Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. 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

Andreas Vesalius Bruxellensis (1514- 1564)

A Flemish anatomist and surgeon, Andreas Vesalius was born on December 31, 1514 in Brussels, Belgium. He is considered to be the father of the science of Anatomy. Up until his studies and publications human anatomy studies consisted only on the confirmation of the old doctrines of Galen of Pergamon (129AD - 200AD). Anatomy professors would read to the students from Galen's work and a demonstrator would point in a body to the area being described, if a body was used at all. The reasoning was that there was no need to dissect since all that was needed to know was already written in Galen's books. Vesalius, Fallopius, and others started the change by describing what they actually saw in a dissection as opposed to what was supposed to be there. 

Vesalius had a notorious career, both as an anatomist and as a surgeon. His revolutionary book "De Humani Corporis Fabrica: Libri Septem" was published in May 26, 1543. One of the most famous anatomical images is his plate 22 of the book, called sometimes "The Hamlet". You can see this image if you hover over Vesalius' only known portrait which accompanies this article. Sir William Osler said of this book "... it is the greatest book ever printed, from which modern medicine dates" 

After the original 1543 printing, the Fabrica was reprinted in 1555. It was re-reprinted and translated in many languages, although many of these printings were low-quality copies with no respect for copyright or authorship.

The story of the wood blocks with the carved images used for the original printing extends into the 20th century. In 1934 these original wood blocks were used to print 617 copies of the book "Iconaes Anatomica". This book is rare and no more can be printed because, sadly, during a 1943 WWII bombing raid over Munich all the wood blocks were burnt.

One interesting aspect of the book was the landscape panorama in some of his most famous woodcuts which was only "discovered" until 1903.

Vesalius was controversial in life and he still is in death. We know that he died on his way back from a pilgrimage to Jerusalem, but how he died, and exactly where he died is lost in controversy. We do know he was alive when he set foot on the port of Zakynthos in the island of the same name in Greece. He is said to have suddenly collapsed and die at the gates of the city, presumably as a consequence of scurvy. Records show that he was interred in the cemetery of the Church of Santa Maria delle Grazie, but the city and the church were destroyed by an earthquake and Vesalius' grave lost to history. Modern researchers are looking into finding the lost grave and have identified the location of the cemetery. This story has not ended yet.

For a detailed biography of Andreas Vesalius CLICK HERE.

Personal note: To commemorate Andrea Vesalius' 500th birthday in 2014, there were many scientific meetings throughout the world, one of them was the "Vesalius Continuum" anatomical meeting on the island of Zakynthos, Greece on September 4-8, 2014. This is the island where Vesalius died in 1564. I had the opportunity to attend and there are several articles in this website on the presence of Andreas Vesalius on Zakynthos island. During 2015 I also attended a symposium on "Vesalius and the Invention of the Modern Body" at the St. Louis University. At this symposium I had the honor of meeting of Drs. Garrison and Hast, authors of the "New Fabrica". Dr. Miranda


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The "Little Brain" Inside the Heart

Anterior view of the heart
Anterior view of the heart

Personal Note: A few weeks ago, I came across a very interesting article in Spanish by Dr. Jose Manuel Revuelta from the University of Cantabria, Spain. The article talked about the “small brain inside the heart”. One of my interests in the anatomy of the heart is the intrinsic system called the cardiac “ganglionated plexuses”, “ganglionated plexi”, or “GPs”.

It is our proposal that this nervous system inside the heart, which works autonomously (if needed to or forced to) and also dependent, of the autonomic nervous system, is responsible for the intrinsic working of the heart and its dysfunction is probably the root of cardiac dysrhythmias. We have several seminars on this topic here.

In a recent publication with Dr. Randall K. Wolf, he explained both the Wolf Procedure and the anatomical basis that underline atrial fibrillation.

The concept of the "small brain of the heart" is not new. It has been mentioned by Woolard (1926), Armour (1997), Pauza (2000), and others. These authors and others are referenced in this publication. Unfortunately, the diffusion of the concept of an intrinsic, interconnected mesh of clusters of neurons within the heart and other organs that have rhythmic activity, has many names used by the media. That is why you can find articles on the "little brain of the gut", the "gut brain", the "enteric nervous system", the "little brain of the heart", etc. 

