Adriaan van den Spiegel (1578-1625): Anatomist, physician, and botanist

Public human dissection and societal connect of anatomical sciences: A glorious association in the past but ethically forbidden practice at present

Under the futuristic vision of anatomical sciences, a strong societal connection is mandatory. The anatomical practice experienced robust societal participation through public human dissection from the 16th century onward. With a perspective to explore the intersection of spirituality with anatomy, the present study analyzed this momentous period. From a spiritual perspective, the study also reflects on two relevant but presently uncoupled entities of public human dissection and societal connection through the prism of current regulations. Strong representation from the general public during public human dissection was primarily driven by spiritual proclivity and an endorsement from religious authorities. To regulate large gatherings and maintain academic sanctity, anatomical theaters emerged as dedicated spaces for such a merger. With time and growing financial support, the theaters transformed from temporary structures to elaborate architectural marvels, further propelling already robust societal connections associated with the practice. Nevertheless, a confluence of multiple factors led to the violation of spiritual principles and a consequent decrease in societal participation from the early 18th century, eventually culminating in the demise of such spectacle. Presently, public human dissection-when done-is mostly conducted for commercial gains and in contravention of ethical norms. It is against the essence of spirituality and harbors a bleak prospect for societal connection. Contrastingly, measures adopted to promote societal participation (mostly related to body donation) were quite effective and followed the principles of spirituality. Societal connections served anatomy in the past and can lead to its advancement if approached through a righteous path.

Spigelian hernia: current approaches to surgical treatment-a review

BACKGROUND

Spigelian hernias (SpH) belong to the group of eponymous abdominal wall hernias. Major reasons for diagnostic difficulties are its low incidence reaching maximum 2% of abdominal wall hernias, a specific anatomical localization with intact external oblique aponeurosis covering the hernia sac and non-constant clinical presentation.

METHODS

A literature review was completed to summarize current knowledge on surgical treatment options and results.

RESULTS

SpH presents a high incarceration risk and therefore should be operated upon even if the patient is asymptomatic. Both laparoscopic and open repair approaches are validated by current guidelines with lesser postoperative complications and shorter hospital stay in favour of minimally invasive surgery, regardless of the technique used. Overall recurrence rate is very low.

CONCLUSION

All diagnosed SpH should be planned for elective operation to prevent strangulated hernia and, therefore emergency surgery. Both open and laparoscopic SpH treatment can be safely performed, depending on surgeon's experience. In most cases, a mesh repair is generally advised.

The evolution of epistemological methodologies in anatomy: From antiquity to modern times

Present day scenario regarding epistemological methods in anatomy is in sharp contrast to the situation during ancient period. This study aimed to explore the evolution of epistemological methodologies in anatomy across centuries. In ancient times Egyptian embalmers acquired anatomical knowledge from handling human bodies and likewise anatomical studies in India involved human dissection. Ancient Greeks used theological principles-based methods, animal dissection and human dissection in practice of anatomy. Human dissection was also practiced in ancient China for gaining anatomical knowledge. Prohibition of human dissection led to use of animal dissection in ancient Rome and the trend continued in Europe through Middle Ages. Epistemological methods used by Muslim scholars during Middle Ages are not clearly chronicled. Human dissection returned as primary epistemological method in Renaissance Europe and empirical methods were reinstated after ancient period in human dissection during 16th century. The situation further improved with introduction of pragmatic experiment based approach during 17th century and autopsy-based methods during 18th century. Advances in anatomical knowledge continued with advent of microscope-based methods and emergence of anatomical sections in practice of human dissection in 19th century. Introduction of human observational studies, medical imaging, and molecular methods presented more options in terms of epistemological methods for investigating the human body during 20th century. Onset of 21st century has witnessed dominance of technology-based methods in anatomy. Limited emphasis on ethics in epistemological methodologies since antiquity is a dark aspect of otherwise an eventful evolutionary journey but recent developments are in positive direction.

Raymond de Vieussens (1641-1715): connoisseur of cardiologic anatomy and pathological forms thereof

Raymond de Vieussens was an exemplary anatomist who made seminal contributions in the field of cardiology. During initial part of his academic career, he adopted human dissection based experiments as medium of his research. This was in accordance with prevailing trend among anatomists during 17th century. He discovered the presence of tiny venous tributaries communicating between cardiac veins and chambers of heart (ducti carnosi/venae cordis minimae). He reported the existence of a collateral circulatory pathway between right and left coronary arterial systems (Vieussens arterial ring). He was the first to note the valve at the junction of great cardiac vein and coronary sinus (valve of Vieussens) and the prominent oval margin of the fossa ovalis (Vieussens Annulus). All his findings were associated with considerable clinical significance as evidenced in literature that followed. Vieussens accurately demonstrated the three-layered orientation of myocardium and gave a precise description of coronary arteries and their branches. At the onset of 18th century, buoyed by royal patronage from King Louis XIV of France, the second half of Vieussens illustrious career was defined by pathologic anatomy (autopsy based) and anatomo clinical correlations. This was a new trend initiated by Vieussens in anatomical research and was later adopted as a signature method by anatomists of 18th century. As a true connoisseur of cardiologic anatomy, Vieussens accurately charted the anatomo clinical correlations of cardiac tamponade, mitral stenosis and aortic regurgitation. His contributions were pivotal elements in metamorphosis of cardiology as a robust discipline of medicine in modern times.

