Demonstration Of Anatomy Research Articles

Correlation of HRCT mastoid with clinical presentation and operative findings in ear diseases

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">HRCT is found to be extremely useful for evaluating the ear diseases involving the external auditory canal, middle ear cavity, vertical segment of facial nerve canal, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint.<strong> </strong>Our main objective was to correlate the clinical presentation and operative findings of ear diseases with HRCT mastoid. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This study is done in our institute otorhinolaryngology dept. from April 2014 to April 2016. This is prospective study involves 36 patient belonging to different age and sex groups with high suspicious of ear diseases. We have taken detail history of each patient with complete ear nose throat examination done and after that all patient were investigated with routine blood investigation, X-ray and HRCT mastoid to correlate clinical finding and subjected for operation to compare operative findings with HRCT finding. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Determined using Pearson chi square test indicated a statistically significant correlation between HRCT temporal bone with clinical presentation and operative findings of ear diseases (p<0.05). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">With the advent of modern high-resolution CT scanners, detailed demonstration of temporal bone anatomy is practically possible now. We have been able to identify many significant structures not demonstrated by any of the known imaging modalities. The improved contrast and soft tissue a definition possible with HRCT has resulted in production of excellent images of soft tissue lesions in air spaces. Hence HRCT appears to be the diagnostic modality of choice for cholesteatomas and other soft tissue lesions in middle ear.</span></p>

Using 3D Printing for Complex Pediatric Transplantation: An Interview with Pankaj Chandak

Pankaj Chandak speaks to Alexandra Thompson, Senior Editor Pankaj Chandak is a Specialist Registrar in Transplant Surgery at Guy's, St Thomas’ and Great Ormond Street Hospitals and a Royal College of Surgeons of England Research Fellow at King's College London under Professor Nizam Mamode, Professor Anthony Dorling and Mr Chris Callaghan. Having qualified from Guy's, King's and St Thomas’ University of London, Pankaj was Anatomy Demonstrator under Professor Harold Ellis and is currently a member of the Teaching Faculty of Surgical Anatomy at the Royal College of Surgeons. He has been awarded The Royal College of Surgeons of England Arnott Lecture and Medal for 2016 and The Royal College of Surgeons of England Lister Essay Prize and Medal. His interests include pediatric transplantation, organ perfusion, innovation and public engagement in science. His multidisciplinary work on integrating 3D printing into complex pediatric transplantation as a world first was awarded The Royal Society of Medicine Norman Tanner Medal and the prestigious Worshipful Company of Cutlers’ Clarke Medal and Prize, 2016. He has been invited lecturer at The British Science Festival, The Royal Institution in London and The Royal College of Surgeons Hunterian Museum amongst others. The original 3D model created by the team has been accepted by The Science Museum (London, UK) for permanent exhibition in the Medical Gallery. Mr Chandak was elected a Fellow of the Royal Asiatic Society.

L’acquisition en France d’une cire anatomique pour Pierre le Grand: autour d’un traité et de ses suites

During his second tour of Europe, whose 300th anniversary is celebrated in 2017, Peter I visited Paris. He visited the main landmarks of the city, especially those related to his interest in the natural sciences and technology. For instance, he repeatedly visited the Royal Botanical Garden. There, he became acquainted with the renowned doctor, professor of anatomy, and member of the Paris Academy of Sciences Joseph-Guichard Duverney (1648–1730). He was well known in Europe, had a lot of connections with other scientists, and was famous for his wax anatomical models and ‘anatomical demonstrations’ (public lectures in anatomy). Among others, Duverney communicated with Robert Areskine, a physician of Scottish descent at Peter’s court. Peter ordered an anatomical model for his collection in the Kunstkamera, which proves the interest the tsar had in Duverney’s talents. Areskine represented Peter the Great in the purchase. The anatomical model of a human brain and skull is still kept in the Kunstkamera collection. However, until recently there was no information on how it was made. Referring to a previously unpublished document from the National Archive of France and other French and Russian sources (including archival ones), this article reconstructs the story of the model’s creation and provides new historical data that helps us to understand Peter’s initial idea after meeting Duverney and the changes the project underwent while it was being implemented.

Sonographic tracking of trunk nerves: essential for ultrasound-guided pain management and research.

