MISTAKES IN THE USAGE OF ANATOMICAL TERMINOLOGY IN CLINICAL PRACTICE

a Department of Anatomy, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Praha 10, 100 00, Czech Republic b Department of Medicine and Humanities, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic c Institute of Czech Language and Theory of Communication, Faculty of Arts, Charles University in Prague, Czech Republic d Department of History of Medicine, Third Faculty of Medicine, Charles University in Prague, Czech Republic e Centre of Scientific Information, Third Faculty of Medicine, Charles University in Prague, Czech Republic f Institute of Information Studies and Librarianship, Faculty of Arts, Charles University in Prague, Czech Republic


BACKGROUND
All scientific fields use terminology as a basic tool for communication and recording.Anatomy can be considered as the first exact medical field dating back to the ancient period and that is why its terminology stems from Greek and later Latin.This principle has endured until now and serves as a base for anatomical nomenclature.The aim of this article is to show the current situation of the anatomical terminology which is used both during the study of medicine and in the communication among specialists from all medical branches.Using terms that were omitted in newer revisions of the Latin anatomical terminology, is currently very common.Who is responsible for the inappropriate use of terminology?Clinicians, who are not well informed about new versions of the anatomical nomenclature?Or is the nomenclature itself insufficient?And as a result, the clinicians introduce their own terms for some anatomical structures.
Firstly, it is necessary to define several terms.Anatomy uses a special vocabulary, but anatomical terminology and nomenclature must be distinguished unlike in many other medical fields.Terminology is a system of terms used in a certain scientific branch.Nomenclature is a standardized system of precisely defined terms, set according to certain classification principles and containing terms created within the scope of terminology.The nomenclature is usually assented by a special commission of the appropriate scientific field.

Vena femoralis communis
The last proximal valves in the end segment of the vena saphena magna and the vena saphena parva

Valvula terminalis
The second last proximal valves in the end segment of the vena saphena magna and the vena saphena parva

