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PubMed1998

What should we do about Eduard Pernkopf's atlas?

Eduard Pernkopf created a classic anatomy atlas during World War II. He was also an ardent Nazi. Questions have been raised recently about the propriety of using an atlas created by a Nazi and illustrated by dissections of cadavers whose identities are unknown, but who could have been victims of Nazi political terror. To examine the ethical issues involved, the author first reviews recently published work regarding Pernkopf and his atlas, with the caution that facts are few in a debate where emotions run high and opinions abound. He then considers what has been written by bioethicists on the use of scientific data from the Nazi era and how those arguments might apply to Pernkopf and his atlas. Important questions remain, however. For example, are scientific data tainted by their associations with Nazism, or should such data (including the atlas) be assessed on their own merits, separate from the persons and ideologies involved in their creation? Finally, the author offers his own perspective as a young gross anatomist and physician. He argues that rejecting the hateful beliefs of Pernkopf and his fellow Nazis does not necessitate rejecting the elegant anatomic images they produced. The author further suggests that use of the atlas is itself the most fitting tribute to those who died for it, whether they were victims of Nazi repression or not. Those cadavers not only teach anatomy, they "can remind us of suffering not only in the past but in the present, that we may be more compassionate physicians, more compassionate citizens of the world."

Anatomy, Artistic↗
PubMed2002

Assessment of an integrated curriculum in radiology.

OBJECTIVE: To describe an interdisciplinary team's experience using a six-stage curriculum-development model to assess an integrated curriculum in radiology. DESCRIPTION: In 1996 the University of Maryland School of Medicine implemented reforms of its undergraduate curriculum. A third-year required clerkship in radiology was eliminated, but an integrated curriculum was developed for first- and second-year students and for third-year students during their core clinical clerkships. A fourth-year elective was retained. In 2000 the school's Curriculum Coordinating Committee found that it lacked data regarding program performance or learner competencies in radiology since the reforms were implemented. The Committee designated an interdisciplinary team including a radiologist, an anatomist, and an internist with medical education expertise to conduct a rapid review of the adequacy of the curriculum as it is currently integrated. The team mapped the curriculum, identifying where radiology was taught, and analyzed each sub-curriculum according to a six-stage curriculum-development model. This method permitted nearly concurrent assessment of the national literature, local needs assessment, presence and adequacy of educational objectives and methods, adequacy of resources to support curriculum implementation, and the availability and adequacy of learner and program outcome measures. The team identified changes in the clinical classrooms that have been unanticipated four years earlier, including implementation of PACS systems for digital film storage and retrieval, rapid advances in clinical imaging capabilities, and diminished faculty teaching time due to increased clinical volumes. The team concluded its work in four months and issued a report recommending revisions to third-year curricula. The Curriculum Committee, the Dean's Office, and the Department of Radiology accepted the analysis and have dedicated personnel, technical, and financial resources to effect the recommended revisions, which include (1) revision of clinical clerkship objectives for competencies in radiology, (2) development of Web-based modules for self-directed learning, (3) faculty development to enhance teaching skills, and (4) competency-based assessment measures based on learning objectives. DISCUSSION: Schools and faculty are often faced with the need to develop and implement innovative curricula rapidly. Periodic assessments by oversight groups such as curriculum committees identify where additional information is required to assess the performances of learners and curricula in rapidly-changing clinical contexts. In this study a three-member team with focused expertise in radiology, anatomy, and medicine/medical education conducted a rapid in-depth review of an integrated radiology curriculum "hosted" by several departments. A curriculum-development model provided a template for analysis of needs, objectives, methods, resources, and assessment measures for all curricula, and guided the team's recommendations for targeted revision. Each team member brought expertise in some element of the integrated curriculum or in curriculum design. The team identified what integrated curricular elements had not been designed adequately, what could no longer be supported with current resources, and how curricular revisions could be assessed for adequacy.

Curriculum↗
PubMed1985

The mysterious second temporal fat pad.

Temporal eyelid fullness due to residual herniation of orbital fat is a complication of cosmetic oculoplastic surgery. It frequently occurs despite the surgeon's excision of temporal herniated orbital fat and requires a second surgical procedure to remove. Anatomists have demonstrated three lower eyelid fat pads, temporally, centrally, and nasally. I have found a second temporal fat pad that was not evident until the first had been removed. Searching for and excising the second temporal fat pad have eliminated the complication of residual temporal lower, eyelid fat herniation following cosmetic eyelid surgery.

