Left anterior cerebral artery arising from a right internal carotid artery: a rare case of carotid-anterior cerebral artery anastomosis.

Carotid-anterior cerebral artery anastomosis (carotid-ACA anastomosis) is described as infrequent vascular connections between the pre-ophthalmic segment of the internal carotid artery (ICA) and the A1 segment of the anterior cerebral artery (ACA). The embryological origin of these variant is still unclear and they are often associated to other vascular anomalies of the circle of Willis, as well as to the presence of aneurysms. Carotid-ACA anastomosis is often right-sided although left and bilateral cases have also been described. We report a rare case by MR angiography of a carotid-ACA anastomosis in which the abnormal vessel arises from the right ICA and takes an infraoptic course to join the A2 segment of the contralateral ACA, making this vascular anomaly function as a 'left ACA with an origin at the right ICA'. The A1 segment of the left ACA is absent and both A2 segments of the ACAs present fenestration. To our knowledge, no similar cases have been reported in English literature so far.

Prevalence of retromolar foramen in nineteenth century Spanish population.

Among the non-metrical variants of the mandible that have been proven to be a key issue for dental practitioners, the retromolar foramen constitutes one of the most controversial details regarding its prevalence and associated variables. Thus, this study evaluated the prevalence of the retromolar foramen and the variables associated with its presence in a large Spanish collection of human dry mandibles from the nineteenth century. Six hundred Spanish human dry mandibles (1200 sides) belonging to an osteology collection were examined. The presence of teeth, the presence or absence of retromolar foramen, as well as its side, diameter, number, and location were evaluated. Descriptive analysis and analysis of the associations between the variables were performed. The retromolar foramen was observed in 184 mandibles (31%) and was predominantly present unilaterally (60.8%). Most mandibles (54.9%) had a single foramen. The most common location was the retromolar trigone region (84%). On analysis of the association of variables, it was observed a strong association (p < 0.001) between the presence or absence of the foramen and the presence of teeth. Moreover, a significant association was also found between sex vs. presence of teeth (p = 0.033), sex vs. presentation side of the foramen (p = 0.028), sex vs. number of foramina found (p = 0.004), and diameter vs. number of foramina found (p < 0.001). This study reveals that the retromolar foramen showed a high prevalence of 31% in nineteenth century Spaniards and was located primarily in the retromolar trigone, suggesting that dentists should be aware of and consider the relevant findings of this study.

The attitudes of European medical students towards the clinical importance of neuroanatomy.

The attitudes of medical students towards the clinical importance of neuroanatomy have been little studied. Because it has been reported that medical students find neuroanatomy difficult and can have 'neurophobia', here we test the hypothesis that early-stage medical students across Europe have a low regard for neuroanatomy's clinical relevance. The work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG), with just over 1500 students from 12 European medical schools providing responses to a survey (52% response rate) that assessed their attitudes using Thurstone and Chave methodologies. Regardless of the university surveyed, and of the teaching methods employed for neuroanatomy, our findings were not consistent with our hypothesis. However, the students had a less favourable opinion of neuroanatomy's importance compared to gross anatomy; although their attitudes were more positive than previously reported for histology and embryology. The extent to which neuroanatomy plays a significant role in the early years of medical education is moot. Nevertheless, we conclude that in addition to newly recruited medical students being informed of the subject's role in a healthcare profession, we advocate the use of modern imaging technologies to enhance student understanding and motivation and cognisance of the core syllabus for the subject being developed by the International Federation of Associations of Anatomists (IFAA).

Estudio Transversal Hispano-Ecuatoriano: Discapacidades derivadas de Ictus cerebral / Hispano- Ecuadorian Cross-Sectional Study: Disabilities derived from cerebral stroke

INTRODUCCIÓN: En la actualidad el ictus es considerado una de las principales causas de discapacidad en el mundo. Globalmente 5 millones de personas adquieren discapacidad permanente cada año por esta causa; hasta el 30% de los pacientes afectados padecen algún tipo de discapacidad. El manejo temprano del paciente puede disminuir las secuelas derivadas de las lesiones. El objetivo de este estudio es conocer si existen diferencias en las discapacidades derivadas de ictus entre las ciudades de Madrid (España) y Cuenca (Ecuador), en relación a una atención temprana programada. MATERIALES Y MÉTODOS: El presente, es un estudio observacional, descriptivo, de corte transversal, multicéntrico. La muestra estuvo conformada por 40 pacientes diagnosticados de ACV, 20 pertenecientes al Grupo Cuencano, de Ecuador (GC) y 20 al Grupo Matritense, de España (GM). Los datos fueron obtenidos de las historias clínicas. Se compararon ambos grupos mediante la prueba Chi-cuadrado (X2) de Pearson para cada variable estudiada. RESULTADOS: En el GM el 80% de los ACV fueron de origen isquémico, en el GC fueron el 90%, sin asociación significativa. En los dos grupos el mayor porcentaje de secuelas se dieron por afectación del territorio de la arteria cerebral media (ACM). No se evidenció diferencia significativa en el porcentaje de discapacidades derivadas de ictus entre los grupos, el grupo matritense de España presentó una menor tasa de discapacidades derivadas que fue del 45%, frente al grupo cuencano de Ecuador que tuvo un 76% de capacidades derivadas, pero la diferencia no fue significativa (p=0.069); sin embargo la asociación entre el porcentaje de exitus entre los grupos si tuvo asociación estadísticamente significativa (p=0.003). CONCLUSIÓN: No se encontró asociación significativa en cuanto a etiología, factores de riesgos y características clínicas del Ictus entre los grupos. No hay diferencias significativas en las secuelas derivadas de ictus entre los grupos, pero si hay diferencias significativas en relación al porcentaje de exitus con la aplicación de un programa tipo "Código Ictus".

BACKGROUND: Currently, stroke is one of the main causes of disability in the world. Globally 5 million people acquire permanent disability each year for this cause; up to 30% of affected patients suffer from some type of disability. Early management of the patient can reduce the sequelae derived from the injury. The aim of this study is to find out if there are differences in disabilities derived from strokes, between the cities of Madrid (Spain) and Cuenca (Ecuador), in association with programmed early patient care. METHODS: This is an observational, descriptive, cross-sectional, multicenter study. The sample consisted of 40 patients diagnosed with stroke, 20 from Cuenca, Ecuador, and 20 from Madrid, Spain. Data was obtained from the patient's medical records. Both groups were compared using Pearson's Chi-square test (Χ2) for each studied variable. RESULTS: in the Madrid Group 80% of the strokes were ischemic, in the Cuenca Group 90% of the strokes were ischemic, there is not significant association. In both groups the highest percentage of sequelae occurred due to injury of the middle cerebral artery (MCA). There was no significant difference in the percentage of disabilities derived from stroke between the groups, the Madrid Group had a lower rate of derived disabilities (45%), compared to Cuenca Group (76%), but the differences was not significant (p=0.069); however, the association between the death percentage among the groups was statistically significant (p=0.003). CONCLUSION: No significant association was found in terms of etiology, risk factors and clinical characteristics of stroke between the groups. There are no significant differences in the sequelae derived from stroke between the groups, but there is significant difference in terms of death percentage between the groups, with the application of "Código Ictus" type of program.

The role of an expert discussion panel on shaping the views of the undergraduate in health sciences on the use of stem cells and pre-implantation embryos / La influencia de un panel de discusión de expertos en la formación de opinión sobre el uso de células madre y embriones preimplantacionales en los estudiantes de ciencias de la salud de pregrado

INTRODUCTION: There are four objectives to this paper: (1) To determine whether undergraduates enrolled in Health-Sciences studies agree with the use of human stem cells for medical research, treatment and genetic uses. (2) Whether they would consider the use of pre-implantation-embryos for medical research. (3) Whether attitudes toward the previous two issues are linked to gender, field of study, transcendental/spiritual convictions and political biases. (4) A panel of discussion will modify their opinion. RESULTS: The present study shows that, before attending a discussion panel session, media was the main source of information that the students had on the surveyed topics. A discussion panel was useful for clarifying respondents' opinions on the explored items. Significantly, the discussion panel had an influence on those respondents who did not have a formed opinion on the explored items. CONCLUSIONS: A discussion panel is a convenient, but limited tool, in the shaping of undergraduate opinions on ethically controversial scientific matters

INTRODUCCIÓN: Los objetivos de este artículo son conocer si: 1) los estudiantes de pregrado matriculados en titulaciones de grado de ciencias de la salud están de acuerdo con la utilización de las células madre humanas para la investigación médica de los embriones preimplantatorios, la cura de enfermedades y los usos génicos; 2) consideran el uso de los embriones preimplantatorios humanos para la investigación; 3) las actitudes hacia los 2 temas anteriores están relacionadas con el género, el grado universitario en curso, la afiliación política y las convicciones trascendentales o espirituales, y 4) conocer si un panel de discusión, con expertos, modifica esas opiniones. RESULTADOS: Los resultados del presente estudio mostraron que antes del panel de discusión, los medios de comunicación eran la principal fuente de información de los encuestados sobre los temas estudiados. El panel de discusión fue útil para aclarar las opiniones de los encuestados, aprobar o desaprobar los ítems explorados. Significativamente, el panel de discusión influyó en los encuestados que dijeron que no tenían una opinión formada sobre los ítems explorados antes del panel de discusión. CONCLUSIONES: El panel de discusión es una herramienta conveniente pero limitada en la formación de las opiniones de los estudiantes de pregrado en titulaciones de ciencias de la salud sobre cuestiones científicas éticamente controvertidas

Early stages of development of the alar fascia (human specimens at 6-12 weeks of development).

In recent years, there has been much discussion concerning the cervical fasciae. The aim of this study is to confirm and to describe the development of the alar fascia as well as its relationship with nearby structures. Histological preparations of 25 human embryos (6-8 weeks of development) and 25 human fetuses (9-12 weeks of development) were studied bilaterally using a conventional optical microscope. Our study confirms the existence of the alar fascia and permits three stages to be established during its development. The initial stage (1st), corresponding to the 6th week of development (Carnegie stages 18-19), is characterized by the beginning of the alar fascia primordium in the retroesophageal space at the level of C7-T1. In the formation stage (2nd), corresponding to the 7th and 8th weeks of development (Carnegie stages 20-23), the alar fascia primordium grows upwards and reaches the level of C2-C3. In the maturation stage (3rd), beginning in the 9th week of development, the visceral, alar and prevertebral fasciae can be identified. The alar fascia divides the retrovisceral space (retropharyngeal and retroesophageal) into two spaces: one anterior (between the alar fascia and the visceral fascia and extending from C1 to T1, named retropharyngeal or retroesophageal space according to the level) and the other posterior (between the alar fascia and the prevertebral fascia, named danger space). We suggest that this latter space be named the retroalar space. This study suggests that alar fascia development is related to mechanical factors and that the alar fascia permits the sliding of the pharynx and the oesophagus during swallowing.

Initial stages of development of the submandibular gland (human embryos at 5.5-8 weeks of development).

The aim of this study was to determine the main stages of submandibular salivary gland development during the embryonic period in humans. In addition, we studied submandibular salivary gland development in rats on embryonic days 14-16 and expression in the submandibular salivary gland region with the monoclonal antibody HNK-1. Serial sections from 25 human embryos with a greatest length ranging from 10 to 31 mm (Carnegie stages 16-23; weeks 5.5-8 of development) and Wistar rats of embryonic days (E) 14-16 were analysed with light microscopy. Five stages of submandibular salivary gland development were identified. The prospective stage (1), between weeks 5.5 and early week 6, is characterized by a thickening of the epithelium of the medial paralingual groove in the floor of the mouth corresponding to the primordium of the submandibular salivary gland parenchyma. At this stage, the primordium of the parasympathetic ganglion lies below the lingual nerve. The primordium of the submandibular salivary gland parenchyma is observed in rats on E14 in the medial paralingual groove with mesenchymal cells, underlying the lingual nerve. These cells are HNK-1-positive, corresponding to the primordium of the parasympathetic ganglion. The bud stage (2), at the end of week 6 in humans and on E15 in rats, is characterized by the proliferation and invagination of the epithelial condensation, surrounded by an important condensation of the mesenchyme. The pseudoglandular stage (3) at week 6.5 is characterized by the beginning of the formation of lobes in the condensed mesenchyme. The canalicular stage (4), between week 7 and 7.5, is characterized by the appearance of a lumen in the proximal part of the submandibular duct. The innervation stage (5) occurs during week 8, with the innervation of the submandibular and interlobular ducts. Nervous branches arriving from the parasympathetic ganglion innervate the glandular parenchyma. Numerous blood vessels are observed nearby. Our results suggest that submandibular salivary gland development requires interactions among epithelium, mesenchyme, parasympathetic ganglion and blood vessels.

Arch of cricoid cartilage anatomical variation: morphological and radiological aspects.

