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It is well known that Roy Porter’s oeuvre in the history of psychiatry was partly stimulated by, and in no small measure pitched against, Michel Foucault’s Madness and Civilization (Folie et deraison). But what was Porter’s response to Foucault’s Birth of the Clinic (Naissance de la clinique)?1 By the ‘birth of the clinic’, let us recall, Foucault referred to the remarkable change in medicine that took place in the Paris Ecole de Sante between 1800, when Xavier Bichat’s Traite des membranes initiated his new doctrine of tissues, which rapidly invigorated pathological anatomy, and 1817, when Rene-Theophile-Hyacinthe Laennec (1781–1826), one of the most influential pupils of the new school and himself a master of pathological anatomy, invented the stethoscope. Foucault himself, as we shall see, regarded this as the most important transformation in Western medicine’s entire history, and although not all commentators would go this far, none would deny that pathological anatomy made giant strides in the Paris school, or that the stethoscope gave an unprecedented impulse to physical examination, with permanent effects. Thus we are dealing here with a momentous set of events, which means that Porter’s view of Birth of the Clinic is of considerable interest.

Mitral annular disjunction (MAD) is an abnormal insertion of the hinge line of the posterior mitral leaflet on the atrial wall: the mitral annulus shows a separation or "disjunction" between the leaflet-atrial wall junction and the crest of the left ventricle myocardium. This anomaly is often observed in patients with myxomatous mitral valve prolapse. The anatomical substrate of MAD remains unclear for the following reasons: (1) most studies are focused on the association between MAD and arrhythmias, rather than on pathomorphological aspects of MAD; and (2) the complex anatomic architecture of the posterior mitral annulus is often simply described as the posterior segment of a fibrous ring. The aims of this paper are to review the pertinent normal anatomy of the mitral valve and to propose new hypotheses on the morphological nature of MAD.

Contains fulltext : 244686.pdf (Publisher’s version ) (Open Access) Cloacal malformations are among the most complex types of anorectal malformation and are characterized by the urological, genital, and intestinal tracts opening through a single common channel in the perineum. Long-term outcome is affected by multiple factors, which include anatomical variants of the malformation itself, associated anomalies, and the surgical approach. Reconsidering these variables and their influence on "patient important" function might lead to strategies that are more outcome-driven than focused on the creation of normal anatomy. Key outcomes reflect function in each of the involved tracts and the follow-up needed should therefore not only include the classical fields of colorectal surgery and urology but also focus on items such as gynecology, sexuality, family-building, and quality of life as well as other psychological aspects. Involving patients and families in determining optimal treatment strategies and outcome measures could lead to improved outcomes for the individual patient. A strategy to support delivery of personalized care for patients with cloacal malformations by aiming to define the best functional outcomes achievable for any individual, then select the treatment pathway most likely deliver that, with the minimum morbidity and cost, would be attractive. Combining the current therapies with ongoing technological advances such as tissue expansion might be a way to achieve this.

Tanulmányomban, amely egy szélesebb kutatás része, a haderő aktív állományának mozgásszervi terhelését és az annak következtében kialakuló panaszokat vizsgálom, a nemzetközi szakirodalomban fellelhető hasonló kutatások áttekintésével. Cikksorozatom első része a csípőízülettel, annak biomechanikai összefüggéseivel, a terhelés következtében fellépő erőhatásokkal és azok következményeivel foglalkozik. A csípőben kialakuló terhelési viszonyok bemutatásával látható, hogy még egészséges, normál anatómiájú csípő esetén is jelentős terhelés esik az ízület porcára. A túlterheléssel, az ízület anatómiai eltéréseinek következtében vagy ezek együttes hatására a panaszok nagyobb valószínűséggel alakulnak ki.

Objective A radiology sign that references a resemblance to something which is not actually present within an image has been termed a 'metaphoric' sign. Metaphoric signs are widely described in the literature and commonly used in teaching as a form of pattern recognition, or ‘pareidolia’. However, the educational benefit of metaphoric signs has not been previously assessed. We aimed to assess the utility of metaphoric signs in medical student teaching. Materials and Methods Fifteen radiology cases were prepared into two lecture formats for medical student education. A 'test' lecture utilizing metaphoric radiology signs to describe the appearance of the cases and a 'control' lecture where pathology was compared to normal anatomical appearances without reference to metaphoric signs. Forty-nine volunteer medical students were randomized with cluster sampling to receive either the test or control lecture. Four days later, students were quizzed to determine retention of knowledge and to assess interest in the lecture on a visual analogue scale from 0 to 100. Results The median interest level of the test group (69.5) was higher than the control group (50) (p = 0.001). The mean quiz score was higher in the test group (34.5) than in the control group (29) (Difference 5.5, 95% confidence interval 0.08-10.92, p = 0.047). Conclusion The use of metaphoric signs in radiology education of medical students increased interest, descriptive ability and short-term knowledge retention, compared to the same material taught with normal anatomy correlation. Metaphoric signs should be considered as a useful radiology teaching tool.

