Deep infiltrating endometriosis with sacral plexus involvement: Improving knowledge through human cadaver dissection.

INTRODUCTION: The aim of this study was to assess a human cadaver model of sacral plexus dissection for learning about deep innervation in the female pelvis, and the latter's relationship with deep infiltrating endometriosis. METHODS: This was a prospective, observational study. Eight residents in obstetrics and gynecology were tested before and after a lecture on innervation of the female pelvis and a cadaver dissection class. Standardized cadaver dissection was used to identify the sacral nerve roots S2 to S4, superior and inferior hypogastric plexuses, hypogastric nerve, and splanchnic nerves. RESULTS: The residents' level of knowledge improved significantly after a one-hour lecture (p = 0.9.10-5) and after a cadaver dissection class (p = 0.6.10-6). The improvement was significantly greater for the dissection class (p = 0.0003). All the pelvic nerve structures were identified in all but one of the cadavers and had similar measurements. A vascular anatomical variant was observed in one case. CONCLUSION: A human cadaver model is of value for learning about deep pelvic innervation and the latter's relationship with deep infiltrating endometriosis. The reproducibility and safety of cadaver dissection might improve surgical skills.

Survey of Gross Anatomy Education in China: The Past and the Present.

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears / Avaliação endoscópica das variações anatômicas da orelha média em uma série de autópsias: análise de 204 orelhas

Abstract Introduction Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. Objective The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. Methods All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. Results One hundred and two cadavers were included in the study. The mean age was 49.08 ± 17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. Conclusion The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Resumo Introdução A otomicrocirurgia requer avaliação completa da anatomia cirúrgica da orelha média, especialmente da anatomia da cavidade timpânica posterior. A avaliação pré-operatória da cavidade timpânica é limitada pela permeabilidade do tímpano e densidade do osso temporal. Portanto, a exploração da orelha média é um método extremamente útil para identificar anormalidades estruturais e variações anatômicas. Objetivo Determinar as variações anatômicas da orelha média em uma série de autópsias. Método Todas as avaliações foram realizadas no necrotério do Instituto Médico-Legal. Os casos com mais de 18 anos, sem trauma do osso temporal e história de cirurgia otológica foram incluídos neste estudo. Resultados Cento e dois cadáveres foram incluídos no estudo. A média de idade foi de 49,08 ± 17,76 anos. A proeminência da parede anterior do conduto auditivo externo estava presente em 27 de todos os cadáveres (26,4%). A membrana timpânica era normal em 192 orelhas (94%), enquanto várias alterações do tímpano foram detectadas em 12 orelhas (6%). Agenesia da eminência piramidal e do tendão do estapédio foi encontrada em 3 orelhas. Enquanto o pontículo tinha formato de crista óssea em 156 das 204 orelhas (76,4%), tinha o formato de ponte em 25 orelhas (12,3%). O pontículo estava ausente em 23 orelhas (11,3%). Enquanto o subículo completo estava presente em 136 de todas as orelhas (66,7%), encontrava-se incompleto em 21 orelhas (10,3%). O subículo estava ausente em 47 orelhas (23%). Deiscência facial foi encontrada em 32 orelhas e o nicho da janela redonda estava coberto por uma pseudomembrana em 85 orelhas (41,6%). A platina fixa foi observada em 7,4% de todas as orelhas e a artéria estapediana persistente não foi vista. Conclusão A frequência da pseudomembrana que cobre o nicho da janela redonda foi diferente daquela encontrada na literatura. Além disso, a frequência da proeminência da parede do canal auditivo externo foi relatada pela primeira vez.

Impact of Background Music on Medical Student Anxiety and Performance During Anatomical Dissections: A Cluster Randomized Interventional Trial.

Anatomical dissection on cadavers can be a source of anxiety for medical students. Studies in other stressful settings have shown a reduction in anxiety when there is background music. The objective of this study was to determine if music can have an impact on student anxiety, student satisfaction, and student performance in dissection room. This cluster randomized interventional trial included 187 second-year medical students. The intervention was standardized background music, selected based on the literature, with a tempo of between 60 and 80 bpm. Six balanced clusters were randomized (1:1) to music or no music during dissection sessions. The main assessment criterion was a validated self-evaluation scale score for anxiety, the State Trait Anxiety Inventory. Student satisfaction was measured using a visual analog scale and dissection performance was evaluated by an examination. The outcomes were analyzed with mixed models adjusted on group effect, chronic anxiety, and confounding factors. A significant (58%) relative decrease in acute anxiety, odds ratio 0.423 [0.160; 0.710] was found for the music intervention group. Music also had a positive impact on performance with students in the intervention group attaining higher grades than those in the control group (0.42/10 higher, P = 0.0016). The study also showed a nonsignificant increase in satisfaction with 0.37 extra points (P = 0.137) in the intervention group. Background music had a significant impact on anxiety in the dissection room and on technical and theoretical performance in the subsequent anatomy examination. This music intervention could be extended to other stressful work environments.

Endoscopic evaluation of middle ear anatomic variations in autopsy series: analyses of 204 ears.

INTRODUCTION: Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations. OBJECTIVE: The aim of this study is to determine anatomic variations of the middle ear in an autopsy series. METHODS: All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study. RESULTS: One hundred and two cadavers were included in the study. The mean age was 49.08±17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases. CONCLUSION: The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time.

Prevalence of smoking and clinical characteristics in fibromuscular dysplasia. The ARCADIA-POL study.

PURPOSE: Smoking was identified as a potential factor contributing to fibromuscular dysplasia (FMD). To evaluate the prevalence of smoking and clinical characteristics in FMD subjects. MATERIAL AND METHODS: We analysed 190 patients with confirmed FMD in at least one vascular bed. The rate of smokers in FMD patients was compared to that in two control groups selected from a nationwide survey. RESULTS: The rate of smokers in FMD patients was 42.6%. There were no differences in frequency of smokers between FMD patients and: a group of 994 matched control subjects from general population and a group of matched hypertensive subjects. There were no differences in the characteristics of FMD (including rates of multisite FMD and significant renal artery stenosis) and its complications (including rates of dissections and aneurysms) between smokers and non-smokers. Smokers as compared with non-smokers were characterized by higher left ventricle mass index. CONCLUSIONS: There is no difference in the rate of smokers between FMD patients and subjects from the general population. Moreover, we did not find any association between smoking and clinical characteristics of FMD patients nor its extent and vascular complications. Our results do not support the hypothesis that smoking is involved in the pathophysiology of FMD.

Pulmonary sequestration in adults: a retrospective review of resected and unresected cases.

BACKGROUND: Pulmonary sequestration (PS) is a form of congenital pulmonary malformation that is generally diagnosed in childhood or adolescence and usually resected when diagnosed. We aim to identify the clinical presentation and course of patients diagnosed to have PS during adulthood. METHODS: Using a computer-assisted search of Mayo clinic medical records, we identified adult patients with PS diagnosed between 1997 and 2016. Clinical and radiological data were collected including postoperative course for those who underwent surgical resection. RESULTS: We identified 32 adult patients with PS; median age at diagnosis was 42 years (IQR 28-53); 17 patients (53%) were men. The median sequestration size was 6.6 cm (IQR 4.4-9.3). The type of sequestration was intralobar in 81% and extralobar in 19%. The most common location was left lower lobe posteromedially (56%). Forty-seven percent of the patients presented with no relevant symptoms. The most common radiographic finding was mass/consolidation in 61% and the most common feeding artery origin was the thoracic aorta (54%). Surgical resection was performed in 18 patients (56%) and postoperative complication was reported in 5 patients (28%). There was no surgical mortality. Median duration of follow-up after diagnosis for unresected cases, most of whom were asymptomatic, was 19 months (IQR 4-26) with no complications related to the PS reported. CONCLUSIONS: Nearly one-half of adult patients with PS present with no relevant symptoms. The decision regarding surgical resection needs to weigh various factors including clinical manifestations related to PS, risk of surgical complications, comorbidities, and individual patient preferences.

Benefits of extracurricular participation in dissection in a prosection-based medical anatomy program.

The purpose of this study was to evaluate the extracurricular cadaveric dissection program available to medical students at an institution with a modern (time-compressed, student-centered, and prosection-based) approach to medical anatomy education. Quantitative (Likert-style questions) and qualitative data (thematic analysis of open-ended commentary) were collated from a survey of three medical student cohorts who had completed preclerkship. Perceived benefits of dissection included the hands-on learning style and the development of anatomy expertise, while the main barrier that limited participation was the time-intensive nature of dissection. Despite perceived benefits, students preferred that dissection remain optional. Analysis of assessments for the MD2016 cohort revealed that dissection participation was associated with enhanced performance on anatomy items in each systems-based unit examination, with the largest benefits observed on discriminating items that assessed knowledge application. In conclusion, this study revealed that there are academic and perceived benefits of extracurricular participation in dissection. While millennial medical students recognized these benefits, these students also indicated strong preference for having flexibility and choice in their anatomy education, including the choice to participate in cadaveric dissection. Anat Sci Educ 11: 294-302. © 2017 American Association of Anatomists.

Topical 5-Fluorouracil for Women With High-Grade Vaginal Intraepithelial Neoplasia.

OBJECTIVE: To examine success rates of 5-fluorouracil, excision, and laser ablation as the initial and secondary management strategies for women with high-grade vaginal intraepithelial neoplasia. METHODS: We conducted a retrospective case series of women referred to a single center for management of biopsy-proven, high-grade vaginal intraepithelial neoplasia between April 1994 and May 2016. Data including demographic characteristics, human papillomavirus risk factors, antecedent Pap cytology, concurrent or prior cervical and vulvar dysplasia, and treatment outcome including follow-up Pap cytology were recorded. All women were counseled on options of excision, laser ablation, or 5-fluorouracil, which was administered intravaginally according to a standardized regimen. Recurrence was defined as a biopsy showing any vaginal intraepithelial neoplasia diagnosis after primary treatment. RESULTS: Forty-seven patients were treated initially with 5-fluorouracil, 35 were treated with excision, and 22 were treated with laser ablation. Demographics were similar between groups. No recurrence was noted in 35 women treated with 5-fluorouracil (74%; 95% CI 62-87%), 20 treated with excision (57%; 95% CI 41-74%), and nine treated with laser ablation (41%; 95% CI 20-61%). Among 13 patients treated with 5-fluorouracil for recurrence, eight (62%) did not experience a second recurrence. Nine of 58 (16%) patients ever treated with 5-fluorouracil reported a side effect, most commonly irritation and dyspareunia. CONCLUSION: 5-fluorouracil was associated with a 74% success rate as the initial treatment modality for high-grade vaginal dysplasia. There is also a role for 5-fluorouracil in the management of recurrent or persistent high-grade vaginal intraepithelial neoplasia.

The influence of tutor training for peer tutors in the dissection course on the learning behavior of students.

INTRODUCTION: Student tutors in the dissection course are expected to meet high demands in their job, to fulfill these expectations they receive training. Combined tutor training is well accepted by tutors and tutees, however, it is not known how tutor training influences student learning. Deduced from the learning goals of the tutor training, a randomized, controlled, single-blinded study was set up with a quantitative cross-sectional analysis to compare student learning behavior. METHODS: A total of 197 medical students, coached either by ten trained or ten untrained tutors, were enlisted in the study. To assess the students' learning behavior we employed the LIST questionnaire. A common factor analysis was calculated to extract dimensions. Factor scores of the extracted dimensions were calculated for both groups to estimate differences in learning behavior. RESULTS: Factor analysis of the LIST questionnaire revealed eight factors explaining 47.57% of the overall variance. The eight factors comprise: deep learning, attention, learning organization, cooperative learning, time management, learning effort, superficial learning and learning environment. Comparing the factor scores of the extracted dimensions, students coached by trained tutors learned significantly more with their fellow students (factor score in cooperative learning 0.194 vs. -0.205, p<0.05), than students trained by untrained tutors. Students coached by trained tutors also tend to be better organized in their learning (factor score in learning organization 0.115 vs. -0.122, p=0.16). CONCLUSION: The learning behavior of students coached by trained tutors differs from the learning behavior of students coached by untrained tutors. Students coached by trained tutors learn significantly more often in teams than their colleagues and are better organized.

Relationship Between Muscle Dissection Method and Postoperative Muscle Atrophy in the Lateral Suboccipital Approach to Vestibular Schwannoma Surgery.