Dr. Revuelta's article shows that the interest on the GPs continues on, and more research is being done on this topic. He has graciously granted us permission to translate and publish his article in “Medical Terminology Daily”. He has also expressed interest in publishing some of his articles in this blog. Dr. Miranda


The “Little Brain” Inside the Heart

Dr. José Manuel Revuelta Soba
Professor of Surgery. Professor Emeritus, University of Cantabria, Spain


Dr. José Manuel Revuelta


In December 2024, the prestigious journal Nature Communications published that a group of researchers from the Karolinska Institute (Sweden) and Columbia University (United States) have discovered that the heart contains a small autonomous brain.

In general, scientific knowledge has been relating cardiac activity to the brain, as the only organ that regulates its functioning. This intimate bidirectional relationship regulates the adaptation of its rhythm and contractile force to changing energy demands, through impulses and signals transmitted by the autonomic nervous system. However, the heart surprises us again with new properties that go beyond what is known.

Autonomic nervous system

The neurovegetative nervous system of the human being is involuntary, comprising the sympathetic and parasympathetic nervous systems, essential for the functioning of the organism. They act in conjunction with the enteric nervous system, which also has involuntary action and regulates the activity of the gastrointestinal tract. The complex interactions between these autonomous systems, which have opposing actions, maintain cardiovascular homeostasis, that is, they provide the appropriate amount of oxygenated blood to the organs and tissues according to their demands.

The sympathetic nervous system regulates, among other functions, the body's response to any danger perceived as a threat to physical or mental health, known as the "fight or flight" reaction, described in 1915 by the physiologist Walter B. Cannon in the United States. This instinctive reaction leads to the immediate release of certain chemical substances into the blood, such as adrenaline and noradrenaline. These hormones act as neurotransmitters that produce an increase in the contractile force of the heart, tachycardia, contraction of blood vessels, hypertension and dilation of the airways. These neurotransmitters are released in the brain, facilitating the diffusion of their messages through the extensive network that forms this autonomous nervous system, increasing the state of alertness and eliminating any feeling of drowsiness. By producing an immediate tachycardia, it improves the supply of oxygen to the organs and tissues, enlarges the pupils and reduces the digestion of food to save energy and make it available for this reaction to an unexpected danger.

The parasympathetic nervous system controls the relaxation of the body at the end of the stress caused by the sudden “fight or flight” reaction, once the threat has passed, restoring the normal functioning of the organism. Its main function is the conservation and storage of energy through the release of acetylcholine, a powerful neurotransmitter, discovered by the English physiologist Henry H. Dale, for which he was awarded the Nobel Prize in Medicine in 1936. This substance produces vasodilation, reduction of blood pressure, decreased heart rate and increased intestinal motility.

The enteric nervous system has the exclusive mission of regulating the functioning of the gastrointestinal tract, which is completely covered by hundreds of millions of nerve fibers that transmit brain messages for digestive mobility and function, modifying the volume of blood flow via vasoconstriction or vasodilation.

The small brain of the heart

The innervation of the heart is more complex than previously thought, conditioned by messages from the autonomic nervous system and others from the organ itself. In the early 1990s, scientists described that the heart contained some neurons similar to those in the human brain, which led to speculation about the possible existence of independent neuronal activity within the heart that mediated its functioning and rhythm. This fascinating discovery soon became a priority objective of scientific research.

In 2021, James S. Schwaber and R. Vadigepalli, researchers at Thomas Jefferson University in Philadelphia, performed a three-dimensional mapping of the heart's neural center. They found that the heart receives constant information from the brain about the internal and external state of its environment, adjusting heart rate, blood pressure, and cardiac output. However, these messages also came from the heart's own neural system, called the "little brain," behaving as if there were an internal loop, something similar to what systems engineers call a programmable logic controller or PLC. Most of these neurons are located near the aortic and pulmonary valves, with their largest neuronal cluster (74 percent) located in the area of the sinoatrial plexus, on the upper lateral wall of the right atrium, in immediate relation to the mouth of the superior vena cava.

