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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Georg Eduard Von Rindfleisch
(1836 – 1908)
German pathologist and histologist of Bavarian nobility ancestry. Rindfleisch studied medicine in Würzburg, Berlin, and Heidelberg, earning his MD in 1859 with the thesis “De Vasorum Genesi” (on the generation of vessels) under the tutelage of Rudolf Virchow (1821 - 1902). He then continued as a assistant to Virchow in a newly founded institute in Berlin. He then moved to Breslau in 1861 as an assistant to Rudolf Heidenhain (1834–1897), becoming a professor of pathological anatomy. In 1865 he became full professor in Bonn and in 1874 in Würzburg, where a new pathological institute was built according to his design (completed in 1878), where he worked until his retirement in 1906.
He was the first to describe the inflammatory background of multiple sclerosis in 1863, when he noted that demyelinated lesions have in their center small vessels that are surrounded by a leukocyte inflammatory infiltrate.
After extensive investigations, he suspected an infectious origin of tuberculosis - even before Robert Koch's detection of the tuberculosis bacillus in 1892. Rindfleisch 's special achievement is the description of the morphologically conspicuous macrophages in typhoid inflammation. His distinction between myocardial infarction and myocarditis in 1890 is also of lasting importance.
Associated eponyms
"Rindfleisch's folds": Usually a single semilunar fold of the serous surface of the pericardium around the origin of the aorta. Also known as the plica semilunaris aortæ.
"Rindfleisch's cells": Historical (and obsolete) name for eosinophilic leukocytes.
Personal note: G. Rindfleisch’s book “Traité D' Histologie Pathologique” 2nd edition (1873) is now part of my library. This book was translated from German to French by Dr. Frédéric Gross (1844-1927) , Associate Professor of the Medicine Faculty in Nancy, France. The book is dedicated to Dr. Theodore Billroth (1829-1894), an important surgeon whose pioneering work on subtotal gastrectomies paved the way for today’s robotic bariatric surgery. Dr. Miranda.
Sources:
1. "Stedmans Medical Eponyms" Forbis, P.; Bartolucci, SL; 1998 Williams and Wilkins
2. "Rindfleisch, Georg Eduard von (bayerischer Adel?)" Deutsche Biographie
3. "The pathology of multiple sclerosis and its evolution" Lassmann H. (1999) Philos Trans R Soc Lond B Biol Sci. 354 (1390): 1635–40.
4. “Traité D' Histologie Pathologique” G.E.
Rindfleisch 2nd Ed (1873) Ballieres et Fils. Paris, Translated by F Gross
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"The only constant in anatomy is variation"
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This dictum is incredibly powerful and true. Even the so-called "anatomical constants" are subject to it.
One common misconception is that "we are all the same". This could not be further from the truth. Every body is different from every else's body. Anatomical variations range from the minimal to the incredible. One of the most interesting anatomical variations is the one called "situs inversus". In this case the individual is a mirror image of a human. The apex of the heart points to the right side of the body; the duodenum circles to the right, the liver "hangs" from the left side of the respiratory diaphragm, etc. This particular anatomical variation presents in different degrees and can sometimes coexist with some cardiovascular congenital abnormalities.
Of course there are minor anatomical variations that have no effect on daily life at all and are only discovered by accident, or upon autopsy or dissection. One of the most complete resources on this topic is the Illustrated Encyclopedia of Human Anatomic Variations. An excerpt from this site states: "It is clear that textbook writers and teachers over the centuries, even until today, fail to understand or to transmit to their students the crucial concept that anatomical and physiological diversity and variation is a canon of living organisms. This failure leads to the belief that textbooks are conveying immutable facts with only few anomalous exceptions".
Shown here is an extremely rare case of a third kidney. Dixon (1911) describes in his research paper that as of that date, only 10 cases were known, of these only eight were recorded, with 87% of them found on the left side of the body. Click on the image for a larger depiction.
Source and primary image: "Supernumerary kidney: The occurrence of three kidneys in an adult male subject" Dixon, A.F. J. Anat. Physiol. 45:117-121, 1911.
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The prefix [para-] has a Greek origin and means "beside" or "alongside". Today we add the meaning of "parallel to".
We see the daily application of this prefix in words such as [paramedic], [parajournalism], [paralogism], and [paranormal]. Medical applications of the term include:
- parasternal: alongside the sternum, such as the internal thoracic vessels
- paramedian: alongside the median plane
- parasagittal: parallel to a sagittal plane (synonym with paramedian)
- paraumbilical: alongside the umbilicus, such as paraumbilical visceral extrusion in a gastroschisis
- parathyroid glands: glands that are found besides the thyroid gland, etc.
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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. Otto C. Brantigan
Otto C. Brantigan, MD. (1904-1981) An American surgeon and anatomist, Otto Charles Brantigan was born in Chattanooga, TN in 1904. Having dropped out of high school to help his family and working as a first class machinist, he decided to continue with graduate school. He studied at the Northwestern University in Chicago, where he graduated from the Medical School in 1933. In 1948 he became Chief of Surgery, and eventually became Professor of Surgery, Professor of Thoracic Surgery, and Professor of Anatomy at the Maryland School of Medicine. He retired in 1976 having earned many accolades for his profuse surgical work and publications.
As a surgeon of the times, Dr. Brantigan had a wide area of interest. His over 110 publications and surgical work range from thoracoscopy to vascular, plastic, cardiac, and orthopedic surgery. He is most remembered for the pioneer work he did on chronic obstructive pulmonary disease (COPD), emphysema and lung volume reduction surgery (LVRS), which he presented in 1958. The procedure had (at the time) a very high mortality rate (16 -20%) and Brantigan's work was not readily accepted.
