Nuevos Recursos Digitales y 3D en la Enseñanza de Anatomía. Experiencia Internacional Reportada en el "Sectra Users Meeting 2019", Karolinska Institutet, Suecia, antes de la Pandemia de COVID-19 / New Digital and 3D Resources in the Teaching of Anatomy. International Experience Reported in the "Sectra Users Meeting 2019", Karolinska Institutet, Sweden, Before the Pandemic COVID-19

El uso de nuevos recursos tecnológicos en la enseñanza de anatomía ha impulsado la necesidad de adaptar el modelo educativo haciéndolo más centrado en el estudiante, dinámico y participativo mediante herramientas digitales y 3D; orientando los conocimientos hacia su aplicación clínica, pero bajo un ajuste curricular que tiende a cursar menos horas presenciales en aula o laboratorio. Este trabajo describe la experiencia local de una nueva Escuela de Medicina en Chile, reportada el año 2018, además y otros trabajos de centros formadores presentados en el "SECTRA Users Meeting 2019 Estocolmo", Karolinska Institutet, Suecia. Este trabajo describe los reportes orales sobre la aplicación de nuevos recursos digitales como; la mesa de disección digital táctil SECTRA® y modelos anatómicos cadavéricos impresos en 3D Erler-Zimmer®, bases de datos sobre anatomía digital, además, su impacto en el desempeño académico, reportado por usuarios de diferentes países, tales como: Australia, Canadá, Chile, China, Colombia, Estados Unidos de Norteamérica (EUA) y Suecia. Los datos fueron recopilados y analizados a partir de la información reportada en las presentaciones orales y resúmenes entregados por los expositores. La gran mayoría de los países expositores declararon el uso combinado de recursos digitales y 3D sumados a los tradicionales para la enseñanza de anatomía. Sólo el representante de EUA declaró usar exclusivamente recursos digitales (en laboratorio y en línea), experiencia correspondiente a una joven e innovadora escuela de medicina. La mayoría de los centros docentes declaró utilizar la mesa de disección digital en una amplia proporción de sus contenidos curriculares, en asociación a plataformas tipo RIS/PACS como IDS7 portal de SECTRA o las utilizadas por el centro formador. El uso de nuevas tecnologías digitales y 3D ha ganado un importante espacio en el currículum de la enseñanza de anatomía, complementando el uso de los recursos tradicionales.

SUMMARY: The use of new technological resources in the teaching of anatomy has promoted the need to adapt the educational model, making it more student-centered, dynamic, and participatory through digital and 3D tools, directing the knowledge towards its clinical application, but under a curricular adjustment that tends to take fewer contact hours in the classroom or laboratory. This work describes the local experience of a new School of Medicine in Chile, reported in 2018, and other work from training centers presented at the "SECTRA Users Meeting 2019 Stockholm", Karolinska Institutet, Sweden. This work describes the oral reports on the application of new digital resources such as; the SECTRA® digital tactile dissection table and Erler- Zimmer® 3D printed cadaveric anatomical models, databases on digital anatomy, in addition, its impact on academic performance, reported by users from different countries, such as Australia, Canada, Chile, China, Colombia, United States of America (USA) and Sweden. The data was collected and analyzed from the information reported in the oral presentations and summaries delivered by the speakers.The vast majority of the exhibiting countries declared the combined use of digital and 3D resources added to the traditional ones for teaching anatomy. Only the representative from the USA stated that they exclusively used digital resources (in the laboratory and online), an experience corresponding to a young and innovative medical school. Most of the educational centers stated that they used the digital dissection table in a large proportion of their curricular contents, in association with RIS/PACS-type platforms such as the IDS7 SECTRA portal or those used by the training center. The use of new digital and 3D technologies has gained an important space in the anatomy teaching curriculum, complementing the use of traditional resources.

Analysing the Effect of Incorporating Images While Framing MCQs For Online Clinical Anatomy Assessment Among First Year Medical Students

The disruptions caused by COVID-19 pandemic has significantly affected the assessment component of the undergraduate medical curriculum. The lack of physical ascertainment of the learning outcomes has forced the medical educators across the world to adopt online modes of assessment. Though multiple options like true / false, short answers and viva were available, the most common tool for many was multiple choice questions as they could be arranged according to the cognitive hierarchy of Miller’s pyramid. The present study was undertaken to analyze the effect of incorporating images while framing MCQs for online anatomy assessment among first year medical students. The study was planned in a quasi-controlled design where a batch of 150 students were subjected to a set of 40 multiple choice questions (20 text based and 20 image based MCQs). The questions were designed following Ebel and Frisbie guidelines of MCQs and validated by three investigators independently. Three cycles of assessments were conducted, and the scores were analyzed. At the end of 3 cycles of assessment feedback was taken from the students regarding this method of assessment. The performance of students was better in image based MCQs compared to traditional MCQs in all regions. Upon documenting the percipience, students had felt that image based MCQs were interesting, improved their clinical reasoning skills, lateral thinking abilities and quest for learning applied anatomy. Thus, we postulate that image based MCQs could be considered as better assessment tool in the era of online learning

