Methods and outcomes of teaching functional anatomy of the musculoskeletal system: A scoping review

PURPOSE

Although musculoskeletal anatomy is inherently related to motion, there is a lack of evidence review about the best teaching practices for the locomotor apparatus functional anatomy. We aimed to detect the strategies that have been implemented for functional musculoskeletal anatomy education, and their outcomes, with the ultimate purpose of suggesting the most effective teaching methods.

METHODS

The databases PubMed, Scopus, ERIC, and Cochrane Library were searched for papers with the purpose of exploring the outcomes (participants' perceptions and/or examination performance) of teaching functional musculoskeletal anatomy. From each study, the following information was extracted: author(s), number of participants, implementation method, participants' perceptions and/or examination performance after the educational intervention, and classification of the outcomes according to the Kirkpatrick hierarchy.

RESULTS

Seven papers were included. Six of them involved active learning strategies (other than seeing, listening, and taking notes). Several specific teaching methods were implemented, including physical activities, lectures, textbooks, atlases, prosected specimens, near-peer teaching, and digital and physical models. Overall, methods that involved active learning, especially some form of physical activity, had the best educational outcomes, while passive learning was not found to be significantly more effective in any case. The role of modern anatomy education technologies has been inadequately explored.

CONCLUSIONS

It appears that teaching functional musculoskeletal anatomy is more successful when using active learning methods, especially involving some form of physical activity. More research is necessary to determine the best environment for these methods and investigate the role of modern technologies in functional musculoskeletal anatomy education.

The effectiveness of three-dimensional printing in undergraduate and postgraduate anatomy education: A review of reviews

PURPOSE

Several reviews and meta-analyses about the value of three-dimensional (3D) printing in anatomy education have been published in the last years, with variable-and sometimes confusing- outcomes. We performed a review of those reviews, in order to shed light on the results concerning the effectiveness of 3D printing in anatomy education, compared to specific traditional methods and other technologies.

METHODS

The electronic databases PubMed, ERIC and Cochrane library were searched for reviews or meta-analyses with purpose to investigate the effectiveness of 3D printing in undergraduate and postgraduate anatomy education.

RESULTS

Seven papers were included: four systematic reviews with meta-analysis, one narrative, one scoping and one systematic review. Overall, it has been shown that 3D printing is more effective than two-dimensional (2D) images for undergraduate health science students, but not for medical residents. Also, it seems to be more effective than 2D methods for teaching anatomy of some relatively complex structures, such as the nervous system. However, there is generally lack of evidence about the effectiveness of 3D printing in comparison with other 3D visualization methods.

CONCLUSIONS

For students, the effectiveness of 3D printing in anatomy education is higher than 2D methods. There is need for studies to investigate the effectiveness of 3D printing in comparison with other 3D visualization methods, such as cadaveric dissection, prosection and virtual reality. There is also need for research to explore if 3D printing is effective as a supplementary tool in a blended anatomy learning approach.

Fracture of the Second Rib: An Indirect Sign of Serious Trauma Like Fracture of the First Rib?

Background

The first 3 ribs are anatomically well-protected, shielded by the large thoracic muscles, the shoulder girdle, and the arm. A significant force is required to fracture these ribs; thus, such fractures suggest a high-energy trauma and are associated with injuries to vital organs of the thorax, such as the aorta, the heart, the lungs and the great vessels.

Methods

A retrospective analysis was conducted over a 10-year period at a single hospital. The study assessed patients with fractures of the second rib, including their concurrent injuries and the overall severity of their trauma.

Results

Among the 76 patients included in the study, the average age was 47.35 years, 81.5% were men, and 19.5% were women. Thirteen patients (17.1%) survived their injuries. The most common causes of injury were road traffic accidents (63%) and pedestrian injuries (22%). The patients who did not survive sustained injuries to an average of 5 additional organs, while survivors had injuries to an average of 2.07 additional organs. Left rib fractures were the most frequently observed (46%). The most serious concurrent injuries reported were to the aorta (5.26%), heart (10.52%), lung (52.36%), head (57.89%), liver (30.2%), spleen (26.31%), and kidney (17.1%).

