A 56-year-old man presented following a right middle cerebral artery territory infarction (figure). In addition to left hemiparesis and neglect, he was unable to close his left eye on command (video at Neurology.org), though he was able to blink spontaneously and keep his eyes closed during sleep. He could maintain closure of both eyes once manually closed. Apraxia of eyelid closure is distinguished clinically from eyelid closure weakness by ability to blink reflexively and maintain eyelid closure. Activation of the oculomotor cortex has been associated with voluntary eyelid closure and lesions in right frontal and parietal lobes with eyelid closure apraxia.
In a patient with sickle cell disease receiving chronic transfusion, exacerbation of anemia with reticulocytopenia must prompt consideration of a delayed hemolytic transfusion reaction with hyperhemolysis, as further transfusion may worsen this condition; definitive diagnosis is sometimes difficult. Anemia evolving during parvovirus B19-induced erythroid hypoplasia (transient aplastic crisis) should be attenuated in chronic transfusion patients due to superior survival of transfused over endogenous red blood cells. A 16-year-old with sickle cell disease receiving chronic transfusion of modified intensity (goal to maintain hemoglobin S<50%) who developed symptomatic anemia with reticulocytopenia was later shown to have had transient aplastic crisis.
In an effort to improve the first‐year medical students’ anatomy lab experience, we as second‐year students created our own custom dissection manual. Working with the course director, we tailored this dissector to Columbia University's anatomy course with marked advantages over commercial dissectors.Many factors make our dissector unique: step‐by‐step photographs of a cadaver dissection and supplementing diagrams, review checklists, concise instructions, dissection tips, and information only pertinent to structure identification. The dissector's efficacy was evaluated by comparison of student surveys, faculty assessments, and exam statistics from the 2010 and 2011 classes, who used the commercial or custom dissector, respectively.Comparison of 2010 and 2011 surveys showed an overwhelming increase in satisfaction with the new dissector, increased learning ease, more efficient use of lab time, and decreased frustration. Faculty reported an overall “higher dissection quality” and “less dependence on faculty” in the lab. Exam means increased by at least one standard deviation (N = 236, p < 0.0001).Due to its unique student‐developed nature, this project has closely addressed students’ needs, and has proven itself highly effective in its implementation at Columbia University. This student‐led model can serve as a template for other schools looking to customize and improve their anatomy curriculum.Grant Funding Source: none
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