Some of the earliest depictions of the human spine: a glimpse into European history.

INTRODUCTION: Drawings of the human form have a history almost as old as mankind itself. However, illustrations of the human spine as seen with the vertebral column were not seen until much later. This paper reviews some of the early European depictions of the human vertebral column from the twelfth (e.g., Fünfbilderserie "Bone-Man": 1152 A.D.) and thirteenth (e.g., Ashmole 1292) centuries. Man's understanding of his body has evolved over hundreds of years. CONCLUSIONS: This glimpse into our past and early drawings of the human spine illustrate how this particular anatomical structure was perceived almost a millennium ago and would not be structurally correct renditions until Leonardo da Vinci in the fifteenth century.

Families' experiences of raising concerns in health care services: An interpretative phenomenological analysis.

BACKGROUND: This exploratory study aimed to increase understanding of the experiences of families of people with intellectual disabilities when noticing and raising concerns in services. A qualitative design was employed. METHODS: Seven participants (all female) were recruited through local and national voluntary agencies; five were mothers of people with intellectual disabilities, one was the aunt and one the sister. Participants took part in semi-structured interviews centred on their experiences of noticing and raising concerns, these were recorded and transcribed. The data were analyzed using interpretative phenomenological analysis (IPA; Smith, 1996). RESULTS: The data were grouped into three superordinate themes: the nature and importance of concerns, relationships between familes and staff and the process of raising concerns. A key and surprising finding was the importance of "the little things." CONCLUSIONS: This research highlights important implications for services such as the need to simplify the process of raising concerns, attend to the relationship with families and ensure advocacy services are identified for those without family.

Development of profound Chiari I malformation and cerebellar tissue loss and resolution following shunting of posterior fossa extra-axial cyst. Case report.

INTRODUCTION: Chiari I malformation can be due to a multitude of etiologies such as craniosynostosis or hydrocephalus. A posterior fossa extra-axial cyst (PFEAC) appears to be an extremely rare cause of this form of hindbrain herniation. CASE REPORT: Herein, we report a case of PFEAC that presented with no Chiari I malformation and then presented months later with a significant Chiari I malformation. Following shunt placement of a PFEAC, striking reversal of the Chiari malformation as well as reconstitution of the cerebellum was noted. CONCLUSIONS: Patients with PFEAC might develop a Chiari I malformation and this might be treated with shunting of the PFEAC alone.

A comprehensive review of the foramina of Luschka: history, anatomy, embryology, and surgery.

PURPOSE: The purpose of this review is to comprehensively review the foramina of Luschka in regard to their discovery, embryology, anatomy, and surgical relevance. METHODS: This subject review of the foramina of Luschka was composed after conducting a thorough review of the available literature on this topic using PubMed and other primary sources. RESULTS: The foramina of Luschka are paired apertures located in the lateral recesses of the fourth ventricle, within the posterior cranial fossa. The foramina of Luschka are of importance clinically as their blockage can disrupt the flow of cerebrospinal fluid leading to the development of hydrocephalus. These apertures were first described by the German anatomist Hubert von Luschka in the nineteenth century. These foramina are thought to emerge at around the 26th week of development. The apertures project into the cerebellopontine angle at the lateral border of the pontomedullary sulcus. CONCLUSION: The foramina of Luschka may be surgically manipulated for the excision of tumors involving the fourth ventricle and surrounding structures and accessed for cochlear nucleus stimulation.

Skull Base and Cervical Spine Involvement in Jansen Syndrome: Case Report.

INTRODUCTION: Metaphyseal chondrodysplasia, Jansen type (JMD), is a rare form of endochondral ossification resulting in short limbs and dwarfism. CASE REPORT: A child presented with JMD and was found to have involvement of the cervical spine. Conservative treatment was given to the patient who at the long-term follow-up continues to have no neurological findings or cervical spine instability. CONCLUSIONS: To our knowledge, this case represents the first report of involvement of the superior cervical spine in a patient with JMD. Clinicians should be aware of this potential albeit rare finding.

The neuroanatomy of depression: A review.