Conclusion

As indicators of serious injury to vital endothoracic organs, isolated fractures of the second rib should be considered equal to first rib fractures in clinical importance.

The Brachiocephalic Trunk Variant Origin and High-Riding Course: Two Cadaveric Cases

OBJECTIVE

The current report describes two rare cadaveric findings of a left sided brachiocephalic trunk (BCT) in relation to the trachea, and its high-riding course above the suprasternal notch (SN).

CASES DESCRIPTION

In two elderly body donors dissected after death, a left-sided BCT was identified with a high-riding course (0.5 and 0.8 cm above the SN). The BCT originated from the aortic arch, in common with the left common carotid artery, more distally than the typical left-side location and crossed in front of the trachea. In the 1st case, the ascending and descending aortae, and the left subclavian artery had aneurysmal dilatation. In both cases, the trachea was displaced to the right side and had a stenosis due to the chronic compression.

CONCLUSION

A high-riding BCT is of paramount clinical importance, as it may complicate tracheotomy, thyroid surgery and mediastinoscopy, leading to fatal complications. BCT injury leads to a massive bleeding during neck dissection (level VI), when the vessel crosses the anterior tracheal wall.

Do virtual dissection tables add benefit to cadaver-based anatomy education? An evaluation

PURPOSE

The anatomy education literature suggests blended-learning approaches as more effective. We performed a literature review to answer the question if virtual dissection tables can play a significant role as supplements to traditional cadaver-based anatomy education methods.

METHODS

PubMed, SCOPUS, ERIC and Cochrane databases were searched for articles with purpose to explore the outcomes of the use of virtual dissection tables in conjunction with cadaver-based anatomy education.

RESULTS

Six articles were included. Three articles were comparative and comprised evaluation of participants' anatomy examinations results. Three articles were non-comparative and comprised only evaluation of participants' opinions about the educational intervention. In all studies, the participants expressed satisfaction about the educational value of this intervention, while the data about anatomy examinations' results suggest that virtual dissection tables may also enhance students' academic performance, when they are used in conjunction with cadavers.

CONCLUSION

Virtual dissection tables seem to do have a role in modern blended-learning anatomy curricula and could essentially supplement the educational power of cadaver-based methods. Our findings may stimulate further implementation of virtual dissection tables as supplementary tools to cadaver-based anatomy education.

Gestures-enhanced anatomy teaching: A literature review of an educational strategy with promising outcomes

PURPOSE

The educational use of gestures has resulted in positive outcomes in several fields. We performed a literature review to investigate the outcomes of the use of gestures to enhance the existing anatomy education methods.

METHODS

PubMed, SCOPUS, ERIC and Cochrane databases were searched for papers with purpose to investigate the outcomes of the use of gestures (either seeing or performing them or both) as adjuncts to existing anatomy education methods.

RESULTS

Six articles were included. Three studies comprised both seeing and performing gestures by the students, while the remaining three studies only comprised either seeing or performing gestures by the students. Most studies evaluated the acquisition of anatomical knowledge after the educational intervention and demonstrated that the addition of gestures resulted in significant benefit compared to control groups, while positive students' perceptions were recorded. It was not clarified whether seeing or performing gestures by the students leads to better educational outcomes.

CONCLUSION

Gestures-enhanced anatomy education seems to be a promising teaching strategy, given that it has led to significantly increased acquisition of anatomical knowledge compared to no gestures-enhanced modalities. The addition of gestures to existing anatomy education modalities seems able to increase their potential without increasing their cost. Further research is needed to determine if seeing or performing gestures by the students is more effective.

Evaluation of the use of cadaveric computed tomography in anatomy education: An overview

OBJECTIVE

We aimed to explore to what extent the literature supports that the use of cadaveric computed tomography can play an important role in anatomy education.

