Endoscopic Orientation of Juxta-pituitary Carotid in Transsphenoidal Approaches: Critical Considerations for Clinical Applications

Abstract Introduction In sphenoid sinuses with ill-defined carotid bony landmarks, accidental injury of the internal carotid artery (ICA) remains one of the most challenging complications, which is particularly reported in the endoscopic endonasal transsphenoidal approaches (EETAs). Objectives To describe an anatomical model for the endoscopic orientation of the juxta-pituitary segment of the ICA in relation to the lateral opticocarotid recess (OCR) as a nearby bony landmark. Methods Dissection was performed progressively, simulating the EETA, in twenty fresh adult cadavers. After reducing the posterior and lateral walls of the sphenoid sinuses, various measurements were taken from both lateral OCRs to "contact points" on the juxta-pituitary segment of the ICA and lateral margins of the pituitary gland. Results The current results have enabled us to divide the region between the lateral OCRs into 3 compartments: 2 lateral parasellar compartments contain juxta-pituitary segments of the ICA with a mean width of 8 mm and a narrow range from 7 mm to 10 mm; and a central intercarotid sellar compartment represents the safe region for bone drilling, showing widely variable widths ranging from 9 mm to 20 mm. In all specimens, the variation in the width of the intercarotid compartment correlated with the distance between both lateral OCRs. Conclusion The present study improves surgeon awareness of the variations in the course of the ICA through the EETA along sphenoid sinuses with ill-defined bony landmarks. An appreciation of the measurements taken in the present study can help in operative training, and can also provide a base for future studies to confirm ICA courses associated with a higher risk of injury.

Lower Four Cranial Nerves in the Management of Glomus Jugulare: Anatomical Study

Abstract Introduction The surgical management that achieves minimal morbidity and mortality for patients with glomus and non-glomus tumors involving the jugular foramen (JF) region requires a comprehensive understanding of the complex anatomy, anatomic variability, and pathological anatomy of this region. Objective The aim of this study is to propose a rational guideline to expose and preserve the lower cranial nerves (CNs) in the lateral approach of the JF. Methods The technique utilized is the gross and microdissection of 4 fixed cadaveric heads to revise the JF's surgical anatomy and high part of the carotid sheath compared with surgical cases to understand and preserve the integrity of lower CNs. The method involves radical mastoidectomy, microdissection of the JF, facial nerve, and high neck just below the carotid canal and the JF. The CNs IX, X, XI, and XII are microscopically dissected and kept in sight up to the JF. Results This study realized well the surgical and applied anatomy of the lower CNs with relation to the facial nerve and JF. Conclusions The JF anatomy is complicated, and the key to safely operate on it and preserving the lower CNs is to find the posterior belly of the digastric muscle, to skeletonize the facial nerve, to remove the mastoid tip preserving the stylomastoid foramen, to skeletonize the sigmoid sinus and posterior fossa dura not only anterior but also posteroinferior to reach and drill the jugular tubercle.

Programa de entrenamiento de parotidectomía en modelo cadavérico perfundido

Introducción: La parotidectomía es una cirugía infrecuente y técnicamente compleja determinada por la dificultad de disección del nervio facial, cuya lesión produce alto grado de morbilidad en los pacientes. Los modelos de simulación animales no logran reproducir las características de la anatomía regional, por lo que se hace necesario explorar otras alternativas para el entrenamiento de estas habilidades. Nuestro objetivo es evaluar un programa de entrenamiento de técnicas de parotidectomía en un modelo cadavé-rico perfundido. Métodos: Se diseñó un programa educacional de Kern de entrenamiento de residentes de Cirugía de Cabeza y Cuello para la realización de parotidectomía total en un modelo cadavérico perfundido. La evaluación se realizó mediante el modelo de Kirkpatrick, en los niveles 1 (reacción), 2A (cambio de actitudes) y 2B (adquisición de conocimientos y habilidades). Resultados: Se elaboró un programa teórico-práctico basado en cátedras y simulación de alta fidelidad. En su mayoría los participantes: recomendarían el curso (Nivel 1); tuvieron mayor motivación para el aprendizaje (Nivel 2) y presentaron mejores indicadores sobre conocimientos, habilidades y percepción de mejoría de sus competencias (Nivel 2B). Conclusión: La utilización de un programa de parotidectomía simulado en un modelo de alta fidelidad basado en modelos cadavéricos humanos perfundidos es una alternativa que mejora la calidad de entrenamiento y es útil y factible para el aprendizaje de técnicas de parotidectomía en residentes de Cirugía de Cabeza y Cuello.

Introduction: The parotidectomy is an infrequent and technically complex surgery due to a difficult dissection that may affect the facial nerve, generating high degree of morbidity in patients. Animal simulation models may not reproduce the human characteristics of cervical anatomy. Therefore, it is necessary to explore other alternatives for training dissection skills. Our objective is to evaluate a parotidectomy's techniques training program in a perfused cadaveric model. Methods: A Kern educational program was designed to train Head and Neck Surgery residents to perform total parotidectomy in a perfused cadaveric model. The evaluation was performed using Kirkpatrick model, at levels 1 (reaction), 2A (change of attitudes) and 2B (acquisition of knowledge and skills). Results: A theoretical-practical program based on lectures and high-fidelity simulation was developed. Most of the participants would recommend the course (Level 1); had greater motivation for learning (Level 2) and showed better indicators of knowledge, skills and perception of improvement in their competencies (Level 2B). Conclusion: The use of a simulated parotidectomy program in a high-fidelity model based on perfused human cadaveric models is an alternative that improves the quality of training and is useful and feasible for learning parotidectomy techniques in residents of Head and Head Surgery.