Adipose Tissue↗
PubMed1990

Dryander of Marburg and the first textbook of neuroanatomy.

Born in Wetter, Germany, in 1500, Johannes Eichmann (Dryander) studied medicine and anatomy at the University of Paris from 1528 to 1534. In 1535, he was appointed professor of medicine at the University of Marburg. During the next year he held two public dissections, and in 1536 he was the author of the first text illustrating a Galenic dissection of the human brain. An expanded edition of this early book, the Anatomiae pars prior, was published in 1537. These texts represented an important transition from the dogma of medieval scholasticism to the precise observations of Vesalius. The books depicted the brain in eight figures, with four additional plates describing the skull, skull base, and cranial sutures. Detailed illustrations of the dura mater, cerebral cortex, and posterior fossa structures with clear, but inaccurate, relationship to the cranial nerves demonstrated Dryander's reliance on his own dissections. In 1542, he published a translated edition of Mundinus' anatomy. As was common at that time, the text plagiarized a portion of Vesalius' Tabulae sex, which resulted in the famous anatomist's anger. Despite this, Dryander continued to write on medical subjects as well as mathematics and astrology until his death in 1560. Because he was a progenitor of rational scientific thought, his earlier books represented an important advance in the progression to modern anatomic description and illustration.

Anatomy, Artistic↗
PubMed1996

Neurological surgery at the University of Vienna.

ANTON VON EISELSBERG was the first to resect a cerebral tumor at the First Surgical Clinic at the General Hospital in Vienna in 1904. He successfully removed a cerebral glioma, the first of no fewer than 15,000 tumors operated on at that hospital to date. von Eiselsberg and his successors, Egon Ranzi and Leopold Schönbauer, as heads of the First Surgical Clinic, devoted themselves intensively to brain surgery, and neurosurgery developed to be an integral part of Viennese surgery. During the first decades, a prominent neurologist, Otto Marburg, and a world-famous anatomist, Julius Tandler, were members of the neurosurgical operating team. This approach changed in the 1950s, when the brain surgeons aimed at becoming independent of the basic sciences. The founding of an independent neurosurgical department at the University of Vienna in 1964 under Herbert Kraus also marked the beginning of the formation of specialized sections for pediatric and stereotactic neurosurgery. After 1968, the operating microscope was greatly emphasized. As of 1970, cerebral tumors and cerebrovascular lesions were treated microneurosurgically. Many operations were performed by surgeons who were experienced in neurosurgery. This again changed in 1978 under the new head of the department, Wolfgang Koos, who regarded the neurosciences as the basis for neurosurgical training as well as neurosurgical activity. The reorganization of the neurosurgical institution coincided with the construction of a large modern building with state-of-the-art equipment for microneurosurgery, radiosurgery (gamma knife), neurodiagnostics, laboratories, etc. Many details of the construction plans, the equipment, and the organization of the department have their roots in the years that the present head of the department spent in the United States; this is also the reason for the close connection and cooperation of Vienna neurosurgery with many neurosurgeons in the United States.

Austria↗
PubMed1997

A magnetic resonance template for normal cerebellar development in the human fetus.

OBJECTIVE: Although ultrasound is the primary imaging modality for prenatal anatomic evaluation, some central nervous system malformations may be better defined with high-resolution magnetic resonance imaging (MRI). MRI allows us to visualize the features of brain development that were previously only seen histologically by embryologists and anatomists. Although there are several reports of the postnatal development of the cerebellum as revealed on magnetic resonance (MR) images, systematic MR studies of cerebellar development during the fetal period are lacking. Our objective was to use high-resolution MRI to provide a template of cerebellar development during the late first and early second trimesters, a period when the diagnosis of congenital malformations is most medicoethically relevant. The MR findings were then correlated with histological data. METHODS: Twenty-six normal formalin-fixed fetal specimens with a gestational age of 9 to 24 weeks were examined with high-resolution MRI using a conventional clinical magnet and pulse sequences. The MR findings were correlated with the whole-mount histological specimens catalogued in a well-known fetal atlas. RESULTS: Resolution of the morphological features of cerebellar development in fetuses greater than 10 weeks gestational age was possible. Development of the rhombic lips, vermis, fourth ventricular roof, foramen of Magendie, and the cerebellar fissures was documented. Development of the cerebellum as revealed on MR images lagged behind the known stages of development by as much as 5 weeks. Features of cerebellar histogenesis were beyond the resolution of MRI. However, differences in signal intensity between gray and white matter of the developing cerebellum were detected and are postulated to represent differences in cellularity and water content of the constituent tissues. CONCLUSION: Direct correlation of MR images of fetuses during the late first and early second trimesters with anatomic atlases could result in a mistaken diagnosis of delayed or abnormal development of the posterior fossa contents because of a time lag in the detection of structures on MR images. An MR template of normal cerebellar development would be useful to avoid confusion of normal development with abnormal development and to identify the expected developmental features when provided the estimated gestational age of a fetus.

Cerebellum↗
PubMed2000

Fiber dissection technique: lateral aspect of the brain.

OBJECTIVE: The fiber dissection technique involves peeling away the white matter tracts of the brain to display its three-dimensional anatomic organization. Early anatomists demonstrated many tracts and fasciculi of the brain using this technique. The complexities of the preparation of the brain and the execution of fiber dissection have led to the neglect of this method, particularly since the development of the microtome and histological techniques. Nevertheless, the fiber dissection technique is a very relevant and reliable method for neurosurgeons to study the details of brain anatomic features. METHODS: Twenty previously frozen, formalin-fixed human brains were dissected from the lateral surface to the medial surface, using the operating microscope. Each stage of the process is described. The primary dissection tools were handmade, thin, wooden spatulas with tips of various sizes. RESULTS: We exposed and studied the myelinated fiber bundles of the brain and acquired a comprehensive understanding of their configurations and locations. CONCLUSION: The complex structures of the brain can be more clearly defined and understood when the fiber dissection technique is used. This knowledge can be incorporated into the preoperative planning process and applied to surgical strategies. Fiber dissection is time-consuming and complex, but it greatly adds to our knowledge of brain anatomic features and thus helps improve the quality of microneurosurgery. Because other anatomic techniques fail to provide a true understanding of the complex internal structures of the brain, the reestablishment of fiber dissection of white matter as a standard study method is recommended.

Brain↗
PubMed1984

Parotid fascia and face lifting: a critical evaluation of the SMAS concept.

Classical anatomists were mistaken in their description of the parotid and masseteric regions. According to their description, the fascia superficialis (or SMAS) would be in continuity with the platysma. Data from fresh cadaver dissections, histology, and embryology indicate, on the contrary, that it is the parotid fascia, which is continuous with the platysma. Comparative anatomy provides further confirmatory evidence, demonstrating that the parotid fascia is only the uppermost part of a muscle that has undergone fibrous degeneration. This muscle is the "primitive" platysma. In consequence, the sub-SMAS dissection plane is too superficial and creates a purely fatty flap. Conversely, deep dissection below the parotid fascia (and therefore below the primitive platysma) respects the true anatomic features and guarantees the solidity of the flap and the safety of the facial nerve.

Animals↗
PubMed1985

Inclinations of the facial profile: art versus reality.

The average inclinations of five basic facial profile lines and five individual facial profile segments were determined by direct anthropometry in a total group of 232 healthy young adults, all North American Caucasians. Significant sex-related differences were found only in the inclination of the forehead, the lower face, and the lower third of the face, with greater inclinations in males. These results were compared with data obtained from 49 art works produced by ancient, Renaissance, post-Renaissance, and contemporary artists and drawings of the face in scientific papers published by anthropologists, orthodontists, anatomists, and plastic surgeons. In the population study the average inclination of the general and the aesthetic profile lines, the lower face, the forehead, and the lower lip show a receding trend. The upper face is slightly protruded in the males and close to vertical in the females. The chin and the nose are equally prominent in both sexes. The only significant difference is in the greater recession of the lower face in males. The average female population values are reminiscent of those of the Renaissance. The average male inclinations come closest to the findings in the statues of antiquity. The population sample and the contemporary artists showed similar inclinations of the nasal bridge and the lower lip. Generally, the average inclination of the chin in the population is smaller than in any artistic style.

Adult↗
PubMed1988

Anatomic surgical dissection of the extraparotid portion of the facial nerve.

The direction followed by the facial nerve branches beyond their emergence from the ventral, cephalic, and caudal borders of the parotid gland up to the facial muscles has been studied by several anatomists, but no consistent description of them has been given so far. This research, based on the dissection of 30 hemifaces, studies the characteristics of those branches using three points of reference: the intertragal notch, the palpebral lateral commissure, and the labial commissure. Tables showing average length and number of branches have been computed with a statistical level of confidence of 99 percent. No fixed common pattern suitable to represent the distribution of branches of the facial nerve in a model was found, but as a rule, these branches run beneath the superficial musculoaponeurotic system (SMAS) in their path below the zygomatic arch, and approximate emergence points have been identified. In the opinion of the authors, such points may be of more surgical relevance than a theoretical pattern of arborization.

Adult↗
PubMed1998

Focus on the breast fascial system: a new approach for inframammary fold reconstruction.

Anatomists and surgeons have underestimated the importance of understanding the anatomic connective frame of the inframammary region. The submammary fold does not originate as a self-governing unit but depends on breast mould and on a fine superficial fascial system suspension. The authors investigated the inframammary fold anatomy and subcutaneous breast territory in cadaver and live dissection with histologic analyses, without sharing the theories about superficial fascia splitting and inframammary ligament existence. The authors have understood that a reliable and fine correction of inframammary fold contour in breast reconstruction may only be achieved by an empirical surgical procedure that exclusively concerns the restoration of the superficial fascial system. The literature on this subject is reviewed. Fascial anchoring surgery, after capsulotomy and superficial fasciotomy, without lower thoracic advancement flap or deep subcutaneous undermining, was performed for 100 breast reconstructions after biodimensional device programming. Technique and results are also discussed.

Adult↗
PubMed2001

Nose muscular dynamics: the tip trigonum.

In 1995, the senior author (E.E.F.) published an article in which he described the musculus digastricus septi nasi labialis. In the article presented here, work carried out by anatomists and other researchers who, over the last two centuries, studied nose muscular dynamics is described. The present study is based on Gray's Anatomy, which, in 1858, first described the nasal tip muscles, along with the other nasal muscles. Later works not only used different terminology for these muscles but also ignored some, creating tremendous confusion. The study presented here provides an update of the exact terms, location, insertions, and muscle functions of the muscles of the nose. Each nose muscle is described with regard to the two portions able to produce separate contractions. In this study, the term "dual function" is used and characterizes the nasal mimetic muscles that do not have well-defined fascia. Therefore, there is doubt about the existence of a real nasal superficial muscle aponeurotic system. The musculus myrtiformis seems to have a dual function, inserting in the canine fosse and in the periosteum of the central incisors, forming two portions-one to the septum and the other to the nostril-each of which has specific functions. This study has been based on research in physiognomy, the science of expression. With regard to the basis for nose expressions, common anatomical research is excluded because it provides a different view of the dynamics studied to date. The term trigonum musculare apicis nasi defines the interaction of the musculi compressor narium minor and dilator naris anterior, connecting with the columellar bundle of the musculus digastricus and levering the nasal spine. This muscular trigone creates circular concentric and eccentric movements of the nasal tip.

Facial Muscles↗
PubMed1989

Medical College of Alabama in Mobile, 1859-1920: a legacy of Dr. Josiah Clark Nott.

The first legislated orthodox medical school within Alabama was founded in Mobile in 1859, a legacy of Dr. Josiah Clark Nott. That it developed later than other Southern medical schools has been attributed to multiple factors, among them rural isolation, restricted communication, limited transportation, sparse population, cultural deprivation, and climatologic enervation. The rationale for a medical school within Alabama was also multifactorial: to supply physicians to rural Alabama, to reverse the economic and cultural drain among Alabamians that out-of-state education implied, and to educate medical students regarding the unique health care requirements of a predominantly rural Alabama populace. A medical school building was constructed east of the Mobile City Hospital, and was equipped with an elegant collection of anatomic models acquired by Nott during his travels in western Europe in 1859. After only two sessions, however, the War Between the States (1861 to 1865) forced the medical school to close, as faculty and students joined the Confederate forces. In 1868, with the continued involvement of Dr. W. H. Anderson as Dean, the institution was reopened. During the succeeding 52 years of its existence, the financially strapped medical school attempted to cope with evolving medical technologies and educational philosophies. Despite the commitment of the administrators and faculty, sociopolitical factors and insufficient economic support militated against the school's continued existence. Nott has been characterized as a physician, anatomist, anthropologist, and ethnologist. His opinions as revealed in his writings were controversial because they addressed sociopolitical and racial issues. Nevertheless, his commitment to the Medical College of Alabama in Mobile was unstinting, and he provided the major leadership role in its establishment.

Alabama↗
PubMed2001

The origin of eponyms used in cochlear anatomy.

