Posted on March 17, 2016February 17, 2023 by Ashley Davidoff

Anatomy of Endometriosis and Adenomyosis

Ashley Davidoff MD

Endometriosis is a disease caused by misplaced or ectopic endometrial tissues located beyond the uterus most commonly resulting in pain at the time of menstruation. The ectopic endometrial tissue is controlled by the oestrogen and progesterone cycles. The ectopic tissue bleeds at the time of menstruation and causes pain. Since neither the ectopic endometrium nor the blood can be extruded from the body, recurrent bleeding eventually results in scar formation which may cause non cyclical chronic pain.

Chronic Pelvic Pain is Unbearable

Endometriosis and adenomyosis cause horrific pain. For some the pain may only occur during the menstrual cycle but for others it can be constant, day and night, excruciating in nature, invading every aspect of normal daily life . Pain is a common symptom defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” This statement characterizes the evolved nature of pain as a warning system and feedback mechanism that influences how we adapt to our environment. However, pain at its core it is suffering and its persistence can be insufferable for people and diagnostically problematic to those who care for the sick, as well being a burdensome cost to society.

The cause of endometriosis is not truly known. Long standing hypotheses include spillage of endometrial tissue into the peritoneal cavity via the fallopian tubes or transvascular spread to remote areas . More recent hypotheses include spillage of stem cells during embryonic development, metaplasia of coelomic epithelium, abnormal vasculogenesis, and environmental factors

Endometriosis occurs in 5-10% of women. When endometrial tissue is located outside of the uterus, it can cause pelvic and back pain, as well as pain with sexual intercourse (dyspareunia). It is also associated with infertility by distorting anatomy, (for example Fallopian tube adhesions) , or physiological changes that result in altered immune and hormonal environments with consequent impairment of ovum implantation .

From a structural standpoint, endometriosis most commonly affects the ovaries and Fallopian tubes but can affect any of the pelvic organs including the peritoneal cavity, bladder, ureters, bowel, broad ligaments, uterosacral ligaments, cul de sac and even the nerves. Implants range in size from small microscopic implants, but are are commonly about 1-2cm.

The Intraperitoneal Aspect of the Pelvic Cavity

The peritoneal cavity or coelomic cavity is a large cell lined space via which almost all the abdominal organs are connected . It may be considered the suburban space around which the houses of the town are positioned. The ova are released from the ovary into the peritoneal space, but they are quickly directed by the fimbriae into the Fallopian tubes.

Endometriomas

Endometriomas are large hemorrhagic cysts that occur on the ovary and may be up to to 20cms in size. They are usually round in shape, much like a large blood blister after they have bled. The nodules can be red-blue to yellow-brown in color, (chocolate cysts) and occur just below the serosa of the organ to which they are attached. As the lesions undergo recurrent hemorrhage, they can become associated with fibrosis as stated. Rarely they may be associated with malignant transformation.(<1%).

MRI of an Endometrioma

A T2 weighted image of the pelvis (left) with an overlay of colors on the right shows a 10cms endometrioma (overlaid in red) with internal debris better appreciated in the left image. The large ‘chocolate cyst” lies above the uterus (pink) and compresses the bladder (yellow)

MRI has a 90% specificity and 90% sensitivity for endometriomas. On T1 weighted images the endometriomas may be bright and do not lose signal on fat suppressed sequences. Heterogeneity is due to the presence of degraded products. Septations may also be present. Both these features are present in the above image . On T2 weighted sequences “shading” is caused by repeated episodes of bleeding reflecting hemorrhagic contents in various stages of degradation. The wall of the endometrioma may contain hemosiderin which leads to a loss of signal on the T2 weighted sequence.

Unusual Locations

Endometriosis is rarely can be more far reaching and may involve the kidneys, brain, diaphragm, and pleura. When it involves the diaphragm or pleura, shoulder pain may be associated with the entity. Pleural disease can cause life threatening catamenial pneumothorax induced by the menstrual cycle .

Endometriosis on the Bladder

A CT scan through the pelvis (left) shows an endometriotic implant on the bladder wall. The image on the right shows the endometriotic implant overlaid in maroon on the right anterior surface of the bladder (yellow overlay). The implant measures about 1.1cms. The fornix of the vagina is overlaid in pink. Most peritoneal implants are too small to be visualized by conventional imaging and require laparoscopic evaluation for diagnosis.

Endometriosis in the Skin of the Groin

A CT scan through the pelvis (left) shows an endometriotic implant in the subcutaneous region of the skin in the left inguinal region (image a, circled). The region is magnified in image b and the endometriotic deposit is labelled “e” with maroon overlay. An ultrasound of the left groin(c) shows the implanted endometriosis (black) medial to the artery (red) and vein (blue). In image d, the region of endometriosis (e) is overlaid in maroon.

Clinically the entity more commonly occurs in nulliparous women and the degree of pain is variable. As endometrial tissue, it is responsive to the cyclical hormonal fluxes, and thus may bleed in response to hormonal changes. Pain commonly occurs at the time of the menses. The volume of ectopic endometrial tissue does not correlate with the severity of the pain, but rather with the depth of infiltration into the tissue, or the degree of distension that might occur. The pain is usually recurring and commonly but not necessarily occurs during the menses. With induction of fibrosis, pain may be caused by other structural changes that are unrelated to the menses.

Diagnosis is suspected clinically and confirmed by ultrasound. When a woman in the reproductive phase of her life presents with pain, the imaging study of choice is a pelvic ultrasound. Hemorrhage into evolving follicles is a common cause of pelvic pain and these could be also quite large. This entity has to be differentiated from an endometrioma that has a characteristic ultrasonographic appearance shown below

ovary, ovaries, genitourinary tract, genitourinary system, woman, Art in Anatomy, Ashley Davidoff MD, endometriosis, endometrioma, chocolate cyst, ultrasound,

Endometrioma on Ultrasound

A transvaginal ultrasound of the adnexa shows an endometrioma with characteristic low level echoes reminiscent of the texture of the testes on ultrasound. The image on the right is an overlay in a biloculate cyst. Some through transmission is present.

Chocolate Cyst on US and CT

A 25 year old female presents with painful menses. The ultrasound shows a cystic mass in the pelvis with a large amount of debris in the cystic cavity consistent with a chocolate cyst (a). Image b is an overlay showing the fine granular appearance of the sediment. When the patient is in decubitus position (c) , the sediment settles to the dependant portions with a clear supernatant. Image (d) is a CT scan of the same patient, showing a non specific cyst in the left ovary. In this instance CT has little diagnostic value in the characterization of the abnormality other than localising a large cyst, and excluding other causes for the pain. Although the appearance on the ultrasound is consistent with endometriosis, a hemorrhagic cysts is possible and the distinction may only be made pathologically.

When a female patient in the reproductive age presents with pelvic pain and ultrasound or MRI are negative, laparoscopy is indicated both for diagnosis of small or flat lesions lesions as well as for therapy. Microscopic deposits which may cause symptoms will not be identified by imaging techniques and will only be seen laparoscopically. The reluctance to undergo an “invasive” procedure is understandable, but delaying or worse still missing the diagnosis will cause unnecessary long term suffering.

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Laparoscopy

Laparoscopic image of small blood blisters characteristic of endometriotic lesions of the pelvic wall in the peritoneum

Courtesy Author Hic et nunc. Acknowledged work is in public domain

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Blood Blisters in the Cul De Sac and Sacrouterine Ligament

Laparoscopic image of endometriotic lesions in the pouch of Douglas and on the sacrouterine ligament.
Courtesy Author Hic et nunc. Acknowledged work is in public domain

Treatment options depend on patient preference, including whether fertility is desired, but include both medical and surgical options. Medical management frequently involves suppression of regular menses/hormones . Surgical options include removal of implants or surgical induction of menopause (i.e. oophorectomy and hysterectomy).

Adenomyosis

Adenomyosis is a disease of the myometrium caused by misplaced or ectopic endometrium in the myometrium resulting in myometrial hyperplasia and smooth muscle hypertrophy clinically manifesting as pelvic pain and uterine enlargement. The entity can be focal or diffuse

Enlarged and Painful Uterus of Adenomyosis

The exact cause of the displacement is not known but it is presumed that a breach in the endometrial myometrial barrier enables a small amount of endometrium to translocate and remain viable. There is a high prevalence rate with about 40% of hysterectomy specimens displaying the entity.

The junctional zone of the uterus is the epicenter of the structural abnormality The junctional zone is subendometrial smooth muscle that is more compacted, and contains less water in comparison to the outer myometrium. (McCarthy) The junctional zone is functionally different from the outer myometrium.

The Normal Junctional Zone on MRI

The normal sagittal view of the uterus is a T2 weighted MRI from a 16 year old female with pelvic pain. The myometrium consists of an outer part (dark red) and an inner more homogeneous part called the junctional zone (light maroon) Since a T2 weighted image is sensitive to water, we understand from this image that the outer part has greater white signal and therefore contains more water, and likely more vascularity. The junctional zone (light maroon) on the contrary has less water and therefore is blacker. The endometrial canal, cervical canal and vaginal cavity are outlined in yellow and the vaginal wall is overlaid in pink.

Clinically the patient presents with pelvic pain, dysmenorrhea, menorrhagia and may contribute to infertility. On exam the uterus is enlarged.

The diagnosis is best made by MRI which shows a thickened junctional zone (>10-12mms) s. The deposition of acute blood, blood degradation products such as iron, or the presence of fluid filled microglandular deposits in the junctional zone make the MRI findings highly specific for the diagnosis.

Treatment options include pain management with NSAIDS, and hormonal manipulation. Surgery and hysterectomy is the only current option for cure.