RESULTS
This year, 114 years have passed since the first anatomical nomenclature approval in Latin in the year 1895.The first traces of the nomenclature go back to the time of Hippokrates of Kós (circa 460-370 BC) in Greece.He introduced for example the term bronchus or peritoneum.Aristotle (Aristoteles, 384-322 BC) wrote of the diaphragma, pancreas or aorta.Rufus of Efesos (late 1st century AD) published the first book concerning the terminology, entitled "On the naming of the parts of the body".Aulus Cornelius Celsus (25 BC-circa 50 AD) introduced sutura, patella or cartilago.Cladius Galenos of Pergamon (129 or 130-199 or 200) described many new parts of the body but avoided the use of terminology; nevertheless he introduced e.g.epiphysis and hypophysis, coccyx, tarsus, pylorus, aponeurosis or epididymis 1 .Andreas Vesalius Bruxellensis (Andreas van Wesel, 1514-1564), author of the first true anatomy atlas "De fabrica corporis humani libri septem" which replaced all the Greek and Arabic terms with Latin ones and initiated the usage of ordinal numbers for muscles, bones, blood vessels and nerves.In osteology alone, he included more than 700 structures 2 .Jacobus Sylvius (Jacques Dubois, 1478-1555) preferred descriptive terms and invented new terms for muscles, blood vessels and nerves Caspar (Gaspard) Bauhin (1560-1624) promoted new types of descriptive terms for muscles, based on their origins and insertions 3 .Johannes Jessenius (Ján Jesenský, 1566-1621) employed in his work "Anatomiae pragae anno MDC selenniter administrate historia" both an ordinary and descriptive approach in the terminology 4 .
The modern period brought an exorbitant mass of anatomical terms.Several terms were used as synonyms for the same structure but simultaneously one term could have been applied as a homonym for more structures.Eycleshymer counted 16 synonyms for "glandula pinealis" in 1917, e.g."pineal body, parietal eye, penis cerebri or epiphysis" 3 .Friedrich Gustav Jakob Henle (1809-1885) and Joseph Hyrtl (1810-1894) tried to solve this problem and the latter published an explanatory book called "Onomatologia anatomica", which consists of a detailed linguistic analysis of 421 terms 5 .
The society of German-speaking anatomists (Anatomische Gesellschaft) issued the first Latin anatomical nomenclature in 1895 as the Basiliensia Nomina Anatomica (BNA).In 1903, the International Federation of Associations of Anatomists (IFAA) was founded and began to revise the nomenclature.In 1933, the Anatomical Society of Great Britain and Ireland published its own norm called Birmingham Revision (BR) and the Anatomische Gesellschaft edited a new revision, the Jenaiensia Nomina Anatomica (INA) in 1935.The International Anatomical Nomenclature Committee (IANC) was established by IFAA in 1936 and issued the first version of the Latin anatomical nomenclature accepted worldwide as the Parisiensia Nomina Anatomica (PNA).Due to accelerating research progress, further revisions were published as the Nomina Anatomica (NA): 2 nd to 6 th edition (1961, 1966, 1977, 1983, 1989).The 4 th edi-tion of NA was combined with the first Latin histological and embryological nomenclatures (Nomina Histologica, Nomina Embryologica).A new commission was nominated (The Federative Committee on Anatomical Terminology -FCAT; it later changed to Federative International Committee on Anatomical Terminology -FICAT) in 1989 and for the time being the last revision was edited in 1998 as the Terminologia Anatomica, subtitled International Anatomical Terminology (TA) [6][7][8] .
The first real steps of clinicians were two consensus documents, approved in 2001 and 2004 by the International Union of Phlebology (IUP), IFAA, and FICAT which revised and extended the nomenclature of the lower extremity veins [9][10][11][12] .The last enterprise of FICAT is the Terminologia Histologica (TH), subtitled International Terms for Human Cytology and Histology 13 .
The official terms of the TA, used in this article, are written in italics and with quotation marks; the unofficial, old or incorrect terms are in normal font and with quotation marks.
TA (including the CD-ROM) comprises the 7635 Latin anatomical terms which are considered as standardized.They are accompanied by the terms currently used in the English-speaking countries.Each pair of terms owns a unique identification number.Indentation and headings are used to indicate the relation between the two following terms.The list of Latin terms is recommended to serve as a base for revising the national anatomical nomenclatures.FCAT kindly invites constructive comments and considerations for future editions in the preface of TA.They should be sent by e-mail to leser.service@thieme.deor by mail 6,14 .
We start with general anatomy.The terms used to describe the planes, sections, and directions are very old and stated by all versions of the nomenclature.But due to the inclination of INA towards the veterinary anatomy, many terms have been erroneously applied to the human body by simply changing the position from vertical to horizontal to unify the human and animal anatomy.PNA brought the definitive replacement of terms for the direction ("cranialis-caudalis, ventralis-dorsalis") with terms for the position ("superior-inferior, anterior-posterior"), i.e.. "arteria mesenterica superior" instead of "arteria mesenterica cranialis" (which remained for the veterinary anatomy only).Except the nervous system, the term "cranialis" is used only to describe the relation to the skull ("cranium") -"pars intracranialis arteriae carotidis internae"), the term "caudalis" in "retinaculum caudale" in hypodermis above the coccyx, "ventralis" in some small muscles of the trunk and "dorsalis" in case related to the dorsum of an organ (hand, foot, tongue, penis).In brain, due to its flexion during the development anteriorly, the original terms do not designate the appropriate directions, e.g.there are both "nuclei anteriores et posteriores" and "nuclei ventrales et dorsales" in the diencephalon.
