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Extrauterine pregnancy: a historical review(3).

This article reviews historical developments in the recognition and management of abdominal and ectopic pregnancy since these entities were first recognized centuries ago. Contributions of the early anatomists who studied the female reproductive system and the courage of early surgeons who dared invade the abdomen cleared the path for the extraordinary success of today's obstetricians and gynecologists in the treatment of conditions formerly fatal to both mother and fetus.

Journal Article↗

Hippocampal terminology: concepts, misconceptions, origins.

The mammalian hippocampus is certainly one of the best investigated brain regions. It fascinates neuroscientists particularly because of its important role in memory. The names for the various parts of the hippocampal formation were created in the course of the first thorough explorations of human brain anatomy. The present, internationally agreed terminology reflects an unfortunate muddle that has been going on for several hundred years. Not surprisingly, even today the origins of some of the names are not always given correctly. It is generally accepted that the Italian anatomist Arantius was the first to apply the term 'hippocampus' to part of that region in the human brain. To later authors, however, this name appeared more or less enigmatic and they proposed various other terms. Yet careful reading of the entire original text of Arantius leads to the conclusion that it was not the hippocampus in our modern terms but the dentate gyrus which he compared to a little sea horse or a silkworm.

Anatomy↗

Otology through the ages.

Recounted are some, not all, of the most significant contributions to otology. The history of otology has, for the most part, followed the history of medicine: Little was known of otology by the ancient physicians, but their work must be reviewed to appreciate the progress that has been made. Most of the otology produced during the Middle Ages was limited to those structures that were readily accessible; otologic surgery was confined to trauma and removal of foreign bodies from the external auditory canals. Examination of the ear began after studies of the ear by Italian anatomists during the seventeenth century. It was not until the end of the eighteenth century that magnification was used so that the minute anatomic details could be observed. The clinical specialty of otology started in France (1850s), emerged as a scientific specialty in England, and received explosive progress from the German-speaking countries at the end of the nineteenth century. Otology has a remarkable background.

Ear↗

MRI of human entorhinal cortex: a reliable protocol for volumetric measurement.

A new protocol for measuring the volume of the entorhinal cortex (EC) from magnetic resonance images (MRI) was developed specifically to measure the EC from oblique coronal sections used in hippocampal volumetric studies. The relative positions of the anatomic landmarks demarcating EC boundaries were transposed from standard coronal sections to oblique ones. The lateral EC border, which is the most controversial among anatomists, was defined in a standard and conservative manner at the medial edge of the collateral sulcus. Two raters measured the EC twice for 78 subjects (healthy aged individuals, very mild AD patients, and elderly patients who did not meet criteria for dementia) to study intra- and inter-rater reproducibility and reliability of measurements. The level of accuracy achieved (coefficients of reproducibility of 1.40-3.86%) and reliability of measurements (intraclass correlation coefficients of 0.959-0.997) indicated that this method provides a feasible tool for measuring the volume of the EC in vivo.

Adult↗

Facial asymmetry with severe unilateral hypoplasia of the muscles of mastication: a report of clinical and electromyographic findings.

Mild degrees of asymmetry of the human body have been recognised both by classical sculptors and more recently by anatomists as both normal and widely occurring. Morphologic asymmetries of the face of a more severe nature are, however, quite rare. When such deformities occur, both the hard and soft tissues may be involved and the abnormality may be acquired as a result of trauma, infection, neoplasia or surgery or be of a developmental origin as in the syndromes affecting the first pharyngeal arch. Developmental asymmetries of the jaws may also arise as a result of unilateral disruption of mandibular development during the time of normal facial growth leading to hemiretrognathism. Severe hypoplasia of the muscles of mastication on one side only has not previously been reported.

Adolescent↗

August Knoblauch and amusia: a nineteenth-century cognitive model of music.