MRI

Adenomyosis with a Thickened Junctional Zone and Enlarged Uterus

A T2 weighted MRI (a) shows fluid in the endometrial cavity, surrounded by a thick dark layer of the junctional zone, and then surrounded with a slightly brighter outer myometrium. The color overlay in b, shows a small amount of fluid in the endometrial cavity (yellow) surrounded by a thickened subendometrial junctional zone (light maroon) measuring up to 13 mms characteristic of adenomyosis. The outer myometrium (dark maroon) is normal

The junctional zone thickening is key to the diagnosis of adenomyosis on MRI. The junctional zone normally measures 8mm or less. Between 8-11mm it is considered indeterminate, and when it measures 12mm or greater, it is considered diagnostic for the disease. The junctional zone may thicken normally in the first few days of the menstrual cycle or during myometrial contractions. Cystic changes in the junctional zone are also characteristic and relatively common and represent small blood blisters. Linear striations radiating from endometrium to myometrium are also seen but these are not as easy to discern. These probably reflect a breech in the endometrium reflecting microscopic tears extending into the myometrium.

Ultrasound

The Normal Junctional Zone on Ultrasound

A transvaginal ultrasound of a premenstrual woman in the sagittal plane (left) reveals a normal view of the uterus with characteristic premenstrual appearance. Image on the right is an overlay showing the components of the endometrium and subendometrial layers. The stripe is almost homogeneously echogenic and thick but also shows a hypoechoic halo of the junctional zone or inner myometrium. (salmon) The homogeneous stripe is made up from two histological layers (barely distinguished by this ultrasound)– the inner stratum functionalis (deep orange) that will shed once the spiral arteries vasoconstrict, and the outer stratum basalis (deep yellow) that will not shed, and will be the basis for regenerating the endometrium in the next cycle. The next layer as stated above is the compact myometrium – the junctional zone (aka inner myometrium) , and is followed by the thicker outer myometrium (maroon).

The junctional zone is hypoechoic due to decreased water content, and is formed by smooth muscle cells that are tightly packed. The extracellular matrix and water content are sparse. It usually measures less than 8mm.

Adenomyosis with Ectopic Deposits in the Junctional Zone

Two echogenic nodules (overlaid in green in image on the right) are present in the subendometrial layer, (junctional zone) in a woman with menorrhagia. The nodules are in close proximity and have appositional relationships with the endometrial stripe (yellow overlay). They distort the endometrial lining. These findings likely account for the menorrhagia. Included in the differential diagnosis are dystrophic changes in prior foci of adenomyosis and submucosal fibroids. An MRI would assist to characterize the lesions in the subendometrial layer.

Posted on March 14, 2016February 17, 2023 by Ashley Davidoff

Art, Anatomy, and Wisdom of the Kidneys

Art Anatomy and Wisdom of the Kidneys

March is NATIONAL KIDNEY MONTH and March 14 2016 is WORLD KIDNEY DAY – dedicated to my teachers Dr Edward Smith and the late Dr Harry Mellins and …. so here goes.

The Kidneys and Their Golden Adrenals

serve to preserve our precious water. The kidneys face each other (eye to eye) in the body as trusting life long partners. When the going gets tough for the one, the other is there to fill the void. How much more can one ask of a life long partner?

The Nephron – The Little People and the Backbone of the Kidney

nephron, proximal tubule, Bowman's capsule, glomerulus, loop of Henle, arteriole, kidneys, renal, genitourinary tract, genitourinary system,bladder, urethra, Art in Anatomy, Ashley Davidoff MD Filter, Flow Concentrate

The story of urine production is the story of the complex physiology. The diagram simplifies the steps in the production of urine involved in the production of urine using linear and wavy shapes and showing the connectivity and interdependence of the parts. Blood (red) is filtered by the Bowman’s capsule(blue). The filtered plasma travels through a series of tubes (yellow) called proximal convolued tubule, loop of Henle, then distal convoluted tubule and with the magic of physiology enables water reabsorption and subsequent concentrated urine production. The urine is collected by collecting tubules, and transported via the calyces, renal pelvis and then ureters (orange) to the bladder (oval orange). The final pathway is out back to the environment via the urethra. The art is a combination of minimalism, linearity, and spherism .

Filter Flow and and Concentate

Same story – different way of artistically portraying the structural and functional order of urine production

Parts of the Kidney Using Labels

Fish Eye View of a Kidney Nephron

is a sphere providing a view of the tissues making up the micro-tubular structure of the filtering system of the kidneys. The connections between the tubular systems, arteries and veins, and the positioning of the loops of Henle are essential to the micro-function and macro-function of the kidney. The style of spherism provides a sense of wholeness.

An Ocean View of the Nephron

“Ocean View of a Kidney Nephron with Glomerulus Bowman’s Tubules Henle Arterioles and Venules at Sunset” shows a an out of context depiction of the nephron. The art piece has a surreal appearance with the sun at the bottom of the ocean and the tubules of the nephron with shapes reminiscent of Miro. In addition there is a sense of spherism with the vascular system surrounding the nephron and the round shape of the sun. The water theme and the colors create a quiet and peaceful ambiance.

Moods of the Kidney Nephron

“Moods of the Kidney Nephron with Glomerulus Bowman’s Tubules Henle Arterioles and Venules in All Colors” is collage of different colors of the nephron indicating different moods. The art piece has a surreal appearance with a hint of Miro in the shapes of the structures. The moods projected by the colors are mostly upbeat.

kidneys-0023-small-signature

Kidneys – Macro and Micro

“Kidneys- Macro and Micro” combines the histology of the kidney with its macroscopic image. The nephron with the arteriole, glomerulus, Bowman’s capsule, proximal and distal convoluted tubules, loop of Henle, and collecting ducts are shown in the their distribution in the cortex and medulla of the kidney. The collecting ducts enter the papilla, then the calyx and reach the ureters via the infundibulum and renal pelvis.

Kidneys Water to Water

“Water to Water, Dust to Dust – If you have to Pee, then You Must” is one of the captions that has been used to describe this image. 95% of urine is water and the” dust” is represented by organic and inorganic compounds. These include urea, chloride, sodium, potassium, organic solutes including urea, creatinine, uric acid. In addition there are trace amounts of enzymes, carbohydrates, hormones, fatty acids, pigments, and mucins. The inorganic ions include sodium (Na⁺), potassium (K⁺), chloride (Cl^–), magnesium (Mg²⁺), calcium (Ca²⁺), ammonium (NH₄⁺), sulfates (SO₄^2-), and phosphates (e.g., PO₄^3-).

Kidneys Ureters and Bladder in Pink

“Kidneys, Ureters, and Bladder in Pink” is abdominal X-ray of the abdomen after contrast injection and shows the kidneys, calyces, renal pelvis, ureters and urinary bladder. The pink hue softens the classical black and white X-ray, but is in contrast to obvious blackened skeletal structures, including the lumbar spine, and pelvic bones.

The Dancing Kidneys

The Hora at the Royal Renal Wedding

“The Kidney Hora at the Royal Renal Wedding” shows the bride and groom in the center of the first hora dance at their wedding. The dancing guests are derived from original CT angiograms showing the renal arteries and kidneys . The bride is derived from a nephrostogram (UPJ traumatic disruption) and the groom was created from a retrograde pyelogram.

Dancing the Rock ‘N Roll

“Kidneys Doing the Rock and Roll with Arteries and Veins Holding Tight” is the venous phase of an MRI angiogram . The kidneys each in different party colors, with a background of pastel colors gives a feeling or mood of celebration and delight. The way they are bonded with vein on vein, and artery on artery provides the sense of partners holding tight in a rock and roll dance at the festivity.

Paso Doble

“Paso Doble of the Kidneys in the Autumn” shows a duet in the Fall. It portrays the passion of male and female in a fiery dance. The image was derived from a CT urogram showing the kidneys, calyces, renal pelves, ureters and bladder. The mature and mellow colors are reflected in the yellows and oranges but are also characteristic Spanish colors.

Renal Arteries Doing the Rumba

“The Renal Arteries Doing the Rumba” shows two fashionable folks pairing in an elegant rumba . The two images are derived from separate CT angiograms and shows a normal aorta with renal arteries in different projections. The dancer on the left has a sleek twist while the the dancer on the right is in upright position with open arms for his partner.

The Renal Arteries Hip Hopping

“The Renal Arteries Doing the Hip Hop” shows two fashionable folks in a high spirited rippin hot wild Hip Hop dance. The two images are derived from separate CT angiograms and shows the aging atherosclerotic aorta with the renal arteries in different projections. The dancer on the left has two stents at the origin of the renal arteries that look like part of the dress. The dancer on the right has a small infrarenal aortic aneurysm and an accessory renal artery on the right. The elongated heads of the dancers give them a funky and wild look.

The Kidney Tree

Summertime in the Kidney Tree

This art piece shows a color Doppler of the kidney and outlines the renovascular tree . The black and white has been replaced by a skyblue color, while the red and blue of the Doppler has been replaced by the green, blue and purples of summer color. The image has been given an impressionistic feel with a Seurat pointillism effect. The result is an image that has a feel of Seurat’s “A Sunday Afternoon on the Island of La Grande Jatte”

Forest of Trees of the Renal Veins

A rendering of a Doppler ultrasound that has been reconstructed in 3D revealing the veins subtending the kidney. Artistically the tree like structure of the veins has been rendered to create a forest of trees. The work gives a sense that the viewer is deep within the quiet of the forest, since only the base of the tree trunks dominate the view. The color provides a mood of peacefulness, and the magnification of the trunks provides a spirituality and humbles the viewer in the face of the magnificence and grandeur of nature.

Forest of Trees on CT Urogram

The CT scan has been reconstructed in the coronal plane revealing the bonds between the kidneys, calyces, pelves, ureters, and the bladder. Artistically the tree like structure of the kidneys has been rendered to create a bunch of flowers or forest of trees depending on the perspective of the viewer.