The rotator cuff footprint in Filipinos: A cadaveric study

Introduction@#Rotator cuff tears are one of the common etiologies of shoulder pain. Rotator cuff repair is recommended for a patient who failed conservative treatment. Proper knowledge of the rotator cuff footprint is needed in restoring correct anatomy during the repair. The size of the footprint is important in determining the kind of repair.@*Objective@#This study aimed to define the average measurements of the rotator cuff footprint on the humerus in Filipino cadavers.@*Methods@#This is a descriptive, cross-sectional study of preserved human cadaver upper extremity specimens. We measured the length, width, and shape of the supraspinatus, infraspinatus, subscapularis, and teres minor.@*Results@#We obtained 27 upper extremity specimens. The median age of the source cadavers was 50.5 years with the equal male-to-female distribution. The mean measurement of the supraspinatus is 22.92 mm in length and 10.17 mm in width. The shape of the supraspinatus was found to be trapezoidal. The infraspinatus length was found to be 17.20 mm and the width at 10.72 mm. Its shape was found to be trapezoidal. The teres minor length was measured at 15.15 mm and the width at 11.04 mm. The shape was mostly trapezoidal but some were triangular. Finally, the subscapularis length was 17.68 mm while the width was 11.26 mm. The shape was trapezoidal or comma-shaped.@*Conclusion@#The average measurement of the rotator cuff footprint was found to be smaller in our study than reported in terms of length and width. The footprint shape was similar to the studies reported.

Resultados post operatorios en pacientes con prótesis total de revisión de cadera mas injerto óseo cadavérico de banco de tejidos en el Hospital de Clínicas en el periodo 2017 al 2020 / Postoperative results in patients with total hip revision arthroplasty and cadaveric bone graft of tissue bank at the Hospital de Clínicas in the period 2017 to 2020

Introducción: La artroplastia total de cadera de revisión junto con la utilización de injerto óseo cadavérico de banco de tejidos es una alternativa de tratamiento eficaz ante los procedimientos de reemplazo con déficit óseo femoral o acetabular. El presente estudio, analizó los resultados post operatorios en pacientes intervenidos quirúrgicamente en el Hospital de Clínicas. Materiales y métodos: Estudio descriptivo. Muestreo no probabilístico de casos consecutivos atendidos en la Cátedra de Ortopedia y Traumatología de la Facultad de Ciencias Médicas (U.N.A). Fueron captados pacientes con indicación de artroplastia total de cadera de revisión (ATCR) más injerto óseo cadavérico de banco de tejidos, entre diciembre 2017 - octubre 2020, previo consentimiento informado. Se relevaron datos cuya caracterización fue posible mediante un instrumento establecido previamente, ingresado en base Excel. Resultados: 12 pacientes con déficit óseo femoral y acetabular han sido tratados con artroplastia total de cadera de revisión más injerto óseo cadavérico de banco de tejidos, en donde además de la funcionalidad y a través de seguimientos radiológicos se ha determinado la osteointegración total de los aloinjertos. La relación masculino-femenina fue 1/1, siendo el diagnóstico preoperatorio para la colocación de la prótesis de revisión más injerto óseo cadavérico de banco de tejidos el aflojamiento séptico en un 75%. El motivo de consulta más frecuente fue dolor y la secreción y el tiempo quirúrgico fue en promedio de 116 minutos. Conclusión: La artroplastia total de cadera de revisión más aloinjerto presenta óptimos resultados en relación a la osteointegración total y funcionalidad.

Introduction: Revision total hip arthroplasty with use of cadaveric bone graft is an effective treatment for replacement procedures in patients with bone loss femoral or acetabular. The present study analyzed the postoperative results in patients who underwent surgery at the Hospital de Clínicas. Materials and methods: Descriptive study. Non-probabilistic sampling of consecutive cases treated at the Department of Orthopedics and Traumatology of Hospital de Clínicas. Data of patients with indication for revision total hip arthroplasty plus cadaveric bone graft from a tissue bank with prior informed consent,were analyzed between December 2017 and October 2020. Results: 12 patients with femoral and acetabular bone deficits have been treated with revision total hip arthroplasty plus cadaveric bone graft from a tissue bank. A radiological and functional follow up was made. The male-female ratio was 1/1, with the preoperative diagnosis for placement of the revision prosthesis plus cadaveric bone graft,from the tissue bank,was septic loosening in 75%. The most frequent symptom was pain, all revision total hip arthroplasties were performed through a posterior approach, and the surgical time was an average of 116 minutes,using a later approach in all cases.Two intraoperative fracture was presented, and were resolved. Conclusion: Revision total hip arthroplasty plus allograft presents optimal results in relation to total osseointegration and functionality.

