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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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Cardiac apex

The word [apex] is Latin and means "the top". It refers to the highest point in a mountain or in a pyramid; the point furthest from the base. The plural form is [apices].  There are several anatomical apices in the human body.

The cardiac apex (also known by the Latin term apex cordis) is a misunderstood term. It refers to the "top" of the heart, but this is clear only when you place the heart in such a way that the apex is actually pointing "up" (see image). In this position the heart is like a pyramid and the base will be the surface opposite the apex. The anatomical location of the apex of the heart is posterior to the left 5th intercostal space in adults, just medial to the left midclavicular line.

Click on the image for a larger picture.

Human heart - Cardiac apex

Endo-

The prefix [endo-] is of Greek origin and means "inner or within". There are many uses of the term as follows:

Endocardium: the root term [card] means "heart" and the suffix    [-ium] refers to a "layer or membrane" - Inner layer of the heart
Endocrine: the suffix [-crine] means "secretion", the word meaning "inner secretion". Refers to a gland that deposits its secretions within the bloodstream. The products of endocrine glands are known generically as "hormones"
Endometrium: the root term [-metr-] is Greek, meaning "uterus" . The word endometrium means "inner layer of the uterus"
Endoscope: the term [-scope] refers to an instrument used for viewing. There is a consensus that a viewing instrument that enters through a natural body cavity will be called an "endoscope" (see image). All others will adopt the name of the cavity that is being viewed, as a laparoscope, a thoracoscope, an arthroscope, etc.

Original image courtesy of  Wikipedia.

   

Benign / Malignant

These two opposing terms are used to describe key characteristics of a tumor. [Benign] derives from the Latin term [benignus], meaning "good" and "gentle". The medical application of the word denotes a condition (or tumor) that is not bad (malignant), and that it is favorable for treatment and recovery.

The term [malignant] derives from the Latin word [malus], meaning "ill-disposed, malicious, or bad". The medical application is to a condition or tumor that is unfavorable to treatment and recovery. Over time the term malignant has become synonymous with "cancer".


Anterior - Posterior

These two opposite terms must be studied together. Both words are used as directional anatomical and surgical terms, and most importantly, they are relationship terms, that is, they express the spatial location of one structure in reference to another.

The term [anterior] is Latin and means "in front of". It is related to the prefix [ante-] which means "before", or "anterior" and the Latin [anticus], which means "in the very front".

The term [posterior] is more complex. Although it is based on a Latin term meaning "after", the prefix [poster-] is used as a comparative to mean "behind (a structure of reference)". Following are some examples of the proper use of these terms:

- The aorta is anterior to the spine
- The sternum is anterior to the heart
- The occipital bone is the most posterior bone of the cranium
- The trachea is anterior to the esophagus 

Because a human body is always studied in the anatomical position, in the hand, the anterior aspect is the palm and in this case a synonym for anterior is [volar].  

Image property of: CAA.Inc. Artist: Victoria G. Ratcliffe

Anterior - Posterior

Salomon Hakim, MD


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.

Dr. Salomón Hakim (1922 - 2011). Dr. Hakim was born in the city of Barranquilla, Colombia. He started medical school in 1944 and elected neurosurgery as his specialty. He had special interest in electricity and physics, which he used extensively in his research.

In 1957 Dr. Hakim was exposed to a strange case of a young man with what was known then as "symptomatic occult hydrocephalus". Until that time the accepted knowledge was that hydrocephalus was due to an increase in intracranial pressure of different etiology. The problem was that the young man had normal pressure, yet had a hydrocephalus and enlarged ventricles. Dr. Hakim applied his knowledge of physics and laid the conceptual basis for what became known as "Normal Pressure Hydrocephalus" a condition until then unrecognized and that is found in aging patients with dementia, Alzheimer's, and other pathologies.

Working at home, Dr. Hakim developed a pressure-regulating shunt  to drain the excess cerebrospinal fluid (CSF) from the ventricular system of the brain. These valves were later produced by medical industry. His son Carlos has continued his legacy and now the Hakim programmable valve is one of the best CSF shunt systems in the world.

Original image courtesy of The Hydrocephalus Association

I had the pleasure of meeting Dr. Hakim in 1993 in Santiago, Chile, and again later in the US, as he presented his valve system to a group of neurosurgeons.  This short article does not do justice to the physician, researcher, and family man. I encourage you to read more in the following links. Dr. Miranda

Sources:
1. "Salom?n Hakim and the Discovery of Normal-Pressure Hydrocephalus" Wallenstein, MB; McKhann, GM. Neurosurgery (2010) 67;1:155-159
2. "The Reprieve: Reversing Dementia" online article byRose Tibayan
3. "Salom?n Hakim, alma y vida de cient?fico"Article by Paulina Ortiz
4. 
"Salom?n Hakim: Un milagro de Colombia para el mundo"


Lapar-

The root term [-lapar-] term is Greex, and although today we use it to mean "abdomen", it actually means "flank" or "loins".

In its pure etymological meaning the root term [lapar], as in "laparotomy" or "laparoscopy" should be used to denote a surgical action in only two of the abdominal regions, the right and left lumbar regions (or flank regions) denoted in the accompanying image.

The first use of the term [-lapar-] referring to the whole of the abdominal region was in January, 1878 by Thomas Bryant, FRCS in his book "A Manual for the Practice of Surgery" using the term [laparotomy] to describe an "incision in the abdomen". Other terms used to denote the abdominal region are "ventral", and of course, "abdominal".

Laparotomy: the suffix [-otomy] means to "open" or "to cut", the term means then " to cut of to open the abdomen"
Laparoscope: an instrument used to view into the abdomen
Laparoscopy: the act of using a laparoscope
Laparostomy: an unusual procedure where the abdomen is not closed, but left partially open (but protected) so that the surgeon can come back periodically to perform an abdominal "lavage" to manage an intractable abdominal sepsis
Laparorrhaphy: the suffix [-orrhaphy] means "to repair". Refers to the repair or closure of a laparotomy

Abdominal regions and their content

Sources:
1. Mughal, M. M., Bancewicz, J. and Irving, M. H. (1986), ‘Laparostomy’: A technique for the management of intractable intra-abdominal sepsis. Br J Surg, 73: 253–259
2. Thomas, B.(1878). "A Manual for the Practice of Surgery" PHiladelphia: Henry C. Lea and Sons