Using mathematical models, they observed that when this peculiar neural programmable logic controller was activated, it perfectly adjusted the heart's response to the various impulses and signals from the brain to improve cardiac performance, making its work more efficient. Without the presence of this "little brain" it would be impossible to eliminate or correct the possible errors and damage contained in some brain messages, so the heart could become erratic, causing irregular heartbeats or arrhythmias, as well as defects in its contractility.

As these scientists analyze their 3D heart models, obtained from various mammals, new questions arise about the actions of this "brain of the heart", its internal organization, its influence on the contractile force and rhythm of the heart, as well as its coordination and responses to the constant messages from the brain. Currently, these three-dimensional maps are being used to better understand how the vagus nerve connects with cardiac neurons, opening new opportunities for the greater integration of systems engineering into the field of cardiology.

Recent findings from the Karolinska Institutet and Columbia University have revealed that the heart does indeed have its own “mini-brain,” containing a nervous system that self-regulates its rhythm and function according to demand. This complex neurological center is made up of various types of neurons with different functions, some of which function as cardiac pacemakers.

This important research project was carried out in the zebrafish, an animal model that has great similarities with the human heart, both in terms of its heart rate and its general functioning. These scientists mapped the composition, organization and functions of neurons within this small intracardiac brain, using a combination of anatomical methods, electrophysiological techniques and neuronal RNA sequencing. They carried out a complete molecular and functional classification of intracardiac neurons, revealing a complex neuronal diversity within the heart itself.

This intracardiac neurological center is not part of the autonomic nervous system governed by the brain, contrary to what was believed. The data obtained in this interesting scientific investigation show that this “small brain” is made up of several types of independent sensory neurons with clear neurochemical and functional diversity. This population of neuronal cells allows the expression of various genes that encode various neurotransmitter receptors (glycine, glutamate, adrenergic, inotropic, GABA, muscarinic, serotonergic receptors, etc.), suggesting a complex network of neurotransmission specific to the heart, which ignores its total dependence on central orders from the brain.

“We were surprised to see the complexity of this small brain inside the heart, which has a key role in maintaining and controlling the heartbeat, similar to how the brain regulates other rhythmic functions such as locomotion and breathing. Better understanding this nervous system could lead to new insights into heart disease and help develop new treatments, such as for arrhythmias. We will continue to investigate how the heart’s brain interacts with the real brain to regulate cardiac functions under different conditions, such as exercise, stress or disease”, explains Konstantinos Ampatzis, a senior researcher at the Department of Neuroscience at Karolinska Institutet, Sweden, who led the study.

Future electrophysiological, pharmacological and molecular research will be critical to better understand the tangled interactions and complex regulatory mechanisms of the internal neurotransmission of this autonomous “small brain” and thus understand its overall regulation of cardiac rhythm, contraction and output in the face of the multiple physical and mental changes to which we are exposed throughout life.

“There is a wisdom of the head and a wisdom of the heart"
Charles Dickens (1812-1870), English writer

“Facts do not cease to exist because they are ignored”
Aldous Huxley (1894-1963), English writer and philosopher.


Sources:
1. “Decoding the molecular, cellular, and functional heterogeneity of zebrafish intracardiac nervous system”. Pedroni, A; Yilmaz, E; Del Vecchio,L; et al. Nature Communications, 2024; 15 (1) DOI: 10.1038/s41467-024-54830-w
2. Bodily changes in pain, hunger, fear, and rage; an account of recent researches into the function of emotional excitement” Cannon, W. 1915. D. Appleton and Co. USA. 
3. “Mapping the little brain at the heart by an interdisciplinary systems biology team” Vadigepalli, Rajanikanth et al. iScience, Volume 24, Issue 5, 102433. https://doi.org/10.1016/j.isci.2021.102433
4. A comprehensive integrated anatomical and molecular atlas of rat intrinsic cardiac nervous system. Achanta S. et al. iScience 2020 Jun 26;23(6):101140 doi: 10.1016/j.isci.2020.101140
5. "Minimally Invasive Surgical Treatment of Atrial Fibrillation: A New Look at an Old Problem" Randall K. Wolf, Efrain A. Miranda, Operative Techniques in Thoracic and Cardiovascular Surgery, 2024, doi.org/10.1053/j.optechstcvs.2024.10.003


A special guest at a lecture in the University of Cincinnati

Mila Colliza and Dr. Miranda
Mila Colliza and Dr. Miranda


On January 23rd, 2025, I was invited to deliver a lecture on “Human Anatomical Models: History and Development of Plastination”.  The lecture was delivered at the Anatomy Learning Lab which is found at the Donald C. Harrison Health Sciences Library at the University of Cincinnati.

