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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

Dr. Thomas Dent Mütter
Dr. Thomas Dent Mütter (1811-1859)

Dr. Thomas Dent Mütter

(1811-1859)

Thomas Dent Mutter was born on March 9, 1811, in Richmond, VA. His mother died in 1813, and his father died of tuberculosis in 1817. Thomas was orphaned when he was barely 8 years old. His father left him a somewhat meager inheritance and in his early life had to do with less that others with his objectives in life. He was well educated under the tutelage of Robert Carter, his guardian, and in 1824 he started his studies at the Hampden Sidney College of Virginia. He continued with a medical apprenticeship with a Dr. Simms in VA. He was well respected and even at his early age he would do home visits for his medical benefactor with great results. He started medical studies at the University of Pennsylvania, where he earned his MD in 1831. The new young doctor, Thomas Dent Mutter, MD was only 20 years of age.

At the time, Europe was the place to go to if you wanted advanced medical studies. Dr. Mutter had no money, so he applied as a ship surgeon to be able to cross the Atlantic. Once in Europe, he spent time in Paris, where he studied under the tutelage of Dr. Guillaume Dupuytren. He later studied for a short time in England where he met Dr. Robert Liston. Following Dupuytren's teachings, Mutter was fascinated by plastic surgery.

A chance encounter with what was to become his first well-known acquisition of a medical curiosity, Mutter started thinking on how to help those people that were known at that time as “monsters”, patients who the general public did not see, because they did not appear in public. The curiosity in question was a wax reproduction of the face of a French woman who had a “horn” arising from her forehead. This piece is on exhibit at the Mütter Museum.

Back in the United States in 1832, Thomas Dent Mutter changed his last name to give it a more “European” sound and added an “umlaut”, so now he was Thomas D. Mütter, MD. It may also be that he wanted to pay homage to his Scottish-German heritage, who knows? He opened his medical office in Philadelphia and although it took time, eventually he had a thriving practice. One of his specialties was the work on “deformities” so common at the time because of facial scars born out of the use of open fires in houses, and deformities caused by burns and loss of tissue due to chemicals used in local industry. Dr. Mütter is the pioneer of what we call today “Reconstructive Surgery”.

In 1835 he was asked to join the Medical Institute of Philadelphia as an assistant professor of Surgery. He was an instant success. Dr. Mütter was adored by his students because, he would question the students and guide them to discovery instead of just lecturing and leaving. In his Discourse eulogy of Dr. Mütter by Joseph Pancoast he writes:” The power of attracting students near him by his mingled gentleness, energy, and enthusiasm; of fixing their attention by the lucid and methodical arrangements of his Subject, by his clear demonstrations, and sprightly oral elucidations, came so readily to him, and was so early displayed) as to seem almost intuitive.” In 1841 Dr Mütter was appointed Professor of Surgery at the Jefferson Medical College in Philadelphia.

Dr. Mütter had always had poor health, even in childhood, and his dedication to his passion, long hours, took its toll on his body. In 1956 he set sail for Europe and resigned his teaching duties. He was named Emeritus Professor of Surgery. Unfortunately, the trip did not help, and he returned to the US in early 1958. Fearful of another winter in cold Philadelphia, he moved to Charleston, SC, where he died on March 19, 1859.

Dr. Mütter’s story does not end here. He was an avid collector and throughout his short life he had pulled together an impressive collection of medical oddities, samples, and curiosities. Knowing that his life was at an end, he negotiated with the Philadelphia College of Physicians to have them host his collection in perpetuity as well as the creation of a trust fund that would ensure that the public and medical students would have access to this incredible collection. Through the years this collection has increased and is known today as the Mütter Museum of the Philadelphia College of Physicians. I strongly urge our readers to visit this incredible museum. For more information, click here.

Personal notes: In the late 90’s, I attended a meeting of the American Association of Clinical Anatomists.  During the meeting I met Gretchen Worden, who at the time was the Curator of the Mütter museum. Gretchen was inspirational, fun, and a great conversationalist! I had the opportunity to visit Gretchen at the Mütter museum and had the luck to be treated to a “behind the scenes” tour. What an experience! I was saddened to hear that Gretchen Worden passed on August 2, 2004. Still, in my recent visit to the Mütter Museum, I was glad to see a new section at the museum that remembers Gretchen. Her biography can be read here.

