Anterior view of the stomach

The term “lesser curvature” refers to the shorter, curved, and concave right-sided border of the stomach. The lesser curvature extends between the esophagogastric junction superiorly and the pylorus inferiorly.

Although generally curved, the lesser curvature presents with a sharp angulation called the incisura angularis or the angular notch.

The lesser curvature is connected to the liver by a double-layered fold of peritoneum called the lesser omentum. The lesser omentum is composed of two regions:

1. The gastrohepatic ligament, the larger component, found between the lesser curvature and the liver. It includes the pylorus.
2. The gastroduodenal ligament, the smaller component, found between the first portion of the duodenum (superior portion, duodenal ampulla) and the liver. The common bile duct is found between the layers of the omentum.

The image shows the lesser curvature with an animated dashed line. The blue arrow points to the incisura angularis.

Sources:
1 "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. "Anatomy of the Human Body" Henry Gray 1918. Philadelphia: Lea & Febiger
Original pastel image by Dr. E. Miranda

Anterior view of the stomach

The term "incisura" is Latin, derived from the verb [incidere]* meaning "to cut" or [incisura]” meaning a "notch" or indentation in a structure, suggesting a distinctive incision, or cut. The second component, "angularis," is also Latin, derived from "angulus," which translates to "angle." The term "incisura angularis" can be translated as the "angular notch", a term that is also use for this gastric anatomical landmark.

The incisura angularis is a notch located along the lesser curvature of the stomach. Externally, it marks the transition between the body (corpus) and antrum of the stomach, an abdominal viscus. It is related to the gastrohepatic portion of the lesser omentum superolaterally. It should be mentioned that the lesser curvature vascular arcade runs within the lesser omentum, closely related to the gastric lesser curvature.

Found approximately midway between the esophagogastric junction and the pylorus, this external anatomical feature is easily identifiable internally during gastric endoscopy.

Structurally, the incisura angularis is formed by a fold of mucous membrane on the inner surface of the stomach, creating a small recess along the lesser curvature.

The stomach, although it has the same layers as the rest of the GI tract, presents an extra muscular layer in the area of the lesser curvature, which renders this area less distensible forming a muscular channel called the magenstrasse.

The mucosa layer is the deepest of the stomach layer. Within it, three areas of gastric mucosa are usually described: pyloric, transitional, and fundic. The incisura angularis corresponds mostly to the transitional zone. When there are mucosal changes that shown an invasion of another type of mucosa, it can mean preneoplastic changes. For this reason, the incisura angularis is an area that, when biopsied, can show early cancerous changes, as well as muscular atrophy, intestinal metaplasia, and dysplasia.

Preservation of the anatomy of the incisura angularis is critical during a sleeve gastrectomy, the most common bariatric procedure worldwide. The objective of a sleeve gastrectomy is to reduce the size of the stomach by placing a curved staple line along the left border of the magenstrasse, a lesser known gastric anatomy term.

Because of the location of the incisura angularis, improper placement of a straight gastric stapler could cause stenosis or stricture at this level. Another potential postoperative problem in this procedure is gastroesophageal reflux disease (GERD) where some authors have proposed an omentopexy as a way to modify the angle of the incisura angularis.

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
3 "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
4. “The Rarely Sampled Incisura Angularis Is Useful for the Detection of Gastric Preneoplastic Lesions” Singhal, A. , Saboorian, H. , Turner, K. , Rugge, M. & Genta, R. (2023). The American Journal of Gastroenterology, 118 (10S), S1407-S1407.
5. “Incisura angularis belongs to fundic or transitional gland regions in Helicobacter pylori-naive normal stomach: Sub-analysis of the prospective multi-center study” Nakajima, S at al Digestive Endoscopy 2021; 33: 125–132
6. “Increasing the angle at the incisura angularis using omentopexy reduces/prevents GERD symptoms five years after laparoscopic sleeve gastrectomy?” Presidential Grand Rounds. Surgery for Obesity and Related Diseases, Volume 18, Issue 8, Supplement, 2022
7. “Gastric POEM to treat incisura angularis torsion after sleeve gastrectomy” Baptista, A; Davila, M; Guzman, M. Endoscopy 2019; 51(04)
8. “Obstruction after Sleeve Gastrectomy, Prevalence, and Interventions: a Cohort Study of 9,726 Patients with Data from the SOReg” Sillen, L; Andersson, E, Edholm, D. OBES SURG 31, 4701–4707 (2021)

Note: Google Translate includes the symbol (?). Clicking on it will allow you to hear the pronunciation of the word.

[UPDATED] This is a medical term derived from the Latin [incisus] or [incisura], meaning "to cut". The Greek word [Τομή] (tomí) from which the suffixes [-otome], or [-otomy] derive, have a similar meaning.