As you may know, I am quite interested in the history of Medical Sciences and one of the topics is the history of surgical stapling.  Wrote extensively on this topic and the life and works of Dr. Mark M. Ravitch.

At this lecture among the attendees were several colleagues and friends and one special guest, the great granddaughter of Dr. Ravitch.  Her name is Mila Colizza and she is a first year medical student here at the University of Cincinnati.

Keeping the medical tradition of the Ravitch family… Way to go Mila!!!. My best wishes in your medical career.


Leon Hirsch and the founding of the United States Surgical Corporation

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.

Leon C. Hirsch
Leon C. Hirsch


Leon C. Hirsch
(1927 – 2023). The story of the development of surgical staplers in America cannot be told without the presence and vision of Leon Hirsch, an American business executive and entrepreneur... 

After his 1958 trip to the USSR with two other surgeons, Dr. Mark Ravitch tried to have his colleagues take interest in the surgical stapling technology. Dr. Ravitch and Dr. Felicien Steichen stated in one of their books “Interestingly enough, a number of American manufacturers, knowing of our interest, visited our laboratories and operating rooms to see how the staplers performed, but for one reason or another decided that there was no future in stapling – to their later expressed regret! (1)”

There have been several apocryphal stories, including one where L. Hirsch was a down-on-his luck shoe salesman (not true) that met with his friend Ravitch as they both lived close to each other (not true either). So, what is the real story of how Leon Hirsch met Mark Ravitch and founded the United States Surgical Corporation (USSC).?

The original story, as told by Leon Hirsch, can be found in the May 1990 edition of the medical journal “Surgical Rounds” (2), an edition entirely dedicated as a “Festschrift (commemorative publication) to Mark Ravitch, MD”, after his death.

Leon Hirsch says: “In 1963, I was engaged in a discussion with a patent broker in New York City when I noticed a strange-looking metal object on his desk, which he described to be a Russian surgical stapler. Further inquiry led to the disclosure that this patent broker had been retained by the Russian government to try to market Soviet-made surgical staplers in America”. This patent broker had tried to garner the attention of at least five companies (Ethicon, Davis & Geck, American Hospital Supply, Aloe Corp., and Ipco, Inc) with no success.

This statement by Leon Hirsch goes against everything I knew, that is, that Dr. Ravitch was the one trying to bring the patents from the then USSR to the USA. In another version of this story Dr. Ravitch bought the patents and tried to sell them to USA medical companies! None of these are true.

Mark M. Ravitch, MD

Mark M. Ravitch, MD 

Felicien Steichen, MD

Felicien Steichen, MD

Leon Hirsch continues “The patent broker offered to lend me his information book on Russian stapling… the package disclosed that recently, three American surgeons had been to Moscow to study Russian surgical techniques, including the technique of surgical stapling”. This statement by the Soviet government is not correct, as Dr. Ravitch and two other surgeons had been to Moscow, yes, but to study Russian transfusion and resuscitation techniques, and the fact that they ended observing surgery (and seeing surgical staplers at work) was serendipitous. That in itself is another story.

Leon Hirsch phoned Dr. Ravitch who at the time was working at John Hopkins. They planned to meet for 15 minutes, which stretched into lunch, then back to Dr. Ravitch’s office for a demo of the staplers. The discussion veered into the difficulty of loading the staples one by one in this large, cumbersome device. “Intrigued, I asked Dr. Ravitch to borrow the instrument, took it back to my home workshop, and realized that the answer to the loading problem was to separate the instrument from the staples. I made a model of a cartridge (in balsa wood) that could be preloaded with staples and easily slipped into the instrument. Dr. Ravitch was elated”. The idea of the interchangeable cartridge was Hirsch's!

With this idea, and financial support that he pursued, Leon Hirsch proceeded to form the United States Surgical Corporation, with four initial employees. It took three years (1964-1967) to develop a stainless steel surgical stapler that had interchangeable preloaded stapler cartridges that were up to American standards. Since then, thousands of patients have benefited from these devices.

