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

Larsen

William J. Larsen, PhD
(1942-2000)

An American scientist, Dr. Larsen was a gifted scientist, consistently producing research at the forefront of cell, developmental, and reproductive biology. Early in his career he published a landmark paper that conclusively established mitochondrial fission as the mechanism of mitochondrial biogenesis. He went on to become the first to demonstrate the endocytosis of gap junctions. Moreover, his work on the hormonal regulation of gap junction formation and growth culminated in an authoritative review article in Tissue and Cell, “Structural Diversity of Gap Junctions (1988)”, which became a citation classic.

Throughout his 25 year teaching career, his sixty-seven peer reviewed publications—not to mention numerous invited reviews, abstracts, and book chapters—covered a wide range of research areas including adrenal cortical tumor cells, human ovarian carcinomas, preterm labor, cumulus expansion, oocyte maturation, ovulation, folliculogenesis, and in-vitro fertilization.

In addition to his many contributions to basic research, Dr. Larsen loved to teach and was much appreciated by his students. His exceptional ability was reflected in the four teaching awards he received as a professor at the University of Cincinnati.

Notably, he was the author of Human Embryology, a textbook for medical students that was the first to incorporate modern experimental research into a subject that had traditionally been taught in a strictly descriptive style. On its initial publication in 1998 it was hailed as, “a magnificent book…” by the European Medical Journal. With the release of the fourth edition in 2008, the book was renamed “Larsen’s Human Embryology” in recognition of Dr. Larsen's place as the originator of this revolutionary text. This book is today in it's 6th Edition.

His stellar scientific career would be enough for most people, but Dr. Larsen pursued his numerous and varied interests with such extraordinary passion, energy, and skill that he seemed to have more hours in a day than the ordinary person. He was fascinated with the American Southwest and studied and collected traditional arts and crafts of the Hopi, Zuni, and Navajo peoples. He was a woodworker who built three harpsichords and a fortepiano for his wife, and, with his two children, over 100 pieces of gallery-quality furniture. In addition, he loved to regale his friends, colleagues, and students with jokes and stories, and to share his love for gourmet cooking.

The William J. Larsen Distinguished Lecture Series

An annual lecture series was created for the Department of Cancer & Cell Biology at the University of Cincinnati to honor Dr. Larsen's research which was at the forefront of cell developmental and reproductive biology. This series recognizes forward-thinking research scientists in the field of developmental biology and asks that they share their research and findings with students and faculty of the University of Cincinnati, College of Medicine.

Personal note: I had the opportunity to meet and attend Dr. Larsen’s embryology lectures as he and I worked in the Anatomy, Embryology, and Histology program at the University of Cincinnati Medical College. Unfortunately, I never had the opportunity to have Dr. Larsen sign my personal copy of his book. He is sorely missed, Dr. Miranda

Sources:

1. "The William J. Larsen Distinguished Lecture Series" University of Cincinnati, College of Medicine.
2. https://www.larsenbooks.com
3. 2022 Larsen Lecture Series brochure (download here)
4. Dr. Larsen's family personal communications


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Coumadin ridge

UPDATED: The [Coumadin ridge], also known as the [Warfarin ridge], or a [left atrial pseudotumor]. is an excessive elevation or protrusion of a normal ridge found between the left superior pulmonary vein and the internal ostium of the left atrial appendage. Usually this ridge will extend inferiorly towards and anterior to the ostium of the left inferior pulmonary vein. The Coumadin ridge is considered an anatomical variation of the otherwise small ridge, known as the left lateral ridge.

Because of its location and morphology, some cardiologists and radiologists have mistaken this elevation or fold of the internal anatomy of the left atrium for a thrombus and prescribed anticoagulant therapy (Coumadin or Warfarin) when none was needed, hence its name.

Coumadin ridge
Click on the image for a larger version
To understand the generation of the Coumadin ridge we must understand the embryology of this area of the heart. The left atrial appendage is the original left atrium in the embryo, which is displaced anteriorly and superolaterally when the veins that enter the atrium start to dilate at their distal end creating the left sinus venarum. After the left atrium proper has formed, the left atrial appendage is left as nothing more than an embryological remnant that can cause problems if the patient has atrial fibrillation (AFib). The ridge forms at the point where the left atrial appendage and the sinus venarum meet.

