Sanjib Kumar Ghosh

Human cadaveric dissection: a historical account from ancient Greece to the modern era

The review article attempts to focus on the practice of human cadaveric dissection during its inception in ancient Greece in 3rd century BC, revival in medieval Italy at the beginning of 14th century and subsequent evolution in Europe and the United States of America over the centuries. The article highlights on the gradual change in attitude of religious authorities towards human dissection, the shift in the practice of human dissection being performed by barber surgeons to the anatomist himself dissecting the human body and the enactment of prominent legislations which proved to be crucial milestones during the course of the history of human cadaveric dissection. It particularly emphasizes on the different means of procuring human bodies which changed over the centuries in accordance with the increasing demand due to the rise in popularity of human dissection as a tool for teaching anatomy. Finally, it documents the rise of body donation programs as the source of human cadavers for anatomical dissection from the second half of the 20th century. Presently innovative measures are being introduced within the body donation programs by medical schools across the world to sensitize medical students such that they maintain a respectful, compassionate and empathetic attitude towards the human cadaver while dissecting the same. Human dissection is indispensable for a sound knowledge in anatomy which can ensure safe as well as efficient clinical practice and the human dissection lab could possibly be the ideal place to cultivate humanistic qualities among future physicians in the 21st century.

Can maternal serum placental growth factor estimation in early second trimester predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction? A prospective cohort study

To determine whether maternal serum placental growth factor (PlGF) estimation in early second trimester (20–22 weeks of gestation) can predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction (IUGR).

Serum placental growth factor as a predictor of early onset preeclampsia in overweight/obese pregnant women

The purpose of this study was to analyze whether maternal serum placental growth factor (PlGF) could predict early onset preeclampsia (<32 weeks of gestation) in overweight/obese pregnant women, and whether it could do it more effectively than in normal/underweight pregnant women. A prospective cohort study was conducted on 1678 pregnant women with singleton pregnancies, who were grouped as underweight, normal, overweight, and obese on the basis of body mass index, followed by serum PlGF estimation at 20 to 22 weeks of gestation. A cut-off value of <144 pg/mL for PlGF was determined by Receiver Operating Characteristic curve analysis to identify risk of early onset preeclampsia. Univariate logistic regression analysis revealed significantly stronger association between PlGF <144 pg/mL and early onset preeclampsia in overweight/obese pregnant women (odds ratio 7.64; 95% confidence interval 5.34-10.12; P = .000) than in normal/underweight pregnant women (odds ratio 2.95; 95% confidence interval 1.74-4.26; P = .007). Weight and PlGF levels in study women had a significant negative correlation (r = 0.663; P = .002). Serum PlGF in early second trimester could be an effective predictor of early onset preeclampsia in overweight/obese pregnant women and may be more effective than in normal/underweight pregnant women.

Potential sites of compression of tibial nerve branches in foot: A cadaveric and imaging study

Hypertrophy of abductor hallucis muscle is one of the reported causes of compression of tibial nerve branches in foot, resulting in tarsal tunnel syndrome. In this study, we dissected the foot (including the sole) of 120 lower limbs in 60 human cadavers (45 males and 15 females), aged between 45 and 70 years to analyze the possible impact of abductor hallucis muscle in compression neuropathy of tibial nerve branches. We identified five areas in foot, where tibial nerve branches could be compressed by abductor hallucis. Our findings regarding three of these areas were substantiated by clinical evidence from ultrasonography of ankle and sole region, conducted in the affected foot of 120 patients (82 males and 38 females), aged between 42 and 75 years, who were referred for evaluation of pain and/or swelling in medial side of ankle joint with or without associated heel and/or sole pain. We also assessed whether estimation of parameters for the muscle size could identify patients at risk of having nerve compression due to abductor hallucis muscle hypertrophy. The interclass correlation coefficient for dorso‐planter thickness of abductor hallucis muscle was 0.84 (95% CI, 0.63–0.92) and that of medio‐lateral width was 0.78 (95% CI, 0.62–0.88) in the imaging study, suggesting both are reliable parameters of the muscle size. Receiver operating characteristic curve analysis showed, if ultrasonographic estimation of dorso‐plantar thickness is >12.8 mm and medio‐lateral width > 30.66 mm in patients with symptoms of nerve compression in foot, abductor hallucis muscle hypertrophy associated compression neuropathy may be suspected. Clin. Anat. 26:768–779, 2013.

