Anatomical Reasoning Research Articles

Anatomical reasoning for the risk of elbow joint injuries in animals

Anatomical reasoning for the risk of elbow joint injuries in animals

Anatomical reasoning for the risk of elbow joint injuries in animals

Anatomical reasoning for the risk of elbow joint injuries in animals

The retroperitoneal approach for contemporary open abdominal aortic aneurysm surgery: The anatomical reasoning.

In current practice, the place of open surgery in managing abdominal aortic aneurysm is a contentious issue. The principal reason being greater applications of endovascular techniques treating increasingly complicated aortic disease. Development of branched and fenestrated devices enabled this, with numbers increasing annually. This meant a good risk patient with a long infrarenal aortic neck and normal diameter non-tortuous iliac arteries may be suitable for both endovascular and open techniques. However, indications for open surgery are becoming increasingly unclear nowadays due to short-term gains in morbidity and mortality. Exact aortic anatomical morphologies optimum for open or endovascular techniques remains unclear. As graft technology evolves, possibilities for endovascular options are expanding. Currently, establishing optimum treatment plans for complicated abdominal aortic aneurysm (little or no infrarenal neck) is difficult without considering general fitness of the patient. Hence, two sets of possible postoperative complications and follow-up protocols must be explained to patients before either approach. Complicating matters is the optimum surgical approach used for any open repair. The standard approach for open abdominal aortic aneurysm surgery has been transperitoneal as this provides excellent access to the infrarenal aorta and iliac arteries. However, although less commonly used, the retroperitoneal approach has advantages particularly when location of proximal aortic disease indicates suprarenal clamp might be optimum. This paper scrutinises benefits of the retroperitoneal approach performed purely for anatomical reasons where stent graft may be considered complicated. Also, long-term outcomes are examined in terms of endo-leak and subsequent development of true and false aneurysm following both endovascular and open repair.

Anatomical Reasoning for Atraumatic Trocar Placement during Implantation of a Transobturator Suburethral Sling

The aimof this research was to study the variant anatomy of the obturator complex in terms of surgical treatment of stress urinary incontinence, as well as to determine the most atraumatic technique for conducting a surgical trocar for a transobturator suburethral sling.Material and methods.A suburethral sling was implanted on 40 sagittally dissected samples of the female pelvis with preserved soft tissues using two techniques: the conventional one based on the use of external landmarks and the technique of the trocar rotation around the lower branch of the pubic bone developed at the University Clinic of St. Petersburg. After implantation of a transobturator suburethral sling, the probability of injury to the branches of the obturator nerve was assessed by precision preparation for each of the presented techniques using 40 samples. It was also suggested to develop a protocol for atraumatic placement ofa sling for stress urinary incontinence.Results. Based on the results obtained and study of the topographic relationships of the trocar and branches of the obturator nerve, it is concluded that the obturator complex has significant anatomical variability. This relates to both the muscular component –the internal and external obturator muscles, and neurovascular structures. The obturator nerve has two types of branching: joint and separate. The latter is a risk factor for intraoperative nerve injury. The technique of suburethral sling implantation by rotating the surgical trocar around the inferior branch of the pubic bone is atraumatic and safe.Conclusions.Variant anatomy of the obturator complex influences the probability of trauma in a transobturator suburethral sling implantation. In particular, the separate branching of the obturator nerve is a risk factor for its intraoperative injury. Further clinical studies are required to assess the outcomes of surgical t reatment of stress urinary incontinence taking into account the variant anatomy of the true pelvis.

Does general comorbidity impact the postoperative outcomes after surgery for large and giant petroclival meningiomas?