The Coumadin ridge can vary in morphology, from presenting as an elevated ridge, to a bulbous, pedunculated mass that seems to float within the left atrial appendage and undulate, following the cardiac motion, forcing the cardiologist into believing they are in the presence of a thrombus or a tumor within the heart.

This fold of tissue may contain the ligament of Marshall, autonomic nerves, and a small artery. In rare cases there may be an actual tumor arising from the location of the Coumadin ridge, but this is just a coincidence.

Now that the Coumadin ridge is a better known anatomical variation, cardiologist sometimes refer to their finding as a pseudotumor, a description that may scare the patient, but is only but a fold of tissue inside the heart.

Finding a Coumadin ridge in a patient with atrial fibrillation can be an interesting situation requiring differential diagnosis, as a patient with AFib can present with thrombi in the left atrial appendage. What to do? Is it or is it not a thrombus? Also, a differential diagnosis is needed in the case where the image is actually that of a left atrial tumor or an atrial myxoma.

The accompanying image is own work based on Sra (2004) and McKay (2008), and is a graphite on paper sketch. The image shown an internal view of the left atrium showing the left superior and inferior pulmonary vein, the ostium of the left atrial appendage and a segment of the area of the mitral valve.

We would like to thank Dr. Randall K Wolf, a contributor to Medical Terminology Daily for suggesting this article.

Sources:
1. “Coumadin ridge: An incidental finding of a left atrial pseudotumor on transthoracic echocardiography” Lohdi,AM, et al. World J Clin Cases. 2015 Sep 16; 3(9): 831–834
2. “Coumadin ridge” Tasco, V. https://radiopaedia.org/articles/coumadin-ridge
3. “Papillary fibroelastoma arising from the coumadin ridge” Malik, M, Shilo, K, Kilic,A. J Cardiovasc Thorac Res. 2017;9(2):118-120.
4. “‘Coumadin ridge’ in the left atrium demonstrated on three dimensional transthoracic echocardiography” McKay,T., Thomas, L. Europ J Echocard (2008) 9, 298–300
5. “Endocardial imaging of the left atrium in patients with atrial fibrillation” Sra J; Krum D; Okerlund D; Thompson H. J Cardiovasc Electrophysiol 2004 Feb; Vol. 15 (2), pp. 247

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The presence of Andreas Vesalius in Zakynthos (3)

Continued from "The presence of Andreas Vesalius in Zakynthos (2)"

According to Theo Dirix, Belgian Consul to Greece and Vesalius enthusiast, there are other reminders on the island such as a painting in one of the local schools.

On September 3rd, 2014, as part of the Vesalius Continuum meeting on Zakynthos Island, a new bronze statue was unveiled to celebrate the life and works of Andrea Vesalius and remember his death on Zakynthos. This statue is a representation of Vesalius’ style of depicting anatomy in his book “De Humani Corporis Fabrica Libri Septem” and is a “muscle man” mixed with the motif of the famous plate 20 of Book 1 that shows a skeleton musing over a skull. The statue also presents the Vesalius family coat of arms. The statue is the work of Richard Neave and Pascalle Pollier.

Pascale Pollier, a biomedical artist specializes in face reconstructions and made a new bust of Vesalius based on the only known portrait of the great anatomist found on the pages of his immortal book “The Humani Corporis Fabrica Libri Septem”.

The statue was unveiled in front of an international crowd of anatomists, medical historians, biomedical artists, and film makers. Following the ceremony a display of artistic works related to Vesalius was opened in the Zakynthos municipality.

These are today the signs of the presence of Vesalius on Zakynthos. We know today that his body is interred in the cemetery of the church of Santa Maria della Grazie in Zakynthos. Sadly this church was destroyed twice in earthquakes and in 1953 was completely demolished along with 85% of the city. It was not rebuilt and now lies under the new, rebuilt city. One of the research papers presented at the 2014 Vesalius Continuum meeting has rediscovered the location of the church with great accuracy. The account of this paper and how I was able to find this geolocation will be presented in another article.

