anatomical dissection

解剖解剖
  • 文章类型: Journal Article
    将医生理解为在当地日常生活中实施早期现代集体经验主义理想的行为者,本文探讨了1720年代和1780年代德国南部帝国城市的两个案例,在这些案例中,解剖学研究受到了质疑。通过分析两位医生用来证明和继续解剖的策略和论点,它侧重于他们对不同类型的(本地)社区的引用,并将这些引用与另一种类型的集体联系起来:科学学院的成员资格。为了检查对社区的引用,它被提议,提供了一个机会,以更好地了解作为集体项目的自然研究的理想的传播和实践,以及它如何与神圣罗马帝国的秩序和社会的概念和结构交织在一起。
    Understanding physicians as actors who implemented the early modern ideal of collective empiricism into their practices within the local contexts of everyday life, the paper explores two cases from imperial cities in southern Germany in the 1720s and 1780s in which anatomical studies were contested. By analyzing the strategies and arguments that the two physicians used to justify and continue their anatomical dissections, it focuses on their references to different kinds of (local) community and relates these references to another type of collective: membership in a scientific academy. To examine references to community, it is proposed, offers an opportunity to better understand the spread and practice of the ideal of the study of nature as a collective project and how it was intertwined with concepts and structures of order and society in the Holy Roman Empire.
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  • 文章类型: Journal Article
    背景:知情同意对于维持与高等教育机构利用人类供体机构相关的道德标准至关重要。身体捐赠计划负责为教学和研究目的采购人类捐赠机构。然而,其流程需要对最佳实践指南和《南非国家卫生法》(SA-NHA)(2013)进行审查。此外,承认和解决当前对人体捐赠的看法对于弥合学术界和社会之间的差距是不可或缺的。这项研究旨在根据国际准则比较南非高等教育机构及其附属人体捐赠计划(HBDP)的知情同意文件和程序。研究结果用于创建符合当前国际最佳实践的人体捐赠表格模板,供南非HBDP考虑。
    方法:对从南非的8份HBDP收集的信息和同意书进行审查。分析包括对所提供信息的广泛评估,从机构的使用条款到HBDP对捐助者的承诺。结果与国际解剖学协会联合会和其他最近关于HBDP知情同意的出版物一起审议。
    结果:八个HBDP中只有两个以一种以上语言提供了信息和同意书。大多数人允许捐赠者选择如何利用他们的身体——教育,培训和/或研究。有些人(6/8)为近亲接受骨灰作出了规定。只有一家高等教育机构在其文件中提到了追悼会的发生。创建了符合当前国际最佳实践的HBDF模板,用于SAHBDP的演示和可能的改编。
    结论:人体捐赠形式(HBDF)需要对HBDP的推广和可持续性进行全面检查。通过采用标准化的非技术术语进行有效的沟通,这些术语的语言是可以理解的,并且是潜在捐助者的母语,这有助于达成知情同意。身体使用和管理方面的不一致促使人们对人体捐赠的看法减弱。因此,确保获得遗体捐献知情同意的过程应与公众意识运动结合进行,并以必要的政策和立法改革为基础。
    BACKGROUND: Informed consent is critical for maintaining the ethical standards associated with the utilization of human donor bodies by tertiary education institutions. Body donation programs undertake the responsibility for procuring human donor bodies for didactic and research purposes. However, its processes require scrutiny regarding best practice guidelines and the South African National Health Act (SA-NHA) (2013). Moreover, acknowledging and addressing the current perceptions of human body donation are indispensable in bridging the gap between academia and society. This study aimed to compare informed consent documentation and procedures across South African tertiary education institutions and their affiliated human body donation programs (HBDP) in accordance with international guidelines. The findings were used to create a human body donation form template aligned to current international best practices for consideration by the South African HBDP.