Evaluating the Effectiveness of Early Clinical Exposure Program in Learning Clinical Anatomy amongMedical Undergraduates

Introduction:Early clinical exposure (ECE) is viewed as a way to provide contexts of basic science and highlight its relevance to medical picture 67(39.3%) and the commonest the parietal bone was commonly affected 85(55.6%). In closed TBI, majority had subarachnoid hemorrhage130 (84.9%). All cases of T BI had brain edema, with one coincidental finding of metastatic adenocarcinoma. A total of 42cases of TBI had brain herniation practice. It is one of the measures taken by Medical Council of India to enact its vision 2015. ECE promotes self –directed learning and analytical skills in students when they are exposed to it at an earlier phase. Subjects and Methods: This study was conducted among volunteered participants of first year medical undergraduate during their regular ECE sessions in the department of Anatomy at Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry after the approval of Instituition al Ethical Committee. The ECE program was used as a supplement to the traditional lectures. Feedback questionnaire after getting validated by the faculty were filled by the students. Results: Statistical analysis was done by Students Paired - Test. The Pre- Test score was (44.5+_16.1) and the Post - est Score was (53.1+_14.54).The Pre- value obtained was 0.0009 which was extremely significant. The results demonstrated that the ECE program will definetly influence the analytical understanding aspects along wi th getting accustomed to the hospital environment for the students. On a longer run it will have major impact on the academic as well on the attitudinal aspect of students.Conclusion: Medical students found their first experience with clinical setting va luable. Providing clinical exposure in the initial years of medical curricula and teaching the application of basic sciences knowledge in clinical practice can enhance students’ understanding of the role they will play in the future as a physician.

Application of the preclinical education integrated with clinical medicine in the teaching of clinical anatomy / 中华医学教育探索杂志

This project starts with the teaching of clinical anatomy for eight-year medical students, selects specialists to enter the courses according to the content of clinical anatomy, and explores the deep integration of basic and clinical education. This study used the self-made questionnaire to evaluate the effect of the integrated teaching model, and Likert scale was used to score. Meanwhile, the correlation between the scores of each question and total points was analyzed with the item analysis. Moreover, we assessed the principal components through the exploratory factor analysis. The results showed that more than 95% questioned students thought the preclinical education integrated with clinical medicine teaching model is necessary and practical, which can assist medical students in the anatomical structure learning combined with clinical disease, and meanwhile cultivate students' clinical thinking. Only fewer than 10% thought it can connect the basic knowledge and clinical cases effectively, and over 35% thought there are difficulties. Additionally, more than half students (54%) hold the negative attitude which clinicians can't completely replace basic teachers in teaching. Our finding suggests that the integrated teaching model is attractive and feasible. Nonetheless, clinicians can’t replace preclinical teachers completely in the clinical anatomy education yet.

Clinical anatomy of cast specimens of the pancreatic duct / 解剖学报

Objective To explore the distribution and structure of pancreatic ducts and lobules in human pancreas and explore their clinical application value. Methods Three human pancreatic specimens were dissected, 2 of which were fresh whole pancreas samples which were collected from the donated human bod)' after dead,UW organ preservation solution was immediately perfused, and the pancreatic duct was rinsed at low pressure. The surface and internal structure of 1 case was observed as a fixed specimen. Paraffin sections were taken for HE staining to observe the structure of lobules and the distribution of catheters in the leaves. Results The gross specimen showed that the pancreas was composed of lobules of different sizes, with thin layers of connective tissue between the lobules. The pancreatic duct had a complete cast structure and could be clearly displayed to the main duct and the branches of the interlobular duct. The diameters of the interlobular ducts varied widely, and finally a main trunk flowed into the main duct. Each trunk was distributed independently, and the distal pancreatic duct formed a lobule-like structure with different sizes of lobules and no interlobular communication. HE staining showed that the pancreatic lobules were surrounded by connective tissue, in which vascular and ductal structures were visible. Intralobular duct could also be observed in the pancreatic lobules. Conclusion The cast specimen of the human pancreatic duct can clearly show the branch distribution of the pancreatic duct, and the study of the morphological of the pancreatic duct and lobular structure is of great reference value for understanding the clinical problems.

