Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their 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

Jean-Louis Petit

Jean Louis Petit
(1674 – 1750)

French surgeon and anatomist, Jean Louis Petit was born in Paris in on March 13, 1674.  His family rented an apartment at his house to Alexis Littre (1658 – 1726), a French anatomist. Petit became an apprentice of Littre at seven years of age, helping him in the dissections for his lectures and at an early age became the assistant in charge of the anatomic amphitheater.

Because of Petit’s dedication to anatomy and medicine, in 1690 at the age of sixteen, became a disciple of a famous Paris surgeon, Castel.

In 1692, Petit entered the French army and performed surgery in two military campaigns. By 1693 he started delivering lectures and was accepted as a great surgeon, being invited to the most difficult operations.  In 1700 he was appointed Chief Surgeon of the Military School in Paris and in the same year he received the degree of Master of Surgery from the Faculty of Paris.

In 1715 he was made a member of the Royal Academy of Sciences and an honorary member of the Royal Society of London. He was appointed by the King as the first Director General of the Royal Academy of Surgery when it was founded in 1731.

Petit’s written works are of historical importance.  “Traite des Maladies des Os” ( A Treatise on Bone Diseases);  “Traite des Maladies Chirurgicales et des Operation” (A Treatise on Surgical Diseases and their Operations” This last book was published posthumously in 1774. He also published a monograph on hemorrhage, another on lachrymal fistula, and others.

He was one of the first to perform choIecystotomy and mastoidotomy. His original tourniquet design for amputations saved many in the battlefield and the design of the same surgical instrument today has not changed much since its invention by him.

His name is remembered in the lumbar triangle, also called the "triangle of Petit", and the abdominal hernia that can ensue through that area of weakness, the lumbar hernia or "Petit's hernia".

Sources:
1. “Jean Louis Petit – A Sketch of his Life, Character, and Writings” Hayne, AP San Fran Western Lancet 1875 4: 446-454
2. “Oeuvres compl?tes de Jean-Louis Petit” 1837 Imprimerie de F. Chapoulaud
3. Extraits de l'eloge de Jean-Louis Petit Ius dans Ia seance publique de I' Academie royale de chirurgie du 26 mai 1750” Louis A. Chirurgie 2001: 126 : 475- 81


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Otto C. Brantigan, MD


This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.To search all the articles in this series, click here.

Otto C. Brantigan, MD. (1904-1981) An American surgeon and anatomist, Otto Charles Brantigan  was born in Chattanooga, TN in 1904. Having dropped out of high school to help his family and working as a first class machinist, he decided to continue with graduate school. He studied at the Northwestern University in Chicago, where he graduated from the Medical School in 1933.  In 1948 he became Chief of Surgery, and eventually became Professor of Surgery, Professor of Thoracic Surgery, and Professor of Anatomy at the Maryland School of Medicine.  He retired in 1976 having earned many accolades for his profuse surgical work and publications.

As a surgeon of the times, Dr. Brantigan had a wide area of interest. His over 110 publications and surgical work range from thoracoscopy to vascular, plastic, cardiac, and orthopedic surgery. He is most remembered for the pioneer work he did on chronic obstructive pulmonary disease (COPD), emphysema and lung volume reduction surgery (LVRS), which he presented in 1958. The procedure had (at the time) a very high mortality rate  (16 -20%) and Brantigan's work was not readily accepted.

Dr. Otto C. Brantigan

It was not until J. Cooper and his team, revisited the operation proposed by Brantigan  that the operation was accepted, now with new surgical stapling and staple line buttressing technology.  Dr. Brantigan's name was recognized as a pioneer in lung emphysema surgery, unfortunately 14 years after his death. In 1994 his son, Dr Charles O. Brantigan delivered a beautiful biography of Dr. Otto Brantigan in the same meeting where Cooper presented his results with LVRS.

Personal note: I am proud to own one of the copies of Dr. O.C. Brantigan;s "Clinical Anatomy", a book that I use quite frequently. It is listed in my library catalog. Dr. Miranda.

