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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 

Title page of Anathomia Corporis Humanis by Mondino de Luzzi. Image courtesy of the National Library of Medicine
Title page of "Anathomia Corporis Humanis" by Mondino de Luzzi

Alessandra Giliani

 
(1307 – 1326

Italian prosector and anatomist. Alessandra Giliani is the first woman to be on record as being an anatomist and prossector. She was born on 1307 in the town of Persiceto in northern Italy.

She was admitted to the University of Bologna circa 1323. Most probably she studied philosophy and the foundations of anatomy and medicine. She studied under Mondino de Luzzi (c.1270 – 1326), one of the most famous teachers at Bologna.

Giliani was the prosector for the dissections performed at the Bolognese “studium” in the Bologna School of Anatomy. She developed a technique (now lost to history) to highlight the vascular tree in a cadaver using fluid dyes which would harden without destroying them. Giliani would later paint these structures using a small brush. This technique allowed the students to see even small veins.

Giliani died at the age of 19 on March 26, 1326, the same year that her teacher Mondino de Luzzi died.  It is said that she was buried in front of the Madonna delle Lettere in the church of San Pietro e Marcellino at the Hospital of Santa Maria del Mareto in Florence by Otto Agenius Lustrulanus, another assistant to Modino de Luzzi.

Some ascribe to Agenius a love interest in Giliani because of the wording of the plaque that is translated as follows:

"In this urn enclosed are the ashes of the body of 
Alessandra Giliani, a maiden of Persiceto. 
Skillful with her brush in anatomical demonstrations 
And a disciple equaled by few, 
Of the most noted physician, Mondino de Luzzi, 
She awaits the resurrection. 
She lived 19 years: She died consumed by her labors 
March 26, in the year of grace 1326. 
Otto Agenius Lustrulanus, by her taking away 
Deprived of his better part, inconsolable for his companion, 
Choice and deservinging of the best from himself, 
Has erected this plaque"

Sir William Osler says of Alessandra Giliani “She died, consumed by her labors, at the early age of nineteen, and her monument is still to be seen”

The teaching of anatomy in the times of Mondino de Luzzi and Alessandra Giliani required the professor to be seated on a high chair or “cathedra” from whence he would read an anatomy book by Galen or another respected author while a prosector or “ostensor” would demonstrate the structures to the student. The professor would not consider coming down from the cathedra to discuss the anatomy shown. This was changed by Andreas Vesalius.

The image in this article is a close up of the title page of Mondino’s “Anothomia Corporis Humani” written in 1316, but published in 1478. Click on the image for a complete depiction of this title page. I would like to think that the individual doing the dissection looking up to the cathedra and Mondino de Luzzi is Alessandra Giliani… we will never know.

The life and death of Alessandra Giliani has been novelized in the fiction book “A Golden Web” by Barbara Quick.

Sources 
1. “Books of the Body: Anatomical Ritual and Renaissance Learning” Carlino, A. U Chicago Press, 1999 
2. “Encyclopedia of World Scientists” Oakes, EH. Infobase Publishing, 2002 
3. “The Biographical Dictionary of Women in Science”Harvey, J; Ogilvie, M. Vol1. Routledge 2000 
4. “The Evolution of Modern Medicine” Osler, W. Yale U Press 1921 
5. “The Mondino Myth” Pilcher, LS. 1906 
Original image courtesy of NLM
 


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Snowman sign

The “snowman sign” is a particular image on a chest X-Ray image, which is seen in anomalous pulmonary venous drainage and coarctation of the aorta which causes a Total Anomalous Pulmonary Venous Return (TAPVR).

This abnormality occurs when the pulmonary veins fail to drain into the left atrium and instead form an aberrant connection with some others cardiovascular structures. Such abnormalities account for approximately 2% of cardiac malformations.

There are four types of TAPVR; type 1 is the most common (and the one that creates the snowman sign). In this case the pulmonary veins terminate at the supracardiac level, emptying into the right atrium by way of an anomalous pulmonary venous drainage into the superior vena cava (SVC), and the left brachiocephalic vein (by way of a vertical vein). The confluence of these veins dilates the right brachiocephalic vein, which appears as a dilated vessel on the right of the upper mediastinal edge. When seen in an AP Chest X-Ray, the TAPVAR type 1, resembles a snowman; the dilated vertical vein on the left, the right brachiocephalic vein superiorly, and the SVC on the right form the head of the snowman, the body is formed by the enlarged right atrium.

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

Snowman sign
Snowman sign.
Click on the image for a larger depiction

Sources:
1. Emma C. Ferguson, Rajesh Krishnamurthy, and Sandra A. A. Oldham. (2007) Classic Imaging Signs of Congenital Cardiovascular Abnormalities. RadioGraphics 27:5, 1323-1334.
2. Somerville, J., & Grech, V. (2009). The chest x-ray in congenital heart disease 1. Total anomalous pulmonary venous drainage and coarctation of the aorta. Images in Paediatric Cardiology, 11(1), 7–9.