Caracterización inmunogenética de donantes cadavéricos cubanos en el año 2019 / Immunogenetic characterization of Cuban cadaveric donors in 2019

Introducción: El trasplante es la opción terapéutica más favorable para las personas con insuficiencia renal crónica. El donante puede ser cadavérico o donante vivo, emparentado o no. Los resultados del trasplante están en relación con varios factores inmunológicos y no inmunológicos. Objetivo: Caracterizar inmunogenéticamente a los donantes cadavéricos cubanos para trasplante renal. Métodos: Se realizó un estudio transversal y descriptivo de los donantes cadavéricos durante el año 2019. Se analizó la región de procedencia, sexo, color de la piel y rangos de edades de los donantes, así como, grupo sanguíneos ABO y Rhesus Rh; serología para VIH, Virus de hepatitis B(VHB) y Virus de hepatitis C (VHC); y hábitos tóxicos. Resultados: Se estudió un total de 95 donantes cadavéricos, 62 provenientes del occidente y 33 del centro del país. El 63,2 por ciento fueron masculinos y 36,8 por ciento femenino. El grupo de edad de mayor frecuencia fue 40 - 60 años y la edad media de 49,45 años. El 58,95 por ciento de los pacientes fueron de grupo sanguíneo O; 30,53 por ciento grupo A y los grupos B y AB tuvieron 5,26 por ciento de prevalencia; y solo 8 fueron Rh negativos. Todos tuvieron serología para VIH, VHB y VHC negativas. Las enfermedades asociadas más frecuentes fueron la hipertensión arterial y la diabetes mellitus. Conclusiones: Los donantes cadavéricos durante el año 2019 mostraron características similares a las reportadas por otros estudios. El aumento de las edades de los donantes incide en la aparición de enfermedades asociadas y esto pudiera repercutir en el resultado del trasplante(AU)

Introduction: Transplantation is the most favorable therapeutic option for people with chronic renal failure. The donor can be a cadaveric or living donor, related or not. Transplant outcomes are related to various immunological and non-immunological factors. Objective: To characterize Cuban cadaveric donors for renal transplantation Materials and methods: A cross-sectional and descriptive study of cadaveric donors was carried out during the year 2019. The region of origin, sex, skin color and age ranges of the donors were analyzed, as well as ABO and Rhesus Rh blood groups; serology for HIV, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV), and toxic habits. Results: A total of 95 cadaveric donors were studied, 62 from the West and 33 from the Center of the country. 63.2 percent were male and 36.8 percent female due to the most frequent age group being 40-60 years and the mean age of 49.45 years. 58.95 percent of the patients were of blood group O, 30.53 percent group A and groups B and AB had 5.26 percent prevalence; and only 8 were Rh negative. All had negative serology for HIV, HBV and HCV. The most frequent associated diseases were arterial hypertension and diabetes mellitus. Conclusions: The cadaveric donors during the year 2019 showed characteristics similar to those reported by other studies. The increase in the age of the donors affects the appearance of associated diseases and this could affect the result of the transplant(AU)

The effect of the minimum effective volume for suprainguinal fascia iliaca block in fresh cadavers / El efecto del volumen efectivo mínimo para el bloqueo de la fascia ilíaca suprainguinal en cadáveres frescos

SUMMARY: The goal of ultrasound-guided suprainguinal fascia iliaca block (USG-SFIB) is anesthetic spread to three nerves, which are lateral femoral cutaneous nerve (LFCN), femoral nerve (FN), and obturator nerve (ON). The 90 % minimum effective volume (MEV90) for USG-SFIB is each result of studied showed the successful block and effect in various volume for block. So, Thus, the study purposes to demonstrate the efficiency of the effective volume (MEV90,62.5 ml) for USG-SFIB and confirm the staining of dye in connective tissue of nerve (nerve layer) that focused on the obturator nerve by histological examination in cadavers. The histological result showed the dye staining on the nerve layer of the ON in epineurium (100 %) and un-staining perineurium & endoneurium. Therefore, the minimal effective volume (MEV) is effective for USG-SFIB. Moreover, dye stain at the epineurium of stained obturator nerve only.

RESUMEN: El objetivo del bloqueo de la fascia ilíaca suprainguinal guiado por ecografía (USG-SFIB) es la propagación anestésica a tres nervios, cutáneo femoral lateral, femoral y obturador. El volumen efectivo mínimo del 90 % (MEV90) para USG-SFIB en cada uno de los resultados mostró el bloqueo exitoso y el efecto en varios volúmenes por bloqueo. Por lo tanto, el estudio tuvo como objetivo demostrar la eficiencia del volumen efectivo (MEV90,62.5 ml) para USG-SFIB y confirmar la tinción de tinte en el tejido conectivo del nervio, el cual se centró en el nervio obturador a través del examen histológico en cadáveres. El resultado histológico mostró tinción de colorante en el epineuro (100 %) del nervio obturador, sin embargo no hubo tinción del perineuro y endoneuro. Por lo tanto, el volumen efectivo mínimo (MEV) es efectivo para USG-SFIB.

Distribution of various volumes of methylene blue injection in suprainguinal fascia iliaca block under ultrasound guidance: a cadaveric study / Distribución de varios volúmenes de inyección de azul de metileno en el bloque suprainguinal de la fascia ilíaca bajo guía por ultrasonido: un estudio cadavérico

SUMMARY: The local anesthetic volume for a single-shot suprainguinal fascia iliaca block (SFIB) is a key factor of a block success because the courses of the three target nerves from the lumbar plexus (LP), the lateral femoral cutaneous nerve (LFCN), femoral nerve (FN), and obturator nerve (ON), at the inguinal area are isolated and within striking distance. Thus, this cadaveric study aims to demonstrate the distribution of dye staining on the LFCN, FN, ON, and LP following the ultrasound-guided SFIB using 15-50 ml of methylene blue. A total of 40 USG-SFIBs were performed on 20 fresh adult cadavers using 15, 20, 25, 30, 35, 40, 45, and 50 ml of methylene blue. After the injections, the pelvic and inguinal regions were dissected to directly visualize the dye stained on the LFCN, FN, ON, and LP. All FN and LFCN were stained heavily when the 15-50 ml of dye was injected. Higher volumes of dye (40-50 ml) spread more medially and stained on the ON and LP in 60 % of cases. To increase the possibility of dye spreading to all three target nerves and LP of the SFIB, a high volume (≥40 ml) of anesthetic is recommended. If only a blockade of the FN and LFCN is required, a low volume (15-25 ml) of anesthetic is sufficient.