Other examples of the obsolete terms from previous nomenclature or from clinical use their valid Latin anatomical terms, used in TA, are listed in the Table 1.
An interesting phenomenon is an extensive introduction of new terms in TA, reflecting the rapid development of some scientific branches.This is seen especially in the nervous system with 1082 new items when compared to PNA.This includes newly described nuclei (e.g."sagulum" in lateral part of the tegmentum pontis), various groups of cells "aggregationes cellularum chemergicarum" -33 terms of cell groups producing neuromediators), pathways, tracts, etc.
TA introduced abbreviations and symbols, placed behind the term in square brackets using Arabic and Roman ciphers and upper case letters -see Table 2.The abbreviation "Th" for the thoracic vertebrae was simplified to mere "T".
Not only were whole words and terms changed, but also the orthography.The diphthong -ae -has been successively simplified to -e -(e.g.instead of "praeputium", "peritonaeum", "aequator" we use "preputium", "peritoneum", and "equator").As for the grammar, many errors can be found in current journals concerning problems with declension, e.g."vasa femoralis" instead of "vasa femoralia" or "vasa vasora; vasa vasorium" in place of "vasa vasorum".Frequently, the authors of articles themselves introduce errors, for example "nodus sinuatrialis" is sometimes written as "nodus sinoatrialis", or clinical terms for examination should be used as sinuscopy and sinutomy and not sinotomy a sinoscopy, because they are both derived from the term "sinus".The adjective "inguinalis" is related to "inguen" (groin) and must not be written as "inquinalis".Often used term "arteria carotica" shall be replaced with "arteria carotis" (with plural term "arteriae carotides").Spelling mistakes are represented by for example "siphon caroticum", which is different from the English translation carotid syphon, or by terms "ileofemoralis" or "ilicocavalis" which should be written as "iliofemoralis" and "iliocavalis", since they have been derived from the term "iliacus".An often used term "musculus dilator pupillae", obviously influenced by English, should be omitted and replaced with "musculus dilatator pupillae".
However, grammar mistakes are also present in the TA.We present two examples: "systema conducente cordis"the middle word should be written as "conducens" -and "lineae distractiones cutis" -the middle word should be stated as "distractions" 15 .
Thanks to the clinical anatomists, several clinical terms have been incorporated in the anatomical nomen-clature, either in TA or in its extensions 12 , see Table 3.There are discussions concerning including further terms, such as "articulatio femoropatellaris", "sinus venosus sclerae", and "ductus nasolacrimalis" 16,17 or arguing about the definition of the extent of the "canalis analis" 18 and the definition of the term "fascia" in various parts of the body -in hypodermis of abdomen and perineum, thoracic and abdominal cavity, or in lesser pelvis [19][20][21][22] .
For the description of the caudal end of the spinal cord, the terms "conus" and "epiconus" are frequently used in neurology.Unfortunately, only the term "conus medullaris" is a part of TA.
In radiological articles, concerning the distal part of humerus, a term "capitellum" is disposed with different meanings.It is applied either to the "capitulum humeri", then it should be omitted and replaced with the latter, or to the ossification center in the mass of the "capitulum humeri" and not only to its articular surface 23 .
Finally, ridiculous terms are components of the nomenclature ("hippocampus, oliva, amygdala") but a really startling paradox is the usage of the term "substantia innominata" of Reichert in TA.Joseph Hyrtl already expressed his amazement over such terms in 1880 15 .

CONCLUSION
The TA has not found its way among the medical specialists in the Czech Republic and thus has remained well-known only to the anatomists.We notice this sad and unpleasant situation in many translations of medical books in the Czech language after 1998.There are several exceptions in original Czech anatomical atlases and a few translated ones [29][30][31][32][33][34][35][36][37][38] .It is especially non-fiction books which suffer from this absence of information.This article should recall the existence of the TA and reiterate its fundamental importance.It should also draw attention to several principle changes and frequent mistakes in the Latin anatomical nomenclature.
As for the future of the nomenclature, FICAT prepares to issue the Terminologia Embryologica and to revise the Mistakes in the usage of anatomical terminology in clinical practice TA.All these activities are aimed at one goal: simple and unambiguous communication in our increasingly globalized world.
Authors of the article strongly recommend to use the recent revision of the Latin anatomical nomenclature, either in oral or in written form, both in theoretical and clinical medicine. ABBREVIATIONS

Table 1 .
The comparison of the obsolete terms from previous nomenclature or clinical use and the recently valid Latin anatomical terms.

Table 2 .
Terms and their abbreviations and symbols in TA.

Table 3 .
The clinical terms (or their definition) incorporated in TA and its extensions.