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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Sinuatrial (SA) node

The sinuatrial node, is also known as the "sinoatrial node", "SA node" or by its eponym, the "node of Keith and Flack". It is the initial component of the conduction system of the heart.

It is a small nodule of cardiac muscle tissue, somewhat horseshoe-shaped that is found at the junction of the superior vena cava and the right atrium. Because of the inherent automaticity and rhythmical contractions of the SA node, it acts as the main pacemaker of the heart, being the base for normal heart beat, also known as "sinus rythm"

It receives blood supply from the SA node artery, usually the first or second branch that arises off the right coronary artery. The SA node artery is a long vessel that passes between the right atrium and the ascending aorta on its way to the SA node.

Conduction system of the heart

The SA node receives innervation from both sympathetic and parasympathetic nerves. The parasympathetic innervation is by way of the vagus nerve, the Xthcranial nerve. The sympathetic innervation is by way of the cardiac nerves, a plexus that has its origin in the ventral ramiof the first four thoracic spinal nerves (T1-T4).

The SA node was discovered in 1906 by Martin W.  Flack (1882-1931) and Arthur Keith (1866-1955). They named it originally the sinoauricular node.

Click on the image for a larger version. Image modified from the original: "3D Human Anatomy: Regional Edition DVD-ROM." Courtesy of Primal Pictures

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Wilhelm His Jr.

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.

Wilhelm His Jr.
Wilhelm His Jr.

Wilhelm His Jr. (1863-1934). Also known as Wilhelm His the Younger, was born in Switzerland in the city of Basel. His father was a well-known and famous anatomist by the same name who worked at the University of Basel. Wilhelm His Jr. studied in several universities, including Leipzig, Strasbourg, Bern, and Geneva. He received his medical degree from the University of Leipzig in 1889.

Although not an anatomist, his 1893 single and most brilliant contribution to the eventual understanding of the conduction system of the heart was the discovery and description of a muscular bundle that connected the atrial septum with the ventricular septum. Until that moment it was known that no muscles crossed from the atria to the ventricles, leading anatomists and physiologists to wonder how does the heart contract.  

In his article His states "after long search I have succeeded in finding a muscle bundle which unites the auricular and ventricular septal walls, and which, up to now, has escaped observation because of incomplete exposure, for it is visible in its entire extent only when the septa are cut exactly in their longitudinal direction".

What is interesting is that His not only found the bundle that today honors his name, but he included in that description the atrioventricular node, the actual structure that crosses the atrioventricular connective tissue barrier known as the "skeleton of the heart". The AV node was later to be clearly identified and researched by Sunao Tawara (1873 - 1952).

Dr. His continued his research on gout and joint diseases. He became a German citizen and joined the German army as a consulting physician. He retired in 1932 and died in 1934.

Although Wilhelm His Jr. did not discover or described the esophagogastric angle, in 1906 JD Cunningham started calling this angle the "Angle of His" in honor of Wilhelm His Jr. This eponym has stayed with us until today.

Sources:
1. "Wilhelm His Jr." JAMA. 1964;187(6):453-454
2. "His, Jr., W.: The Activity of the Embryonic Human Heart and Its Significance for the Understanding of the Heart Movement in the Adult" Arb Med Klin Leipzig, pp 14-49, 1893; Bast, TH,Gardner, WD trans: J Hist Med 4:289-318, 1949
3. "Wilhelm His, Jr. and the Bundle of His" Bast, TH, Gardner, WD J Hist Med All Sci; 1949; 4, (2) 170 -187
4. Firkin BG (1996) Dictionary of medical eponyms.London: Parthenon Publishing Group, 181
Original image
in the public domain, courtesy of the National Library of Medicine.


Sphincter of Oddi

The [sphincter of Oddi]  is a complex system of smooth muscles that controls flow of bile and pancreatic juice into the duodenum. Although known by its eponym, this structure has the anatomical name of "sphincter of the hepatopancreatic ampulla". Although described previously by others, it was Ruggero Oddi (1864-1913) who described not only its structure, but also its function.

The hepatopancreatic ampulla or "ampulla of Vater" is a dilation found at the conjunction and end of the common bile duct and pancreatic duct. The presence of the hepatopancreatic ampulla creates a nipple-like elevation of the duodenal mucosa called the "duodenal papilla".

The sphincter of Oddi has several components:

Cutaway view of the second portion of the duodenum showing the sphincter of OddiImages property of:CAA.Inc. Artist:Dr. E. Miranda
• Sphincter papillae: This portion of the sphincter surrounds the papillary and intramural portion of the hepatopancreatic ampulla
• Sphincter choledochus: This portion of the sphincter surrounds the most distal portion of the common bile duct. It must be noted that this is the narrowest portion of the common bile duct, allowing for potential lodging of bile stones, cause for choledocholithiasis
 Sphincter pancreaticus: This portion of the sphincter surrounds the most distal portion of the pancreatic duct and prevents reflux of bile from the hepatopancreatic ampulla to the pancreatic duct.