Early models of human cognition can be traced to nineteenth-century investigations of brain and behavior. Influential neurologists such as Wernicke, Kussmaul, and Lichtheim constructed diagrammatic models to illustrate current theories of cognition. Language was the most commonly studied cognitive function during this time; however, investigators also studied other cognitive functions, such as music and visual processing. While a number of nineteenth-century neurologists made observations about music abilities in aphasic patients, August Knoblauch, a German physician and anatomist, was the first to propose a diagrammatic model of music (1888/1890). He described a detailed cognitive model of music processing, hypothesized the existence of nine disorders of music production and perception, and coined the term "amusia." Knoblauch's model is the earliest cognitive model of music and is largely unrecognized as an important part of the history of neurology, neuropsychology, and music cognition.

Agnosia↗

Ludwig Fraenkel: 'spiritus rector' of the early progesterone research.

The search for the corpus luteum hormone progesterone took more than three decades and the efforts of many scientists all over Europe and the USA. In 1934, after a dramatic neck-and-neck scientific race, four research groups independently from each other reported on the successful isolation of the pure substance. Two of the groups were from the then-German cities of Breslau and Danzig, the others were from the USA and Switzerland. Possibly, the Breslau group had already had the purified hormone as early as 1933. At that time, gynecologist Ludwig Fraenkel (1870-1951) had been their 'spiritus rector' for more than three decades. It was Fraenkel himself who at the beginning of the century, in examining a hypothesis of the anatomist Gustav Jacob Born (1851-1900), had provided experimental proof for an endocrine function of the corpus luteum. Later on, Fraenkel enlisted the help of chemist Karl Heinrich Slotta (1895-1987) in the purification of the hormone. This took place after important requirements for the isolation and for the semiquantitative determination of the hormone (e.g. Corner-Allen test) had been established elsewhere. Also belonging to the Breslau research group were Erich Fels (1897-1981) and Heinrich Ruschig (born in 1906). Fels was an assistant to Fraenkel, Ruschig a PhD candidate directed by Slotta. Shortly after the group had succeeded in purifying progesterone, the Breslau group was broken apart by the National Socialist's racial policies: Fraenkel, Fels and Slotta were forced into emigration.

Corpus Luteum↗

An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy.

OBJECTIVE: To provide a detailed description of the steps involved in a laparoscopic radical prostatectomy in relation to the complex neurovascular anatomy of the male pelvis. AIM AND HYPOTHESIS: We aimed at delineating the neurovascular anatomy to assist in nerve preservation during laparoscopic and robotic radical prostatectomies. METHODS: A team of urologists and an anatomist performed anatomic dissections of 12 male cadavers using a combination of laparoscopic equipment, magnification, and open surgical dissection. Each step involved in laparoscopic prostatectomy was reviewed in relation to the possible impact the step could have on the neurovascular bundles. RESULTS: Dissections were performed systematically to mimic various steps of laparoscopic and robotic prostatectomy. The neurovascular bundles were identified and correlated with video images of actual surgery. This enabled us to construct computer simulations and show the actual nerves on the operative pictures. We specially unraveled the relationship between neurovascular bundles and lateral pelvic and Denonvillier's fascias, both of which enclose and hide these important structures. The course of the bundles was traced from its origin at pelvic plexus to its distal course along the urethra. We also showed the important relationship between pelvic plexus ganglions and seminal vesicles to illustrate the vulnerability of these nerves to thermal, electrical and/or crush injury during seminal vesicle and prostatic pedicle dissections. The importance of additional fine neural plexus along the posterior and antero-lateral surface of the prostate was shown by both gross anatomical and microscopic images. The distal precarious location of the bundles was illustrated by dissections showing anteriorly lifted prostate.These anatomico-operative correlations have not been published for laparoscopic and robotic prostatectomies, which differ significantly in its visual angles, magnifications and sometimes three-dimensional (3D) visualization from its open counter part. CONCLUSION: Laparoscopic and robotic radical prostatectomy provides exposure and visualization of male pelvis not previously appreciated. It is only through a careful reexamination of the anatomy of the male pelvis, in the context of this new procedure, that the improvements in visualization and exposure benefit the surgeon. Our work provides a detailed map relating to operative steps to aid the surgeon in the performance of a nerve sparing robotic and laparoscopic radical prostatectomy.