Kabourophobia

Kabourophobia is the fear of crabs and lobsters.

The etymology of the word [kabourophobia] comes from the Greek word [καβουρης] (pronounced “kavouris”), meaning [crab], and the suffix [-phobia], also from the Greek, arises from the word [φοβία] (pronounced “fovía”)

Kabourophobia is an extremely rare phobia, but it was brought to the public’s attention when a modern pop singer stated that she was afraid of crabs. Also, a prank (maybe acted) was shown on video on the internet with a man surrounded by lobsters.

Kabourophobia is very specific, and it can also be a part of a wider phobia called ostraconophobia, which is the fear of crustaceans, adding shrimp, oysters, clams, crabs, lobsters, etc.

 Liocarcinus vernalis © Hans Hillewaert  via Wikimedia Commons

Click on the image for a larger version. 

An interesting point is that the word [crab] in Greek has another acception, that is the word [Καρκίνος] (pronounced “karkinos”), which is the root for the medical term [cancer].

We thank Jackie Miranda-Klein for her contribution suggesting this word. Please consider contributing to Jackie's medical mission to Belize by "clicking here".


Sympathetic / parasympathetic

The word sympathetic is the adjectival form of sympathy. This word arises from the Greek [συμπάθεια]and is composed of [syn/sym] meaning “together” and [pathos], a word which has been used to mean “disease”. In reality “pathos” has to do more with the “feeling of self”. Based on this, the word sympathy means “together in feeling”, which is what we use today.

How the term got to be used to denote a component of the so-called autonomic nervous system is part of the history of Medicine and Anatomy.

Galen of Pergamon (129AD-200AD), whose teachings on Medicine and Anatomy lasted as indisputable for almost 1,500 years, postulated that nerves were hollow and allowed for “animal spirits” to travel between organs and allowed the coordinated action of one with the other, in “sympathy” with one another. As the knowledge of the components of the nervous system grew, this concept of “sympathy” stayed, becoming a staple of early physiological theories on the action of the nervous system.

Jacobus Benignus Winslow (1669-1760) named three “sympathetic nerves” one of them was the facial nerve (the small sympathetic), the other the vagus nerve, which he called the “middle sympathetic”, and the last was what was known then as the “intercostalis nerve of Willis” or “large sympathetic", today’s sympathetic chain. Other nerves that worked coordinated with this “sympathetics” were considered to work in parallel with it. It is from this concept that the term “parasympathetic” arises.

Galen of Pergamum
Galen of Pergamon 
(129AD - 200AD)

 

Interestingly, the ganglia on the sympathetic chain were for years known as “small brains” and it was postulated that there was a separate multi-brain system coordinating the action of the thoracic and abdominopelvic viscera. The coordination between this “autonomous nervous system” and the rest of the body was made by way of the white and gray rami communicantes.

Today we know that there is only one brain and only one nervous system with an autonomic component which has a “sympathetic” component that is mostly in charge of the “fight or flight” reaction and a “parasympathetic” component that has a “slow down” or “depressor” function. Both work coordinated, so I guess Galen was not "off the mark" after all.

So, we still use the terms “sympathetic” and “parasympathetic”, but the origin of these terms has been blurred by history.

Sources:
1. "Claudius Galenus of Pergamum: Surgeon of Gladiators. Father of Experimental Physiology" Toledo-Pereyra, LH; Journal of Investigative Surgery, 15:299-301, 2002
2. "The Origin of Medical Terms" Skinner, HA 1970 Hafner Publishing Co.
3. "Medical Meanings:A Glossary of Word Origins" Haubrish, WS American College of Physicians Philadelphia, 1997
4. "The History of the Discovery of the Vegetative (Autonomic) Nervous System" Ackerknecht, EH Medical History, 1974 Vol 18. 
Original image courtesy of Images from the History of Medicine at nih.gov

Note: The links to Google Translate include an icon that will allow you to hear the pronunciation of the word.


Epistaxis

The medical term [epistaxis] refers to a “nose bleed”.

It is considered to be a Modern Latin term that originates from the Greek word [επίσταξη(epístaxí). The word is composed of [επί] [epi-] meaning "on", "upon", or "above", and [στάζει] (stázei), meaning "in drops", "dripping".

The term was first used by Hippocrates, but only as [στάζει] , to denote dripping of the nose, and was later changed to [επίσταξηto denote “dripping upon”. The term itself does not include or denote that the blood loss is from the nose, but its meaning has been implied and accepted for centuries. The plural form for epistaxis is epistaxes.

Skinner (1970) says that the term was first used in English in a letter by Thomas Beddoes (1760-1808) in a letter to Robert W. Darwin (1766-1848) in 1793. Robert Darwin was an English physician, father or Charles Darwin (1809-1882) author of “The Origin of the Species”.

Sources:
1. "The Origin of Medical Terms" Skinner, HA 1970 Hafner Publishing Co.
2. "Medical Meanings - A Glossary of Word Origins" Haubrich, WD. ACP Philadelphia 

Note: The links to Google Translate include an icon that will allow you to hear the pronunciation of the word.