Delineation of architecture of peripheral nerves can be successfully achieved by high-resolution ultrasound (US), which is essential for US-guided pain management. There are numerous musculoskeletal pain syndromes involving the trunk nerves necessitating US for evaluation and guided interventions. The most common peripheral nerve disorders at the trunk region include thoracic outlet syndrome (brachial plexus), scapular winging (long thoracic nerve), interscapular pain (dorsal scapular nerve), and lumbar facet joint syndrome (medial branches of spinal nerves). Until now, there is no single article systematically summarizing the anatomy, sonographic pictures, and video demonstration of scanning techniques regarding trunk nerves. In this review, the authors have incorporated serial figures of transducer placement, US images, and videos for scanning the nerves in the trunk region and hope this paper helps physicians familiarize themselves with nerve sonoanatomy and further apply this technique for US-guided pain medicine and research.

Contrast-Enhanced Magnetic Resonance Cholangiography: Practical Tips and Clinical Indications for Biliary Disease Management.

Since its introduction, MRCP has been improved over the years due to the introduction of several technical advances and innovations. It consists of a noninvasive method for biliary tree representation, based on heavily T2-weighted images. Conventionally, its protocol includes two-dimensional single-shot fast spin-echo images, acquired with thin sections or with multiple thick slabs. In recent years, three-dimensional T2-weighted fast-recovery fast spin-echo images have been added to the conventional protocol, increasing the possibility of biliary anatomy demonstration and leading to a significant benefit over conventional 2D imaging. A significant innovation has been reached with the introduction of hepatobiliary contrasts, represented by gadoxetic acid and gadobenate dimeglumine: they are excreted into the bile canaliculi, allowing the opacification of the biliary tree. Recently, 3D interpolated T1-weighted spoiled gradient echo images have been proposed for the evaluation of the biliary tree, obtaining images after hepatobiliary contrast agent administration. Thus, the acquisition of these excretory phases improves the diagnostic capability of conventional MRCP—based on T2 acquisitions. In this paper, technical features of contrast-enhanced magnetic resonance cholangiography are briefly discussed; main diagnostic tips of hepatobiliary phase are showed, emphasizing the benefit of enhanced cholangiography in comparison with conventional MRCP.

Preprocedural ultrasound assessment does not improve trainee performance of spinal anesthesia for obstetrical patients: a randomized controlled trial

Study objectiveThis randomized controlled trial was designed to evaluate the efficacy of additional information from preprocedure ultrasound examination to aid anesthesiology trainees performing spinal anesthesia for obstetric patients. DesignTrainee residents were randomly allocated to landmark technique and anatomy demonstration via ultrasound examination or landmark technique only for spinal anesthetic placement. SettingObstetric delivery suite. PatientsEighty healthy obstetric patients undergoing elective cesarean delivery. InterventionUltrasound examination prior to spinal anesthetic placement. MeasurementsThe primary outcome was the number of attempts for the spinal anesthetic. Secondary outcomes included placement duration; block height; and the incidence of need for staff intervention, paresthesia, and bloody tap. Subjective ease of placement was rated on a 100-mm visual analog scale. Main resultsBaseline demographic data were similar between the patient groups. The median number of attempts with preprocedure ultrasound and landmark was 3 (interquartile range, 2-7). This was not significantly different from the number of attempts with landmark technique only of 3 (1-60) (P=.69). The median duration of spinal placement with ultrasound and landmark was 92 (51-140) seconds vs 75 (53-126) seconds with landmark only (P=.57). There was no statistical difference between the groups in spinal placement duration, need for staff intervention, paresthesia, bloody tap, lumbar interspace, or block height. There was no difference in subjective ease of spinal placement by the resident. ConclusionsIn this study of junior anesthesia trainees performing obstetrical spinal anesthesia with preprocedure ultrasound and landmark technique or landmark technique only, no significant difference was observed in the number of attempts, duration of spinal placement, subjective ease of spinal placement, or any other measured secondary outcome.

The maxillary artery as a recipient vessel option for complex midface and anterior skull base microsurgical repair: A cadaveric study

Variations in the operative situation for complex head and neck defect reconstructions resulting from mechanisms such as trauma, oncologic resection, and prior radiation exposure can result in situations of a vessel-depleted neck. This requires an awareness of alternate, innovative options for use in reconstructive repairs. The purpose of this study was to provide characterization of the third segment of the maxillary artery necessary to consider its use as a recipient vessel in free flap repair of complex midface defects. Seventeen cadaver hemifaces were used for anatomic demonstration of the maxillary artery third segment by a transmaxillary approach to obtain descriptive measures for statistical analysis. The average artery intraluminal cross-section diameter was obtained for the sphenopalatine (1.39 ± 0.12 mm) descending palatine (0.94 ± 0.10 mm), and terminal maxillary (1.68 ± 0.17 mm) arterial vessels. The mean transmaxillary depth with was (43 ± 1.2 mm). Mean mobilizable lengths for sphenopalatine, descending palatine, and terminal maxillary arteries were (30 ± 2 mm), (29 ± 2 mm), and (20 ± 2 mm), accordingly. Vessel patterns were characterized using Morton and Kahn classification for sphenopalatine-descending palatine bifurcation as well as the Kwak classification for maxillary artery third segment morphology. In situations where primary recipient vessel sites are unavailable, the maxillary artery represents an innovative option to be considered with suitable recipient artery characteristics.