An interesting side note is that Leon Hirsch wanted Mark Ravitch to play a part in this new company, but Ravitch declined. Hirsch states: "Dr. Ravitch said that he had no commercial interest in pursuing such a project but he would be willing and happy tp evaluate, first in the laboratory and if successful clinically, such new devices. In typical Ravitch fashion he added that he planned to report exactly what he found, good or bad". 

The story of USSC continued through acquisitions, so USSC became Tyco, then Tyco Healthcare, Covidien, and today is the Stapling Division of Medtronic.

Leon Hirsch and USSC confronted the conundrum of training surgeons in the use of the new staplers. To this end he initially hired eight nurses, but eventually created a six-week extremely difficult grueling training program that took sales representative from basic medical terminology to being able to direct the surgeon through the steps on the use of the surgical staplers in the procedure. By doing this, he changed the way medical devices surgical representatives operate in the medical arena. Some of the readers of this article probably went through this challenging training program! In fact, some medical companies started trying to hire people that had been trough this training.

Drs. Ravitch and Steichen continued their quest training surgeons on the benefits of surgical stapling, while at the same time testing and improving the newer devices that Leon Hirsch and USSC developed.

In 2018, The Mullings Group interviewed Leon Hirsch (then 91 years old) and published a video of this interview, where he covers these topics and more. This video now forms part of the History of Surgical Stapling.

My personal thanks to Joe Mullings, Chairman & CEO of the Mullings Group Companies for his permission to share this video and some video captures for this article.

Sources:
1.  “Current Practice of Surgical Stapling” Ravitch, M; Steichen, F; Welter, R. 1991 Lea & Febiger Publishers, USA.
2. “Festschrift to Mark Ravitch, MD” Surg Rounds J. May 1990. Romaine Pierson Publication.
3. "Stapling in Surgery" Ravitch, MM; Steichen, FM.1984 Yearbook Medical Publishers USA.
4. The Origin of Medical Terms" Skinner 1970
5. "Notes by Dr. Mark Ravitch on Trip to Russia - September 1958" Personal notes.
6.“Leon Hirsch: Opportunity is Everywhere” YouTube video by the Mullings Group. Oct 2018
7.  “Tribute to Felicien Steichen” SAGES Minimally Invasive Surgery Videos. April 2012 
All images are in the public domain, or. have been authorized for use.


An incredible find in surgical stapling history

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.

Dr. Mark M. Ravitch
Dr. Mark M. Ravitch


Young surgeons today use surgical staplers without a thought as to the history of the development of these surgical devices. The same is true for many who work in the medical devices (surgical staplers) industry. I have worked as a consultant and a trainer for the stapler industry both with Ethicon Endosurgery (today Ethicon, stapling division) and the United States Surgical Corporation (today Medtronic, stapling division) and developed a special interest in the medical history related to the origin, research, and development of surgical staplers.

The history of surgical stapling is quite interesting and has many characters, starting with the early works of Humer Hutl. There are whole books dedicated to this topic.

It cannot be denied that one of the main drivers of surgical stapling in the United States was Dr. Mark M. Ravitch (1910-1989). History tells us that he saw these staplers in action being used by Dr. Nikolai Mikhailovich Amosov (1913–2002) during a visit to the Thoracic Surgical Institute in Kiev in September 1958. Kiev was then part of Russia (then called the USSR).

What I did not know is that Dr. Ravitch had his notes typewritten, and those loose leaf notes are now part of my library in a binder.

The notes in this binder are the carbon copies in onionskin paper of notes typewritten personally by Dr. Mark. M. Ravitch during his trip to the USSR in September 1958. According to his family, Dr, Ravitch had notoriously bad handwriting and he liked to maintain records of his work, so he was a very fast typewriter. He used his personal typewriter and he traveled everywhere with it even during his military service in WWII.

 

 

Dr. N. M. Amosov

Dr. Nikolai Mikhailovich Amosov

Cover of Dr. Ravitch's personal notes

Cover of Dr. Ravitch's personal notes

The original notes were bound in a book (also in my collection) and gifted by Dr. Ravitch to his parents. Unfortunately, the paper he used for the originals was not acid-free and the pages in this unique book are slowly crumbling and some of them are today unreadable. Thankfully, the carbon copies are acid-free, and the pages have been carefully scanned in TIF and PDF format by David M. Klein and then placed in separate plastic sleeves for preservation in a binder that is now in my library.