Aspectos morfológicos del arco palmar superficial en individuos adultos mayores / Morphological aspects of the surface palmar arch in old adult individuals

RESUMEN: El objetivo de este trabajo consiste en el análisis de la posición del arco palmar superficial en la palma de la mano, con identificación del origen, forma de disposición, anastomosis presentes y terminación del mismo, proporcionando la experiencia propia y comparándola con los referentes del área, sin llevar adelante una comparación de clasificaciones, sino por el contrario, buscando analizar la información desde un punto de vista clínico-quirúrgico, demostrando la importancia del conocimiento de la anatomía real del arco palmar superficial al momento de abordar la anatomía vascular de la mano en todo tipo de situaciones patológicas.

SUMMARY: The objective of this work consists in the analysis of the position of the superficial palmar arch in the palm of the hand, with identification of the origin, form of disposition, present anastomosis and termination of the same, providing the own experience and comparing it with the referents of the area, without carrying out a comparison of classifications, but on the contrary, seeking to analyze the information from a clinical-surgical point of view, demonstrating the importance of knowledge of the real anatomy of the superficial palmar arch when addressing the vascular anatomy of the hand in all kinds of pathological situations.

Comunicación preliminar acerca de la disposición morfológica, la funcionalidad y las implicancias clínicas del modiolo del ángulo oral (Modiolus anguli oris) / Preliminary communication about the morphological arrangement, functionality and clinical implications of modiolus of angulus oris (Modiolus anguli oris)

RESUMEN: La disposición anatómica de los músculos faciales es de una notable complejidad y requiere de un estudio pormenorizado para lograr su reconomiento preciso. La comprensión de la disposición morfológica y la funcionalidad del modiolo del ángulo oral (Modiolus angulis oris) es de gran relevancia al momento de analizar la constitución muscular de la comisura labial, y para comprender clínicamente las lesiones del ángulo de la cavidad oral, lo que permitirá un abordaje terapéutico adecuado, crucial para la preservación y reconstitución de la armonía facial.

SUMMARY: The anatomical arrangement of the facial muscles is of considerable complexity and requires a detailed study to achieve its precise recognition. The understanding of the morphological disposition and the functionality of the angle of the mouth (Modiolus angulis oris) is of great relevance when analyzing the muscular constitution of the labial commissure, and to understand clinically the injuries of the angulus oris, what that will allow an adequate therapeutic approach, crucial for the preservation and reconstitution of facial harmony.

Maltreatment and non-infant maltreatment, relevance of forensic clinical anatomy, presentation of a case / Maltrato y no maltrato infantil: relevancia de la anatomía clínica forense: presentación de un caso

In a recently published article, Andrea Porzionato et al, they expose the relevance of Forensic Clinical Anatomy as a tool in judicial strata when there are medical-legal implications for suspected child abuse and the presence of anatomical variants and traumatic injuries that at any given time are difficult to differentiate. A case is reported where the careful dissection of a minor's body reveals a congenital malformation of the genital-urinary tract that causes repeated urinary tract infections resulting in sepsis and death, based on this description and the context of death is determined that death is associated with child abuse from lack of medical attention.

En un artículo de reciente publicación, Andrea Porzionato et al, exponen la relevancia de la Anatomía Clínica Forense como herramienta en estratos judiciales cuando existen implicaciones médico-legales por sospecha de maltrato infantil y la presencia de variantes anatómicas y lesiones traumáticas que en un momento dado son difíciles de diferenciar. Se reporta un caso donde la cuidadosa disección del cuerpo de un menor revela una malformación congénita del tracto genital-urinario que ocasiona infecciones repetidas del tracto urinario resultando en sepsis y muerte, con base en esta descripción y se determina el contexto de muerte la cual está asociada con abuso infantil por falta de atención médica.

Ultrasound Anatomy of the Thyroid Gland in Dogs

Ultrasonography is a method of choice for imaging visceral organs in animals. The aim of the study was to determine the ultrasonographic characteristics of the thyroid gland in healthy dogs and to correlate the relationships of thyroid gland size and volume with body weight. A total of 24 apparently healthy dogs of different breeds were grouped into four groups (each with 6 animals) based on their body weight viz., less than 7 Kgs, 7-15 kgs, 15-30 kgs and more than 30 kgs. Each thyroid lobe was ultrasonographically observed in both transverse and longitudinal planes. The maximal length, width and height of each lobe and thyroid volume were measured. The data were analyzed statistically. In all the groups, thyroid lobes were round to oval in transverse images and fusiform or elliptical in longitudinal images with the smooth capsule. The parenchyma of the thyroid lobes had a homogenous echogenic pattern. There was no significant difference observed between the mean height, length, width and volume of both the lobes of the thyroid gland with body weight among the four groups at 5% level of significance (p< 0.05)

