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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Pelvic diaphragm

The pelvic diaphragm is one of the four diaphragms in the human body (do you know the other three?) and it represents the lower boundary of the abdominopelvic cavity. This thin and  transversely oriented structure is formed from anterior to posterior by the puboccygeus, the iliococcygeus, and the coccygeus muscles.

The first two anterior muscles overlap, the pubococcygeus muscle being superior to the iliococcygeus muscle. Both of them attach laterally to a thickening of the obturator internus fascia that covers the obturator internus muscle. This thickening is known as the arcus tendineus levator ani (ATLA in the image). Because of the relation of the medial fibers of the puboccygeus muscle to the anal canal (puborectalis muscle), and what happens when these muscles contract, these two anterior muscles are known by one common name, the "levator ani" muscle. Click on the picture for a larger image.

Pelvic diaphragm, superior view
The posterior component of the pelvic diaphragm is the coccygeus muscle, which is found lying on the internal aspect of the sacrospinous ligament.
Image property of: CAA.Inc.Artist: D.M. Klein
Word suggested and edited by: Dr. Sanford S. Osher, MTD Contributor
 
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Gynecology

The root word [-gyne-] is Greek, from [gynaik] meaning "woman" or "female". The suffix [-ology] is also Greek,  derived from [logos] meaning "study of". [Gynecology] is then "study of a woman or a female". The term refers to the medical specialty that studies and treats the female reproductive system. A separate specialty, obstetrics, deals with the care of the pregnant patient and delivery of the fetus.

Originally, both specialties were the domain of midwives. It was not until the 1600's that male physicians were allowed to treat gynecological problems and attend  births. As the image shows, man-widwifes in Europe were allowed access to the patient only with the use of a "modesty blanket". This is plate XV from the 1681 book "Korte en Bondige Van Der Voortteeling en Kinderbaren" by Samuel Janson.

A man-midwife and a 'modesty blanket' c.1681
As an interesting side note in history, the first male physician to work as a man-midwife was Dr. Wertt from Hamburg. Dr Wertt decided to disguise himself as a woman to attend patients. When he was discovered, the punishment was "swift and salutary": He was burned at the stake.
 
Source:
"The Story of Surgery" by H. Graham, 1939
Word suggested and edited by: Dr. Sanford S. Osher , MTD Contributor
 
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-ostomy

From the Greek word [stoma] meaning "mouth or opening", and the suffix [-y] meaning "process or condition". The suffix [-(o)stomy] refers to the "process of creating an opening". This process can be physiological, without intervention, as in the creation of a spontaneous fistula, or it can be a surgical procedure.

As a working explanation of [-ostomy] in surgery, we like to use the term "drainage". Therefore, an [ileostomy] would be the procedure by means of which a drainage opening is creating an anastomosis between the ileum and the abdominal wall.

The accompanying image shows an early 1900's procedure to create a gastrostomy (Wietzel's gastrostomy). The root term [gastr-] means "stomach".

Gastrostomy
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Surgery

From the Greek [kheirurgia], a compound word meaning "a work done by hand". The Greek word [kheir/cheir] means "hand", and [ergon] means "work". The intent of the word is that of a medical treatment that is realized by the use of the hands and/or hand instrumentation.

Technology has advanced the evolution of surgery. Today minimally invasive surgical procedures, videoscopic procedures,  and robotic-enhanced surgery are commonplace

Images and links courtesy of: www.wikipedia.com

Cardiovascular bypass surgery (www.wikipedia.com)

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Arcuate line

The arcuate line is the arch-shaped (hence the name) inferior border of the posterior sheath of the rectus abdominis muscle. This structure is seen in a laparoscopic (posterior) view (see image, label "B") and represents the transition from a superior area with well-formed aponeurotic posterior rectus sheath to an area devoid of the posterior rectus sheath.

At this point, the inferior (deep) epigastric vessels (see image, label "C") pass from deep to superficial, under the arcuate line and continue superiorly providing blood to the rectus abdominis muscle.

The arcuate line also represents a transition from a well-formed and stronger wall posterior to the rectus abdominis muscle to a weaker region, covered only by deep muscle fascia and transversalis fascia. This allows a surgeon to enter the preperitoneal region using a Totally Extraperitoneal (TEP) approach for a laparoscopic herniorrhaphy.

Label "A" shows the "corona mortis" anatomical variation 

Image property of: CAA.Inc.Artist: M. Zuptich

Arcuate line (B)
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Inguinal ligament

The inguinal (Poupart's) ligament has always been described as a separate, discrete,  distinctive ligamentous structure. This is not so. The inguinal ligament is the thickened, incurved, lower free border of the external oblique aponeurosis. This structure extends between the anterior superior iliac spine (ASIS) superolaterally, and the pubic tubercle inferomedially. The inferomedial portion of the inguinal ligament send fibers towars the pectineal ligament (Cooper's ligament) and forms the lacunar (Gimbernat's) ligament.

Inferior to the inguinal ligament is an open region (subinguinal space) that allows passage of structures between the abdominopelvic region and the femoral region. Some of these structures are: Iliacus muscle, psoas major muscle, femoral nerve, lateral femoral cutaneous nerve, femoral artery, femoral vein, etc.

Inguinal ligament
Although described by Vesalius, Fallopius, and others it was the French anatomist and surgeon Francois Poupart (1661-1708) who described this structure in relation to hernia in his book "Chirurgie Complete" published in 1695.

Image property of: CAA.Inc.. Artist: D.M. Klein

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