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ABSTRACT: Rapid changes in medical knowledge are forcing continuous adaptation of the basic science courses in medical schools. This article discusses a three-year experience developing a new Computed Tomography (CT)-based anatomy curriculum at the Sackler School of Medicine, Tel Aviv University, including describing the motivations and reasoning for the new curriculum, the CT-based learning system itself, practical examples of visual dissections, and student assessments of the new curriculum. At the heart of this new curriculum is the emphasis on studying anatomy by navigating inside the bodies of various living individuals utilizing a CT viewer. To assess the students' experience with the new CT-based learning method, an anonymous questionnaire was administered at the end of the course for three consecutive academic years: 2008/2009, 2009/2010, 2010/2011. Based upon the results, modifications were made to the curriculum in the summers of 2009 and 2010. Results showed that: (1) during these three years the number of students extensively using the CT system quadrupled (from 11% to 46%); (2) students' satisfaction from radiologists involvement increased by 150%; and (3) student appreciation of the CT-based learning method significantly increased (from 13% to 68%). It was concluded that discouraging results (mainly negative feedback from students) during the first years and a priori opposition from the teaching staff should not weaken efforts to develop new teaching methods in the field of anatomy. Incorporating a new curriculum requires time and patience. Student and staff satisfaction, along with utilization of the new system, will increase with the improvement of impeding factors. Anat Sci Educ. © 2013 American Association of Anatomists.
Anatomical Sciences Education 02/2013; · 2.98 Impact Factor
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ABSTRACT: According to the "brain reserve hypothesis," a larger premorbid brain protects against the development of dementia. The aim of this study was to reveal a possible pathophysiology of brain degenerative diseases by studying intracranial bone lesions that act to reduce intracranial volume (ICV), such as hyperostosis frontalis interna (HFI).
Three hundred and eighty postmenopausal females (aged 60+) who had undergone a head computerized tomography scan (Brilliance 64, Philips Healthcare, Cleveland, OH) at the Carmel Medical Center, Haifa, Israel, before the study were included. The subjects were divided into four groups according to their degree of HFI. Six measurements of the skull and brain were taken.
As HFI becomes more severe, the cranial bone thickness and cranial bone volume increase. This process is accompanied by a decrease in ICV. In none of the HFI groups studied there was a significant association between ICV and cranial bone thickness. The inter-relationships between the various thickness parameters are not disturbed by the degree of HFI.
HFI is accompanied by an increase in thickness of all calvarial bones and reduced ICV. In addition, the thickening process initiated by HFI is synchronized among the calvarial bones. Presence of HFI suggests a decrease in brain volume and has a major clinical significance as it may indicate the beginning of degenerative processes of the brain. In addition, as females age, their skulls tend to develop more robust characteristics. Am. J. Hum. Biol. 2012. © 2012Wiley Periodicals, Inc.
American Journal of Human Biology 09/2012; 24(6):812-9. · 2.27 Impact Factor
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ABSTRACT: Although Schmorl’s nodes (SNs) are a common phenomenon in the normal adult population, their prevalence is controversial and
etiology still debatable. The objective was to establish the spatial distribution of SNs along the spine in order to reveal
its pathophysiology. In this study, we examined 240 human skeleton spines (T4-L5) (from the Hamann–Todd Osteological Collection)
for the presence and location of SNs. To determine the exact position of SNs, each vertebral body surface was divided into
13 zones and 3 areas (anterior, middle, posterior). Our results show that SNs appeared more frequently in the T7-L1 region.
The total number of SNs found in our sample was 511: 193 (37.7%) were located on the superior surface and 318 (62.3%) on the
inferior surface of the vertebral body. SNs were more commonly found in the middle part of the vertebral body (63.7%). No
association was found between the SNs location along the spine and gender, ethnicity and age. This study suggests that the
frequency distribution of SNs varies with vertebra location and surface. The results do not lend support to the traumatic
or disease explanation of the phenomenon. SNs occurrences are probably associated with the vertebra development process during
early life, the nucleus pulposus pressing the weakest part of the end plate in addition to the various strains on the vertebrae
and the intervertebral disc along the spine during spinal movements (especially torsional movements).
