Lumbar dorsal root Ganglia location: an anatomic and MRI assessment.

BACKGROUND: The dorsal root ganglion (DRG) is a key structure in the mechanism of symptomatic radicular pain, weakness and change in sensation. DRG localization can assist in the decision making process of which areas require decompression, and type of procedure that should be performed to treat radicular symptoms. In this study we determine dimensions of lumbar foramina, DRG and its relationship to the neuroforamina through anatomic and magnetic resonance imaging (MRI) evaluation Agreement between MRI and anatomic assessment of DRG location will be determined. METHODS: Sixteen embalmed cadavers, 10 females and 6 males, aged 68 to 106 years had an MRI of the thoracolumbar spine followed by dissection. Measurements made included foraminal height and width, DRG size and nerve root take off angle. The center of the DRG and its relationship to the foramina were measured and the probability of agreement between anatomic and MRI assessment were made. RESULTS: The greatest width of the DRG was 6.5mm bilaterally at L5 (range 3.2-6.5mm). The nerve root take off angle was largest at L5 on the left (range 50.5o-58.8o) and L4 on the right (range 50.5o-57.2o). The center of the DRG was found bilaterally in the medial zone of the foramen of L1-4 and lateral zone at L5. Foramina size increased from L1 to L5 in the ventral to dorsal and cephalad to caudal direction. Pedicle width increased from L1 to L5. The estimated overall probability of agreement between anatomic and MRI DRG location was 86.3% (95% confidence interval = 77.5% - 92.0%). CONCLUSIONS: The percentage of agreement between MRI and anatomic evaluation of lumbar DRG location significantly exceeded our pre-defined threshold of 70% (p = 0.0013). CLINICAL RELEVANCE: Our results aid in surgical decision-making as true anatomic position can be directly correlated to what's seen on MRI.

Florida State University College of Medicine: from ideas to outcomes.

The Florida State University College of Medicine (FSU COM) was established in 2000, the first new MD-granting medical school in the United States in over 25 years. In its brief history, the FSU COM has developed rapidly in accordance with its founding mission to meet the need for primary care physicians, especially those caring for the elderly and the underserved. The school recently received a full continuation of accreditation for the maximum period, eight years, from the Liaison Committee on Medical Education.The authors describe FSU COM's new, innovative educational program using community-based clinical training on six statewide regional campuses and two rural sites. Third- and fourth-year students are assigned to community physicians in a one-on-one clinical training model in all of the settings where physicians practice. Over 70% of student clinical training is in such settings. The authors describe how the model operates, including curricular oversight (which ensures quality and equivalence of the educational experience at all sites), the regional campus structure, administration, education program delivery during core clerkships, and assessment of students' performance. Ongoing required faculty development for all clerkship faculty is an essential feature of the training program, as is tracking of all individual student contacts through an online clinical data collection system used for evaluation of the clerkship experiences as well as research.The authors demonstrate that the school has been highly successful in implementing its mission, and that the challenge ahead is to sustain its approach to the training of future physicians.

The surgical clerkship: a contemporary paradigm.

BACKGROUND: Traditional surgical clerkships have been composed of hospitalized patients, usually in academic centers, daily resident interaction, periodic attending rounds, assigned texts, and a lecture format. However, traditional clerkships do not reflect the current changes in learning theory nor the economic realities of today's surgical practice. Initiated in 2001, the allopathic Florida State University College of Medicine provided an opportunity to create a contemporary surgical clerkship. METHODS: At each of 6 regional campuses, clerkship students served as apprentices to a board-certified community surgeon. In addition, during weekly meetings with the student, a campus-specific Clerkship Director administered a centralized curriculum with defined objectives and competencies. Contact with residents was minimal, and lectures were not used. Students were free to choose from suggested texts or to use alternative learning sources. An electronic data system monitored patient contacts. Evaluations of the students' clinical performance are 360 degrees. RESULTS: To date, 450 students have graduated. No significant differences were found between campuses for the following: types of patients encountered, U.S. Medical Liscensure Examination Step 2 Clinical Knowledge and Clinical Skills scores, internal Objective Structured Clinical Examination results, or National Board of Medical Examiners scores (P > 0.05). The national examination metrics have been met or exceeded. On the recent anonymous Association of American Medical Colleges Graduation Questionnaire survey, the students rated the surgery clerkship as the best course in the school. Overall, 23.3% of graduates have chosen some aspect of surgery as a career. CONCLUSIONS: A quality clerkship in surgery can be provided using a nontraditional community-based system, with as many as 6 distributed campuses. Also, the distributed campus model does not lead to inequality in learning opportunities, surgical experiences, or basic surgical knowledge. Third, documentation of campus comparability is markedly assisted by electronic monitoring. Fourth, the tutorial model offers, at the very least, a comparable learning experience and is strongly supported by both students and the community surgical faculty. Finally, student learning and acquisition of a fund of surgical knowledge in this system has been confirmed by national metrics.

Histología: texto y atlas color / Histology a text and atlas

Ofrece al alumno los conocimientos histológicos pertinentes y hace hincapié en los nuevos hallazgos destacables de la biología celular, que sirven para comprender la estructura y función de las células, tejidos y órganos

Histología: texto y atlas color / Histology a text and atlas

Ofrece al alumno los conocimientos histológicos pertinentes y hace hincapié en los nuevos hallazgos destacables de la biología celular, que sirven para comprender la estructura y función de las células, tejidos y órganos