My partner in crime and fellow traveler, Theo Dirix, has just published a new account of our common quest for the lost grave of Andreas Vesalius. Until the scientific results of our latest mission in Zakynthos in September 2017, will become public, this collection of articles published since 2014 represents a detailed and complete status quaestionis of a search that will never be the same anymore.

I'm proud and grateful to be part of a team he describes a most tenacious.

Following is a remarkable quote from the book: "The beast you have in your hands may appear as aged and stubborn: indeed, the texts collected here are not new and they regularly echo each other. The beast barks and growls: these words do not intend to examine or research but were meant to sell a project to potential sponsors. I feel the taste of the creature’s spit in my face, but pleading not guilty to any accusation of self-glorification, I do hope I managed to teach it a few tricks you will enjoy. While continuing to write about Vesalius’s death and his grave, black dogs may still be scratching at my hermitage. When I will finally throw open the doors to the beauty beyond, here’s hoping the encounter with the female spider will taste as fresh as a first kiss and be the beginning of something else."

No surprise some have described the book as: "a truly captivating story (a Live Adventure!) written in a fascinating, passionate and inspiring way. Theo Dirix, with his unique style is describing facts from his adventure to locate the grave of Vesalius and he is mentioning with great respect all his collaborators, the friends of Vesalius and those who share the same passion for Anatomy and Art." (Vasia Hatzi on Med in Art).

Cover of the book by Theo Dirix.
Click on the image for a larger depiction

The book can be ordered here: https://www.shopmybooks.com/US/en/book/theo-dirix-32/in-search-of-andreas-vesalius. (English version of the website). More information about the author on his website www.theodirix.com. or here.

Personal note: Thanks to Pascale Pollier, a contributor to this website, for allowing us to publish this article, originally published on Vesalius Continuum.

I received a personalized copy from the author, Theo Dirix; Thank you very much for the recognition and the use of this website as reference in some of your comments. It is a great read for anyone even mildly interested in the life and specially the death and disappearance of the grave of Andreas Vesalius. There are several passages in the book that I will have to research and transform in articles for this blog.

For those who collaborated in the GoFundMe campaign because or our article entitled Do you want your name in a book? The Quest for the Lost Grave.... this is the book and the name of all the contributors are listed in it! 

The quest continues... Dr. Miranda

HOUSTON AFib PATIENT EXPERIENCE SEMINAR

Saturday, April 21st, 2018 9am – 4pm
Westin at Memorial City, 945 Gesner Rd.
Houston, TX 77024
877-900-AFIB (2342)

This seminar is free and open to the public. To attend, please call the telephone number to register.

WELCOME MESSAGE FROM DR. RANDALL WOLF

In my experience over the last 18 years as a physician who specializes in the treatment of Atrial fibrillation (AFib), I have learned AFib sufferers want two things: Hope and a chance to feel better.

The first step to hope and to feeling better is to self educate. Learn about the latest medications, techniques and devices to treat AFib. Ask questions. Get a second opinion. Take charge of your health.

The purpose of the Houston AFib Patient Experience Seminar is to help AFib sufferers like you take charge of your health.

Despite the common occurrence of AFib around the world, a recent study found that in patients who were diagnosed with AFib, 40-50% of patients with an elevated risk of stroke were not treated with the best therapy, and the rate of stroke over the next five years was 10%.

Here in Houston, we can do better! Learn more about AFib right here today, and I guarantee you will have hope and be more likely to reach your goal of feeling better.

Towards an AFib free healthy life,

Randall K. Wolf, MD.

SEMINAR AGENDA

9:00 am     Introductions -  Randall Wolf, MD, FACS, FACC, Professor at McGovern Medical School, Cardiothoracic Surgery, Course Director for the AFib Patient Experience Seminar

9:15 am      The cost of AFib

9:30 am     Mechanisms

9:45 am     Blood Thinners – W. Ross Brown, MD, FACC, Comprehensive Heart Care, PA

10:15 am   Medications – Sunil Reddy, MD, Assistant Professor at McGovern Medical School, Cardiovascular Medicine

10:30 am   BREAK

10:45 am   Diet – Baxter Montgomery, MD, FACC, Clinical Assistant Professor of Medicine, McGovern Medical School, Department of Cardiology