Kiesselbach's plexus

Kiesselbach's plexus is named after Dr. Wilhelm Kiesselbach (1839 – 1902), a German otolaryngologist. It is an area in the anteroinferior aspect of the nasal septum where several arteries from different origins meet and anastomose.

This arterial plexus is also known as the "locus Kiesselbachii", Kiesselbach's triangle, or Little's plexus, or Little's area. This area of the anteroinferior nasal septum has a propensity for epistaxis or nasal bleeding. In fact, close to 90% of nose bleeds (epistaxes) happen in this area.

in this region, terminal branches of the anterior ethmoid artery, greater palatine artery, sphenopalatine artery and superior labial artery anastomose forming an anastomotic circle. The anastomoses are numerous enough to form a plexus.

Kiesselbach's plexus
Click on the image for a larger view

There is a secondary area where epistaxis may happen, but this is a venous nose bleed. This is Woodruff's plexus, a venous plexus found in the posterior aspect of inferior turbinate on the lateral wall of the nose. 

Thanks to Jackie Miranda-Klein for suggesting this post. Jackie is studying for the Physician Assistant Master's degree at Kettering College. Dr. Miranda.


Halsted’s “Rules of Surgery”

In my many years working with medical industry, surgeons, and surgery, I have heard many times that such and such surgical technique follows “Halsted’s Rules of Surgery”. The problem is that only two of these “rules” were mentioned and never did I receive an answer while working with Ethicon and Ethicon Endosurgery, and never did I receive an answer as to where could I find the reference regarding the other rules, if they even existed.

I recently read a great 1957 book by Samuel James Crowe, MD (1883-1952), titled “Halsted of John Hopkins; the man and his men”. Dr. Crowe lived for one year with Dr. William Stewart Halsted (1852-1922) and his wife as a medical student at John Hopkins. He was also an intern for Dr. Harvey Cushing, and although he wanted to follow Cushing into neurosurgery, Dr. Halsted placed him in charge of the newly created department of otolaryngology at John Hopkins, a position he did not want. Dr. Crowe went on to become a world-wide renown otolaryngologist.

Here are Halsted’s “Rules of Surgery” as explained by Dr. Crowe, based on Halsted’s research, experiments, and observations (with my own notes and comments):

1. Wounds are resistant to infection when no bits of tissue have been:

a. torn with clamps 
b. torn by the rough handling of retractors 
c. devitalized by hastily and carelessly applied ligatures

HalstedWilliam S. Halsted
mouseover for
Samuel J. Crowe

Note: this follows the ancient rule of “primum non nocere”: first and foremost, do not harm

2. Wounds or parts rich in blood vessels usually heal without any visible granulation, even when no antiseptic precautions have been taken.

3. Incisions should be closed carefully and gently, layer by layer

4. The approximating sutures should never put the tissues under tension, since tension interferes with the blood supply and may cause necrosis

Note: Tension-avoidance surgical techniques follow this, one of the prime rules of surgery.

5. The end of the forceps used to pick up bleeding points should be small, to avoid crushing and destroying the vitality of surrounding tissues

Note: This observation led to the creation of fine, multiple toothed thumb forceps used today in cardiovascular surgery , such as the Cooley, DeBakey, Castaneda, etc. type forceps.

6. A drain is essential when there is necrotic tissue and infection

7. Silk should never be used in the presence of infection

Note: This makes sense. Since silk is an organic material, infected tissues will react to the presence of this extraneous material causing more inflammation, and the phagocytic cells in the tissues will destroy the silk and its capacity to hold the tissues together

8. The silk (suture) employed should never be coarser (larger gauge) than necessary and it is well to employ a suture a thread that is not stronger that the tissue it holds

9. A greater number of fine stitches is better than a few coarse ones

Note: This also makes sense. Halsted was known to be extremely meticulous and he could place a hundred stitches of fine silk thread where other surgeons would place a lesser number of coarser stitches. Using a larger number of fine stitches distributes the approximating tension of the sutures over a larger area, thus reducing the chance for suture dehiscence.

10. Avoid when possible the combined use of silk and catgut in a wound

11. For sewing up an abdominal wound, when it is necessary to take heavy deep stitches perforating skin and muscles, silver wire serves admirably

Note: Remember the times when these guiding principles where laid. Nylon, polypropylene, and other synthetic absorbable and non-absorbable sutures had yet to be discovered. Today the same dictum would probably say “For sewing up an abdominal wound, when it is necessary to take heavy deep stitches perforating skin and muscles, a synthetic non-absorbable suture material serves admirably”

It must be noted that Halsted never called the above the “rules of surgery”, rather they are observations that have become guiding principles. These have influenced the world of surgery to this day.

SIDE NOTE: It has been said many times that Dr. Halsted was the first to use rubber gloves. This is not true, Dr. Crowe says that “it was an evolution rather than a happy thought” and it involved his wife Caroline Hampton. This will be the subject of another article.