Depression is the most common psychiatric disorder, the number one cause of disability and affects up to 15% of the population. The aim of this review is to present a brief synopsis of the various biochemical imbalances thought to contribute to depression, aspects of anatomy possibly implicated in depression, and treatments related to targeting these specific locales. Multiple neurotransmitters and parts of the brain are involved with the disorder of depression. Although an exact etiology for depression has not been found in most cases, various treatments, medicinal, psychiatric and surgical, exist for this disabling disease. An improved knowledge of anatomical sites involved in patients with depression will help in future treatment modalities. Clin. Anat. 30:44-49, 2017. © 2016 Wiley Periodicals, Inc.

Translation of Hecker's 1922 "the occipital-atlanto-axial ligament system": A study in comparative anatomy.

In 1922, Paul Hecker, a French physician and Head of Anatomy at the Medical College of Strasbourg, published a sentinel thesis on the ligaments of the craniocervical junction based on a study of comparative anatomy. Unfortunately, this dissertation has been lost to history and until now, was unavailable in the English language. Herein, we present a translation of Hecker's work with an update in its nomenclature, which with modern imaging capabilities of the craniocervical junction is germane and timely. Clin. Anat. 30:322-329, 2017. © 2017 Wiley Periodicals, Inc.

A history of the autonomic nervous system: part I: from Galen to Bichat.

INTRODUCTION: The development of our current understanding of the autonomic nervous system has a rich history with many international contributors. CONCLUSIONS: Although our thoughts of an autonomic nervous system arose with the Greeks, the evolution and final understanding of this neural network would not be fully realized until centuries later. Therefore, our current knowledge of this system is based on hundreds of years of hypotheses and testing and was contributed to by many historic figures.

A history of the autonomic nervous system: part II: from Reil to the modern era.

INTRODUCTION: The history of the study of the autonomic nervous system is rich. At the beginning of the nineteenth century, scientists were beginning to more firmly grasp the reality of this part of the human nervous system. CONCLUSIONS: The evolution of our understanding of the autonomic nervous system has a rich history. Our current understanding is based on centuries of research and trial and error.

Meningeal relationships to the spinal nerves and rootlets: a gross, histological, and radiological study with application to intradural extramedullary spinal tumors.

INTRODUCTION: Juxtapositional tumors of the spinal nerve roots have been noted to not only interact with the roots at various vertebral levels, but also differ among patients. Therefore, the aim of the current study was to elucidate the potential for variation among the relationships of the meningeal layers at different nerve levels. METHODS: In 20 unembalmed adult cadavers and five fetal specimens, the spinal nerve roots from the cervical, thoracic, and lumbar regions were harvested with their associated meningeal layers and subjected to microdissection, histological analysis, or radiological imaging using 9.4-T MRI. RESULTS: As the nerve rootlets passed from the cord, they received their root sheath covering from the pia. After crossing the subarachnoid space to reach the apertures in the dura, they received two additional looser sheaths, an outer from the dura and an inner from the arachnoid. The pia mater always ended proximal to the arachnoid, and the pia and arachnoid layers extended more distally along the roots with caudal descent. Although the dorsal and ventral roots generally exited through separate dural openings, a single dural opening was also observed, often in the lower spinal regions. Thin intradural septations almost always separated the dorsal and ventral rootlets. The left and right sides frequently differed within individuals. CONCLUSIONS: On the basis of our study, variations of the meninges surrounding the spinal nerve roots are common, but themes do exist. Such data support surgical observations of the different interactions between tumors in these regions with surrounding neural tissues.

Formaldehyde exposure and its effects during pregnancy: Recommendations for laboratory attendance based on available data.

Formalin is commonly used in fixation of cadaveric specimens. Exposure to formaldehyde, a component of formalin and a known carcinogen, during gross anatomy laboratory dissection is a continuing concern for pregnant students and instructors. Since there is little literature on this specific topic, the current review was compiled in the hope of offering recommendations to pregnant students and instructors who are engaged in human anatomical dissection where formalin is used. Relevant articles were obtained through searches of PubMed and Google Scholar for the terms "formaldehyde," "pregnant," "formalin," and "exposure." A literature search was conducted for chemical information and articles about exposure as issued by government regulatory agencies and chemical companies that produce formaldehyde. This led to the compilation of 29 articles each of which included references to previous, relevant, human research. The reviewed literature contains data strongly suggesting that pregnancy can be affected by formaldehyde exposure. Therefore, on the basis our analysis, female students who might be pregnant should avoid formaldehyde exposure, including that in a gross anatomy laboratory. Instructors should find other means of ensuring anatomical competence for these students.