11:00 am   Sleep Apnea – Murtuza Ahmed, MD, FAASM, Razzack and Associates, Houston

11:15 am   AF Monitoring – Sunil Reddy, MD, Assistant Professor at McGovern Medical School, Cardiovascular Medicine

11:30 am   Questions with panel

12 noon      LUNCH

Testimonials: Donna Roth, Houston, TX Gary Wight, Houston, TX Mac Peirson, Houston, TX Ross Wroblewski, Lompac, CA Michaela Senk-Eustace, Hartford, CT

1:00 pm     Catheter Ablation – Siddharth S. Mukerji, MD, Assistant Professor at McGovern Medical School, Cardiovascular Medicine

1:30 pm     Surgery – Randall Wolf, MD, FACS, FACC

2:00 pm     Stop AFib.org – Mellanie True Hills, President

2:30 pm     Panel Discussion

2:45 pm     Stroke – Ritvij Bowry, MD, Assistant Professor at McGovern Medical School, Vivian L. Smith Department of Neurosurgery

3:00 pm     LAA Closure – Siddharth S. Mukerji, MD, Assistant Professor at McGovern Medical School, Cardiovascular Medicine & Randall Wolf, MD, FACS, FACC

3:30 pm     Panel Discussion

4:00 pm     Adjourn – Meet with Faculty

ABOUT THE HOUSTON AFIB PATIENT EXPERIENCE SEMINAR

The University of Texas McGovern Medical School, Cardiothoracic and Vascular Surgery Department in Houston, is proud to host the inaugural Houston AFIB Patient Experience Seminar. The purpose is to educate the public in an interactive format allowing the audience to engage in conversation in a question/answer format with leading medical professionals. Our list of panel members and guest presentations include surgeons, cardiologists, neurologists, pulmonologists as well as testimonials from AFib patients. We are honored to be able to bring awareness to the resources and options available to patients suffering from AFIB.

NOTE: If you cannot attend the seminar, there is more information on Atrial Fibrillation at this website; click here.

UPDATED: [Pes anserinus] is the name given to a tri-flanged structure formed by the attachment of the flattened tendons of three muscles to the anteromedial surface of the superior aspect of the shaft of the tibia. The tendons correspond to the sartorius, the gracilis, and the semitendinosus muscles. The pes anserinus is related superficially to the the tibial insertion of the medial collateral ligament of the knee. 

There is a bursa deep to these tendons, the [bursa anserinus], which can be the cause of painful bursitis.

The term [pes anserinus] literally means “goose foot”, as early anatomists compared this structure to the foot of this bird. In Latin [pes] means “foot”, and [anserinus] or [anser] means “goose”.

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

Image modified from the original: "3D Human Anatomy: Regional Edition DVD-ROM." Courtesy of Primal Pictures

The word [torus] is of Latin origin and refers to “a rounded protuberance or swelling”. In science, it refers to a doughnut-shaped structure (see image). It also refers to the rounded, bulging, and circular base component of a pillar, found between the square plinth and the main body of the pillar. The torus can be seen in Egyptian, Greek, and Roman style pillars.

The term is used in anatomy and medicine to denote normal or abnormal circular or semicircular protuberances, as in the case of the “torus tubarius”, a normal semicircular elevation found at the ostium of the auditory tube (of Eustachius) in the lateral walls of the rhinopharynx. The torus tubarius elevation is due to the presence of lymphoid tissue which can get inflamed.

Click on the image for a larger view

In orthopedics it is used to denote a compression fracture where the cortex of a long bone close to one of its epiphyses buckles under longitudinal (axial) compression. The look of the fracture is similar to the location of the torus in a pillar. An example of this is the torus fracture (also known as buckle fractures) in children.

The term [torulus] is related to [torus], as it means a “small torus” and it refers to a small elevation, which is synonymous with the word “papilla”. An example of this is the term torulus tactiles palmaris, referring to small elevations on the palms of the hand. Another related term is [torulosis], referring to a large number of small elevations or pimples.