The Pennsylvania Anatomy Act of 1883: Weighing the Roles of Professor William Smith Forbes and Senator William James McKnight.

Effective Anatomical Acts transformed medical education and curtailed grave-robbing. William S. Forbes, Demonstrator of Anatomy at Jefferson Medical College in Philadelphia, authored the Pennsylvania Anatomy Act of 1867, but it was ineffective. In December of 1882, Forbes and accomplices were charged with grave-robbing. Forbes was acquitted in early 1883, but his accomplices were all convicted; nevertheless, these events precipitated a strengthened Anatomy Act in 1883. Forbes was crowned the Father of the Pennsylvania Anatomy Act and was revered by the Philadelphia medical community for his personal sacrifices for medical education; they even paid his legal fees. Over the remainder of his life, Forbes received many honors. However, there was a second major player, rural doctor William J. McKnight, a convicted grave-robber and State Senator. The evidence shows that Forbes precipitated the crisis, which was a racial powder keg, and then primarily focused on his trial, while McKnight, creatively working behind the scenes in collaboration with Jefferson, Anatomy Professor William H. Pancoast, used the crisis to draft and pass transformative legislation enabling anatomical dissection at Pennsylvania medical schools. While not minimizing Forbes suffering throughout these events, McKnight should be appropriately recognized for his initiative and contributions, which far exceeded those of Forbes.

Student Selected Components - a modern curriculum to complement a systems-based medical degree.

This article was migrated. The article was marked as recommended. AbstractThe 2009 version of the GMC's Tomorrows Doctors describes student selected components as "an integral part of the curriculum, enabling students to demonstrate mandatory competences while allowing choice in studying an area of particular interest to them". The definition of SSCs and guidance for their delivery and assessment have been interpreted in a variety of ways by individual medical schools and by regional consortia of medical schools. To complement our systems-based MBBS modules we have developed a longitudinal Student Selected Studies (SSS) curriculum which has been reviewed and modified since 2011.Throughout the SSS curriculum, students develop academic skills and competences such as literature review or developing a clinical or research question. In years 1 to 3 these competences are acquired whilst focusing on topics from a given theme of study, for example physiology, pharmacology or ethics. In year 4 the students apply the skills acquired in the earlier years to the evaluation of a case described in their own clinical-placement log-book.In the first three years when students learn how to deliver formal presentations, using PowerPoint, conference-style posters, or anatomy demonstrations, they are given specialist tutor support, and feedback is given in formative assessments; allowing the students to make corrections and refine their skills before summative assessments take place.Our curriculum development has been shaped by the use of a competency-based teaching and assessment strategy with a focus on the student's longitudinal development through the use of a feedforward strategy (Hattie, 2007) during and after formative assessments.

A multi-specialty surgical course for residents transitioning from early to intermediate training.

It has been estimated that approximately 15000 to 20000 hours are required to train a surgeon.1 However, several time-constrains imposed globally2 have significantly reduced training time in the Operating Room (OR) posing a significant challenge for surgical educators and creating an impetus for the development of new educational methods.3 Since August 2005, all medical graduates in the United Kingdom must enter a 2 year postgraduate programme prior to commencing training in their chosen medical or surgical specialty.4 What is the problem? Despite this two-year programme being a good introduction to duties as a doctor there have been some concerns that the trainees do not gain significant experience in surgical procedures leading to reduced confidence.5 Which can make transition from a second year postgraduate (Foundation) doctor (PGY2) to a surgical resident particular difficult. To gain more experience a large number of doctors undertaking additional posts, which are not part of the recognised training scheme, in the UK and abroad, or roles such as anatomy demonstrators, in order to broaden their skills and relevant knowledge prior to progressing to surgical training.6

Berry's Ligament and the Inferior Thyroid Artery as Reliable Anatomical Landmarks for the Recurrent Laryngeal Nerve (RLN) - A Fresh Cadaveric Study Relevant to the Cervical Spine