MATERIALS AND METHODS

PubMed, SCOPUS, Education Resources Information Center and Cochrane Databases were searched for papers with purpose to explore the outcomes of the use of cadaveric computed tomography scans in anatomy education. The following data were obtained from each paper: authors, number of participants, type of study (comparative or not), level of outcome according to Kirkpatrick hierarchy, possible evaluation of statistical significance, acquisition of anatomical knowledge after the educational intervention and perceptions about the effectiveness of this intervention in anatomy learning.

RESULTS

Seven articles were included. Four of them evaluated students' knowledge after the use of cadaveric computed tomography scans in anatomy education and three papers evaluated only students' perceptions. Generally, the outcomes, which mainly concerned students' perceptions, were positive, while it was showed that students' academic performance may also be improved.

CONCLUSIONS

The outcomes of the use of cadaveric computed tomography scans in anatomy education encourage the implementation of this teaching modality in anatomy curricula. Further research, including comparative studies with evaluation of acquisition of students' knowledge, is needed to show if cadaveric computed tomography will be proved a remarkable supportive tool in anatomy educators' hands.

Incorporation of team-based learning in the cadaveric anatomy laboratory: An overview

PURPOSE

Team-based learning is a strategy which has resulted in positive outcomes concerning health professions education. We aimed to shed light on the role of this strategy when it is incorporated in the cadaveric anatomy laboratory.

METHODS

We explored PubMed, SCOPUS, ERIC and Cochrane databases for articles with purpose to investigate the educational outcomes of the integration of team-based learning in the cadaveric anatomy laboratory.

RESULTS

Six articles were eligible for inclusion. One of them assessed only participants' opinions about the educational intervention and five papers evaluated students' knowledge. Overall, the research showed significant improvement in students' examinations performance and significant superiority to control groups, as well as positive perceptions. There are limited data regarding the factors which may contribute to this success, but it seems that particularly the degree of teacher's involvement and competency needs to be further investigated.

CONCLUSION

Anatomy educators may consider further adopting team-based learning to facilitate the achievement of the learning objectives of the cadaveric anatomy laboratory and increase the teaching potential of cadavers.

Anatomical Variations of the Iliohypogastric Nerve: A Systematic Review of the Literature

Several anatomical variations of the iliohypogastric nerve branches have been observed in earlier studies. Knowledge of these variations is useful for the improvement of peripheral nerve blocks and avoidance of iatrogenic nerve injuries during surgeries. The purpose of this study was to perform a systematic review of the literature about the anatomical topography and variations of the iliohypogastric nerve. An extensive search on PubMed, Scopus, and Web of Science electronic databases was conducted by the first author in November 2021, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Anatomical or cadaveric studies about the origin, the course, and the distribution of the iliohypogastric nerve were included in this review. Thirty cadaveric studies were included for qualitative analysis. Several anatomical variations of the iliohypogastric nerve were depicted including its general properties, its origin, its branching patterns, its course, its relation to anatomical landmarks, and its termination. Among them, the absence of the iliohypogastric nerve ranged from 0 to 34%, its origin from L1 ranged from 62.5 to 96.5%, and its isolated emergence from psoas major ranged from 47 to 94.5%. Numerous anatomical variations of the iliohypogastric nerve exist but are not commonly cited in classic anatomical textbooks. The branches of the iliohypogastric nerve may be damaged during spinal anesthesia and surgical procedures in the lower abdominal region. Therefore, a better understanding of the regional anatomy and its variations is of vital importance for the prevention of iliohypogastric nerve injuries.

A Novel Test, the Sternomental Distance Ratio, Used as a Predictor of Difficult Laryngoscopy in a Normal Population and in Thyroid Tumor Surgery Patients: A Preliminary Study

OBJECTIVE

The aim of the present preliminary study was to assess whether the sternomental distance ratio (SMDR) could be suitable as a predictor of difficult laryngoscopy, in both normal surgical patients and patients scheduled to undergo thyroid tumor surgery.