Adriaan van den Spiegel (1578–1625): Anatomist, physician, and botanist

Adriaan van den Spiegel (1578–1625) was a Flemish anatomist and physician. He was one of the most prominent anatomists at the University of Padua during the 17th century and became professor of anatomy and surgery there in 1619. He was privileged to have two of the most accomplished anatomists of that period, Fabricius ab Aquapendente and Iulius Casserius, as his teachers. His anatomical works were published after his death by his pupil Bucretius and his son‐in‐law Liberalis Crema, with illustrations procured from Casseriuss unpublished anatomical atlas. He contributed significantly to establishing basic morphological facts about the developing embryo in his text De formato foetu liber singularis. In his book De humani corporis fabrica libri decem, Spiegels lobe (caudate lobe) of the liver and the linea semilunaris (Spiegels line) on the lateral side of the rectus abdominis muscle were described for the first time. Subsequently, Spigelian aponeurosis (between the lateral margin of the rectus abdominis and the linea semilunaris) and Spigelian hernia (lateral ventral hernia) were named after him. He was a renowned physician in his time and was the first to give a detailed description of malaria. He made significant contributions as a botanist: the genus Spigelia, which has six species, is named after him. Clin. Anat. 27:952–957, 2014.

Association between placental growth factor levels in early onset preeclampsia with the occurrence of postpartum hemorrhage: A prospective cohort study.

OBJECTIVES To determine the association between PlGF (placental growth factor) estimation in early second trimester (22-24weeks of gestation), with the occurrence of postpartum hemorrhage in pregnant women with early onset preeclampsia and whether the mode of delivery (cesarean or vaginal) has any association with increased risk of developing postpartum hemorrhage. STUDY DESIGN A prospective cohort study was conducted on 788 pregnant women with singleton pregnancies diagnosed with early onset preeclampsia between March 2009 and June 2011. Maternal serum PlGF level estimation was done between 22 and 24weeks of gestation and a cut-off value of <122pg/ml was determined by receiver operating characteristic (ROC) curve analysis for identifying those at risk of developing postpartum hemorrhage. Association between serum PlGF level <122pg/ml and cesarean deliveries with the risk of developing postpartum hemorrhage was analyzed by logistic regression analysis and Odds ratio, which were computed. The results were considered statistically significant when P-value <0.05. MAIN OUTCOME MEASURES Proportion of study population developing postpartum hemorrhage. RESULTS Logistic regression analysis showed the association of serum PlGF <122pg/ml at 22-24weeks (Odds ratio 8.9516; 95% CI, 5.0728-15.7963) and that of cesarean delivery (Odds ratio 2.4252; 95% CI, 1.4573-4.0360) with the risk of developing postpartum hemorrhage. Both the associations were found to be statistically significant. CONCLUSION Maternal serum PlGF level <122pg/ml at 22-24weeks of gestation and cesarean delivery are both strongly associated with the risk of developing postpartum hemorrhage in pregnant women with early onset preeclampsia.

Learning anatomy from the internet

Learning methodologies in anatomy have been revolutionised in the 21st century and, in accordance with adult learning principles, 1 students are exploring newer media for learning the subject. The internet is an emerging platform for learning anatomy worldwide, and this has been complemented by the availability of highquality, as well as easy to retrieve, online resources. 2 The internet is a phenomenal data resource, providing the user with numerous learning tools, and we suggest that a little assistance could be useful for helping students use the net more effectively for learning anatomy. We hypothesised that the perceptions of fi rstyear undergraduate students could be the basis for identifying the popular anatomy learning tools from the internet and analysing their effectiveness in actually assisting students to learn the subject. In our opinion this would be of considerable help to future medical students in learning anatomy from the internet.