The duodenal muscular layer parts to allow passage of the complex formed by the hepatopancreatic ampulla and the sphincter of Oddi, creating a window called the "choledochal window". Longitudinal fibers from the duodenal muscularis externa pass and join to the sphincter of Oddi.

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Chol- / chole-

This is a root term of Greek origin. In both presentations [-chol-] or [-chole-] it means "bile" or "gall". The English word "gall" is of Anglosaxon origin and means "bile", referring to its yellowish-green color. The word [bile] is of Latin origin, from [bilis].

These root terms are used in many medical words, such as:

cholecystitis: [cyst] means "sac" or "bladder", [itis] means "inflammation" or "infection". Gallbladder inflammation
• cholecystectomy: [cyst] means "sac" or "bladder", [ectomy] means "removal". Gallbladder removal
• cholangiogram: [angi] means "vessel", [(o)gram] means "examination". Examination of a bile vessel
• choledocholithiasis: Condition of stones in the bile duct. Click on the link for more information
• cholera: The suffix [-era] is "flow" or "discharge". The term refers to the constant vomiting of bile in patients afflicted with this disease. This term has been heatedly discussed and this is but one of the theories as to the etymology of the word.

In the early days of physiology, yellow bile was considered one of the "four humors" that made up human personality, temperament, and health. A person with an excess of yellow bile would be considered bad tempered, angry, or "choleric". Observe how the root term [chole] also is found in the word "choleric".

Sources:
1. "The Language of Medicine" John H. Dirckx Pub: Harper & Row 1976
2. "Medical Meanings" Haubrich, William S. Am Coll Phys Philadelphia 1997
3. "The origin of Medical Terms" Skinner, AH, 1970

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Ruggero Oddi


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.
Ruggero Oddi  (1864-1913). Anatomist and physician, his complete name was Ruggero Ferdinando Antonio Giuseppe Vincenzo Oddi Pampaglini, born on July 20, 1814 in the city of Perugia, Italy.  He studied medicine in the University of Perugia, where he had a keen interest in anatomy and phyisology, graduation with a medical degree in 1889. In 1887, as a fourth year medical student Oddi published a paper that would make his name eponymically tied to the sphincter found around the hepatopancreatic ampulla; what today is known as the "sphincter of Oddi". His paper was entitled "Di una Speciale Disposizione a Sfintere allo Sbocco del Coledoco" (On a Special Sphincteric Arrangement at the Outlet of the Common Bile Duct).

Although the circular muscle of the sphincter of Oddi had already been described by Glisson in 1681, Oddi was the one who did a complete anatomical and physiological study of this structure uncovering the fact that it was indeed a sphincter. He continued his studies on the hepatobiliary sphincter until 1894, when he moved to Congo and later back to Belgium. 

Because of his inclination towards methaphysical studies, Oddi started experimenting with drugs on himself and became addicted.

Ruggero Oddi

Original imagecourtesy of National Library of Medicine.

His later life was surrounded by scandal and controversy, because of drug abuse and fiscal mismanagement of University funds. Oddi died in poverty in 1913 and his site of burial is unknown.

Sources:
1. "Ruggero Ferdinando Antonio Guiseppe Vincenzo Oddi" Lukas, M, et al. World J Surg (2007) 31:2260–2265
2. "Ruggero Oddi; To commemorate the centennial of his original article--"Di unaspeciale disposizione a sfintere allo sbocco del coledoco" Ono, K; Hada, R. Jap J Surg, VOL. 18, No. 4 pp. 373-375, 1988
3. "Ruggero Oddi: 120 years after the description of the eponymous sphincter: A story to be remembered" Capodicasa, E. J Gastroent Hepat 23 (2008) 1200–1203
4. "Oddi: The Paradox of the Man and the Sphincter" Modlin, IM; Ahlman, H. Arch Surg 129 (1994) May 550-557

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Angle of His

Angle of His
Esophagogastric junction

The "Angle of His" refers to the normally acute angle between the abdominal esophagus and the fundus of the stomach at the esophagogastric junction.

This angle is one of the elements that are important in the prevention of gastroesophageal reflux disease (GERD). When the fundus of the stomach gets expanded by air, because of the normal anatomy and relations of the esophageal hiatus, the esophagogastric junction structures are "pushed" from left to right, pushing close the gastroesophageal flap valve or "rosette". There are other mechanisms that add to the sphincter-like action of the esophagogastric junction structures.

The eponym "angle of His" remembers Dr. Wilhem His Jr. (1864 -1934), a German physician and anatomist, who also described the atrioventricular bundle or "Bundle of His", one of the components of the conduction system of the heart.

Thanks to Debbie Donovan for suggesting this post.
Images property of:CAA.Inc. Artist:Dr. E. Miranda