METHODS

Two hundred and twenty-one consecutive adult patients (among them 122 patients with presumed normal airways and 33 patients with thyroid tumors), scheduled to undergo elective surgery under general anesthesia, were included in this study. Physical and airway characteristics, SMDR, difficult laryngoscopy (using Cormack-Lehane scale) and any kind of assisted intubation were assessed.

RESULTS

Decreased SMDR demonstrated a strong correlation with difficult laryngoscopy in both thyroid tumor (Kendall's tau-b -0.578 (P=0.004) and normal patients -0.362 (P<0.001). Difficult laryngoscopy was 0 at SMDR>1.9 and 33% at SMDR <1.55 (P<0.001). The higher the SMDR was, the better the glottic view obtained.

CONCLUSIONS

? SMDR>1.9 indicates an easy laryngoscopy, whereas SMDR <1.55 indicates a difficult one in both thyroid tumor and normal patients. SMDR is an objective test to assess difficult airway in thyroid surgery.

An Unusual Bilateral Duplication of the Suprascapular Vein and Its Relation to the Superior Transverse Scapular Ligament Revealed by Anatomage Table

OBJECTIVE

The aim of our paper is to present a rare variation of the suprascapular vein, its incidence and clinical significance.

CASE REPORT

A rare case of a double suprascapular vein was observed in a digitalized human cadaver on Anatomage Table 5.0. The vein divided into two branches, one passing over the transverse scapular ligament, while the other one coursed underneath the ligament, inside the notch.

CONCLUSION

This variation has major clinical importance as it is associated with the appearance of Suprascapular nerve entrapment syndrome.

Sternomental Distance Ratio as a Predictor of Difficult Laryngoscopy: A Prospective, Double-Blind Pilot Study

Background:

No single test has shown to be an accurate predictor of difficult laryngoscopy.

Aims:

This study aims to evaluate the effectiveness of the ratio of the sternomental distance (SMD) in neutral and full neck extension position SMD ratio (SMDR) as a predictor of difficult laryngoscopy and any need of assisted intubation.

Settings and Design:

Prospective, double-blind pilot study.

Materials and Methods:

This study included 221 consecutive adult patients scheduled to undergo elective surgery under general anesthesia. Physical and airway characteristics, SMDR, difficult laryngoscopy (using Cormack/Lehane [C/L] scale), and any kind of assisted intubation were assessed.

Statistical Analysis:

The optimal cutoff point for SMDR was identified using receiver operating characteristic (ROC) analysis. The association between SMDR and the intubation method was evaluated through multiple logistic regression analysis.

Results:

A SMDR below 1.55 led in 33% of the cases to assisted intubation and 33%–53% of C/L III–IV glottic views for McCoy and Macintosh blades, respectively. On the other hand, SMDR above 1.9 led to no C/L IV glottic views for both blades and 4% and 11% C/L III views glottic views for McCoy and Macintosh, respectively. The best sensitivity and specificity cutoff point as defined by the ROC curve was identified for an SMDR value of 1.7 (area[s] under the curve: 0.815; 95% confidence interval: 0.743–0.887). Assisted intubation rates were significantly higher in patients with an SMDR inferior to 1.7 (30.5% compared to 3.5%, P < 0.001).

Conclusions:

SMDR is a simple, objective, and easy to perform test. The present study indicates that SMDR may be helpful in predicting difficult laryngoscopy and assisted intubation.

