Does simulation-based training facilitate the integration of human anatomy with surgery? A report of a novel Surgical Anatomy Course.

BACKGROUND: Knowledge of gross anatomy, as a basic core subject, is fundamental for medical students and essential to medical practitioners, particularly for those intending a surgical career. However, both medical students and clinical teachers have found a significant gap in teaching basic sciences and the transition into clinical skills. The authors present a Surgical Anatomy Course developed to teach the anatomical basis of surgical procedures with particular emphasis on laparo-scopic skills while incorporating medical simulation. MATERIALS AND METHODS: An evaluation of the students' satisfaction of the Surgical Anatomy Course was completed using a mix of multiple choice and open-ended questions, and a six-point Likert Scale. Questions were asked about the students' perceived improvement in surgical and laparoscopic skills. Manual skills were assessed using a laparoscopic simulator. RESULTS: Both evaluation of the course structure and the general impression of the course were positive. Most students believed the course should be an integral part of a modern curriculum. The course supported the traditional surgical classes and improved anatomical knowledge and strengthened students' confidentiality and facilitated understanding and taking surgical rotations. CONCLUSIONS: A medical course combining the practical learning of anatomy and surgical-based approaches will bring out the best from the students. Medical students positively evaluated the Surgical Anatomy Course as useful and benefi-cial regarding understanding anatomical structure and relationship necessary for further surgical education. (Folia Morphol 2018; 77, 2: 279-285).

Diversity among posterior thalamoperforating branches originated from P1 segment: systematic review.

BACKGROUND: The P1 segment of the posterior cerebral artery (PCA) begins at the termination of the basilar artery and ends at the origin of posterior commu-nicating artery, within the interpeduncular cistern. Perforating branches arising from this segment are called posterior thalamoperforating arteries (TPAs) and the main and biggest artery among those is called TPA. Perforating branches are a crucial component of cerebrovascular system supplying the posterior part of the thalamus, subthalamus, hypothalamus, substantia nigra, perforated substance, posterior part of internal capsule and the nucleus of III and IV cranial nerve. It is very important for neurosurgeon to know the anatomy of perforating branches because of their susceptibility to injury. The aim of this study is to determine the morphometry of posterior TPAs and allow a better understanding of their bran-ching patterns and relation to basilar artery. MATERIALS AND METHODS: An extensive search was undertaken in order to identify published literature related to the posterior cerebral circulation system and the anatomy of posterior TPAs using key words. Medline, Embase, Ovid and Google Scholar databases were searched for publications dated from 1970 until July 2016. We collected and analysed all the data describing the mean number of branches per P1 segment, range of branches, number of analysed PCA, largest diameter of TPA, mean diameter of TPA and average distance from the basilar artery bifurcation. RESULTS: Thirteen cadaver studies were analysed and the data was extracted. We focused on the mean number of branches arising from P1 segment, perforators range, mean diameter of perforating branches, largest diameter of perforating branches. CONCLUSIONS: Mean number of branches per hemisphere was 2.91 (min. 1.51, max. 4.1). In more than half of analysed studies, authors did not find any pre-sence of posterior TPAs. Mean diameter of those perforators was 0.51 mm (min. 0.125 mm, max. 0.8 mm). Average distance from basilar artery bifurcation was 2.29 mm (min. 1.93 mm, max. 2.75 mm). There were many branching patterns presented by different authors.

Supernumerary renal vessels: analysis of frequency and configuration in 996 computed tomography studies.

BACKGROUND: Number, course and division pattern of renal vessels is highly variable. Variant renal vasculature is of high interest in nephrectomy for the renal transplantations, both in deceased and living donors. The purpose of the study was to analyse the frequency of supernumerary renal vessels in a large cohort of patients undergoing the multiphase abdominopelvic computed tomography (CT), as well as analyse the possible patterns of coexisting supernumerary arteries in veins. MATERIALS AND METHODS: A retrospective analysis of abdominopelvic CT studies within 1 year period was performed. In each study, number of renal arteries and veins was recorded. Course of left renal vein was classified into normal, retro- or periaortic. For statistical analysis of normal distribution data, t-Student test was used. Chi-square test was used for frequency of variant vessel distribution. Pearson correlation coefficient was used for the analysis of coexistence of supernumerary vessels. RESULTS: 996 patients were included in the analysis, male to female ratio: 481:515 (48%:52%). Mean age was 57.9 ± 14.7 years. Single renal arteries were observed in 73% of cases, while single renal veins in 95%. Circumaortic or retroaortic courses of left renal veins were observed in 10% of cases. Number of renal vessels has been compared in patients with and without supernumerary vessels. In patients with supernumerary left renal artery, significantly more right renal vessels were observed. In patients with supernumerary right renal vein, mean number of all remaining vessels was significantly higher. CONCLUSIONS: Supernumerary renal vessels are a frequent finding in abdominal CT studies. Finding a supernumerary vessel should increase awareness of possible other supernumerary renal vessels.