RESUMEN: El volumen de anestésico local para un bloqueo de la fascia ilíaca suprainguinal (FISI) de una sola inyección es un factor clave para el éxito del bloqueo, debido a que los cursos de los tres nervios objetivo del plexo lumbar (PL), el nervio cutáneo femoral lateral (NCFL), femoral (NF) y el nervio obturador (NO), en el área inguinal están aislados y dentro de la distancia de abordaje. Por lo tanto, este estudio cadavérico tiene como objetivo demostrar la distribución de la tinción de tinte en NCFL, NF, NO y PL siguiendo el FISI guiado por ultrasonido usando 15-50 ml de azul de metileno. Se realizaron un total de 40 USG-FISI en 20 cadáveres adultos frescos utilizando 15, 20, 25, 30, 35, 40, 45 y 50 ml de azul de metileno. Después de las inyecciones, se disecaron las regiones pélvica e inguinal para visualizar directamente el tinte teñido en NCFL, NF, NO y PL. Todos los NF y NCFL se tiñeron intensamente cuando se inyectaron los 15- 50 ml de colorante. Volúmenes mayores de colorante (40-50 ml) se esparcen más medialmente y tiñen el NO y la PL en el 60 % de los casos. Para aumentar la posibilidad de que el colorante se propague a los tres nervios objetivo y al PL del FISI, se recomienda un volumen elevado (≥40 ml) de anestésico. Si solo se requiere un bloqueo de NF y NCFL, un volumen bajo (15-25 ml) de anestésico es suficiente.

Validity and reliability of image intensifier articular step-off and gap measurements for distal radius fractures using a cadaveric model

OBJECTIVES@#The purpose of this study was to determine the accuracy and reproducibility of image intensifier (fluoroscopic) measurements of gap and step-off displacements on the articular surface of the distal radius using a standard cadaver osteotomy fracture model.@*METHODS@#Fourteen orthopedic residents were randomly assigned using the fish bowl method to measure the gap and step-off displacements in cadaveric fluoroscopic images using a digital caliper. Each physician was randomly assigned the images where they examined the images twice and the average taken using a standard technique. The interobserver and intra-observer reliability were calculated using the intraclass correlation coefficient (ICC). Rank Sum test was used to evaluate the validity of measurements.@*RESULTS@#The results of the study showed that there was no significant difference between the cadaveric and measured step-off and gap displacements. Intraclass correlation coefficient scores showed moderate (0.41) to perfect (1.0) agreement.@*CONCLUSION@#The study showed that fluoroscopy can aid in the interpretation of gap and step-off displacements in acute distal radius fractures.

Assisting Role of Pulmonary Hypostasis Phenomenon in Diagnosis of Drowning / 法医学杂志

OBJECTIVES@#To study the phenomenon of pulmonary hypostasis in corpses of various causes of death, and to explore the potential value of this phenomenon in assisting forensic pathological diagnosis of drowning.@*METHODS@#A total of 235 cases with clear cause of death through systematic autopsy were collected from January 2011 to June 2021 in Guangzhou. According to the location of body discovery, the cases were divided into the water body group (97 cases) and the non-water body group (138 cases), and the water body group was further divided into the water drowning group (90 cases) and the water non-drowning group (7 cases). Non-water body group was further divided into the non-water drowning group (1 case) and the non-water non-drowning group (137 cases). Three senior forensic pathologists independently reviewed autopsy photos to determine whether there was hypostasis in the lungs. The detection rate of pulmonary hypostasis was calculated.@*RESULTS@#The detection rate of pulmonary hypostasis in the water drowning group (90 cases) was 0, and the negative rate was 100%. The detection rate of pulmonary hypostasis in the water non-drowning group (7 cases) was 100% and the negative rate was 0. The detection rate of pulmonary hypostasis in the water body group and in the non-water body group (after excluding 2 cases, 136 cases were calculated) was 7.22% and 87.50%, respectively. There were statistically significant differences in the detection rate of pulmonary hypostasis between water body group and non-water body group, and between water drowning group and water non-drowning group (P<0.05).@*CONCLUSIONS@#The disappearance of pulmonary hypostasis can be used as a specific cadaveric sign to assist in the forensic pathological diagnosis of drowning.

Anatomical description and variations of the anterior arterial brain circulation in Colombian cadaveric specimens / Descripción anatómica y variaciones de la circulación cerebral arterial anterior en especímenes cadavéricos colombianos

SUMMARY: Understanding microsurgical neuroanatomy is a fundamental part of the training of neurosurgeons. Notwithstanding the fact that throughout history the study in cadavers has been a fundamental part of training, the publication of these studies has never marked a trend, and in our country the available studies are limited. A descriptive anatomical study was carried out on 22 specimens regarding the anatomical arrangement of the anterior circulation arteries of the brain and the most frequent anatomical variants in the sample used. To this end, bilateral pterional and bifrontal approaches were performed, obtaining a total of 132 arteries, including supraclinoid internal carotid arteries (ICA), anterior cerebral arteries in their A1 segment (ACA), and middle cerebral arteries in their M1 segment (MCA). measurements in each of these segments were made and anatomical variants were documented. Out of 22 cadaveric specimens, 17 (77 %) were male. the mean age was 59 years (range 36-81 years). Internal carotid artery mean length was 12.73 and 12.86 in the right and left side respectively. Anatomical variants identified were hypoplasia of segment A1 in 1 (4.5 %) specimen, duplication in 1 (4.5 %) and trifurcation of segment M1 in 3 (13.6 %) specimens. A similarity was found between our data and data reported by literature, with some differences, especially in the anterior communicating artery.