Arthroscopic resection of extra-articular knee osteochondroma: report of two cases

Osteochondroma is the most common benign tumor of the growing bone, usually affecting the knee joint, located extra-articularly. Solitary intra-articular osteochondroma is very rare. In the current paper, two cases of solitary extra-articular knee osteochondromas adjacent to the capsule producing pain and restriction of knee motion are described. Diagnostic evaluation is based on combination of radiography and magnetic resonance imaging. Both osteochondromas excised arthroscopically, resulting in complete symptoms relief and full range of knee motion. On follow-up, no recurrence was recorded. Based on our experience, although limited, not only the intra-articular, but also some solitary extra-articular knee osteochondromas can be successfully treated by arthroscopy, resulting in better cosmetic result, less postoperative pain and faster recovery.

Non-Recurrent Laryngeal Nerve and Concurrent Vascular Variants: A Review

OBJECTIVE

The purpose of this paper is to review the current data on the coexistence of non-recurrent laryngeal nerve (RLN) and vascular variations.

METHODS

A systematic literature search was conducted on MEDLINE for case reports, original articles and reviews regarding the presence of non-RLN and coexisting vascular variants.

RESULTS

From the literature search, 104 cases of non-RLN with confirmed vascular variants were reported. More specifically, 97.7% (n=101) of cases involved a right and 2.3% (n=3) a left non-RLN. The most common concurrent vascular variant reported with a right non-RLN was an aberrant right subclavian artery (97%; n=98). One case report (0.9%) of an intrathyroidal right common carotid artery was noted and 2 cases (1.9%) were associated with normal vascular anatomy. Furthermore, all 3 cases of a left non-RLN were associated with a right aortic arch, while 2 of them were also accompanied with situs inversus.

CONCLUSIONS

The presence of vascular variations of the great vessels must prompt the surgeon to search for a non-RLN. Intraoperative neuromonitoring increases the detection rate of non-RLN. Further research is required to determine anatomic landmarks for the perioperative identification of a non-RLN, allowing its protection from potential injury.

The position of the mental foramen in dentate and edentulous mandibles: clinical and surgical relevance

BACKGROUND

The knowledge of the exact location of the mental foramen (MF) in dentate and edentulous mandibles is clinically important when constructing complete dentures, performing anaesthetic block of the lower-anterior teeth area and intervening in the MF nearby area. In edentulous mandibles, the bone resorption after teeth loss makes the mental nerve (MN) prone to damage due to the extreme location of the MF very close to the alveolar crest (AC). Chronic compression on the MN may result in pain in the area of MN distribution (ipsilateral face and cheek area) and numbness at the lower lip. The purpose of the current study is to evaluate the exact position of the MF, calculating the distances MF-superior border of the AC and MF-inferior border of the mandible (IBM) in dentate and edentulous mandibles.

MATERIALS AND METHODS

One hundred and two (36 edentulous and 66 dentate) adult dry Greek mandibles were studied.

RESULTS

In 9 out of 36 edentulous mandibles (25%), the MF was found nearby the AC, while in 27 edentulous mandibles (75%), the MF was located at an average distance 6.4 mm from the AC and 12.6 mm from the IBM. In 38 out of 66 dentate mandibles (57.6%), the MF was located at an average distance 13.6 mm from the AC and 15.2 mm from the IBM. The dental status significantly affected (p = 0.001) the distances MF-AC and MF-IBM. Side symmetry was observed for both dentate and edentulous mandibles (p = 0.39 and p = 0.45).

CONCLUSIONS

The MF is an important landmark and its location needs to be considered prior to dental implants placement in order to avoid the MN injury and related complications. The position of MF is altered in edentulous mandibles compared with the dentate ones. The MF is a symmetric structure in Greeks.

The Effect of Low Molecular Weight Heparins on Fracture Healing

Venous Thromboembolism is a serious complication in the trauma patient. The most commonly studied and used anticoagulant treatment in prophylaxis of thrombosis is heparin. The prolonged use of unfractionated heparin has been connected with increased incidence of osteoporotic fractures. Low molecular-weight-heparins (LMWHs) have been the golden rule in antithrombotic therapy during the previous two decades as a way to overcome the major drawbacks of unfractioned heparin. However there are few studies reporting the effects of LMWHs on bone repair after fractures. This review presents the studies about the effects of LMWHs on bone biology (bone cells and bone metabolism) and underlying the mechanisms by which LMWHs may impair fracture healing process. The authors' research based on literature concluded that there are no facts and statistics for the role of LMWHs on fracture healing process in humans and the main body of evidence of their role comes from in vitro and animal studies. Further large clinical studies designed to compare different types of LMWHs, in different dosages and in different patient or animal models are needed for exploring the effects of LMWHs on fracture healing process.