The cricoid cartilage serves as an anatomical reference for several surgical procedures for access to the airway. Additionally, it serves as an attachment point for muscles that move the vocal folds. We present a case where the cricoid cartilage arch is divided into distinct superior and inferior arches, with a fibrous membrane between them. We did not find any similar description to this case in the literature, which makes it unique to date. This type of variation is important knowledge for clinicians and surgeons during airway management in the anterior neck region. The presence of this variation could induce an error during a palpation of the thyroid and cricoid cartilages, realized in clinical examination and surgical or emergency procedures.

Persistent trigeminal artery: a cross-sectional study based on over 3 years conventional angiography, CT angiography and MR angiography images.

PURPOSE: The trigeminal artery is one of the four primitive anastomosis established between the internal carotid artery and the vertebrobasilar system that regresses at the sixth week of embryonic development. Its persistence in adult life (PTA) is usually found incidentally. The aim of this study is to determine its prevalence, main characteristics and clinical significance. METHODS: A cross-sectional study was performed over the last 3 years, 2012-2014, to analyze images performed on conventional angiography, CT angiography and MR angiography of patients who attended the Neuroradiology Department of the Hospital Universitario Doce de Octubre in Madrid, Spain, to control their underlying pathology. RESULTS: Nine cases of PTA were found (prevalence 0.37 %, two men, seven women; three right, six left; age range 13-88 years). Eight PTA emerged from the cavernous ICA and one from the petrous segment. Six cases were lateral or petrosal type and one was medial or sphenoidal type. The whole PTAs anastomosed the BA, six at the middle third and three at the distal third. Weon et al.'s type 3 was predominant. CVD incidence was 55.6 % and aneurysm incidence was 22 %. CONCLUSIONS: PTA prevalence was similar to those previously reported, being commonly left-sided, Salas et al.'s lateral or petrosal type, Weon et al.'s type 3 and with no gender predominance. CVD and aneurysms incidence in the presence of a PTA were higher than in general population. Its anatomical relations make it essential to consider its presence and directional blood flow when planning endovascular and neurosurgical treatments.

Initial experience using the 3MAX cerebral reperfusion catheter in the endovascular treatment of acute ischemic stroke of distal arteries.

INTRODUCTION: The advancement of technology has allowed the development of new catheters that may provide safe intracranial navigation. OBJECTIVE: To report our first experience with the direct aspiration first pass technique in small arteries as the primary method for recanalization with the Penumbra 3MAX cerebral reperfusion catheter. METHODS: A retrospective case series analysis study of patients with acute ischemic stroke endovascularly treated with the direct aspiration technique using the 3MAX reperfusion catheter in our hospital in the past year. RESULTS: We treated six patients in our hospital for acute ischemic stroke using the 3MAX aspiration catheter as first choice. The patients had a median National Institutes of Health Strokes Scale (NIHSS) score of 12 (range 10-17) at admission, with occlusions of an M2 segment of a middle cerebral artery (MCA) treated through an anterior communicating artery, pericallosal artery, P2 artery, and M2-MCA and M3-MCA arteries. Recanalization (TICI 2b-3) was achieved in all cases and no complications occurred. It was not necessary to combine treatment with a stent retriever in any of the patients. All the patients showed early neurological improvement. The median NIHSS score at discharge was 1 (0-3) and 5/6 (83%) patients had a modified Rankin Scale score 0-2 at discharge. CONCLUSIONS: Our initial experience suggests that treatment of distal cerebrovascular occlusions with the 3MAX catheter is feasible. We achieved complete recanalization in all cases without unexpected complications while obtaining good clinical results. However, larger studies are necessary to establish its benefits and its safety.

Toledo School of Translators and their influence on anatomical terminology.

Translation facilitates transmission of knowledge between cultures. The fundamental transfer of anatomic terminology from the Ancient Greek and Islamic Golden Age cultures, to medieval Latin Christendom took place in the so-called Toledo School of Translators in the 12th-13th centuries. Translations made in Toledo circulated widely across Europe. They were the foundation of scientific thinking that was born in the boards of first universities. In Toledo, Gerard of Cremona translated Avicenna's Canon of Medicine, the key work of Islamic Golden Age of medicine. Albertus Magnus, Mondino de Luzzi and Guy de Chauliac, the leading authors of anatomical Latin words in the Middle Ages, founded their books on Gerard's translations. The anatomical terms of the Canon retain auctoritas up to the Renaissance. Thus, terms coined by Gerard such as diaphragm, orbit, pupil or sagittal remain relevant in the current official anatomical terminology. The aim of the present paper is to bring new attention to the highly significant influence that the Toledo School of Translators had in anatomical terminology. For this, we shall review here the onomastic origins of a number of anatomical terms (additamentum; coracoid process; coxal; false ribs; femur; panniculus; spondylus; squamous sutures; thorax; xiphoid process, etc.) which are still used today.

