Luis-Alfonso Arráez-Aybar

Dissection as a modulator of emotional attitudes and reactions of future health professionals

Context  There is ongoing discussion within the medical education community about dissection as an educational strategy and as a professional training tool in technical and emotional skills training.

Relevance of human anatomy in daily clinical practice

AIM the aim of this study has been to evaluate the relevance of gross human anatomy in daily clinical practice and to compare it to that of other basic sciences (biochemistry, bioethics, cytohistology, microbiology, pharmacology, physiology, psychology). MATERIALS AND METHODS a total of 1250 questionnaires were distributed among 38 different medical speciality professionals. Answers were analyzed taking into account speciality (medical, surgery and others), professional status (training physician or staff member) and professional experience. RESULTS the response rate was 42.9% (n=536). Gross human anatomy was considered the most relevant basic discipline for surgical specialists, while pharmacology and physiology were most relevant for medical specialists. Knowledge of anatomy was also considered fundamental for understanding neurological or musculoskeletal disorders. In undergraduate programmes, the most important focuses in teaching anatomy were radiological, topographical and functional anatomy followed by systematic anatomy. In daily medical practice anatomy was considered basic for physical examination, symptom interpretation and interpretation of radiological images. When professional status or professional experience was considered, small variations were shown and there were no significant differences related to gender or community. CONCLUSION our results underline the relevance of basic sciences (gross anatomy, physiology, and pharmacology) in daily professional activity. Evidence-based studies such as ours, lend greater credibility and objectivity to the role of gross anatomy in the undergraduate training of health professionals and should help to establish a more appropriate curriculum for future professionals.

Initial experience using the 3MAX cerebral reperfusion catheter in the endovascular treatment of acute ischemic stroke of distal arteries

Introduction The advancement of technology has allowed the development of new catheters that may provide safe intracranial navigation. Objective To report our first experience with the direct aspiration first pass technique in small arteries as the primary method for recanalization with the Penumbra 3MAX cerebral reperfusion catheter. Methods A retrospective case series analysis study of patients with acute ischemic stroke endovascularly treated with the direct aspiration technique using the 3MAX reperfusion catheter in our hospital in the past year. Results We treated six patients in our hospital for acute ischemic stroke using the 3MAX aspiration catheter as first choice. The patients had a median National Institutes of Health Strokes Scale (NIHSS) score of 12 (range 10–17) at admission, with occlusions of an M2 segment of a middle cerebral artery (MCA) treated through an anterior communicating artery, pericallosal artery, P2 artery, and M2-MCA and M3-MCA arteries. Recanalization (TICI 2b–3) was achieved in all cases and no complications occurred. It was not necessary to combine treatment with a stent retriever in any of the patients. All the patients showed early neurological improvement. The median NIHSS score at discharge was 1 (0–3) and 5/6 (83%) patients had a modified Rankin Scale score 0–2 at discharge. Conclusions Our initial experience suggests that treatment of distal cerebrovascular occlusions with the 3MAX catheter is feasible. We achieved complete recanalization in all cases without unexpected complications while obtaining good clinical results. However, larger studies are necessary to establish its benefits and its safety.

A case of a type II proatlantal artery with arteriovenous malformation

We describe a 64-year-old woman evaluated with angiography a case of persistence of a proatlantal artery (type II) with an arteriovenous malformation associated to the posterior cerebral artery. This association has been reported once in the literature consulted. The proatlantal artery arises from external carotid artery, cranial to the origin of facial artery at the level of C4 vertebra, anteromedial to the internal carotid artery, laying on it during its course cranial, lateral and posterior. After making a loop at the level of the transverse process of C3 vertebra, it enters into the transverse foramen of C3 vertebra and continuing its course, through the transverse foramen of C2 and C1 vertebra, as vertebral artery. Winds behind the superior articular process of the atlas enters the skull through the foramen magnum and, at the lower border of the pons, joins with the vessel of the opposite side to form the basilar artery. The internal carotid artery is normal. This variation is associated with congenital arteriovenous malformations that represent the persistence of an embryonic pattern of congenital vessels.

Toledo School of Translators and their influence on anatomical terminology

Translation facilitates transmission of knowledge between cultures. The fundamental transfer of anatomic terminology from the Ancient Greek and Islamic Golden Age cultures, to medieval Latin Christendom took place in the so-called Toledo School of Translators in the 12th-13th centuries. Translations made in Toledo circulated widely across Europe. They were the foundation of scientific thinking that was born in the boards of first universities. In Toledo, Gerard of Cremona translated Avicennas Canon of Medicine, the key work of Islamic Golden Age of medicine. Albertus Magnus, Mondino de Luzzi and Guy de Chauliac, the leading authors of anatomical Latin words in the Middle Ages, founded their books on Gerards translations. The anatomical terms of the Canon retain auctoritas up to the Renaissance. Thus, terms coined by Gerard such as diaphragm, orbit, pupil or sagittal remain relevant in the current official anatomical terminology. The aim of the present paper is to bring new attention to the highly significant influence that the Toledo School of Translators had in anatomical terminology. For this, we shall review here the onomastic origins of a number of anatomical terms (additamentum; coracoid process; coxal; false ribs; femur; panniculus; spondylus; squamous sutures; thorax; xiphoid process, etc.) which are still used today.

