Our Sponsors caatmsmtdad    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 
Sir Astley Paston Cooper
Sir Astley Paston Cooper
(1768 - 1841) 

An English anatomist and surgeon, Astley Cooper started his medical studies when he was only 16, at the St. Thomas hospital in London. He studied under Henry Cline, and later under John Hunter. Astley Cooper was a well-known anatomist, lecturer, and surgeon in his time. He is known for his many studies in abdominal hernia, otology, aneurysms, and the anatomy and diseases of the breast. In 1804 he described the abdominal transversalis fascia and the internal inguinal ring.

Born in the village of Brooke, Norfolk. At 16 years of age he was placed under the tutelage of Henry Cline (1750 - 1827), senior surgeon at the St. Thomas hospital in London for a seven-year apprenticeship. In 1789 he was appointed as an anatomy lecturer at the same hospital. In 1800 Cooper was appointed Surgeon to the Guy's Hospital in London.

He was the first to attempt the ligation of the abdominal aorta in a patient that had suffered an aortic abdominal aneurysm rupture. The patient survived for one additional day. "Astley Cooper introduced no new philosophy, policy or practice into surgery but was the perfect exponent of the scientific approach to surgery combined with skillful and successful practical ability" Brock (1969)

Cooper’s name survives in several eponymous anatomical structures and diseases he described, following are two of them:

Cooper's ligaments of the breast: Connective tissue ligamentous strands between the pectoral fascia and the skin overlying the breast. • Cooper's pectineal ligament: A thickening of the periostium on the superior aspect of the pubic bone, lateral to the pubic tubercle. This structure is a preferred site for staple positioning during a laparoscopic herniorrhaphy. When placing the staples, consideration should be placed on the potential presence of an anatomical vascular variation named the "Corona Mortis".

Although Cooper published a number of books and research papers, his seminal contribution to surgery was his two-volume "Treatise on Hernia". The first volume was published in 1795 and the second volume in 1807, with a revised second edition published in 1827.

1. "Sir Astley Paston Cooper." Singal, R. et al. Indian J Surg 73:1 (2011): 82-84.
2. "Sir Astley Paston Cooper, 1768-1841:the prince of surgery"Rawling, EG. Can Med Assoc J 99.5 (1968): 221.
3. "The life and work of Sir Astley Cooper" Brock, RC. Ann Royal Coll Surg England 44.1 (1969): 1-18
Photograph courtesy of: surgical-tutor.org.uk 


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Ligament of Treitz

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The ligament of Treitz is formed by 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 (see image #1) has an unusual in structure in that it is formed by a tendon with two muscular ends  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.

Anterior view of the duodenum and the suspensory muscle of the duodenum
Click on the image for a larger version
Original image by Dr. Václav Treitz
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.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.

"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