Clinical Anatomy最新文献

{"title":"Topographical Anatomy of the Superficial Peroneal Nerve: A Cadaveric Study on Anatomical Patterns and Clinical Implications.","authors":"Kyu-Lim Lee, Soo-Bin Kim, KyeongSik Yoon, Hee-Jin Kim","doi":"10.1002/ca.24275","DOIUrl":"https://doi.org/10.1002/ca.24275","url":null,"abstract":"<p><p>The notable anatomical variability of the superficial fibular nerve (SFN) affects clinical and surgical procedures that involve it. The aim of this study was to analyze the course and branching patterns of the SFNs relative to bony landmarks to provide foundational data for surgical precision and thereby minimize iatrogenic injuries. Thirty-four embalmed Korean cadavers were dissected. The points at which the SFN (1) pierced through the crural fascia and (2) bifurcated into the medial and intermediate dorsal cutaneous nerves were measured from the lateral malleolus and fibula. The SFN piercing point was located at an average of 89.6 ± 30.8 mm (range: 26.5-153.8 mm) above the lateral malleolus and 14.7 ± 3.6 mm (range: 7.1-21.5 mm) horizontally from the fibula. In 32 specimens, the SFN pierced the fascia and then bifurcated, but in the other two cases it bifurcated before piercing the fascia. The bifurcation point was identified at an average height of 40.8 ± 20.1 mm and a horizontal distance of 25.1 ± 7.5 mm from the fibula. There was significant anatomical variability in the trajectory and branching patterns of the SFN. These findings underscore the importance of precise anatomical knowledge for minimizing complications during foot and ankle surgeries. This study provides a foundation for preoperative planning and clinical application around the SFN.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lazarus Sign, a Misnomer to an Anatomical Spinal Reflex.","authors":"Sabrina Costantini, Joe Iwanaga, Trifon Totlis, Nihal Apaydin, Marios Loukas","doi":"10.1002/ca.24279","DOIUrl":"https://doi.org/10.1002/ca.24279","url":null,"abstract":"<p><p>The Lazarus sign is a well-documented spinal reflex observed in brain-dead patients, characterized by involuntary upper limb movements that can resemble voluntary gestures. Initially described during the 1980s, this phenomenon has contributed to ongoing discussions about the physiological basis of spinal reflexes and their role in assessing brain death. The Lazarus sign was once considered a diagnostic challenge, but recent research reports confirm that it originates solely from the spinal cord, independent of brainstem or cortical activity. However, recent studies also suggest that spinal reflexes in brain-dead patients, including the Lazarus sign, can be more variable than previously thought, occurring in multiple limb regions beyond the upper limbs. Prolonged survival in brain-dead patients exhibiting the Lazarus sign has also raised new questions about its physiological significance. Its recognition has helped refine brain death criteria, ensuring accurate diagnoses and minimizing misinterpretations in critical care and organ donation settings. PubMed-indexed studies and backward citations were reviewed. Studies were included if they explicitly described spinal reflexes in brain-dead patients, examined neurophysiological mechanisms, or provided clinical observations on the Lazarus sign. Exclusion criteria included studies focusing solely on brainstem activity without considering spinal reflexes or case reports lacking detailed methodology. These investigations explored the prevalence, neurophysiological mechanisms, and clinical significance of the Lazarus sign. Research highlights its variable presentation, its occurrence in up to 40% of brain-dead patients, and its potential to be misunderstood by families and healthcare providers. The sign does not indicate residual brain function, but it reinforces the need for clear communication in end-of-life care. Future research should focus on standardizing diagnostic protocols, educating clinicians, and addressing ethical concerns. Integrating this knowledge into brain death assessments will enhance clinical decision-making and patient management.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Basis of the Palatal Injection Technique for Pulpal Anesthesia of Maxillary Teeth.","authors":"Sergey Kabak, Joe Iwanaga, Yuliya Melnichenko, Ruslan Mekhtiev, Nina Savrasova","doi":"10.1002/ca.24277","DOIUrl":"https://doi.org/10.1002/ca.24277","url":null,"abstract":"<p><p>The aim of this study was to assess the effectiveness of palatal injection for managing the pulpal pain of unilateral maxillary teeth from central incisor to second premolar and to establish the anatomical basis for this technique. For this prospective observational study, 62 patients (aged 18-70 years) were included. They had been treated for carious dentine lesions, receiving prosthodontic, endodontic treatment, or extraction of any tooth/teeth in the region from central incisor to second premolar. A total of 100 teeth were treated. Cone-beam computed tomography (CBCT) scans were analyzed preoperatively to identify accessory canals (ACs) (≥ 0.5 mm in diameter) associated with canalis sinuosus (CS). The anesthetic was injected into the area of the target tooth or adjacent