After Dr. Ravitch’s parents passing, both these notes were in the library of his son, Michael M. Ravitch, Ph.D. Michael lent these notes to Dr. Felicien Steichen (1926 – 2011) , who after a time returned the notes with a letter, also included in this binder. In this letter Dr. Steichen says that these notes should be preserved for future research, even mentioning Leon Hirsch (CEO of the United States Surgical Corporation) to support this endeavor.

Michael Ravitch’s widow, Myrnice Ravitch contacted me in 2017 because of my interest in medical history and the life and work of Dr. Ravitch. She donated some books that were in Dr. Ravitch’s library. In early 2024, and with the blessing of Dr. Ravitch’s daughter Binnie and the rest of the Ravitch family, they donated these notes that are now part of the history of surgical stapling and are today part of my library.

In a separate article I will present some of the actual notes regarding surgical stapling, although these notes also include invaluable observations on medicine and surgery in the USSR and Dr. Ravitch’s comments on the Russian culture and people at the time. Keep in mind that Dr. Ravitch’s parents where Russian immigrants and he was fluent in Russian.

In the future, and following Dr. Steichen’s suggestion, I will try to publish a book with these notes along with additional notes on Dr. Ravitch’s trip to China in 1983

Note: The photograph of Dr. Asomov was taken by Dr. Ravitch, but it has since degraded, so it was enhanced using Winxvideo AI.

Note: Dr. N.M. Amosov had an incredible surgical career and recognized with medals and honors. The Institute where Dr. Ravitch saw him operate with surgical staplers is today known as the Amosov National Institute of Cardiovascular Surgery in Kiev, Ukraine.

Sources:
1. "Current practice of surgical Stapling" Ravitch, MM; Steichen, FM; Welter,W.  1991 Lea & Ferbiger USA
2. "Stapling in Surgery" Ravitch, MM; Steichen, FM.1984 Year Book Medical Publishers USA.
3. "Surgical Rounds" Edition dedicated to Dr. M.M. Ravitch  May 1990
4. "Notes by Dr. Mark Ravitch on Trip to Russia - September 1958" Personal notes, unpublished.


Anton Nuck

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.

Anton Nuck

Antonius Nuck


Anton Nuck (1650-1692), a Dutch surgeon and anatomist used several forms for his name such as Antonio Nuck, Anton Nuck, Antonii Nuck, and Antonius Nuck van Leyden. Born in Harderwijk, Netherlands, he moved to Leyden in South Holland, where he studied medicine at the University of Leyden. He received his doctorate in February 1677 with this thesis “De Diabete”.

In 1683 he became a reader (lecturer) of anatomy and surgery at the Collegium Anatomicum Chirurgicum, in Haag (The Hague, Netherlands). He returned to his alma mater in Leyden, where the was appointed to the chair of Medicine and Surgery.

Nuck is known today for the first description of  the processus vaginalis, a peritoneal evagination thar runs lateral to the gubernaculum into the inguinal canal in the fetus, both male and female, terminating in the labioscrotal fold, an area that will become the scrotum in the male or the labium majus in the female. This canal is known eponimycally today as the "Canal of Nuck"

The processus vaginalis in the male runs lateral to the vas deferens into the scrotum. The processus vaginalis in normally closed, but if it stays patent, it becomes a passageway for abdominal contents into the scrotum, setting the stage for an indirect inguinal hernia.