Sources:
1. "Biography of Otto C Brantigan" C.O. Brantigan 1994 Meeting of the American Association for Thoracic Surgery
2. "LVRS in chronic obstructive pulmonary disease" Davies, L; Calverley, P. Thorax 1996;51(Suppl 2):S29-S34
3. ""Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease" Cooper, J.,The Journal of Thoracic and Cardiovascular Surgery Volume 109, Number 1:106-119
4. "The Surgical Approach to Pulmonary Emphysema" Brantigan, OC; Kress, MB; Mueller, EA. Chest. 1961; 39(5):485-499
5. "History of Emphysema Surgery" Naef, AP. Ann Thorac Surg 1997;64:1506-1508

Original image  courtesy of National Institutes of Health. Biography of Dr. Otto Brantigan courtesy of Dr. Charles O. Brantigan.

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Rectum

The rectum is the most distal segment of the large intestine. 

The word [rectum] arises from the Latin [rectus] and means "straight", such as its use in the name "rectus abdominis" for the "straight muscle of the abdomen".

It seems a misnomer, as the rectum of the human species is actually "S" shaped, as seen in the accompanying image. The reason for this discrepancy is that the rectum was named by Galen of Pergamon (129AD - 200 AD) who himself studied this structure in animals such as sheep and goats. In these animals the rectum is indeed straight, and since contradicting Galen was not acceptable (see Michael Servetus), the name has survived until this day. Even Andreas Vesalius has in his 1953 "Fabrica" a depiction of a straight rectum in the human! Click on the bar beneath the image to see Vesalius' image of the rectum.

The proximal end of the rectum is not clearly discernible from the sigmoidorectal region, from here the rectum has an "S" shape, measures approximately six to seven inches in length (15 - 17 cm), and it ends distally at the junction of the rectum with the  pelvic diaphragm. It is at this point that the anal canal begins.

1. Sigmoid colon 2. Rectum 3. Anus 4. Inferior rectal valve 5. Middle rectal valve 6. Superior rectal valveLarge Intestine - Vesalius 1543
The rectum is characterized by three transverse rectal folds, one on the right side, and two on the left side. These folds are know as the "rectal valves" or the "valves of Houston". The middle rectal fold is known to European anatomists as the "valve of  Kohlrausch" Their function in maintaining fecal material in place as well as their function in defecation is still under study. The rectal valves also have a high level of anatomical variation and may not be present at all.

Image source: "Tratado de Anatomia Humana" Testut et Latarjet 8 Ed. 1931 Salvat Editores, Spain
Recommended reading: "Transverse Folds of Rectum: Anatomic Study and Clinical Implications" Shafik, A, et al. Clin Anat 14: 196-203 (2001).

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Collateral circulation

The term "collateral circulation" is generally used to denote a situation where small blood channels dilate and provide blood supply when a pathology creates a stricture and diminishes blood flow (ischemia).

Although the above is correct, the term is also applicable to a normal, non-pathological situation most common in the human body. Please refer to the accompanying image for the following explanation. If needed, click on the image for a larger depiction. In the image, the arrows represent direction of flow.

Most organs or organ segments receive blood supply from more than one source of blood supply. In some cases, like the stomach, there are up to four arteries that provide blood supply to the organ: the right and left gastric arteries, and the right and left gastroepiploic arteries.

Collateral circulation. The arrows indicate direction of arterial blood flow. The dashed lines delimitate vascular territoriesImages property of:CAA.Inc. Artist: Dr. E. Miranda
In other cases, like the small intestine shown in the image, blood arrives to the organ arising from several arteries (A, B, and C) that themselves arise from a parent structure. Because of hydrodynamics, the vascular territories of each artery (represented by dashed lines) tend not to overlap. If for any reason there is stenosisor blockage in any of these arteries (A,B, or C) blood will flow immediately through an alternate route and the organ will not suffer ischemia or necrosis

This is extremely important, as these collateral channels maintain blood supply to areas that may be affected by bending, such as the elbow and knee, which have a rich collateral network. Most of the organs in the body, with some exceptions (brain, heart), have collateral circulation.

Collateral circulation is extremely important for surgery, as surgeons can safely remove parts of organs without affecting the blood supply to the organ. This is also true for all gastrointestinal anastomoses.

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Histology

Histology is the scientific branch that studies tissues.

The root term [-hist-] is used to mean "tissues", but how the term came to be used is somewhat convoluted. It arises from the Greek [histos], which indicates the mast of a ship, it then was used to denote a Greek weaver's loom central mast (where the fabric is woven horizontally), and then it was used to indicate that which was woven [histios], the fabric, or the "tissues".  The suffix [-ology] also has Greek origin from [logos] meaning a "book", a "treatise" or "to study". 