Lessons from the Kidney Tree

Time for the Summer, Time for the Winter

This artpiece teaches us the unpredictability of fate and time . The power Doppler ultrasound of the kidneys shows a variation of the renal vasculature. On the left side, the vascular system is abundant, while on the right side, just the skeleton of the veins is demonstrated. The artist saw this image as an opportunity to explore concepts such as opposites, abundance, paucity, situational changes, time, and life lessons. Relevant quotes include “Make Hay while the Sun Shines” and “There is a Time for Every Every Season” . Artistically a sharp line differentiates the left side from the right. This abrupt change from the one season to the next can also infer unpredictable, and fateful situational change in life. In this case -there is a seasonal change, but the situation could just as easily reflect an abrupt change with the arrival of a devastating disease on the doorstep of life. This image precedes a similar image showing the browns of the fall to the left and the winter to the right (below).

Time for the Fall, Time for the Winter

This artpiece teaches us the same lesson of unpredictability of fate and time. Rather than going from summer to winter as time changes, this image goes from the browns of fall to the black and white of winter

Lessons from the Kidneys

The Pair in Purple

The art piece shows the kidneys with calyces, infundibula, renal pelves, and ureters. The pair have a intimate position as they face each other. They have the same purpose in life -to rid the body of waste and to preserve water. There is a commitment by the kidneys to each other The art represents a promise of the kidneys to stay together through thick and thin – till death do them part. Personal ego plays no part in their relationship. There is a clarity and simplicity in the art piece at the surface with well known underlying extreme complexity of the physiology.

Said the Kidney to the Heart…

“You allow me to be myself, and do what I do best. Without you I would be nothing!” Said the heart to the kidneys “You rid us of waste and toxins, and you recycle our water. Without you, we all would be nothing!” This profound conversation between the two organs contains the universal wisdom of biology and life . We all need to do what we do best. When we do this, the whole society of cells, organs, or people benefit. The success of the one is the success of all. The art piece shows the collaborative form of the two kidneys resulting in a heart shaped tree. The color of the trunk of golden urine brings the artistic element back to the reality of the kidney function and the gushing forth of urine.

And so ends the story of the Art, Anatomy and Wisdom of the Kidneys

Posted on February 29, 2016February 17, 2023 by Ashley Davidoff

Anatomy of Winter Water

February 2016 in Boston Massachusetts – Ashley Davidoff MD

Winter Water changes its size, shape, position and character depending on the temperature, gravity, time and surrounding confines.

Snow Outside in Boston

The winter of 2016 in Boston had not been too bad compared to the unforgettable winter of 2015. We got 8-12 inches on the day this image was taken just a few days before Valentine’s day. As always the snow left a trail of beauty particularly when viewed from the inside of a warm house. Though truthfully, a walk in freshly fallen snow among the trees is also a magical experience. The view from our kitchen window is shown above.

On Valentine’s day 2016, 2 or 3 days after the snowstorm, the lowest temp reached -9 degrees F. This was the coldest Valentine’s day since 1957. It was zero degrees Fahrenheit when the photograph was taken.

Frost and Ice on the Window Pane

4 basic layers evolved on the kitchen window. This is explained diagrammatically in the next image. The real beauty was at the the bottom of the window pane there was a whole bevy of magnificent gems of the winter, hanging on the outside of a double paned kitchen window. The crystals were attached to a large ice droplet. The result of nature’s work was more beautiful than any man made piece of jewelry.

Frost and Ice on the Window Pane Explained

The relatively warm top part of the window showed a few ice crystals of collected fallen snow (layer 1) which quickly melted to form small droplets of water (layer 2). Gravity caused these water bubbles to flow downward and get a little larger as they accumulated smaller droplets to form the bigger drops in the frosted background (layer 3). When they reached the bottom part of the pane the temperature was lowest resulting in crystallization and formation of beautiful gem-like structures .

Gems of Ice Crystal at the Bottom of the Window Pane

Under given conditions in the winter, snow is formed from the water in the clouds and the water gets transformed into a wide variety of sizes, shapes and character. The result was breathtaking!

Melted Frost and Ice Gems

The following day, the temperatures rose and the beautiful forms of crystallized ice, melted into a few nondescript water droplets, still beautiful but in a very rustic way.

In the Meantime on the Outside Winter Water Creates Miracle Art

As the temperatures rose, I took the dog for a walk in the local park and was greeted by an infinite variety of microcosmic ice formations caused by the rising temperatures. The puddles of frozen water started to crack, revealing magnificent shapes and a variety of ice and crystal formations in various stages between the solid and liquid form of water. Within a span of 30 minutes, I took over 200 images and here follows the result of the short photographic excursion with my macro lens.

Ice Crystals on Columns of Thin Ice

The shapes in this small ice pond took the form of columns of thin transparent ice with horizontal needle-like crystals projecting off the columns.

Picasso Flying on Thin Ice

The art piece discovered in an ice pond by a macro lens revealed Picasso the eternal artist of yesteryear from the perspective of winter water. The Picasso-like face in a boot with wings was perceived by the artist. The formation of ice crystals require special winter conditions. In this case ice bubbles formed around a structure reminiscent of a face with a peaked hat. Waves of water in the ice form the wing-like structures

Mirror Mirror on The Wall – What Do you See?

The art piece was discovered in an ice pond by a macro lens and reveals an abstraction of shapes. MIRROR MIRROR ON THE WALL..I see an evil queen – What do you see? The formation of ice crystals and shapes in the thin ice require special winter conditions. In this case sharp white lines form a variety of shapes. Waves of water in the ice form the corrugated structures.

I See an Evil Witch in the Mirror

What do you see? The artist’s perception is overlaid in color. The face of the evil witch in the mirror (left) consists the face with red lips, blue eyes, and a hooked nose. To the right is a person with a light green shirt and purple head.

Images of the Architecture of our Ancient Civilization

Tower of Babel ce Bubbles and Wood Chips

In this art piece crystalised bubbles project off pieces of wood chips. The artist saw the an ill formed Tower of Babel crowned by a beautiful formation of ice bubbles

Images of the Architecture of Our Current Civilization

One World Trade Center and Ground Zero in Ice

The art piece is centered on a vertical skyscraper representing One World Trade Center. This art piece is a dedication to the great city of New York from the tiny ice ponds of a Boston park. One World Trade Center is clustered with other skyscrapers in the center surrounding one of the main avenues traversing the city. At the base of the skyscrapers, the foundation soil that shines through the ice water reflects the ground zero earth on which this magnificent building with its deep seated history, was built. The iced up East river surrounds Manhattan. To the left there is a structure that represents the Brooklyn bridge and the wave like ice formation is a continuation of the bridge as it is seen lit up at night that extends from Brooklyn to Manhattan. The whole scene reflects a nighttime scene with city lights that abound.

One World Trade Center The Brooklyn Bridge and the East River

Lessons of Biology

Images of the Natural World

Birds

pelican, log fish, winter, ice, cold, crystals, ice crystals, temperature, freezing, shapes, ice crystals, frost, temperature, gravity, science, water

Pelican Catching a Log Fish in ice Water

The art piece was discovered in an ice pond using a macro lens and reveals an abstract appreciation of the shapes. To the photographer and artist, a pelican is seen to the left of the image with a wide open beak pursuing one of the two fish swimming in the water. The shapes of the fish look more like logs. The small ice ponds in the local park were the source of this photograph. The macro lens allows the capture of the minute detail, otherwise not appreciated fully by the naked eye. There has been no electronic alteration to the art of natural form.

Trees and Plants

Winter Trees of Ice Crystals

A walk in the cold of Boston with a macro lens exposed a tiny forest of winter trees beside a big pond under the warming winter sun. Crystals of ice lined along a horizontal line reminiscent of a small forest, surrounded by the frozen water. The surrounding ice pond has its own innate and naturally beautiful shapes. Above the left side of the forest, the bundle of orange vegetation, likely debris from the previous fall, represents a ball of warming sun to complete the scene.

The scene reminded me of the photograph of the Grove of Cone Shaped Trees below

Cone Shaped Grove of Trees

The other images below of the ice crystals on the kitchen window and the similar morphology in the botanical world

Boston Winter Mediterranean Summer

Ice Crystals and Arborvitae

Feather Shaped Ice Crystals Grasses and Flowers

Lessons of Biology

The Marvelous Macrophage – Soldier of the Body

The artist found this brave young macrophage lady in the ice pond of a Boston winter bravely fighting off pathogenic bacteria. AiA applies the concept of multiple cyst like ice structures to the anatomy of the body, and in this instance to the lysosomes and other organelles in the cell. The pseudopods of the dendritic cell are presented as the spiculated ice formations emanating from the edge of the white cell.

Human Biology Romance and Reproduction in Ice

Adam, Eve and the Snake

A Female Torso of Ice Floating On a Film of Cold Water

Woman Looking at Black Ice

In this art piece a woman is portrayed. She admires the black ice through the cleft of her breasts. The solid thick ice has assumed the rounded shapes of a woman’s breasts. The sheets of black ice is seen in contrast to the white ice that dominate the image.

Abstract of Male Organs and Reproductive Cells

The testes are in the bottom right hand corner filled with reproductive cells (sperm). At the appropriate time during ejaculation they take a trip via the vas deferentia. The vasa deferentia are depicted as tubular structures travelling from the testes to the base of the penis down the prostatic urethra where they collect the prostatic secretion. They then travel down the urethra and out into the female geniutal tract. The race is on as they all seek to win the hand of the queen – the ovum de jour.

Single Celled Flagellated Cells Looking for a Single Celled Partner

The shapes that manifest in this instance were small microbubbles with waves of icy water. The small bubbles are reminiscent of sperm cells and the waves of transparent ice reminiscent of the tail of the sperm. The race is on!

Ovary and Follicles in Ice

AiA applies the concept of multiple cyst like ice structures to the anatomy of the body and in this instance to the ovary. Ice bubbles form around air and other small structures of the earth and create follicular shaped structures of varying size on the ovarian like structure. The formation of ice crystals requires special winter conditions. Freezing cold and water are basic ingredients.

Pregnancy in Ice

In this art piece a pregnancy is portrayed. The cracked thin ice has assumed the rounded shapes of a woman with a rotund abdomen reminiscent of pregnancy. The grass of the earth is magnified and illuminated in the pregnant abdomen, and a fetal structure is suggested in the expected location of the uterus.

