in insulation workers.

They are themselves not malignant, but patients with this plaques have a greater risk of mesothelioma and bronchogenic cancer than the general population and patients with exposed to asbestos but not pleural plaques.

Holly leaf sign - Case radiograph courtesy of Dr Çağlayan Çakır, Radiopaedia.org. From the case rID: 22986Holly leaf sign.
Click on the image for a larger depiction

The plaques arise in the parietal pleura and have predilection for the diaphragmatic dome and the undersurface of the lower posterolateral ribs. Rarely involve the visceral pleura but occasionally they are found in the fissures of the lungs.

On plain radiographic plaques appear as a geographic, usually calcified, opacities with irregular but well-defined edges. The irregular thickened nodular edges of the pleural plaques are likened to appearance of a Holly leaf, which has sharp spines along its margin.

Sources:
1. Jane R, Gulati A., Dwivedi R., Avula S., Curtis J., Abernethy L. (2013) We wish you a Merry X-Ray-mas: Christmas signs in radiology. BMJ 347:f7020 doi: 10.1136/bmj.f7020
2. Walker C., Takasugi J., Chung J., Reddy, G., Done S., Pipavath S., Schmidt R., Godwin J. (2012). Tumor-like Conditions of the Pleura. Radiographics 32:971–985.
3. Case radiograph courtesy of Dr Çağlayan Çakır, Radiopaedia.org. From the case rID: 22986

Figure below. Ilex aquifolium. Courtesy of A.Prof Frank Gaillard, Radiopaedia.org. From the case rID: 12398

Holly leaf sign - Ilex aquifolium. Courtesy of A.Prof Frank Gaillard, Radiopaedia.org. From the case rID: 12398
Holly leaf sign.
Click on the image for a larger depiction

Article submitted by: Prof. Claudio R. Molina, MsC..


Prostatic utricle

[UPDATED] The [prostatic utricle], also known as "utriculus prostaticus" or "utriculus" is a small 6 mm small dead-end channel found in the male prostatic urethra.

The word [utriculus] is Latin and means "little sac"..

What is interesting about this structure is that it is the embryological remnant in the male of the Müllerian ducts that form the vagina and the uterus in the female. In fact, in some texts the prostatic utricle is referred to as "uterus masculinus". Some researchers differ and point to the fact that this structure may not be a Müllerian duct derivate.

The prostatic utricle is found inside the prostate, forming part of the posterior wall of the prostatic urethra. It is in the upper part of a small mound which is part of the prostatic crest. This mound is called the [colliculus seminalis] or  [verumontanum], which is Latin and translates as the "mountain or mound of truth". On the verumontanum are the two slit-like openings of the ejaculatory ducts. Lateral to the verumontanum are the prostatic sinuses, depressions where the prostatic ducts are found.

Sources:
1. "The prostatic utricle is not a M?llerian duct remnant: immunohistochemical evidence for a distinct urogenital sinus origin" Shapiro E, Huang H, McFadden DE, et al. (2004) J Urol 172; 1753–1756
2. "Gray's Anatomy"38th British Ed. Churchill Livingstone 1995
3. "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain

Anterior view of section of the prostate. The blue dotted line shows the edges of the prostatic urethra
    Anterior view of a section of the prostate gland. The blue dotted line shows the edges of the prostatic urethra.


The unknown patient / donor


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 seriesclick here.
When writing the article “The Ephraim McDowell House and Museum” I realized that there are so many patients that by volunteering to a novel or sometimes experimental procedure or donating their bodies have been the catalyst of the advancement of medical science, surgery, and anatomy. Benigno says it so clearly in his paper explaining the physician/patient relation of McDowell and his patient: “Because of his innovative genius and finally honed surgical skills, Ephraim McDowell gave Jane Todd Crawford her life, and she, in return, gave him immortality”.

Few patients have influenced local history more than Jane Todd Crawford. In Kentucky there is a road named after her, a hospital bears her name in Greenville, KY, and there is even a formal "Jane Todd Crawford Day" on December 13!

By contrast, there are so many unknown patients whose names history has forgotten, and yet the fame of the physician continues through time in eponymic hospitals, educational institutions, named surgical procedures or maneuvers, surgical instruments, etc.

Some of the names and stories have survived, but many have not. In some cases, we know the name, but little else.

Dr. Henry Heimlich used his “Heimlich maneuver” for the first time to save his neighbor Patty Ris, in 2016, forty-two years after publishing it in 1974. The maneuver itself was used that same year (1974) to save the first person, Irene Bogachus, who was choking at a restaurant. Hundreds of thousands of people have been saved from death from choking by the proper use of this maneuver.

Jane Todd Crawford - Daguerrotype
Jane Todd Crawford - Daguerrotype
Click on the image for a larger depiction

Dr. Christiaan Barnard, performed the first successful heart transplant on December 3, 1967. We know the name of the donor, 25 year-old Denise Darvall, and the recipient Lewis Washkansky.

Dr. Antoine Dubois and Dr. Dominique-Jean Larrey in France performed the first mastectomy on September 30, 1811. This was decades before the advent of anesthesia or aseptic technique. The patients was Fanny Burney, a famous novelist.

Dr. Edward Jenner developed the smallpox vaccine after working with a milkmaid, Sarah Nelmes. Jenner’s work saved the Americas from the smallpox epidemic through the work of Don Antonio de Gimbernat y Arbós and Don Francisco Javier de Balmis i Berenguer and his “Balmis Expedition

The examples can continue, but who was the patient on the first Billroth procedure, who was the patient in the first Scopinaro procedure? Who was the patient on whom Dr. Eric Muhe performed the first laparoscopic cholecystectomy? Many are unknown yet they helped pave the way of the future.

The same can be said for the world of human anatomy. Today we honor the donors who will their bodies so that future physicians can study the intricacy of the human body, but we never know their names or their stories. Many a time I have stood at the side of a body while medical students dissect and study and wondered about their identities, the life they had, and what led them to give us their bodies as a wonderful gift to science and medicine.

There was a time (long ago) when the dissection of a human body was punished by the Church, or the times when the scarcity of bodies was such that some started to rob graves, or when the punishment for a crime was “death and a public anatomy”.

Some of these people we know, most of them we do not. Some have given their body willingly, others have not.

Joseph Paul Jernigan, a murderer, who after given the death penalty, donated his body to a now world-renown endeavor, the Visible Human Project.

The oldest known anatomical preparation is a skeleton mounted in Basel (Belgium) by Andreas Vesalius in 1543. The skeleton belongs to Jacob Karrer von Geweiler, a bigamist and attempted murderer who was beheaded for his crimes.

It is sad that we know the names of these criminals, and in some cases not that of their victims.

We do not know the names of many who, during the Nazi regime in WWII, were taken from concentration camps for medical experiments and as we understand, possibly murdered and dissected to illustrate now infamous anatomical atlases. Research is being done to discover their identities.

Times have changed and body donation has become accepted and praised by society. I am always touched by the words of Morgagni above the entrance to the dissection rooms at the University of Cincinnati: “hic locus est ubi mors gaudet succurrere vitae” meaning “in this place death rejoices helping the living”.

I cannot but end this article with the words that are found in the left side column of this blog and will always be there:

“Clinical Anatomy Associates, Inc., and the contributors of "Medical Terminology Daily" wish to thank all individuals who donate their bodies and tissues for the advancement of education and research”.