[The use of stem cells in some rheumatic diseases]. / Zastosowanie mezenchymalnych komórek macierzystych w wybranych chorobach reumatycznych.

Stem cells (SC) are characterized by the possibility of a potentially unlimited number of divisions, that are, its self-renewal and differentiation pot in all tissues of the body. The term "stem cells" was first used by the Russian histologist Alexander Maksimova in 1908 in relation to the hematopoietic stem cell (HSC - haematopoietic stem cells). SC, because of their ability to self-renewal and proliferation enormous potential, became the subject of numerous research around the world. These studies offer hope for improving the prognosis and optimization methods for the treatment of many types of diseases, including diseases of the developing autoimmune which include rheumatic diseases. Pain associated with the most common rheumatic diseases, like rheumatoid arthritis and osteoarthritis, cause temporary restriction of efficiency, frequent use of sick leave and abuse of painkillers. Rheumatic diseases often have young people in the labor force, have a chronic condition, and despite of the treatment over time lead to permanent disability and even premature death. Therapy with stem cells, can become an effective alternative to standard therapies used so far. The results of the first studies on the use of stem cells are promising and warrant further work on their application not only in rheumatic diseases.

Bilateral coronary artery to pulmonary trunk fistulae detected by coronary angiography and evaluated by ECG-gated SPECT myocardial perfusion imaging: report of two cases.

Coronary artery fistulae (CAF) are anomalies related to coronary artery abnormal termination. This is a very rare congenital malformation accounting for about 0.2-0.4% of congenital cardiac anomalies, but in some patients it can be haemodynamically important. Single-photon emission computed tomography or positron emission tomography myocardial perfusion imaging (MPI) using radioactive agents is widely used in clinical practice for cardiac ischaemia detection as a very sensitive and non-invasive tool. We are going to present 2 patients with bilateral CAFs to the pulmonary trunk without signs of the rest or stress ischaemia in MPI.

Simulation techniques in the anatomy curriculum: review of literature.

Modern medical education faces a problem of combining the latest technology, procedures and information with classic teaching methods. Simulation is a technique, which replaces or amplifies doctor-patient experiences in controlled conditions and therefore evokes or replicates substantial aspects of the real world in a fully interactive manner. The basic course of anatomy in medical education could be recognised as the best example of implementing new educational techniques such as simulation, into the traditional medical curriculum. The PubMed database was searched using specific key words. Finally 72 articles were accepted and were divided into 3 basic categories of teaching methods: Category 1 - cadaveric dissection, Category 2 - simulator based education and Category 3 - other. A state of the art anatomical curriculum offers numerous possibilities and solutions including the oldest like cadaveric dissection and newest like simulators. Different simulation techniques are used with different intensity; however cadaveric dissection is still the most popular method. The second most frequent method is simulation-based training, in which North America is the leading country. The identification of anatomical structures during virtual surgical procedures or laparoscopic robotic procedures can be integrated into the traditional anatomy course. New technologies are supportive and beneficial in anatomy teaching however each excitement of new technologies sometimes should be tempered and evaluated for its usefulness in making the learning process constructive for students and their future practice.

Common origin of left anterior descending artery and right coronary artery from right aortic sinus: presentation of rare variant.

The authors discuss a case of 55-year-old man admitted to hospital with clinical symptoms and electrocardiac signs of myocardial infarction, who underwent invasive diagnosis and one of most rare coronary arteries anomaly was observed: common origin of right coronary artery and anterior interventricular artery (left anterior descending artery) from right aortic sinus. Anatomical variants of coronary arteries are rare amongst general population, ranging between 0.29% to 1.3% and such anomaly is found in 0.03% of all coronarographies and is responsible for 2.3% of all coronary variations. Knowledge about coronary arteries anomalies is helpful not only in making better diagnosis but also in making better therapeutic decisions.