We assessed the role of the general condition of the patient in addition to usual anatomical reasoning to improve the prediction of personalized surgical risk for patients harboring a large and giant petroclival meningiomas. Single-center, retrospective observational study including adult patients surgically treated for a large and giant petroclival meningioma between January 2002 and October 2019 in a French tertiary neurosurgical skull-base center by one Neurosurgeon. Inclusion criteria were as follows: (1) histopathologically proven meningioma; (2) larger than 3cm in diameter; (3) located within the upper two-thirds of the clivus, the inferior petrosal sinus, or the petrous apex around the trigeminal incisura, medial to the trigeminal nerve. Clinical and radiological characteristics were gathered preoperatively including ASA score, the modified frailty index, and the Charlson comorbidity index. Post-operative severe neurological and non-neurological complications were collected. A total of 102 patients harboring a large and giant petroclival meningioma were included. The rate of postoperative death was 3.0% related to a congestive heart failure (n = 1), a surgical site hematoma (n = 1), and an ischemic stroke (n = 1). A severe neurological impairment was found in 12.8% and a severe non-neurological morbidity was found in 4.0%. The overall rate of severe morbidity and mortality was 15.7% after large and giant petroclival meningioma surgery. The presence of brainstem peri-tumoral edema (adjusted OR, 4.83 [95% CI 1.84-7.52], p = 0.028) was independently associated with a history of postoperative severe neurological morbidity. Male gender (adjusted OR, 7.42 [95% CI 1.05-49.77], p = 0.044), major cardiovascular morbidity (adjusted OR, 9.5 [95% CI 1.05-86.72], p = 0.045), and an ASA score ≥ 2 (adjusted OR, 11.09 [95% CI 1.46-92.98], p = 0.038) were independently associated with a history of postoperative severe non-neurological morbidity. A modified frailty index ≥ 1 (adjusted OR, 3.13 [95% CI 1.07-9.93], p = 0.047) and a low neurosurgical experience (adjusted OR, 5.38 [95% CI 1.38-20.97], p = 0.007) were independently associated with a history of postoperative overall morbidity and mortality. Pre-operative cranial nerve deficits (adjusted OR, 4.77 [95% CI 1.02-23.31], p = 0.024) and gross total resection (adjusted OR, 10.72 [95% CI 1.72-66.90], p = 0.022) were independently associated with postoperative new cranial nerve deficits. This study suggests to add scores assessing the patient general condition in daily practice to improve the selection of patients eligible for surgery. Collaborative international multicenter studies will be necessary to confirm these results and allow their implementation in clinical routine.

IDENTIFYING SAFETY ANATOMICAL PARAMETERS OF PERIANAL SEGMENT IN RADICAL SURGICAL OPERATIONS FOR PILONIDAL DISEASE IN CHILDREN

Pilonidal disease is a common pathology; the history of its investigating is quite long that can explain a large number of existing theories regarding its genesis and methods of correction. However, one of the best methods of performing radical surgery for pilonidal disease was the surgical intervention suggested by G.E. Karydakis in 1992. However, the lack of a clear anatomical reasoning for performing this surgery can lead to damage to important anatomical structures that are within the area of ​​surgery. Objective: to carry out detailed study at the microscopic level the structure of muscular tissues forming the internal and external sphincters of the rectum to provide anatomical grounds for selecting the techniques of radical surgery and to determine clear anatomical landmarks when performing surgical access. Materials and Methods: the study was performed on 10 corpses of children who had no any perianal and pelvic pathology in their lifetime. The age of children (5 girls and 5 boys) ranged from 12 to 17 years. Tissue samples were fixed in 10% neutral formalin solution for 24-48 hours and then dehydrated. Histological cross sections were stained with hematoxylin and eosin and by van Gieson technique. Results and discussion. The histological examination of the removed blocks of tissues located at 3`, 6`, 9` and 12` in the dorsal position revealed the main morphometric characteristics of the soft tissues of the perianal area with a targeted examination of the external sphincter of the anus. It has been established that the cross-sectional area of ​​the muscle bundles of the latter can vary significantly depending on the age and physique of the child. The spatial structure of the external sphincter of the anus has been described as well. According to morphometry, the latter is ellipse-shaped, elongated along the anterior-posterior direction with the centre displaced in the caudal direction relative to the anus. Conclusion. 1. The anatomical structure of the perianal area contains fibers of the external anal sphincter in the thickness of the subcutaneous fat, which can be damaged when performing radical surgery for pilonidal disease in children. 2. A detailed study of the anatomy of the perianal area enables to clearly identify the anatomical landmarks of the access edges in radical surgery for pilonidal disease in children. 3. The implementation of radical surgery for pilonidal disease in children requires more detailed study, since the empirical recommendations for their performing pose some risks of disruption of the normal body functioning due to damage to important anatomical structures of the perianal area. 4. The distal incision boundaries when removing the pilonidal cyst should be replaced not by 2 cm from the edge of the anal ring, but by 3 cm, as there is a risk of damage to part of the sphincter apparatus of the outlet.