Thomas Willis, a pioneer in translational research in anatomy (on the 350th anniversary of Cerebri anatome).

The year 2014 marked the 350th anniversary of the publication in London of Cerebri anatome, a ground-breaking work of neuroscience heavily influenced by the political and cultural context of Baroque Europe and mid-17th century England. This article aims to review the work of the English physician and anatomist Thomas Willis, specifically with regard to the contents of his Cerebri anatome. Willis's academic and professional career was influenced by the turbulent period of the English Civil War during which he studied medicine. Willis went from chemistry to dissection arguably because of his need to justify the body-brain-soul relationship. As a result, he became a fellow of a select club of eminent experimentalists, and afterward was a Fellow of the Royal Society. Later on, he went to London, leaving the academic life to dedicate himself fully to the profession of medicine. As a physician, Willis did not base his practice on aphorisms but on a 'bench to bedside' approach to medicine, while studying neuroanatomy--covering embryology, comparative anatomy and pathological anatomy--as a basis for the comprehension of neurological pathology. He developed innovative anatomical methods for the preservation and dissection of the brain, injection of coloured substances and illustration of his findings. In Cerebri anatome, Willis recognized the cerebral cortex as the substrate of cognition. He also claimed that the painful stimuli came from the meninges, but not from the brain itself. He explained for the first time the pathological and functional meaning of the brain's circular arterial anastomosis, which is named after him. He also specified some features of the cranial origin of the sympathetic nerves and coined the term 'neurologie'. Cerebri anatome marked the transition between the mediaeval and modern notions of brain function, and thus it is considered a cornerstone of clinical and comparative anatomy of the nervous system. The new contributions and methods employed by Willis justify his place as a father of neurology and a pioneer of translational 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.

Wound healing reaction: A switch from gestation to senescence.

The repair of wounded tissue during postnatal life could be associated with the upregulation of some functions characteristic of the initial phases of embryonic development. The focusing of these recapitulated systemic functions in the interstitial space of the injured tissue is established through a heterogeneous endothelial barrier which has excretory-secretory abilities which in turn, would induce a gastrulation-like process. The repair of adult tissues using upregulated embryonic mechanisms could explain the universality of the inflammatory response against injury, regardless of its etiology. However, the early activation after the injury of embryonic mechanisms does not always guarantee tissue regeneration since their long-term execution is mediated by the host organism.

Antonio Gimbernat y Arbós: an anatomist-surgeon of the Enlightenment (in the 220th anniversary of his "A new method of operating the crural hernia").

This article focuses on Antonio de Gimbernat y Arbós (1734-1816), with particular attention paid to his famous publication "Nuevo método de operar en la hernia crural" (2013 marking its 220 anniversary), which was translated into English by Thomas Beddoe two years later (A new method of operating for the femoral hernia Translated from the Spanish of Don Antonio de Gimbernat, To which are added, with plates by the translator, queries respecting a safer method of performing inoculation). Antonio de Gimbernat y Arbós, a Spanish anatomist and surgeon, was one of the pioneers during the "Age of Dissection" (late 18th Century). He was a man of great willpower, bright, thorough, and unique. From his careful anatomical study in the inguinal region, he made a detailed description of the lacunar ligament, which John Hunter called the Gimbernat's ligament in his honor. Antonio de Gimbernat y Arbós also proposed an advanced treatment for strangulated femoral hernias. He acquired extraordinarily broad surgical skills with therapeutic orientation, conservative, not aggressive, based on the knowledge he had gained through dissection. Furthermore, though this is less well known nowadays, Antonio de Gimbernat y Arbós was also relevant organizer of education and health-services - as it was the custom of the great physician of this time. Consequently, Antonio de Gimbernat y Arbós is truly representative of the great figures of the anatomists-surgeons of the Enlightenment.

Audiovisual material as educational innovation strategy to reduce anxiety response in students of human anatomy.