It was not until J. Cooper and his team, revisited the operation proposed by Brantigan that the operation was accepted, now with new surgical stapling and staple line buttressing technology. Dr. Brantigan's name was recognized as a pioneer in lung emphysema surgery, unfortunately 14 years after his death. In 1994 his son, Dr Charles O. Brantigan delivered a beautiful biography of Dr. Otto Brantigan in the same meeting where Cooper presented his results with LVRS.
Personal note: I am proud to own one of the copies of Dr. O.C. Brantigan;s "Clinical Anatomy", a book that I use quite frequently. It is listed in my library catalog. Dr. Miranda.
Sources:
1. "Biography of Otto C Brantigan" C.O. Brantigan 1994 Meeting of the American Association for Thoracic Surgery
2. "LVRS in chronic obstructive pulmonary disease" Davies, L; Calverley, P. Thorax 1996;51(Suppl 2):S29-S34
3. ""Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease" Cooper, J.,The Journal of Thoracic and Cardiovascular Surgery Volume 109, Number 1:106-119
4. "The Surgical Approach to Pulmonary Emphysema" Brantigan, OC; Kress, MB; Mueller, EA. Chest. 1961; 39(5):485-499
5. "History of Emphysema Surgery" Naef, AP. Ann Thorac Surg 1997;64:1506-1508
Original image courtesy of National Institutes of Health.Biography of Dr. Otto Brantigan courtesy of Dr. Charles O. Brantigan.
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The rectum is the most distal segment of the large intestine, along with the anal canal.
The word [rectum] arises from the Latin [rectus] and means "straight", such as its use in the name "rectus abdominis" for the "straight muscle of the abdomen".
It seems a misnomer, as the rectum of the human species is actually "S" shaped, as seen in the accompanying image. The reason for this discrepancy is that the rectum was named by Galen of Pergamon (129AD - 200 AD) who himself studied this structure in animals such as sheep and goats. In these animals the rectum is indeed straight, and since contradicting Galen was not acceptable (see Michael Servetus), the name has survived until this day. Even Andreas Vesalius has in his 1953 "Fabrica" a depiction of a straight rectum in the human! Click on second image to see a larger depiction of Vesalius' idea of the rectum. Although Vesalius stated that he wanted to show human anatomy as it is, and not as Galen said it should be, here is a demonstration that in 1543 he was still a lukewarm Galenist.
There is an area between the sigmoid and the rectum called the sigmoidorectal junction, although most anatomists call it (wrongly) the rectosigmoid junction (RSJ). This is an anatomically diffuse area with no clear anatomical transition between the sigmoid and the rectum or the RSJ from the rectum.
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As the proximal end of the "S" shaped rectum is not clearly discernible from the sigmoidorectal region, there is no clear agreement on the length of the rectum. Authors state that it measures approximately six to seven inches in length (15 - 17 cm), while others measure it as between 8-10 inches. The rectum ends distally at the junction of the rectum with the pelvic diaphragm. It is at this point that the anal canal begins.
The rectum is characterized by three transverse rectal folds, one on the right side, and two on the left side. These folds are know as the "rectal valves" or the "valves of Houston". The middle rectal fold is known to European anatomists as the "valve of Kohlrausch" Their function in maintaining fecal material in place as well as their function in defecation is still under study. The rectal valves also have a high level of anatomical variation and may not be present at all.
Images:
1. "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
2. "De Humani Corporis Fabrica, Libri Septem" A. Vesalius 1543 Brussels
Recommended reading: "Transverse Folds of Rectum: Anatomic Study and Clinical Implications" Shafik, A, et al. Clin Anat 14: 196-203 (2001).
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The term "collateral circulation" is generally used to denote a situation where small blood channels dilate and provide blood supply when a pathology creates a stricture and diminishes blood flow (ischemia).
Although the above is correct, the term is also applicable to a normal, non-pathological situation most common in the human body. Please refer to the accompanying image for the following explanation. If needed, click on the image for a larger depiction. In the image, the arrows represent direction of flow.
Most organs or organ segments receive blood supply from more than one source of blood supply. In some cases, like the stomach, there are up to four arteries that provide blood supply to the organ: the right and left gastric arteries, and the right and left gastroepiploic arteries.
In other cases, like the small intestine shown in the image, blood arrives to the organ arising from several arteries (A, B, and C) that themselves arise from a parent structure. Because of hydrodynamics, the vascular territories of each artery (represented by dashed lines) tend not to overlap. If for any reason there is stenosis or blockage in any of these arteries (A,B, or C) blood will flow immediately through an alternate route and the organ will not suffer ischemia or necrosis.
This is extremely important, as these collateral channels maintain blood supply to areas that may be affected by bending, such as the elbow and knee, which have a rich collateral network. Most of the organs in the body, with some exceptions (brain, heart), have collateral circulation.
Collateral circulation is extremely important for surgery, as surgeons can safely remove parts of organs without affecting the blood supply to the organ. This is also true for all gastrointestinal anastomoses.
Image property of: CAA, Inc. Artist: Dr. Miranda
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Histology is the scientific branch that studies tissues.
The root term [-hist-] is used to mean "tissues", but how the term came to be used is somewhat convoluted. It arises from the Greek [histos], which indicates the mast of a ship, it then was used to denote a Greek weaver's loom central mast (where the fabric is woven horizontally), and then it was used to indicate that which was woven [histios], the fabric, or the "tissues". The suffix [-ology] also has Greek origin from [logos] meaning a "book", a "treatise" or "to study".
The concept of the body being formed by different tissues was pioneered by Marie-Francois Xavier Bichat (1771-1802) who called them "membranes" Bichat is considered to be the "father of Histology". The image shows a histological slide of cardiac muscle. Click on the image for a larger depiction.
Original image by S. Girod and A. Becker, courtesy of Wikipedia.