RESUMEN: Entender la neuroanatomía microquirúrgica es una parte fundamental de la formación de los neurocirujanos. A pesar de que, durante la historia, el estudio en cadáveres ha sido parte fundamental del entrenamiento, no ha sido tendencia la publicación de estos estudios, y en nuestro país son limitados los que se encuentran. Se realizó un estudio descriptivo anatómico en 22 especímenes acerca de la disposición anatómica de las arterias de la circulación cerebral anterior y las variantes anatómicas más frecuentes en población colombiana. Para dicho objetivo se realizaron abordajes bilaterales pterionales, y bifrontales obteniendo un total de 132 arterias incluyendo las arterias carotídeas internas supraclinoideas (ACI), arterias cerebrales anteriores en su segmento A1 (ACA) y las arterias cerebrales medias en su segmento M1 (ACM), se realizaron mediciones en cada uno de estos segmentos y se documentaron las variantes anatómicas. De los 22 especímenes cadavéricos, 17 (77 %) eran masculinos, la edad media fue de 59 años (rango 36-81 años). La longitud media de la arteria carótida interna fue de 12,73 mm en el lado derecho y de 12,86 mm en el lado izquierdo. Las variantes anatómicas identificadas fueron hipoplasia del segmento A1 en 1 (4,5 %), duplicación de A1 en 1 (4,5 %) y trifurcación del segmento M1 en 3 (13,6 %) muestras. Se encontró una similitud entre nuestros datos y los reportados por la literatura, con algunas diferencias, especialmente en el segmento de la arteria comunicante anterior.

Sushruta on human dissection as pre-requisite to surgery / Sushruta sobre la disección humana como requisito previo a la cirugía

SUMMARY: In the western surgical tradition there has been little acknowledgement of the ancient Vedic surgeon Sushruta who initiated many aspects of surgical practice. In his compendium the Sushruta Samhita, Sushruta systematised medicine in various areas. His meticulous knowledge in many branches of medicine is evident. A brilliant surgeon, he developed plastic surgical techniques, types of bandaging, hygiene practices and over one hundred surgical instruments. In this article, I focus on Sushruta's ideas on human dissection as a pre-requisite for surgery, his method of preparation of human cadavers and his anatomical pedagogy. Sushruta pioneered the instruction of cadaveric based anatomical learning which is still being used in medical teaching.

RESUMEN: En la tradición quirúrgica occidental existe escaso reconocimiento del antiguo cirujano védico Sushruta, quien inició muchos aspectos de la práctica quirúrgica. En su compen-dio, el Sushruta Samhita, Sushruta sistematizó la medicina en varias áreas. Es evidente su meticuloso conocimiento en muchas ramas de la medicina. Cirujano brillante, desarrolló técnicas de cirugía plástica, tipos de vendajes, prácticas de higiene y más de cien instrumentos quirúrgicos. El enfoque de este artículo se centra en las ideas de Sushruta sobre la disección humana como requisito previo para la cirugía, su método de preparación de cadáveres humanos y su pedagogía anatómica. Sushruta fue pionero en la instrucción del aprendizaje anatómico basado en cadáveres que todavía se utiliza en la enseñanza médica.

Anatomy education of medical students during the COVID 19 pandemic / Educación en anatomía de estudiantes de medicina durante la pandemia de COVID-19

SUMMARY: COVID-19 created extraordinary challenges to anatomy education and teaching practices, as the anatomists try to achieve best knowledge delivery level for their discipline, without the use of traditional teaching aids such as the cadavers and microscopic slides. The present study was conducted to collect medical students' response and opinions regarding the pros and cons of online teaching vs traditional teaching. 2263 medical studentswere recruited from the first three academic years. A multiple choice close-ended questionnaire regarding their opinion about virtual teaching mode for the anatomy discipline during COVID-19 pandemic was designed and circulated via emails.The majority (78.12 %) of the students agreed that they missed their traditional anatomy learning mode. Moreover, (92.92 %) of the students missed their campus and the college social life. The students strongly felt there is a gap and difficulty in understanding the topics that required practicing and visual orientation such as dissections, models, microscopic slides which help them in better memorizing and recalling the anatomical terms. The lack of proper devices and the absence of high quality internet were among the top reported issues that negatively affect online learning. These results indicated that, compared with traditional methods of teachings, the online learning in the medical schools had relatively poor planning and required continuous and combined efforts in order to improve the quality of online teaching specially for anatomy discipline, which may be an essential response for any unforeseen situation such as the COVID-19 pandemic. We should look at the current situation as an opportunity to apply modern anatomy education approaches which may be a necessity at the present time, with huge accomplishments achieved in the information and online technology field.

