Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Revolution in the training of anatomy has been based on the lack of adequate instructors, cadavers and the general high cost of anatomy training. This has led to the abandonment of dissection by most countries in favour of other methods of learning. At the University of Nairobi, the need for more instructors has been addressed by training anatomists and by incorporating surgical resident students in the training of undergraduate medical students. The catchment of collecting cadavers has been increased to address the need for cadavers, with increased competition for this resource from other medical schools in Kenya. This article shares our experience at the Department of Human Anatomy, University of Nairobi, and presents arguments for the dissection course as a central tool for teaching macroscopic anatomy.
Anatomy ; education ; Cadaver ; Curriculum ; Dissection ; education ; Education, Medical, Undergraduate ; Humans ; Kenya ; Schools, Medical ; Students, Medical

In most of the medical colleges in India, unclaimed bodies from various mortuaries reach the dissection hall; and here, the body donors club has yet to gain the desired dimensions. In spite of all the adverse circumstances, the cadaver and the dissection both have survived the most rigorous test of pedagological fitness--the test of time. Today, many of the Western countries have long donor waiting lists where cadavers are acquired as anatomical gifts or through body donor programmes. Thailand's approach to body donors offers a role model for resolving the present situation. The spirit of volunteerism reflects the drastic shift in public perception and a global change in approach is needed in the present time.
Anatomy ; education ; Cadaver ; Dissection ; Education, Medical, Undergraduate ; Humans ; India ; Tissue Donors

OBJECTIVES: The aim of the present study was to evaluate changes in the management and 5-year survival rates of patients with oral cancer in our department over a 30-year period. MATERIALS AND METHODS: We investigated the patient distributions, treatment methods, method of neck dissection according to cancer stage, and 5-year survival rates for 700 oral cancer patients over the periods of 1982-1996 (256 patients), 1999-2006 (248 patients), and 2007-2011 (196 patients). RESULTS: Stage IV patients were the largest group in all of the time periods evaluated. Although surgery and radiotherapy were the most common methods in all periods (over 50%), the prevalence of patients who underwent concomitant chemoradiotherapy increased from 7.0% to 16.2%. The use of radical neck dissection decreased from 43.0% to 5.3%, while conservative surgical methods increased from 24.1% to 76.3%. Lastly, the overall 5-year survival rate increased from 31.6% to 63.5% during the study period. CONCLUSION: Although the 5-year survival rate reached the same level as that of other developed countries during the course of our study, most patients continue to come to the hospital with stage IV disease. In order to increase the 5-year survival rate of oral carcinoma, it may be necessary to improve public education and social efforts relevant to early diagnosis.
Chemoradiotherapy ; Developed Countries ; Early Diagnosis ; Education ; Humans ; Mouth Neoplasms* ; Neck Dissection ; Neoplasm Staging ; Prevalence ; Radiotherapy ; Survival Rate*

BACKGROUND/AIMS: In endoscopic submucosal dissection (ESD) training, only a flat target lesion can usually be simulated in the normal mucosa. This study aimed to evaluate the feasibility of simulated targets in the stomachs of live pigs for complete training. METHODS: Six trained endoscopists with hands-on experience with ex vivo, isolated pig stomachs were enrolled in this pilot study. An endoscopic banding device was used to create a polyp that was snared, leaving an ulcerated lesion. This simulated target model was used to perform ESD in pigs. The en bloc resection rate, procedure time, complications, quality of resection, and participants' opinions on the simulated targets were compared with the conventional model. RESULTS: En bloc resections were achieved in all six simulated targets and six conventional models. The mean size of the resected specimens was 32.2 mm (range, 20 to 39 mm) in the simulated target group and 23.5 mm (range, 11 to 40 mm) in the conventional group. The target model had a high quality of resection and had a high satisfaction rate for margin identification and correct peripheral marking. CONCLUSIONS: Good identification of the lesion and ease of periphery marking in the target model may improve resection quality.
Adult ; Animals ; *Clinical Competence ; Dissection/*education ; Feasibility Studies ; Female ; Gastric Mucosa/*surgery ; Gastroscopy/*education ; Humans ; Male ; Models, Anatomic ; Pilot Projects ; Stomach/surgery ; Stomach Neoplasms/surgery ; Sus scrofa