The dorsoepicondylar medial muscle a clinically relevant anatomical variation / El músculo dorsoepicondylar medial: una variación anatómica clínicamente relevante

Anatomical variations in the axillary region do not always appear in modern human anatomy texts, which leaves the risk of diagnostic and surgical errors by doctors unaware of these variations. This work presents an anatomical variation of muscular type in the axillary region that can potentially generate clinical manifestations or iatrogenic results during surgical procedures. Routine dissection of an upper limb in a male cadaver. An atypical muscle was found in the axillary region, located at the base of the right axilla, and conformed by three muscle fascicles that give rise to a common muscular belly. The three fascicles are joined at the base of the axilla, and form a thin flat muscle 120 mm long from this join to its tendon, with a cross-section diameter of 15 mm and a thickness of 2 mm. The common belly of the muscle establishes a posterior relationship with the neurovascular elements of the axillary fossa and partially covers them. The tendon 150 mm in length originates at the level of the union of the upper and middle thirds of the arm and ends inserted in the medial epicondyle of the humerus, relating in its path with muscular and neurovascular elements of the arm. Being familiar with this variation enriches diagnostic and surgical abilities and reduces the possibility of iatrogenia in surgery of the axillary and brachial regions.

Las variaciones anatómicas son frecuentes en la región axilar, sin embargo no siempre figuran en los textos modernos de anatomía humana, existiendo un potencial riesgo de error diagnóstico y quirúrgico para quienes no las consideren. Se presenta una variación anatómica en la región axilar de tipo muscular que potencialmente puede generar manifestaciones clínicas o inducir iatrogenias durante un abordaje quirúrgico. Disección de rutina de miembro superior realizada en un cadáver adulto de sexo masculino. Se detectó un músculo atípico en la región axilar ubicado en la base de la axila derecha, compuesto por 3 fascículos musculares que dieron origen a un vientre muscular común. Los 3 fascículos, se unían en la base de la axila, formando un músculo delgado y plano de 120 mm longitud desde la unión de los fascículos hasta su tendón, con un diámetro transversal de 15 mm y un grosor de 2 mm. El vientre común del músculo establecía una relación posterior con los elementos neurovasculares de la fosa axilar y los cubría parcialmente. A nivel de la unión de los tercios superior y medio del brazo, desde el vientre muscular común se originaba un delgado tendón de 150 mm de longitud, que terminaba insertándose en el epicóndilo medial del húmero, relacionándose en su trayecto con los elementos musculares y neurovasculares del brazo. Conocer esta variación enriquece la capacidad diagnóstica y quirúrgica reduciendo la posibilidad de iatrogenia en la cirugía de las regiones axilar y braquial.

Lateral-bilateral costal branch (R. costalis lateralis): a clinically relevant anatomical variation / Rama costal lateral bilateral (R. costalis lateralis): una variación anatómica clínicamente relevante

SUMMARY: The lateral costal branch (LCB) is a variation present in 15-30 % of the population. This blood vessel runs parallel and laterally to the internal thoracic artery from which it originates. Knowledge about the LCB is relevant for thoracic surgeons. In this study we present the findings from the dissection in a practical teaching exercise of the cadaver of a 62-year-old male. The thoracic contents were accessed by raising the anterolateral thoracic wall, the pulmonary pedicles were dissected and both lungs were removed. We observed bilaterally the trajectory of the LCB at the level of the medial axillary line parallel to the internal thoracic artery. On the right side, the LCB originates from the internal thoracic artery at the level of the first rib and extends to the eighth intercostal space, with a length of 26 cm and a caliber of 1.95 mm, communicating with the anterior and posterior intercostal arteries. The left branch originates from the internal thoracic close to their origin artery and extends until the sixth intercostal space, with a length of 14 cm and a caliber of 1.55 mm. it connects with the anterior and posterior intercostal arteries. On both sides the arteries were accompanied by a pair of satellite veins. The lateral costal arteries form part of the circulation of the thoracic wall, constituting an accessory arterial system with a trajectory parallel to the internal thorax and the aorta. Knowledge of it is relevant for invasive procedures, and myocardial revascularization procedure.

