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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Ligament of Treitz

The ligament of Treitz is a fold of peritoneum over the suspensory muscle of the duodenum. This muscle is also known as the "muscle of Treitz" or "musculus suspensorius duodenii". This muscle was first described in 1853 by Dr. Václav Treitz. 

The muscle has an unusual in structure in that it is formed by a tendon with two muscular ends (see image #1) of dissimilar embryological origin and function. The superior muscular component is skeletal (voluntary) muscle and arises as a slip of muscle (Hilfsmuskel) from the right esophageal crus of the respiratory diaphragm, as well as muscular and ligamentous fibers arising in the region of origin of the celiac trunk and superior mesenteric artery. The inferior portion of the muscle is smooth (involuntary) muscle and has been described as continuous with both the longitudinal and circular muscle layer of the intestine at the duodenojejunal junction.

The ligament of Treitz is an anatomical landmark used by anatomists and surgeons to denote the duodenojejunal junction and the point where the small intestine passes from retroperitoneal duodenum to intraperitoneal jeunum. Surgeons use the ligament of Treitz to measure the jejunum to decide where to perform an anastomosis.

Suspensory muscle of the duodenum 1. skeletal muscle 2. tendon 3. smooth muscle
Click on the image for a larger version
Original image by Dr. Vaclav Treitz
Click on the gray bar below the image to see the original sketch published by Dr. Václav Treitz in his 1853 publication "Ueber einen neuen Muskel am Duodenum des Menschens" (On a new muscle in the duodenum of man). The 'muscle of Treitz" is marked by an arrow.

Clinical anatomy, pathology, and surgery of the gastrointestinal tract are some of the many lecture topics developed and delivered to the medical devices industry by Clinical Anatomy Associates, Inc.

Sources:
1.
"Clinically Oriented Anatomy" Moore, KL. 3r Ed. Williams & Wilkins 1992
2. "The origin of Medical Terms" Skinner, AH, 1970
3. "The suspensory muscle of the duodenum and its nerve supply" Jit, I.; Singh, S. J. Anat. (1977), 123, 2, pp. 397-405
4. "Anatomical and functional aspects of the human suspensory muscle of the duodenum." Costacurta, L. Acta Anat (Basel). 1972;82(1):34-46
Image property of:CAA.Inc. Artists:Dr. E. Miranda and D.M. Klein