The attitudes of European medical students towards the clinical importance of neuroanatomy.

The attitudes of medical students towards the clinical importance of neuroanatomy have been little studied. Because it has been reported that medical students find neuroanatomy difficult and can have 'neurophobia', here we test the hypothesis that early-stage medical students across Europe have a low regard for neuroanatomy's clinical relevance. The work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG), with just over 1500 students from 12 European medical schools providing responses to a survey (52% response rate) that assessed their attitudes using Thurstone and Chave methodologies. Regardless of the university surveyed, and of the teaching methods employed for neuroanatomy, our findings were not consistent with our hypothesis. However, the students had a less favourable opinion of neuroanatomy's importance compared to gross anatomy; although their attitudes were more positive than previously reported for histology and embryology. The extent to which neuroanatomy plays a significant role in the early years of medical education is moot. Nevertheless, we conclude that in addition to newly recruited medical students being informed of the subject's role in a healthcare profession, we advocate the use of modern imaging technologies to enhance student understanding and motivation and cognisance of the core syllabus for the subject being developed by the International Federation of Associations of Anatomists (IFAA).

Obtaining patient-specific point model of the human ilium bone in the case of incomplete volumetric data using the method of parametric regions.

In this paper, we present the methodology for determining the point model of the ilium bone in cases when volumetric data of the whole bone are not available. An extreme traumatic bone damage, osteoporosis, destruction of bone tissue by malignant bone tumors or the existence of only 2D medical image (X-ray) can be the reason for the lack of complete volumetric data. Points on the bone surface were defined at the curves that run through 26 previously defined parameters, at the edges of anteroposterior (A-P) and lateral projections and at the parts of the surface between some parameters. Those parts of the surface, enclosed by parameters, represent ten parametric regions. The values of coordinates, which represent the input data in the statistical program, were measured in a uniquely defined coordinate system. After establishing the correlations between the values of coordinates, 8869 different linear and nonlinear regression models were obtained. The prediction values for point coordinates were calculated and exported to a CAD program. Results obtained were tested on a randomly chosen male right ilium bone, applying the methodology for creating the prediction model using the method of parametric regions, which allows creating a complete polygonal model, for each region separately or just for some parts of the region. Results obtained in the form of regression equations for the right ilium bone can be applied to the left ilium bone. The results of the research were verified using a comparative deviation and distance analysis between the initial and obtained polygonal models.

The attitudes of medical students in Europe toward the clinical importance of histology.

Many studies have been undertaken to assess the attitudes of medical students to the clinical importance of gross anatomy. However, much less is known about their attitudes toward the clinical importance of histology. Using Thurstone and Chave methods to assess attitudes, over 2,000 early stage medical students across Europe provided responses to a survey that tested the hypothesis that the students have a high regard for histology's clinical relevance. Regardless of the university and country surveyed, and of the teaching methods employed for histology, our findings were not consistent with our hypotheses, students providing a more moderate assessment of histology's importance compared to gross anatomy but more positive than their attitudes toward embryology. Histology should play a significant role in medical education in terms of appreciating not just normal structure and function but also pathology. We conclude that teachers of histology should pay special attention to informing newly-recruited medical students of the significant role played by histology in attaining clinical competence and in underpinning their status as being learned members of a healthcare profession. This work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG). Clin. Anat. 30:635-643, 2017. © 2017 Wiley Periodicals, Inc.

The Parametric Model of the Human Mandible Coronoid Process Created by Method of Anatomical Features.