    METHODS: A review of information and consent forms collected from South Africa\'s eight HBDP was conducted. The analyses consisted of a broad evaluation of information provided, ranging from the terms-of-use for human donor bodies to the commitments made by HBDP to body-donors. The results were considered in conjunction with the International Federation of Associations of Anatomists and other recent publications on informed consent in HBDP.
    RESULTS: Only two of the eight HBDP provided information and consent forms in more than one language. Most allowed donors to select how their bodies will be utilized - education, training and/or research. Some (6/8) made provisions for the next-of-kin to receive the cremains. Only one tertiary educational institution mentioned the occurrence of a memorial service in its documentation. An HBDF template was created aligned to current international best practices for presentation and possible adaption by SA HBDP.
    CONCLUSIONS: Human body donation forms (HBDF) requires thorough examination for the promotion and sustainability of HBDP. Effective communication by employing standardized non-technical terminology conveyed in language that is understandable and native to potential donors facilitates the deliverance of informed consent. Inconsistencies regarding the use and management of bodies catalyze the weakening perception of human body donation. Thus, this process of securing informed consent for body donation should be conducted in conjunction with public awareness campaigns and underpinned by the necessary policy and legislative reform.
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  • 文章类型: Journal Article
    解剖解剖是许多医学生痛苦的原因。明确的教学策略对于减少学生的困扰和支持他们的个人发展非常重要。对PubMed的系统评价,奥维德,PsycINFO,进行了WebofScience数据库,以检查有关医学院干预措施的定量数据,以减少解剖对医学生的负面心理和道德影响。在1189份独特的摘要中,14篇论文符合筛选标准。学生的痛苦随着教育视听材料的使用和对供体身体的分级暴露而减少。教育讲座,纪念仪式,和背景音乐的利用有不同的结果。
    Anatomical dissection is a cause of distress for many medical students. Explicit pedagogical strategies are important in reducing student distress and supporting their personal development. A systematic review of PubMed, Ovid, PsycINFO, and Web of Science databases was conducted to examine quantitative data regarding medical school interventions to reduce the negative psychological and moral impact of anatomical dissection on medical students. Of 1189 unique abstracts, 14 papers met screening criteria. Student distress decreased with the use of educational audiovisual materials and graded exposure to donor bodies. Educational lectures, memorial ceremonies, and utilization of background music had mixed results.
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  • 文章类型: Journal Article
    目的:医学培训经历了许多转变,将诊断成像纳入侧面解剖教育。已经提出了在解剖之前对身体供体进行验尸计算机断层扫描(CT)扫描。然而,它带来的挑战仅次于防腐过程和其他死后生理变化,这些变化显着改变了成像质量。这项研究的目的是比较身体供体的死前和死后CT扫描的病理学鉴定的准确性,并评估这些扫描在基于解剖的过程中的整合,使用增强现实(AR)将这些图像覆盖到身体供体上。
    方法:这项研究的参与者包括35名四年级医学生,5名放射科住院医师和3名放射科医师。一个汇聚者,平行混合方法设计采用定量措施,包括病理病变识别的双盲比较的统计分析,在两个图像集上,该小组对研究参与者调查的回应以及来自成像存储库的登录访问数据.该研究还包括对选修后结构化访谈的定性分析。
    结果:双盲比较显示,放射科医生只能识别,在验尸照片上,他们在死前扫描中能够检测到的病变的54.8%。对调查和登录访问数据的分析表明,60%的放射科居民和56%的学生更喜欢验尸扫描,并且比验尸扫描更频繁地使用这些扫描(分别为67访问和36访问)。然而,当使用AR覆盖到身体供体上时,验尸扫描是显著优选的(p=0.0047).
    结论:这些结果表明,验尸成像与验尸成像一样有价值,因为它们代表了在图像上看到的解剖结构和病理与正在解剖的东西之间的最一致性。
    OBJECTIVE: Medical training has undergone many transformations to incorporate diagnostic imaging along side anatomical education. Post-mortem computed tomography (CT) scanning of body donors prior to dissection has been proposed. However, it poses challenges secondary to the embalming process and other post-mortem physiological changes that significantly alter the imaging quality. The purposes of this study were to compare the accuracy of pathology identification on pre- and post-mortem CT scans of body donors and to assess the integration of those scans in a dissection-based course, where these images were overlaid onto body donors using augmented reality (AR).
    METHODS: Participants in this study included 35 fourth year medical students, 5 radiology residents and 3 radiologists. A convergent, parallel mixed methods design was employed with quantitative measures that included statistical analyses of a double-blinded comparison of pathological lesions recognition, on both image sets, the group responses to a study participant survey and the login access data from imaging repository. The study also included qualitative analysis of post-elective structured interviews.
    RESULTS: The double-blinded comparison revealed that staff radiologists can only identify, on post-mortem images, 54.8% of the pathologies that they were able to detect on the pre-mortem scans. Analyses of the surveys and login access data reveal that 60% of radiology residents and 56% of students preferred pre-mortem scans and used those scans more often than post-mortem scans (67 access vs 36, respectively). However, post-mortem scans were significantly preferred when used to overlay onto body donors using AR (p = 0.0047).
    CONCLUSIONS: These results show that post-mortem imaging can be valuable alongside pre-mortem imaging, as they represent the most concordance between the anatomical structures and pathologies seen on the images and what is being dissected.
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  • 文章类型: Journal Article
    目的:大脑后动脉的开窗非常罕见,因此,值得被举报。
    方法:在教育解剖中,发现了大脑后动脉(PCA)的特殊解剖变体。
    结果:在针对右桥小脑角的教育解剖中,发现了正确PCA的特殊变体。相应的后交通动脉向后插入PCA的P1和P2段的交界处。P1段比P2段薄。那个交界处高于动眼神经,有开窗,后内侧的手臂面对着大脑的脚,以及由P1段的远端和P2段的近端形成的较大的前-侧臂。
    结论:据作者所知,先前未通过解剖发现PCA的开窗P1-P2连接。这里提供的证据建议不要忽视这种变化。
    OBJECTIVE: Fenestrations of posterior cerebral artery are exceedingly rare and, therefore, deserve being reported.
    METHODS: During an educational dissection, a peculiar anatomical variant of the posterior cerebral artery (PCA) was found.
    RESULTS: During an educational dissection targeting the right cerebellopontine angle, a peculiar variant of the right PCA was found. The respective posterior communicating artery inserted posteriorly into the junction of the P1 and P2 segments of the PCA. The P1 segment was thinner than the P2 segment. That junction was superior to the oculomotor nerve and was fenestrated, with a thin postero-medial arm facing the cerebral peduncle, and a larger antero-lateral arm formed by the distal end of the P1 segment and the proximal end of the P2 segment.
    CONCLUSIONS: To the authors\' knowledge, fenestrated P1-P2 junctions of PCA were not found previously by dissection. The evidence presented here recommends such variations not to be ignored.
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  • 文章类型: Case Reports
    2015年,我们在医学生的解剖解剖过程中遇到了一例双下腔静脉,左下腔静脉占主导地位。右侧下腔静脉(正常下腔静脉)宽2.0mm,左下腔静脉宽23.2毫米。右侧下腔静脉开始于右侧髂总静脉,沿着腹主动脉的右侧上升,然后在第一个腰椎下缘的水平处加入左下腔静脉。优势左下腔静脉从左髂总静脉开始,沿腹主动脉左侧上升。大多数双下腔静脉患者无症状,这些变异是通过计算机断层扫描或磁共振成像偶然检测到的。它们的存在可能对手术有重大影响,尤其是腹主动脉旁淋巴结肿大患者以及接受腹腔镜根治性肾切除术或下腔静脉滤器置入术的患者的腹部手术。我们在此讨论基于双下腔静脉变异的详细解剖数据的双下腔静脉的胚胎学。包括那些需要临床关注的。
    We encountered a case of a double inferior vena cava with major predominance of the left inferior vena cava during an anatomical dissection course for medical students in 2015. The right inferior vena cava (normal inferior vena cava) was 2.0 mm wide, and the left inferior vena cava was 23.2 mm wide. The fine right inferior vena cava began at the right common iliac vein, ascended along the right side of the abdominal aorta, and then joined the left inferior vena cava at the level of the lower margin of the first lumbar vertebra. The dominant left inferior vena cava started from the left common iliac vein and ascended along the left side of the abdominal aorta. Most patients with a double inferior vena cava are asymptomatic, and these variants are incidentally detected by computed tomography or magnetic resonance imaging. Their presence may have significant implications for surgery, particularly abdominal surgery in patients with paraaortic lymphadenopathy and in those undergoing laparoscopic radical nephrectomy or inferior vena cava filter placement. We herein discuss the embryology of a double inferior vena cava based on detailed anatomical data of the variations of a double inferior vena cava, including those that require clinical attention.
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  • 文章类型: Journal Article
    神经外科是最复杂的外科学科之一,其中精神运动技能和深厚的解剖学和神经学知识得到最大的表达。要获得扎实的理论背景和技术技能,必须经过长时间的准备,提高手动灵活性和视觉空间能力,并尝试改进手术技术。此外,学习和外科实践都是深入理解神经解剖学的必要条件,结构之间的关系,和三维(3D)方向是神经外科医生准备的核心。由于所有这些原因,一个显微外科神经解剖学实验室与人类尸体标本的结果在一个独特的和不可替代的训练工具,使病人的位置再现,3D解剖学,组织的一致性,一步一步的外科手术几乎和真正的一样。
    我们描述了我们在建立新的显微外科神经解剖学实验室(IRCCSNeuromed,Pozzilli,意大利),专注于制定培训活动计划和显微外科里程碑,以培训下一代外科医生。列出了所有需要的材料和仪器。
    根据居住年份设计了六个能力等级,为每个能力水平定义的培训练习和程序:(1)软组织解剖,骨钻孔,和显微外科缝合;(2)基本开颅手术和神经血管解剖;(3)白质解剖;(4)颅底经颅入路;(5)内窥镜入路;和(6)微吻合。提供了带有里程碑的清单。
    对人体尸体标本进行显微外科解剖是在手术室安全进行神经解剖学和神经外科手术之前进行学习和培训的最佳方法。我们为神经外科住院医师提供了一本“神经外科手册”,其中包含了逐步发展的里程碑。这一循序渐进的计划可以提高培训质量,并保证各国获得平等的技能。我们认为,应该做出更多努力来创建新的显微外科实验室,普及遗体捐献的重要性,并在大学和实验室之间建立网络,以引入强制性的手术培训计划。
    UNASSIGNED: Neurosurgery is one of the most complex surgical disciplines where psychomotor skills and deep anatomical and neurological knowledge find their maximum expression. A long period of preparation is necessary to acquire a solid theoretical background and technical skills, improve manual dexterity and visuospatial ability, and try and refine surgical techniques. Moreover, both studying and surgical practice are necessary to deeply understand neuroanatomy, the relationships between structures, and the three-dimensional (3D) orientation that is the core of neurosurgeons\' preparation. For all these reasons, a microsurgical neuroanatomy laboratory with human cadaveric specimens results in a unique and irreplaceable training tool that allows the reproduction of patients\' positions, 3D anatomy, tissues\' consistencies, and step-by-step surgical procedures almost identical to the real ones.
    UNASSIGNED: We describe our experience in setting up a new microsurgical neuroanatomy lab (IRCCS Neuromed, Pozzilli, Italy), focusing on the development of training activity programs and microsurgical milestones useful to train the next generation of surgeons. All the required materials and instruments were listed.
    UNASSIGNED: Six competency levels were designed according to the year of residency, with training exercises and procedures defined for each competency level: (1) soft tissue dissections, bone drilling, and microsurgical suturing; (2) basic craniotomies and neurovascular anatomy; (3) white matter dissection; (4) skull base transcranial approaches; (5) endoscopic approaches; and (6) microanastomosis. A checklist with the milestones was provided.
    UNASSIGNED: Microsurgical dissection of human cadaveric specimens is the optimal way to learn and train on neuroanatomy and neurosurgical procedures before performing them safely in the operating room. We provided a \"neurosurgery booklet\" with progressive milestones for neurosurgical residents. This step-by-step program may improve the quality of training and guarantee equal skill acquisition across countries. We believe that more efforts should be made to create new microsurgical laboratories, popularize the importance of body donation, and establish a network between universities and laboratories to introduce a compulsory operative training program.
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  • 文章类型: Journal Article
    未经批准:在目前的文献中,关于膝关节前内侧区域解剖结构的研究很少。然而,前内侧结构,尤其是纵向内侧髌骨支持带(MPR),可能在限制胫骨外旋转中起重要作用。
    UNASSIGNED:对膝关节前内侧进行逐层解剖,并定性和定量描述与手术相关标志有关的MPR解剖结构。
    未经评估:描述性实验室研究。
    UNASSIGNED:本研究使用了10只新鲜冷冻的人尸体膝盖(平均年龄81±16.3岁),没有先前的韧带损伤史。进行了逐层解剖,并且使用触觉3维(3-D)测量臂获得测量结果,以定义与手术相关标志有关的MPR的解剖结构,如浅内侧副韧带(sMCL)和内侧髌股韧带(MPFL)。3-D数据集用于多平面重建。
    UNASSIGNED:在100%的病例中发现了MPR的胫骨和股骨附件。逐层解剖证实了其与sMCL的接近形貌。MPR的平均长度为84.9±9.1mm。胫骨和股骨附件的平均宽度为23.8±3.1mm和69.2±8.2mm,分别。从MPR胫骨附件的中点到sMCL的远端胫骨附件的中点的距离为27.2±5.8mm。股骨,MPR附着在MPFL的前边缘,平均距离为52.3±9.4mm。
    未经评估:MPR是一种独特的胫骨股结构,具有明确的胫骨和股骨附件,可以一致地识别。逐层解剖证实了其与sMCL和MPFL的接近形貌。
    未经评估:由于膝关节前内侧的损伤可能会导致前内侧旋转旋转不稳定(AMRI),对MPR的基本解剖结构的精确了解可能是进行膝关节前内侧解剖重建所必需的。
    UNASSIGNED: In the current literature, studies on the anatomy of the anteromedial region of the knee are scarce. However, the anteromedial structures, especially the longitudinal medial patellar retinaculum (MPR), may play an important role in restraining external tibial rotation.
    UNASSIGNED: To conduct a layer-by-layer dissection of the anteromedial side of the knee and describe qualitatively and quantitatively the MPR anatomy pertaining to surgically relevant landmarks.
    UNASSIGNED: Descriptive laboratory study.
    UNASSIGNED: A total of 10 fresh-frozen human cadaveric knees (mean age 81 ± 16.3 years) without history of previous ligament injury were used in this study. A layer-by-layer dissection was performed, and measurements were obtained using a tactile 3-dimensional (3-D) measuring arm to define the anatomy of the MPR in relation to surgically relevant landmarks, such as the superficial medial collateral ligament (sMCL) and medial patellofemoral ligament (MPFL). The 3-D datasets were used for multiplanar reconstruction.
    UNASSIGNED: The tibial and femoral attachment of the MPR were identified in 100% of cases. Layer-by-layer dissection confirmed its close topography to the sMCL. The mean length of the MPR was 84.9 ± 9.1 mm. The average width of the tibial and femoral attachment was 23.8 ± 3.1 mm and 69.2 ± 8.2 mm, respectively. The distance from the midpoint of the MPR tibial attachment to the midpoint of the distal tibial attachment of the sMCL was 27.2 ± 5.8 mm. Femorally, the MPR attached at the anterior border of the MPFL over a mean distance of 52.3 ± 9.4 mm.