Introduction While most cadaveric studies of the Recurrent Laryngeal Nerve (RLN) have focused on course variations as a suitable guide for Right versus Left RLN, they have mostly been done on preserved (fixed) cadavers which renders the RLN immobile. Our aim was to perform anterior cervical exposures from C2 to T2/3 with particular attention to the course of the RLN on right and left sided exposures in fresh cadaveric specimens. In addition, we aimed to expose the entire course of the RLN. Finally, we wanted to show the position of the RLN in relation to the trachea-oesophageal groove, inferior thyroid artery and Berry's ligament. Methods Eight fresh cadavers had extensive layer by layer dissections performed by 2 surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). The RLNs were exposed in their entire length and relationship to different landmarks recorded. Photographs were taken at each stage of the exposure. Results In all specimens, we were able to demonstrate the entire course of both RLNs from origin to insertion. The RLNs were consistently associated with the inferior thyroid artery and Berry's ligament bilaterally with the RLNs passing at almost perpendicular to these structures. Conclusion The near horizontal direction of the Berry's Ligament in the cervical tissue planes exposed during anterior cervical exposures enables the surgeon to reliably identify the expected position of RLN at its medial end and hence avoid it prior to visual observation of the nerve on either side. We found that the most reliable anatomical landmark bilaterally for the RLN was the inferior thyroid artery and Berry's ligament both of which would be encountered in anterior surgical exposure prior to the nerve itself. We believe that this will help spinal surgeons refine their surgical technique to identify this nerve where necessary and thus reduce the incidence of iatrogenic injury. [Figure: see text][Figure: see text][Figure: see text]

C5 Palsy after ACDF: Topographic Correlation with Chassaigne's Tubercle (C6)? A Fresh Cadaveric Study

Introduction Our aim was to explore the possible topographic correlation of C5 nerve root with regards to its course and regional relation to C6 tubercle. We hypothesized that etiologic mechanisms proposed thus far in the current literature although may have some plausible explanation, however they still cannot explain why C5 and not any other adjacent level suffer a post-operative palsy. Materials and Methods Fresh cadaver had extensive layer by layer dissection performed by 2 surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). Roots of Brachial plexus were exposed in relationship cervical transverse processes. Photographs were taken at each stage of the exposure. Results We observed a close relation of path of C5 root with the C6 tubercle bilaterally, moreover we noted a sharper decent of C5 in comparison with the other adjacent roots. Conclusion Sharper angle of C5 nerve root, variations in intra-operative neck position and shoulder pull may play a role in predisposing the nerve root to neuropraxia against this most prominent lateral cervical boney element. We speculate that C5 nerve palsy may be related to the close association of the C5 nerve with Chassaigne's tubercle (C6). We would suggest a closer analysis of the C5 nerve in this region using finite element analysis with emphasis on the close proximity of the nerve and changes due to cervical motion. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]

Norman Alan Green

Norman Alan Green was born in Leicester to Norman Green and Lilian Goins. He was educated at Wyggeston Grammer School, Leicester. He was house surgeon to Sir Edward Tuckwell and...

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications.

Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented. Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst. Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

Kongens Stol i Domus Anatomica Hafniensis

The scientifically-minded King Frederik III often witnessed Thomas Bartholin’s anatomical demonstrations in the anatomy theatre at the University of Copenhagen. On these occasions the monarch, together with his courtiers, occupied what is called a conclave superius, which has been translated as ‘a private apartment on the first floor’.However, the accuracy of such an interpretation may be questioned, particularly because another source describes it as Kongens stol, ‘the king’s chair’. One must therefore inspect the meaning of this stol, which clearly corresponds to the Latin conclave. It consequently appears that stol here signifies a box, which is located aloft, that is, raised above the rest of the seats in the auditorium. Moreover, the king’s box was enclosed, inasmuch as it was provided with a lattice, so that the king and his attendants could survey the anatomical demonstrations unobserved.

John Hunter (1728-1793) and his legacy to science.

