Human Atlas:- Video Education of Anatomy?

As the above caption suggests, if you click one of the topics, you can see and listen to a beautiful and quite simple description of different anatomical structure of human Body. 

For someone who is just learning Anatomy or atlas of the Human body,  this is a good place to start......... you can start here. 

Audio and visual learning is more effective than just reading, though nothing can replace a careful and thorough reading habit. Modern tools makes learning much more easier and simpler. 

Here it is, hope you will find it useful.

One of the topic I clicked to see the video was "Anatomy of Spine", quite simple but appropriate information to begin learning the spine anatomy.

This can be a very good tool for someone who might be interested in learning neuroanatomy and neurophysiology. These 3D descriptions can be useful for non-neuroscience as well as neuroscience students, for Neuromonitoring newbies?.. and even for those who know the field, a quick refresher. 

Few Example Video's:

3D: Anatomy of Spine

3D: Lumbar Laminectomy

3D: Spinal Stenosis

Link:http://www.atlantichealth.org/en/atlantic/healthinformation/human+atlas+videos.html

Neurophysiology Recitation of Texts Only: 1824-1889?

Today, we have the most sophisticated tools to study and learn science and medical subjects. Most of the ground breaking scientific and medical findings came out of a laboratory research that involves animal research or human research, without practical research, can't imagine the fate of our medical and scientific achievements. If that is true for general science and medical field, the progress we made in neuroscience in general and clinical neuroscience like Neurophysiology and Intraoperative neuromonitoring is an amazing break through of our learning using modern tools. What were they during just 200 years ago in physiology and neurophysiology?. Not much.......... Physiology was studied and taught by only reciting the texts like some of those Jabber's of religious scriptures in temples, really?. 

Yes, 

it seems during early to late 1800's the Physiology was taught by reciting the texts. For the very first time live animal demonstration in anesthetized animals was introduced in America by Dalton.

Neurology 2000;55:859-864
© 2000 American Academy of Neurology 

---

Historical Neurology

John Call Dalton, Jr., MD

America’s first neurophysiologist

Edward J. Fine, MD, Tara Manteghi, BA, Sidney H. Sobel, MD and Linda A. Lohr, MA

From the Department of Veterans’ Affairs Medical Center and Department of Neurology (Dr. Fine and Ms. Manteghi), State University of New York at Buffalo; Finger Lakes Radiation Oncology (Dr. Sobel), Clifton Springs, NY; and the Robert L. Brown, MD, History of Medicine Collection (Ms. Lohr), State University at Buffalo, NY.

Address correspondence and reprint requests to Dr. Edward J. Fine, Neurology Service, Department of Veterans’ Affairs Medical Center, 3495 Bailey Avenue, Buffalo, NY 14215.

Before the discoveries of John Call Dalton, Jr., MD (1824–1889), innervation of laryngeal muscles, long-term effects of cerebellar lesions, and consequences of raised intracranial pressure were poorly understood. Dalton discovered that the posterior cricoarytenoid muscles adducted the vocal cords during inspiration. He confirmed Flourens’ observations that acute ablation of the cerebellum of pigeons caused loss of coordination. Dalton observed that properly cared for pigeons gradually recovered "coordinating power." Dalton observed that prolonged raised intracranial pressure caused tachycardia and then fatal bradycardia in dogs. Before Dalton published his photographic atlas of the human brain, neuroanatomy atlases were sketched by Europeans and imported into the United States. Dalton’s atlas of the human brain contained precise photographs of vertical and horizontal sections that equal modern works. Before Dalton introduced live demonstrations of animals, physiology was taught by recitation of texts only. Dalton was the first American-born professor to teach physiology employing demonstrations of live animals operated on under ether anesthesia. He wrote an essay advocating experimentation on animals as the proper method of acquiring knowledge of function and that humane animal experimentation would ultimately improve the health of man and animals. His eloquent advocacy for humane experimental physiology quelled attacks by contemporaneous antivivisectionists. Dalton was America’s first experimental neurophysiologist.

73% of Patients suffered Complications, 11 out of 15 Patient?, What kind of IONM Company serves such a Surgeon?

