maxillary melanotic neuroectodermal tumor of infancy … maxillary melanotic neuroectodermal tumor...

Maxillary Melanotic Neuroectodermal Tumor of Infancy

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Editors-in-ChiefAsim Kurjak (Croatia)

Frank A Chervenak (USA)

Executive EditorsSanja Kupesic (USA)

Ritsuko K Pooh (Japan)Ivica Zalud (USA)

Co-EditorsKazuo Maeda (Japan)—History Ana Bianchi (Uruguay)—ObstetricsGiovanni Monni (Italy)—Invasive diagnostic procedures Zoltan Papp (Hungary)—Prenatal diagnosisEberhard Merz (Germany)—3D/4D sonography Veljko Vlaisavljevic (Slovenia)—Human reproductionMiroslaw Wielgos (Poland)—Education Radu Vladareanu (Romania)—GynecologyMilan Stanojevic (Croatia)—Neonatology Narendra Malhotra (India)—Developing countriesCarmen Comas (Spain)—Echocardiography Aris Antsaklis (Greece)—Twins

Editorial Board

Donald School Journal ofUltrasound in Obstetrics and Gynecology

The Official Journal of the Ian Donald Inter-University School of Medical Ultrasound

www.jaypeebrothers.comwww.jaypeejournals.com

®

Sameer Abdullah (Saudi Arabia)Nelson Aguilar (Colombia)Badreldeen Ahmed (Qatar)Vincenzo D’ Addario (Italy)Tony Duan (China)Alaa Ebrashy (Egypt)Jadranka Dizdarevic (Bosnia and Herzegovina)Orion Gliozheni (Albania)Alfredo Guzman (Peru)Tze Kin Lau (Hong Kong)Aleksandar Ljubic (Serbia)Abdal-Latif Ashmaig Khalifa (Sudan)Berivoj Miskovic (Croatia)

Oliver Vasilj (Croatia)Anton Mikhailov (Russia)Azen Salim (Indonesia)Cihat Sen (Turkey)Yuriy P Vdovychenko (Ukraine)Liliana Voto (Argentina)Hari Shrestha (Nepal)Alexandra Matias (Portugal)Syed Amir Gilani (Pakistan)Corazon Yabes-Almirante (Philippines)Abdallah Adra (Lebanon)Mohamed S Elmahaishi (Libya)

Fawaz Akhazaleh (Jordan)

Secretary of the JournalJadranka Cerovec

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Three years ago I made a transition to the USA and joined Texas Tech University in El Paso, theinstitution with a famous slogan: "From here it's possible". In 1921 the first President of Texas TechUniversity, American educator, Paul Whitfield Horn stated: "It is a country that lends itself to bigness.It is a country that does not harmonize with things little or narrow or mean. Let our thoughts be bigthoughts and broad thoughts. Let our thinking be in worldwide terms." Indeed, only two years after Icame to this picturesque and exotic place on the borderland, Paul L Foster School of Medicine (PLFSOM)was established as one of the forefront institutions in a shift in medical education.

I feel privileged to share my experience on the role of imaging and ultrasound in Obstetrics andGynecology in medical students' education and explore the opportunity for worldwide collaborationwith medical educators in this field. A significant proportion of illustrations in seventeen articles of thisspecial issue have been previously published in different textbooks and monographs of Jaypee Brothers. They kindly permitpublishing them in our Journal.

The aim of this issue is to demonstrate a few examples as to how PLFSOM is bypassing the standard biomedical sciences infavor of integrated curriculum that teaches the students through a series of clinical presentations, clinical skill activities and caseexample sessions. Instead of taking three semesters of anatomy, two semesters of physiology, microbiology and immunology,one semester of biochemistry, and so on, our students learn the relevant basic science knowledge as it relates to most commonclinical presentations. For example, in reproduction unit twelve most common clinical presentations are comprehensively discussed:amenorrhea, infertility, contraception counseling, menopause, prolapse and pelvic floor relaxation, screening and prevention,vaginal discharge and sexually transmitted disease, abnormal genital tract bleeding, pelvic mass, pelvic pain, pregnancy andcomplications in pregnancy. The relevant basic science information from all the traditional subjects is woven into the instructionrelated to the most common symptoms that obstetrics and gynecology specialists diagnose and treat in their practice. Clinicalpresentations are schematically organized as elegantly illustrated in the article by Dr Patham on integrative diagnostics approachof a patient with abnormal genital tract bleeding. For every clinical presentation inductive reasoning diagnostic process isprovided by an expert clinician. The medical curriculum of PLFSOM is a variant of a Calgary Medical School model, introduced in1995. The curriculum content is loaded to students' laptops and great majority of our curriculum is paperless.