RESUMEN: La rama costal lateral es una variación presente en el 15-30 % de los casos, y sigue paralelo y lateral a la arteria torácica interna, de la cual se origina, siendo su conocimiento relevante para los cirujanos de tórax. Se presenta un hallazgo durante una disección en una actividad práctica docente, en un cadáver de sexo masculino de 62 años. Se accedió al contenido torácico levantando la pared esternocostal, procedimiento que comenzó con disección de la piel y musculatura hasta exponer ambas clavículas, se realizó un corte transversal de éstas en su tercio lateral para posteriormente realizar sección bilateral desde la primera hasta la octava costilla siguiendo la línea axilar anterior. Una vez revertida la pared esternocostal, se seccionaron los pedículos pulmonares, y se retiraron ambos pulmones. Se observó bilateralmente en la pared torácica el trayecto de un paquete vascular a nivel de la línea axilar media paralela a la arteria torácica interna. En el lado derecho se originaba a 2 cm del trayecto de la arteria torácica interna y se extendía hasta el octavo espacio intercostal con una longitud de 26 cm y un calibre de 1,95 mm, estableciendo comunicaciones con las arterias intercostales anteriores y posteriores, agotándose en ellas. La rama izquierda se originaba a 1,5 cm del trayecto iniciado por la arteria torácica interna extendiéndose hasta el sexto espacio intercostal; presentó un calibre de 1,55 mm y una de longitud de 14 cm, estableciendo comunicaciones con las arterias intercostales anteriores y posteriores, agotándose en ellas. En ambos lados las arterias eran acompañadas por un par de venas satélites. Las arterias costales laterales forman parte de la circulación de la pared torácica, constituyendo un sistema arterial accesorio al de la arteria torácica interna y la aorta. Su conocimiento es relevante en procedimientos invasivos, además de tener un alto valor docente y formativo.

Metodologias ativas auxiliando no aprendizado das ciências morfofuncionais numa perspectiva clínica: um relato de experiência / Active methodologies assisting in learning the morphological and functional sciences in a clinical perspective: an experience report

Introdução: o estudo da anatomia é encarado algumas vezes com obstáculos que não permitem motivação e engajamento dos estudantes prejudicando o seu desempenho. É importante renovar e buscar outras práticas pedagógicas, inserindo metodologias inovadoras, que permitam dinamizar as aulas das ciências morfofuncionais favorecendo a formação de profissionais críticos, reflexivos e com maior tomada de decisões. Objetivo: relatar a experiência no uso de metodologias ativas no processo de ensino e aprendizagem da disciplina Morfofuncional no curso de Medicina da UFOB. Metodologia: realizou-se um relato observacional e descritivo das metodologias ativas no processo de ensino e aprendizagem utilizados na disciplina Morfofuncional de forma interdisciplinar e inovadora. Os métodos ativos utilizados foram mapa conceitual, estudo de caso e construção de peças anatômicas, na qual os discentes foram instruídos a confeccionar modelos anatômicos didáticos que auxiliassem na compreensão da anatomia dos diferentes sistemas do corpo humano, associando a fisiologia e a aplicação clínica para dar significado ao aprendizado. Resultados: as peças anatômicas desenvolvidas estão relacionadas com: deformidade do raquitismo; distrofia muscular de duchenne; condromalácia patelar; acúmulo de cristais de ácido úrico na articulação do osso metatarsal; lesão no ligamento colateral medial do joelho; síndrome do ovário policístico; doença de crohn; endometriose; hipertireoidismo e a gastrite. Os discentes mostraram-se satisfeitos com a dinâmica anatômica, principalmente com absorção do conhecimento e a aplicação clínica. Conclusão: a experiência permitiu uma boa alternativa no ensino das ciências morfofuncionais estimulando a criatividade, o trabalho interdisciplinar, motivação ao trabalhar com problemas reais, interesse, investigação, planejamento, execução e construção do conhecimento

Introduction: the study of anatomy is sometimes faced with obstacles that do not allow students' motivation and engagement to impair their performance. It is important to renew and seek other pedagogical practices, inserting innovative methodologies, that allow to stimulate the classes of the morphofunctional sciences favoring the formation of critical professionals, reflective and with greater decision making. Objective: to report the experience in the use of active methodologies in the teaching and learning process of discipline Morphofunctional in the medical course of the UFOB. Methodology: an observational and descriptive account of the active methodologies in the teaching and learning process used in the Morphofunctional discipline in an interdisciplinary and innovative way was carried out. The active methods used were conceptual map, case study and construction of anatomical pieces, in which the students were instructed to make anatomical didactic models that aided in understanding the anatomy of the different human body systems, associating physiology and clinical application to give meaning to learning. Results: the anatomical pieces developed are related to: rickets deformity; duchenne muscular dystrophy; chondromalacia patelar; the accumulation of uric acid crystals in the metatarsal bone joint; injury to the medial collateral ligament of the knee; polycystic ovarian syndrome; crohn's disease; endometriosis; hyperthyroidism and gastritis. The students were satisfied with the anatomical dynamics, mainly with absorption of knowledge and clinical application. Conclusion: the experience allowed a good alternative in the teaching of the morphofunctional sciences stimulating creativity, interdisciplinary work, motivation when working with real problems, interest, research, planning, execution and construction of knowledge.