Today's "Daily Record" carried the following news about a"medical malpractice suit"filed against Northwest Medical Center. In addition to the hospital and the surgeon, the neuromonitoring company known as American Intraoperative  Monitoring LLC? is also in trouble?.

"If" one has to go by this report and the number of surgeries done by the surgeon involved in this suit, 11 out of 15 patients (73%) had complications after spinal corrections (it not clear what kind of surgical procedure done on all the 15 surgical procedures, but the current case that is reported here is an anterior discectomy and fusion simply known as ACDF?). The number of patients suffering from post surgical complications are very significant, going by this report. This amount of surgical complications in the first place is rare, I haven't heard of a 73% complications (unless someone send me some past reports or ref?). 

Nevertheless, for argument I am wondering, what kind of a Neuromonitoring Company will provide neurophyisological monitoring services to a surgeon of this kind reported in this law suit?. Why?. Are you part of a bad practice and demoralized medical ethics, do you know what you are doing inside the OR?.

The report also claims that the Neuromonitoring Staff, seems to be an RN trained in neuromonitoring was aware about abnormalities (?? is this SSEPs loss? or Motor Loss or Spinal cord damage or what?) but did not warn the surgeon while it was happening during the surgery, neither he or she reported this after the surgical procedure?............Immmmmm...?

Northwest Medical Center added to malpractice suit

By Scott F. Davis Northwest Arkansas Times

Posted on Friday, January 23, 2009

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FAYETTEVILLE - A Bentonville couple amended their malpractice lawsuit Thursday against Dr. Cyril "Tony" Anthony Raben and his clinic, Northwest Arkansas Spine and Orthopedic Associates, adding three new parties as defendants.

Theresa Paulino and her husband, Eddie Paulino, seek damages because she lost the use of her legs following neck surgery by Raben on Dec. 17, 2008, according to the complaint.

The Paulinos added Northwest Medical Center to the lawsuit, claiming "negligent credentialing" after learning that an audit by the Arkansas State Medical Board showed a very high complication rate for Raben's prior surgeries.

Read the full story: click the topic of this news linked to the original news.

Dexmedetomidine- A New Short Term Sedative?

Interesting Review on "Dexmedetomidine", the most recent sedative approved by the FDA.

Dexmedetomidine: a novel sedative-analgesic agent Ralph Gertler, MD,1 H. Cleighton Brown, MD,1 Donald H. Mitchell, MD,1 and Erin N. Silvius, MD1 1From the Department of Anesthesiology and Pain Management, Baylor University Medical Center, Dallas, Texas; and Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center at Dallas. Corresponding author. Corresponding author: Ralph Gertler, MD, Department of Anesthesiology and Pain Management, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, Texas 75246 (e-mail: Ralph_Gertler10@excite.com). Since the first report of clonidine, an α2-adrenoceptor agonist, the indications for this class of drugs have continued to expand. In December 1999, dexmedetomidine was approved as the most recent agent in this group and was introduced into clinical practice as a short-term sedative (<24 style="font-size: 0.8em; line-height: 0.8em; white-space: nowrap; ">2-Adrenoceptor agonists have several beneficial actions during the perioperative period. They decrease sympathetic tone, with attenuation of the neuroendocrine and hemodynamic responses to anesthesia and surgery; reduce anesthetic and opioid requirements; and cause sedation and analgesia. They allow psychomotoric function to be preserved while letting the patient rest comfortably. With this combination of effects, α2-adrenoceptor agonists may offer benefits in the prophylaxis and adjuvant treatment of perioperative myocardial ischemia. Furthermore, their role in pain management and regional anesthesia is expanding. Side effects consist of mild to moderate cardiovascular depression, with slight decreases in blood pressure and heart rate. The development of new, more selective α2-adrenoceptor agonists with improved side effect profiles may provide a new concept for the administration of perioperative anesthesia and analgesia. This review aims to give background information to improve understanding of the properties and applications of the novel α2-adrenoceptor agonist, dexmedetomidine.

Neuromonitoring & Peadiatric Cardiopulmonary bypass surgical procedures?:- Boosts Evidence Based practice & Best Practice?