RESUMEN: La pandemia de COVID-19 creó desafíos extraordinarios para la educación y las prácticas de enseñanza de la anatomía, debido al objetivo del anatomista de lograr el mejor nivel de educación para su disciplina sin el uso materiales didácticos tradicionales, tal como los cadáveres y las láminas microscópicas. En este studio se analizó la respuesta y las opiniones de los estudiantes sobre los pros y los contras de la enseñanza en línea frente a la enseñanza tradicional. Se reclutaron 2263 estudiantes de medicina de los tres primeros años académicos. Se diseñó un cuestionario cerrado de opción múltiple con respecto a su opinión sobre el método de enseñanza virtual para la disciplina de anatomía durante la pandemia de COVID-19 y se distribuyó por correo electrónico. Además, (92,92 %) de los estudiantes dejaron de participar en la vida social universitaria y se ausentaron del campus. Los estudiantes sintieron fuertemente que hay una brecha y dificultad para comprender los temas que requieren práctica y orientación visual, como disecciones, modelos, diapositivas microscópicas que les ayudan a memorizar y recordar mejor los términos anatómicos. La falta de internet de calidad, y de dispositivos adecuados se encuentran entre los principales problemas reportados que afectan negativamente el aprendizaje en línea. Estos resultados indicaron que, en comparación con los métodos tradicionales de enseñanza, el aprendizaje en línea en las escuelas de medicina tenía una planificación relativamente deficiente y requería una planificación continua, además de esfuerzos para mejorar la calidad de la enseñanza en línea de anatomía, lo que que podría ser de apoyo fundamental ante cualquier situación imprevista como la pandemia de COVID-19. Actualmente, se debe considerar esta situación como una oportunidad para aplicar enfoques modernos de educación en anatomía con importantes logros en el campo de la tecnología informática y en línea.

Accuracy of sonographic identification of suprascapular nerve at supraclavicular fossa: a cadaveric study / Precisión de la identificación ecográfica del nervio supraescapular en la fosa supraclavicular: un estudio cadavérico

SUMMARY: Sonographic identification of suprascapular nerve (SSN) is essential for diagnosis of suprascapular neuropathy and ultrasound-guided suprascapular nerve block. This study aims to demonstrate the accuracy of identification of SSN at supraclavicular region by ultrasonography in fresh cadavers. Ninety-three posterior cervical triangles were examined. With ultrasonography, SSN emerging from the upper trunk of brachial plexus was identified and followed until it passed underneath the inferior belly of omohyoid muscle. Sonographic visualization of SSN in supraclavicular fossa was recorded. Then, cadaveric dissection was performed to determine the presence or absence of SSN. An agreement between sonographic identification and direct visualization was specified and categorized the following three patterns: "correctly identified" (pattern I), "incorrectly identified" (pattern II), and "unidentified" (pattern III). The identification of SSN using sonography was correct in almost 90 %. The diameter of SSN with pattern I was the largest compared to those of other two patterns. In pattern I, SSN ran laterally from the upper trunk of brachial plexus and passed underneath the inferior belly of omohyoid muscle. Therefore, SSN was easily identified under ultrasonography. In pattern II, nerve identified by ultrasonography was literally the dorsal scapular nerve. In pattern III, SSN was unable to be identified because of its anatomical variation. The accuracy of ultrasonographic identification of SSN at supraclavicular fossa is high and the key sonoanatomical landmarks are the lateral margin of brachial plexus and the inferior belly of omohyoid muscle. The anatomical variants of SSN are reasons of incorrect or unable identification of SSN under ultrasonography.

RESUMEN: La identificación ecográfica del nervio supraescapular (NSE) es esencial para el diagnóstico de neuropatía supraescapular y bloqueo del nervio supraescapular mediante la ecografía. Este estudio tiene como objetivo demostrar la precisión de la identificación de NSE en la región supraclavicular por ecografía en cadáveres frescos. Se examinaron noventa y tres triángulos cervicales posteriores. Se identificó el NSE emergente de la parte superior del tronco del plexo braquial con la ecografía, y se siguió hasta su trayecto por debajo del vientre inferior del músculo omohioideo. Se registró la visualización ecográfica del NSE en la fosa supraclavicular. Luego, se realizó disección cadavérica para determinar la presencia o ausencia de NSE. Se especificó un acuerdo entre la identificación ecográfica y la visualización directa y se categorizaron los siguientes tres patrones: "identificado correctamente" (patrón I), "identificado incorrectamente" (patrón II) y "no identificado" (patrón III). La identificación de NSE mediante ecografía fue correcta en casi el 90 %. El diámetro del NSE con el patrón I fue el más grande en comparación con los de los otros dos patrones. En el patrón I, NSE corría lateralmente desde la parte superior del tronco del plexo braquial y pasaba por debajo del vientre inferior del músculo omohioideo. Por lo tanto, el NSE se identificó fácilmente mediante ecografía. En el patrón II, el nervio identificado por ecografía era literalmente el nervio escapular dorsal; en el patrón III, el NSE no pudo ser identificado debido a su variación anatómica. La precisión de la identificación ecográfica del NSE en la fosa supraclavicular es alta y los puntos de referencia sonoanatómicos clave son el borde lateral del plexo braquial y el vientre inferior del músculo omohioideo. Las variantes anatómicas de NSE son razones de identificación incorrecta o incapaz de NSE bajo ecografía.

