Glaucoma Mini-Shunt Implantation After Keratoplasty.

PURPOSE: To report the outcomes of patients who underwent miniature glaucoma shunt implantation after secondary glaucoma due to keratoplasty. MATERIALS AND METHODS: Prospective study of consecutive clinical cases who underwent mini-glaucoma shunt implantation following keratoplasty. In brief, a fornix-based conjunctival flap was performed, approximately 50% thickness scleral flap. Mitomycin C 0.025% placed under Tenon's capsule. A 25-G needle created entry for mini-shunt. Ex-PRESS model P-50 was inserted. Scleral flap and conjunctiva were closed with 10-0 Nylon. STATA 8.0 and SPSS software were used for statistical analysis. RESULTS: Seventeen eyes of 17 patients with a mean age of 39.70 years (SD=18.33, range: 18 to 76). A total of 64.70% were male and 35.30% female. Eleven cases after penetrating keratoplasty, 3 cases after triple procedure, 2 after deep anterior lamellar keratoplasty, and 1 following endothelial keratoplasty. Most of the indications for keratoplasty were keratoconus in 9 cases (52.94%), 4 due to endothelial failure (23.52%), 3 cases of herpetic keratitis (17.64%), and 1 case of post-LASIK ectasia (5.88%). Mean preoperative intraocular pressure was 35.94 mm Hg with maximal medical therapy (SD=9.65, range: 18 to 55). Decreasing intraocular pressure to 12.76 mm Hg postoperatively (SD=2.51, range 10 to 18) (P=0.001). Mean follow-up after mini-glaucoma shunt implantation was 23.76 months (SD=8.73, range: 10 to 35 mo). Preoperative mean uncorrected distance visual acuity (UDVA) was 1.31±0.63 (20/408 Snellen) and postoperative mean UDVA was 0.85±0.40 (20/141 Snellen) (P=0.001). Preoperative mean corrected distance visual acuity (CDVA) was 0.83±0.76 (20/135 Snellen) and postoperative mean CDVA was 0.56±0.44 (20/72 Snellen) (P=0.032). CONCLUSIONS: Ex-PRESS miniature glaucoma shunt could be an alternative treatment in postkeratoplasty glaucoma resistant to medical treatment. This technique may be helpful, in trying to avoid corneal damage produced by conventional glaucoma procedures.

Teaching skills to promote clinical reasoning in early basic science courses.

Basic and superior reasoning skills are woven into the clinical reasoning process just as they are used to solve any problem. As clinical reasoning is the central competence of medical education, development of these reasoning skills should occur throughout the undergraduate medical curriculum. The authors describe here a method of teaching reasoning skills in a clinical context during a human anatomy course.

Resilience does not predict academic performance in gross anatomy.

Few studies have evaluated resilience in an academic environment as it relates to academic success or failure. This work sought to assess resilience in regular and remedial students of gross anatomy during the first and second semesters of medical school and to correlate this personal trait with academic performance. Two groups of students were compared: the first group included first-year medical students in the regular course, and the second group included first-year medical students who did not pass the regular anatomy course and so were enrolled in the remedial course. Both groups completed anonymous surveys designed to gather demographic data and establish scores on the Connor-Davidson resilience scale, which includes 25 statements rated zero to four on a Likert scale (maximum score 100). The average resilience score was the same for both groups, 80 +/- 9. The average anatomy grades differed significantly between regular students (67+/- 15.0) and remedial students (61 +/- 12.0). While there was no overall correlation between resilience score and anatomy grade, regular students with resilience scores of 75 or greater showed slightly better academic performance than their classmates. Similarly, remedial students with resilience scores of 87 or greater faired better academically. Resilience does not predict academic performance in gross anatomy, and further work is necessary to identify those intrinsic and extrinsic factors that influence students' achievements.

Estudio Anatómico de los Arcos Palmares: Diámetro y Presentación / Anatomic Study of the Palmar Archs: Diameter and Presentation

Las arterias más importantes de la mano son la radial y ulnar, las que forman los arcos palmares superficial y profundo. La descripción detallada de las características anatómicas de los arcos palmares ha contribuido al desarrollo de nuevas técnicas microquirurgicas en la mano. Los objetivos de este estudio fueron establecer el patrón arterial de la mano, así como determinar el diámetro luminal de las arterias que contribuyen a la formación de los arcos. Se realizó un estudio descriptivo, utilizándose 25 manos de cadáveres embalsamados. Se seccionaron las arterias en diferentes puntos para su tinción y observación al microscopio de luz. El arco palmar superficial completo fue observado en 14 (56%) muestras y en 11 (44%) se presentó de manera incompleta. El arco palmar profundo completo se encontró en 20 muestras (80%) y sólo en 5 (20%) fue incompleto. La presentación de los arcos arteriales palmares es muy compleja y variada, encontrándose siempre, al menos uno de los arcos completo.

The radial artery and unlar artery are the most important arteries of the hand, they form a superficial and deep palmar arches. The detailed description of the anatomic characteristics of the palmar arches have contributed to develop new microsurgical techniques for the hand. The aim of this study was to establish the arterial pattern in the hand, and also to determine the luminal diameter of the arteries that contributes to palmar arches. It was a descriptive study. We used 25 hands of embalmed cadavers. We cut the arteries in differents points and after that they were stained and observed in optical microscope. The complete superficial palmar arch was found in 14 (56%) samples and 11 (44%) samples it was incomplete. The complete deep palmar arch was found in 20 (80%) samples and 5 (20%) it was incomplete. The presentation of the palmar arches is complex and variable, but always exist one complete arch (deep or superficial).

Study pace as a factor that influences achievement in a human anatomy course.

Determining the optimal conditions for learning anatomy will help medical students to do better in a gross anatomy course. We examined the two types of anatomy courses offered in our institution: slow-paced (SP) and fast-paced (FP) courses, in which the same content is taught in approximately the same number of hours (SP = 91 hr; FP = 90 hr), but the duration of each course differed (SP = 91 1-hr sessions lasting 20 weeks; FP = 45 2-hr sessions lasting 9 weeks). The objective of this study was to find out whether a relationship exists between anatomy course pace and achievement. Two groups of students were tested on their anatomy knowledge both before beginning and after completing either the SP or the FP course. The average difference in scores obtained on the pre- and postcourse tests for each group was obtained and a t-test was used (P < 0.05) to compare the mean score for each group. A significant difference was found between group SP and group FP, with the highest achievement obtained by group SP. The pace of the course is thus a factor that influences achievement.

Dissection as a teaching tool: past, present, and future.

Cultural changes, scientific progress, and new trends in medical education have modified the role of dissection in teaching anatomy in today's medical schools. We discuss in this article the role of dissection itself, the value of which has been under debate for the last 30 years. The importance of dissection is considered from different points of view: educational, bioethical, and human values. Included are different opinions from professors and students. Finally, the current practice of dissection is described for some universities in the United States and Europe, showing its use as a learning tool.