Geometrically accurate and anatomically correct 3D models of the human bones are of great importance for medical research and practice in orthopedics and surgery. These geometrical models can be created by the use of techniques which can be based on input geometrical data acquired from volumetric methods of scanning (e.g., Computed Tomography (CT)) or on the 2D images (e.g., X-ray). Geometrical models of human bones created in such way can be applied for education of medical practitioners, preoperative planning, etc. In cases when geometrical data about the human bone is incomplete (e.g., fractures), it may be necessary to create its complete geometrical model. The possible solution for this problem is the application of parametric models. The geometry of these models can be changed and adapted to the specific patient based on the values of parameters acquired from medical images (e.g., X-ray). In this paper, Method of Anatomical Features (MAF) which enables creation of geometrically precise and anatomically accurate geometrical models of the human bones is implemented for the creation of the parametric model of the Human Mandible Coronoid Process (HMCP). The obtained results about geometrical accuracy of the model are quite satisfactory, as it is stated by the medical practitioners and confirmed in the literature.

Contribution to the method for determining femoral neck axis.

INTRODUCTION: Femoral neck axis plotting is of great significance in measuring parameters that define femoral head-neck junction sphericity in the group of patients with the femoroacetabular impingement. Literature methods of femoral neck axis determination have weaknesses associated with the risk of obtaining inaccurate values of certain parameters. OBJECTIVE: Method of plotting of the femoral neck axis by two parallel lines that belong to the medial quarter of the femoral neck is proposed. Method was tested on the anatomic specimens and the respec tive radiograms. METHODS: A total of 31 anatomic specimens of the proximal femur and respective radiographs were used, on which three axes of the femoral neck were plotted; accordingly, alpha angle value was determined and tested with corresponding parametric tests, with the measurement error of less than 5% and the strength of the applied tests of 80%. RESULTS: Alpha angle values obtained by plotting femoral neck axis using the literature and methods we have proposed were not significantly different in our series, and, in more than a half of the specimens, the two axes overlapped each other. CONCLUSION: The advantage of the proposed method does not depend on the position of the femoral head rotation center in relation to the femoral neck, which favors proposed method for measuring the angles of femoral head sphericity in patients with the femoral head translation. Disadvantage of the study is a small sample size for valid conclusions about the applicability of this method in clinical practice.

Aspects of orthodontic-prosthetic rehabilitation of dentofacial anomalies.

Skeletal class III malocclusion is one of the most difficult dentofacial anomalies, characterized by deviation in the development of the mandible and maxilla in the sagittal plane, where the mandible is dominant in relation to the maxilla. In patients with class III malocclusion, anomalies in the dentoalveolar level and esthetic discrepancies are also frequent. The etiology of class III malocclusion is multifactorial due to the interaction of hereditary and environmental factors. Rehabilitation and treatment of malocclusion is one of the major goals of modern dentistry. This article presents the orthodontic-prosthetic therapy and rehabilitation of a 45-year-old patient with an abnormal occlusal vertical dimension and a skeletal class III malocclusion. The patient came to the clinic complaining about degraded esthetics and disordered functions of the orofacial region (functions of eating, swallowing, speech) and also pain in the temporomandibular joint. After the diagnosis was made, the patient was first referred to orthodontic treatment with fixed orthodontic appliances (self-ligating brackets system Rot 0.22). Upon completion of the orthodontic treatment, the patient was sent for further prosthetic treatment. Fixed prosthetic restorations were made in the upper and lower jaw, thus achieving a satisfactory result in terms of esthetics and function of the stomatognathic system.

[Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: a case report].

INTRODUCTION: The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. CASE OUTLINE: We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. CONCLUSION: Contamination and devitalization of the soft-tissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury.

Symptomatic idiopathic noncommunicating intradural arachnoid cyst of the S1 nerve root: a case report.