OBJECTIVES: To define the risk of occult cervical metastasis of maxillary squamous cell carcinoma (SCC) and the therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients. MATERIALS AND METHODS: Sixty-seven patients with maxillary SCC and cN0 neck were analyzed retrospectively, including 35 patients with maxillary gingiva and 32 patients with maxillary sinus. RESULTS: Of 67 patients, 10 patients (14.9%) had occult cervical metastasis. The incidence of occult cervical metastasis of maxillary gingival SCC was higher than that of maxillary sinus SCC (17.1% and 12.5%, respectively). The 5-year overall survival rate was 51.9% for the END group and 74.0% for the non-END group. The success rate of treatment for regional recurrence was high at 71.4%, whereas that for local or locoregional recurrence was low (33.3% and 0%, respectively). CONCLUSION: The incidence of occult cervical metastasis of maxillary SCC was not high enough to recommend END. For survival of cN0 patients, local control of the primary tumor is more important than modality of neck management. Observation of cN0 neck is recommended when early detection of regional recurrence is possible irrespective of the site or T stage. The key enabler of early detection is patient education with periodic follow-up.
Carcinoma, Squamous Cell* ; Epithelial Cells* ; Follow-Up Studies ; Gingiva ; Humans ; Incidence ; Maxilla* ; Maxillary Sinus ; Neck Dissection* ; Neck* ; Neoplasm Metastasis ; Patient Education as Topic ; Recurrence ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVES: Due to the complexity of the anatomy and function of head and neck region, the reconstruction of ablative defect in this area was always challenging. Also the increasing interest in quality of life makes the role of free flap more important for good functional result. The aim of this study is to review the result of early experience with free flap reconstruction and to show the importance of appropriate reoperation of compromised flaps. SUBJECTS AND METHOD: The medical records of patients who underwent free flap reconstruction from 2004 to 2007 were reviewed retrospectively. There were 37 patients with the average age of 58 years. The applied type of flap, primary tumor required for free flap and result for flap reoperation were analyzed. RESULTS: The overall success rate was 92% with 3 failure cases. Less experience and radical neck dissection sacrificing internal jugular vein were significant risk factor for flap failure. Reoperation due to compromised circulation of flap was performed in 8 patients (21.6%) and seven out of eight flap could be salvaged successfully (87.5%). The average time interval between detection of flap discoloration and reoperation was 54 min. CONCLUSION: The free flap technique is safe but needs some learning period and careful monitoring. Early intervention is important for saving the free flap and lowering the failure rate.
Early Intervention (Education) ; Free Tissue Flaps ; Head ; Humans ; Jugular Veins ; Learning ; Medical Records ; Neck ; Neck Dissection ; Quality of Life ; Reoperation ; Retrospective Studies ; Risk Factors

Carotid artery dissection is a significant cause of stroke in young patients. It may be asymptomatic and go undiagnosed, or minimal transient manifestations may follow, commanding a higher index of suspicion than ordinarily exists to avoid misdiagnosis. Reported herein is a 27-year-old man who suffered extracranial internal carotid artery dissection while practicing a Brazilian Jiu-Jitsu submission maneuver. The patient's condition suddenly deteriorated one week later due to distal embolization and stroke. Despite endovascular treatment, with stenting of the cervical carotid artery, neurologic deficits remained. Of note, the objective in martial arts, which is to kill or incapacitate, has yet to be fully tempered in transitioning to sport. Brazilian Jiu-jitsu, a relatively new and fast-growing form of martial art, places emphasis on submission maneuvers. Related injuries are not common knowledge and are poorly described in the literature. This account is intended to shed light on the risk of this discipline. Through education and improved supervision, vascular injuries of this nature and the potentially lethal or disabling consequences may thus be prevented in young athletes.
Adult ; Athletes ; Carotid Arteries ; Carotid Artery Injuries ; Carotid Artery, Internal* ; Carotid Artery, Internal, Dissection* ; Diagnostic Errors ; Education ; Humans ; Martial Arts ; Neurologic Manifestations ; Organization and Administration ; Sports ; Stents ; Stroke ; Vascular System Injuries