Title page of Adenographia & Uteri (Nuck)

Title page of Adenographia & Uteri

 

 

Plate XL of Adenographia (Nuck)

Plate XL of Adenographia & Uteri

In the female the processus vaginalis runs lateral to the round ligament of the uterus. Since the round ligament ends in the labium majus, a patent processus vaginalis sets the stage for an indirect inguinal hernia that bulges into the labium majus (see figure 4 in Source 1- WARNING the image depicts external female genitalia)

Before Nuck, it was argued that females could not have inguinal hernias. In 1691 Nuck published his book "Adenographia Curiosa & Uteri Foeminei Anatome Nova", where he showed that indeed some females could indeed have hernias. For additional information on the canal of Nuck and the text in the book, click here

Chapter 10 of this book is entitled “De Peritoneai Diverticulis Novis” (On a New Peritoneal Diverticulum”.  Not only Nuck described the processus vaginalis, but he described a pathology today known as “Nuck’s cyst” or “Nuck’s hydrocele”, a cyst within Nucks’ canal.  The images above show the title page of his book "Adenographia Curiosa & uteri foeminei anatome nova" and a composite image of plate XL and text. This book was dedicated to the mainly to the topic of lymphatic vessels. The discovery of a patent processus vaginalis was not its intent, but when he found it, he added it to his book. The text on image XL reads "diverticulum novum oculis subjiciens, ex subjecto humano" that can be freely translated as "On a new opening, seen with our eyes in a human subject"

Because of laparoscopic and robotic surgery that requires a pneumoperitoneum, an undiagnosed patent canal of Nuck can lead to a pneumatocele or pneumolabium (See Sources 6)

Besides general surgery, Anton Nuck practiced dentistry and ophthalmic surgery, being the first one to perform a paracentesis for hydrophthalmia (glaucoma) to reduce the pressure inside the eye. He also performed the first recorded vitrectomy. He studied the salivary glands and called the process sialography.

Sources:
1. “Quiste del Conducto de Nuck: una Patología Vulvar Poco Frecuente” Nuñez, JT; Virla, Ln, Delgado del Fox, MD; Gonzalez, A. Rev Obstet Ginecol Venez v.66 n.1 Caracas mar. 2006
2. “Revisiting the clinico-radiological features of an unusual inguino-labial swelling in an adult female” Vinoth, T; Lalchandani, A; Bharadwaj, S; Pandya, B. 2022. International Journal of Surgery Case Reports, 98(Complete)
3. “Early Descriptions of Vitreous Surgery” Grzybowski, A. & Kanclerz, P. (2021) Retina, 41 (7), 1364-1372.
4. The Origin of Medical Terms" Skinner 1970
5. "The cyst of the canal of Nuck: a great mimicker of groin hernia in female" Ben Ismail, I., Sghaier, M., Rebii, S., Zeznaidi, H. and Zoghlami, A. (2024) ANZ Journal of Surgery
6. "Unilateral Vulvar Pneumatocele (Pneumolabium) Diagnosed during Robotic Hysterectomy" Zoorob, D; Spalsbury, M;Slutz, T; et al. (2019) Case Reports in Obstetrics and Gynecology2019, 8106451
7. "A Family of Early English Oculists (1600-1751), With a Reappraisal of John Thomas Woolhouse"Leffler CT, Schwartz SG. (2017) Ophthalmol Eye Dis. 
Anton Nuck's portrait in the public domain, courtesy of the Universiteit Leiden Digital Collections.
Images from "Adenographia Curiosa", public domain, courtesy of Archive.org.


Musculi levator labii superioris alaeque nasi

musculi levator labii superioris alaeque nasi
Click for a larger image


UPDATED:The [musculi levator labii superioris alaeque nasi] is one of the superficial muscles of expression found in the face. It is a small bilateral muscle found at the angle of the nose and its function is to elevate the superior lip and the side ("wing") of the nose, slightly opening or "flaring" it. When both of these muscles are activated the facial expression attained is called a "snarl".

Its name is Latin and can be loosely translated  as the "muscle that lifts the upper lip and the wing of the nose". The muscle attaches to the superior  frontal process of the maxilla and inserts into the skin of the lateral part of the nostril and upper lip.

This muscle has two components, one superficial and the other deep. From the insertion point (see red arrow in accompanying image), the deep muscular fibers insert in the skin of the posterior aspect of the nasal wing. The external muscle fibers cross superficially over the orbicularis oris muscle and insert in the deep skin of the upper lip towards the lip anle.

My friend Dr. Elizabeth Murray calls it "a small muscle with the longest name in human anatomy". Fact is, I think she is right! It is worse in Spanish, where the name of the muscle is "músculo elevador común del ala de la nariz y del labio superior"!

Image modified from the original. Public Domain. "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain