Classic versus millennial medical lab anatomy.

This study investigated the integration, implementation, and use of cadaver dissection, hospital radiology modalities, surgical tools, and AV technology during a 12-week contemporary anatomy course suggesting a millennial laboratory. The teaching of anatomy has undergone the greatest fluctuation of any of the basic sciences during the past 100 years in order to make room for the meteoric rise in molecular sciences. Classically, anatomy consisted of a 2-year methodical, horizontal, anatomy course; anatomy has now morphed into a 12-week accelerated course in a vertical curriculum, at most institutions. Surface and radiological anatomy is the language for all clinicians regardless of specialty. The objective of this study was to investigate whether integration of full-body dissection anatomy and modern hospital technology, during the anatomy laboratory, could be accomplished in a 12-week anatomy course. Literature search was conducted on anatomy text, journals, and websites regarding contemporary hospital technology integrating multiple image mediums of 37 embalmed cadavers, surgical suite tools and technology, and audio/visual technology. Surgical and radiology professionals were contracted to teach during the anatomy laboratory. Literature search revealed no contemporary studies integrating full-body dissection with hospital technology and behavior. About 37 cadavers were successfully imaged with roentograms, CT, and MRI scans. Students were in favor of the dynamic laboratory consisting of multiple activity sessions occurring simultaneously. Objectively, examination scores proved to be a positive outcome and, subjectively, feedback from students was overwhelmingly positive. Despite the surging molecular based sciences consuming much of the curricula, full-body dissection anatomy is irreplaceable regarding both surface and architectural, radiological anatomy. Radiology should not be a small adjunct to understand full-body dissection, but rather, full-body dissection aids the understanding of radiology mediums. The millennial anatomy dissection laboratory should consist of, at least, 50% radiology integration during full-body dissection. This pilot study is an example of the most comprehensive integration of full-body dissection, radiology, and hospital technology.

Distal semimembranosus muscle-tendon-unit review: morphology, accurate terminology, and clinical relevance.

BACKGROUND: Our knowledge of the stability of the posteromedial knee is evolving. The distal semimembranosus is an important posteromedial stabilizer of the knee. Current anatomical texts and atlases do not accurately detail the distal insertion. Journal literature commonly mentions multiple distal insertions, one of which contributes to the oblique popliteal ligament. The purpose of this study was to review the literature, current morphology, terminology and clinical relevance of the distal semimembranosus muscle-tendon-unit (SMTU), and suggest alternative nomenclature. : METHODS: Literature search was conducted on anatomical and clinical texts, atlases, journals and websites to analyze the distal morphology of the semimembranosus muscle. Deep dissections were performed on 31 embalmed cadavers, 56 knees in total (27Rt and 29L), identifying the distal semimembranosus tendon morphology. : : RESULTS: Literature search revealed significantly inconsistent morphology of the distal semimembranosus muscle-tendon-unit. Cadaver dissection revealed a consistent trifurcation with three dominant expansions. Cadaver dissection also revealed an oblique popliteal tendon/expansion, indigenous to SMTU, not a ligament. : CONCLUSION: This study provides evidence of a consistent morphology and suggests a more precise nomenclature of the distal SMTU, which includes renaming the oblique popliteal ligament as the oblique popliteal tendon/expansion.

Anatomical factors causing oedema of the lower limb during pregnancy.

BACKGROUND: The objective of this study was to investigate the morphology of the common iliac artery and vein (CIA&V) comparing right and left sides in females versus males. Pregnant women favour lying on one side at rest and during sleep. The reason for this may be due to the morphology and orientation between the CIA&V. Virtually all women during their pregnancy suffer from lower limb swelling. This study provides an anatomical explanation for the propensity to lie consistently on one side, for lower limb swelling, and offers prevention measures. MATERIALS AND METHODS: A literature search was conducted on anatomical texts, atlases, journals, and websites regarding the morphology and orientation of the right and left CIA&V, lower limb oedema, and sleeping positions during pregnancy. Measurements from 15 dissected cadavers were conducted on the right and left CIA&V. RESULTS: The literature search revealed very limited studies on the morphology and orientation of the right and left CIA&V with no studies relating this orientation to lower limb oedema or sleeping positions during pregnancy. Cadaver dissection revealed a relatively direct anterior to posterior orientation left CIA&V and an oblique lateral to medial right CIA&V. CONCLUSIONS: This study suggests an explanation of why women lie on their left side when resting and sleeping during the third trimester due to the clinically relevant anatomy between the CIA&V.