In this context, distance teaching modules are used to foster integration of basic science and clinical science knowledge andinductive reasoning. When computer assisted learning program and series of web-based interactive tutorials were created for ourresidents in June 2009, anonymous survey indicated that all of them (100%) found it was a powerful learning stimulus which hasmade a positive impact on their practice. PLFSOM computer-based learning tutorials in obstetrics and gynecology provide thelearners with numerous ultrasound images, organized according to clinical presentations, expert schemes and algorithms, whichare created to render the learning process irrespective of the learner's location. In our articles Dr Eichbaum and I share ourexperience and thoughts on the role of imaging, distance learning programs and telemedicine in Medical Schools of tomorrow.

In PLFSOM curriculum we have recognized the importance of ultrasound simulation training. As Drs Akins and Ho havepointed out in their article, the portability, affordability and lack of ionization have made ultrasound indispensable in many areas.Being experts in medical simulation, they propose ultrasound simulators should be used in undergraduate, graduate andpostgraduate education to increase the competence of health care providers in using and interpreting the ultrasound studies.

In our Medical School, traditional lectures, computer learning modules, team based and small group learning sessions arecreated to emphasize the importance of imaging from the very first day. The anatomist, Dr Black, uses imaging and ultrasound tohelp students to identify and assess the anatomical structures, and demonstrate the advantages and disadvantages of variousimaging techniques in evaluation of different organs. The embryologist, Dr Beale, has invited international experts to join ourinitiative to use 2-D and 3-D prenatal ultrasound illustrations and videos in teaching normal and abnormal human developmentfrom conception to birth and facilitate knowledge accumulation and retention in embryology. Dr Janssen demonstrates how 2-Dand 3-D color and power Doppler may be efficiently used to provide functional information related to physiology, while DrPiskurich and Dr Subramanya explore the potential of ultrasound imaging in teaching the basic concepts of immunologic andinfectious diseases in pregnancy.

Clinical medical educators, Dr Brower and Dr Zafar elaborate on the use of ultrasound in teaching fetal neuroanatomy andemergency medicine, respectively. In a very interesting clinical vignette, Drs Loaiza and Arroyave present a patient confrontedwith a diagnosis of multiple structural fetal malformations diagnosed by ultrasound. Obstetrics and gynecology has beenenriched by ultrasound, but a physician's rapport with his/her patient will never be replaced. Therefore, while delivering bad newsto your patients, make sure you spend enough time with them explaining the ultrasound findings in details. Ultrasound may also

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be used in teaching pharmacology, as excellently demonstrated by Dr Quest, who proposed ultrasound to be used for longitudinalassessment of drug safety and effectiveness. Finally, in a well-illustrated article Dr Rajkumar provides preliminary data on the useof 2-D and 3-D power Doppler ultrasound in evaluation of mammary gland tumor volumes and vascularity in animal models, andtesting their response to different lines of medication.

We believe that the readers of this issue, dedicated to medical education in the field of obstetrics and gynecology ultrasoundwill find our contributions both useful and stimulant to further enhance their teaching strategy.

Medical educators in sonography are aware that training in obstetrics and gynecology ultrasound requires extensivevisualization and spatial training. Web-based interactive tutorials are perceived by adult learners as a better strategy of assimilatinginformation, because they can be accessed at anytime and from anywhere. This type of distance teaching serves as a great toolfor developing basic skills for images interpretation, facilitates referral and decision making skills and assures better longitudinaland vertical integration of knowledge. Computer assisted learning is applicable in preclinical, clinical and postgraduate settingsaccording to the need of learners of today and tomorrow, who have different learning styles from their predecessors.

According to the decision of the leadership of Ian Donald Inter-University School of Medical Ultrasound in the near futuredistance teaching program will become available for all 50 branches of Ian Donald Inter-University School of Ultrasound.Recognizing the importance of continuous education, Albert Einstein has stated: "Education is what remains after one hasforgotten everything he/she learned in school". Having a free access and link to web-based interactive tutorials and ultrasoundimage library created by prominent ultrasound educators will be like having a group of experts at your fingertips. View it regularlyfor the benefit of your current and future patients and students.

Being recently appointed as an Executive Director for Distance Teaching of Ian Donald Inter-University School of MedicalUltrasound I look forward to working closely with all of you. Please find a welcome place for our website among the favorites onyour computer's desktop. And remember, before every sonographer or physician who touches the patient with an ultrasoundprobe, there is a medical educator who has touched them. Be one of them.

Sanja Plavsic KupesicMD PhD

Professor of Obstetrics and Gynecology and RadiologyDepartment of Medical Education

Director of Clinical and Translational ResearchPaul L Foster School of Medicine

Texas Tech University Health Sciences Center, El PasoTexas, USA

Paul L Foster School of Medicine in El Paso, Texas, USA

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IAN DONALD SCHOOL DIRECTORS

Country E-mail address

School Directors

Asim Kurjak Croatia asim.kurjak@public.carnet.hr

Frank A Chervenak USA fac2001@med.cornell.edu

Co-Directors

Jose Maria Carrera Spain jmcarrera@matres-mundi.org

Wolfgang Holzgreve Germany wolfgang.holzgreve@uniklinik-freiburg.de

Kazuo Maeda Japan maedak@mocha.ocn.ne.jp

Giampaolo Mandruzzato Italy mandruzzatogiampaolo@tin.it

Directors and Secretaries of National Branches

Sameer Abdullah Saudi Arabia samirabdullah@hotmail.com

Abbas Aflatoonian Iran abbas_aflatoonian@yahoo.com

Awatif Al Bahar UAE ajAlBahar@dohms.gov.ae

Magdy Alfaramawi UAE magdy205@hotmail.com

Nelson Aguilar Colombia nelsonyesid@gmail.com

Badreldeen Ahmed Qatar profbadreldeen@hotmail.com

Saadia Amour Sultan/ Oman saadiariyami@hotmail.comKanchana Rajan raajaan@omantel.net.om

Aris Antsaklis Greece arisants@otenet.gr

MA Bashed Bangladesh mabashed@bttb.net.bd

Ana Bianchi Uruguay abianchi@asesp.com.uy

Carmina Comas/ Spain carcom@dexeus.comBernat Serra BERSER@dexeus.com

Pavel Calda Czech Republic calda@gynstart.cz

Vincenzo D'Addario Italy v.daddario@gynecology4.uniba.it

Tony Duan China tduan@yahoo.com

Alaa Ebrashy Egypt ebrashy3@yahoo.com

Jadranka Dizdarevic Bosnia and Herzegovina jadranka.dizdarevic@gmail.com

Orion Gliozheni Albania gliorion@icc-al.org

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Country E-mail address

Alfredo Guzman Peru aguzmanc@viabcp.com

Tze Kin Lau/ Hong Kong tzekinlau@cuhk.edu.hkChen Min

Aleksandar Ljubic Serbia maleksal@EUnet.yu

Ritsuko K Pooh Japan rkpooh@guitar.ocn.ne.jp

Abdal-Latif Ashmaig Khalifa Sudan profashmaig@hotmail.com

Narendra Malhotra India mnmhagra3@gmail.com

Berivoj Miskovic/ Croatia berivoj.miskovic@gmail.comOliver Vasilj oliver.vasilj@gmail.com

Anton Mikhailov Russia amikhailov@AM2697.spb.edu

Alexander Papitashvili Georgia ampsmpge@hotmail.com

Zoltan Papp Hungary Pz@noi1.sote.hu

Azen Salim Indonesia azen364@msn.com

Cihat Sen/ Turkey csen@perinatology.org.trMurat Yayla myayla99@yahoo.com

Florin Stamatian/ Romania florin_stamatian@yahoo.comRadu Vladareanu vladareanu@gmail.com

Yuriy P Vdovychenko/ Ukraine vdovichenko@perinatolog.com.uaAndrew Tkachenko avt@perinatolog.com.ua

Veljko Vlaisavljevic Slovenia vlai@ukc-mb.si

Liliana Voto Argentina lvoto@intramed.net

Miroslaw Wielgos Poland mwielgos@amwaw.edu.pl

Ivica Zalud/ USA Zaludi001@hawaii.rr.comRaydeen Busse

Roberto Cassis Martinez Ecuador cassisma@porta.net

Hari Shrestha Nepal omhrc@wlink.com.np

Eberhard Merz Germany emerz@mail.uni-mainz.de

Yves Ville France yville@wanadoo.fr

Huda Al Thawadi Bahrein bdf.inhousetrn@bdfmedical.orghuda2591@batelco.com.bh

Alexandra Matias Portugal almatias@mail.telepac.pt

Francisco Filho Mauad Brazil fmn@ultra-sonografia.com.br

Syed Amir Gilani Pakistan profgilani@gmail.com

Snezana Crnogorac Montenegro snezana_cg@yahoo.com

Karl Erwin Schweinfurth Honduras karlerwin@yahoo.comAlvarado

Miguel Antonio Ruoti Cosp Paraguay mruoticosp@hotmail.commruoticosp@gmail.com

Corazon Yabes-Almirante Philippines Cora313@yahoo.com

Mohammad Hashim Wahaai Afghanistan wahaajhospital@yahoo.com

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Abdallah Adra Lebanon adramfm@inco.com.lb

Mohamed S Elmahaishi Libya elmahaishi@elmahaishi.com

Fawaz Alkazaleh Jordan fawaz_obgyn@yahoo.com

Administrative Secretary of the School

Jadranka Cerovec Croatia jadranka.cerovec@yahoo.com

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IAN DONALD SCHOOL COURSES IN 2009

