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Exploring Deep Space - Uncovering the Anatomy of Periventricular Structures to Reveal the Lateral Ventricles of the Human Brain

Anatomy students are typically provided with two-dimensional (2D) sections and images when studying cerebral ventricular anatomy and students find this ...

Australian National University

Much has been written and discussed about the reasons for reduced interest in surgery, but few institutions have chosen to examine the loss or attrition of general surgery residents from their own programs. In preparation for an upcoming Residency Review Committee analysis of our program, we took the opportunity to examine the reasons for attrition in our own institution.

Why do residents leave general surgery? The hidden problem in today's programs.

To examine whether duty-hour restrictions have been consequential for various aspects of the work of surgical faculty and if those consequences differ for faculty in academic and nonacademic general surgery residency programs.

Duty-hour restrictions and the work of surgical faculty: results of a multi-institutional study.

This study examined how surgical residents and faculty assessed the first year of the Accreditation Council for Graduate Medical Education duty-hour restrictions.

How surgical faculty and residents assess the first year of the Accreditation Council for Graduate Medical Education duty-hour restrictions: results of a multi-institutional study.

We evaluated the documentation of informed consent for 2 common prostate operations using current, conventional, paper based consent forms. Based on the results of the review the conventional paper based consent system was replaced with a new, standardized electronic consent system.

Informed versus uninformed consent for prostate surgery: the value of electronic consents.

Surgical site infections (SSIs) result in significant postoperative morbidity and mortality. Although many of these infections can be prevented by timely administration of preoperative antibiotics, data suggest that many patients do not receive such therapy.

Reducing surgical site infections through a multidisciplinary computerized process for preoperative prophylactic antibiotic administration.

Analysis of magnetic resonance (MR) images of healthy volunteers.

Synovial folds of the lateral atlantoaxial joints: in vivo quantitative assessment using magnetic resonance imaging in healthy volunteers.

Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine.

Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis.

The synovial folds of the cervical spine are regarded as a potential source of neck pain and headache, especially following whiplash injury. Damage to the synovial folds following motor vehicle trauma has been well documented in post-mortem studies. However, methods of identifying injury to the synovial folds in the survivors of motor vehicle trauma have proven elusive to date. Recently, it has been made possible to image the synovial folds in vivo using magnetic resonance imaging. This now makes it feasible to investigate the potential involvement of synovial folds in the generation of neck pain and headache and its relief using spinal manipulation. This paper reviews critically the morphology of the synovial folds of the cervical spine that underpins the hypotheses proposed to explain their functional and clinical significance and a new system of naming and classifying the synovial folds is presented. Although there is some evidence to support the contribution of the synovial folds to neck pain, several theories have little or no support and require investigation and further evaluation. These findings have implications for understanding the anatomical basis of neck pain and headache and the rationale for the use of spinal manipulation in their management.

Synovial folds - a pain in the neck?

Intra-articular synovial folds of the cervical spine are considered to be a potential source of neck pain and disability. The purpose of the present study was to devise and validate a method to determine the normal morphometry of the synovial folds as a basis for understanding their functional and clinical significance.

Morphometry of the synovial folds of the lateral atlanto-axial joints: the anatomical basis for understanding their potential role in neck pain.

Research involving chiropractors is evolving and expanding in Europe while resources are limited. Therefore, we considered it timely to initiate a research agenda for the chiropractic profession in Europe. The aim was to identify and suggest priorities for future research in order to best channel the available resources and facilitate advancement of the profession.

The first research agenda for the chiropractic profession in Europe.

Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to the head and neck induced by a sudden braking event in a commonly experienced non-collision traffic incident. The likely mechanism of injury resulted from interaction between the occupant and the 3-point seat belt. These findings indicate that ICA dissections are substantially more likely to be associated with SAH following head and neck trauma, regardless of the magnitude of the traumatic event or whether an impact was involved.

Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

Barium sulfate and lead oxide contrast media are frequently used for cadaver-based angiography studies. These contrast media have not previously been compared to determine which is optimal for the visualisation and measurement of blood vessels. In this study, the lower limb vessels of 16 embalmed Wistar rats, and four sets of cannulae of known diameter, were injected with one of three different contrast agents (barium sulfate and resin, barium sulfate and gelatin, and lead oxide combined with milk powder). All were then scanned using micro-computed tomography (CT) angiography and 3-D reconstructions generated. The number of branching generations of the rat lower limb vessels were counted and compared between the contrast agents using ANOVA. The diameter of the contrast-filled cannulae, were measured and used to calculate the accuracy of the measurements by comparing the bias and variance of the estimates. Intra- and inter-observer reliability were calculated using intra-class correlation coefficients. There was no significant difference (mean difference [MD] 0.05; MD 95% confidence interval [CI] -0.83 to 0.93) between the number of branching generations for barium sulfate-resin and lead oxide-milk powder. Barium sulfate-resin demonstrated less bias and less variance of the estimates (MD 0.03; standard deviation [SD] 1.96 mm) compared to lead oxide-milk powder (MD 0.11; SD 1.96 mm) for measurements of contrast-filled cannulae scanned at high resolution. Barium sulfate-resin proved to be more accurate than lead oxide-milk powder for high resolution micro-CT scans and is preferred due to its non-toxicity. This technique could be applied to any embalmed specimen model. Copyright © 2016 John Wiley & Sons, Ltd.

Contrast agent comparison for three-dimensional micro-CT angiography: A cadaveric study.

The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in the literature. However, the correct identification of individual muscles is clinically important because certain conditions of the cervical spine, for example whiplash associated disorders, idiopathic neck pain, cervical nerve root avulsion and cervical spondylotic myelopathy, are associated with different morphological changes in specific muscles visible on MR images. Knowledge of the precise structure of different cervical spine muscles is crucial when comparisons with the contralateral side or with normal are required for accurate description of imaging pathology, management and assessment of treatment efficacy. However, learning the intricate arrangement of 27 muscles is challenging. A multi-level cross-sectional depiction combined with three-dimensional reconstructions could facilitate the understanding of this anatomically complex area. This paper presents a comprehensive series of labeled axial MR images from one individual and serves as a reference atlas of the cervical spine musculature to guide clinicians, researchers, and anatomists in the accurate identification of these muscles on MR imaging. Clin. Anat. 29:643-659, 2016. © 2016 Wiley Periodicals, Inc.

Magnetic resonance imaging atlas of the cervical spine musculature.

Accessory attachments of the levator scapulae (LS) muscle have been described in the literature in previous cadaveric studies, but there is little knowledge about the incidence and distribution. Knowledge of LS accessory attachments is relevant to clinicians working in the fields of radiology, surgery, neurology, and musculoskeletal medicine. The purpose of this study was to explore the incidence and spectrum of LS caudal accessory attachments in vivo using magnetic resonance (MR) imaging in a young cohort.

Article	Year
Why do residents leave general surgery? The hidden problem in today's programs. Current surgery\| PubMed ID: 15708164	2005
Duty-hour restrictions and the work of surgical faculty: results of a multi-institutional study. Academic medicine : journal of the Association of American Medical Colleges\| PubMed ID: 16377820	2006
How surgical faculty and residents assess the first year of the Accreditation Council for Graduate Medical Education duty-hour restrictions: results of a multi-institutional study. American journal of surgery\| PubMed ID: 16399099	2006
Informed versus uninformed consent for prostate surgery: the value of electronic consents. The Journal of urology\| PubMed ID: 16813921	2006
Reducing surgical site infections through a multidisciplinary computerized process for preoperative prophylactic antibiotic administration. American journal of surgery\| PubMed ID: 17071203	2006
Synovial folds of the lateral atlantoaxial joints: in vivo quantitative assessment using magnetic resonance imaging in healthy volunteers. Spine\| PubMed ID: 19730202	2009
Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. The New England journal of medicine\| PubMed ID: 20054046	2010
Synovial folds - a pain in the neck? Manual therapy\| PubMed ID: 21216653	2011
Morphometry of the synovial folds of the lateral atlanto-axial joints: the anatomical basis for understanding their potential role in neck pain. Surgical and radiologic anatomy : SRA\| PubMed ID: 21667263	2012
The first research agenda for the chiropractic profession in Europe. Chiropractic & manual therapies\| PubMed ID: 24512854	2014
Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma. Forensic science, medicine, and pathology\| PubMed ID: 26499790	2015
Contrast agent comparison for three-dimensional micro-CT angiography: A cadaveric study. Contrast media & molecular imaging\| PubMed ID: 27075920	2016
Magnetic resonance imaging atlas of the cervical spine musculature. Clinical anatomy (New York, N.Y.)\| PubMed ID: 27106787	2016
Anatomic variations of levator scapulae in a normal cohort: an MRI study. Surgical and radiologic anatomy : SRA\| PubMed ID: 27515303	2017
Teaching is the best way to learn: student-led screencasting. Medical education\| PubMed ID: 27762002	2016

Alexandra L. Webb

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