Fascia↗

Anatomical and computed tomographic analysis of C1 vertebra.

Craniovertebral junction surgery requires knowledge regarding the anatomy of this region, particularly the C1 vertebra. Both C1 laminectomy and C1-2 instrumentation necessitate preoperative information about bony landmarks and the vertebral artery. This study compares the results obtained from anatomic and computed tomographic measurements of C1 bony landmarks. 31 C1 cervical vertebrae were measured; the C1 AP diameter, and C1 transverse diameter, the facet diameter, the distance between the anterior tubercle and the anterior aspect of the C1 lateral mass on a lateral view, the distance between the midline and the vertebral artery groove on the outer cortex of the posterior arch of C1 anatomically and computed tomographically. Anatomic measurements were performed by an anatomist using a Vernier caliper accurate to 0.1 mm, whereas the computed tomographic measurements were performed by a radiologist on bone window computed tomography (CT). The mean values and the differences between two measurement modalities were analysed using a paired t-test. There was no statistical difference between the results obtained by anatomical and radiological measurements for six parameters. There was, however, a statistically significant difference between two modalities regarding the distance between the midline and vertebral artery groove on the outer cortex of posterior arch of C1, while slightly different, the difference is within 1 mm and, therefore, not clinically significant. It is concluded that CT reflects most anatomical details of bony landmarks of C1.

Cadaver↗

Problems of the third dimension.

The problems facing a pathologist or anatomist who wishes to embark on computer-assisted reconstruction of structures seen in serial light microscope sections are reviewed. They are illustrated by comparing a reconstruction of a bronchial gland made by cutting out polystyrene sheets with models generated by four computer-assisted systems, i.e. the IBAS 2000 system, the SSRCON (MRC) system, the AT-Videoplan system and the CHD (Cookson, Holman, Dykes) system. It is obvious that computer-assistance cannot solve the preparation problems of three-dimensional reconstruction (3DR) and that choosing a computer-assisted system is fraught with difficulties. It is recommended that intending purchasers of computer-assisted 3DR systems prepare material in advance to try out on the systems they are considering.

Bronchi↗

Do the tensor tympani and tensor veli palatini muscles of man form a functional unit? A histochemical investigation of their putative connections.

The discussion among anatomists and otolaryngologists about the muscles originating from the Eustachian tube and the connections between the tensor tympani and tensor veli palatini muscles started in the 1860s. From then on, a considerable number of contradictory hypotheses and data have been presented. However, before discussing whether or not these two muscles form a functional unit, interest should focus on the question of whether it is even possible. The cartilaginous portion of the Eustachian tube with all muscles originating from it, including the whole tensor tympani muscle, was dissected from five perfusion-fixed cadavers and removed in toto. Complete longitudinal serial sections of 10 microm were made in the axis of the tensor tympani muscle. Sections were alternatingly stained according to Cason's and Maskar's techniques. The macroscopic aspect (under the operating microscope) of a tendinous connection between the two muscles under consideration could be proven by the histochemical methods used in all cases. Based on our findings and the literature reviewed we are convinced that the tensor tympani and tensor veli palatini muscles of man constitute a functional unit. This represents an important step forward towards the understanding of the possible functions the tensor tympani muscle serve in man.

Eustachian Tube↗

[Is posterior lumbar epidural space partitioned?].