KeywordsSpine-Spinal diseases-Intervertebral disc-Spine pathology-Disc herniation
European Spine Journal 04/2012; 19(4):670-675. · 1.97 Impact Factor
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ABSTRACT: Estimation of sex and age in skeletons is essential in anthropological and forensic medicine investigations. The aim of the current study was to examine the potential of hyperostosis frontalis interna (HFI) as a criterion for determining sex and age in forensic cases. Macroscopic examination of the inner aspect of the frontal bone of 768 skulls (326 males and 442 females) aged 1 to 103, which had undergone a head computerized tomography scan, was carried out using the volume rendering technique. HFI was divided into two categories: minor and major. HFI is a sex- and age-dependent phenomena, with females manifesting significantly higher prevalence than males (p<0.01). In both females and males, prevalence of HFI increases as age increases (p<0.01). We present herein the probabilities of designating an unknown skull to a specific sex and age cohort according to the presence of HFI (standardized to age distribution in an Israeli population). Moreover, we present the probability of an individual belonging to a specific sex or age cohort according to age or sex (respectively) and severity of HFI. We suggest a valid, reliable, and easy method for sex and age identification of unknown skulls.
Deutsche Zeitschrift für die Gesamte Gerichtliche Medizin 09/2011; 125(5):669-73. · 2.59 Impact Factor
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ABSTRACT: To examine whether the prevalence and severity of hyperostosis frontalis interna (HFI) has significantly changed during the past 100 years.
Two female populations, 100 years apart, were studied; 992 historic and 568 present day females. Detection of HFI was carried out via direct observation or CT images (Brilliance 64, Philips Medical Systems, Cleveland, Ohio). HFI was graded according to Hershkovitz et al.’s (1999) 4-scale definition and according May et al.’s (2010c) 3-scale definition.
Following correction for age, present day females manifested a significantly higher HFI prevalence compared with historic females (P < 0.05). The risk of developing HFI was found to be approximately 2.5 times greater in present day females compared with females living 100 years ago (P < 0.05). In the young age cohort, present day females manifested a significantly higher prevalence of HFI type B (P < 0.05), whereas in the old age cohort, a significant difference in the prevalence of HFI types C and D was noted between the two groups (P < 0.05). HFI tended to appear at a younger age in the present population. The last two decades has witnessed an increase in HFI prevalence(from 55.6% to 75%).
HFI prevalence has increased during the last century, especially among young individuals, possibly indicating a profound change in human fertility patterns, together with the introduction of various hormonal treatments) and new dietary habits.
American Journal of Human Biology 03/2011; 23(3):392-7. · 2.27 Impact Factor
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ABSTRACT: A descriptive study of the epiphyseal ring's structural design along the thoracolumbar spine.
To characterize and analyze the shape and size of the epiphyseal ring, to better understand its function.
The literature is lacking in metrical data pertaining to the epiphyseal ring that is usually described as a narrow bony labrum on which the external fibers of the anulus fibrosus are anchored. Most researchers express doubts as to whether the term epiphysis is justified in this case.
The sample studied included 240 human skeletons (vertebrae T4-L5) from a normal adult population (divided by sex, ethnicity, and age). Measurements of the vertebral body and epiphyseal ring were taken using a digital caliper at four different locations: anterior, posterior, right, left. In addition, each vertebral surface was photographed and the epiphyseal ring area measured (using image analyzer software Image J).
We found that relative to vertebral body size throughout the thoracolumbar spine, the anterior section of the ring was the widest and the posterior section the narrowest. The lateral parts presented intermediate values. Relative to the discal area, the epiphyseal ring area gradually decreased from T7 to T12 and increased from T12 to L4. The area of the inferior ring was always larger than the superior ring (significant only for lumbar vertebrae), regardless of sex, ethnicity, and age.
The epiphyseal ring varies largely in size and shape along the thoracolumbar spine. Much of its metrical properties are dictated by the applied mechanical stress regime during various movements, and/or the general anatomic structure of the spine.
Spine 01/2011; 36(11):850-6. · 2.08 Impact Factor
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ABSTRACT: The aim of this study was to recognize the radiological characteristics of hyperostosis frontalis interna (HFI) and to establish a valid and reliable method for its identification and classification. A reliability test was carried out on 27 individuals who had undergone a head computerized tomography (CT) scan. Intra-observer reliability was obtained by examining the images three times, by the same researcher, with a 2-week interval between each sample ranking. The inter-observer test was performed by three independent researchers. A validity test was carried out using two methods for identifying and classifying HFI: 46 cadaver skullcaps were ranked twice via computerized tomography scans and then by direct observation. Reliability and validity were calculated using Kappa test (SPSS 15.0). Reliability tests of ranking HFI via CT scans demonstrated good results (K > 0.7). As for validity, a very good consensus was obtained between the CT and direct observation, when moderate and advanced types of HFI were present (K = 0.82). The suggested classification method for HFI, using CT, demonstrated a sensitivity of 84%, specificity of 90.5%, and positive predictive value of 91.3%. In conclusion, volume rendering is a reliable and valid tool for identifying HFI. The suggested three-scale classification is most suitable for radiological diagnosis of the phenomena. Considering the increasing awareness of HFI as an early indicator of a developing malady, this study may assist radiologists in identifying and classifying the phenomena.