Lessons of Life

Time, Natural Disaster, Religion, Love, Sorrow, Fulfillment

Time

Time Passes – A Cold Reality

The AiA rendering shows a fallen dead life still with beautiful colors of a Fall and a time gone by, trapped by the ice and cold of the present tense. The message pertains to a yearning for the warmer, richer and mellow days of the autumn. These are but sweet memories which are confronted by the harsh reality of the present and a cold, and sometimes unforgiving winter. Though sweet memories are always sweet, one has to be realistic and deal with the present, knowing full well that the future will spring new realities. Below the ice you may sense just a hint of green of the grass which will be part of the future of this vista. The life lesson – time passes.

Natural Disaster,

winter, ice, cold, crystals, ice crystals, temperature, freezing, shapes, ice crystals, frost, temperature, gravity, science, water, snow, cracked

Snowquake

A natural disaster

Sorrow and Winter Water

Black Eyes, A Shiny Nose and Odd Looking Tears

The art piece reveals a different perspective of ice on the grate of a manhole cover in a Boston winter. Two square black holes represent the two dark eyes, while the ice on the vertical limb with cracked ice of the manhole cover represents the shiny nose. Two drops of water on the eyes in odd positions represent the odd looking tears providing the intrigue of the art piece. What does the artist infer regarding the sadness in the eyes – that is up to you to think about! Hidden messages abound

Pursuit of Fulfillment with Winter Water

Said the Ice Bird to the Triangle

In this art piece a bird who appears fulfilled in every beautiful way and is trying in a motherly way to teach the triangle a life lesson. She pleads with the triangle not to lose its roots and foundation, because without the foundation it loses its identity as a triangle. She then pleads with the triangle to remain true to itself and in that way it will grow and become something more profound – and in this case the artist draws attention to the triangular shape of the bird’s beak that plays a highly important function in the bird’s life. Finally she tells the degenerating triangle that “..if you don’t pull yourself together, you will end up like all the other sticks in my nest!”

Religion Love, Broken Love, Sorrow and Winter Water

Broken Heart at the Crux of the Cross

taken in the local park after the Boston Valentine’s day freeze.A teardrop is seen at bottom right. The image has a religious feel of course and I also love the way the heart of ice illuminates the oxidized green on the steel grate of the manhole cover. Hidden messages abound.

And that is Boston February 2016 folks- and fun with anatomy of the winter ice water

References for Winter Water

Water Wiki

Window Frost Wiki

Frost Wiki

Formation of Ice Crystals and Snow 5 star

Guide to Frost

Posted on February 15, 2016February 17, 2023 by Ashley Davidoff

Heart Shapes in Nature

Heart shapes in nature abound. The shape of the heart has a deep meaning in almost every culture and whenever one finds a shape reminiscent of the classical shape of heart shape, it provides a little extra beat of excitement.

I have collected such gems over the years and present some in the following blog.

History of the Heart Shape and Implications in our Culture

History of the Shape of the Heart Icon

The collage reveals the symbols that contributed to the shape of the heart icon as we know it. Elements from anatomy of animals that were exposed during sacrifice, from botany with leaves and seeds that reflected similar emotional connections as the heart, and elements of human anatomy associated with attraction, love and romance combined to result in the shape of the icon of the heart as we know it.

Adapted and modified from public domain photograph by Frank Eugene, taken 1898, called Adam and Eve and published in Camera Work no. 30,1910

The Heart Shape in the Skies

Heaven’s Heart

Found a cloud in the sky that said it all… or at least some of it…heaven’s heart. The art piece is a photograph that reflects all good things about the heart; its place in the heavens, prayer, love, truth, beauty, honesty, and compassion. The artistic element reflects a window for two way of love and admiration; from the heavens to humankind and mankind to the heavens.

Heart Shapes in the Leaves

Heart Shaped Leaves of the Linden Tree

The heart shaped leaf of the Linden tree is derived from a photograph taken in Bergen Norway. The leaf had fallen on a transparent roof and a few drops of water were trapped on its surface. It reminded me of a tearful end of a romance with tears caught in the heart of the saddened lover.

Heart Shaped Leaf of the Ivy

The heart shaped Canarian ivy leaf is from a vine. In the art piece the dark green has been lightened to give a freshness to the leaf which is surrounded by a heart shape colored in purple

Heart Shaped Leaf of the Caladium

The art piece shows a heart-shaped leaf with two beautiful variations of green. The dark green veins of the leaf are in distinct contrast to the paler green background, creating both complexity to the appearance, and giving us insight into its transport systems. The caladium plant in its many forms has a intensely colored heart shaped and colorful varieties leaf. It belongs to a genus of flowering plants in the family Araceae originating in South America. Almost 1000 variations of the original plant now exist. Other names include “Angel Wings”, “Heart of Jesus”, and “elephant ear”

Heart Shaped Leaf of Sweet Potato Vine

The art piece shows the heart-shaped leaf partially illuminated, with an almost mysterious feel of a dark background. The leaf of the sweet potato vine arises from a versatile plants around, which grows in sun the sun or shade, in containers, or garden beds. The plant shown here is a bright green or chartreuse. The beauty of the plant derives not only from the color of the foliage, its flowing nature but also of course the shape of its leaf

Heart Shaped Leaf of the Black Coral Elephant Ear Plant

The art piece shows the heart-shaped leaf with unusual black color. The purple veins of the leaf are difficult to see since they are of a similarly dark color. The leaf of the Colocasia “Black Coral” Elephant Ear plant is similar to leaf of the Coladium plant whose members are also named elephant ears because of the shape. The leaves can be very large, and are between 8 and 60 inches long.

Yin Yang Heart Shaped Hosta Leaf

The heart shaped leaf of the Hosta plant is surrounded by a yin yang swirl of green. The Hosta plant (aka plantain lilies (Britain) giboshi (Japan) is known for its hardiness and the fact that it thrives in the shade. There are as many as 45 species with foliage of varying sized leaves and shades of green. Yin Yang relates to a Chinese philosophy that uses opposite forces to bring unity and solidarity. These opposite forces abound. In the context of love it reflects opposite sexes that come together in reproduction of a new single being. Other examples include night and day, dark and light, fire and water, or positive and negative forces.

Heart Shapes in Flowers Fruits and Seeds

Chinese Lantern Flower

The Chinese Lantern flower depending on perspective is also heart shaped – . The dried flower reveals a delicate capillary like infrastructure and therefore even more fitting for Valentine’s day. The delicate flower enfolds and defends a barely appreciated, delicate fruit buried within its husk. The need to protect the fruit of its loins manifests motherly and fatherly love!The herbaceous perennial plant physalis alkekengi enfold and defend the small, delicate fruit buried within their husks, they may be the perfect symbol for protection. Their fiery orange red hue denotes a passion for life, amiability, endurance and vitality.

Black Walnut Husk

The male and female components occur on the same tree. Imagine the two seeds born out of love between the male and female flowers that occur on the same tree (monoecious species) in a pod that is heart shaped. The image reflects the heart shaped husk with seeds likely removed by squirrels who tore into the heart out of the heart shaped pod – how cruel nature can sometimes be? – But squirrels will travel miles, will dig dig deep to retrieve the glorious tasty reward for their tenacious effort. (Acknowledgement Dr Edward Fisher MD Cardiologist)

Heart Shaped Pod of the Goldenrain Tree

The pod is lantern shaped reminiscent of the the Chinese lantern flower, and Cape Gooseberry and is about 5cms long and 3cm wide and starts as a green to yellow color and becomes orange to pink in the fall. The black seeds are 5-8mms in diameter. (Acknowledgement Dr Edward Fisher MD Cardiologist)

Heart Shaped Pod of the Amour en Cage

The art piece shows the inverted pod surrounded by the more rotund yellow shape of a heart. The orange fruit peeks out through a defect in the husk. The French name Amour en Cage (love in a cage) is the most appropriate and romantic term for the fruit!

Heart Shapes that Tell a Story Through the Natural Elements

Bleeding Heart

The bleeding heart (aka Lamprocapnos spectabilis, Asian bleeding-heart, Dutchman’s breeches, lyre flower and lady-in-a-bath) belongs to the poppy family Papaveraceae, and is found in China, Japan, Korea and Siberia. It flowers in the early spring with a pink or white flower and is one of the earlier joys of the spring. It tells a sad story as it opens its heart and pours out its white tears. The shape is quite unique.

Heart Shape – Tamarind Seeds at Sunset

The heart shape of the Tamarind seed is the subject of this art piece. The shape of the seed is heterogeneous. With Valentine’s day in mind, I searched the many seeds of the leguminous edible fruit at the dinner table, and came up with two heart shaped seeds.

Rock Lovers Rock

Rock Lovers Rock shows a pair of heart shaped rocks in a background of sensuous and gentle curves of surrounding rock formation. Despite the solid and hard nature of the stone and the almost heartless assigned character, the art piece provides a soft and romantic side to the usually lifeless stone.

Valentine’s Day Walk – a Walnut and a Rock

Damaged Heart Shaped Leaf

The art portrays that part of the heart has been lost – but also infers that that all is not lost and there is still a lot of love to give. The color is sombre, and results in a melancholic mood.

Heart Shaped Leaves of Love Lost

The art piece shows two heart-shaped leaves (left) of a Linden tree in Norway at lovers’ odds, with tears streaming down their bodies, a bleeding heart (say no more) and the worst – a black leaf – who has totally given up on love. The whole image reminds me of a “Sergeant Pepper’s Lonely Hearts Club Band”. The thing about romance is that more often than not, it does not reflect basic love. Love of a child, parent, spouse friend, or animal has a deeper, more meaningful and more basic element of humanity and compassion that is open to all. Romance is sometimes a closed club.