    UNASSIGNED: The MPR is a distinct tibiofemoral structure with well-defined tibial and femoral attachments, which could be consistently identified. Layer-by-layer dissection confirmed its close topography to the sMCL and MPFL.
    UNASSIGNED: As injuries to the anteromedial side of the knee may contribute to anteromedial rotational rotatory instability (AMRI), precise knowledge of the underlying anatomy of the MPR may be necessary to perform an anatomic reconstruction of the anteromedial side of the knee.
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  • 文章类型: Case Reports
    大反营养不良症(MDL)的脚趾是一种罕见的,先天性,不成比例的过度生长,涉及下肢的一个或多个数字。尽管是良性疾病,如果不及时治疗,它可能会导致身体损伤并干扰日常活动。这种形式的局部巨人症是神经内纤维脂肪组织以及相关的大指过度增殖的结果。治疗的主要方法是切除或截肢以适应患者的日常活动,以及宇宙。在这个案例报告中,临床和影像学检查结果,解剖学描述,和组织病理学发现。MDL之间的区别,还讨论了纤维脂肪瘤性错构瘤(FLH)和神经脂肪瘤病(LON)。
    Macrodystrophia Lipomatosa (MDL) of the toe is a rare, congenital, disproportionate overgrowth involving one or more digits in the lower limb. Despite being a benign condition, when left untreated, it may cause physical impairment and interfere with daily activities. This form of localised gigantism is the result of excessive proliferation of fibroadipose tissue within the nerve along with associated macrodactyly. The mainstay of treatment is debulking or amputation to accommodate the patient\'s daily activities, as well as for cosmesis. In this case report, the clinical and radiographic findings, anatomical descriptions, and histopathological findings are presented. The difference between MDL, fibrolipomatous hamartoma (FLH) and lipomatosis of the nerve (LON) are also discussed.
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  • 文章类型: Journal Article
    腰交感神经阻滞常用于治疗复杂的局部疼痛综合征,但它似乎有很高的故障率。这项研究寻求对这种明显失败的解剖学解释,以完善我们的阻滞程序。对四个新鲜的,进行了两个模拟的交感神经干阻滞,在L2椎体水平的透视控制下,冷冻保存的未防腐的人类尸体,然后在另一侧的L4椎体水平处再进行两个模拟块。注射了染料,并按照特定的协议对这些区域进行了解剖。然后,我们将描述染料的解剖结构和扩散与荧光镜检查中造影剂的扩散相比。神经节位于不同的椎骨水平,和不同的尸体。在这个解剖学的澄清之后,我们现在更喜欢在第四腰椎水平进行腰椎交感神经阻滞,在椎骨的尾端使用椎间孔外入路,在中点避开椎体的前外侧边缘。
    The lumbar sympathetic block is often used to treat complex regional pain syndrome, but it seems to have a high failure rate. This study seeks anatomical explanations for this apparent failure in order to refine our block procedure. Two simulated sympathetic trunk blocks were carried out on four fresh, cryopreserved unembalmed human cadavers under fluoroscopic control at the L2 vertebral body level, followed by two further simulated blocks at the L4 vertebral body level on the other side. Dye was injected, and the areas were dissected following a specific protocol. We then describe the anatomy and the spread of the dye compared to the spread of the contrast medium on fluoroscopy. The ganglia were differently located at different vertebral levels, and differed among the cadavers. Following this anatomical clarification, we now prefer to perform lumbar sympathetic blocks at the fourth lumbar vertebra level, using an extraforaminal approach at the caudal end of ​​the vertebra, avoiding the anterolateral margin of the vertebral body at the midpoint.
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