Re-enchanting the body: overcoming the melancholy of anatomy.

I argue here that Weberian disenchantment is manifest in the triumph of instrumental reason and the expansion of analytic enquiry, which now dominates not simply those sciences upon which medicine depends, but medical practice itself. I suggest ways that analytic enquiry, also referred to here as anatomical reasoning, are part of a particular ideology-a way of seeing, speaking about, and inhabiting the world-that often fails to serve the health of patients because it is incapable of "seeing" them in the moral sense described by Iris Murdoch and others. I use the work of James Elkins and Wendell Berry to call for the recovery of a way of seeing the human body as both other and more than an object of scientific enquiry and social control.

An analysis of the educational value of low‐fidelity anatomy models as external representations

Although high-fidelity digital models of human anatomy based on actual cross-sectional images of the human body have been developed, reports on the use of physical models in anatomy teaching continue to appear. This article aims to examine the common features shared by these physical models and analyze their educational value based on the literature on cognition, learning, and external representations. A literature search on these physical models in three popular anatomy journals published over a 10-year period from 2001 to 2010 found that all of them have low fidelity: they oftentimes do not closely resemble the regions of the human body they are representing. They include only a small number of the structures that exist in these regions of the human body and do not accurately represent the shape and surface details of these structures. However, these models strongly correspond to the human body in the spatial relationship of the represented structures, which is crucial to achieving their educational purpose of teaching three-dimensional comprehension and anatomical reasoning. The educational value of these models includes acting as memory aids, reducing cognitive overload, facilitating problem solving, and arousing students' enthusiasm and participation. Because these models often lack a close resemblance to the human body, their use in anatomy teaching should always be accompanied by adequate explanations to the students to establish the correspondence between the models and the parts of the human body they are representing.

Body symmetry and asymmetry in early Greek anatomical reasoning

This historical note focuses on some of the earliest reports of human anatomy found in Greek medical literature. These passages testify the initial steps taken by Greek scientists in building a theoretical model of the human body. In these excerpts, one finds erroneous anatomical descriptions, which shed light on the epistemological approach used by these intellectual pioneers. Because of the lack of systematic dissection, it appears that early Greek anatomists developed a somewhat stylized idea of the human body that used a certain degree of symmetry. Overcoming the concept of a strict left-right bilateral parallelism in human body architecture was a challenging intellectual task that required prolonged observation of dissected corpses.

Anatomical reasoning in the informatics age: Principles, ontologies, and agendas

Reasoning about anatomy shares historical scientific roots with formal logic and artificial intelligence. With advances in computer-based intelligent programming, high-level biological structural knowledge may be exploited directly for biomedical research, clinical tasks, and educational applications. We consider the special nature of anatomical domain knowledge, emphasizing the complex concepts and semantics that must be represented in the development of ontologies, formally structured databases of biological information. We review the evolution of the fundamental scientific principles of logic and artificial intelligence needed for building machines that can make use of anatomical knowledge. We look at methods for compiling ontologies and compare the structural designs of the Foundational Model of Anatomy and Open GALEN ontologies. We further consider issues related to mapping developing anatomy resources with other biological ontologies in genomics, proteomics, and physiology. Although early results are promising, considerable resources and continuing effort must be committed to completing and extending anatomical ontologies for the ultimate success of computer-based anatomical reasoning. Anat Rec (Part B: New Anat) 289B:72-84, 2006. (c) 2006 Wiley-Liss, Inc.