Heart Shaped Anthurium at the End of Valentine’s Day

The heart shaped anthurium flower (aka flamingo flower, and laceleaf) originates in the Americas including northern Mexico and northern Argentina but also in the Caribbean. In this art piece the flower looks droopy and exhausted after a long day of romance

Chest of Fruit – Heart Lungs and Ribs

The chest with ribs, heart and lungs are created using fruit. The lungs are grapes, the pulmonary arteries – carrots, the ribs a banana peel and the heart is a red pepper.

Dogs Have Hearts Too

It may take a moment to see the face of labrador with the heart of the chest projected as his mouth and his two black eyes on either side of his cervical spine! Once you appreciate the eyes – the rest will fall into place

And so ends our story.

Posted on February 5, 2016February 17, 2023 by Ashley Davidoff

Heart Symbolisms – Cultural Anatomy

Heaven’s Heart

Heart symbolisms abound in almost every culture. The heart has been the center of almost every civilization, and assigned the epicentre of physical emotional and spiritual life. In ancient cultures the brain was mostly ignored and its many functions were attributed to the heart. Despite new knowledge, many of the ancient cultural concepts remain ingrained in the religion, the psyche, language, literature, poetry, and art of modern civilization.

In the West, the heart has evolved as a symbol of love, in both romantic and religious spheres. In the East, it is seen as a symbol of wisdom and spirituality.

Heart Symbolisms in History

Ancient belief in almost every major culture put the heart and heart symbolisms at the centre of the body and soul . Life with all its emotions, thoughts and beliefs centered around the heart.

The iconic heart symbol was identified in the culture of the Cro Magnon hunters of Europe before the last Ice Age (10,000-8000 BCE). The inference of the icon to the hunters remains a mystery.

The ancient Egyptians (3500BC-1000 BC) believed the heart controlled the mind and soul, and that it was the center of morality. It was also considered the source of memory, emotions, and personality. They believed that God spoke to individuals through the heart. There was concern among Egyptians that after death, that the heart might testify against the deceased; to prevent this, the ancient Egyptians often wrapped a heart scarab within the bandages to prevent the heart from speaking. They also preserved the heart during mummification so it would not be weighed during judgement after death.

The 5000 year old ancient Chinese culture believes that the heart is the root of the body, mind and soul of life. Additionally it controls joy, reflects facial expression, and has important roles in the psyche.

The Jewish culture goes back 5000 years as well. The Old testament, originated around 1500 BC, and references to the heart abound . It is viewed as the organ of conscience, the origin of human action, imagination, determination, emotion, love, virtue and vice, good and evil, humility and pride. The heart is revealed as the “inner” person:

“the Lord seeth not as man seeth; for man looketh on the outward appearance, but the Lord looketh on the heart” [Samuel 16:7].

Also among many other references

“it grieved him (God) at his heart.”

Genesis 6:6

The word “heart” appears 725 times in the Old testament,

Art in the Clouds, Love, and Prayer

Love and Prayer …… a cloud in the sky that says it all… or at least some of it… The art piece is a collection of different modes of prayer with the same goal in mind ie to connect with a higher power. An idea of a central God may not necessarily fit with all religions,. The central “God” therefore in this piece relates to a central focus of core beliefs.

In Hinduism, a culture that started around 1750 BCE, teaches that the heart is the center of life, action, emotion, consciousness, and the soul. The belief is that it nourishes the organs and supplies energy for the formation of semen. Similar to Egyptian belief, it has importance in connecting heaven and earth. It also is the organ where the love of God is experienced.

In ancient Greece, Aristotle, who lived in the 4th century B.C., described the heart as the most important organ of the body. He considered it the seat of intelligence, motion, sensation and vitality.

In Christianity the heart reflects love, piety, and charity. In the art of the middle ages and thereafter, the flaming heart reflects religious passionate fervor. A flaming heart pierced by an arrow symbolizes faith despite trial, and repentance. The New Testament started in the middle of the 1st century AD. Jesus repeatedly uses “pure of heart”

Paul prays

“that Christ may dwell in your hearts through faith;” [Ephesians 3:3].

The word “heart” appears 105 times in the New Testament.

In the 1st millennium AD in ancient Mexico, the Teotihuacan culture believed that the the teyolia – the spiritual force of the heart, was responsible for life.

Galen who lived in the second century A. D., reaffirmed the Greek concepts of the heart and promoted it as the organ most closely related to the soul.

The Heart of Galen – Creator of the Vital Spirit

The AiA rendering shows the body according to Galen. Heat plays a central role in his theory. He believed the heart was closely related to the soul and the source of the body’s heat . The liver, he taught was the primary source of the humors that controlled the body, and that the heart played a subordinate role.

At the beginning of the eleventh century, the Persian, Avicenna (980-1037 AD), authored “The Book of Healing” that included medical and philosophical content. Avicenna describes the heart as the source of life.

The Aztecs a nomadic tribe of northern Mexico, arrived in Mesoamerica in the 13th century and reached their pinnacle in the 15th century. They believed that the heart, or the yollotli, was the seat of life and the soul. Before cremation a green jewel was placed in the mouth of the dead person to represent the heart. The culture also believed that human sacrifice for the offering of the heart to the Gods was required for ongoing prosperity. It was a ritual performed at the highest level and required to honour the gods. Interestingly the yollotli was also a standard of measurement from the mid chest to the tip of the outstretched arm, equivalent to about 3 feet.

In summary the heart was central to the body mind of soul in so many cultures that it pervaded day to day life, and therefore became central to the emotional aspects of most, if not all cultures. The innate need to represent these emotions in all facets of life including religion, philosophy, literature, poetry, music, and art was a natural outcome.

The History of the Icon

History of the Shape of the Heart Icon

The collage reveals the symbols that contributed to the shape of the heart icon as we know it. The shape of the heart became familiar to cultures who hunted or sacrificed animals (image top left). The heart shaped leaves and seeds had parallel emotional connections. The silphium seed for example (seen as golden heart shaped structure above) , was used by ancient Greeks for contraception and was reproduced on their coins. Organs relating to the nitty gritty of romance including breasts, mons pubis, buttocks and scrotum have rotund shape that has parallels in the icon of the heart . It is no wonder that the the shape gained popularity and application to the romantic elements of life.

This art piece was adapted and modified from public domain photograph by Frank Eugene, taken 1898, called Adam and Eve and published in Camera Work no. 30,1910

Art and the Heart – A History

History of Heart Symbolism

The earliest use of the heart as a symbol of love is found in an art piece in the middle of the 13th century. The collage depicts, romantic, religious, devotion, emotion, bravery, heraldry, mathematics, geometry, botany, card games, Valentine’s day, and finally and central in the art piece – the traditional emoticon.

Literature and the Heart

Shakespeare and the Heart

From the late Middle Ages onward, literature and poetry romanticize the heart. The above art piece used information from the Oxford Shakespeare Concordance and identifies the frequency of the word heart and heart related words (eg heartless and heartily). More than 1100 instances were found.

In the Divine Comedy, Dante (1265-1321) refers to

Love, which is quickly kindled in the gentle heart,
seized this man for the fair form that was
taken from me, and the manner still hurts me.

Also…

Pride, Envy, and Avarice are
the three sparks that have set these hearts on fire.

Valentine’s day itself first became associated with romance during the time of Geoffrey Chaucer (1343–1400).

Literature in which the word “heart” appears in the title from the late 18th, 19th and early 20th century include among many; Heart of the Midlothian – Sir Walter Scott (1771-1832), The Tell Tale Heart by Edgar Allen Poe (1809-1849, Heart of Darkness by Joseph Conrad (1857-1924), The Heart of Man by Erich Fromm (1900-1980), Heartbreak House by George Bernard Shaw (1856-1950), The Heart is a Lonely Hunter by Carson McCullers (1917-1967), Bury My Heart at Wounded Knee: An Indian History of the American West by Dee Brown (1908 – 2002)

Poetry and the Heart

The association of the heart and love abound in poetry.

Charles d’Orlean was a member of the French Royal family who lived in the 15th century. While captive in England he wrote love poems such as the one translated below

Because I cannot see you,
My heart complains day and night,
Lovely lady, peerless one of France,
And has charged me to write you
That he does not have all he desires
In the Prison of Discontent.

by Charles d’Orlean and translated by David A. Fein

Some famous poems of the the late 19th and early 20th century which include the word heart in the title; My Heart and I by Elizabeth Barrett Browning (1806-1861), If I Can Stop One Heart From Breaking, Emily Dickinson (1830-1886), Never Give All The Heart, William Butler Yeats (1865-1939), Flame Heart Claude McKay (1889-1948), The Trusting Heart, Dorithy Parker (1893 -1967), I Carry Your Heart with Me – EE Cummings (1894-1962), The Laughing Heart Charles Bukowski (1920-1994)

Music and the Heart

heart0035-catalogue-signed-500-72dpi

Middle Ages Music, Heart and Love

AiA combined two art pieces that are in the public domain; Heart shaped musical score of Baude Cordier is an offering of love to a lady. Christian and Muslim playing Lutes from the Canticles of Holy Mary during the reign of Alfonso X El Sabio (1221–1284)

Recent Music and the Heart

The Heart in Modern Song

Song ..another emotional outlet for the expression of love romance, and spirituality in culture. Between 1956 and 1978, 15 artists used the word “HEART” in the title of their song and each sold more than a million copy of their records.

Evolving Use of Heart Symbolisms

Valentines Day is a classical example of the persistent use of the symbol of the heart as a symbol of love and romance and it appears on all types of commercial products. The icon of the heart for communication on the web, in emails, electronic messaging, graffiti, in all sorts of arts and crafts abound almost adnauseum.

We seem to be returning to the world of hieroglyphics – and the icon of the heart almost always sends a positive message – and so … that is always good!