Cadaveric Oath - Perceptions of First Year Medical Students

Cadaveric dissection is indispensable for anatomy learning. The student - cadaver relationship stabilized on humanities can serve as a simulation for future doctor-patient relationship. Hence bioethics is introduced in the medical curriculum. To achieve the goal of professionalism, cadaveric oath should be conducted on the first day of anatomy dissection, so that medical students can imbibe values like respect, gratitude, compassion, care and dignity towards their first teacher. MethodsThis is an observational study conducted in the Department of Anatomy of J.N.M.C., Sawangi (Meghe), Wardha. On the first day of anatomy dissection, first year medical students were sensitized about the ethical approach towards cadaver. Students were given cadaveric oath. 220 students who participated in the study marked their responses to the questionnaire about the perceptions of cadaveric oath according to the 5 point Likert scale. Data was analysed statistically. Results172 (78.18 %) and 182 (82.73 %) students strongly agreed upon the importance of cadaveric oath in anatomy learning and that it is unique and essential aspect of the medical curriculum respectively. Students agreed that this event helped them to overcome their inhibitions and the event was heart touching and empathetic 98.18 % students strongly agreed that they should be thankful to the family members for the noble gesture of body donation. 95 % students strongly agreed that they are enlightened about the importance of once lived bodies while 97.73 % strongly agreed that cadaver should be treated with respect, compassion, care and dignity. 97.27 % students agreed that cadavers are their silent mentors. Students strongly agreed that cadaveric oath event should be continued for future medical undergraduates and there should be awareness about bioethical education among medical students. ConclusionsIn the present study, cadaveric oath ceremonies helped learners to develop empathy towards their silent mentors. Students strongly agreed that they will always remember the noble gesture of donors for donating their body for medical education and research which cannot be compared to any of the modern-day virtual dissection tool for anatomy learning.

Ludoaprendizaje en anatomía: impacto en las concepciones culturales y el afrontamiento cadavérico desde la neurociencia cognitiva / Playbased learning in anatomy: impact on cultural conceptions and cadaveric affronting from cognitive neuroscience

El jugar fue resignificado por Huizinga como un recurso didáctico y se lo denominó "ludoaprendizaje", "aprendizaje mediado por el juego" o "técnicas lúdicas". Diversos autores estudiaron su aplicación en distintos contextos fue desarrollado como estrategia didáctica por los impulsores de la Escuela Nueva. Distintos autores (Brunner, Frebel, Decroly, Montessori, Cossettini y Freire) han analizado sus proyecciones pedagógicas y resaltaron el valor formativo e impacto en las estrategias cognitivas para la resolución de problemas, desarrollar la atención y memoria, así como elemento motivador y de creatividad. El objetivo es evaluar el impacto de esta intervención didáctica en las concepciones culturales y conceptuales referidas al material cadavérico durante el TP y su afrontamiento. Realizamos un sstudio observacional y transversal mediante una encuesta aplicada a 658 alumnos (año 2016=198; año 2017= 228; año 2018= 232) que incluyó la Escala de ansiedad ante la muerte de Temple -EAM- modificada, preguntas poblacionales (edad, sexo, lugar de nacimiento, situación en la materia, aspectos laborales, estudios previos, motivaciones en relación con la elección de la carrera) y se indagaron términos asociados a los conceptos "material cadavérico" y "pieza anatómica" con la técnica de listados libres de Bernard y la técnica de montones para investigar concepciones culturales e imaginarios y grupos de dimensiones conceptuales. Dado que la arquitectura de la Cátedra divide a los alumnos en 2 salones distintos, para evaluar diferencias con la inclusión de actividades lúdicas en un grupo. Los resultados fueron procesados con pruebas de estadística descriptiva e inferencial (SPSS para dicho análisis y realización de dendogramas), para análisis de los términos Visual Anthropac Freelists versión: 1.0.1.36 y Visual Anthropac Pilesorts versión: 1.0.2.60. El presente trabajo cumple con los reparos ético-legales y normativos vigentes. Observamos que los términos "material cadavérico" y "pieza anatómica" se asociaron con repugnancia, asco, miedo y elemento de estudio, principalmente. En el grupo de alumnos con técnicas lúdicas se objetivó menor cantidad de términos negativos, así como dimensiones conceptuales más relacionadas con el material como recurso instruccional didáctico y no como factor de distrés. En conclusión, la implementación de técnicas lúdicas en la didáctica del proceso enseñanza y aprendizaje con material cadavérico en la materia Anatomía se asoció con un menor impacto negativo en los términos asociados y dimensiones conceptuales referidos al material cadavérico. Dicho impacto tiene injerencia en el contexto de la enseñanza y se asociaría con la disminución de factores negativos en el afrontamiento cadavérico.

The act of playing is as ancient as humanity itself, yet Huizinga was the one who re-signified the concept of "ludic" as a didactive resource related to culture. Play-based learning was developed as a didactic strategy by the forerunners of the New School. Several Authors (Brunner, Frebel, Decroly, Montessori, Cossettini and Freire) have analyzed its pedagogy projections and stressed the impact and formative value in the cognitive strategies involved in problem solving tasks, attention and memory development, as well it's motivational and creativity elements. The object of the present work is to evaluate the impact of these didactic interventions in the cultural and conceptual conceptions of the students related to cadaveric material in the course of practical working during anatomy classes. Observational and transversal study through a questionnaire applied to 658 medical students (2016, n = 198; 2017, n= 228; 2018 n=232) which included a Modified Templer Death Anxiety Scale, population questions (age, gender, place of birth, situation regarding the subject, work-related aspects, former studies, motivations related to career choice). Terminology related to "cadaveric material" and "anatomic piece" was investigated with Bernard's free-listing and lot-drawing techniques in order to investigate cultural and imaginary conceptions and groups of conceptual dimensions. The class structure divides the students in two different ckassrooms, in order to evaluate difference with the inclusion of play-based activities in one of them. The results were processed using tests of descriptive and inferencial statistics (SPSS and dendrogram making), to evaluate the terminological analysis, Visual Anthropac Freelists versión: 1.0.1.36 and Visual Anthropac Pilesorts versión: 1.0.2.60. The present research takes into account all current ethical and legal norms. It has been observed that terms such as "cadaveric material" and "anatomic piece" were associated mainly with repugnancy, disgust, fear and study material. It was observed, in the group of student using play based techniques, a lesser number of negative terminology, as well as conceptual dimensions related with the material as a didactic and instructional resource instead of a distress factor. In conclusion the implementation of play-based techniques in the learning process of the Anatomy coursework was positively associated with a lesser negative impact in both associated terminology and in conceptual dimensions related to cadaveric material. Such an impact is of particular importance in the context of teaching and it would relate with the decrease of negative factors in cadaveric affronting.