I would like to thank Dr. Leslie Wolf for lending me the book by O’Keefe that lead to me writing this article. Dr. Miranda

Sources:
1. “Dr. Mütter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine” O’Keefe, C. 2015 Penguin Random House, LLC
2. “A Discourse Commemorative of the Late Professor T.D. Mütter” Pancoast, J. 1859 J Wilson Publisher
3. “Thomas Dent Mütter: the humble narrative of a surgeon, teacher, and curious collector” Baker, J, et al. The American Surgeon, Atlanta 77:iss5 662-14
4. “Thomas Dent Mutter, MD: early reparative surgeon” Harris, ES; Morgan, RF. Ann Plast Surg 1994 33(3):333-8
5. “5 Things I Learned from Thomas Dent Mütter” O’Keefe C.


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Glossary of Terms for Thoracic Imaging

One of the current challenges in medical sciences is to achieve a common and universal language that allows establishing, promoting the understanding and communication between people of different cultures and nationalities.

The use of anatomical and radiological terms in the chest is not exempt from this theme. An adequate terminology allows describing findings and unifying concepts that facilitate communication, teaching, research, in brief, the transmission of knowledge.

From the radiological point of view, ignorance of appropriate terminology creates confusion and may eventually lead to inaccuracies and misdiagnoses. Therefore, reaching consensus in terminology is an attempt to minimize the effects of language vices, which are unfortunately passed on to future generations.

On the other hand, in recent years, technical advances in radiology have improved the capture, recording and storage of images, which in turn has involved the need for a new language to explain new concepts.

Fleischner
Felix Fleischner, MD
Within this context, the Fleischner Society, an international and multidisciplinary medical society for thoracic radiology, was founded in 1969 in memory of Dr. Félix Fleischner. Among the objectives of this society is the publication of formal statements that have been adopted for several years, as standards in the field of chest radiology, generating an important point of discussion and consensus around this issue.

Thus, as in 1971 a proposal for initial terminology was made, which was consolidated in 1984 and 1996 with the publications of the Fleischner Society glossary for Chest X-rays and Tomographies respectively. In 2008 (Radiology 2008; 246: 697-722) this glossary is finally updated using new terms, modifying or eliminating some of those that have become obsolete and others in which their meaning has changed.

Sources:
1. Austin JHM, Müller NL, Friedman PJ. Glossary of Terms for CT of the Lungs: Recommendations of the Nomenclature Committee of The Fleischner Society. Radiology 1996; 200:327-30.
2. Fraser RS, Müller NL, Colman N, Pare PD. Diagnosis of diseases of the Chest. 4th ed. Philadelphia: WB Saunders Company, 1999.
3. Tuddenham WJ. Glossary of Terms for Thoracic Radiology: Recommendations of the Nomenclature Committee of The Fleischner Society. Am J Roentgenol 1984; 143:509-17.
4. Souza Jr AS, Araújo Neto CA, Jasinovodolinki D,Marchiori E, Kavakama J, Irion KL et al. Terminologia para a Descrição de Tomografia Computadorizada do Tórax (Sugestões Iniciais para um Consenso Brasileiro). Radiol Bras 2002; 35:125-8.
5.David M. Hansell, Alexander A. Bankier, Heber MacMahon, Theresa C. McLoud, Nestor L. Müller, and Jacques Remy Fleischner Society: Glossary of Terms for Thoracic Imaging Radiology 2008 246:3, 697-722


This article belongs to the series "Glossary of Terms for Thoracic Imaging" by Prof C. Uribe, MsC. This series is based on the "Glossary of Terms for Thoracic Imaging" by the Fleischner Society

Johann Gottfried Zinn


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.

Johann Gottfried Zinn (1727–1759) anatomist and botanist, was born on December 6, 1727 in the city of Ansbach, Germany. He started his medical studies in his native city, becoming later a student of Dr.  Albrecht von Hallers at the University of Göttingen, and received his MD in 1749.

He left for Berlin to continue his studies but came back shortly thereafter. He became a professor of anatomy at the University of Göttingen and in 1753 he also became the director of the botanical garden in the same city.

He is known for his anatomical treatise on the anatomy of the human eye: “Descriptio anatomica oculi humani iconibus illustrata”. Because of this, his name has become an eponym in the “Zonule of Zinn”, a ring of strands that forms a fibrous band connecting the ciliary body with the capsule of the lens of the eye. Zonule of Zinn is sometimes referred to as the suspensory ligaments of the lens, or the “ligament of Zinn”.

Carol Linné (Carolus Linneaus) named a genus of flowers in the family Asteraceae known vernacularly today as “Zinnia” in his honor. Hover your cursor over his portrait to see the flower.