The concept of the body being formed by different tissues was pioneered by Marie-Francois Xavier Bichat (1771-1802) who called them "membranes" Bichat is considered to be the "father of Histology". The image shows a histological slide of cardiac muscle. Click on the image for a larger depiction.

Cardiac muscle (Dr. S. Girod, A. Becker)Original image by S. Girod and A. Becker, courtesy of Wikipedia. 
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Spondylosis

The root term [-spondyl-] arises from the Greek [spondylos] meaning "vertebra", and the suffix [-osis] means "condition", but with the connotation of "many". The word [spondylosis] means " condition of many vertebrae". This does not add much to the use of this word as an indicator of a pathology, but it does indicate that there is excess bone in a vertebral pathology.

Spondylosis is an osteoarthritic degeneration of the vertebrae and the spine characterized by abnormal bony growths  on the vertebrae that can impinge on nerves and other structures causing pain and mobility problems. The definition of spondylosis also includes degenerative changes in the intervertebral discs.

The abnormal growth of portions of the vertebral body, usually forms "bone spurs", also referred to as "spondylophytes". The accompanying image shows a lumbar vertebra with spondylophytes. Click on the image for a larger depiction.

Spondylophytes on a lumbar vertebraImage property of: CAA.Inc. Photographer: David M. Klein
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Rudolf Nissen, MD


This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.To search all the articles in this series, click here.
Dr. Rudolf Nissen (1896 - 1981).  Dr Nissen’s life is extraordinary. Born in the city of Neisse, Germany in 1896, he was the son of a local surgeon. He studied medicine in the Universities of Munich, Marburg, and Breslau. He was the pupil of the famous pathologist Albert Aschoff (discoverer of the heart’s AV node, along with Sunao Tawara).

Nissen became a professor of surgery in Berlin, and in 1933 moved to Turkey where he was placed in charge of the Department of Surgery of the University of Istanbul. In 1939 he moved to the US, first to the Massachusetts General Hospital and later to the Jewish Hospital in Brooklyn, New York. After becoming a US citizen, he moved again in 1952 to Basel, Switzerland as Chief of the Department of Surgery, where he retired in 1967. He died in 1981.

His contributions to surgery are innumerable. He wrote over 30 books and 450 journal articles. Known for the development in 1956 of what is today known as the “Nissen fundoplication” for esophageal hiatus hernia surgery, Nissen also worked with his assistant, Dr. Mario Rossetti to develop the “floppy Nissen fundoplication”, also known as the “Nissen-Rossetti procedure”. This would be enough to honor this man, still, he (with Sauerbruch) performed the first lung lobectomy and the first pneumonectomy (called then a total pneumonectomy). In 1949 he performed the first esophagectomy with a gastroesophagostomy for lower esophageal cancer.

Dr. Rudolph NissenOriginal imagecourtesy of Universit?t Basel.
His personal life is even more interesting. Drafted at 20, he fought in WWI and was wounded several times. In 1933, under the Nazi regime, he was ordered to fire all the Jewish-German assistants under his care. Being Jewish himself, he was told that he would keep his job, Nissen could not take this. He resigned his position and moved out of Germany.

Another little known fact is that he operated on Albert Einstein in 1948. He operated on Einstein because of intestinal cysts. Having found a developing abdominal aortic aneurysm, he reinforced it with cellophane, undoubtedly giving his patient a few extra years to live. Einstein died in 1955.

As a personal side note, our good friend Dr. Aaron Ruhalter scrubbed in with Dr. Nissen while serving as a surgical resident at the Brooklyn Jewish Hospital!

Sources:
1. “Rudolf Nissen: The man behind the fundoplication” Schein et al. Surgery 1999;125:347-53
2. “Rudolf Nissen (1896–1981)-Perspective” Liebermann-Meffert, D. J Gastrointest Surg (2010) 14 (Suppl 1):S58–S61
3. “The Life of Rudolf Nissen: Advancing Surgery Through Science and Principle” Fults, DW; Taussky, P. World J Surg (2011) 35:1402–1408
4. “Total Pneumonectomy” Nissen, R. Ann Thorac Surg 1980; 29:390-394
5. “Historical Development of Pulmonary Surgery” Nissen, R. Am J Surg 80: Jan 1955 9- 15

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