Report of an unusual combination of arterial, venous and neural variations in a cadaveric upper limb

In this study an unusual combination of arterial, venous and neural variations discovered during dissection of cervical, axillary and brachial area of a cadaver is described. Variations are thoroughly described and literature is briefly reviewed. Lateral cord of brachial plexus was not formed; Eight Cervical root divided into anterior and posterior division before uniting with First Thoracic root and Upper Trunk was unusually short. Axillary artery gave origin to a superficial brachial artery and then continued as deep brachial artery. Multiple variations in typical axillary artery branches were present including existence of inferior pectoral artery. Cephalic vein was absent. A variety of interventions, from relative simple as central venous catheter placement to most complicated as brachial plexus injury repair demand thorough knowledge of area's regional anatomy. Familiarity with anatomic variations allows more precise and careful interventions. Research on these variations is valuable for anatomists and embryologists but also for clinicians because it may provide useful information for non - typical cases but also helps in raising a high level of suspicion.

Median to ulnar nerve anastomosis: a review of the literature

Median to Ulnar nerve anastomosis in the forearm has been shown to be of clinical significance leading to "anomalous" innervation and is correlated with misdiagnosis during the assessment of nerve lesions, injuries and Carpal Tunnel Syndrome (CTS). In 1763, Martin first described the anastomosis and Gruber next mentioning it, in 1870 thus referred to as Martin--Gruber anastomosis. Despite its long history, its nature remains unclear. Many anatomical, electrophysiological, histological and genetic studies have been published, reporting the anastomosis' frequency, citing its clinical importance and classifying it into various classes and types. Diagnosis is made mostly with electrophysiological studies whereby researchers have cited certain clues taking into consideration the asymptomatic nature of the anastomosis. The current literature on median to ulnar nerve anastomosis is reviewed, highlighting its frequency and clinical significance making an excellent tool for correct diagnosis in many clinicians.

The first anatomy professors in the medical school of the University of Athens

The purpose of this historical review is to add new elements to the international literature in relation to the birth and progress of the science of anatomy in modern Greece. Step by step, it outlines the efforts of prominent Greek anatomists to establish the course of the basic science of anatomy in the newly founded Medical School, the laborious effort to collect cadaveric material to compile museum anatomical collections and to gradually build the foundations of modern anatomy science at the Medical School of the Athenian University.

Anatomical variation and morphology in the position of the palatine foramina in adult human skulls from Greece

OBJECTIVE

To investigate the anatomical variability of the palatine structures in Greek population.

MATERIAL AND METHODS

71 Greek adult dry human skulls were examined to detect the position of the greater palatine (GPF) and lesser palatine foramina (LPF) related to adjacent anatomical landmarks.

RESULTS

The perpendicular distance of the GPF to the midline sagittal suture was 1.53 cm and 0.3 cm from the inner border of the alveolar ridge. The mean distance from the posterior palatal border was consistent 0.46 cm on the right and 0.47 cm on the left side of the skulls. In the greater majority of the skulls (76.2%), the GPF were between proximal-distal surfaces of the 3rd maxillary molar. A single LPF was observed in 53.45% of the skulls, two LPF were observed in 31% of the skulls bilaterally and five LPF were rare (2.1%). The commonest position of LPF was at the junction of the palatine bone and the inner lamella of the pterygoid plate (71.9%).