References

Jager Eric – Reading the Book of the heart from the Middle Ages to the twenty First Century; University of Chicago Press

Posted on January 29, 2016February 17, 2023 by Ashley Davidoff

To My Dear Heart…

To my dear Heart,

Of all my children that I have grown up with

And who have been part of me for my life

All of whom I owe deep gratitude

For Life itself

For thinking, seeing, doing, loving, and crying

For making sure that my water is OK

That poisons do not run amok in me

Ridding me of my waste

Supporting me

Protecting me

Allowing me to dance

And to sing

To run

To play ball

Allowing me to grow

Allowing me to give birth to new beings

How do I say this without being unfair to them

Yet enabling my deep feeling of admiration and passion for you to be revealed

I have to single you out as my favorite

You have the asymmetric symmetry that makes you so interesting and intriguing

You have the male power in your left ventricle

And the female power of receptivity, compassion, and logical sense of modulation in your right ventricle

You have rhythm

You have grace

You have romance and tenacity

You have simplicity

Combined with uncanny complexity

A poem from the heart to the heart by Ashley Davidoff MD – previously published on The Common Vein web site thecommonvein.com

Posted on January 26, 2016February 17, 2023 by Ashley Davidoff

Anatomy of the Caribbean Heavens

The heavens are rich with artistry creativity, and lessons to teach us

When viewed from a ship at sea they are even richer – and vacation provides the time and opportunity to explore and express this beauty. The art is biased of course by the perspective of the observer. AiA finds the shapes and character of “things” related to the body, biology, art and culture of primary interest. The Caribbean heavens explored from a boat contains a wealth of material.

As we started our journey….

I swear I saw Prometheus running down from the heavens !

and then I looked a little closer …

and then put on my shades… and yes twas a powerful athlete running down to earth from the skies and he was carrying something!

Prometheus is a Greek mythological figure who brought fire to the earth that he stole from Mount Olympus. He was punished by Zeus who chained him to the rocks of Mount Caucasus. In addition an eagle (Zeus himself) punished Prometheus by daily feeds on his liver. The ancients knew of the magical regenerative properties of the liver and the antiseptic qualities of bile. The eagle (Zeus) is later slain by Heracles and Prometheus is given his freedom. He gains strength due the the regenerative powers of the liver (also known by contemporary physicians in the world of hepatology and hepatic surgery).

Talking of animals of the sky? And what about the Scottie dog? What lessons does he have to teach us?

Scottie of the Skye in the Sky

In this image a Scottie dog was found romping in the heavens. The Scottie is an endearing name for the Scottish terrier – aka Aberdeen terrier. It is part of the group of Skye terriers and therefore is fittingly suited for the theme of the wonderful sightings in the sky. The Scottie is one of the terrier breeds that come from Scotland. Other terriers in this group include the Skye, West Highland Terrier, Dandie Dinmont and the Cairn . The Scottie has a characteristic compact and powerful body. The torso and head are rectangular, ears are pointed , eyes are almond shaped, and the beard has long and soft hair. The legs are short but powerful allowing for agility and quick movement. The breed exemplifies “power in a small package” . The confident and independent nature has earned them the nickname “Diehard”. It is extremely territorial. Both President Franklin D Roosevelt and George W Bush owned Scotties. George, the fourth Earl of Dumbarton owned a pack of brave Scottish Terriers, that were named “Diehards”. Dumbartons regiment in the The Royal Scots were fittingly named the “Dumbarton Diehards” Scotty Cramp is a disease in Scottish Terriers that causes muscle spasms resulting in hyperflexion and hyperextension of the legs. It is an inherited recessive trait of the breed. It is caused by a deficiency in serotonin.

1 Real Scottie, 1 in the Sky, and 2 in Dem Bones

In Radiology we look at the neck of the Scottie dog in a condition of the lumbar spine that causes back pain in athletes called spondylolysis. The neck of the Scottie is overlaid in maroon in the image on the right and represents the pars interarticularis which may undergo stress fracture in young athletes (spondylolysis) resulting in one lumbar vertebral body slipping forward on the other (spondylolisthesis). It is one of the causes of back pain in young athletes.

Rain – Good or Bad? –

“Anatomy of Rain in the Sky at Sunrise”

In this image sunrise brings a shower of rain in the east. The sun shining through the dark clouds illuminates other clouds and brings some hope. In the context of the vacationer the rain is a disappointment and means an undesirable day indoors. For the farmer and for mother earth it is a blessing!

The art piece is dominated by falling rain and a rising sun that shines through and illuminates the vista.

and what does that teach us – It all depends on context

Some quotes:

Predicting rain doesn’t count. Building arks does. Warren Buffett

Let the rain kiss you. Let the rain beat upon your head with silver liquid drops. Let the rain sing you a lullaby. Langston Hughes

As the day continued – it got grayer and grayer

Anatomy of Rain in the Sky

In this instance the gray skies of rain bring a gloom for some and yes … also a bloom .. of life for others. It is an essential to all biology.

The image shows rain romping from the heavens.

Some Quotes

The best thing one can do when it’s raining is to let it rain. Henry Wadsworth Longfellow

Gray skies are just clouds passing over. Duke Ellington

The rain began again. It fell heavily, easily, with no meaning or intention but the fulfilment of its own nature, which was to fall and fall. Helen Garner

but things change..time moves on..and

“Time and Tide Wait for No Man”

And the following day – all had changed – the rain had passed and bright orange heavens illuminated the sky a moment before sunrise

Anatomy of the Sky Before Sunrise

Moments before sunrise brings light to the darkness, just before the sun pokes its head from the blanket of the ocean. The sun shining illuminates the sky with an orange optimism in the cloudless sky.

Anatomy of the Sky at the Moment of Sunrise

Anatomy of the Sky 1 Minute after Sunrise

Anatomy of the Sky 3 minutes After Sunrise

Time passes quickly

Quotes

“You can’t stop the future, You can’t rewind the past, The only way to learn the secret…is to press play.” – Jay Asher

“Life is a series of natural and spontaneous changes. Don’t resist them; that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.” ― Lao Tzu

As the day progressed – Nirvana – a blue blue sky , and a blue blue ocean – interrupted only by a ruffle of waving white

Blue Sky, Blue Water, and A Ruffle of Waving White

and this also was not for long .. as time passed and ever changing cloud pattern passed before our eyes – containing all sorts of people

… and a surprise artist made his appearance –

Chagall Blessing the Sky

Blessing in the Sky with Overlay

The artist spotted Chagall flying in typical fashion through the heavens of the Caribbean. he had his arms outstretched as if to bless the sky

And by the end of the first day… the clouds rolled in to compete for kingdom of the earthly sky

Anatomy of the Sky as the Sun Starts to Set

The kingdom of the earthly sky is shared by the sun with the clouds as each seeks to dominate. For the sun this is a small battle since its kingdom stretches over the entire solar system. For the clouds this is a major battle since they only rule over the earth. They both play an essential role in preserving life on earth. The sun is constant and dependable. The clouds are transient and fickle. The setting sun descends through the blanket of the clouds, and gives the sky a mysterious, and magical feel.

And the next day… the clouds and the sun shared the spotlight at sunrise

I took a nice cuppa tea, and sat on a chaise – longue to watch the spectacle. To my surprise I saw my knee caps…

“Sunrise View of the Knee Caps”

The art piece expresses a joint experience of my knees and the sun. As I sit on the chaise-longue sipping tea and watching the sunrise with X-ray vision, I share a gaze with the sun. The sun looks at the sunrise view of my knees and I look at its sunrise in the sky. In radiology we use the ‘sunrise view” to evaluate the joint space between the patella and the femur.

As the day progressed the clouds disappeared, and a day moon appeared.

Day Moon

And nighttime came – not a cloud in the sky … blackness descended revealing the light of a crescent moon and its neighbour Venus.

The Moon and Venus in Conversation

and the heavens turned black – and I saw the overshadowed crescent moon talking to Venus… “What are people thinking?- Do they not realise life rules over death? Peace over terror? Why do the leaders of the people not declare this universal truth? It is so clear from where we stand, that there is something going wrong down there….Leaders must not remain silent! “

And after the moon rose my hand rose to tell the moon something…

I Have a Bone to Pick with You .. I said

In this art piece the larger than life bones of the hand reach out into the sky in conversation. Tongue in cheek it wants to share the idea that it has a bone in its wrist that shares a common feature with the moon. The lunate bone is is found in the proximal row of metacarpal bones in the wrist, so named because of its shape. “Luna” is the Latin name for the moon.

and then two more hands with their scaphoids appeared to teach us the last lessons from the Caribbean

Scaphoids That Pass Under the Lunar Night

The art piece shows a night time sky with the X-ray of three hands. The hand on the left and right side of the image have the scaphoid bone of the wrist outlined in color. The scaphoid is so named because of its ship like shape. “Skaphos” means ship in Greek. The middle hand dominates the trio of hands and unrealistically dominates the skyline. The lunate bone is highlighted in the middle hand. It is so named because it is moon shaped. Artistically the scaphoid bone on the right is colored in Irish green since the ring finger carries a claddagh ring -an Irish ring that represents love, loyalty, and friendship. The larger than life delicate fingers of the middle hand reach out to the moon and talks with the moon about their common shapes… small talk in the big picture

From a literary point of view the title “Scaphoids that Pass Under the Lunar Night” infers and invokes the sentiment of Longfellow in “Tales of a Wayside Inn” about the “ships that pass in the night”

“Ships that pass in the night, and speak each other in passing,
Only a signal shown and a distant voice in the darkness;
So on the ocean of life we pass and speak one another,
Only a look and a voice, then darkness again and a silence.”

“Ships that pass in the night” speaks of chance meetings that are transitory that come and go and are just part of life that do not result in a meaningful relationship – and in other contexts of two people who almost encounter each other – but do not. In both cases, with a little effort of either party, a connection may have been life changing.

… and these were just a few lessons taught by the Caribbean sky!

Posted on November 27, 2015February 17, 2023 by Ashley Davidoff

Hermit of the Abdomen – Dedication to The Pancreas

The Hermit of the Abdomen – History of the Anatomy of the Pancreas

O’ Dear Pancreas

You have been called the hermit of the abdomen
By whom I do not know
But in your dark and hidden way, you have
Spoken without a word
From the gurgling depths of the abdomen
Yes – you have earned this lonely title
and a coin should be tossed
to the person who coined the phrase
But it took a long time to understand who this hermit was – and what he was doing in the darkness of the abdomen

Can You see the Zebra-like Pancreas in the Dark of the Abdomen?

