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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Don Antonio de Gimbernat i Arbós

Don Antonio de Gimbernat i Arbós
(1734-1816)  

Spanish anatomist and surgeon. His complete name was Don Manuel Luis Antonio de Gimbernat i Arbós. He was born to a farmer’s family in 1734 in Cambrils (Tarragona), in what today is Cataluña. Gimbernat studied Latin and Philosophy at the University of Cervera, continuing his studies at the School of Surgery in Cádiz, where he graduated in 1762.

Gimbernat joined the Spanish Navy, but because of this capabilities, in 1765 he was offered the position of Anatomy Professor at the Royal School of Surgery in Barcelona. In 1768 he made an anatomical discovery that would render him immortal: he demonstrated the presence of the lacunar ligament. Furthermore he applied his knowledge of this ligament to improve on the surgical technique to reduce a strangulated femoral hernia. Gimbernat also discovered the lymph node found in the femoral ring (later to be known as Cloquet’s or Rosenmueller’s node)

In 1774 Gimbernat traveled through Europe to learn the latest surgical techniques. This trip was sponsored by King Carlos III. During his stay in London Gimbernat studied with John Hunter (1728 – 1793). In an attitude not common for a student at the time, at the end of one of Hunter's anatomical lectures on hernia, Gimbernat asked to go to the cadaver and demostrate his findings. With approval of the teacher, he demonstrated for Hunter the lacunar ligament as well as his strangulated femoral hernia technique. Hunter watched the demonstration and at the end of it he just said "You are correct, sir".

Hunter was so impressed that from that day on he referred to the lacunar ligament as “Gimbernat’s ligament) and adopted his surgical technique. Gimbernat also showed Hunter his studies and technique to repair diaphragmatic hernias.

Manuel Gimbernat participated in the creation of the Spanish Royal School of Surgery, became a professor of surgery and  orthopedics, and in 1789 he was named First Royal Surgeon and president of all the surgical schools in Spain.

In 1793, Gimbernat published his “ Nuevo Método de Operar en la Hernia Crural” dedicated to King Charles IV,  which was translated as “A New Method of Operating for the Femoral Hernia”, into English in 1795.

All of his titles and positions were removed by King Fernando VII because Gimbernat was a supporter of Napoleon during his invasion of Spain in 1808.  Sick, poor, blind, and with ailing mental faculties, Don Manuel Gimbernat died in Madrid on November 17, 1816.

Gimbernat was also a pioneer in ophthalmology, vascular surgery and urology. As for his incredible anatomical dissection capabilities, Gimbernat often said “mi autor más favorito es el cadaver humano" (my favorite author is the human body”

Sources:
1. “Manuel Antonio de Gimbernat y Arbós. 1734-1816” Trauma (2012) 23: (1)
2. ” Gimbernat y Arbós, Antonio de (1734-1816) Loukas M et al World J Surg 2007; 31: 855-7
3. “Epónimos médicos: Ligamento de Gimbernat” Febrer JLF 1999
(Link) 
4. “Antonio de Gimbernat (1734- 1816). Anatomist and surgeon” Puig-LaCalle J, Martí-Pujol R. Arch Surg 1995; 130: 1017- 20
5. “Antonio de Gimbernat, 1734-1816” Matheson NM. Proc R Soc Med 1949; 42: 407-10.
6. "Antonio Gimbernat y Arbós: An Anatomist-surgeon of the Enlightenment (In the 220th Anniversary of his ‘‘A New Method of Operating the Crural Hernia’’) Arraez-Aybar LA, Bueno-Lopez JL. Clin Anat (2013) 26:800–809
 


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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