Relationship between pharyngitis and peri-odontoid pannus: A new etiology for some Chiari I malformations?

The pathophysiology underlying Chiari I malformations (CIMs) provides room for debate with several theories attempting to address this issue. We retrospectively reviewed many of our past patients with pediatric CIMs (specifically, those with peri-odontoid pannus), and present a hypothesis for the development of the malformation in some of said patients. Our experience with the pediatric CIM has shown that almost 1 in 20 patients who present with symptoms is found to have a peri-odontoid pannus. These masses ranged in size from 4 to 11 mm in diameter. Forty percent had a history of clinically significant pharyngitis or pharyngeal abscess. Pannus formation around the dens (odontoid) resulted in ventral compression of the craniocervical junction in each of these patients. Highlighting the hypermobility that causes such lesions, following fusion, the pannus and symptoms in several patients were diminished. Impairment of normal cerebrospinal fluid circulation out of the fourth ventricle and across the craniocervical junction appears to be a plausible endpoint in this discussion and a suitable explanation for some patients with CIM. Still, the mechanisms by which cerebrospinal fluid circulation is compromised may be variable and are not well understood. This is the first study dedicated to the evaluation of pannus formation in the CIM population. We hypothesize that pharyngeal inflammatory conditions contribute to the formation and progression of hindbrain herniation in a small subset of patients with CIMs.

The foramen of Monro: a review of its anatomy, history, pathology, and surgery.

INTRODUCTION: The foramen of Monro lies at the junction between the paired lateral ventricles and the third ventricle of the brain. METHODS: A comprehensive review of the literature was performed focusing on the foramen of Monro. CONCLUSIONS: A good understanding of the anatomy of the foramen of Monro is essential for the neurosurgeon, especially with the increasing use of intraventricular endoscopy.

Factors associated with social interactions between deaf children and their hearing peers: a systematic literature review.

Research indicates that deaf children can have marked social difficulties compared with their hearing peers. Factors that influence these social interactions need to be reviewed to inform interventions. A systematic search of 5 key databases and 3 specialized journals identified 14 papers that met the inclusion criteria. Methodological quality of the articles was assessed using an adapted checklist. There was a general lack of consensus across studies. The main factors investigated were the deaf child's communication competency, age, and level of mainstreaming, which overall were positively associated with peer interactions. Some studies also found that females were more likely to have positive social interactions. The majority of studies were cross-sectional. Some studies lacked appropriate control groups and did not recruit an appropriate range of informants. A wide range of factors were associated with social interactions between deaf and hearing children. The role of communication gained the highest consensus across studies. Other factors were involved in more complex interactions.

Pistis as Relational Way of Life in Galatians.

Using the Septuagint as an example, this article supports Teresa Morgan's recent contention that πίστις is essentially relational. On the basis of the prevalence of relationality, the article offers a critique of readings of Galatians that privilege other concepts, such as Benjamin Schliesser's emphasis on spatiality. The study then argues that, instead of Morgan's 'pistis is a relationship', it would be more accurate and exegetically useful to bring out the action-reference of πίστις with an expression such as 'πίστις is a relational way of life'. The article will argue that the most likely relational reading of πίστις in Galatians is one in which πίστις primarily represents trust, loyalty and/or trustworthiness in the relationship between the current Christ and people. This raises questions over the focus of πίστις on past events in the work of scholars such as Richard Hays and John Barclay. If πίστις Χριστοῦ is to be read as involving an 'objective genitive' it probably denotes people's trust in and loyalty to Christ and also possibly to God through Christ. If it is to be read as a 'subjective genitive', it would probably primarily denote Christ's current reliability and loyalty in his relationship to people, and conceivably also to God. Various directions of πίστις between people, Christ and God are possible in Galatians but the one most often clearly evidenced is between people and Christ.