John Hunter was born in 1728 in Kilbride East, Lanarkshire, Scotland, as the youngest child of a family of ten children. John’s father died in 1741 and he was thus left to care for his mother. When John was about 17, young John moved to London to study under William Hunter (1718–1783), his 10-yearelder brother and was already an anatomist and obstetrician [24]. He studied as a dissector in William’s Anatomy School in Covent Garden in 1748 and showed his abilities on cadaver dissections. In 1749, he became a lecturer and demonstrator in anatomy [11]. His brother obtained permission for him to attend the Chelsea Hospital under the supervision of Dr. William Cheselden (1688–1752), Hunter’s first master in surgery and the most celebrated surgeon of his time. On the retirement of Dr. William Cheselden from Chelsea Hospital, Hunter entered as surgeon’s pupil at St. Bartholomew’s Hospital and became a pupil of Percivall Pott (1714–1788) [17]. During his studies under the aforementioned scientists, John made a great progress on dissection. In 1753, as an award of his progress and an honor bestowed upon his mentor Percivall Pott, Hunter was elected Master of Anatomy at Surgeon’s Hall [3]. During the Seven Years’ War (1756–1763) with France, Hunter was commissioned as an army surgeon in Belle Isle and Portugal. He acquired surgical skills and experienced on gunshot wounds and inflammation [11]. He began to collect materials on those issues which published posthumously in 1794 [15]. On his return to England in 1763, he began to build up his private practice. In 1767, he was elected as a Fellow of the Royal Society [22]. He published the first part of his Treatise on the teeth in May 1771 [12, 19]. Two months later, he married Anne Home (1742–1821), a daughter of an old Scottish family [8]. In 1768, he was elected Surgeon to St. George’s Hospital and he was appointed as SurgeonExtraordinary to King George III in 1776. In 1786, he won the Copley Medal, the highest award of the Royal Society [24]. While meeting of the Board of Governors of St. George’s Hospital, he collapsed and died on 16 October 1793. There are some conflicts on the reason of his death. The autopsy demonstrated lesions in his aorta compatible with his self-induced syphilis [22]. Others argued that there was no autopsy evidence of syphilis but evidence only of advanced arteriosclerotic vascular disease [6, 10]. He was initially buried in a crypt of the Church of St. Martin-in-the-Field. His remains were transferred to Westminster Abbey in February 1859 [24].

Choosing between a clinical teaching fellowship and an anatomy demonstrator post

Dedicated teaching roles are increasingly popular options as time out from formal training. David Roberts advises on how to choose between two roles

"I believe that training in careful dissections is still the best discipline".

The anatomist Alexander Macalister (Fig. 1) was born in Dublin, Ireland. Strikingly, he began his medical studies at the age of 14 when he was allowed to enter the Royal College of Surgeons of Ireland. Soon after, he was appointed Demonstrator of Anatomy at the College. In 1877, he became Professor of Anatomy and Surgery at Trinity College and then in 1883, he became Chair of Anatomy at Cambridge. He was a prolific writer and is most remembered for his “Observations of Muscular Anomalies” published in 1871. Cheever (1933) quotes Macalister as saying, “I believe that training in careful dissections is still the best discipline.” Alexander Macalister, 1844–1919. In reference to Macalister, Barclay-Smith (1919) stated, “His facile eloquence, lightened by occasional flashes of quaint dry humour, would at times fascinate and almost mesmerize his hearers. Following no tradition, shackled by no exigencies of examination, a rich spring of anatomical knowledge, ornate with morphological illustration and historical interlude, flowed out in a quiet but inspiring stream.” “Although he knew more about the anatomy of the human body than any man living, anatomy after all was but a small part of his mental equipment.” For example, he was a mathematicican and fluent in many languages both living and dead (Barclay-Smith, 1919). The editors of Clinical Anatomy believe that Macalister would have found many of the papers in our current issue both appealing and compelling. As always, we welcome our readership's comments and suggestions on how our Journal can be improved.

Two years of experience with near‐peer anatomists in a new medical school's setting

In response to the shortage of medical doctors in Israel, a new Faculty of Medicine was established in a remote locale (Galilee). Here we report on a 2 years of our near‐peer teaching program of cooperative learning. Our near‐peer teacher course was designed for 1st year medical students who successfully finished the Anatomy block, in order to develop their anatomy teaching skills, mostly for dissection, and their didactic ability, to be applied in the next academic year. In a debriefing questionnaire administered at the end of the course, on the five‐point Likert scale the overall rating for the “elective course” was 4.33. Learning prosection and anatomy demonstration skills scored 4.3 and 4.15, respectively. Importantly, the participants appeared at ease in the dissecting room amongst their peers; they were able to prepare and confidentially lead a case‐based learning session. The top course graduates (selected based on their peer evaluations to serve as near‐peer teachers) were then evaluated by their more junior peers (first‐year students), at the end of the next year's Anatomy block. On the Likert scale, the average score was 4.10, somewhat lower than the general satisfaction score for the preclinical teachers during the first‐year classes (4.22). We conclude that students as peer teachers can make a valuable contribution to the teaching faculty, especially in a new school. Personal gain in terms of confidence, focus and motivation are at least as important as practical dissection and teaching skills.

Current MR neurography techniques and whole-body MR neurography.

MR neurography (MRN) techniques continue to evolve, leading to a better demonstration of peripheral nerve anatomy and pathology. This article discusses various technical perspectives and provides recommendations to obtain the best possible high-resolution imaging of the peripheral nerves in various areas of the body. We also discuss technical perspectives of whole-body MRN and its potential utility.