Evolution of the fabric of cardiovascular science: Saga of an enduring process of refinement

BACKGROUND

The core elements of cardiovascular science have been established by scholarly pursuits of numerous scientists across centuries. In this article, we have tried to trace the evolutionary journey of cardiovascular science from a rudimentary form in ancient period to a robust scientific discipline in modern times.

METHODS

A literature search of relevant, peer-reviewed, published articles was undertaken from indexed databases (Medline & Pubmed, Scopus, Embase, CINAHL Plus, Web of Science and Google Scholar).

RESULTS

Cardiovascular science has its roots in antiquity, when Greek scholars mostly relied on philosophical thoughts and ancient texts. This was followed by addition of few structural details to the theory of circulation by Galen based on animal dissection. Arab scholar Ibn al-Nafis provided new insights regarding circulation pathway in humans. Nevertheless, an erroneous concept prevailed into the onset of European Renaissance. Even with legalization of human dissection, little headway could be made till sixteenth century due to persistent reliance of anatomists on ancient Galenic principles. During seventeenth century, the circulatory pathway (as we know it today) was established due to significant contributions from scholars like Harvey and Malpighi. Their efforts were based on findings from experiments and logical conclusions. Eighteenth century witnessed the emergence of autopsy based methods which led to valuable contributions from Vieussens, Thebesius, Morgagni and Hunter regarding normal and pathologic anatomy of cardiovascular system. With structural details mostly established, researchers during nineteenth century focussed on innovations in diagnostic methods based on human experiments. Further development of advanced human experiment models during twentieth century led to emergence of contemporary treatment methods for various cardiac conditions. In the twenty-first century, cardiovascular science is undergoing comprehensive progress at an exponential rate due to technological advances.

CONCLUSION

The evolutionary journey of cardiovascular science as a discipline across centuries has been intriguing and eventful.

Anatomy of nervous system and emergence of neuroscience: A chronological journey across centuries

Scholars began exploring anatomy of nervous system from ancient times; however, considerable progress could only be made during the European Renaissance from the 14^th century onwards. The present study aimed to document significant discoveries in this context in chronological order to establish the cascading pattern of advancement in knowledge. The findings of Leonardo da Vinci (15^th century), Vesalius (16^th century) and their contemporaries, which were based on macroscopic dissection, helped to break the shackles of misconceptions in hypotheses prevalent from the time of Galen. However, very little headway could be achieved beyond superficial descriptions. Willis (17^th century), through his experimental studies, provided the much-needed impetus and his discoveries put the study of brain and nervous system on their modern footing. In the following years, prominent researchers through their observations based on the use of microscopy and advanced histological techniques (prevalent after invention of microtome) contributed towards significant discoveries related to the morphological details of different components of nervous system. Such scientific activities culminated in remarkable advancements by the middle of 19^th century. The advent of Golgi's staining technique and subsequent histological exploits of Cajal (late 19^th century) established the neuron theory, which is central to comprehending the functioning of nervous system. Availability of Golgi's staining technique remarkably contributed in detailing the anatomical structure of nervous system at microscopic level. Access to structural details pertaining to living anatomy (late 20^th century) and focus on findings at the molecular level by turn of 21^st century have firmly established neuroscience as a sovereign academic discipline.

Spigelian hernia in gynaecology

Background

A Spigelian hernia is a rare hernia through the Spigelian fascia between the rectus muscle and the semilunar line. This hernia is well known in surgery. Symptoms vary from insidious to localised pain, an intermittent mass and/or a bowel obstruction.

Results

The Spigelian hernia is poorly known in gynaecology. Spigelian hernias may be causally related to secondary trocar insertion. This review is written to increase awareness in gynaecology and is illustrated by a case report in which the diagnosis was missed for 4 years even by laparoscopy. Smaller hernias risk not to be diagnosed and will thus not be treated. Even larger Spigelian hernias might not be recognised and treated appropriately.

Conclusions

The gynaecologist should consider a Spigelian hernia in women with localised pain in the abdominal wall lateral of the rectus muscle some 5 cm below the umbilicus. Smaller hernias can be closed by laparoscopy without a mesh. Larger hernias require a mesh repair.