Psoriasis and unreported excessive alcohol intake--a simple screening approach.

Psoriasis is a chronic immune-mediated skin disease of complex aetiology. Alcohol overuse has long been suspected to contribute to psoriasis pathology, and the knowledge of individual's drinking pattern may be of substantial importance for managing the disease. Unfortunately, a number of patients fail to admit to their true alcohol consumption and there is no single sign, symptom or laboratory parameter adequate for alcohol abuse diagnosis. However, there are some laboratory findings that, when present, should raise physician's suspicion that alcohol may be a problem. The aim of this article was to present simple, widely available and relatively reliable laboratory markers that might effectively assist physicians in establishing patient's drinking status. A possible screening approach is illustrated by two distinct reports of psoriatic patients who initially concealed having the problem with alcohol.

Application of rapid prototyping techniques for modelling of anatomical structures in medical training and education.

Rapid prototyping has become an innovative method of fast and cost-effective production of three-dimensional models for manufacturing. Wide access to advanced medical imaging methods allows application of this technique for medical training purposes. This paper presents the feasibility of rapid prototyping technologies: stereolithography, selective laser sintering, fused deposition modelling, and three-dimensional printing for medical education. Rapid prototyping techniques are a promising method for improvement of anatomical education in medical students but also a valuable source of training tools for medical specialists.

Spiegelian hernia - - anatomy, diagnosing and imaging difficulties-report of 2 cases.

Spiegelian hernias account for less than 1% of all hernias diagnosed in the adult population. The most important factors in the proper diagnostic process are detailed physical examination combined with imaging procedures. Two cases of Spiegelian hernias are presented. The anatomical background of the pathology, as well as diagnostic procedures and surgical treatment, is discussed.

IL-1B -31T>C promoter polymorphism is associated with gastric stump cancer but not with early onset or conventional gastric cancers.

It has been reported that interleukin-1beta (IL-1B) genes play a crucial role in the genetic predisposition to gastric cancer although there is no information about their role in different subtypes of gastric cancer. We performed single nucleotide polymorphism analysis of IL-1B in 241 gastric cancers including early onset gastric cancers (EOGC), conventional gastric cancers, and gastric stump cancers (GSCs) as well as 100 control patients, using real-time polymerase chain reaction and sequence analysis. The C allele was present in 60% of EOGCs, 59% of conventional gastric cancers, and 90% of GSCs, compared to 62% in the control group. Interestingly, there was no difference between early onset and conventional gastric cancer with respect to the IL-1B -31T>C polymorphism distribution. A statistically significant difference in the presence of the C allele compared to the control group was found in patients with gastric stump cancer (p = 0.008) with the T allele conferring protection against gastric stump cancer. In summary, we have shown that the IL-1B -31C allele promoter polymorphism is significantly associated with gastric stump cancer compared to the control group. Although several molecular differences have been identified between conventional gastric cancer and early onset gastric cancer, the IL-1B -31 allele distribution is similar between these two groups.

The body constitution of patients and intubation scales as predictors of difficult intubation considered in relation to the experience of the intubator.

The aims of the study were to identify factors that may result in difficulties in intubation, and to compare the results obtained when an experienced and when a less experienced anaesthesiologist was involved. The 96 patients included in the study were evaluated for difficult intubation according to the following scales: Mallampati, upper lip bite test (ULBT) and Patil. The mobility of the cervical segments of the vertebral column, the distance between the jugular notch of the sternum and the chin and the anatomical constitution of the body were other factors that were taken into consideration. Statistical analysis was performed in order to identify factors that may result in difficulties in intubation for an experienced and for a less experienced anaesthesiologist.

Cytokine response in the postoperative period after surgical treatment of benign adnexal masses: comparison between laparoscopy and laparotomy.

BACKGROUND: Cytokines are the main mediators of the inflammation and the response to trauma. The purpose of the present study was the comparative assessment in sera of patients with benign adnexal masses treated by laparoscopy or laparotomy of the following proinflammatory and anti-inflammatory cytokines: interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), and IL-10 in the early postoperative period. METHODS: A total of 40 patients with benign adnexal masses were studied; 25 of whom underwent laparoscopy and 15, laparotomy. Blood serum concentration of IL-1beta, IL-6, IL-8, TNF-alpha, and IL-10 were measured by commercially available ELISA assays before and 4 h, 24 h, and 48 h after the operation. RESULTS: Concentrations of IL-6 were significantly increased in both groups at 4 h, 24 h, and 48 h after the surgery; levels of IL-10 showed a significant increase 4 h and 24 h after the operation; an increase in IL-1beta levels was observed only after laparotomy; no significant variations were observed in serum levels of IL-8; the postoperative increase of IL-1beta, IL-6, and IL-10 levels was more pronounced in patients undergoing laparotomy than in those treated laparoscopically; length of the surgical procedure, amount of CO2 used, tumor diameter, age, and body mass index (BMI) of the patients did not influence the postoperative patterns of the studied cytokines. CONCLUSIONS: Systemic cytokine response after operations for benign adnexal masses depends on the degree of the surgical trauma, and is less pronounced in patients undergoing laparoscopy.

What do clinicians think of the anatomical knowledge of medical students? Results of a survey.

Human anatomy is one of basic courses in medical education. It usually takes place during the first year of the medical school syllabus. However, the results of the course, if defined as profound anatomical knowledge, are not applied by the students until several years after the final anatomy examination. The aim of the study was to evaluate the anatomical knowledge of senior medical students. For this reason a survey was distributed among teachers responsible for clinical rotas. The results of the study were intended to give the answer to the question, "What do students remember several years after the anatomy examination?" as expressed by their clinical teachers. The questionnaire included four closed questions and one open question. The closed questions concerned general anatomical knowledge, whether the anatomy course should be extended and whether additional courses should be introduced and included a question about student knowledge of particular systems. The open question concerned ways of improving anatomical education. As a result of the survey it was observed that surgical specialists had a significantly lower opinion of the medical knowledge of their students than had medical specialists. Most of the suggestions for improving anatomical education were related to introducing clinical applications of anatomical knowledge.

The activity and immunoexpression of cathepsin D in rat male reproductive organs.

Cathepsin D is a cysteine endopeptidase that belongs to the lysosomal enzyme family. The aim of the study was to evaluate the enzyme immunoexpression and activity in selected male genital organs in mature Wistar rats. The activity of cathepsin D was measured spectrophotometrically in homogenates of the testis, epididymis, seminal vesicle and prostate. Immunohistochemical staining was also performed in the ductus deferens. Enzyme activity was found in the following sequence: testis>epididymis>dorsal prostatic lobe>seminal vesicle>lateral prostatic lobe>ventral prostatic lobe. Although there were differences in enzyme activity between various organs of the male reproductive system, cathepsin D immunoreactivity was seen exclusively in the Sertoli and Leydig cells in the testis.

Selected biochemical parameters and ultrastructural picture of pancreas due to Ulinastatin treatment of experimental acute pancreatitis.

Urinary trypsin inhibitor (UTI, Ulinastatin) is a protease inhibitor that has not been yet used in Europe in any experimental trial of severe acute pancreatitis. We have combined the experimental model of severe, hemorrhagic form of acute pancreatitis, and pharmacological treatment with a protease inhibitor. Male Wistar rats were divided into four experimental groups: healthy controls, operated, operated with experimentally induced acute pancreatitis, and animals with acute pancreatitis--treated with UTI preparations. Subjects in the last group were administered UTI intraperitoneally 1 h after pancreatitis induction in an average standard dose of 3000 units/animal. Additionally, four subgroups were created in this treated group, based on the UTI administration time--number of standard doses received: 2 h - 1 standard dose, 6 h - 5 standard doses, 12 h - 11 doses, 24 and 48 h - 15 doses. Statistically significant differences in the serum amylase and lipase activity between the UTI-treated and non-treated subjects were found. In the group of non-treated animals, there a profound destruction of cellular organelles was observed with a total degradation of nuceli, endoplasmatic reticulum and zymogen granules. However, in the UTI-treated subjects, pathological processes proceeded with the significantly slower pace and in much smaller quantities.

An unusual crossed course of separately originating left circumflex and left anterior descending arteries with concomitant anomalies found in multi-slice computed tomography.