The following images are of a Greek pillar taken in 2014 in Athens showing the location of the torus. The next image shows a torus fracture. The image is from www.kidsfractures.com/forearm/ and we thank them for sharing the image with us. This is a great site for information on fractures in children.

Click on the image for a larger view

Click on the image for a larger view

Sources:
1. “Medical Meanings: A Glossary of Word Origins” Haubrich, WS. Am Coll Phys. Philadelphia 1997
2. “The Origin of Medical Terms” Skinner, HA 1970, New York. Hafner Publishing Company
3. “Taber’s Cyclopedic Medical Dictionary” 16th Ed. 1989. Philadelphia. FA Davis Company
4.  www.kidsfractures.com/forearm/

Torus image: By LucasVB [Public domain], via Wikimedia Commons

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

The normal components of the aortic valve are part of the aortic root. The valve is composed of three leaflets, each of which are related to a sinus of Valsalva, and three interleaflet triangles. The anatomy of the aortic root, the aortic valve and the interleaflet triangles of the aortic root have been described in other articles in this website.

A bicuspid aortic valve (BAV) is probably the most common cardiac defect of congenital origin. The prevalence of BAV ranges from 0.9% to 2% in the general population with a 3:1 male-female ratio.

In spite of the anomaly, a BAV may achieve normal valvular function, but this probably does not last, as BAV tend to develop calcifications in the adult leading to valvular disease, dysfunction, valvar stenosis, so complications are common, the most common being dilation of the aortic root and ascending aorta.

There are several attempts at classifying BAV, as the leaflets that fuse are different, and so is the way of fusion.

There is one rare BAV called “pure”. This purely BAV is a true BAV, composed of two leaflets of similar size where there is no clear fusion line or “raphe” between the fused leaflets (see image). This valve has two well developed interleaflet triangles and the third can be absent or vestigial.  The image depicts the excised calcified leaflets where the left and right coronary cusps are fused.  

Other types of BAV have a well-developed raphe, have two well developed interleaflet triangles and the third may be large or anomalous. The leaflets may also be asymmetrical. The classification of the different types of BAV goes beyond the objective of this article, but they can be studied in the references at the end of this article. There is no doubt that the different types of BAV can cause valvar disease and hemodynamic chaos, so the surgical approach for these may be different, including valve repair, aortic annuloplasty, interleaflet triangle remodeling, and of course valve removal and prosthetic implant, either biological or mechanical.

Clinically, the pathologies related to the function of the aortic valve are stenosis, valvular incompetence, and in some cases intimal aortic dissection, which is a catastrophic complication. Some of these complications are triggered by the calcification of the bicuspid leaflets. Interestingly, although BAV is a congenital disease, only one in fifty children known to have BAV have clinically significant disease by adolescence.

PERSONAL NOTE: I have permission to publish the image in this article… because the bicuspid aortic valve depicted in this article is my own. My personal thanks to the medical and support personnel at the Memorial Hermann Heart & Vascular Institute, in Houston, TX., and my three cardiovascular physicians without whom I would not be back writing this article, Drs. Randall K. Wolf (contributor to this website), Dr. William Ross Brown (cardiologist), and Dr. Tuyen Nguyen, who operated on me. Dr. Miranda.

Sources:
1. “Etiology of bicuspid aortic valve disease: Focus on hemodynamics: Atkins, SA, Sucosky, P World J Cardiol. 2014 Dec 26; 6(12): 1227–1233.
2. “A classification system for the bicuspid aortic valve from 304 surgical specimens” Sievers, HH., Schmidtke, C. J Thorac Cardiovasc Surg 2007;133:1226-33
3. “Bicuspid Aortic Valve Disease” Siu, SC, Silversides, CK. JACC Vol. 55, No. 25, 2010:2789 – 800
4. “Bicuspid aortic valve aortopathy in adults: Incidence, etiology, and clinical significance” Int J Card 2015:1;400-407
5. ”Sutureless valve in freestyle root: new surgical valve-in-valve therapy” Villa E, Messina A  et al. Ann Thorac Surg  2013:96:e155–e157
6.” Sutureless aortic bioprosthesis valve implantation and bicuspid valve anatomy: an unsolved dilemma?” Lona, M, Guichard JB, et al Heart vessels 2016.31:1783-1789