tooth next to the palatal openings of the AC(s) into the submucosa of the anterior hard palate. The effectiveness of anesthesia was confirmed by pulp tester readings and a survey using the Verbal descriptor and Likert scales before and during treatment. Pulpal anesthesia was successful in 100% of the treated vital teeth. In all cases, openings of ACs originating from the CS were identified on CBCT scans. Three patients underwent bilateral dental treatment under unilateral anesthesia. The bilateral communications of the CS in the midline of the upper jaw were identified in the CBCT scans of these patients. The authors have established the palatal alveolar foramen injection (PAFI) technique. Injection of an anesthetic solution into the area of the openings of CS on the palate (i.e., palatal alveolar foramina) induces pulpal anesthesia of adjacent target teeth with 100% efficiency. PAFI requires less of the anesthetic solution and is the ideal technique for restorative and prosthodontic treatment involving anterior teeth because it does not cause numbness of the lip and face.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Lumbar Sympathetic Trunk and Its Branching Variability: Relevance for Clinical and Interventional Strategies.","authors":"Agustina A Pontecorvo, Nicolás F Laurensio, Tomás R Patrón, Manuel Gatto, Verena B Franco-Riveros, Juan Carlos Flores, Joe Iwanaga, André P Boezaart, Miguel A Reina, Bruno Buchholz","doi":"10.1002/ca.24280","DOIUrl":"https://doi.org/10.1002/ca.24280","url":null,"abstract":"<p><p>Precision medicine relies on a thorough understanding of lumbar sympathetic anatomy and its branches to elucidate related pathophysiology and improve treatment of conditions such as low back pain, lumbopelvic pain, and vascular autonomic disorders affecting the lower limbs. This study aims to expand knowledge of fetal lumbar sympathetic anatomy by providing a detailed description and systematic classification of the communicating branches, their specific distribution to each lumbar spinal nerve, and the origin of lumbar splanchnic nerves. The lumbar and retroperitoneal regions of 25 human fetuses (50 sides) were subjected to detailed sub-macroscopic dissections. The lumbar sympathetic trunk generally comprises three ganglia. The L2 and L3 ganglia are consistently present, but accessory ganglia along certain communicating branches are rare. The 466 communicating branches examined (229 on the right, 237 on the left) comprised 144 superficial, 251 deep transverse, and 71 deep discal branches. Deep transverse branches appeared consistently across all levels, whereas superficial branches originated only from the L1, L2, and occasionally L3 ganglia. Discal branches were inconsistent across ganglionic levels. All lumbar spinal nerves received at least one communicating branch, though the distribution varied by branch type. Most lumbar splanchnic nerves originated from a single root, those having two roots or accessory splanchnic nerves being less common. The origins of splanchnic nerves were frequent at L1 and L2, less common at L3, and inconsistent at L4 and L5. There were no differences between the left and right sides regarding ganglia, origin, or distribution of sympathetic branches. In conclusion, the fetal autonomic branching patterns and connections of the lumbar sympathetic trunk are significantly variable, though they are more consistent than those in the cervical region. Detailed anatomical knowledge of this area is essential for improving the precision and effectiveness of lumbar sympathetic trunk interventions and minimizing complications in lumbar and retroperitoneal surgeries.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating Clinical Examination Skills Into a Preclinical Anatomy Course: A Method for Facilitating Engagement and Interest.","authors":"Aysha Alani, Justin O'Leary, Andrew Stieb, John P McNamara, Michael F Nolan","doi":"10.1002/ca.24276","DOIUrl":"https://doi.org/10.1002/ca.24276","url":null,"abstract":"<p><p>Anatomy instruction is enhanced when students are engaged and interested in course material, and the relevance of the subject matter to their academic success and professional careers is emphasized. We developed a learning activity for a pre-clinical anatomy course using the clinical skills of inspection and palpation of a cadaver donor to demonstrate the value of those skills in learning anatomy and to facilitate anatomical understanding in a format similar to that used in clinical practice. Students were instructed to inspect and palpate various anatomical structures and relationships on their donor cadavers to identify features that could help in recognizing potential abnormalities, understanding disease mechanisms, and learning the anatomical bases of certain medical interventions and surgical procedures. Using these techniques, a tumor mass involving the medial end of the clavicle was identified. Student interest was increased, which led to further study and subsequent pathological identification of the tumor as a rare osteochondroma. We found that the addition of inspection and palpation as methods for learning human anatomy in the dissection laboratory, methods not commonly used, facilitated both engagement and interest in a particular area of the subject. Students also developed a respect for their donors, viewing them as their first patients. In light of the diversity in lifestyles, medical conditions, and causes of death within donor populations, we believe the approach described here can contribute greatly to the value of human anatomy courses that use cadaver donors.