Descriptive analysis of unplanned readmission and reoperation rates after intradural spinal tumor resection.

INTRODUCTION: Spinal cord tumors (SCT) are relatively uncommon and usually require surgical treatment. Readmission within 30days after discharge is an important indicator of health care quality. The aim of this study was to investigate the rates and causes of unplanned readmissions and reoperations after SCT surgery. METHODS: A retrospective analysis of patients' charts at a single center from May 2007 to September 2015 was completed. INCLUSION CRITERIA: history of laminectomy with excision of neoplasm in the spinal cord. EXCLUSION CRITERIA: (1) surgery outside the timeframe; (2) less than 19years old; (3) non-neoplastic intramural pathologies; (4) previous resection at the same location; (5) metastatic lesions. RESULTS: We found 131 patients that met criteria. Six patients (4.5%) were readmitted within 30days and two within 90days (1.5%). Four underwent reoperation: one for a cerebrospinal fluid leak, two for pseudomenigoceles, and one for repeat laminectomy. Resection of intramedullary tumors resulted in twice the risk of having one or more complications compared to extramedullary tumors (RR 2.0; 95% CI: 1.0-4.2; p=0.057), and nearly four times the risk of having a neurological complication (RR 3.8; 95% CI 1.5-9.5; p=0.005). CONCLUSION: This study analyzes readmission, reoperation and complication rates for the surgical care of SCT highlighting how SCT surgery is still involved with morbidity in experienced and specialized centers. This information is useful both for health care enhancement projects and for evidence-based patient counseling.

Longitudinal analysis of the impact and cost of person-centered planning for people with intellectual disabilities in England.

Person-centered planning is central to United Kingdom policies regarding the support of people with intellectual disabilities. However, little evidence exists on the impact or cost of introducing person-centered planning. We examined the efficacy, effectiveness, and costs of introducing person-centered planning for 93 people with intellectual disabilities over 2 years across four localities in England. A person-centered plan was successfully developed for 65 people. Little change was apparent prior to introducing person-centered planning. After its introduction, modest positive changes were found in the areas of social networks; contact with family; contact with friends; community-based activities; scheduled day activities; and choice. The direct training and support cost of introducing person-centered planning was $1,202 per participant; indirect costs were negligible.

Clinical supervision for clinical psychology students in Uganda: an initial qualitative exploration.

BACKGROUND: Burn out in clinical psychologists working in low income countries has been reported. Clinical supervisory structures do not yet exist in Uganda. A way to decrease levels of burn out and increase quality of care for people with mental illness is through clinical supervision. The aim of this study was to explore the initial experiences of supervision for clinical psychology students in Uganda to ascertain whether or not clinical supervision is culturally appropriate, and what aspects of supervision had been helpful and unhelpful. METHODS: A qualitative design with thematic analysis was utilized. A focus group was held with 12 second year clinical psychology students to ask their experiences of receiving supervision. RESULTS: Data analysis created five themes. Firstly, the negative emotions that resulted from the training processed were discussed, and how supervision helped and did not help the students to manage these. Secondly, the students voiced that supervision helped them to learn through observational experiences, co-therapist roles and parallel processes within the supervisory relationship. Thirdly, supervision had taught the clinical psychology students their role as a clinical psychology student, how to act within the Ugandan mental health system and skills to conduct therapy. Fourthly, suggestions for the future of supervision were given, with the students requesting for it to start earlier in the training, for supervisors who can meet with the students on a regular basis to be selected and for the training the students receive at university to match the skills required on their placements, with a request for more practical techniques rather than theory. The final theme related to left over miscellaneous data, such as the students agreeing with each other. CONCLUSIONS: The students stated that supervision was helpful overall, implying that clinical supervision is culturally appropriate for clinical psychology students in Uganda. Suggestions for future supervision were given. In order to decrease high levels of staff burn out in the mental health systems in Uganda, supervisory structures with an emphasis on self care need to be established.