Giovanni Battista Morgagni (1682-1771): father of pathologic anatomy and pioneer of modern medicine

Giovanni Battista Morgagni (1682-1771) was an Italian anatomist who introduced the anatomo-clinical concept in medicine and established anatomy as the instrument to identify the seat and etiology of any disease. He was professor of anatomy at the prestigious University of Padua for more than 50 years. His first documented text in anatomy, Adversaria Anatomica was published in three volumes between 1706 and 1719. His accurate anatomical descriptions of human organs enhanced his reputation as the most famous anatomist of Europe during that period. Morgagni published the most important work of his life, the masterpiece in pathologic anatomy, De Sedibus, in 1761. The text is based on his pathologic observations from about 700 autopsy dissections of patients whom he had treated during their lifetime. De Sedibus provides the reader with a precise correlation between the anatomo-pathologic findings at post-mortem and the clinical symptoms of a disease observed during a lifetime. Morgagni's ability to integrate and synthesize information set him apart from his contemporaries, and his anatomo-clinical method was a major breakthrough in the history of medicine as it helped physicians to diagnose a disease, analyse the prognosis of that disease and prepare a management protocol for the same. His achievements led to the emergence of pathologic anatomy as an exact science and with him began modern medicine.

Iulius Casserius: revolutionary anatomist, teacher and pioneer of the sixteenth and seventeenth century

The demand for anatomical illustrations in the early modern period coincided with a scientific revolution. Starting out as a servant, Iulius Casserius became a great anatomist, who challenged the Galenic doctrine. The aim of this paper is to honor his memory and recreate the stylism of his anatomical illustrations. Online databases were searched for articles and original works. A medical graphic designer then recreated the figures presented in the article. Casserius was born around 1552. After moving to Padua, he served Fabricius in performing dissections. Obtaining his medical degree, he began working as an anatomical dissector and surgeon, later giving private anatomy lectures to students. He published De Vocis Auditusque and Pentaestheseion, and then became the lecturer of Surgery. In 1616, Casserius started his first Anatomy course and then died suddenly, at the height of his career. From the sixteenth century, illustrative techniques began focusing less upon artistry in favor of precise depictions of anatomical structures. Fabricius is considered to have used a strict scientific approach to illustrations for the first time. Anatomists of subsequent generations would still frequently use artistry in illustrations. Despite Casserius' mixed accuracy and artistry, his plates mark a new epoch in anatomic representation. Casserius left numerous eponyms and depicted, for the first time, many anatomical structures. Reprints in textbooks in the centuries following show convincing evidence of his success. Casserius contributed to medical education by taking the theatricality out of anatomy. Our article is a tribute to Casserius's achievements and depicts the revolution brought forth by a pioneer of his times.

Sella turcica: an anatomical, endocrinological, and historical perspective

INTRODUCTION

The sphenoid bone has a superior depression called the sella turcica, Latin for "Turkish saddle," where the pituitary gland is found. The availability of modern radiological imaging techniques has replaced plain radiography of the sella turcica in the investigation of hypothalamo-pituitary abnormalities. However, the size of the sella turcica, and smaller sella turcica size in particular, may cause pituitary dysfunction because of the changes in the structure of pituitary gland or may be associated with some genetic or acquired endocrine disorders. The name "sella turcica" is one of the most commonly used terms in everyday endocrine practice.

METHODS

In this review, after a brief explanation of the anatomical and endocrinological features of the sella turcica had been given, a historical perspective of sella turcica nomenclature was presented for the first time.

FINDINGS AND CONCLUSIONS

After Andreas Vesalius's description of it as a suitable cavity for the gland that receives the "phlegm of the brain" in De Humani Corporis Fabrica (1543), medical scholars began to use seat/saddle-related terms such as the ephippium, pars sellaris, sella equina, sella ossis, and sella sphenoidalis. The real designation of the sella turcica, however, was introduced to the anatomical nomenclature by the anatomist Adrianus Spigelius (1578-1625) in his famous work De Corpora Humanis Fabrica (1627).

An atypical lateral hernia and concomitant inguinal and umbilical hernias in a patient with polycystic kidney disease and an intracranial aneurysm - a combined approach of clinical and radiological investigation, endoscopic hernia repair, and anatomical cadaver model documentation and a systematic review of the literature

Atypical hernias are difficult to diagnose due to their rarity and often unspecific symptoms. In the literature there exist hints to peri-inguinal hernias, i.e. direct lateral hernia, but most of them are forms of Spigelian hernias. Since the majority were described during the first half of the past century or even earlier, only very few cases have been documented using modern diagnostic techniques. We report a unique case of a 51 year old patient presenting with an atypical inguinal hernia with concomitant inguinal and umbilical hernias in combination with cystic kidney disease and intracranial aneurysm. The atypical position of the hernia was assumed from clinical inspection, ultrasound and CT scan and verified during pre-peritoneoscopy. Using an anatomical cadaver dissection approach, we followed the unusual position of the hernia through the abdominal wall below the aponeurosis of the external oblique muscle. After a thorough literature search, we assume that the present hernia containing a hernial sac has not been documented before, especially not in such a multidisciplinary approach comprising radiological, surgical and anatomical localisation and endoscopic treatment in a patient with a clinical situation being aggravated by large cystic kidneys leading to dialysis-dependency. Rare hernias have been described as being often associated with concomitant inguinal or other hernias, a predisposition for the male gender and a pathogenic mechanism related to other soft tissue defects such as cystic kidney disease or cranial aneurysm. Thus, we consider this a unique case that has not been documented in this constellation previously, which may increase the awareness for these rare hernias.