Anatomy into the future.

The necessary increase in the clinical components of the medical curriculum has created pressure to reduce the amount of time spent on basic science, particularly the detailed learning of anatomy. Methods of learning must be re-evaluated, but departments will be constrained by resources available. The clinical aspects of anatomy should form the principles of a core course, with a limit to the wider anatomical knowledge required. Feedback from the students is recommended as an initial form of monitoring the course. (Ref. 13.)

Fibularis tertius: revisiting the anatomy.

Fibularis tertius (FT) may be used during reconstructive surgery and muscle transposition with retention of function. The muscle was examined in both lower limbs of 41 cadavers. Measurements were made of muscle belly length and width, tendon length and width, and the size of the origin on the fibula. Tendon insertion, nerve and blood supplies were also examined. FT was absent in five (6.1%) lower limbs of three (7.3%) subjects. The size of its origin demonstrated inter- and intra-individual variation. FT arose from the distal fibula and on average occupied (28.4 +/- 9.1)% (mean +/- S. D.) of the total shaft length. In all cases the tendon inserted into the dorsal surface of the shafts of both the fourth and fifth metatarsals. A small nerve branch consistently arose from the deep fibular nerve near the origin of extensor digitorum longus. The nerve ran parallel to the length of this muscle, between it and extensor hallucis longus, before piercing FT. Anatomy textbooks describe FT as inserting into the fifth metatarsal only. This study, supported by data from previous reports, suggests that the "textbook" accounts of FT should be updated to record that most commonly its tendon reaches both the fourth and fifth metatarsals.

Femoral nerve entrapment: a new insight.

Compression of the femoral nerve in the iliac fossa has been reported as a consequence of several pathologies, but never as a result of muscular compression. Aberrant slips of iliacus, however, have occasionally been reported to cover or split the femoral nerve. This study aimed to assess such variations as potential factors in femoral nerve compression. A large and homogeneous sample of 121 embalmed cadavers (242 specimens) was studied. Statistical comparisons were made using the chi-squared test. Muscular slips from iliacus and psoas, piercing or covering the femoral nerve, were found in 19 specimens (7.9%). No significant differences by sex or side were found. The more frequent variation was piercing of the femoral nerve by a muscular slip (17 specimens, 7.0%). The nerve then entered the thigh as one or more branches. The less frequent variation found was a muscular slip or sheet covering the femoral nerve as it lay on iliacus (2 specimens, 0.8%). Each disposition may be a potential risk for nerve entrapment.

The topographical anatomy of the lumbar epidural space.

Although clinically important, the lumbar epidural space is inconsistently described in textbooks of both anatomy and anaesthetics. This anatomical study of twelve cadavers was performed in an attempt to clarify the description of this region. The dura mater, which possesses a midline fold in a very few cases, is apposed to the walls of the vertebral canal, and attached to them by connective tissue, which is sufficient to allow for displacement of the dural sac during movement of the spine and venous engorgement. Between the dura mater and the vertebral canal is a thin layer of areolar tissue. This contains the internal vertebral venous plexus and a posterior deposit of fat which lies in a recess between the ligamenta flava. These findings are discussed in relation to previous studies in an attempt to arrive at a cohesive description of the epidural region.

Feedback from dental students: performance in an anatomy department.

A questionnaire was devised and administered to first-year dental students to obtain feedback on the courses in an anatomy department. A closed statement format was used with a small number of open requests for comment, both to elicit information which would lead to course improvement, and also to validate the questionnaire itself and assess its suitability for inclusion in a formal appraisal system. Data were produced on course structure, teaching methods, examinations and personal tutoring. The students were divided into subgroups and their perceptions in these areas compared. The median responses to closed statements for each discipline within anatomy were calculated and displayed graphically as course profiles. The questionnaire itself is discussed in detail in relation to the validity of the feedback produced. Improvements are suggested and the questionnaire found to be suitable for wide usage in an appraisal system, particularly with the development of course profiles. The specific responses by the students, and their requests for further guidance, are also considered and suggestions made for alterations in the courses.

Proliferation of thymocytes in relation to T-cell receptor beta-chain expression.

During proliferation and differentiation of maturing thymocytes, T-cell receptor beta-chain products are first expressed in the cytoplasm. Only subsequently are they expressed on the cell surface, presumably as part of the alpha beta/CD3 receptor complex. This study uses double immunofluorescence labelling to identify these cytoplasmic and surface phases separately in relationship to cell-cycle parameters. The use of a mitotic arrest agent and tritiated thymidine autoradiography both show that cells with cytoplasmic beta-chains are in cell cycle, whereas cells with surface beta-chains are cycling slowly, if at all.

Resin injection studies of the lumbar extradural space.

Two resin injection studies of the lumbar extradural space were performed to elucidate its size and shape. To counteract the lack of cerebrospinal fluid pressure in the cadaver, the subarachnoid space was filled with water. In group 1, the extradural injection of resin caused an immediate increase in subarachnoid pressure. The casts produced varied in thickness, but were situated predominantly in the dorsomedial and dorsolateral regions of the spinal canal. Thin anterior spread occurred in 40% of cases. In group 2, resin was injected to the subarachnoid space before the extradural injection of dyed resin. The resulting extradural casts were thinner than in group 1, but the distribution of resin was similar. The problems of interpreting resin casts are discussed in relation to the results obtained, with reasons for suggesting that the extradural space is only potential.