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing Novel Surgical Clinical Correlations Into an Undergraduate Medical Anatomy Course.","authors":"Liam McLoughlin, Theofano Zoumpou, George P Holan, Bao-Ngoc Nasri, Daniel B Jones, Jeremy J Grachan","doi":"10.1002/ca.24274","DOIUrl":"https://doi.org/10.1002/ca.24274","url":null,"abstract":"<p><p>Anatomy education is a hallmark of many preclinical medical school curricula, but students are often unable to identify the clinical relevance of anatomy and its applications. Vertical curricula that integrate clinical concepts into the preclinical basic science years and vice versa have been shown to benefit student learning and increase educational enjoyment. This study explores second-year medical students' perceptions of the integration of clinical surgical concepts and surgical faculty into a preclinical digestive system (GI) anatomy course. The GI anatomy course at Rutgers New Jersey Medical School was modified to build on traditional anatomy content by correlating it directly with clinical surgical content. This included a novel, focused anatomy and surgery correlations booklet and surgical videos relevant to anatomical topics. Additionally, practicing general surgeons came to the anatomy lab to interact with the students and provide further clinical relevance. Survey data were collected regarding students' perceptions of integrating surgical concepts and surgeons into the anatomy curriculum, and exploring factors influencing their interest in a surgical career. The data revealed that students valued both the correlations booklet and interacting with surgeons in the anatomy lab. When ranked on a five-point Likert scale, students found both surgeons in the laboratory (M = 4.15, SD = 0.86) and the surgical correlation booklet (M = 3.52, SD = 0.51) helped them in learning the anatomy curriculum. The data did not suggest a direct relationship between interacting with surgeons in the anatomy lab and student surgical career interest. Instead, students reported additional experiences (i.e., shadowing and preceptorships) and anatomical dissection as influencing their career decisions. This study provides further evidence for the benefits of a vertical medical school curriculum by integrating clinical content and formal interactions with clinicians during the preclinical curriculum. The findings also demonstrate that further research should be completed to understand the factors influencing student interest in a surgical career.</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Anatomy…is a science which has revealed man's body to himself”","authors":"R. Shane Tubbs","doi":"10.1002/ca.24278","DOIUrl":"10.1002/ca.24278","url":null,"abstract":"<p>One hundred thirty years ago, Thomas Armitage (1819–1896) wrote, “The three great branches which man loves to study in himself are his organization, his vital functions, and his moral and intellectual powers.” He specifies, “Anatomy…is a science which has revealed man's body to himself in detail, and therefore always commands his interest” (Armitage <span>1895</span>).</p><p>In this issue of <i>Clinical Anatomy</i>, we offer the reader papers that explore the organization of the human body, including topics such as the tibial collateral ligament and neck of the left atrial appendage. Educational papers include one on practicing dentists' perceptions of what and how dental students are taught gross anatomy. Technical papers that will undoubtedly be of interest include how ChatGPT can be used to create case-based multiple-choice questions for anatomy exams and a systematic review of the roles of Artificial Intelligence in teaching anatomy (Figure 1).</p>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":"38 4","pages":"407-408"},"PeriodicalIF":2.3,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ca.24278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Anatomy of the Lateral Femoral Cutaneous Nerve in Patients With and Without Meralgia Paresthetica: A Systematic Review and Meta-Analysis","authors":"Jacob M. Johnson,&nbsp;Simbarashe J. Peresuh,&nbsp;Joseph E. Nassar,&nbsp;Michael Shipp,&nbsp;Joseph A. Gil,&nbsp;Julia A. Katarincic","doi":"10.1002/ca.24273","DOIUrl":"10.1002/ca.24273","url":null,"abstract":"<div>\u0000 \u0000 <p>The anatomical variations of the lateral femoral cutaneous nerve (LFCN) are well documented, with several studies hypothesizing that specific variants may increase the LFCN's susceptibility to meralgia paresthetica (MP). This systematic review and meta-analysis aimed to compare the prevalence of LFCN anatomical variations among limbs with and without MP. It also sought to determine if the LFCN's cross-sectional area (CSA) on ultrasound differed between limbs with and without MP. PubMed, SCOPUS, CINAHL, and Cochrane databases were used to