The root term is [-cis-] and uses of this term include:

• Incision : "To cut in" • Incisive: Something that "cuts in"

• Incisor: Refers to a type of tooth that has a "cutting in" action

• Excision: The prefix [ex-] means "out" or "outside". To cut out, or to extirpate. See the meaning of the suffix [-ectomy] here

• Circumcision: The prefix [circum-] means "around", or "in a circle". To cut around (in a circle)

Note: Google Translate includes the symbol (?). Clicking on it will allow you to hear the pronunciation of the word.

Lateral view - Human embryo about
eight and a half weeks old

(UPDATED) The term [ventral] arises from the Latin word [venter] and the root term [ventr-] meaning "belly" or "sac". The adjective [ventral] means "towards the front" , or "towards the belly side of the body". The term ventral therefore means "abdomen".

Many use the term [ventral] synonymously with "anterior"; although this is technically correct, the proper term to use when referring to the patient in the anatomical position should be "anterior". In embryology, since the embryo is curved, most of the anterior aspect of the embryo looks towards the abdomen, ergo ventral.

A ventral hernia is any herniation that occurs in the anterior aspect of the abdomen, including Spigelian hernias, omphaloceles, etc.

Other terms that arise from the same root term are [ventricle], meaning "little belly", or "little sac", and [ventricular], meaning "pertaining to a ventricle".

Note: A comment from my friend Dr. Elizabeth Murray: 

"My understanding of "anterior" means "in the direction of movement" for any given organism (and "posterior" means opposite the direction of movement for an organism). Thus, ventral does not ever change for any creature (vertebrate or even invertebrate), as it refers to a body part/surface.  But when considering two-legged and four-legged (or finned) creatures, you see the differences:  Ventral = anterior in us, but in a dog or fish ventral = inferior.

Ventral/dorsal refer to belly/back in any organism, and cranial/caudal refer to head-end and tail-end in any organism -- those four terms refer to body parts.  However, anterior/posterior refer to the way an organism moves in space, and superior/inferior refer to an organism's relationship to the earth/pull of gravity."

An interesting side note: The word [ventriloquist] arises from the root term [-ventri-] from the Latin [venter] and the suffix [-loquist], from the Latin [loquos] and [locutus], meaning "to speak", or "someone who speaks". The term [ventriloquist] means then "someone who speaks from the abdomen (or stomach)". We now know that this is not so, but that is what most people think a ventriloquist does!

Sources:
1 "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. "Anatomy of the Human Body" Henry Gray 1918. Philadelphia: Lea & Febiger
Image modified by CAA, Inc. Original image by Henry Vandyke Carter, MD., courtesy of bartleby.com

Right homonymous superior quadrantanopia

[Quadrant]-[an-[opia ] The root “quadrant” is based on the Latin "Quadri" meaning "four" and “Quarto”, meaning one fourth. The suffix anopia is composite: “an” meaning “without or absence of”; and opia (or “opsia”) relate to vision, based on the Greek word “οπτασία”  (optasía) meaning “sight”.  Literally, the term quadrantanopia (or quadrantanopsia) means “absence of sight in a quadrant”.

It can be associated with a lesion of an optic radiation of the internal capsule. While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it is most commonly associated with lesions in the occipital lobe.

What is interesting are the terms “homonymous” and “heteronymous” used to describe variants of quadrantanopia. Each eye has four quadrants and two visual fields, right and left.  A homonymous quadrantanopia means that the patient has lost the vision of a quadrant in the same field in each eye (right-right or left-left), heteronymous means that the patient has lost the vision of a quadrant in the opposite field of each eye (right-left or left-right).

The fact is that the term homonymous means “same name” not same side, and the word heteronymous means “different name”, from the Greek “όνομα” “nym” meaning name. For further confirmation, try finding the meaning of synonym, antonym, acronym, patronymic, etc.

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
3. "Dorlands's Illustrated Medical Dictionary" 26th Ed. W.B. Saunders 1994

Note: Google Translate includes the symbol (?). Clicking on it will allow you to hear the pronunciation of the word.
Image courtesy of Mudsk, CC0, via Wikimedia Commons.

I had the honor of being invited to participate in the 53rd Annual Chilean Meeting of Anatomy (XLIII Congreso Chileno de Anatomía) which was held in conjunction with the 1st Latin American Congress of Clinical Morphology (Primer Congreso Latinoamericano de Morfología Clínica). Along with these meetings were two symposia: The First Joint Symposium of Chilean/Korean Anatomists and the First Joint Chilean - IFAA-FIPAE Symposium (International Federation of Associations of Anatomists - Federative International Program for Anatomy Education).

Universidad de Los Andes, Chile

This meeting was held on November 11- 14, 2023 and was hosted by the University of Los Andes (Universidad de Los Andes), a Chilean institution of private higher education that offers careers and postgraduate programs in different areas of knowledge including Education, Engineering, Nursing, Obstetrics, Medicine, Psychology, Law. etc. Their campus is located on the slopes of the beautiful Andes mountains overlooking the city of Santiago, Chile.

