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A Moment in History

Dr. Jean-Francois Calot 
Original image courtesy of the National Library of Medicine

Jean-Francois Calot
(1861 – 1944)

French physician and anatomist, Jean-Francois Calot was born in Arrens-Marsous, a small farming community of the Hautes-Pyrénées. He received his bachelor degree in 1880 at Saint-Pe de Bigorre,  and then continued to study Medicine at the University of Paris, where he worked as an anatomy prosector. His doctoral thesis “De La Cholecystectomie” (On Cholecystectomy) was published in 1890 and republished in 1891.

Although his main interest laid in orthopedics and tuberculosis, Calot’s name is eponymically tied to an anatomical landmark described in his thesis, the “Triangle of Calot”, a triangular area that includes the biliary ducts associated with the gallbladder and the vascular supply to the gallbladder. This is an important region because of the high number of anatomical variations found in the area.

There is a discrepancy between the original description of this triangular region by Calot and what is used today. For more information, click on this link to read more on the “Triangle of Calot”, also known as the “cystohepatic triangle”.

During his medical career Calot worked at several French hospitals including the Rothschild hospital where he became Chief of Surgery. He was also the Chief of Surgery for the Cazin-Perrochaud Hospital, and the Orthopedic Institute of Berck-sur-Mer

During his orthopedic career Calot published many books “Chirurgie et orthopédie de guerre”, “Les maladies qu'on soigne á Berck”, “Berck et ses traitements : les raisons de sa supériorit?”, but his opus magnus is the book “« L'orthopédie indispensable aux praticiens” (Indispensable orthopedics for practitioners).

Calot is also known for his treatment of tuberculotic abscesses, and a conservative approach to musculoskeletal tuberculosis. The surgical approach of the times was to surgically open and clean the tuberculotic bone. Calot is known to have said “Ouvrir la tuberculose, c'est ouvrir la porte d' la mort” (To open the tuberculosis is to open the door to death).

Continuing his studies and treatment of tuberculosis, on December 22nd, 1896 Calot presents the the French Academy of Medicine a study of the treatment of 37 patients with hyperkyphosis due to Pott’s disease, a tuberculotic spinal deformity, named after Sir Percival Pott. This method included traction and a brace. The second image shows this treatment. Dr. Calot is standing at the center, looking at the patient.

In 1900 Calot founded the “Orthopedic Institute of Berck” which today is known as “Calot’s Institute of Berck-sur-Mer”.

1. “Calot's triangle” Abdalla S, Pierre S, Ellis H. Clin Anat. 2013 May;26 (4):493-501
2. “La Vie et l'OEuvre de Francois Calot, chirurgien orthopédiste de Berck” Loisel, P. (in French). Report presented at Société Francaise d'Histoire de la Médecine on 18 March 1987

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Sternalis muscle

The Sternalis muscle has been nominated as a supernumerary anatomical variation; the highest prevalence is in China (23.5%) and the lowest in Chile (0.87%).

The muscle is a wide band of muscular tissue located in the anterior thoracic wall, where fibers travel near-parallel to the sternum, inferior to the clavicles, aterior to the pectoralis major and the pectoral fascia. It has received many names: rectus sternalis, parasternal, episternal, superficial abdominal rectus, among other names. To avoid confusion, a true sternalis muscle should have the following characteristics:

(1) be localized between the subcutaneous tissue of the anterior thoracic region and fascia pectoralis;
(2) originate superiorly from the sternum or infraclavicular region;
(3) be inserted inferiorly in the ribs, rib cartilage, external oblique muscle aponeurosis and sheath of the rectus abdominis muscle;
(4) its innervation must come from the anterior root of the intercostal nerves. Another possible innervation from medial and lateral pectoral nerves has been mentioned.

Even though the Sternalis muscle does not appear to have a significant function, it is important to bear it in mind when evaluating mammograms, because one could misdiagnose it as a mammary cancer, as exposed by many authors. It is crucial to be familiar with this muscle to avoid confusion with pathology, such as extra-abdominal desmoid tumors, diabetic mastopathy, abscesses, hematomas, fat necrosis, and others; its unilateral presence may cause breast or chest asymmetry.

Sternalis muscle (Andreas Vesalius 1543)
Sternalis muscle (Andreas Vesalius 1543)
Note: The image in this article depicts this variation and is from the 1543 " De Humanis Corporis Fabrica, Libri Septem " by Andreas Vesalius.