BACKGROUND: Various techniques are available for occipital skull exposure with muscle dissection, as well as different types of skin incisions in the lateral suboccipital approach to vestibular schwannoma (VS) surgery. The skin incisions are generally classified as S-shaped, J-shaped, or C-shaped. In each method, the technique used for muscle dissection differs in terms of cut, single layer, and multiple layers. This study was performed to identify the relationships among muscle dissection method, skin incision type, and muscle atrophy in the lateral suboccipital approach to surgery for VS. METHODS: Between 2002 and 2011, we performed surgical resection in 53 patients with VS at Shinshu University Hospital. Of these 53 patients, 35 with radiographic annual follow-up for >3 years after surgery were evaluated retrospectively. These patients included 14 who underwent an S-shaped incision, 6 with a J-shaped incision, and 15 with a C-shaped incision. Bilateral areas of the skin and occipital muscles were measured, and rates of atrophy were calculated and compared among the 3 methods. RESULTS: Postoperative muscle atrophy was significantly advanced in the second postoperative year, but did not tend to develop further after the third year. The postoperative muscle atrophy ratio was significantly lower in the C-shaped incision group (mean ± SD, 4.0% ± 6.9%) compared with the S-shaped (17.1% ± 9.8%) and J-shaped (17.6% ± 10.0%) incision groups within 2 years after surgery (P < 0.05). CONCLUSIONS: The C-shaped skin incision with multilayer muscle dissection was associated with significantly reduced postoperative muscle atrophy compared with the other methods.

Multidimensional approach to teaching anatomy-Do gender and learning style matter?

BACKGROUND: The aim of this study was to assess the impact of two teaching interventions (ultrasound and arthroscopy) in a peer teaching (PT) environment on anatomy examination scores and also to examine the influence of gender and learning style on these scores. METHODS: We randomly assigned 484 second year medical students to one of three groups: musculoskeletal ultrasound (MSUS), arthroscopy (ASC) and control (CON). The MSUS- and the ASC-group attended two additional training sessions in ultrasound or arthroscopy; the CON-group received no additional lessons. Students were asked to complete Kolb's Learning Style Inventory test. We assessed differences in anatomical knowledge (multiple choice (MC) exam) and subjective evaluation with respect to gender and learning style. RESULTS: There were no relevant differences between the three groups regarding the MC exam. Acceptance of the peer teaching concept was good. All students preferred ultrasound to arthroscopy and thought that they learned more from ultrasound despite the fact that they rated the instructors as less competent and needed more time to gain in-depth knowledge. There was no significant effect of gender on evaluation results. Arthroscopy was best enjoyed by accommodators according to Kolb's Inventory and least by divergers, who found that they had learned a lot through ultrasound. The improvement in spatial conceptualization was greatest for accommodators and worst for assimilators. CONCLUSION: Gender and learning style had no impact on quantitative parameters. Qualitative analysis, however, revealed differences for learning style and further evaluation is warranted to assess the impact on medical education.

Hysteroscopic intrauterine morcellation of submucosal fibroids: preliminary results in Hong Kong and comparisons with conventional hysteroscopic monopolar loop resection.

INTRODUCTION: Hysteroscopic management of submucosal fibroids using the intrauterine morcellation technique is increasingly being adopted worldwide but no literature concerning its safety and efficacy is available within our local population. We aimed to determine the safety, satisfaction, and efficiency of hysteroscopic intrauterine morcellation of submucosal fibroids, and to compare this technique with conventional hysteroscopic monopolar loop resection to identify its potential benefits. METHODS: All cases of hysteroscopic resection of submucosal fibroids performed in a regional hospital in Hong Kong between 1 January 2011 and 31 December 2014, either by hysteroscopic intrauterine morcellation (MyoSure; Hologic, Bedford [MA], US) or conventional hysteroscopic monopolar loop resection, were selected and case notes reviewed. Technical details such as fibroid size, operating time, fluid deficit, operative complications, patient satisfaction, and improvement in haemoglobin level were analysed and compared between the hysteroscopic intrauterine morcellation and the conventional groups. All statistical results were calculated using the Mann-Whitney test. RESULTS: During the 3-year period, 29 cases of submucosal fibroids were managed by hysteroscopic surgery. Conventional hysteroscopic monopolar loop resection was performed in 14 patients and another 15 underwent hysteroscopic intrauterine morcellation with the MyoSure device. At 3-month follow-up, there was no significant difference in overall patient satisfaction (84.6% for conventional method vs 93.3% for hysteroscopic intrauterine morcellation method; P=0.841). Both techniques showed improvement in haemoglobin level at 3 months but without significant difference between the two groups: +21.5 g/L (+1 to +44 g/L) for conventional group and +17.0 g/L (-4 to +40 g/L) for hysteroscopic intrauterine morcellation group (P=0.235). Both techniques achieved 100% satisfaction if the submucosal fibroid had over 60% of its contents protruding into the uterine cavity. The operating time was significantly reduced for the hysteroscopic intrauterine morcellation technique (mean, 36.6 mins vs 53.6 mins in conventional hysteroscopic monopolar loop resection; P=0.005), particularly in those whose fibroids were ≤3.0 cm (mean, 27.6 mins vs 53.4 mins; P=0.019). CONCLUSIONS: This retrospective review suggests that hysteroscopic intrauterine morcellation of submucosal fibroids is a safe and effective method in the management of menorrhagia in Chinese women. Preliminary data suggest this technique to be less time-consuming, especially when managing fibroids of ≤3.0 cm.

East Meets West-A Novel Steerable Grasper to Facilitate Gastric Endoscopic Submucosal Dissection (ESD): Randomized Comparative Study in a Porcine Model.

BACKGROUND: Endoscopic submucosal dissection (ESD) is challenging because of the limited ability of conventional endoscopic tools to achieve adequate traction. We have recently used a novel steerable grasper (SG; ANUBIS grasper, Karl Storz, Tüttlingen, Germany) with intuitive manipulating handles to lift up the mucosa. The aim of this study is to evaluate the efficacy of the assistance of the SG in a porcine acute model. MATERIALS AND METHODS: A total of 36 gastric ESDs were performed in 12 swine (3 ESDs/pig), at the antrum, greater curvature of the gastric body, and cardia. Pigs were randomly assigned to the SG group (n = 6) or to the control group (n = 6). ESD steps included the following: scoring the area, submucosal injection, and precut and submucosal dissection with or without SG assistance. Outcomes measured were as follows: dissection time, dissection speed, size of specimen, completeness of dissection (all marks included in the specimen), en bloc dissection, and complications. RESULTS: Overall mean dissection time was 18.6 ± 7.56 versus 29 ± 18.14 minutes (P = .032), and mean dissection speed was 94.74 ± 39.74 mm(2)/min versus 65.41 ± 39.5 mm(2)/min (P = .033) in the SG and control groups, respectively. Mean size of the specimen was 1451.4 ± 549.2 mm(2) in the SG group and 1615.3 ± 605.9 in the control group. Complete and en bloc dissections were achieved in all cases. One deep muscular injury occurred in the control group (gastric body). CONCLUSION: The ANUBIS grasper is a user-friendly, effective, and safe tool to achieve adequate traction and exposure of the ESD plane in the pig model.

"Mors auxilium vitae"--causes of death of body donors in an Austrian anatomical department.

BACKGROUND: Anatomical dissection is, despite several critical annotations, a highly valuable component of under- and postgraduate medical education and research. Our current causes-of-death statistics on our body donors is aimed to find out to which extent they are representative of the Austrian population. METHODS: We evaluated the causes of death stated in their death certificates of a total of 3399 people who donated their bodies to our department in the course of the last 25 years (1988-2013). The categorisation is based on the official ICD-10-WHO classification. RESULTS: Our data show a prevalence of cardiovascular diseases in about half of the donors (42%) examined; no gender difference could be revealed in cardiovascular diseases. Tumours were responsible for about 20% of deaths, lead by lung cancer; cancers showed a slight male excess. All other deaths were caused by diseases of the respiratory system, the digestive organs, the genitourinary system, the nervous system, alimentary and metabolic disorders, infections and blood diseases, psychiatric disorders, external and other causes in descending order. Compared to the official Austrian and German statistics, there are only minor deviations. CONCLUSION: Our data clearly show that body donors, at least in our department, depict a representative sample of Austrian population in terms of their causes of death. Therefore anatomical dissection provides appropriate insight into the morbidity of the increasing major target population of medicine, the elders. Limitations in the acceptance by age, excluding either young or old donors, which appear to exist in other anatomical departments, will limit this representativeness. Being aware of these facts, the anatomical dissection course cannot only provide anatomical learning experiences but can also provide an introduction to the basics of epidemiology. Therefore, a topographical dissection course remains an indispensable method for both undergraduate and postgraduate training as well as for research.

Anatomists' views on human body dissection and donation: an international survey.

