Major national and international critiques of the medical curriculum in the 1980s noted the following significant flaws: (1) over-reliance on learning by rote memory, (2) insufficient exercise in analysis and synthesis/conceptualization, and (3) failure to connect the basic and clinical aspects of training. It was argued that the invention of computers and related imaging techniques called to question the traditional instruction based on the faculty-centered didactic lecture. In the ensuing reform, which adopted case-based, small group, problem-based learning, time allotted to anatomical instruction was severely truncated. Many programs replaced dissection with prosections and computer-based learning. We argue that cadaver dissection is still necessary for (1) establishing the primacy of the patient, (2) apprehension of the multidimensional body, (3) touch-mediated perception of the cadaver/patient, (4) anatomical variability, (5) learning the basic language of medicine, (6) competence in diagnostic imaging, (7) cadaver/patient-centered computer-assisted learning, (8) peer group learning, (9) training for the medical specialties. Cadaver-based anatomical education is a prerequisite of optimal training for the use of biomedical informatics. When connected to dissection, medical informatics can expedite and enhance preparation for a patient-based medical profession. Actual dissection is equally necessary for acquisition of scientific skills and for a communicative, moral, ethical, and humanistic approach to patient care. Anat Rec (New Anat) 269:20-32, 2002.

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Mammalian atria have previously been shown to produce a variety of peptides with natriuretic and vasorelaxant activities. Certain of these atrial natriuretic factors (ANF) have been localized immunocytochemically in secretory granules of atrial myocytes. However, the precise sites of action and extra-atrial synthesis or accumulation of ANF have not been identified immunocytochemically. In the present study, immunoreactive ANF was detected in rat atrial myocytes, intercalated cells of the renal collecting ducts, adrenal medullary chromaffin cells, and gonadotrophs of the anterior pituitary using an antibody against synthetic rat ANF-IV (H2N-Arg-Ser-Ser-Cys-Phe-Gly- Gly-Arg-Ile-Asp-Arg-Ile-Gly-Ala-Gln-Ser-Gly-Leu-Gly-Cys-Asn-Ser-Phe- Arg-Try-COOH). The localization of ANF in specialized cells of the renal collecting tubules and ducts supports suggestions that these structures may be a site of natriuretic action of ANF. In addition, immunocytochemical localization of ANF in the rat adrenal medulla and anterior pituitary suggests the existence of alternate sites of action and/or synthesis. We believe these findings are important for a more complete understanding of the role of ANF in fluid and sodium regulation and of the participation of ANF in the development of sodium-dependent hypertension.

Background Postoperative pain after total knee arthroplasty remains one of the most important challenges facing patients undergoing this surgery. Providing a balance of adequate analgesia while limiting the functional impact of regional anesthesia and minimizing opioid side effects is critical to minimize adverse events and improve patient satisfaction. Questions/Purposes We asked whether bupivacaine delivered through an elastomeric device decreases the (1) patients' perception of pain after TKA; (2) narcotic consumption; and (3) narcotic-related side effects as compared with a placebo.Methods In this prospective, double-blind, placebocontrolled study, all patients received standardized regional anesthesia, a preemptive and multimodal analgesic protocol, and a continuous intraarticular infusion at 5 mL/hour through an elastomeric infusion pump. The patients were randomized to receive either an infusion pump filled with (1) 300 mL of 0.5% bupivacaine, the experimental group (n = 75); or (2) 300 mL of 0.9% normal saline solution, the control group (n = 75). Data concerning postoperative pain levels through a visual analog scale, postoperative opioid consumption, opioid-related side effects, and complications were collected and analyzed.