From the day of antiquity
You have been looked upon by many
Herophilus, the father of anatomy had the first incisive insights into you
As he was one of the very few who had the guts to explore the guts in open fashion

Aristotle (384 BC -322 BC)

(extracted from a painting by Raphael)

Aristotle at the same time seemed to have known something about you
but then you lay unharmed and unexplored for almost 500 years
Until Rufus mistook you for a piece of meat –
You must have laughed at the “pan kreas” thing
How wrong he was – you evasive little trickster

And then the Talmud – always seeming to be right
thought you were the finger of the liver –
little did they know how independent you were

While Vesalius was up to your “hide and seek” game

Vesalius (1514-1564)

the magical eyes of da Vinci missed you completely
even though he saw the serpiginous splenic artery snake right above you

The Serpiginous Splenic Artery Above the Pancreas

(da Vinci – 1452-1519)

The splenic artery which lies above the pancreas was described by da Vinci

but by the time the dissection took place the pancreas had autolysed and therefore was not seen by the genius da Vinci.

Your ducts seemed to have intrigued the next generation Wharton Wirsung and de Graaf
as you sustained the pain of the quill penetrating your inner gut
(I forget you were already dead but it must of hurt just watching!)
A little later it was that man called Vater and the little Italian Santorini who found your minor duct and your nipple
And so by this time we had a good understanding of you in your nakedness
but of course, as said – you were dead

And so young Bernard explored your factories, and got a sense of your canine workings,
But you were able to hold on to your sweet secret for just a little longer
until the Langerhans found the family jewels in the famous 2% of your population-
The islets – those beautiful eyelits – governess of all things sweet in the body

Islets of Langerhans

(Paul Langerhans 1847-1888)

Eberle, Bernard, Danilevsky, and Kuhne joined up across the world to expose your antacid and enigmatic enzymatic brew
And once again your wonderful workings for a better world were exposed –
and we knew then, that you were the quiet and effective type –
a hermit who did good
but did not want the limelight

To see you as you lived and breathed in the flesh
was the mission of Wilhelm the X-Ray man
who crusaded the path to visualise 40,000 Angstroms under the skin
And then there was a slew of heroes who learned to slew your sickened parts – including the famous Whipple who was able to Whipple you in an inimitable way

And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
exposed the insular chemistry of you insulin that had given you the power over the sweet
Never mind – in the end it was for the good of all –
And a new era was borne

C._H._Best_and_F._G._Banting_ca._1924

Best and Banting

(Charles Best 1899- 1978 Frederick Banting 1894- 1941 )

And with the advent of ultrasound, CT, MRI, and endoscopy

You came out and were a hermit no more

Coming Out Party in the Abdomen for the Pancreas

And so we try to understand your form as our scans explore you as you live and breathe
and we stare in awe at your odd shape – why oh why did you choose that shape?
What are you supposed to look like? – we have no clue
And we are happy – so happy for you that you are well nourished by a double blood supply

Blood Supply of the Pancreas

And we wonder why you have no skin – we thought all the organs had a skin
except for your tail – almost a foreskin
And you are off axis on two planes – what is that all about? – kinda crooked
And your twin origins and the intimacy with the duodenum, of the ventral twin
And the strange fusion of the Wirsung guy excluding the little Italian Santorini
It seems to me that your matrimonial fusion with Wirsung and the bile duct has led to more problems than the merger was worth
It does not seem in the long run, to have been a marriage made in heaven
What was that all about? Is there a grand plan to come

And so we try to understand your diseases
And in some way we understand that the guy glugging down the bottle
Could be punished by your reaction
But why Oh why are you so nasty to those whose misfortune it is to have stones roll down and get no satisfaction.. down the green vile bile route
Have you not learned to live with the green secretion by now
And did you not know that by reacting the way you do, that you are cutting off your nose to spite you head?

While type 2 seems remote from you
We don’t know about this Type 1 business
Why are you made to suffer so much at the hands of your own body on your own body
We feel sorry for you – to have your own buddies reject you – must be awful
And then to see so many young ones suffer because you don’t work
We once again see and understand what power you control from that deep dark hermit home of yours

And the cancer thing … so silently it creeps on you causing your collagen to counter
Only making things worse as it strangles nerve, blood vessel, and your spouse duct – the green one, – without regard

And then I think of you in your prime and in your happiness
When you are with your two buddies – the splenic vein and the renal vein
And you all look so much alike, and happy swimming in that deep ocean where you hide
And I wish this was forever

So Happy Swimming Your Buddies Splenic Vein and Renal Vein

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Modified from previous publication in TheCommonVein.com

Posted on November 20, 2015February 17, 2023 by Ashley Davidoff

Anatomy of Circadian Rhythms in the Body

To every thing there is a season, and a time to every purpose under the heaven:

A time to be born, and a time to die; a time to plant, and a time to pluck up that which is planted;

Ecclesiastes 3:1

What is a season?

A season in the classical sense, is a natural division of the year and relates to the position of the earth to the sun. The sun is a source of light, warmth, and energy. A season is a continuum of time divided by the rhythmicity of four seasons. The seasons are characterized by changes in light and dark cycles as well as temperature cycles. These factors impact life in all its aspects.

Cycles Around and Within Us

This image shows the seasonal cycle that occurs within a year. The top left image is the spring when rebirth and restoration of life occurs. The summer (top right) follows where light and temperature are high. The mature mellow autumn follows with orange reds and yellow colors (bottom right) . Light starts to fade and temperatures start to fall Autumn is a time for introspection and recognition of mortality. The bleak and cold winter follows with a silence of impending death (bottom left). The dancers with their own cycles are incorporated into the larger cycle, inferring the intimate integration of internal biology with the changes in the environment. They are positioned like the hands of a clock – again incorporating the element of time.

Spring is a time for birth, freshness and renewal
Summer brings energy, blossoming, productivity and maturation and is the prime of life. Light is brightest during this period and the weather is warmest
Fall brings mellowness and maturation and warns of decline. Symbolically it is a time for introspection during mid life
Winter is the time of aging, bleakness, decline and death. It is characterized by darkness and cold and symbolizes quietness, contemplation, and reminds us of our impending old age and death.

“To every thing there is a season” What does that mean to the structures of the body?

The changes of the seasons have parallels in the internal environment of the body down to the cells and molecules. This implies that “everything” in biology experiences a season.

The annual cycle of the seasons is experienced physically by the body, its organs, cells, and molecules throughout the year. They sense the cold and the warmth, and the light and dark of the external environment.

Seasons of the Feet

The AiA rendering is a collage of photographs with superimposed CT scan of the feet as they walk through the seasons. The four seasons created in a sphere provide a sense of wholeness in time, while the footsteps represent a walk in time. The top left image of the sphere shows the magnolias of Spring, the next (going clockwise) is green forest of Summer, followed by the Fall and finally the deathly cold of winter.

Seasons of the Abdomen

This AiA rendering shows the abdominal structures reflecting the seasons. The spring is in shades of pink, the summer in green of the forest and the blue of the sky, the fall in oranges and red, and the winter in ice blue and white.

Seasons within Seasons and Cycles within Cycles

The cycles of the body range from nano seconds per cycle to a lifetime. Each cycle is part of another cycle. Each cycle consists of a beginning that evolves to full speed production, progressing to a winding down phase and finally a phase of rest and restoration. The Krebs cycle, heart cycle, circadian cycle, menstrual cycle, are all part of the wheel within a wheel concept and in the grand scheme of a single life it revolves around the process of maturation. These same cycles occur within the cycles of evolution with improvement in processes over time.

Biochemical cycles are responsible for growth, and reproduction. The clock has to be rewound, restored to step one so that it can do its duty again. All of these have been optimized by the grand Darwinian cycle of reproduction, generation after generation, picking up fortuitous improvements over the eons.

Seasons of the Day – Parallel Changes in the External and Internal Environments

Seasons of the Body in a 24 hour Period

This image shows the parallel of a 24 hour cycle correlating with the seasonal cycle that occurs within a year. The top left image is the dawn when the day is born and the person is restored from sleep and starts to get ready for the the next 12 hour period. The stress hormones start to rise as the body prepares for the work day which reflects the summer time (top right) where light and temperature are high. After the “summer” the mellow and introspective time of the sunset arrives(bottom right) as light and temperature start to fade. The temporary death of sleep provided by the night follows in the bottom left .

Daybreak at sunrise is the birth of the day, and represents spring time in the body. We wake up restored while it is a little light and a little cold outside and are refreshed and reborn after our slumber. As the day warms up, and the light becomes stronger, we enter the summer of our 24 hour cycle. Our cortisol levels are up to deal with the physical stresses of the day and this preparation is felt in our cells and in our psyche. As a result of the stress we are better able to process and produce at work. During the day we reach the height of our wakefulness and are in our productive prime. At dusk, the autumn of the day moves in as we start to wind down and become introspective. The light starts to go down and without the sun, the day cools down. The winter of the day – nighttime arrives. It is colder and darker, and we prepare for sleep, a transient death that helps us restore.

The internal environment of the body also senses the cycles through a hormonal cycle called the circadian cycle, which is executed via the hypothalamus. enabling rhythmic physiological and behavioral events of the body to work in parallel with the natural rhythms of the external environment.

“Anatomy of Sleep”

The central control system for the circadian rhythms is in the suprachiasmatic nucleus (SCN) of the hypothalamus (turquiose blue butterfly shaped structure at the base of the brain) It is responsible for the control of the circadian rhythms of the body.

Seasons of the Molecules

Circadian Rhythm and the Daily Internal Seasons of the Body

There are three main physiological events in the daily human diurnal circadian rhythm; melatonin secretion, cortisol secretion, and temperature variation.