The menisci of the knee are accurately evaluated by MRI. Knowledge of normal anatomy, imaging parameters, imaging appearance of the normal and torn meniscus, and common anatomic variants and pitfalls are essential in obtaining the correct imaging diagnosis. There are multiple imaging signs of meniscal tear, including linear signal intensity extending to an articular surface on at least 2 images, altered meniscal shape, displaced meniscal flap, ghost meniscus, meniscal extrusion, and parameniscal cyst. After surgery, granulation tissue may mimic tear. Diagnosis is improved by comparison to preoperative images, operative note, and intra-articular contrast administration.

Pendahuluan : Trauma kimia okuli merupakan kasus emergensi dan membutuhkan penanganan segera. Trauma ini sering disebakan berbagai kausa seperti kecelakaan kerja hingga penganiayaan. Tujuan utama terapi adalah meminimalisir kerusakan permukaan bola mata serta mengembalikan anatomi dan fisiologi mata Presentasi kasus : Pria berusia 31 tahun dengan keluhan utama kedua mata tidak dapat melihat akibat disiram cairan dua hari sebelumnya. Pemeriksaan oftalmologis menunjukan VOD LP , VOS HM , palpebra ODS spasme dengan combustio grade III, konjungtiva ODS kemosis dengan limbal iskemia 360 derajat, simblefaron pada kantus lateral , kornea ODS keruh. Pasien mendapatkan perawatan selama 33 hari. Kesimpulan : Trauma kimia okuli derajat berat memiliki prognosis visual yang buruk terlepas dari tatalaksana yang sudah dilakukan karena rusaknya sel punca limbal dan kejadian ikutannya.

Carpal instability is a complex subject and the theories behind the pathoanatomy and management continue to evolve in the literature. The consequences of carpal instability for the patient can be significant and lead to functional impairment and long-term pain. We outline the normal anatomy of the carpus and relate the complex interactions between the ligamentous and bony structures to the patterns of injury both acute and chronic. We then go on to review current opinion on the classification, assessment and management of patients with carpal instability.

Disruption in the normal anatomy and physiology of the skin often leads to wound formation. Its healing is a pretty complex and dynamic biological process with different phases. While there are many biopolymers (and their derivatives) for wound healing purposes. One of the most popular, promising, progressive and attention-grabbing biopolymers is 'chitosan'. It is a polysaccharide biopolymer that has tremendous potential in augmenting the process of wound healing. Most importantly, the derivatives of chitosan have heavily attracted the scientific community's attention to employing them in various formulations for wound healing applications. The prime focus of the present review is to provide scientific and technological prospection about chitosan and its derivatives for wound healing activity, starting from 2010 to 2020. Besides, the review also focuses about toxicity, different formulations and products of chitosan that are currently under clinical trials for wound healing purposes are described. Through this review, we present evidence that abundantly confirms that there is a growing interest in the domain of wound healing using novel, inventive, useful and patent protected chitosan derivatives. We speculate the possibility of more patent protected chitosan derivatives in the future for wound healing applications.

Distal radius fractures (DRF) are common. They have a bimodal distribution typically occurring as a high-energy injury in the young or a low-energy injury in the older patient with osteoporosis. With the number of DRF predicted to rise, it is important to know how to manage DRF appropriately. The options for the surgical management of adult DRF can appear varied and bewildering. This is further confused by the expanse of literature available regarding the different options, the different types of plate design, and the almost bipartisan belief that either minimalist techniques may be all that are required versus the compulsion to meticulously restore normal anatomy in an attempt to maximize function and reduce disability.

The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.

Ulnar collateral, radial collateral, lateral ulnar collateral, and annular ligaments can be injured in an acute trauma, such as valgus stress in athletes and elbow dislocation. Recognizing normal anatomy in magnetic resonance imaging and ultrasonography studies is important to identify ligamentous abnormalities in these imaging modalities.

Abdominal wall hernias are common and can present as technical challenges to surgeons. When large, hernias diminish quality of life. Various classifications of incisional hernias have been proposed; however, there are many terms, sometimes causing confusion (1). Radiologists must know the normal anatomy of the abdominal wall, the CT protocol, and what if any maneuvers can be performed to better identify an abdominal wall defect. The description of the radiological approach for primary and incisional wall hernias is based on the 2007 European Hernia Society classification, with particular emphasis on presurgical and postsurgical imaging findings. This classification provides a simple and reproducible method to describe hernias to offer proper surgical management. We highlight this classification so that radiologists and surgeons can have a unified language.