The anatomy for retroperitoneal laparoscopic splanchnicectomy / La anatomía de la esplacnicectomía laparoscópica retroperitoneal

Greater splanchnic nerves (GSNs) and lesser splanchnic nerves (LSNs) are the dominant nerves in the pain of advanced cancer patients, which provides the base of retroperitoneal laparoscopic splanchnicectomy. We dissected 25 cadavers to provide anatomic basis for the surgery. Most GSNs entered the abdominal cavity close to the medial crus of the diaphragm while most LSNs the middle one. The number of the branch varies from 1 (which was 80 %) ­ 3. The abdominal segment length of LSNs and GSNs was 26 mm and 20 mm respectively. The mean diameter of the nerves was about 2 mm. The laparoscope was put through abdominal wall beneath the 12th rib at the posterior axillary line, best angles and distances for the surgery were 50 ° and 80-110 mm respectively. The anatomic parameters of splanchnic nerves in the abdominal cavity as well as the angle and distance for the retroperitoneal laparoscopic splanchnicectomy and the anatomic landmarks were presented by the study. Besides the advantages of small incision, less pain and quick recovery, the anatomic parameters provided a practicable approach for the retroperitoneal laparoscopic splanchnicectomy.

Los nervios esplácnicos mayores (NEM) y los nervios esplácnicos menores (NEm) son los nervios dominantes en el dolor de los pacientes con cáncer avanzado, que proporciona la base de la esplacnicectomía laparoscópica retroperitoneal. Se disecaron 25 cadáveres para proporcionar base anatómica para la cirugía. La mayoría de los NEM entraron en la cavidad abdominal cerca del pilar medial del diafragma, mientras que la mayoría de los Nem lo hicieron cerca del pilar medio. El número de ramas varía de 1 (que era del 80 %) - 3. La longitud del segmento abdominal de NEm y NEM fue de 26 mm y 20 mm, respectivamente. El diámetro medio de los nervios era de aproximadamente 2 mm. El laparoscopio se colocó a través de la pared abdominal debajo de la 12 costilla en la línea axilar posterior, los mejores ángulos y distancias para la cirugía fueron de 50° y 80-110 mm, respectivamente. Los parámetros anatómicos de los nervios esplácnicos en la cavidad abdominal, así como el ángulo y la distancia para la esplacnicectomía laparoscópica retroperitoneal y los puntos de referencia anatómicos fueron presentados por el estudio. Además de las ventajas de la incisión pequeña, menos dolor y recuperación rápida, los parámetros anatómicos proporcionaron un enfoque práctico para la esplacnicectomía laparoscópica retroperitoneal.

A Morphological Study of the Suprascapular Notch in a Sample of Scapulae at the University of Kwazulu Natal / Estudio Morfológico de la Escotadura Supraescapular en una Muestra de Escápulas de la Universidad de KwaZulu-Natal

The suprascapular notch (SSN) is important, as it is a risk factor in the development of suprascapular nerve entrapment syndrome. The purpose of this study is to describe the morphology of the SSN of a sample of normal scapulae in the Discipline of Clinical Anatomy, University of KwaZulu Natal. Sixty scapulae were used consisting of 37 males and 23 females (mean age 51 years). The superior transverse diameter and maximal depth of the notches were measured. Comparisons were made of the notch in relation to the maximal width and length of the scapulae, laterality and sex. The Rengachary classification method was adopted to describe the shape of the SSN. Analysis of morphological variations showed Type II- wide blunted V-shaped notch to be predominant (65%). Three scapulae had absent notches (Type I). The average notch depth and transverse diameter were 6.51±2.69 mm and 13.18±5.52 mm respectively. The right SSN were significantly deeper than the left (7.54±2.51 mm) (p<0.02). The male scapulae were distinctively larger, with females having a much shallower and wider notch. Understanding the morphological variation of the SSN is important when various radiological imaging techniques are utilized such as during arthroscopic shoulder operations and anaesthesia for landmarking of the suprascapular nerve.