Sources
1. “Andreas Vesalius of Brussels 1514-1564” O’Malley, CD. Los Angeles 1965
2. "Andreas Vesalius; The Making, the Madman, and the Myth" Joffe, SN. Persona Publishing 2009
3. “In Search of Andreas Vesalius – The Quest for the Lost Grave” Dirix, T. Lanoo Campus Belgium 2014

 


 

New Vesalius Statue in Zakynthos 

Bust of Vesalius made by Pascale Pollier

Unveiling of the New Vesalius Statue in Zakynthos

New Vesalius Statue in Zakynthos

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The presence of Andreas Vesalius in Zakynthos (2)

Continued from “The presence of Andreas Vesalius in Zakynthos (1)

The second reminder of the presence of Andreas Vesalius in the Zakynthos Island is a street in the west side of the city of Laganas, “ΟΔΟΣ ΑΝΔΡΕΑ ΒΕΖΑΛ” or” Andrea Vesalius Street”. It is relatively short, narrow and windy, and it has several restaurants and hotels as you get closer to the sea where it ends at the beach. At this point there is a monument that honors Andrea Vesalius. This monument was erected in 1965. It has inscriptions in Greek, and Latin. This is the third memento to Vesalius in Zakynthos.

This monument was erected in Laganas following a legend that Vesalius had shipwrecked and he was found at the beach. Another legend says that Vesalius was left at the beach at Laganas to die as he was very sick. One of the presentations at the 2014 Vesalius Continuum meeting by Dr. Mauritz Biesbrouck disputed these legends with recently found letters by George Boucher to Johanes Metellus. George Boucher was a German jeweler that traveled with Vesalius back from Jerusalem and paid for Vesalius’ burial and monument at the church of Santa Maria della Grazie. These letters were authenticated and analyzed, bringing light to Vesalius’ place of disembarkment in Zakynthos. The Laganas monument, although correct in content, should be moved to the port of Zakynthos, to the point where the old city walls were found, the place where Vesalius collapsed and died.

The monument has a legend in both Greek and Latin. It reads as follows:

ΕΙΣ ΜΝΗΜΗΝ ΤΟΥ
ΑΝΔΡΕΑ ΒΕΖΑΛ
ΜΕΓΑΛΟΥ ΒΕΛΓΟΥ ΑΝΑΤΟΜΟΥ
ΘΑΝΟΝΤΟΣ ΕΝ ΖΑΚΥΝΘΩ ΤΟ 1564
Η ΕΝΩΣΙΣ ΤΩΝ ΔΙΠΛΜΑΤΟΥΧΩΝ ΤΩΝ
ΠΑΝΕΠΙΣΤΗΜΙΩΝ ΚΑΙ ΑΝΩΤΑΤΩΝ ΣΧΟΛΩΝ
ΤΟΥ ΒΕΛΓΙΟΥ, ΤΗΝ ΣΧΟΛΩΝ
ΑΝΗΓΕΙΡΕΝ ΤΘ 1965

IN MEMORIAM

ANDREAE VESALII BRUXELLENSIS
TUMULUS
QUI OBIIT IDIBUS OCTOBRIS ANNO MDLXIV
AETATIS VERO SUAE L
QUUM HIEROSOLYMIS REDISSET

Vesalii cineres venerandaque gentibus ossa
quisquis remota conteueris insula
qua jacer incultis memorosa Zakynthos arenis
gradum, viator et laborem sistito
naturae genium finemque extre maque rerum
vidisse credens coetera insanus labor

The first part is in Greek and reads: ”Here died the great Belgian humanist Andre Vesal. This stone was erected in 1965 by the union of Greeks who gained their qualifications in Belgian Universities” (Dirix, 2014)

The second part is Latin and is a copy of the original epitaph found on Vesalius’ grave as recorded in several manuscripts. It reads:

IN MEMORY
GRAVE OF
ANDREA VESALIUS FROM BRUSSELS
WHO DIED IN OCTOBER OF THE YEAR 1564
AT THE AGE OF 50
DURING HIS RETURN FROM JERUSALEM

Vesalius street sign in Laganas

Directions to the Vesalius monument in Laganas

Vesalius Monument in Laganas

Vesalius Monument in Laganas, Zakynthos Island

The rest is a poem in Latin that is translated as:

“The ashes and bones of Vesalius, sacred to the world
whoever finds then on this isolated island passing by the wild shores of Zakynthos,
should hold his tired steps, and believe that it is here that Vesalius met the ultimate goal of nature
and understood that striving for anything else is pointless” (Stouffis, Z, 1990)

When I visited this spot it was raining very hard and while I waited to take these pictures I looked out at the dark sea almost believing that maybe this was the spot where Vesalius came to land in Zakynthos. Now we know that it is not, but the moment was poignant and made me feel closer to the great anatomist.

On a more mundane note, in this area of Laganas because of the street name there are several businesses named "Vezal", a hotel, a supermarket and a taverna! I could not bring myself to post images of those places.

Continued in  "The presence of Andreas Vesalius in Zakynthos (3)"  

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The presence of Andreas Vesalius in Zakynthos (1)

The island of Zakynthos is one of the Ionian Islands found 155 miles (250 km) to the West of Athens. It is to the South of Macedonia, the island of Odysseus. It is also known as Zanthe or Zante, both pronunciations of the medieval Italian name for this island.

In October 15, 1564 Andreas Vesalius died suddenly at the gates of the main city of the island, also called Zakynthos, after a long and perilous return voyage from his pilgrimage to Jerusalem. The details of this trip and his potential cause of death will be covered in subsequent articles.

As famous as Vesalius is today, you would think that it would be easy to find information as to his grave and presence in the island. This is not so. Vesalius last trip to Jerusalem, his return, his death has been to date shrouded in mystery and legend. Some of these have been clarified in the 2014 Vesalius Continuum meeting in Zakynthos.

There are a few reminders of the presence of Vesalius on the island. The first one is a marble bust found in a small triangular plaza found about 100 yards from the building of the Municipality of Zakynthos and the Dionysios Solomos Square(Πλατεία Διονυσίου Σολωμού). The plaza was initially called “Vesal square” and later was renamed after the former major of Zakynthos, Fotis Ladikos.

Described by O’Malley (1965) in his well-known Vesalius’ biography, I had a difficult time finding the bust, although it is on the main street in front of the sea looking at the port, as most locals do not know about it. It was only by chance that one of the attendees to the meeting, Dr. Kenneth Wise found it close to a well-known Greek Restaurant, the Gallo D’Oro (Golden Rooster). It was also by chance that he and I talked about it when discussing Dr. Wise’s book on Vesalius entitled “All Else Is Mortal”.

The marble bust has a barely readable marble plaque that reads in Greek:

ΑΝΔΡΕΑΣ ΒΕΖΑΛ
ΕΓΕΝΝΗΘΗ ΕΙΣ ΒΡΥξΕλλΕΣ 1-2-1515
ΑΠΕΘΑΝΕ ΕΝ ΖΑΚΥΝΘΩ 15-10-1564

ANDREAS VESALIUS
BORN IN BRUSSELS 1-2-1515
DIED IN ZAKYNTHOS 15-10-1564

This plaque has the wrong date of birth, as it is well documented that Andreas Vesalius was born on the early morning of December 31st, 1514, , making the year 2014 the 500th anniversary of his birth and the 450th  anniversary of this death. This is the year when I spent a week in Zakynthos.

Continued here.

Bust of Vesalius in Zakynthos

Plaque on the Bust of Vesalius in Zakynthos

Bust of Vesalius in Zakynthos

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Prosopagnosia

Prosopagnosia is a neurological disorder characterized by the inability to recognize faces.  It is also known as face blindness or facial agnosia. There are different degrees of presentation of this pathology and some patients go through life without knowing that they have this problem characterizing it as just “a quirk” or that “they just are not good at remembering faces”.

Advanced forms of prosopagnosia cause some patients not to be able to recognize their own face or their own family members. Prosopagnosia is thought to be the result of abnormalities, damage, or functional impairment in the right fusiform gyrus, located in the inferior occipitotemporal region of the brain. The fusiform gyrus is related to the limbic system and seems to coordinate the systems that control facial perception and memory.  Prosopagnosia can result from stroke, traumatic brain injury, or certain neurodegenerative diseases

Prosopagnosia seems to also be congenital and run in certain families, pointing to a possible genetic disorder in the fusiform gyrus region.

Fusiform GyrusFusiform gyrus.

The etymology of the term prosopagnosia is complex. It starts with the Greek word “gnosia”, a derivate of [γνώση] (gnósi)  meaning “cognition”, “awareness”, or "knowledge". Adding the prefix “a-" leads to [agnosia] meaning lack or absence of cognition or awareness. The prefix "prosop-" derives from the Greek term [πρόσωπο] (prósopo) means f"ace". Therefore, prosopagnosia means “absence of facial awareness”.

There are famous people with prosopagnosia including Jane Goodall and Steve Wozniak.

Here is an interesting video from YouTube on the topic.

videocover010

Image courtesy of https://commons.wikimedia.org/wiki/File:Fusiform_gyrus_animation.gif
Video courtesy of YouTube and Lucy Barnarf
Note: The links to Google Translate include an icon ()that will allow you to hear the pronunciation of the word.d

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10 medical words that are used incorrectly

1. In the heart, heart valve, and ring valvuloplasty arena, everybody talks about the “anulus”, but most everybody misspells it! The word anulus originates from the Latin term “anulus” meaning “ring”. The proper way of writing it is ANULUS not ANNULUS, with a double "n"

2. The word “process” is English, therefore its plural form should be pronounce as “processes” not with a Latinized inflection as “processiiis”

3. The inflammation of a tendon is “tendonitis”, not “tendinitis”

4. When there is an excess amount of fluid in the pericardium that interferes with cardiac function, that is called a cardiac “tamponade”, not a “tamponaade” (with a French accent) and please don’t call it a “tapenade” (I have heard it), a dish consisting of puréed or finely chopped olives, capers, anchovies and olive oil!

5. The singular form for “criteria” is “criterium”. The following is wrong:  “only one criteria was used to make the decision”. The proper sentence should be "only one criterium was used to make the decision".

6. When using a scope to examine the fundus of the uterus, the procedure is a funduscopic procedure, not fundoscopic! It is more euphonic, I will agree, but not correct!

7. In spinal anatomy, the term “a facet joint” is most commonly used, but the term should be pronounced with the accent on the first syllable as in “fácet”! And just to be a bit more correct, the proper term for a so-called “facet joint” is “zygapophyseal joint”

8. In colon pathology a “diverticulum” is an outpouching of the colon wall. The plural form for “diverticulum” is diverticula.  The terms diverticulae of diverticuli are not correct

9. The terms centigrade and centimeter are derivate from the Latin word “centus”, meaning “one hundred” therefore the “French-like pronunciation of centimeter and centigrade with a French twist, with a nasal initial "a" although cool, is not correct!

10. An finally, my pet peeve: The words “anatomy” and “dissection” are actually synonymous.  Anatomy has a Greek origin. Ana means “apart” and “otomy” is the “process of cutting”: “to cut apart”  Dissection has a Latin origin and means exactly the same! In fact, for many years the term “to anatomize” was used instead of “to dissect”!

Where is the problem? In the pronunciation! “Dissection” should rhyme with “dissent”. For a complete article on this topic, click here.

Sources:
1. “"The Doctor’s Dyslexicon: 101 pitfalls in medical language" John H. Dirckx The American Journal of Dermatopathology. 27(1):86-88, FEBRUARY 2005 DOI: 10.1097/01.dad.0000148282.96494.0f PMID: 15677983

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