Clinical anatomy : official journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists
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The clinical records of two male subjects with severe cervical spondylotic myelopathy (CSM) who developed respiratory insufficiency after the cervical manipulation involved in preoperative anesthetic intubation were examined. Their cervical imaging was analyzed with respect to the known anatomic relationships of the spinal phrenic nerve nuclei to the spondylotic compressive lesions in an attempt to provide the anatomic and pathologic rationales that may explain this phrenic paresis as a possible traumatic complication of severe CSM. ⋯ Magnetic resonance imaging analyses indicated that the existing degree of upper cervical cord compression, when reinforced by the additional posterior and anterior pressures consequent to cervical spinal extension and flexion, could readily account for the functional impairment of phrenic nerve neuron cells and/or their efferent fibers. Thus, the anatomic relations of the phrenic nerve nuclear columns and their efferent tracts predispose them to interference by compressive lesions found in CSM, and undue manipulation of the cervical spine when advanced stenosis is known to be present should be recognized as a possible cause of cervical spondylotic myelopathic-phrenic paresis.
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Recent developments in undergraduate medical education in the United Kingdom have produced changes in the content and delivery of component courses, including human anatomy. Anatomy can retain its place in the medical course in the new world of problem-based learning and clinical skills teaching by gaining recognition as an integral part of the curriculum which underpins much of the practice of clinical medicine. ⋯ Students take responsibility for their own learning, with appropriate support and resources. In clinical skills courses, anatomy underpins the development and retention of clinical knowledge and skills.
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The anterior cerebral artery (ACA) is a major vessel responsible for the blood supply to the interhemispheric region. The ACA segment after the anterior communicating artery (AComA) origin is called the distal ACA and has central and cortical branches. The cortical branches are distributed in the different regions of the orbital and medial part of the brain. ⋯ Crossing branches of the distal ACA to the contralateral hemisphere were present in 26% of the cases. In some cases a single ACA may supply the posterior hemispheric region through crossing branches. This calls attention to potential bilateral brain infarcts due to a single unilateral ACA occlusion.
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Review
A clinical anatomy curriculum for the medical student of the 21st century: developmental anatomy.
An understanding of human developmental anatomy provides a fundamental framework for the accurate diagnosis and proper treatment of patients with congenital clinical entities, a significant population of any medical practice. Therefore, the regard afforded the study of developmental anatomy in the medical curriculum deserves thoughtful attention. ⋯ It outlines the subject matter and principles that will not only allow the physician to recognize and treat congenital diseases, but will also provide a solid basis for the incorporation of future discoveries, particularly in the rapidly evolving field of molecular developmental anatomy. The AACA seeks to ensure that all medical students receive thorough training in developmental anatomy and that each student, regardless of the institution attended, will be exposed to a curriculum that will provide the necessary competence and confidence for the effective practice of medicine in the 21st century.