La incisura supraescapular (IS) es importante, ya que es un factor de riesgo en el desarrollo del síndrome de atrapamiento del nervio supraescapular. El propósito de este estudio fue describir la morfología de la IS de una muestra de escápulas normales en la disciplina de Anatomía Clínica de la Universidad de KwaZulu-Natal. Se utilizaron sesenta escápulas, 37 de hombres y 23 de mujeres (edad media 51 años). Se midieron el diámetro transversal superior y la profundidad máxima de las incisuras. Se realizaron comparaciones de la incisura en relación al ancho máximo y la longitud de la escápula, su lateralidad y el sexo. Se utilizó el método de clasificación de Rengachary para describir la forma de la IS. El análisis de las variaciones morfológicas mostró que el Tipo II, muesca amplia roma en forma de V, fue predominante (65%). Tres escápulas no presentaron incisuras (Tipo I). La Media de la profundidad y diámetro transversal fueron 6,51±2,69 mm y 13,18±5,52 mm, respectivamente. Las IS derechas fueron significativamente más profundas que las izquierdas (7,54±2,51 mm) (p<0,02). Las escápulas de los hombres fueron significativamente de mayor tamaño que las de mujeres, con una incisura más superficial y ancha. La comprensión de las variaciones morfológicas de la IS son relevantes ya que diversas técnicas de imágenes radiológicas son utilizadas durante cirugías artroscópicas y anestesia del hombro para estimar puntos anatómicos del nervio supraescapular.

Multiple choice questions as a teaching learning tool in addition to assessment method.

Background and Objectives: Learning of a subject becomes effective when the student knows the purpose of learning. The guidance on the relevance of content of basic sciences to clinical sciences is important. Reinforcement of knowledge is essential to indicate the key areas of the subject for in depth study. The aim of the present study was to focus the students on relevant content and educational objectives through multiple choice questions. Methods: The study consisted of an intervention and a control group of seventy five students each. The intervention group was exposed to the new concept of weekly assessment with concept based MCQs. Results: The methodology has been effective in the study group. This has been demonstrated by the mean scores of the study group (17.67 ± 1.72) being higher than the control group (13.6 ± 2.34) (P < 0.01). Program evaluation by the students has revealed that they developed interest to study the subject in depth. It has helped them in comprehending and reinforcement of the conceptual knowledge and guided them to apply it clinical sciences. Conclusion: Well structured MCQs in the form of assessment with an immediate feedback with explanation of the applied anatomy improve the critical thinking and reasoning skills of the student.

An unusual anatomical variation of the levator scapulae muscle / Una variación anatómica inusual del músculo elevador de la escápula

Clinical and surgical importance of the levator scapulae muscle (LSM) requires a better knowledge of its anatomic variation mainly because of the possibility of new findings related to the embryologic development. This article reports a case of a left-sided LSM with atypical attachments in a 58-year-old preserved Caucasian female body. The muscle presented a bifurcation at its midpoint downward path. Its medial band attached to the anterior aspect of the left rhomboideus major muscle while its left band was fixed in the superior angle of the scapula after releasing a muscle expansion to the serratus anterior muscle. The morphometric analysis revealed LSM maximal width of 3.6 cm, bifurcation point located 6.6 cm apart from the C1 vertebral attachment; medial band legth of 5.7 cm and lateral band width of 2.1cm. Regarding anatomic variations of the LSM, they may remain unnoticed or perhaps contribute for pathologic conditions of the neck and the back...

Debido a la importancia clínica y quirúrgica del músculo elevador de la escápula, se hace necesario conocer mejor sus variaciones, principalmente la posibilidad de encontrar hallazgos relacionados con su desarrollo embriológico. Se presenta el caso de un músculo elevador de la escápula del lado izquierdo encontrado en un cadáver de sexo femenino de 58 años. El músculo elevador de la escáula presentaba una bifurcación en el punto medio en su trayectoria más baja. La banda medial se fijaba en la parte anterior del músculo romboides mayor izquierdo; mientras que su banda lateral se fijaba en el ángulo superior de la escápula después de enviar una expansión hasta el músculo serrato anterior. El análisis morfométrico reveló un ancho máximo de 3,6 cm, punto de bifurcación situado 6,6 cm bajo la inserción vertebral C1; longitudes de la banda medial 5,7 cm y lateral de 2,1cm. Las variaciones anatómicas del músculo elevador de la escápula pueden pasar inadvertidas, pero también pueden contribuir con algunas condiciones patológicas del cuello y espalda...