The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology 11/2010; 293(12):2007-11. · 1.47 Impact Factor
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Spine Journal Meeting Abstracts. 09/2010;
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ABSTRACT: Although hyperostosis frontalis interna (HFI) has been documented in the medical literature for over 300 years, its etiology remains undetermined. It is generally assumed to be associated with hormonal disturbances of the gonads. The aim of this study was to examine the association between androgen deprivation and development of HFI in males. Two groups of males over 60-years old were compared: a control group that included 180 healthy males, 45 suffering from benign prostatic hypertrophy (BPH) and a study group of 127 males with prostate cancer: 67 who received complete androgen block treatment, and 60 who received different treatments or none at all. CT head scans were used to identify and classify HFI (Brilliance 64, Philips Medical Systems, slice thickness 3 mm x 1.5 mm). It was found that males who received a complete androgen block manifested significantly higher prevalence of HFI compared to healthy males. However, no significant difference in HFI prevalence was found between males suffering from BPH and healthy males or males with prostate cancer who had not received a complete androgen block. A positive association between length of hormonal treatment and manifestation of HFI was shown. It can be concluded that BPH does not promote development of HFI; males who are hormonally treated for prostate cancer are at a higher risk of developing HFI compared to healthy males; the longer the duration of hormonal treatment, the higher the risk of developing HFI.
The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology 08/2010; 293(8):1333-6. · 1.47 Impact Factor
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ABSTRACT: The lumbar shape in females is thought to be unique, compensating for lumbar hyperlordosis. Yet, the morphological adaptation of various vertebral parameters in the thoracic and lumbar spine to this unique posture in young and adult females has only been partially addressed in the literature. Our aim was to investigate the gender association to vertebral shape in the thoracic and lumbar spine as a possible adaptation to lumbar hyperlordosis in young and adult females. A three-dimensional digitizer was used to measure the vertebral body sagittal wedging, relative spinous process thickness, and relative interfacet width at the T1-L5 level. Two hundred and forty complete, non-pathological skeletons of adults and 32 skeletons of young individuals were assessed. Three major results were found to be independent of age and ethnicity: (a) VB sagittal wedging in females was significantly less kyphotic than males from T9 to L2 (T11 excluded) with a cumulative mean difference of 8.8 degrees ; (b) females had a significantly relatively thinner lumbar spinous processes and (c) females had a relatively wider superior interfacet distance (T9-T10 and L1-L4) than males. We conclude that the combination of less kyphotic VB wedging in the lower thoracic and upper lumbar vertebrae, relatively greater interspinous space and larger interfacet width in the lumbar spine in females are key architectural elements in the lumbar hyperlordosis in females and may compensate for the bipedal obstetric load during pregnancy.
European Spine Journal 05/2010; 19(5):768-73. · 1.97 Impact Factor
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ABSTRACT: A descriptive computed tomography (CT) study of the ligamentum flavum (LF) thickness in individuals with normal and stenotic lumbar spines.
To establish standards for normal and pathologic range of LF thickness and its asymmetry as indicated in CT images and to examine its association with vertebral body size, age, and gender.
LF lines a considerable part of the posterior and lateral walls of the spinal canal and is a major role contributor to spinal canal stenosis. Due to methodologic deficiencies (e.g., small sample size, lack of control for vertebral body size, gender, and age), the normal range of LF thickness is still controversial. Furthermore, data on important aspect of LF thickness such as left-right differences are missing.
Two groups of individuals were studied. The first group included 65 individuals with lumbar spinal stenosis (LSS) (mean age: 66 +/- 9.7 years) and the second, 150 individuals (mean age: 52 +/- 19 years) without LSS-related symptoms. LF thickness was measured on CT images (Philips Brilliance 64), obtained from axial plane scan at the intervertebral disc level. Measurements were performed at the levels of L3-L4, L4-L5, and L5-S1. Analysis of variance and t test were carried out to evaluate the association between LF thickness and demographic factors.
Absolute and relative LF thickness were significantly greater in the LSS group at the levels of L3-L4 and L4-L5 on both sides, compared to control group (P < 0.05). LF thickness was independent of gender (absolute and relative thickness). Even though LF thickness at all levels significantly increases with age, significant changes after the age of 60 occurred only at L3-L4. Significant asymmetry in LF thickness was found at L3-L4 (2.9 +/- 0.90 mm on the right vs. 2.76 +/- 0.90 mm on the left) and L5-S1 (3.42 +/- 1.1 mm on the right vs. 3.22 +/- 1.22 mm on the left) (P < 0.05).