Retention of Anatomical Detail

ABSTRACT. The purpose of this study was to determine the retention rate of anatomical detail in physical therapist students who had taken a human anatomy course based on computerassisted instruction and models and compare their retention rates with those in the literature. The subjects were 28 physical therapist students enrolled in their first professional semester. A test instrument was administered before the students took their required anatomy course, at the conclusion of the course, 6 months after the course was completed, and 1 year after the course was completed. Our study showed that the students retained information on anatomical detail at both 6 months and 1 year after the anatomy course. These observations are in contrast to those previously reported in the physical therapy literature, but they are in agreement with reports from other disciplines. Considering the cost of a dissection laboratory, if the method of instruction makes no difference in student retention, then computer software, models, and other alternatives that save considerable expense are valuable. Key Words: Anatomy, Computer-assisted instruction, Memory, Retention, Teaching methodology. INTROUCTION A substantial knowledge base grounded in human anatomy is necessary for most medical personnel, especially physical therapists. Many studies have investigated which methods are most effective and efficient to teach the details of human anatomy to students. Most of these studies have been done on anatomy courses for dental, dental hygiene, and medical students, and most have used either course grades or student satisfaction as the outcome measure. Very few studies have looked at retention of anatomical detail over time as the important outcome. However, retention of anatomical detail is critical for ongoing clinical practice. It is important because both student and practitioner must recall pertinent information as theory is applied to specific patient problems. The practitioner must use anatomical reasoning to perform a number of clinical tasks. According to Rosse, Anatomical reasoning integrates an understanding of three-dimensional geometry of the body and its parts...with an understanding of functional, developmental, pathological, and other relationships among anatomic entities.1(p4) Several authors have observed inadequate retention of specific anatomical detail in various situations, a problem that may affect the efficiency or effectiveness of a clinician's practice. For example, Scott2 commented on how medical students rapidly lose specific anatomical knowledge, Ilgenfritz et a13 described inadequate retention of anatomy in medical students in their third-year surgical clerkship, and Rossel commented that traditional methods in anatomy have substantial shortcomings for representing and integrating the domains of anatomical reasoning. Lake,4 in his discussion of tutoring physical therapist students in anatomy, referred to the decline in grades in the professional anatomy course compared with the prerequisite anatomy course, which, in part, could be accounted for by lack of retention. Two groups of researchers have looked at retention of anatomical detail within their own curricula and reported 1-year retention rates. Fiebert and Waggoners conducted a study describing physical therapist student retention of anatomical detail after a dissection anatomy course. They showed that the students had a statistically significant decrease in retention of anatomical detail after 13 months (from 89.6% immediately after their course to 59% after 13 months), with no significant change after 23 months (71%). In another study, Huber6 reported a mean retention rate of 55.6% in medical students 1 year after their anatomy course had been completed. There have been several other studies that have compared learning of material after different methodologies were used in different sections of a course or between years that the course was offered, but no retention rates were reported (Barkers for physical therapist students, Gastons for nursing students, Gilmore and Pauly9 for medical students, and Parker and Romberg10 for dental hygiene students). …

Anatomy atlases.

Anatomy atlases are unlike other knowledge sources in the health sciences in that they communicate knowledge through annotated images without the support of narrative text. An analysis of the knowledge component represented by images and the history of anatomy atlases suggest some distinctions that should be made between atlas and textbook illustrations. Textbook and atlas should synergistically promote the generation of a mental model of anatomy. The objective of such a model is to support anatomical reasoning and thereby replace memorization of anatomical facts. Criteria are suggested for selecting anatomy texts and atlases that complement one another, and the advantages and disadvantages of hard copy and computer-based anatomy atlases are considered.