Clinical anatomy study on neurocutaneous vascular flap / 中华显微外科杂志

Objective To provide vascular feature of neurocutaneous vascular flap and anatomical details about how to design the flap.Methods Ten fresh human body sample with twenty limb were perfused.The clinical anatomy of lateral antebrachial cutaneous nerve,medial antebrachial cutaneous nerve,sural nerve,superficial peroneal nerve,saphenous nerve and their nutrient vessels were studied.The distribution of their nutrient perforators were observed.Results Neurocutaneous nutrient vessels or nutrition artery with large diameter were accompanying nervus cutaneus by a long distance; Or longitudinal vascular chains were formed by ramus communicans with the ascending branches and descending branches from multiple segmental vessels.Medial antebrachial cutaneous nerve,lateral antebrachial cutaneous nerve,sural nerve,superficial peroneal nerve,saphenous nerve has the ulnar artery perforating branches,radial artery perforating branches,anteriolateral supra malleolar perforating branches,posterolateral supra malleolar perforating branches,medial supra malleolar perforating branches,accompanied separately,and the occurrence rate were 100％,95％,80％,90％,100％ respectively.Conclusion Cutaneous branch from the main deep artery is the anatomical basis of neurocutaneous nutrient vessel.Its distribution also accord to pressure balance rule.Mostly nervus cutaneus had constant perforator attending to suply its nutrition.Actually neurocutaneous nutrient vessel is a predictable and reliable vascular chain.

Common celiacomesenteric trunk: a rare anatomic variation / Tronco único celíaco-mesentérico: uma variante anatômica rara

Common celiacomesenteric trunk, with the celiac and superior mesenteric arteries having a common origin from the aorta, is the least frequently reported anatomic variation of all abdominal vascular anomalies. Knowledge of variations concerning the celiac trunk and superior mesenteric artery are of great importance for both surgical approaches and angiographic examinations. Clinicians should keep in mind these variations to avoid complications.

O tronco único celíaco-mesentérico, com as artérias celíaca e mesentérica superior tendo uma origem comum a partir da aorta, é a variante anatômica menos reportada dentre todas as anomalias vasculares abdominais. Conhecer as variantes do tronco celíaco e da artéria mesentérica superior é de grande importância tanto para abordagens cirúrgicas quanto para exames angiográficos. É importante que os médicos tenham em mente essas variantes a fim de evitar complicações.

Analysis of Digital Media and Image Delivery System of Human Anatomic Dissection for Medical Students and Clinicians / 체질인류학회지

In the traditional cadaver dissection course, it is hard to demonstrate dissection skills to all the medical students because of limitations such as the high ratio of students to instructors and the lack of facilities. To overcome these limitations, we developed a digital anatomy dissection course. Through this system, it was possible to perform effective instruction of anatomic dissection. This method could provide the appropriate teaching in a short period of time. Furthermore, students can review the dissection course on digital files saved on a CD-ROM. Clinical cadaveric workshops can be provided by this method not only for students but also for continuing medical education for clinicians.

Topography and Morphology of the Medial Pterygoid Muscle for the Surgical Approach of the Mandibular Ramus / 체질인류학회지

It has been known that the medial pterygoid muscle influences the mandibular functions related to mandibular movements. In addition, the muscle bundle of the medial pterygoid muscle influences the stability of a complete denture. Therefore, the topography of this muscle is clinically important. However, researches on the clinical anatomy related to the insertion area, and innervation, of this muscle were rare. Therefore, authors investigated the morphological and topographic characteristics of the medial pterygoid muscle by dissection of 31 Korean cadavers. The following are the results:The middle portion of the medial pterygoid muscle was the longest with the length of 59.4 degrees +/-7.1mm, and upper one third of the total length of the muscle was composed of tendon. When comparing the morphology of the insertion area of the medial pterygoid muscle and the masseter muscle in the mandibular angle region, there was no difference of the length of the insertion from the gonion to the superior margin of the insertion on the ramus. However, the length from gonion to the anterior margin of the insertion on the ramus in the masseter case was twice as long as the medial pterygoid muscle case. Insertion of the medial pterygoid was morphologically classified into six groups based on the insertion pattern and the mylohyoid groove. Type V, which the muscle fibers in the insertion of the medial pterygoid muscle were divided and did not invade the mylohyoid groove, were found the most (26.6%). Most of pterygoid branch of trigeminal nerve entered the medial pterygoid muscle through the posterior one third area or the posterior marginal area. The average length between hamulus and the region where the pterygoid branch of mandibular nerve entered the medial pterygoid muscle was 10.1mm. In conclusion, the anatomical relationship between the medial pterygoid muscle and the surrounding structures will be able to provide useful data for clinical applications.