LF thickness is an age-dependent and gender-independent phenomenon. LF is significantly thicker on the right side. The borderline between normal and pathologic LF thickness should not be set at 4 mm.
Spine 03/2010; 35(12):1225-30. · 2.08 Impact Factor
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ABSTRACT: Although Schmorl's nodes (SNs) are a common phenomenon in the normal adult population, their prevalence is controversial and etiology still debatable. The objective was to establish the spatial distribution of SNs along the spine in order to reveal its pathophysiology. In this study, we examined 240 human skeleton spines (T4-L5) (from the Hamann-Todd Osteological Collection) for the presence and location of SNs. To determine the exact position of SNs, each vertebral body surface was divided into 13 zones and 3 areas (anterior, middle, posterior). Our results show that SNs appeared more frequently in the T7-L1 region. The total number of SNs found in our sample was 511: 193 (37.7%) were located on the superior surface and 318 (62.3%) on the inferior surface of the vertebral body. SNs were more commonly found in the middle part of the vertebral body (63.7%). No association was found between the SNs location along the spine and gender, ethnicity and age. This study suggests that the frequency distribution of SNs varies with vertebra location and surface. The results do not lend support to the traumatic or disease explanation of the phenomenon. SNs occurrences are probably associated with the vertebra development process during early life, the nucleus pulposus pressing the weakest part of the end plate in addition to the various strains on the vertebrae and the intervertebral disc along the spine during spinal movements (especially torsional movements).
European Spine Journal 12/2009; 19(4):670-5. · 1.97 Impact Factor
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ABSTRACT: A descriptive study of the association between Schmorl nodes (SNs) and gender, ethnic origin, and age in a normal skeletal population.
To gain reliable data on behavioral patterns of SNs in various human groups shedding light on its etiology.
Opinions regarding SNs prevalence in human populations vary greatly (from 5% to 70%). This caveat greatly reduced our ability to recognize the etiology of the phenomenon and understand its clinical significance.
Two hundred forty human skeleton vertebrae (T4-L5) from a normal adult population (divided by gender, ethnicity, and age) were examined for SNs. SNs were defined as depressions with sclerotic margins appearing on the vertebral body surface.
One hundred sixteen individuals (48.3%) of the 240 studied manifested SNs along their thoracolumbar spine. SNs are age independent and gender and ethnicity dependent, are significantly more common in males (54.2%) versus females (43%) and more common in European-Americans (60.3%) versus African-Americans (36.7%).
SNs are a common phenomenon in the normal adult populations with almost half of the individuals in our sample manifesting at least 1 vertebra with SN. Its demographic characteristics suggest that the phenomenon is not of occupational origin, promoting the notion of genetic background.
Spine 05/2009; 34(9):E312-5. · 2.08 Impact Factor
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ABSTRACT: A descriptive magnetic resonance imaging (MRI) study on the growth of the lumbar zygapophyseal facets and interfacet area in children from the general population.
To characterize lumbar facet and interfacet shape variation during growth.
The growth of the lumbar facet and interfacet area in children from the general population has rarely been discussed in the literature. This is an important caveat considering the important role these structures play in the development of spinal anomalies.
All lumbar (L1-S1) facet and interfacet widths and transverse orientations were measured twice by the same investigator (Y.M.) from T2-weighted MRIs of 100 healthy children (51 boys and 49 girls) from the general population at the mean age of 12 to 13 years (t0) and after 3 years at the mean age of 15 to 16 years (t1) using the iQ-VIEW system. Statistical analysis included Student t tests and Pearson r after the Kolmogorov-Smirnov test for normal distribution. RESULTS.: The superior facet width is correlated with individual's height only in boys at t0 (0.56 < or = r < or = 0.66). No significant asymmetry in lumbar facet width and orientation is seen in children independent of gender both at t0 and t1. Lumbar facets have widened significantly only in boys from t0 to t1 (up to 30.8%). Girls at t1 manifest greater superior interfacet width relatively to the superior vertebral body width than boys at L2-L4. No significant difference is indicated in facet orientation of the 2 sexes at t0 and t1. In boys only, the superior facet rotates significantly from t0 to t1 (up to-10 degrees in the interfacet angle) toward a more sagittal orientation.
The lumbar facet joints in boys continue to develop after the age of 12, whereas facets in girls seem to have reached maturity at that age. Moreover, lumbar facet asymmetry when noted in children can be considered as a deviation from the normal state. Further research should look into what the consequences might be.
Spine 02/2009; 34(4):408-12. · 2.08 Impact Factor