The cadaveric human skin allograft as a paradigm shift for the management of a large wound of necrotizing soft tissue infection: an interesting case report

Necrotizing soft tissue infection (NSTI) is an uncommon but fatal and rapidly progressing disease which requires emergent recognition and prompt treatment. Patients of NSTI frequently suffer from large soft tissue defects, which require coverage of these defects by auto-skin graft or flap cover. It becomes a challenge to cover the soft tissue defects in an already sick patient. The patient of NSTI has a restricted skin graft donor site and a poor skin grafting bed. Here authors report a case of 50 years old female, known case of type 2 diabetes mellitus, who suffered from NSTI post intramuscular injection of the left gluteal region. Her left thigh, left gluteal region, lower back, pubic and perineal region were involved. She underwent multiple radical debridement’s followed by the use of Cadaveric human skin allografts to cover the raw area temporarily. Meanwhile, authors optimized the patient nutrition state and controlled the infections. Finally, raw areas were covered with an autologous skin graft, and the patient discharged in stable condition.

La rigidez cadavérica, el espasmo cadavérico y tipos de fibras musculares / The cadaveric rigidity, the cadaveric spasm and types of muscle fibers

La rigidez cadavérica (rigor mortis) es un proceso no muy bien comprendido por la mayoría de los médicos. El conocimiento de la intimidad del proceso de la rigidez cadavérica es de vital importancia ya que es una de las variables que junto con las livideces (livor mortis) y la temperatura (algor mortis) del cadáver ayudan a determinar el cronotanatodiagnóstico, tanatocronodiagnóstico o intervalo postmortal del período inmediato de la muerte. Para entender el mecanismo de la rigidez y el espasmo cadavérico es preciso hacer un repaso de la contracción muscular fisiológica en el vivo. Hay que tener presente que el tipo de fibra muscular predominante modificará las características de la contracción muscular fisiológica en el vivo, y también la rigidez y el espasmo cadavérico. (AU)

The cadaveric rigidity (rigor mortis) is a process which is not very well understood by the majority of the doctors. The knowledge of the intimacy of the cadaveric stiffness process is of vital importance since it is one of the variables that, as well as the postmortem lividity (livor mortis) and the body temperature post mortem (algor mortis) help determine the chronotanatodiagnostic, tanatochronodiagnostic or postmortal interval of the immediate period of death. In order to understand the mechanism of stiffness and cadaveric spasm, it is necessary to review the physiological muscle contraction in vivo. We should keep in mind that the predominant type of muscle fiber will modify the characteristics of physiological muscle contraction in vivo, as well as stiffness and cadaveric spasm. (AU)

Evaluation of Surgical Anatomy of Common Hepatic Artery: A Cadaveric Study

Background: Anatomical variations of the hepatic artery areimportant in the planning and performance of abdominalsurgical procedures. Hence; the present study was conductedfor assessing the surgical anatomy of common hepatic artery.Materials & Methods: A total of 18 corpses were included anddissected in the department of human anatomy. All thespecimens were then analyzed. A Performa was made andclinical and gender details of all the specimens were recorded.All the cadavers were preserved in 10 percent formaldehydesolution. Age range of all the cadavers was between 25 to 65years. Analysis of origin, position and course of the arterieswas done followed by measurement of their length anddiameter. After analysis, recording of the relations of all thearteries from the celiac trunk was done. All the arteries whichwere studies were marked with colored thread. All the resultswere recorded in Microsoft excel sheet and were analyzed bySPSS software.Results: Anatomic variations were found to be present in27.78 percent of cadavers. Out of 7 females, anatomicvariations were found to be present in 2 females while out of 11males, anatomic variations were found to be presentin 3 males. Among the hepatic artery specimens showingvariations, it originated directly from the superior mesentericartery. The average length among the variation anatomyspecimens of common hepatic artery was 2.81 cm while themean diameter was 0.70 cm.Conclusion: Variations in the hepatic artery are a commonphenomenon and both anatomists and surgeons should bethoroughly aware of the variation patterns.

Cadaveric Study of Renal Artery Variations

Introduction: Cadaveric study of renal artery variations, tomake aware the clinician, in order not to jeopardize valuablenephrons in the era of rampant MRD. Study aimed to recordthe presence of Extra Renal Arteries (ERA) in adult humancadaveric kidneys.Material and Methods: This study was done in embalmedcadavers in Tirunelveli Medical College- Anatomy departmentbetween 2015 and 2018.Results: We found EBRA in10%, accessory renal arteries in30% and aberrant renal arteries in 22% of cadavers studied.Conclusion: with the advent of laparoscopic renal surgeriesand renovascular interventions, we hope our study of ERAwill be of great benefit.