Vladimir Musil

Clinical anatomy of the calcaneal tuberosity

The aim of the study was a qualitative anatomical analysis of the macroscopic features of the surface of the calcaneal tuberosity, of the architecture of its cancellous bone and histological structure of the whole region. Dry human bones and pathological dissection material 24-36 h post mortem were used in the study. On the tuberosity, the variability of its surface relief and the two borders between the superior, middle and inferior facets were studied. More frequent medial declination of the inferior line, corresponding to the distal circumference of the Achilles tendon attachment, was found. Two systems of expressive condensation of cancellous bone just below the surface of the calcaneal tuberosity were described. In the histological part of the study, the distribution and different thickness of the fibrous cartilage layer covering the attachment region of Achilles tendon, the bottom of retro-calcaneal bursa and the whole surface of the calcaneal tuberosity were described. The functional and clinical relevance of results obtained are evaluated from the point of view of disciplines dealing with the pathology and surgery of the heel region. The relationships of official anatomical terms and a wide spectrum of clinical synonyms designating this region are discussed.

Terminologia Anatomica after 17 years: inconsistencies, mistakes and new proposals.

The article deals with our experience of Terminologia Anatomica (TA) in fields of education (of systemic and topographic anatomy) and clinical medicine (teaching of clinical anatomy and courses for young physicians in endoscopy). The anatomical nomenclature in Latin has been official for 120 years and its latest version for 17 years. Its main weak points should be discussed in public (or at least the discussion should be provoked), which is the reason for publishing the following findings and ensuing proposals. They are classified with seven groups: mistakes in TA, discrepancies in TA, multiplication of terms, synonyms in TA, identical terms for different structures, too long terms and missing terms in TA. The last group comprises missing terms in systemic anatomy, clinical anatomy, a paucity of terms in variant anatomy, in locomotion system and in topographic anatomy. Several attempts to draw attention to these have been made by the publication of inaccuracies in Nomina Anatomica and TA but this article summarizes and reviews current situation, emphasizing the weak points of the TA and brings several proposals and suggestions for further discussion.

The deep venous system of the lower extremity: new nomenclature:

The correct and precise nomenclature of the veins of the lower extremity is a necessary tool for communication. Three important changes have been done over the last 13 years. Terminologia Anatomica, the latest version of the Latin anatomical nomenclature, was published in 1998, extended in the area of the lower extremity veins with two consensus documents, in 2001, during the 14th World Congress of the International Union of Phlebology and in 2004 during the 21st World Congress of the International Union of Angiology. This article is a free continuation of two previous articles, reviewing the detailed anatomy and correct nomenclature of the superficial veins of the lower extremities and veins of pelvis. Now, it is concentrated on the deep venous system, in which 15 new terms have been added in both Latin and English languages.

Calcaneus, calcaneal tendon and retrocalcaneal bursa. Historical overview and plea for an accurate terminology.

Abstract Diseases and injuries of several specific structures in the heel region have been an enduring focus of medicine. The anatomical terminology of many of these structures has not been established until recently. The aim of the study was a historical analysis of the advances of anatomical terminology of three selected morphological units in the heel region-the Achilles tendon, calcaneus and retrocalcaneal bursa. It starts with a critical evaluation of the mythological eposes, the Illiad and Odyssey, describing the exploits of heroes in the Trojan war, followed by a review of relevant terms used for the designation of selected heel structures in the Middle Ages as well as in the 18th and 19th centuries. Principal versions of Latin anatomical terms used for the denotation of the mentioned structures are discussed. Recently applicable Latin terms and their recommended English synonyms, according to the latest version of Terminologia Anatomica (1998) are summed up. It surveys examples of “not very appropriate” terms, which are frequently used in clinical literature. The authors consider the use of official anatomical terms (both Latin and English) as an important step for the improvement of the clinical expressions and formulations.

Achilles tendon: the 305th anniversary of the French priority on the introduction of the famous anatomical eponym

This article presents a detailed chronology regarding the development of terminology relating to the calcaneal tendon, from ancient times to modern day nomenclature. The notable contributions of Flemish anatomist Philip Verheyen, French surgeon Jean-Louis Petit, German anatomist and surgeon Lorenz Heister, along with the actual origin of the famous anatomical eponym “Achilles tendon” are analysed. During the study of the aforementioned authors, it was revealed that the term was first adopted, in its original French form, by J.-L. Petit in 1705 and later in 1717, in its Latin form, by L. Heister.

An important Norwegian contribution to the study of the bursae of the upper and lower extremities

Abstract We present a critical analysis of the monograph of A.S.D. “En anatomisk beskrivelse af de paa over- og underestremiteterne forekommende Bursae mucosae”. The analysis was completed using anatomical information from the historically oldest publications dealing with the bursae of the extremities: . We are of the opinion that Synnestvedts publication is important, not only historically but also as a source of information for recent medical practitioners. Synnestvedts monograph has a wealth of literary citations, unambiguous opinions of seasoned anatomists regarding the structure and function of the synovial membrane, and detailed descriptions of dissections he performed on fetal and adult cadavers. The information in this publication may enhance the diagnosis of bursopathies and enthesopathies of the extremities.