The anatomy of the posterior lumbar epidural space (PLES) has been extensively studied. Besides the anatomists, surgeons, radiologists and anaesthetists have taken an interest in this. However, because each one has considered the PLES from his own specialist field, descriptions are not always concordant. In particular, the reality of a medial partition in the PLES has been suggested by epidurography and intraoperative observations. Lewit and Sereghy and Luyendijk opened the debate by reporting, on antero-posterior epidurographic films, a clear-cut, medial, vertical and narrow picture which partitioned the PLES. However, this was not constant. Savolaine et al. also recognized this partition on epidurographic CT scans. During laminectomies, Luyendijk has taken photographs of a medial fold of the dura mater which appeared to hold it to the posterior vertebral arch, being collapsed on either side of the midline. He named it "plica mediana dorsalis durae matris" (PMD). Several anaesthetists considered that this could explain why epidural analgesia sometimes acted on one side only. Husemeyer and White, and Harrison et al., have tried to confirm this experimentally by making casts with polymerizing resins in cadavers. They did not get very convincing results. Blomberg also tried to see this space by epiduroscopy in the cadaver. Unfortunately, for technical reasons, his photographs were of poor quality. He, however, reported having seen each time the PMD and a band of connective tissue fixing it to the vertebral arch in the midline. However, all these anatomical studies used methods which alter the natural structures. Their results are therefore questionable. The PLES is a virtual space. Histological studies have shown that it is filled with fatty tissue between the dura and the vertebral arch. It is therefore conceivable that any liquid injected into the PLES, such as contrast medium or local anaesthetic, must push back the dura, the only tissue which can move to give it any room. The fatty tissue could therefore be compressed and take any of the shapes which have been described on epidurography. On the other hand, should it be torn, it seems this fatty tissue could make up these haphazard fibrous tracts tensed between the dura and the vertebral arch, such as described in classical anatomy, as Bonica recalled. These can be clearly seen during surgical and anatomical dissections, and during endoscopies carried out on cadavers with sufficient optical means, as opposed to the medial fibrous band fixing the dura to the vertebral arch.(ABSTRACT TRUNCATED AT 400 WORDS)

Endoscopy↗

[Supernumerary muscle on the dorsal surface of the hand. A case report].

The authors report a case of a painful wrist related to a "Manieux muscle" of the dorsal aspect of the hand. Manieux muscles are very rare supernumerary muscles first described by anatomists at the beginning of the 20th century. To our knowledge no symptoms related to this condition have been previously reported. In the present case, symptoms were limited to pain in the wrist with the presence of a fluctuant tumor. The putative diagnosis was synovial cyst. The abnormal muscle was revealed at operation. The operative findings confirmed the responsibility of the Manieux muscle for the patient's symptoms. The muscle was totally resected and pain completely disappeared without any functional impairment.

Female↗

Chiari network entanglement and herniation into the left atrium by an atrial septal defect occluder device.

The Chiari network is a fenestrated membrane consisting of threads and strands in the right atrium. First described in 1897 by anatomist Hans Chiari, it is a congenital remnant of embryonic development resulting from incomplete resorption of the right valve of the sinus venosus. Found in 2% to 3% of the population, it is generally not of clinical importance. Rarely, however, the network may be associated with serious complications such as thrombus formation, embolus entrapment, arrhythmia, tumor development, and catheter entrapment. We report the entanglement of an Amplatzer septal occluder device catheter in a prominent Chiari network that was herniated into the left atrium. Transesophageal echocardiographic recognition of this before deployment and guidance during disentanglement is described below.

Aged↗

Retrograde effects on synaptic transmission at the Ia/motoneuron connection.

The fidelity of impulse propagation through the complex axonal tree en route to the various target cells of that fiber is an important question in neurobiology. Anatomists can trace pathways, but if impulses fail to propagate down to the terminals to release transmitter onto the target cell, there is a significant 'disconnect' between anatomy and physiology. These issues have been studied at length in the spinal cord of the cat where it has proven possible to examine the connections made by afferent fibers on motoneurons under different stimulus conditions. EPSP amplitude varies systematically during high frequency stimulation of the afferents according to the identity of the target motoneuron. This variation is a function of the state of the motoneuron's relation to its peripheral target. It changes after motoneuron axotomy and recovers with reinnervation of the periphery. Neurotrophins delivered to the axotomized motor axons fail to induce recovery. Chronic stimulation of the motor nerve alters muscle properties with coordinated changes in properties of the synapses on motoneurons innervating the stimulated muscle. We cannot yet definitively establish the mechanisms determining synaptic behavior during high frequency stimulation. However, the retrograde regulation of these properties suggests that it is an important variable and thus is worthy of intensive further study.