Aims Hip arthroplasty does not always restore normal anatomy. This is due to inaccurate surgery or lack of stem sizes. We evaluated the aptitude of four total hip arthroplasty systems to restore an anatomical and medialized hip rotation centre. Methods Using 3D templating software in 49 CT scans of non-deformed femora, we virtually implanted: 1) small uncemented calcar-guided stems with two offset options (Optimys, Mathys), 2) uncemented straight stems with two offset options (Summit, DePuy Synthes), 3) cemented undersized stems (Exeter philosophy) with three offset options (CPT, ZimmerBiomet), and 4) cemented line-to-line stems (Kerboul philosophy) with proportional offsets (Centris, Mathys). We measured the distance between the templated and the anatomical and 5 mm medialized hip rotation centre. Results Both rotation centres could be restored within 5 mm in 94% and 92% of cases, respectively. The cemented undersized stem performed best, combining freedom of stem positioning and a large offset range. The uncemented straight stem performed well because of its large and well-chosen offset range, and despite the need for cortical bone contact limiting stem positioning. The cemented line-to-line stem performed less well due to a small range of sizes and offsets. The uncemented calcar-guided stem performed worst, despite 24 sizes and a large and well-chosen offset range. This was attributed to the calcar curvature restricting the stem insertion depth along the femoral axis. Conclusion In the majority of non-deformed femora, leg length, offset, and anteversion can be restored accurately with non-modular stems during 3D templating. Failure to restore hip biomechanics is mostly due to surgical inaccuracy. Small calcar guided stems offer no advantage to restore hip biomechanics compared to more traditional designs. Cite this article: Bone Jt Open 2021;2(7):476–485.

A 32-year-old white male was on a second-story balcony when he fell off and landed on the cement below. With initial X-rays being read as negative on the radiology report due to the subtle nature of the injury, the patient was promptly diagnosed with a medial swivel dislocation by the orthopaedic team, which ended up being fixed, unstable, and irreducible. The patient also had acute skin compromise and needed to be taken to the operating room prior to progression of skin breakdown. This dislocation pattern is a rare variant, especially when paired with the fixed nature of the dislocation and the soft tissue compromise. In the end, open treatment was necessary in order to reduce the talonavicular joint. Because of early recognition and prompt treatment, skin breakdown was avoided. Internal screw fixation of the fractured navicular bone was needed along with K-wire insertion to hold the normal anatomy of the talonavicular joint reduced. All hardware was ultimately removed after healing, and anatomy was restored with excellent patient function. This case report highlights the orthopaedic knowledge needed to not only recognize this rare fracture-dislocation pattern but to also treat it promptly when encountered.

The relation between the facial nerve and the retromandibular vein is of paramount clinical significance during the parotid surgery for the protection of all the facial nerve branches as these two anatomic structures are always in close proximity. However, variations in the relationship of the facial nerve with the retromandibular vein, as presented in this paper complicate parotid surgery and increase the potentiality of unexpected bleeding and injury to the facial nerve injury. This study was conducted in a tertiary care teaching hospital. 4 cases with unusual relation of facial nerve and retromandibular vein in parotid surgeries were studied & included in this study. Out of 70 parotid surgeries which were performed, 4 variations of the retromandibular vein in relation to facial nerve were encountered. With a meticulous dissection the facial nerve branches were separated from the retromandibular vein without causing any injury to the neurovascular structures and functional deficit. Knowledge of normal anatomy of the extra cranial facial nerve and its relation with the retromandibular vein along with the probable anatomical variations leads to a safe parotid surgery.

Anatomy is the key to accurate imaging interpretation. It is essential for radiologists to thoroughly understand the normal anatomy and spatial relationships of the stomach and duodenum to accurately localize the site of abnormality. In this article, we describe in detail the gross and applied radiological anatomy of the stomach and duodenum, and the current role of various radiological investigations (including barium studies, endoscopic ultrasonography, computed tomography, and magnetic resonance imaging) in the evaluation of the diseases involving the stomach and duodenum.

Purpose While a growing number of research studies have reported the inter-observer variability in computed tomographic (CT) measurements, there are very few interventional studies performed. We aimed to assess whether a peer benchmarking intervention tool may have an influence on reducing inter-observer variability in CT measurements and identify possible barriers to the intervention. Materials and Methods In this retrospective study, 13 board-certified radiologists repeatedly reviewed 10 CT image sets of lung lesions and hepatic metastases during three non-contiguous time periods (T1, T2, T3). Each pre-selected case contained normal anatomy cephalad and caudal to the lesion of interest. Lesion size measurement under RECISTS 1.1 guidelines, choice of CT slice, and time spent on measurement were captured. Prior to their final measurements, the participants were exposed to the intervention designed to reduce the number of measurements deviating from the median. Chi-square test was performed to identify radiologist-dependent factors associated with the variability. Results The percent of deviating measurements during T1 and T2 were 20.0% and 23.1%, respectively. There was no statistically significant change in the number of deviating measurements upon the presentation of the intervention despite the decrease in percent from 23.1% to 17.7%. The identified barriers to the intervention include clinical disagreements among radiologists. Specifically, the inter-observer variability was associated with the controversy over the choice of CT image slice (p=0.045) and selection of start-point, axis, and end-point (p=0.011). Conclusion Clinical disagreements rather than random errors were barriers to reducing interobserver variability in CT measurement among experienced radiologists. Future interventions could aim to resolve the disagreement in an interactive approach.