CONCLUSION

Our results can help clinicians localize the palatine foramina in patients with and without maxillary molars and to predict the depth of a needle to anaesthetise the maxillary nerve with greater success when performing surgical procedures in the hard and soft palate.

Lingual nerve entrapment in muscular and osseous structures

Running through the infratemporal fossa is the lingual nerve (i.e. the third branch of the posterior trunk of the mandibular nerve). Due to its location, there are various anatomic structures that might entrap and potentially compress the lingual nerve. These anatomical sites of entrapment are: (a) the partially or completely ossified pterygospinous or pterygoalar ligaments; (b) the large lamina of the lateral plate of the pterygoid process; and (c) the medial fibers of the anterior region of the lateral pterygoid muscle. Due to the connection between these nerve and anatomic structures, a contraction of the lateral pterygoid muscle, for example, might cause a compression of the lingual nerve.

Any variations in the course of the lingual nerve can be of clinical significance to surgeons and neurologists because of the significant complications that might occur. To name a few of such complications, lingual nerve entrapment can lead to: (a) numbness, hypoesthesia or even anesthesia of the tongue's mucous glands; (b) anesthesia and loss of taste in the anterior two-thirds of the tongue; (c) anesthesia of the lingual gums; and (d) pain related to speech articulation disorder. Dentists should, therefore, be alert to possible signs of neurovascular compression in regions where the lingual nerve is distributed.

New distal embolic protection device the FiberNet® 3 dimensional filter: First carotid human study

OBJECTIVE

Evaluate the performance and safety of the FiberNet Embolic Protection System during carotid artery intervention.

BACKGROUND

Carotid Angioplasty and Stenting (CAS) can be proposed to treat the majority of carotid stenoses. Brain embolization takes place and routine use of Embolic Protection Devices (EPD) is warranted. Many EPDs have significant limitations, which may be addressed by a new EPD, the FiberNet (Lumen Biomedical, Plymouth, MN).

METHODS

The system consists of a 3-dimensional expandable filter made of fibers, which expand radially, mounted onto a 0.014'' wire and retrieval catheter. FiberNet can capture particles as small as 40 microm without compromising flow.

RESULTS

35 lesions treated in 34 patients. Male 67.6%. Age: 71.4 +/- 8.8 (50-85). Average stenosis 84.5% +/- 7.9 (70-99). 29.4% were symptomatic. Technical success: 34/35 (97%). No stroke or death within 30 days. Neurological events: two permanent amaurosis, one amaurosis fugax. All samples visually contained significant amounts of emboli. The mean surface area of debris caught was 63.8 mm(2) (37.7-107.5). Comparisons were made with other EPDs. The mean surface area of debris caught was 12.2 mm(2) (2.7-34.3). No changes were noted in CT/MRI at 30-day post procedure.

CONCLUSION

The first human use of this new novel EPD in carotid artery stenting is encouraging. The FiberNet was easy to use and confirmed the ability to capture particles less than 100 microm. The feasibility of the FiberNet has been demonstrated. Additional patients will demonstrate the overall safety and efficacy of this new EPD device.

Safety and efficacy of off-pump coronary artery bypass grafting in chronic dialysis patients

Off-pump coronary artery bypass grafting (CABG) has been recently revived, because cardiopulmonary bypass (CPB) appears to worsen the multiple organ dysfunction after conventional CABG. To evaluate the safety and efficacy of the off-pump CABG in chronic dialysis patients, we compared the perioperative morbidity and mortality between 15 dialysis patients who underwent off-pump CABG at our center over the past 8 years with that of a concurrent group of 19 patients who underwent conventional CABG. Patients were selected for off-pump CABG only when complete revascularization was technically feasible. We found that off-pump CABG is as safe and effective as conventional CABG in selected dialysis patients. It might even be beneficial, because it is associated with less hematocrit drop and blood product use, a lower catabolic rate, and fewer dialysis requirements after surgery. However, the impact of off-pump technique on the long-term clinical outcome and resource utilization in renal patients requires further investigation.