Thomas Willis, a pioneer in translational research in anatomy (on the 350th anniversary of Cerebri anatome)

The year 2014 marked the 350th anniversary of the publication in London of Cerebri anatome, a ground‐breaking work of neuroscience heavily influenced by the political and cultural context of Baroque Europe and mid‐17th century England. This article aims to review the work of the English physician and anatomist Thomas Willis, specifically with regard to the contents of his Cerebri anatome. Williss academic and professional career was influenced by the turbulent period of the English Civil War during which he studied medicine. Willis went from chemistry to dissection arguably because of his need to justify the body‐brain‐soul relationship. As a result, he became a fellow of a select club of eminent experimentalists, and afterward was a Fellow of the Royal Society. Later on, he went to London, leaving the academic life to dedicate himself fully to the profession of medicine. As a physician, Willis did not base his practice on aphorisms but on a ‘bench to bedside’ approach to medicine, while studying neuroanatomy – covering embryology, comparative anatomy and pathological anatomy – as a basis for the comprehension of neurological pathology. He developed innovative anatomical methods for the preservation and dissection of the brain, injection of coloured substances and illustration of his findings. In Cerebri anatome, Willis recognized the cerebral cortex as the substrate of cognition. He also claimed that the painful stimuli came from the meninges, but not from the brain itself. He explained for the first time the pathological and functional meaning of the brains circular arterial anastomosis, which is named after him. He also specified some features of the cranial origin of the sympathetic nerves and coined the term ‘neurologie’. Cerebri anatome marked the transition between the mediaeval and modern notions of brain function, and thus it is considered a cornerstone of clinical and comparative anatomy of the nervous system. The new contributions and methods employed by Willis justify his place as a father of neurology and a pioneer of translational research.

A duplicated Meckel's cartilage in a human fetus.

Abstract An exceptional case of a duplicate Meckel’s cartilage in a human fetus, with a C-R length of 57 mm, is studied. Another small cartilage, isolated from Meckel’s, of rounded morphology, was observed in a small region between the temporomandibular joint and the middle ear. This cartilage was only present on the right side.

Anatomic relationships of the orbital muscle of Müller in human fetuses

A study was carried out in twenty human fetuses on the relationships of the orbital muscle of Müller. This muscle forms a lamina of smooth muscle fibres that cover the inferior orbital fissure. The latter is very wide during the fetal period because ossification of the bones that delimit this region is still incomplete. Some fibres of the orbital muscle extend along the superior orbital fissure under the inferior ophthalmic vein and the lower wall or floor of the cavernous sinus. This association suggests a possible influence on autonomically mediated vascular dynamics.

Antonio Gimbernat y Arbos: An Anatomist-surgeon of the Enlightenment (In the 220th Anniversary of his ''A New Method of Operating the Crural Hernia'')

This article focuses on Antonio de Gimbernat y Arbós (1734–1816), with particular attention paid to his famous publication “Nuevo método de operar en la hernia crural” (2013 marking its 220 anniversary), which was translated into English by Thomas Beddoe two years later (A new method of operating for the femoral hernia Translated from the Spanish of Don Antonio de Gimbernat, To which are added, with plates by the translator, queries respecting a safer method of performing inoculation). Antonio de Gimbernat y Arbós, a Spanish anatomist and surgeon, was one of the pioneers during the “Age of Dissection” (late 18th Century). He was a man of great willpower, bright, thorough, and unique. From his careful anatomical study in the inguinal region, he made a detailed description of the lacunar ligament, which John Hunter called the Gimbernats ligament in his honor. Antonio de Gimbernat y Arbós also proposed an advanced treatment for strangulated femoral hernias. He acquired extraordinarily broad surgical skills with therapeutic orientation, conservative, not aggressive, based on the knowledge he had gained through dissection. Furthermore, though this is less well known nowadays, Antonio de Gimbernat y Arbós was also relevant organizer of education and health‐services — as it was the custom of the great physician of this time. Consequently, Antonio de Gimbernat y Arbós is truly representative of the great figures of the anatomists‐surgeons of the Enlightenment. Clin. Anat. 26:800–809, 2013.