Coronary artery anomalies occur in approximately in 1-2% of the population. The split origin of branches of the left coronary artery is a relatively common anomaly, usually with no significant observable impairment of cardiac function. The application of multi-slice computed tomography (MSCT) for cardiac imaging is increasing and becoming, along with other techniques, a recognised method of examination of the coronary arteries. In the case presented we observed in an ECG-gated MSCT the anomalous origin and proximal course of the arteries of the left sinus of Valsalva. The ostiae of both coronary arteries were located unusually: the ostium of the LAD was found posterior to the ostium of the LCx. Because of this, the proximal part of the LAD crossed the proximal part of the LCx superiorly. Furthermore, muscular bridges were found in the middle part and in the first diameter branch of the LAD. To our knowledge, this is the first case of a crossed course of the LCx and the LAD to be presented in the literature. Applications of MSCT in coronary imaging are presented in comparison with other diagnostic imaging methods. The advantages and limitations of MSCT as a diagnostic tool for anomalies of the coronary arteries are discussed.

Temporary elevation of pancreatic lysosomal enzymes, as a result of the omeprazole-induced peripancreatic inflammation in male Wistar rats.

Omeprazole is one of the substituted benzimidazoles, which is not free of side effects. The aim of the study was to evaluate the influence of omeprazole therapy on pancreas. Omeprazole was administered intraperitoneally, twice a day, for 3 days to the male rats in 0.571 mg/kg b.w. and 5.71 mg/kg b.w. doses. Half of animals were sacrificed in the 4th day of the experiment. The remaining rats were raised for another 6 weeks, without any xenobiotics, and sacrificed on the 47th day. The activity of acid phosphatase, beta-galactosidase, cathepsin B, and L, lipase, N-acetyl-glucosaminidase, and sulphatase was evaluated. The slides of the pancreas were examined in light microcopy in hematoxylin-eosin, asan, periodic acid-Schiff (paS) stains. Statistical increase in total activities of acid phosphatase, beta-galactosidase, lipase, N-acetyl-glucosaminidase, sulphatase, and acute inflammatory infiltration in peripancreatic fat tissue without histological pancreas impairment, were observed after the higher dose on the 4th day of experiment. Histological picture and enzymatic profiles were normalized during the next 6 weeks. We concluded that intraperitoneal administration of omeprazole causes tissue inflammation in the peripancreatic lipid tissue and reactive elevation of some pancreatic lysosomal enzymes.

Changes in pancreatic lysosomal enzymes activity as the potential factors leading to diabetic enteropathy.

The aim of this study was to establish and quantify changes in the activities of total, free and bound fractions of pancreatic lipase, galactoso-6-sulphatase, beta-D-galactosidase and N-acetyl-beta-D-glucosaminidase in the course of alloxan-induced diabetes mellitus. Rabbits were divided into a control group and groups injected with alloxan on the 21st, 42nd, 90th and the 180th day, after which blood samples were taken and the rabbits sacrificed by decapitation. The pancreas was removed and the glucose level measured. Enzyme activities were assayed by spectrophotometric methods. The total activities of N-acetyl-beta-D-glucosaminidase and beta-D-galactosidase were the lowest on day 42 of the test, and the total activity of lipase was the highest at this point of time, as compared to the other periods of the study. We conclude that in the course of alloxan-induce diabetes activities of pancreatic lipase and sulphatase were increasing following the levels of glucose, whilst activities of beta-D-galactosidase and N-acetyl-beta-D-glucosaminidase were declining, being inversely correlated to the level of glucose and activities of the first two mentioned enzymes. Above alterations in activity of lysosomal pancreatic enzymes of alloxan induced diabetic rabbits may be responsible for some aspects of previously reported diabetic enteropathy and chronic complications, or may provide a mechanism for the pancreatic beta-cells to moderate their insulin content.

Branches of the right pulmonary artery to the right upper lobe of the lung.

Studies were carried out on 100 right lungs taken from human cadavers of both sexes aged from 1 month to 80 years. The material was divided into 3 age groups. The pulmonary artery and the bronchi were injected with 65% duracryl and then digested in sulfuric acid. Specimens were examined to determine the number and dimensions of the branches of the right pulmonary artery penetrating upper lobe of the right lung. It was found that in most cases 2 and 3 branches arose from right pulmonary artery. In about 60% of cases the branches which penetrated the lobe were the superior trunk and one or two subsegmental branches. In a dozes or so of cases three types were found: only superior trunk, the apicoanterior trunk and independent segmental or subsegmental branches, the apicoposterior trunk and the remaining branches.