Melatonin

Melatonin is secreted by the pineal body in response to the dark. The retina identifies light and transmits this information to the suprachiasmatic nucleus (SCN) in the hypothalamus. The hypothalamus integrates the light and darkness cycles of the environment with the pineal gland which in turn secretes melatonin in the dark. Melatonin levels are therefore high at night and low in the day. Melatonin is involved in sleep cycles, blood pressure regulation, and in seasonal reproduction.

Cortisol

Seasons at the Molecular Level in the Adrenal Gland

The adrenal gland is an essential component of the circadian rhythm. It produces cortisol which prepares the body for the stresses of the day. The artistic rendering shows background of complex biochemistry artistically incorporated into the gland. This is a featured art piece because of the beautiful manner in which the almost invisible gland transforms the biochemistry into life giving hormones.

Cortisol is a hormone produced by the adrenal gland that is elemental in the control of metabolic function. It prepares the body for impending stresses. Diurnal secretion of cortisol is part of circadian rhythm physiology. The level is highest in the early morning and is at its lowest level at about midnight to 4 am. This high level in the morning prepares the body for the stress of the day. Cortisol is intimately involved in the metabolism of glucose, fat and protein.

Body Temperature

Body temperature is lowest about 2 hours before waking in the morning and highest in the late afternoon and early afternoon. During the night metabolic activity is slowed and the lowered temperature is a mechanism to conserve energy. temperature is elemental to all biochemical processes.

“Body Temp Variation” by user:RHorning – Image Source. Licensed under Public Domain via Commons –

Seasons of the Cells

The molecular changes give rise to cycles in the cells both in a minute to minute variations, hour to hour variations, and eventually into annual variations

Seasons in the Squamous Flower

Cycles in the Columnar Cell of the Colon

What would life be like if there were no seasons?

Although there is a pattern to the seasons – each one is different and as we gain perspective on the cycles.

There are cycles within cycles as time moves on – each not the same as the prior, but having many things in common. The beginning of Spring is so full of life and we soon look forward and want to welcome the blooming of the brighter colors of summer. And then the heat of summer comes and we look forward to the cool and mature fall – and the beautiful first deep snowfall comes and soon grows old, cold, uncomfortable and dreary – and the new cycle begins with our eyes a little changed

Eachseasons bring a lesson of life. We need the seasons to feel the rhythm within us and around us… but each year the seasons are different, and we learn and grow with each season.

The dawn brings us newness and freshness. The day brings us energy in full flight and productivity – the dusk brings quietness and satisfying mellowness and the night brings rest and restoration…. But each day is different, and hopefully we learn and grow with each day

“I think that to one in sympathy with nature, each season, in turn, seems the loveliest.”
― Mark Twain

“Life Cycle of the Uterus”

shows the uterus from birth through maturation to senility

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Posted on November 19, 2015February 17, 2023 by Ashley Davidoff

Art of Anatomy of the Pancreas

Introduction

Pancreas in the Sky

is a photograph that shows a cloud formation embodying the shape of a pancreas

The anatomy of the pancreas is unusual and the physiology is multifaceted. It is a gland and is part of both the digestive and hormonal systems of the body. Structurally it is characterised by its unusual shape and position and the absence of a capsule. Functionally it is involved in the digestion of food as well as in the metabolism of glucose. The most common diseases include pancreatitis, pancreatic carcinoma and diabetes. Serum tests, ultrasound, CT scan, MRI and endoscopy are most commonly used in diagnosis of pancreatic disease. Treatment options include medical treatment (eg insulin in type 1 diabetes) minimally invasive procedures, and surgery.

“Pancreas in Pink”

is artwork derived from a CT scan and shows the upper abdominal cavity with the pancreas in bright pink surrounded by the liver, gallbladder, and kidneys. The aorta and inferior vena cava are the major transport vessels and serve to connect the organs.

Structure

Unusual Shape

“…and we stare in awe at your odd shape – why oh why did you choose that shape?
What are you supposed to look like? – we have no clue”

from “Hermit of the Abdomen”

Shapes of the Pancreas

The pancreas has been compared to many objects including an elongated comma on its side, an elongated number 9 on its side, a prism, a banana, an inverted and curved upside down tobacco pipe, and even an old fashioned revolver. Placing a seahorse or a woodpecker with head down and tail up probably brings us closest to the complex shape of the pancreas. The objects used for description are so varied and disparate, that one wonders if we truly have a grasp of the shape of this organ. A more practical way to look at the shape of the organ is to define the shape of its component parts.

Structure – Position

Deep in the Abdomen in the Retroperitoneum

The pancreas lies in the anterior pararenal space of the retroperitoneum surrounded by a vertebral body and kidneys posteriorly, the liver and gall bladder to its right, the spleen to its left, and the stomach and left lobe of the liver in front. This AiA rendering shows the pancreas cycling through the seasons. In the spring it is in shades of pink, the summer in blue, the fall in red, and in the winter in ice blue and white.

Function

The pancreas has dual functions in the the metabolism of the body. It acts as an as both an exocrine gland (secretes into ducts) and an endocrine gland (secretes into the circulation).

As an exocrine gland it secretes enzymes into ducts that lead to the duodenum. These enzymes aid in the digestion of fat, proteins, and carbohydrates. As an endocrine gland it is a key player in the control of glucose metabolism which it accomplishes by secreting insulin into the circulation.

The acini are the microscopic glands making up 98% of the parenchyma and they function as the exocrine component.

“Blueberries of the Glands of the Pancreas”

is a rendering of the histological appearance of the pancreatic acinar glands. The artpiece illustrates the ductules that subtends the acini which are the exocrine glandular cells. The shape of the acinar cells and ductules are reminiscent of grapes or berries on a stalk.

“Histology of the Glands of the Pancreas”

The exocrine hormones of the pancreas that aid in the digestion of fats, proteins and carbohydrates are produced in the acinar cells in the glandular unit called the acinus. The art piece shows the acinus with acinar cells and the duct that transports the secretions to the pancreatic duct and eventually to the duodenum where they aid in the digestion of proteins fats and carbohydrates.

The islets of Langerhans secrete insulin into the blood stream, very soon after ingestion of a meal in order to control blood sugar and intracellular glucose concentrations. The endocrine cells called the islets of Langerhans represent only 1-2% of the tissue volume of the pancreas, but play a vital role in body function and well being. They are most numerous in the tail of the pancreas.

Islets of Langerhans

Immunohistochemistry on mouse pancreas for insulin shows the brown stained Islets of Langerhans that secrete insulin among the acinar cells. They represent only 2% of the population of pancreatic cells.

(Modified Image – Courtesy Billyboy Wikipedia Public Domain)

Diseases

Acute Necrotic Pancreatitis

This is a CT of an elderly man who had severe pancreatitis. Within the retroperitoneum there is necrotic pancreas (asterisk). It is enlarged and consists mostly of air (arrow), fluid, and high density hemorrhagic components. The findings are consistent with a gangrenous pancreatic abscess. The surgeon noted that the pancreas looked and smelled like a “dead fish…. that had been dead for quite a long time.” Other structures including the gallbladder(gb), liver, kidneys, spleen and stomach surround the pancreas

Pancreatic Cancer with Spread to the Liver

The CT scan shows a primary pancreatic cancer (red asterisk) with metastases to the liver. Four of many metastases are identified with white asterisks

Normal Pancreatic Cells and Pancreatic Cancer Cells

In the upper image the cellular makeup of the acinar cells of the pancreas manifest with a normal nuclear to cytoplasmic ratio reflecting the relative size of the nucleus to the cytoplasm. The 2nd image show cancerous cells of the exocrine pancreas. The blue nuclii are far too large for the amount of the cytoplasm of the cell (abnormal nuclear to cytoplasm ratio). The malignant cells are also too dark (hyperchromatic) and lack uniformity and organization. These are all features of malignant cells . Cancerous cells do not obey the rules of the body and have no regard for the body at large. Malignant cells are equivalent to rebels in the community. They destroy and do not contribute to the wellbeing of the society. They also invade the territory of neighboring structures.

Ravages of Diabetes

The foot of a person with diabetes following amputation of the 2nd, 3rd, and 4th digits as a result of poor circulation of the tissues. The magnified view shows the calcification and hardening of the arteries.

Diagnosis

“Doppler Ultrasound of the Pancreas-Hermit of the Abdomen”

shows the pancreas in black in front of the splenic vein

“ERCP – Ductal Skeleton of the Pancreas”

is from an ERCP with an injection into normal the dorsal pancreatic duct of Wirsung with contrast also noted in the distal common bile duct

“Arteries of the Pancreas”

is from an angiogram of the celiac axis and shows the multiple arteries that supply the pancreas. The head of the pancreas is supplied by the superior pancreatico-duodenal vessels which arises from the gastroduodenal artery, and inferior pancreatico-duodenal artery which arises from the SMA. The body is supplied by the splenic artery and the superior mesenteric artery.

Treatment

Treatment options include medical treatment (eg insulin in type 1 diabetes) minimally invasive procedures for drainage and relief of obstruction, and surgery.

3D Nuclear Magnetic Resonance Structure of Insulin Dimer

(Modified from public domain image from Wikipedia and Courtesy Jawahar Swaminathan Jawahar Swaminathan and MSD staff at the European Bioinformatics Institute)

“And then a bone guy – for God’s sakes – a bone guy! – called Banting and his student Best
exposed the insular chemistry of your insulin that had given you the power over the sweet
Never mind – in the end it was for the good of all –
And a new era was born

from “Hermit of the Abdomen” Davidoff

Pancreas and Buddies

This aquatic scene shows the relationship of the pancreas to its neighbours particularly the splenic vein and left renal vein which run a parallel course, almost like a bunch of buddies romping in the water. The arching bodies with heads all in the same direction is quite beautiful

And then I think of you in your prime and in your happiness
When you are with your two buddies – the splenic vein and the renal vein
And you all look so much alike, and happy swimming in that deep ocean where you hide
And I wish this was forever”

from “Hermit of the Abdomen” Davidoff

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