A survey was conducted to test three hypotheses: anatomists believe that dissection by students conveys not just anatomical knowledge but also essential skills and attitudes, including professionalism; anatomists approve of the donation of their own bodies or body parts/organs for medical/health-care training and research; attitudes towards body dissection and donation are not dependent upon gender or upon the extent of teaching experience, but are related to transcendental convictions relating to beliefs in the afterlife. Eighty-one anatomists, from 29 countries responded to the survey; 80% indicated that they required medical/health-care students to dissect human cadavers (60% females-86% males, p=0.02). Most teachers recorded that dissection was an instrument for training undergraduate students, an instrument for the development of professional skills, and an instrument to help to control emotions in the future doctor rather than being only a means of teaching/learning anatomy facts. Males were more receptive to the concept that dissection helps to control emotions in the future doctor (p=0.02). Most teachers (75%) said they were willing to donate their bodies, 41% saying they would donate body organs only, 9% would donate their entire bodies only, 25% would separately donate organs and also the entire body. The willingness to donate increased significantly with the years of teaching experience (p=0.04). Teachers who were not believers in the afterlife were more likely to donate their organs/bodies than were believers (p=0.03). Our findings showed that anatomists' attitudes towards body dissection and donation are dependent upon gender, upon the extent of teaching experience, and upon transcendental convictions.

The role of laboratory dissection training in neurosurgical residency: results of a national survey.

OBJECTIVE: Work hour restrictions and current quality, financial, and legal concerns have reduced resident operative volume and autonomy. Although laboratory (cadaveric or animal) dissection has a rich history in neurosurgery, its current role in resident training is unclear. Recent literature suggests educators have looked to simulation to accelerate the learning curve of acquiring neurosurgical technical skills. The purpose of this study was to determine the prevalence, characteristics, and extent of laboratory dissection in neurosurgical residency programs in the United States. METHODS: A survey was sent to program directors of all 100 neurosurgical residency programs in the United States. RESULTS: Response rate was 65%. Most programs (93.8%) incorporate laboratory dissection into resident training. Most programs have 1-3 (36.1%) or 4-6 (39.3%) sessions annually. Residents in postgraduate years 2-6 (85.2%-93.4%) most commonly participate. The most common topics are cranial approaches (100%), spinal approaches (88.5%), spine instrumentation (80.3%), and endoscopy (50.8%). Thirty-one (47.7%) programs use artificial physical model or virtual reality simulators; the most common simulators are endoscopy (15.4%), microvascular anastomosis (13.8%), and endovascular (10.8%). Only 8 programs (13.1%) formally grade dissection skills. Educators (95.4%) believe laboratory dissection is an integral component of training and no respondent believed simulation could currently provide greater educational benefit than laboratory dissection. Most (89.2%) respondents would support a national "suggested" dissection curriculum and manual. CONCLUSIONS: In neurosurgical resident education, laboratory dissection is widely used; however, significant variation exists. Nonetheless, program directors believe laboratory dissection plays an integral role in neurosurgical training and is currently associated with greater educational benefit than simulation.

Current usage and future trends in gross digital photography in Canada.

BACKGROUND: The purpose of this study was to assess the current usage, utilization and future direction of digital photography of gross surgical specimens in pathology laboratories across Canada. METHODS: An online survey consisting of 23 multiple choice and free-text questions regarding gross digital photography was sent out to via email to laboratory staff across Canada involved in gross dissection of surgical specimens. RESULTS: Sixty surveys were returned with representation from most of the provinces. Results showed that gross digital photography is utilized at most institutions (90.0%) and the primary users of the technology are Pathologists (88.0%), Pathologists' Assistants (54.0%) and Pathology residents (50.0%). Most respondents felt that there is a definite need for routine digital imaging of gross surgical specimens in their practice (80.0%). The top two applications for gross digital photography are for documentation of interesting/ complex cases (98.0%) and for teaching purposes (84.0%). The main limitations identified by the survey group are storage space (42.5%) and security issues (40.0%). Respondents indicated that future applications of gross digital photography mostly include teaching (96.6%), presentation at tumour boards/ clinical rounds (89.8%), medico-legal documentation (72.9%) and usage for consultation purposes (69.5%). CONCLUSIONS: The results of this survey indicate that pathology staff across Canada currently utilizes gross digital images for regular documentation and educational reasons. They also show that the technology will be needed for future applications in teaching, consultation and medico-legal purposes.