Date City, Country No. of participants

January 20 to 22 Riyadh, Saudi Arabia 160

January 24 to 26 Jeddah, Saudi Arabia 80

April 23 to 25 Iguazu, Argentina 150

May 16 to18 Honolulu, USA 160

May 26 Montevideo, Uruguay 220

June 1 and 2 Sarajevo, BiH 150

June 4 to 6 Tirana, Albania 205

July 1 and 2 Cluj, Romania 562

July 31 and August 1 Khartoum, Sudan 420

September 5 and 6 Agra, India 560

September 7 and 8 Kathmandu, Nepal 240

October 29 to 31 Dubrovnik, Croatia 156

November 4 Cairo, Egypt 80

November 13 to 15 Abu Dhabi, UAE 192

November 28 and 29 Lima, Peru 95

November 28 to 30 Oita, Japan 200

December 5 and 6 Istanbul, Turkey 462

December 5 to 7 Athens, Greece 250

December 12 Budapest, Hungary 80

Total 4422

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Riyadh

Jeddah

Iguazu

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Montevideo

Sarajevo

Honolulu

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Tirana

Cluj

Khartoum

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Agra

Kathmandu

Dubrovnik

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Abu Dhabi

Lima

Oita

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Budapest

Istanbul

Athens

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IAN DONALD SCHOOL COURSES IN 2010

Date City, Country

March 11 and 12 Jakarta, Indonesia

March 12 and 13 Bari, Italy

March 17 and 18 Manila, Philippines

April 16 and 17 Porto, Portugal

April 28 to 30 Alexandria, Egypt

September 17 Mumbai, India

September 22 Barcelona, Spain

October or November Beirut, Lebanon

November 8 and 9 Warsaw, Poland

December 4 and 5 Hamamatsu, Japan

December 11 Budapest, Hungary

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Contents

Donald School Journal of

Ultrasound in Obstetrics andGynecology

October-December 2009 Volume 3 Number 4

Perspective Study

� Role of Imaging in Medical Schools of Tomorrow.......................................................................... 1-5Sanja Plavsic Kupesic

Original Educational Study

� Web Based Interactive Tutorials in Obstetrics and Gynecology ................................................. 7-10Sanja Plavsic Kupesic, Bhargavi Patham, Martha Guerra

Review Articles

� Telemedicine and Ultrasound in Obstetrics and Gynecology ..................................................... 11-15Quentin Eichbaum

� Clinical Simulation in Modern Teaching and Training of Sonography inObstetrics and Gynecology .......................................................................................................... 17-21Ralitsa Akins, Hoi Ho

� Concerning the Use of Doppler and 3-D Ultrasound in the Teaching of GrossAnatomy in a New Curriculum Featuring the Use of Clinical Presentation Schemes ............... 23-27Asa C Black (Jr), Sanja Plavsic Kupesic

� Ultrasound—A Clinical Procedure to Motivate Preclinical Medical Students toLearn Embryology ........................................................................................................................ 29-34Elmus G Beale, Guillermo Azumendi, Sanja Plavsic Kupesic

� Ultrasound Imaging of the Menstrual Cycle ............................................................................... 35-40Herbert F Janssen, Sanja Plavsic Kupesic

� The Physiology of Pregnancy Illustrated with Ultrasound Images ............................................ 41-45Herbert F Janssen, David L Osborne, Sanja Plavsic Kupesic

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� Recognizing TORCH Group of Infections on Fetal Sonography ............................................... 47-50Sandesh Subramanya, Bhargavi Patham, Sanja Plavsic Kupesic

� The Role of Ob/Gyn Ultrasound in Medical Student Education: ImmunologicalDisorders of Pregnancy Assessed by Ultrasound ....................................................................... 51-52Janet F Piskurich

� What should Medical Students Know and Understand about FetalUltrasonography of the Nervous System? .................................................................................. 53-57Richard D Brower

� The Use of Transvaginal Ultrasound by Emergency Physicians inMedical Student Education .......................................................................................................... 59-64Nadah B Zafar, Veronica Greer, Robert H Woolard

� Delivering Bad News: Aspects to Consider When Training MedicalStudents and Residents ................................................................................................................ 65-68Jose Leonardo Loaiza, Ana Maria Arroyave

� Gynecologic Ultrasound as a Pharmacosurveillance Tool .......................................................... 69-72Dale Quest

� Using Ultrasound to Teach Female Reproductive Physiology ................................................... 73-76Herbert F Janssen, Sanja Plavsic Kupesic

� Integrative Diagnostics Approach—A Contemporary Learning Methodology atMedical Schools ............................................................................................................................ 77-80Bhargavi Patham, Sanja Plavsic Kupesic

Preliminary Study

� 3-D and Power Doppler Ultrasound in Translational Research ................................................. 81-84Lakshmanaswamy Rajkumar, Sanja Plavsic Kupesic