The potential of computerized representations of anatomy in the training of health care providers

The purpose of anatomy education is to develop the skills for anatomical reasoning, which is a requirement for performing a number of clinical tasks. Anatomical reasoning integrates an understanding of the three-dimensional (3-D) geometry of the body and its parts (the spatial domain of anatomical information) with an understanding of functional, developmental, pathological, and other relationships among anatomic entities (the symbolic domain of anatomical information). Traditional methods in anatomy have substantial shortcomings for representing and integrating these two information domains. Computer-based methods of knowledge representation have a great potential for overcoming the shortcomings and for promoting anatomical reasoning. To realize this potential, there is a need for (1) establishing 3-D electronic atlases of the human body; (2) generating models of symbolic anatomical information, and (3) developing computer programs (user interfaces) that integrate these knowledge sources and serve the needs of trainees and practitioners in different fields of the health sciences. The Digital Anatomist Program at the University of Washington has begun to build such a client-server framework for anatomical information, and its application for biomedical education is being evaluated.

The representation of medical reasoning models in resolution-based theorem provers

First-order predicate logic essentially is a language to express knowledge concerning objects and relationships between objects in a domain. Many medical problems can be cast naturally in such terms. In this paper the suitability of logic as a knowledge-representation formalism for building medical expert systems is investigated. In particular, we investigate the logical representation of three typical reasoning models in medicine: diagnostic, anatomical and causal reasoning. It turns out that each of these models has its own characteristic logical structure. Furthermore, the pragmatics of using theorem-proving techniques in consulting such logic-based medical expert systems is discussed. In particular, attention is paid to the use of a meta-level architecture to improve the applicability of theorem-proving techniques in building expert systems.

A model-based approach to the diagnosis of the cardiac arrhythmias

The cardiac arrhythmias are abnormalities of the heart beat as observed on the electrocardiogram. They are interesting to workers in medical knowledge-based systems because their full interpretation requires anatomical and temporal reasoning using causal models. This paper presents an architecture for a knowledge-based cardiac arrhythmia monitor in which model-based hypotheses are built dynamically to explain the current portion of a continuous electrocardiographic signal. Based on the hypothesize-and-test paradigm, the control algorithm selects members of a hierarchy of electrophysiologic models and adapts them to the current rhythm to form the current hypotheses. Expectations are generated for each of the current hypotheses and compared with the incoming signal. Mismatched hypotheses are discarded except in special cases relating to artifact or changes in underlying rhythm type. A prototype has been implemented to test the basic concepts of this architecture.

Computer-assisted localization of nervous system injuries

Expert systems to assist in neurological diagnosis require a representation of anatomical relationships. In order to test one representational method, a prototype expert system was developed. It accepts patient signs of neurological dysfunction and identifies the site of nervous system injury. The system's knowledge base is contained in a semantic network which represents nervous system anatomy and the physical signs of injuries. When provided with an individual's physical signs, the network is searched by a simple algorthm; the anatomical locations which best explain the physical signs are the system's output. Medical expert systems which require anatomical reasoning can use a direct representation of spatial relationships to avoid the difficulties of encoding clinical associations in the form of If-Then rules.

INTERNIST-1/CADUCEUS: Problems Facing Expert Consultant Programs

SummaryINTERNIST-1 is an experimental computer program for consultation in general internal medicine. On a series of test cases, its performance has been shown to be similar to that of staff physicians at a university hospital. Despite INTERNIST-1’s apparent success in dealing with complex cases involving multiple diagnoses in the same patient, many shortcomings in both its knowledge representation schemes and its diagnostic algorithms still remain. Among the known problems are lack of anatomical and temporal reasoning, inadequate representation of degrees of severity of findings and illnesses, and failure to reason properly about causality. These drawbacks must be corrected before INTERNIST-1’s successor program, CADUCEUS, can be used. It is estimated that CADUCEUS will not be ready for release to the general medical community for five to ten years.Broader problems faced by all medical diagnostic consultant systems are: design of an efficient human interface; development and completion of medical knowledge bases; expansion of diagnostic algorithms from simple heuristic rules to include a range of complex reasoning strategies, and development of a method for validating computer programs for clinical use.