STUDY DESIGN: A case report of a rare symptomatic, idiopathic, noncommunicating intradural arachnoid cyst (IAC) of the proximal part of the S1 nerve root (NR). OBJECTIVE: To discuss the possible pathophysiology, clinical and magnetic resonance imaging (MRI) presentation, intraoperative findings, and follow-up of IAC of the proximal part of the S1 NR. SUMMARY OF BACKGROUND DATA: Rare variety of the Nabors's Type 3 spinal IAC. The etiopathogenesis are uncertain. Surgical NR decompression with extirpation of the cyst is the treatment of choice. METHODS: A 37-year-old woman clinically presented as monoradiculopathy with a 9-month history of progressive, posture-dependent radicular pain, paresthesia and hypoesthesia in the right S1 dermatome, and mild weakness of the ipsilateral plantar flexors. Magnetic resonance imaging (MRI) showed a noncommunicating IAC of the proximal part of the S1 NR on the right side. Surgical exploration through the ipsilateral L5-S1 hemilaminectomy was performed with microsurgical arachnolysis of the compressed and stretched S1 NR fascicles that surrounded the cyst, during which the cyst spontaneously collapsed. The remnant of the cyst wall was extirpated and histopathology confirmed the diagnosis. RESULTS: After surgery an excellent clinical outcome was archived: the leg pain was no longer present and the paraesthesia, hypoesthesia, and motor weakness were resolved within 3 months. At 12 months of follow-up, the patient continues to be completely asymptomatic with no evidence of recurrence on MRI. CONCLUSION: A rare case of symptomatic, idiopathic, noncommunicating IAC of the proximal part of the S1 NR has been presented. Early recognition and treatment resulted in complete symptom resolution, with preservation of the full working capacity and good quality of life. Isolated monoradiculopathy with progressive, posture-dependent radicular pain seem to be typical clinical findings for such a lesion. Attending physicians should always be mindful of this fact in the total clinical evaluation of such cases.

[Comparative analysis of linear morphometric parameters of the humane mandibula obtained by direct and indirect measurement].

BACKGROUND/AIM: Reconstruction of lost, damaged or distorted mandibular bone presents a challenge from the functional side, as well as from the esthetic point of view. The aim of this study was to determinate potential differences between values of the basic linear moprhometric parameters (LMPs) obtained by direct and indirect manual measurement of the same humane mandibles, with accuracy testing of indirect measurement, which are routinely used in every-day clinical practice. The results are essential for defining of parametric model of the "standard mandible" and virtual modeling of the humane mandible in future researches as well as in clinical medicine. METHODS: A total number of 12 dry bony mandibles of human adults were studied. According to the standard anatomical landmarks, 10 standard LPMs were measured on each mandible by different manual methods: directly by a sliding caliper with nonius, and indirectly using standard software on two-dimensional (2D) reconstructions of mandibular multislice computed tomography (MSCT) scans. The values obtained by the different measuring methods were matched for the same LMPs. RESULTS: Statistically significant differences between compared LMPs values obtained by different measuring methods, appeared in the gnathio-interdental distance (Gn-IdD), as well as in the gnathio-condylar distance (Gn-CoD), bilaterally. In both parameters, significantly higher mean values (with percent of difference) were obtained by direct versus indirect measurement: Gn-IdD (21.57%; 29.2 mm vs 22.9 mm; p = 0.004); Gn-CoD left side (14.1%; 122.7 mm vs 105.4 cm; p = 0.001); Gn-CoD right side (11.87%; 124.7 mm vs 109.9 mm; p = 0.009). CONCLUSION: According to the observed inaccuracy of indirect measurement, we recommended the use of a correction factor for calculation of both Gn-IdD and Gn-CoD real vales, in defining of parametric model of the "standard mandible" based on indirect morphometry on 2D reconstructions of mandibular MSCT scans. Additional studies with larger number of specimens and quantification of anatomical variations regarding to sex, age, dentition status and ethnic origin, additionally should increase measurement accuracy and consequently reliability of future parametric model of the human mandible.

Otic artery: a review of normal and pathological features.