The image shows the Main Library of the University, where the meeting was held.

On November 9 and 10, the days leading to the meeting, there were six Postgraduate Courses, from anatomy to radiology and surgical reconstruction. There were two that I would like to highlight. The first one  was a workshop "Mastering Anatomical Radiology with  IMAIOS", where one of the instructors was my good friend Dr. Cristian Uribe, who was one of the Meeting organizers. Dr. Uribe is one of the contributors to Medical Terminology Daily.

The second one was a "Workshop on Art & Science: A Theoretical-Practical Course on Anatomical Illustration". This course was directed by my good friend, Dr. Carlos Machado, world-renown medical illustrator, physician, and anatomist, editor of Netter's Atlas of Anatomy. Along with him two professors, Drs. Daniel Casanova and Valentina Cerda.

Nov. 11, 2023 Meeting opening

The Meeting was officially opened by Dr. Juan Carlos Lopez, Director of the Morphology Department of the Los Andes University. This was followed by a presentation on "The Role of the Placenta on the Modulation of Human Potential" by Dr. Sebastian Illanes. On the picture, from left to right, Dr. Jens Wasche (Germany), Dra. Valentina Cerda (Chile), Dr. Carlos Machado (Brazil/USA), me (Chile/USA), and Dr. Andres Riveros Valdes (Chile), a good friend and anatomist. Dr. Riveros is the President of the LatinAmerican Meeting on Clinical Morphology.

There were so many great presentations in this meeting! I think the attendees will agree with me that the conference by Dr. Carlos Machado on "The Art of Learning and Teaching Anatomy with Art" was one of the highlights of the Meeting. In his presentation Dr. Machado shared some of his early drawings and his career in Medicine and Medical Illustration, how he has used art to show patient pathology, and most important, the work and dedication that is required when developing a single image that will later become part of the Anatomy Atlases with which he collaborates. 

Dr. Carlos Machado

The image above shows Dr. Machado during his presentation. On the screen an anatomical image he drew when he was 12 year old!.

Poster presentations during a coffee break

The meeting was also geared toward morphology students of different careers including Veterinary, Nursing, Dental School, and Medicine. The students presented their research posters during the coffee breaks. There were very high-quality and in-depth research, including the first osteology atlas of the Chilean flamingo (Phoenicopterus chilensis).  I had interesting discussions on Latin terminology with these students.

There were extremely interesting topics throughout the week, including liver anatomy and liver transplant, ethics, philosophy, body donation, etc.

My presentation was based on the conference I delivered in May 2023 at the University of Antwerp, Belgium. Since the Belgium conference was delivered to a group of Andreas Vesalius experts, this one included much more information on Andreas Vesalius, his work, and additional information on printing techniques circa 1550.

Dr. Miranda during his presentation at the
XLIII  Anatomy Meeting in Chile

The presentation added information on the history of the woodblocks used to print the 1543 Fabrica, the 1555 Fabrica, as well as other books that include the 1925 "The Iconography of Andreas Vesalius" by M.H. Spellman, and the 1934 Icones Anatomicæ.

The included picture was taken towards the end of my presentation where with the help of Dr. Uribe we unveiled Giovanni Paolo Mascagni's (1755-1815) work. At the center is a life-size copy of one of the pages of his book "Anatomiæ Universæ Icones", published in 9 installments between 1823 and 1832. It is important to note that each page of this book was hand-colored by Antonio Serantoni (1780-1837), thus the time it took to print and publish this book.

Mascagni's book, the largest book ever printed, shows in separate pages one third of a larger, life-size individual. Because of the rarity and value of this magnificent work, it cannot be cut and pasted.There are 16 know copies of Mascagni's anatomical opus magnus in the world, one of them at the University of Cincinnati, Ohio. USA.

With the help of Mr. Gino Pasi curator of the Henry Winkler Center for the History of the Health Professions, and the help of Mrs. Samantha Scheck, graphic designer, we measured and scanned some pages of the "Anatomiæ Universæ Icones", cleaned the background (no changes were done to the image itself) and pasted them digitally. The result is a life-size male 5.9 ft tall (1,75 mt). The images are incredible, and having traveled back and forth to Belgium and Chile, they are now part of my personal library.

Once again, my thanks to my old and new friends for making my stay so interesting, both personally and professionally. My thanks to the organizers of these meetings and symposia:

Dr. Juan Carlos López Navarro
President XLIII Chilean Anatomy Meeting
Director Morphology Department - Universidad de Los Andes

Dr. Andrés Riveros Valdés
President I Latin American Clinical Morphology Meeting
Professor - Universidad San Sebastián

Dra. Viviana Toro Ibacache
President Scientific Committee
Professor - Universidad de Chile

Dr. Emilio Farfán Cabello
President Chilean Anatomy Society
Professor - Pontificia Universidad Católica de Chile