Teaching a sonographically guided invasive procedure to first-year medical students using a novel finger transducer.

OBJECTIVES: The exposure to ultrasound technology in medicine is increasing at multiple training levels. Ultrasound transducers have evolved to provide higher-resolution imaging for more accurate structural identification, with few improvements in ease of use. This study investigated a novel finger ultrasound transducer used by first-year medical students conducting structural identification and practicing an invasive procedure. METHODS: A literature search was conducted on texts, specialty journals, and websites regarding the anatomy of internal jugular and subclavian vein central line placement with sonographic guidance and the use of a finger transducer. First-year medical students performed timed sonographically guided cannulation on the internal jugular and subclavian veins on a phantom torso and identified the internal jugular and subclavian veins on a healthy volunteer using the finger transducer and a conventional transducer. After exposure to both transducers, a survey was taken regarding transducer preference. RESULTS: The literature search revealed no studies comparing finger and classic transducers or sonographically guided central line techniques being conducted by first-year medical students. The students identified and cannulated the internal jugular and subclavian veins using both transducers. Survey results revealed that 70% of the students preferred the finger transducer. CONCLUSIONS: This study showed that first-year medical students could interpret sonographic anatomy while conducting a clinical procedure. The finger transducer proved successful in structure identification and was preferred to the classic transducer because of its combined tactile presence. This pilot study of a novel finger transducer showed the benefits of combining palpatory skills with ultrasound technology in teaching first-year medical students to perform invasive procedures.

The "oblique popliteal ligament": a macro- and microanalysis to determine if it is a ligament or a tendon.

Introduction. This study investigated the importance of the "oblique popliteal ligament" (OPL), and challenges its alleged ligament status. The currently named OPL is indigenous to the distal semimembranosus (SMT); therefore, by definition is not a ligament inserting from bone to bone. Clinically, a muscle-tendon unit is different then a ligament regarding proprioception and surgery. Methods. Literature search was conducted on texts, journals and websites regarding the formation of the OPL. Dissection of 70 knees included macro analysis, harvesting OPL, distal SMT and LCL samples and performing immunohistochemistry to 16 knees with antibody staining to the OPL, distal SMT and LCL. Results. All but one text claimed the OPL receives fibers from SMT. Macro dissection of 70 knees revealed the OPL forming from the distal SMT (100%). Microanalysis of OPL, distal SMT and LCL samples from 16 knees demonstrated expression of nervous tissue within selected samples. Discussion. No journals or texts have hypothesized that the OPL is a tendon. Clinically it is important we know the type of tissue for purposes of maximizing rehabilitation and surgical techniques. Conclusion. This study suggests the OPL be considered the oblique popliteal tendon as a result of the macro and micro evidence revealed.

Approaches to proximal tibial bone harvest techniques.

OBJECTIVES: The iliac crest is the standard site for harvesting bone; however, this procedure may require another specialist and a general anaesthetic. The proximal tibial bone harvest has gained popularity for harvesting autogenous bone. An analysis of the clinical literature regarding the various regions for harvesting bone demonstrates that the use of the proximal tibia led to shorter hospital stays, lower morbidity rates, and a shorter learning curve for the surgeon. The purpose of this study was to analyze the clinical anatomy of a proximal tibial bone harvest graft to provide the anatomical architecture supporting a safe procedure. MATERIALS AND METHODS: Dissection of 58 lower limbs from embalmed cadavers was conducted to determine the anatomy of a proximal tibial bone harvest (PTBH). RESULTS: Dissection revealed that the medial approach has fewer clinically relevant neurovascular structures in harms way, and a larger surface area, providing the clinician a confident surgical window to perform the procedure. CONCLUSIONS: The anatomical basis of this study suggests that the medial proximal tibial bone harvest approach would have fewer serious structures in harm's way compared to the lateral; however, the lateral approach may be preferred for a subgroup of patients.