Three primitive arteries - the trigeminal, otic and hypoglossal take the names according to their close relation with the V, VIII and XII cranial nerves, while at the cervical level, the first segmental artery is named the primitive proatlantal intersegmental artery. When the human embryo is 4 mm long, these arteries serve as transitory anastomoses between primitive internal carotid arteries and bilateral longitudinal neural arterial plexus, which is the precursor of future basilar artery. Normal and/or abnormal morphofunctional aspects of the prenatal and postnatal forms of the otic artery are described according to the personal and literature data. Many (ab) normal arteries are also noted in differential diagnosis of the otic artery. Postnatally, individual incidence rates of the carotid-vertebrobasilar anastomoses have been found to be inversely related to their order of disappearance. The persistent trigeminal artery has a reported incidence from 0.06-0.6%, whereas the persistent primitive otic artery has been convincingly documented only in minor rates. Persistent carotid-vertebrobasilar anastomoses between the anterior and posterior cranial circulation are important to recognize during angiography for endovascular and surgical planning. Most frequently, the otic artery was an incidental finding.

Proatlantal intersegmental artery: a review of normal and pathological features.

OBJECTS: Primitive carotid-vertebral and carotid-basilar anastomoses are formed early during human embryogenesis at approximately 24 days. From cephalic to caudal direction, these anastomoses are cranial extensions of the primitive internal carotid, trigeminal, otic, hypoglossal and proatlantal intersegmental arteries. MATERIALS AND METHODS: Normal and/or abnormal morphofunctional aspects of prenatal and postnatal forms of the proatlantal intersegmental artery, from the 24th day of gestation to postnatal eight decades, are described according to personal and literature data. Many (ab) normal carotid-vertebral anastomoses are also marked in differential diagnosis of the proatlantal intersegmental artery. CONCLUSIONS: The proatlantal intersegmental artery maintains the posterior circulation until the vertebral arteries are fully developed between the seventh and eighth gestational weeks. When this artery fails to obliterate, it becomes persistent one. The proatlantal intersegmental artery, most commonly, is an incidental finding or it may be of clinical significance in some patients.

[Treatment of severe spacticity in multiple sclerosis by continuous intrathecal baclofen].

BACKGROUND: Successful treatment of severe spasticity represents an imperative of symptomatic therapy of multiple sclerosis (MS) due to a significant improvement of physical, psychic and social rehabilitation of MS patients, as well as a long-term cost savings for the additional treatments of conditions arising from uncontrolled severe spasticity. Continuous intrathecal administration of baclofen (ITB), using a subcutaneously implanted programmable infusion pump, is a minimally invasive, reversible method for the treatment of severe diffuse spasticity of the spinal origin. CASE REPORT: The first two cases in our country, treated by ITB due to severe spasticity caused by MS, were reported. Despite the local complications of surgical wound healing above the implanted components of the ITB-system in one patient, the optimal reduction of spasticity the with complete elimination of spastic pain was obtained in both patients. CONCLUSION: Our initial experiences confirmed ITB as a safe and effective therapeutical option for the treatment of intractable spasticity in patients with MS. Major prerequisites for this were adequate patient selection and good control of the basic disease. The use of the minimal invasive implantation technique and the experience in choosing of the adequate ITB-system components, could successfully prevent the occurrence of local complications related to the impaired healing of the ITB-system implantation site.

Morphological aspect of the thyroid ima artery in human fetuses.

Some morphological characteristics of the variable thyroid ima artery were investigated on the injected fetal arteries and explained on their 106 static images. Thyroid ima artery of different origin was proven in 18 (16.9%) cases. With respect to the vascular sources of the investigated artery, the branching of the brachiocephalic trunk and right common carotid artery was found in 72.1% of the cases. At the same time, the thyroid ima and superior or inferior thyroid arteries were obvious in all cases, as well as the presence of single or multiple variations and abnormalities of neighbouring arteries in 38.8% of the cases. No major anatomical difference was noted between the fetal form of the variable thyroid artery reported in this paper and the postnatal form reviewed from the literature. Thyroid ima artery probably represents an example of the arterial self-differentiation and induced differentiation of the unilateral vascular trunk.