This study presents the design, effect and utility of using audiovisual material containing real images of dissected human cadavers as an innovative educational strategy (IES) in the teaching of Human Anatomy. The goal is to familiarize students with the practice of dissection and to transmit the importance and necessity of this discipline, while modulating their anxiety. The study included 303 first-year Human Anatomy students, randomly assigned to two groups (Traditional and Educational Innovation). Their state of anxiety was measured using the State-Trait-Anxiety Inventory. Repeated measures ANOVA with between-subject factors was applied. The between-subject factor was Educational Innovation (EI). Two levels were established for this factor. The within-subject factor was Time, four levels being considered here. The results show that the effects of the Educational Innovation factor, Time factor and EI × Time interaction were statistically significant. These results provide an additional element of efficacy to the use of videos as an IES. That is, the use of video material as an introduction into an anxiety-provoking situation which resembles real-life viewing and interaction with human cadavers for the first time significantly diminishes the anticipatory reaction of dread against which novel students have not had the opportunity to develop any cognitive strategy of emotional control.

Relevance of human anatomy in daily clinical practice.

AIM: the aim of this study has been to evaluate the relevance of gross human anatomy in daily clinical practice and to compare it to that of other basic sciences (biochemistry, bioethics, cytohistology, microbiology, pharmacology, physiology, psychology). MATERIALS AND METHODS: a total of 1250 questionnaires were distributed among 38 different medical speciality professionals. Answers were analyzed taking into account speciality (medical, surgery and others), professional status (training physician or staff member) and professional experience. RESULTS: the response rate was 42.9% (n=536). Gross human anatomy was considered the most relevant basic discipline for surgical specialists, while pharmacology and physiology were most relevant for medical specialists. Knowledge of anatomy was also considered fundamental for understanding neurological or musculoskeletal disorders. In undergraduate programmes, the most important focuses in teaching anatomy were radiological, topographical and functional anatomy followed by systematic anatomy. In daily medical practice anatomy was considered basic for physical examination, symptom interpretation and interpretation of radiological images. When professional status or professional experience was considered, small variations were shown and there were no significant differences related to gender or community. CONCLUSION: our results underline the relevance of basic sciences (gross anatomy, physiology, and pharmacology) in daily professional activity. Evidence-based studies such as ours, lend greater credibility and objectivity to the role of gross anatomy in the undergraduate training of health professionals and should help to establish a more appropriate curriculum for future professionals.

Dissection as a modulator of emotional attitudes and reactions of future health professionals.

CONTEXT: There is ongoing discussion within the medical education community about dissection as an educational strategy and as a professional training tool in technical and emotional skills training. OBJECTIVES: This study aimed to discover the emotional reactions, attitudes and beliefs of new students faced with human cadaver dissection; to evaluate the changes produced in these variables by the exhibition and practice of dissection; to analyse the level of anxiety students feel when faced with death, and to elucidate the possible relationships between these items. METHODS: The study used a sample of 425 students who were first-time enrolees in a human anatomy course. Three new instruments were designed, with items covering emotional reactions (cognitive, physiological and motor reactions), beliefs and attitudes related to what the student expects to experience or has experienced in dissection. Death anxiety was measured using the Death Anxiety Inventory. RESULTS: As students gained more experience of dissection, their emotional reactions were reduced and their attitudes and beliefs changed. Statistically significant differences in the level of death anxiety emerged, depending on the perceptions students had of their degree of preparation for dissection, and emotional control and deeper thoughts about life and death during dissection. DISCUSSION: The practice of anatomy allows the student to learn how to face up to and adapt his or her emotional reactions and attitudes; this gives human cadaver dissection great importance as an educational strategy and as a professional training tool in technical and emotional skills training.

Anxiety and dissection of the human cadaver: an unsolvable relationship?

Anxiety is an emotional reaction frequently shown by students when a human cadaver is being dissected. Nonetheless, few studies analyze the nature of the anxiety response in this situation and the ones that do exist are mainly limited to English-speaking countries. Our research has three aims: to study the characteristic anxiety reaction to dissection practices, to determine the weight exerted by internal and environmental variables on this anxiety reaction, and to design practices aimed at reducing the state of anxiety experienced by pupils in their human anatomy practices. The studies were carried out in the dissection room of the Department of Human Anatomy and Embryology II at the Faculty of Medicine of the Complutense University, Madrid, during the 3 academic years 2000-2003. The anxiety response to the first dissection of a human cadaver is mainly determined by a situation considered to be threatening, with novelty as its main characteristic. The students' anxiety response is first determined by the situation itself and reactions depend on individual differences. Repeated or gradual exposure (detailed verbal information on the situation, visits to dissecting rooms when no cadaver is present, videos showing pictures of human dissections, etc.) before carrying out the first dissection reduce the students' anxiety response.