Medical Terminology Daily (MTD) is a blog prepared by Clinical Anatomy Associates, Inc. as a service to the medical community, medical students, and the medical industry. We will post a workweek daily medical or surgical term, its 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

Eustachius  
Bartolomeo Eustachius
(c1500 - 1574)

Italian physician and anatomist, also known as Bartholomew Eustachius, he was born in the small town of San Severino Marche, in the province of Macerata, central Italy. His father was a respected physician, and may have attended as a student the University of Sapienza, where he later taught as a professor of practical medicine. Eustachius’ life is mostly unknown and some of his works remained hidden for over 150 years. His birth date is only an estimate and data varies from c1500 AD to c1510 AD.

It is known that Eustachius lived and worked in Rome from 1549 to 1574. He was both an anatomist and a physician to the Vatican.  As an anatomist, Eustachius is credited for having been the first to prepare anatomical images for printing using copper plates.

As a hospital physician, Eustachius was adamant on the need of autopsies on patients who died at the hospital, crediting him with being one of the first pathological anatomists.

Eustachius’ is credited with several anatomical discoveries, which he published in short monographs, on topics like the kidneys, the suprarenal glands (which he was the first to describe), the movements of the head, the azygos vein, etc. One of these was entirely dedicated to dentistry, “Libellus de Dentibus”, which have led to some to call Eustachius “The Father of Dental Anatomy”.

Eustachius dedicated himself to prepare a number of anatomical copper plates, apparently getting ready to publish a book to rival Vesalius’ “Fabrica”. It is known that Eustachius disliked Vesalius because of Vesalius’ contempt for the teachings of Galen. Eustachius died before completing his work and the copper plates were forgotten for over a century. After being rediscovered, these plates were published with commentaries by anatomists, until a final publication in Latin by Bernard Siegfried Albinus (1697 – 1770) entitled “Explicatio Tabularum Anatomicarum Bartholomaei Eustachii Anatomici Summi” (An explanation of the Anatomical Picture of Bartholomew Eustachius, Supreme Anatomist”.

Besides the suprarenal gland, Eustachius is credited for having discovered the stapes, the tensor tympani muscle, the cervical sympathetic chain and the thoracic duct. Interestingly, he did not discover the Eustachian tube or the Eustachian valve of the heart!

Interesting note: Eustachius’ assistant Petrus Matthaeus Pinus, who helped develop the copper plates, voiced his master’s dislike of Vesalius in a poem that was published by Albinus over a hundred years after the death of all of them, it is also an epitaph for a great anatomist:

“Just as the Master from Pergamon (Galen)
Teaching his method of healing, once refuted
The false writings of the ignorant Thessalus,
So also my BARTOLO (Eustachius)
Teaching his method of denoting every detail, position,
Shape, structure, order, number and condition
Has repulsed the shameless arrogance and claims
Of the impudent Vesalius
To him (Eustachius) all future generations 
Adhere In reverential admiration
The age to come will envy us on account of you Father,
And historians will wish they had lived sooner
They will extol our era, through you fortunate,
Lucky beyond measure"

Sources:  
1. "The root of dental anatomy: a case for naming Eustachius the "Father of Dental Anatomy"" Bennett, G (2009) J Hist Dent (1089-6287), 57 (2) 85 -88
2. “The papal anatomist: Eustachius in renaissance Rome” Simpson, D, ANZ J Surg (2011) 81: (12)905 -910
3. “Bartholomeo Eustachio – The Third Man: Eustachius Published by Albinus” Fahrer, M. (2003) ANS J Surg; 73: 523- 528
4. "Bartolommeo Eustachio; a great medical genius whose masterpiece remained hidden for 150 years" Wells, WA Arch Otolaring (1925) 48:” 58

Original image courtesy of: nlm.nih.gov


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Corona Mortis

Important for inguinal hernia anatomy and surgery, this term is Latin from [corona] meaning "crown' and [mortis] meaning "death'; the "crown or circle of death". The corona mortis (blue arrow) refers to an anatomical variation1, a vascular anastomosis between the obturator and the external iliac vascular systems that passes over Cooper's pectineal ligament and posterior to the lacunar (Gimbernat's) ligament. 

In some cases, the corona mortis is the actual obturator artery that arises from the inferior epigastric artery instead of the internal iliac artery. It can also arise from the external iliac artery. In both cases, it has been called an "aberrant obturator artery". This could be a misnomer, as this anatomical variation can be present in up to 25% of the cases. When present, the corona mortis  can be injured when a surgeon looks to enlarge the femoral ring by opening the lacunar ligament. This vascular structure could even be endangered in a laparoscopic procedure for inguinal of femoral hernia repair and a staple or tack is driven blindly into the pectineal (Cooper's) ligament.

Corona Mortis (A)Image property of: CAA.Inc.Artist: M. Zuptich

Berberoglu states that "although these tiny anastomoses... have been described in classical anatomy textbooks, these texts neglect to mention that theses anastomoses can be life-threatening".

In some rare cases, the corona mortis (aberrant obturator) artery coexists with the normal obturator artery.  Although called a [corona], this anatomical structure is an incomplete circle. In the image, the [corona mortis] is labeled "A".

Sources:
1. Rusu et al: "Anatomical considerations on the corona mortis" Surg Radiol Anat (2010) 32:17–24
2. Berberoglu et al: "An anatomic study in seven cadavers and an endoscopic study in 28 patients" Surg Endosc (2001) 15:72-75