M. Elena Stark

A heat map of superior cervical ganglion location relative to the common carotid artery bifurcation

BACKGROUND: Determining the superior cervical ganglions precise anatomical location for local anesthetic block, when stellate block is not feasible or is contraindicated, is difficult. METHODS: We dissected the superior cervical ganglion in 60 embalmed cadaveric specimens. Multiple regressions determined whether subject characteristics predicted the distance between the superior cervical ganglion and common carotid artery bifurcation and the superior cervical ganglion dimensional width and area. Based on these regressions, we mapped the ganglion and common carotid artery bifurcation using a pseudocolor statistical heat map. RESULTS: The statistical model significantly predicted the superior cervical ganglion–common carotid artery bifurcation distance (P = 0.01), and the superior cervical ganglion dimensional width (P = 0.02). CONCLUSION: This study determined that the common carotid artery bifurcation is a good landmark for localizing the superior cervical ganglion for anesthetic block.

Probabilistic mapping of the cervical sympathetic trunk ganglia

The goal of this study was to create a heat map indicating the probabilistic location of major ganglia of the cervical sympathetic trunk (CST). Detailed dissections of human cadaveric specimens, followed by spatial registration and analysis of the cervical sympathetic ganglia in the neck and upper thorax regions (C1-T1) were performed in 104 neck specimens (both sides from 52 cadavers). Unbiased parametric mapping, visualized with a heat map, revealed a general pattern of two major ganglia located on both sides of the neck: The superior cervical ganglion (SCG) was located 80-90 mm superior to the point at which the vertebral artery entered the transverse foramen (VA-TF); the stellate ganglion (SG) was located approximately 10 mm inferior to the VA-TF in 80% of our sample, or surrounding the VA-TF in the remaining 20% of our sample. In between these ganglia, a highly variable number of smaller and less prevalent ganglia were present on either side of the neck. The middle ganglia on the right side of the neck were located closer to the SCG, possibly indicative of the middle cervical ganglion. On the left side the middle ganglia were located closer to the SG, perhaps indicative of the vertebral ganglion or the inferior cervical ganglion. Individual specimens could be classified into one of seven different patterns of cervical trunks. The results may help surgeons and anesthesiologists more accurately target and preserve these structures during medical procedures.

Variant of the extensor pollicis tertius: a case report on a unique extensor muscle to the thumb

Variations on muscular and tendinous connections of the hand occur frequently in the human population and are often discovered during routine surgical procedures and cadaveric dissections. A knowledge of such anomalies is important to the physician in order to avoid unintentional damage to healthy tendons during surgical procedures. In addition, accessory tendons have the potential to be used in the repair or replacement of damaged tendons through surgical transfer or transplantation. Here we describe a unique variant of the extensor pollicis tertius muscle that has its origin at the proximal end of the extensor indicis muscle and inserts on the tendon of the extensor pollicis longus at the proximal shaft of the proximal phalanx of the thumb.

Exposure to ACGME Core Competencies Through Mentored Basic Science Research: A Pilot Analysis

Since 1998, the Short-Term Training Program (STTP) at the David Geffen School of Medicine at the University of California, Los Angeles has nearly tripled (from 30 to 89) in the number of first-year undergraduate medical students participants. STTP supports mentored research projects in the areas of basic sciences, clinical sciences, medical education, and public health (local and international). Although projects can be very specific in scope, the overall experience in STTP exposes students to some, if not all, of the Accreditation Council for Graduate Medical Education (ACGME) six core competencies–-Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-based Practice. Thus, STTP has been an important aspect of medical education to prepare our students for residency programs. We describe and analyze the STTP as a model system to introduce the ACGME core competencies at an early point in undergraduate medical education. We conclude with a call to provide more mentored anatomical sciences basic and clinically applied research opportunities.

Creation of a Video-Based Learning Module of Extraocular Muscles' Structure and Function

The objectives for the EM module are the following: 1) Describe the movements of the eyeball relative to the visual gaze and principal (cardinal) axes. 2) Compare and contrast the movements of the eyeball mediated by the extraocular muscles. 3) Explain the relationship between clinical testing, extraocular muscle movements and extraocular muscle innervation. 4) Describe which muscles act together to mediate conjugate movements.