The anatomy of the cochlea, one of the most complicated parts of the inner ear, is associated with numerous eponyms, mostly originating from German anatomists of the 19th century. In addition to the organ of Corti and Reissner's membrane, which are the best known, nine other eponymic anatomic terms are associated with the cochlea: Deiters' cells, Hensen's cells, Hensen's strip, Claudius' cells, Boettscher's cells, Rosenthal's canal, Hardesty's membrane, Huschke's teeth, and Nuel's space. All of these anatomic eponyms are described, with their original references.

Cochlea↗
PubMed2006

Cadaver evaluation of EMG needle insertion techniques used to target muscles of the thorax.

STUDY DESIGN: Measure the accuracy of needle insertion in thoracic muscles of human cadavers. OBJECTIVES: Evaluate the effectiveness of known EMG techniques for sampling thoracic innervated muscles. SUMMARY OF BACKGROUND DATA: The evaluation of thoracic radiculopathies requires accurate electrodiagnostic techniques for evaluating the thoracic myotomes. METHODS: An American Board of Electrodiagnostic Medicine certified physician placed needles into pertinent muscles of the thorax and an anatomist serving as a blinded dissector recorded the path and accuracy of needle. RESULTS: Needle examination of thoracic muscles was as accurate as limb needle examination. No notable risks are noted in multifidus sampling. However, in the cadaver, some risks were noted in association with placements in the intercostal muscles. The target muscle was reliably sampled, but the rib or vertebral level was difficult to landmark in the cadaver. CONCLUSIONS: Needle examination of the thoracic multifidus and intercostals is reliable, although further confirmation is needed to accurately verify the appropriate vertebral or rib level being sampled.

Adult↗
PubMed2004

Anatomical analysis of the neurovascular bundle supplying penile cavernous tissue to ensure a reliable nerve graft after radical prostatectomy.

PURPOSE: Urologists and anatomists have disagreed concerning pelvic neurovascular bundle (NVB) structure. Recently interposition nerve grafting has been performed to improve erectile function after radical prostatectomy. To refine this procedure we reviewed NVB structure from the surgical viewpoint. MATERIALS AND METHODS: Seven fresh cadavers and serial horizontal sections from 20 formalin fixed cadavers were used for gross dissection and histological examination. RESULTS: Fresh cadaver dissections demonstrated that the pelvic splanchnic nerve (PSN) joined the NVB at a point distal or inferior to the bladder-prostate (BP) junction. Histologically hypogastric nerve fibers were much more dominant than PSN fibers at the BP junction, and the NVB, covered by the lateral pelvic fascia, became evident at levels more than 20 to 30 mm below the BP junction. PSN components joined the NVB in a spray-like distribution at multiple levels more than 20 mm distal to the BP junction. At these low levels nerves tended to be located outside of the NVB at the dorsolateral margin of the prostate. The cranial end of the mimic interposition nerve graft was directed toward the hypogastric nerve rather than the PSN. CONCLUSIONS: In contrast to general clinical opinion, the NVB appears to supply few PSN components at the BP junction with caudal PSN branches reaching the dorsolateral prostate more than 20 mm below the BP junction. This anatomy has important implications for a reliable nerve graft.

Aged↗
PubMed2004

Ultrastructure of the bladder in classic exstrophy: correlation with development of continence.

PURPOSE: Successful initial surgical management of bladder exstrophy does not always lead to continence. We evaluated the ultrastructure of the exstrophic bladder using electron microscopy (EM) at various stages of reconstruction to determine whether morphology could correlate with the potential for continence. MATERIALS AND METHODS: Bladder specimens obtained from 32 patients undergoing various stages of exstrophy reconstruction were evaluated by EM. Specimens were obtained at primary newborn closure (group 1-10), reclosure following failure (group 2-2), bladder neck reconstruction (group 3-9) and augmentation cystoplasty (group 4-11). Evaluation was performed by a single anatomist with experience with EM. Biopsies were separated into those with good, intermediate or poor ultrastructural parameters and then correlated clinically. RESULTS: In group 1, 4 children had good and 2 had intermediate parameters. All showed increased bladder volumes at followup. Four patients had poor parameters and poor bladder growth. The 2 group 2 children had poor parameters and bladder growth. In group 3, 7 of 9 patients had good and 1 had intermediate parameters. Eight of the 9 patients are doing well. Only 3 of the 11 group 4 children had good parameters and an additional 2 had intermediate parameters. CONCLUSIONS: Ultrastructural evaluation can identify changes in the bladder that may portend a poor prognosis for eventual continence. Although the correlation was good at bladder closure, some patients with good parameters still had failed reconstruction. Since this is a small study, we continue to recommend reconstruction in all patients who have an adequate bladder template.

Biopsy↗