Johann Gottfried ZinnJohann Gottfried Zinn

The chapter on orbital anatomy of his anatomy book, taken from the second edition in 1780, has been translated and the first of three parts is published in an issue of “Strabismus”

His book "Catalogus Plantarum Horti Academici Et Agri" can be seen online here.

His life was short, dying at the early age of 32, but his name lives on in the name of a beautiful flower.

Sources:
1. “Johann Gottfried Zinn" Simonz, HJ Strabismus – 2004, Vol. 12, No. 2, p. 125 
2. "Anatomical Description of the Human Eye" Zinn, JG Strabismus, 13:45–52, 2005 
Images: Public Domain by Wikipedia Commons. 1. Own work I_am Jin, and H. Wilhem Dietz


Update to the "A Moment in History" Series

 As part of the design of this website we added a sidebar called "A Moment in History". The objective was to create a series of articles is to honor those individuals who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research. Later in the development of the series we became aware of other individuals who have contributed in different ways, but still added their life work to the advancement of medical knowledge, as is the case of Marcia Croker Noyes (1869-1946).

Who would not be moved by the work of Allesandra Gilliani (1307-1326), who is probably the first woman dissector in the history of Human Anatomy, with a tragic short life and a love story.

We also decided to add to this series Moments in History that have left a mark on health care, such as "The First Use of Anesthesia in Surgery", or the story of how many individuals and unknown, anonymous children helped to rid the Americas from the scourge of smallpox, in "The Balmis Expedition", 

Another line of articles in this series are those that honor individuals who have used anatomical and surgical knowledge to further other areas of human knowledge, such as that of Juan Vucetich, who used the anatomical differences in fingerprints to create the science of dactiloscopy.

Václav TreitzDr. Vaclav Treitz
Original image
  courtesy of Wikipedia.org.
Yet another line of articles are those that are more personal and dear to the contributors of "Medical Terminology Daily", such as "The Ephraim McDowell House of Museum", or  "Interesting Discovery in and Ex-Libris".

Recently, I had to work in the Wangensteen Historical Library researching rare and antique medical books. The highlight of this work was to be able to read books by authors whose names are attached as eponyms to anatomical landmarks (Ligament of Treitz, Hesselbach's Triangle), pathologies (Koplik's spots), surgical procedures Billroth I and II), medical maneuvers (Heimlich maneuver), and surgical instruments (Finochietto retractor). Of course, the names given here are but a small sample of what has been written to date.

As of today this series is now searchable, all you have to do is type "A Moment in History" in our search page, click on the "A Moment in History" link at the top of the sidebar, or click here

The image in this article is that of Dr. Vaclav Treitz. His eponymically named Ligament of Treitz is the most read article in this blog.


Sternalis muscle

The Sternalis muscle has been nominated as a supernumerary anatomical variation; the highest prevalence is in China (23.5%) and the lowest in Chile (0.87%).

The muscle is a wide band of muscular tissue located in the anterior thoracic wall, where fibers travel near-parallel to the sternum, inferior to the clavicles, aterior to the pectoralis major and the pectoral fascia. It has received many names: rectus sternalis, parasternal, episternal, superficial abdominal rectus, among other names. To avoid confusion, a true sternalis muscle should have the following characteristics:

(1) be localized between the subcutaneous tissue of the anterior thoracic region and fascia pectoralis;
(2) originate superiorly from the sternum or infraclavicular region;
(3) be inserted inferiorly in the ribs, rib cartilage, external oblique muscle aponeurosis and sheath of the rectus abdominis muscle;
(4) its innervation must come from the anterior root of the intercostal nerves. Another possible innervation from medial and lateral pectoral nerves has been mentioned.

Even though the Sternalis muscle does not appear to have a significant function, it is important to bear it in mind when evaluating mammograms, because one could misdiagnose it as a mammary cancer, as exposed by many authors. It is crucial to be familiar with this muscle to avoid confusion with pathology, such as extra-abdominal desmoid tumors, diabetic mastopathy, abscesses, hematomas, fat necrosis, and others; its unilateral presence may cause breast or chest asymmetry.

Sternalis muscle (Andreas Vesalius 1543)
Sternalis muscle (Andreas Vesalius 1543)
Note: The image in this article depicts this variation and is from the 1543 " De Humanis Corporis Fabrica, Libri Septem " by Andreas Vesalius.