1. Jelev L., Georgiev G., Surchev L. (2001) The sternalis muscle in the Bulgarian population: classification of sternales. J. Anat. 199: 359-363. 
2. Bradley F.M., Hoover H.C., Hulka C.A., Whitman G.J., McCarthy K.A., Hall D.A., Moore R., Kopans D.B. (1996) The sternalis muscle: an unusual normal finding seen on mammography. AJR. Am. J. Roentgenol. 166: 33-36. 
3. Scott-Conner C.E.H., Al-Jurf A.S. (2002) The sternalis muscle. Clin. Anat. 15: 67-69. 
4. Shiotani M., Higuchi T., Yoshimura N., Kiguchi T., Takahashi N., Maeda H., Aoyama H. (2012) The sternalis muscle: radiologic findings on MDCT. Jpn. J. Radiol. 30: 729-734.


Vulvar hemangiomata

UPDATED: This article presents a case of vulvar hemangiomata. In superficial or surface anatomy, [vulva] is the anatomical name given to the external female genitalia.

The medical term [hemangioma] is formed by two root terms and a suffix. The root term [hem-] arises from the Greek word [αίμα] (a?ma) meaning "blood", the second root term [-angi-] .from the Greek term [αγγείο] (angeio), meaning "vessel” and the suffix [-oma] (ωμα), also Greek, meaning "mass", "growth”, or "tumor". The plural derivative word [hemangiomata] uses the suffix [-omata] which is the plural form of [-oma].

Vulvar hemangiomata are multiple blood growths or tumors on a female’s external genitalia. In most cases, hemangiomata are idiopathic.

Vulvar hemangiomata
Image property of: CAA.Inc. 
WARNING: Depicts female external genitalia.
Vulvar hemangiomata can be capillary (arterial) or cavernous (venous). They are benign vascular tumors which can be congenital, meaning the patient is born with them, or acquired, meaning that they appear later in life. In both cases they are usually asymptomatic. Patients may become concerned over aesthetics or because of bleeding due to trauma to the lesions. In rare cases, these hemangiomas can be large, requiring excision.

They are usually kept under observation, evaluating their progress (evolution or involution). If they increase in number or become symptomatic, intervention includes the use of sclerosing agents, destruction by cryotherapy or laser therapy, or surgical excision.

Personal note: My thanks to the patient who voluntarily and anonymously provided this image to further learning and knowledge on this pathology. Dr. Miranda

2017 AACA Meeting (5)

2017 AACA Meeting – Thursday, July 20

This is the 2017 Meeting of the American Association of Clinical Anatomists (AACA) in Minneapolis, MN. This 34th meeting of the association, gets together over 300 clinical anatomists, anatomists, physicians, and students from all over the world.

Last day of the meeting! In the morning, there was a poster session and a platform session dedicated to the neck and lower limb.  Now, I must confess that as much as I wanted to attend the meeting, I decided to go somewhere else and skip the morning session… I should feel bad about this, but I do not!!

With two other attendees to the AACA meeting I went to the Wangensteen Historical Library which has a collection of over 80,000 rare books.  We met with the Curator, Lois Hendrickson, Christopher Herzberg, and Emily Beck.

First, we visited the current exhibit, “Medical Exchanges: Mapping the Human Body in Japan and China” with incredible books, medical posters, and artifacts referencing anatomy, surgery, acupuncture, botanical remedies, etc. Then we went into the reading room where they already had a display of books on anatomy, surgery, histology, etc.

We spent at least four hours reading and admiring these books and the knowledge they contain. One of our discussions was on the fact that today there is a great deal of information “lost” in these books because they have not been digitized, or because many are written in languages which the average researched does not master.

For those who read this blog, you know that I am collector of antique medical books and the opportunity to be at this incredible library was unique. There were so many books that is difficult to list. Authors like Bidloo, Hooke, Verhayen, Mascagni, Vesalius, etc. Books like “De Muto Cordis”, “Micrographia”, “De Humani Corporis Fabrica, Libri Septem”, and “De Humani Corporis Fabrica, Epitome” are some of the jewels that we were able to admire.

Personally, the opportunity to spend time with these books was invaluable. There are only 13 known “De Humani Corporis Fabrica, Epitome” books in the world. It is priceless and who knows what its monetary value would be if any makes it to the antiquarian market. Being able to read, admire and touch this book was the “epitome” of my time at the library (pun intended).