Resident doctors: keystone of anatomy teaching

A sound knowledge of anatomy can be a vital link for a fi rst-year undergraduate medical student for the proper learning of the clinical subjects in the later part of the medical course. Unfortunately, in the medical education curriculum of India, didactic lectures have mostly become the medium for transfer of class notes to the notebooks of the students without passing through their brains. It may be suggested that under these circumstances the interactive discussion classes that follow a lecture, and that are mostly facilitated by the resident doctors, become a vital cog in the wheel of learning anatomy.

Cadaveric preservation under adverse climatic conditions

Preservation of cadavers is a matter of concern for anatomists in tropical countries like India. Most of the medical schools have to rely on unclaimed bodies for conducting anatomical studies due to a lukewarm response towards the voluntary body donation program in India [1]. Inadequate supply of dead bodies towards medical education has necessitated cadaveric preservation for conducting dissection sessions during the first two semesters of the undergraduate medical course. Challenging climatic conditions is often the biggest hurdle towards maintaining the cadaver in a viable condition for dissecting the same. The climate in most parts of India is characterized by a dry spell (during winter and early summer) and a humid spell (during late summer and monsoon). Cadaveric dissection and subsequent anatomy teaching are adversely affected in both the weather conditions as dryness make the dissected parts brittle and high humidity increases the risk of cadaveric decomposition. In an effort to overcome the problems related to cadaveric preservation, for the last couple of years we have been following some simple yet logical measures in the department of anatomy of our institution. Like other medical schools in India, formalin is used as the preservative for cadavers in our institution [4]. Although the chemical is associated with numerous health challenges, it is preferred as it is economical and easily available [5]. Human cadavers are subjected to a standard embalming procedure and thereby fixed in formalin upon receipt from the hospital authorities [6]. With the onset of teaching activities for a particular batch of undergraduate medical students, these cadavers are allotted to respective tables in the dissection lab. We ensure that the cadavers are transferred to the tanks containing 10 % formalin solution every day after the teaching activities are over in the dissection lab. They are subsequently taken out from the tanks the next morning, washed under running water for at least 30 min to minimize the offensive smell of formalin as much as possible and placed on the respective dissection tables. Over the weekend, the cadavers are allowed to remain immersed in formalin solution for a window of about 72 h. This is a critical deviation from the practice prevalent in most of the medical schools in India, where cadavers are left in the dissection lab for 5 days in a week, as it suits the students as well as the anatomists due to the diminishing smell of formalin. During the dry spell, at intervals between the dissection hours for a particular day, the exposed area is covered with a thin layer of cotton, soaked in water and glycerol, to minimize the loss of moisture. However during the humid conditions, dry cotton is applied on the dissected part so as to reduce the moisture, which would lower the risk of fungal growth and maggot infestation. The skin flaps are essentially preserved during dissection and are placed over the cotton layer in order to keep them in position. We add eugenol in the formalin solution instead of thymol (used conventionally) as it is more effective in inhibiting fungal growth in liquid medium [8]. Eugenol requires cautious handling as it is potentially hepatotoxic [7] and we have been adding 250 mg of eugenol acetate crystals per liter of 10 % formalin solution in accordance with the minimum inhibitory concentration recommended in recent studies [3]. After the dissection of a particular region of the human body is complete, any subsequent exposure to air increases its risk of getting damaged/decomposed. Hence sequential & Sanjib Kumar Ghosh drsanjib79@gmail.com

Enhancing learning in anatomy lectures

Medical education in India typically consists of a traditional lecture-based curriculum. Accordingly, the anatomy teaching schedule for 1-year undergraduate medical students consists of many hours of classroom-based lectures. During these lecture sessions, we observed that a significant number of the students were regularly absent from class, and among those present, most were not paying attention. In our assessment, these lecture hours were contributing little to the overall learning process in anatomy.