Sources:
1. Jelev L., Georgiev G., Surchev L. (2001) The sternalis muscle in the Bulgarian population: classification of sternales. J. Anat. 199: 359-363. 
2. Bradley F.M., Hoover H.C., Hulka C.A., Whitman G.J., McCarthy K.A., Hall D.A., Moore R., Kopans D.B. (1996) The sternalis muscle: an unusual normal finding seen on mammography. AJR. Am. J. Roentgenol. 166: 33-36. 
3. Scott-Conner C.E.H., Al-Jurf A.S. (2002) The sternalis muscle. Clin. Anat. 15: 67-69. 
4. Shiotani M., Higuchi T., Yoshimura N., Kiguchi T., Takahashi N., Maeda H., Aoyama H. (2012) The sternalis muscle: radiologic findings on MDCT. Jpn. J. Radiol. 30: 729-734.

 


Vulvar hemangiomata

UPDATED: This article presents a case of vulvar hemangiomata. In superficial or surface anatomy, [vulva] is the anatomical name given to the external female genitalia.

The medical term [hemangioma] is formed by two root terms and a suffix. The root term [hem-] arises from the Greek word [αίμα] (a?ma) meaning "blood", the second root term [-angi-] .from the Greek term [αγγείο] (angeio), meaning "vessel” and the suffix [-oma] (ωμα), also Greek, meaning "mass", "growth”, or "tumor". The plural derivative word [hemangiomata] uses the suffix [-omata] which is the plural form of [-oma].

Vulvar hemangiomata are multiple blood growths or tumors on a female’s external genitalia. In most cases, hemangiomata are idiopathic.

Vulvar hemangiomata
Image property of: CAA.Inc. 
WARNING: Depicts female external genitalia.
Vulvar hemangiomata can be capillary (arterial) or cavernous (venous). They are benign vascular tumors which can be congenital, meaning the patient is born with them, or acquired, meaning that they appear later in life. In both cases they are usually asymptomatic. Patients may become concerned over aesthetics or because of bleeding due to trauma to the lesions. In rare cases, these hemangiomas can be large, requiring excision.

They are usually kept under observation, evaluating their progress (evolution or involution). If they increase in number or become symptomatic, intervention includes the use of sclerosing agents, destruction by cryotherapy or laser therapy, or surgical excision.

Personal note: My thanks to the patient who voluntarily and anonymously provided this image to further learning and knowledge on this pathology. Dr. Miranda


2017 AACA Meeting (5)

2017 AACA Meeting – Thursday, July 20

This is the 2017 Meeting of the American Association of Clinical Anatomists (AACA) in Minneapolis, MN. This 34th meeting of the association, gets together over 300 clinical anatomists, anatomists, physicians, and students from all over the world.

Last day of the meeting! In the morning, there was a poster session and a platform session dedicated to the neck and lower limb.  Now, I must confess that as much as I wanted to attend the meeting, I decided to go somewhere else and skip the morning session… I should feel bad about this, but I do not!!

With two other attendees to the AACA meeting I went to the Wangensteen Historical Library which has a collection of over 80,000 rare books.  We met with the Curator, Lois Hendrickson, Christopher Herzberg, and Emily Beck.

First, we visited the current exhibit, “Medical Exchanges: Mapping the Human Body in Japan and China” with incredible books, medical posters, and artifacts referencing anatomy, surgery, acupuncture, botanical remedies, etc. Then we went into the reading room where they already had a display of books on anatomy, surgery, histology, etc.

We spent at least four hours reading and admiring these books and the knowledge they contain. One of our discussions was on the fact that today there is a great deal of information “lost” in these books because they have not been digitized, or because many are written in languages which the average researched does not master.

For those who read this blog, you know that I am collector of antique medical books and the opportunity to be at this incredible library was unique. There were so many books that is difficult to list. Authors like Bidloo, Hooke, Verhayen, Mascagni, Vesalius, etc. Books like “De Muto Cordis”, “Micrographia”, “De Humani Corporis Fabrica, Libri Septem”, and “De Humani Corporis Fabrica, Epitome” are some of the jewels that we were able to admire.

Personally, the opportunity to spend time with these books was invaluable. There are only 13 known “De Humani Corporis Fabrica, Epitome” books in the world. It is priceless and who knows what its monetary value would be if any makes it to the antiquarian market. Being able to read, admire and touch this book was the “epitome” of my time at the library (pun intended).

Unfortunately, for some unknown reason I lost all the pictures I took of this occasion, so I hope to get some from the colleagues that went to the library with me.

Back at the AACA Meeting, we had a Medical Terminology Committee meeting, followed by the AACA Business Meeting, and then the closing banquet with the presentation of Awards. The last order of business was the presidential transition. Neil Norton, PhD ended his presidential tenure with the closing of the 2017 AACA Meeting and Marios Loukas, MD, PhD begins his two-year as President of the AACA.

Next year the AACA meeting will be in Atlanta! See you there!

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