Unfortunately, for some unknown reason I lost all the pictures I took of this occasion, so I hope to get some from the colleagues that went to the library with me.

Back at the AACA Meeting, we had a Medical Terminology Committee meeting, followed by the AACA Business Meeting, and then the closing banquet with the presentation of Awards. The last order of business was the presidential transition. Neil Norton, PhD ended his presidential tenure with the closing of the 2017 AACA Meeting and Marios Loukas, MD, PhD begins his two-year as President of the AACA.

Next year the AACA meeting will be in Atlanta! See you there!

2017 AACA Meeting (4)

2017 AACA Meeting – Wednesday, July 19.

This is the 2017 Meeting of the American Association of Clinical Anatomists in Minneapolis, MN. This 34th meeting of the association, gets together over 300 clinical anatomists, anatomists, physicians, and students from all over the world.

Second day of the meeting, by now I have met most all my old friends from the AACA, and I have started making some new ones… I really like this meeting.

The meeting started with the poster session where I am a judge. I made it a point to look at all the posters yesterday and the quality of the presentations is impressive. I am humbled to have to judge so much talent and feel that many deserve the award for the best poster presentation.

The platform sessions for the day were dedicated to the Upper Limb and Education.

There was a special session dedicated to the topic “The Legal and Ethic Consideration of Being the Guardian of the Gift”. This session dealt with the legal and ethical implications of curating and keeping old collections of fetal tissue, osteology, teratology, and anatomical specimens.

I also attended the Clinical Anatomy Terminology Committee meeting… it was fun. We formed groups and tried to make anatomical definitions according to new standards being developed by the AACA.

The day ended with a social event (food and drinks) where we were treated to samples of books from the Wangensteen library (NO TOUCHING) and medical devices from the Bakken museum. What a day!!!

More nice stuff tomorrow!!!

2017 AACA Meeting (3)

2017 AACA Meeting – Tuesday, July 18.

This is the 2017 Meeting of the American Association of Clinical Anatomists in Minneapolis, MN. This 34th meeting of the association, gets together over 300 clinical anatomists, anatomists, physicians, and students from all over the world.

The meeting started with the official welcome by the president of the AACA, Neil S. Norton, Ph. D., and the welcome by our local Minnesota host Tucker W. LeBien, Ph.D.

Unfortunately, our Honored Member James D. Collins, M.D., is sick and could not attend. We all wish him well.

The rest of the day was spent in poster sessions, the Tech Fair, and a reception where new AACA members can meet our mentors and possibly connect throughout their careers. The AACA aims to help its members through these activities.

We also had time to visit the exhibit hall where our sponsors can present their products. We sincerely thank them for their contribution.

One of the presentations that caught my attention was the use of augmented reality in anatomy, where you can see an anatomical structure floating in the air superimposed on the environment. 3D anatomical resources were also presented by the exhibitors.

One of the highlights of my day was to meet again with Victor M. Spitzer, Ph.D., (Honored Member AACA 2014) and talk about meeting in Colorado at his lab, and the incredible revolution in anatomy that he started with The Visual Human Project. I invited him to become a contributor to our blog…. Hope he accepts!

The day ended with some of the attendees to the meeting going to see a New York Yankees vs, the Minnesota Twins baseball game…. I stayed. Unfortunately for our hosts the NYY won 6-3.

More nice stuff tomorrow!!!

2017 AACA Meeting (2)

2017 AACA Meeting – Monday, July 17.

This is the 2017 Meeting of the American Association of Clinical Anatomists in Minneapolis, MN. This 34th meeting of the association, gets together over 300 clinical anatomists, anatomists, physicians, and students from all over the world.

We started with a judge’s meeting. I will be one of many judges that will evaluate the many posters presented by mostly new AACA members and students sponsored by an AACA member. This is a very important activity, as the winner will be presented with an award. Each poster presenter will explain their scientific research and answer questions from the judges.

After the judge’s meeting, it is time for the inaugural reception. This is the time to meet with old friends and colleagues as well as an opportunity to welcome first time attendees and new AACA members. Luckily, they are easily identifiable by a green badge.

I am very lucky to be here, and looking forward to tomorrow with the inaugural session, the tech fairs, posters sessions, and platform session on the torso.

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