Animals↗

The painted Amsterdam anatomy lessons: anatomy performances in dissecting rooms?

The Anatomy Lesson of Dr. Nicolaes Tulp, painted by Rembrandt in 1632, has recently been fully restored. From 02-10-98 to 10-01-99 this painting and some other Amsterdam painted anatomy lessons were exhibited in the Mauritshuis in The Hague, with the title "Rembrandt under the scalpel". The unique Tulp painting is one of those portraits painted in the tradition of the famous group portraits which flourished in 17th-century Holland, a predominantly urban, middle-class society where the main patrons of the arts were the leading citizens of the various towns. Moreover, it is a portrait in the tradition of the anatomy lessons especially painted for the Guild of Surgeons for their Guild Room. Nine such lessons have been painted for the guild and are still to be found in Dutch museums (Mauritshuis and Amsterdam Historical Museum). The anatomy lesson of Prof. Andreas Bonn, dated 1792, as well as some group portraits of the leading persons of the guild also play an important role in the Amsterdam group portraits. In 1925 the Amsterdam anatomist Louis Bolk commissioned Martin Monnickendam to paint another anatomy lesson. The restoration of the painting of Dr. Tulp has provided new information concerning the original composition of Rembrandt and the later additions. However, from an anatomical point of view, it is doubtful whether the Amsterdam anatomy lessons depict a real contemporary anatomical demonstration. They provide, together with archival sources, reliable information about the praelectores anatomiae and the leading persons of the guild, but fail to give much information about the dissecting room, the anatomy theatre or the procedure. The anatomical demonstration procedures of the guild are discussed in relation to the painted anatomy lessons.

Anatomy↗

[Johann Friedrich Meckel the Younger (1781-1833), an extremely important naturalist and scholar].

Johann Friedrich Meckel the Younger (1781-1833) belongs to the famous scientists of the 19th century. His research work is enormous. Important termini e.g. diverticulum Meckelii, cartilago Meckelii, Meckel syndrome and Meckel Serres law reflect the scientific results obtained by Meckel. He worked as a professor of anatomy, pathology and zoology at the University of Halle, a town in the Central Germany. Meckel founded the scientific teratology. In the literature he is also referred to the German Cuvier. On 8 April 1802, J. F. Meckel defended his doctoral thesis "De cordis conditionibus abnormibus". On occasion of the 200th anniversary of this event, we like to honor J. F. Meckel the famous German anatomist. Therefore, during the 97th session of the Anatomische Gesellschaft at Halle, a satellite symposium "From Meck el to genom" was held.

Anatomy↗

[The scholarly program of Johann Friedrich Meckel the Younger (1781-1833) and it importance for the development of life sciences].

Although Johann Friedrich Meckel the Younger was one of the most famous anatomists, his research work has been severely neglected in the recent historiographical literature on the German morphology. The goal of our study is to approach a general characterization of his research program. Our analysis reveals that Meckel introduced the Cuvierian empiricism in Germany, but he also considered the "Abstraktion" as a main component of the scientific knowledge. According to his epistemology on nascent organisms and transmutable species, both, variability and relatedness of the organic forms are important to the same degree. Meckel explicitly adopted the Jean-Baptiste de Lamarcks (1744-1829) evolutionary theories. Even though in Meckel's discourse about diversity the Cuvierian notion of "functional adaptation" was preserved, the main goal of his research program was to demonstrate empirically the "Allgemeinheit des Bildungstypus". For this purpose, he considered the entire variety of the animal kingdom: normal as well as abnormal organisms, adult specimens and above all embryos. Moreover, he believed that the abnormal development is due to the same laws as the normal development. He applied parallelisms to a new domain, the study of malformation. With Meckel's researches on teratology, a new era in the analyses of the anomalies was opened. They became an integral part of the natural diversity and thus a highly exploited subject of biomedical researches. Meckel's empirical and epistemological writings on the embryology, comparative embryology, teratology, pathology, systematics and comparative anatomy have largely contributed to the foundation of the biological research.

Anatomy↗