query publications from inception to June 13, 2024. Included studies had a population of living patients, with or without the diagnosis of MP, and reported on the LFCN's exit from the pelvis, branching patterns, distance from the anterior superior iliac spine (ASIS), and/or CSA on ultrasound. Eighteen studies were included, nine retrospective and nine prospective, with a total of 1512 nerves. The LFCN in limbs with MP was closer to the ASIS (<i>p</i> &lt; 0.01) and the MP limbs had a higher percentage of nerves exiting the pelvis lateral to or over the ASIS (<i>p</i> &lt; 0.01) when compared to healthy limbs. The CSA was larger in the nerves affected by MP compared to the unaffected nerves (<i>p</i> &lt; 0.01). The results demonstrate that specific anatomical variations of the LFCN, where the nerve courses in a more lateral or superficial position, may increase its susceptibility to developing MP. The differences in nerve CSA also show the potential utility of ultrasound as a diagnostic adjunct for MP.</p>\u0000 </div>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":"38 5","pages":"540-551"},"PeriodicalIF":2.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Septal Swell Body: An Anatomic Misnomer","authors":"William E. Bolger,&nbsp;Zachary Upchurch,&nbsp;Maria Manuela Chemas-Velez,&nbsp;Tatyana Khan,&nbsp;Matthew Mobily","doi":"10.1002/ca.24266","DOIUrl":"10.1002/ca.24266","url":null,"abstract":"<div>\u0000 \u0000 <p>Several recent publications describe a “septal swell body” within the nasal cavity. We review the corresponding sinonasal anatomy and revisit early anatomical descriptions to assess whether this designation is an “anatomical misnomer” and if the classic anatomical nomenclature should be preserved. Citations for the septal swell body and synonyms were searched using PubMed and Cochrane Library databases from inception until December 31, 2023. Classic anatomy articles and historical medical textbooks were also reviewed for references to the regional anatomy and nomenclature. Our database search revealed a variety of anatomical terms for the septal or nasal swell body. However, classic historical anatomical texts that predate the introduction of modern database searches used the terms <i>tuberculum septi</i> or septal tubercle. Accurate knowledge of paranasal sinus anatomy is key in surgery. Precise nomenclature, based on official terms and named anatomical entities, makes communication clear, which is essential for surgical training, medical education, and patient care. Changing anatomical nomenclature and terminology if the existing terms are not wrong can lead to confusion, misunderstanding, anatomical jargon, and misnomers. We recommend the use of <i>tuberculum septi</i> or its English translation “septal tubercle” to denote the thickened area of normal anterior septal anatomy described herein. We also underscore a limitation of modern electronic literature searches in anatomical research.</p>\u0000 </div>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":"38 5","pages":"532-539"},"PeriodicalIF":2.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can ChatGPT Generate Acceptable Case-Based Multiple-Choice Questions for Medical School Anatomy Exams? A Pilot Study on Item Difficulty and Discrimination","authors":"Yavuz Selim Kıyak,&nbsp;Ayşe Soylu,&nbsp;Özlem Coşkun,&nbsp;Işıl İrem Budakoğlu,&nbsp;Tuncay Veysel Peker","doi":"10.1002/ca.24271","DOIUrl":"10.1002/ca.24271","url":null,"abstract":"<div>\u0000 \u0000 <p>Developing high-quality multiple-choice questions (MCQs) for medical school exams is effortful and time-consuming. In this study, we investigated the ability of ChatGPT to generate case-based anatomy MCQs with acceptable levels of item difficulty and discrimination for medical school exams. We used ChatGPT to generate case-based anatomy MCQs for an endocrine and urogenital system exam based on a framework for artificial intelligence (AI)-assisted item generation. The questions were evaluated by experts, approved by the department, and administered to 502 second-year medical students (372 Turkish-language, 130 English-language). The items were analyzed to determine the discrimination and difficulty indices. The item discrimination indices ranged from 0.29 to 0.54, indicating acceptable differentiation between high- and low-performing students. All items in Turkish (six out of six) and five out of six in English met the higher discrimination threshold (≥ 0.30) required for large-scale standardized tests. The item difficulty indices ranged from 0.41 to 0.89, most items falling within the moderate difficulty range (0.20–0.80). Therefore, it was concluded that ChatGPT can generate case-based anatomy MCQs with acceptable psychometric properties, offering a promising tool for medical educators. However, human expertise remains crucial for reviewing and refining AI-generated assessment items. Future research should explore AI-generated MCQs across various anatomy topics and investigate different AI models for question generation.</p>\u0000 </div>","PeriodicalId":50687,"journal":{"name":"Clinical Anatomy","volume":"38 4","pages":"505-510"},"PeriodicalIF":2.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}