Blood vessels of the normal and pathologically changed wall of the human vena saphena magna

The vascular supply of the wall of human vena saphena magna was qualitatively studied by the use of several morphological methods on both normal and pathologically changed veins. The material was obtained from patients undergoing aortocoronary bypass or surgery of the varices, and material from cadavers. Under physiological conditions, the wall of vena saphena magna is supplied by delicate system of vasa vasorum, organized in a form of feeding vessels branched into an irregular loose adventitial mesh and continuing further as a microcirculatory network supplying the two outer thirds of the media. Small local dilatations and tortuosities of adventitial veins were found on heavy varicose veins. Slight increase of vasa vasorum growing into the innermost layer of media was detected, but the hyperplastic intima remained avascular. In patients with recurrent varices or with vein thrombophlebitis intimal hyperplasia, degradation of media and thrombosis, were found. Apparent massive increase of vasa vasorum growing into the whole media, hyperplastic intima and into the organizing thrombi, were regularly observed. The increase of vasa vasorum is a part of the complex of pathophysiological reactions of the vein wall on the hypoxia developing during the most serious pathological changes, and not as the primary varicogenic factor. The vascular supply of the wall of the human vena saphena magna was qualitatively studied by the use of several morphological methods on both normal and pathologically changed veins. The material was obtained from patients undergoing aortocoronary bypass grafting or surgery of varices, as well as materials from cadavers. Under physiological conditions the wall of vena saphena magna is supplied by a delicate system of vasa vasorum. It is organized in a form of feeding vessels branched into an irregular loose adventitial mesh, which continues further as a microcirculatory network supplying the outer two thirds of the media. Small local dilatations and tortuosities of adventitial veins were found on severe varicose veins. A slight increase of the vasa vasorum growing into the innermost layer of media was detected, but the hyperplastic intima remained avascular. In patients with recurrent varices or vein thrombophlebitis, intimal hyperplasia, degradation of media and thrombosis, were found. It was regularly observed that there was an apparent, massive increase of the vasa vasorum growing into the entire media, hyperplastic intima, and into the organizing thrombi. The increase of the vasa vasorum is due to the pathophysiological reaction of the vein wall as a result of hypoxia, which develops during the most serious pathological changes. The increase is not the primary varicogenic factor.

A plea for extension of the anatomical nomenclature. Part 1: Nervous system and senses

A correct, exact, concise and detailed anatomical nomenclature is a cornerstone of communication not only in anatomy and related subjects but also in other medical branches and in the whole medical education. Terminologia Anatomica fulfils this task but some important structures are still missing there. The authors have collected and present here a list of terms including their definitions or explanations to provoke discussion about possible extension of the Terminologia Anatomica. The first part of this contribution, presented in this article, comprises 113 terms concerning the regulation systems of the human body: endocrine glands, central and peripheral nervous system, and senses. It also contains some corrections of anatomical mistakes, systemic inconsistencies and grammar changes.

Contribution to the anatomical nomenclature concerning general anatomy and anatomical variations

Nomenclature of the general and variant anatomy belongs to the most neglected parts of the Latin anatomical nomenclature in Terminologia Anatomica. Although many important small structures are included in Terminologia Anatomica, when describing and teaching particular anatomy of any part of the human body, the general terms are necessary, such as planes, lines and flexion grooves. Moreover, Terminologia Anatomica contains only 149 terms of variant structures, enlisted in the parentheses to differentiate them from constant ones. They are only a rather representative selection and some more should be added, both from the educational and clinical point of view. The authors present some terms, completed with their definitions or explanations concerning the general and variant anatomy to evoke broader discussion on this topic which should issue in incorporation of proposed terms (or their equivalents) into the Terminologia Anatomica.

Contribution to the anatomical nomenclature concerning upper limb anatomy

PurposeThe aim of this article is to revise and extend the existing sections of Terminologia Anatomica dealing with the upper limb structures, which nomenclature belongs to its most neglected and not developing parts, and to justify the use of the proposed anatomical terms in the clinical practice, research, and education.MethodsA sample collected from own educational and research experience was matched in the main anatomical textbooks as well as old and recent anatomical journals and compared with four versions of the official Latin anatomical nomenclatures.ResultsThe authors summarize here 145 terms, completed with their definitions or explanations, concerning both constant and variable (inconstant) morphological structures (bones, joints, muscles, vessels, and nerves) of the pectoral girdle, arm, cubital region, forearm, wrist, and hand, completed with some grammar remarks and several general terms.ConclusionAfter a broad discussion on this topic, the Terminologia Anatomica should be revised and extend with the listed terms (or their equivalents).