Usage of intraoperative neurophysiologic monitoring during Peadiatric cardiopulmonary bypass surgical procedures reported in the following research papers, addition of IONM tothe surgical team has helped them to improve the post surgical neurological complications. Two of the following studies one published recently in Sept-Oct 2008 and the other in 2007, both in peer reveiwed journals discuss the importance of IONM usage in terms of reducing neurological risk, patient safety and faster discharge of patients that could be benefitial to both the patients and the hospitals.

The influence of neurophysiologic monitoring on the management of pediatric cardiopulmonary bypass.

ASAIO J. 2008 Sep-Oct;54(5):467-9

Kimatian SJ, Saliba KJ, Soler X, Valentine EA, Coleman ML, Kunselman AR, Schuler HG, Barnes ML,Thirumala PD, Myers JL.

Department of Anesthesiology, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA. skimatian@hmc.psu.edu

We describe a process by which we sought to determine how the addition of intraoperative neurophysiologic monitoring (IONM) impacted the management of cardiopulmonary bypass (CPB) during pediatric cardiac surgery.

While maintaining a consistent team of surgeons, anesthesiologists, nurses, and perfusionists, a multi-modal, IONM program was established consisting of Near Infrared Spectroscopy, Transcranial Doppler, and eight channel electroencephalography. A retrospective review of cases from 1 year before the institution of the IONM program was compared with data obtained from cases performed after neurophysiologic monitoring was established as a standard of care for pediatric patients on CPB.

This comparative analysis of CPB management revealed a significant increase in the use of donor blood added to the CPB circuit prime as well as in the maintenance of a higher hematocrit during the bypass period after the implementation of IONM.

These changes in the management of pediatric CPB correlated with recommendations of previous studies that examined postoperative neurophysiologic outcomes, suggesting that these changes were not only consistent with best practices, but that the presence of IONM data facilitated a transition to evidence-based practice.

Benefit of neurophysiologic monitoring for pediatric cardiac surgery.

Austin EH 3rd, Edmonds HL Jr, Auden SM, Seremet V, Niznik G, Sehic A, Sowell MK, Cheppo CD, Corlett KM.

Department of Surgery, University of Louisville School of Medicine, Ky., USA.

BACKGROUND: Pediatric patients undergoing repair of congenital cardiac abnormalities have a significant risk of an adverse neurologic event. Therefore this retrospective cohort study examined the

potential benefit of interventions based on intraoperative neurophysiologic monitoring in decreasing both postoperative neurologic sequelae and length of hospital stay as a cost proxy.

METHODS: With informed parental consent approved by the institutional review board,

electroencephalography, transcranial Doppler ultrasonic measurement of middle cerebral artery blood flow velocity, and transcranial near-infrared cerebral oximetry were monitored in 250 patients.

An interventional algorithm was used to detect and correct specific deficiencies in cerebral perfusion or oxygenation or to increase cerebral tolerance to ischemia or hypoxia. RESULTS: Noteworthy changes in brain perfusion or metabolism were observed in 176 of 250 (70%) patients. Intervention that altered patient management was initially deemed appropriate in 130 of 176 (74%) patients with neurophysiologic changes.

Obvious neurologic sequelae (i.e., seizure, movement, vision or speech disorder) occurred in five of 74 (7%) patients without noteworthy change, seven of 130 (6%) patients with intervention, and 12 of 46 (26%) patients without intervention (p = 0.001). Survivors' median length of stay was 6 days in the no-change and intervention groups but 9 days in the no-intervention group. In addition, the percentage of patients in the no-intervention group discharged from the hospital within 1 week (32%) was significantly less than that in either the intervention (51%, p = 0.05) or no-change (58%, p = 0.01) groups.

On the basis of an estimated hospital neurologic complication cost of $1500 per day, break-even analysis justified a hospital expenditure for neurophysiologic monitoring of $2142 per case. CONCLUSIONS:

Interventions based on neurophysiologic monitoring appear to decrease the incidence of postoperative neurologic sequelae and reduce the length of stay. Inasmuch as the break-even cost for neurophysiologic monitoring is more than four times the actual average charge, both patients and hospital may profit from this service.

Because this study was not a truly randomized clinical trial, unintentional statistical bias may have occurred and caution is urged in interpreting the magnitude of apparent intergroup outcome differences.