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Its deep segment is continuous with the puborectalis and forms the anorectal ring, which is palpable upon digital examination. The internal sphincter muscle is a smooth muscle under autonomic control and is an extension of the circular muscle of the rectum. In simple cases, the Goodsall rule can help anticipate the anatomy of a fistula in ano. This rule states that fistulas with an external opening anterior to a plane passing transversely through the center of the will follow a straight radial course to the dentate line. Fistulas with their openings posterior to this line will follow a curved course to the posterior midline see the image below. Exceptions to this rule are external openings lying more than 3 cm from the verge. These almost always originate as a primary or secondary tract from the posterior midline, consistent with a previous horseshoe abscess. The classification system developed by Parks, Gordon, and Hardcastle generally known as the Parks classification is the one most commonly used for fistula in ano. This system see the image below defines four types of fistula in ano that result from cryptoglandular infections, as follows :Unlike the current procedural terminology coding, the Parks and colleagues classification system developed by Parks et al does not include the subcutaneous fistula. These fistulas are not of cryptoglandular origin but are usually caused by unhealed fissures or anorectal procedures eg, hemorrhoidectomy or sphincterotomy. In the vast majority of cases, fistula in ano is caused by a previous anorectal abscess.

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We may have all the knowledge and skills on our endeavor or chosen path but without the proper attitude on handling it we might meet failure. I would like to introduce Hidden Curriculum as Life 101, wherein a student acquires certain set of social skills that confirms to norms but not submitting totally. Having them be with peers without the pressure, letting them be ethical and morally bound, them being strong in character but not be slave to it. It is needless to say that most students today are either socially awkward, stereotypically and pragmatic in the sense that they rely mostly on ideas fed to them by the media, the educational institution and their religious beliefs. As an instructor reading on about this Hidden Curriculum I realized its relevance and its impact. I also got to reflect whether as a teacher I am really helping my students cope with their own selves.

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Students can find additional information in the Undergraduate Student Guide and Graduate and Professional Student Guide. Ann McKee, a MED professor of neurology and pathology, studies the long term effects of repetitive brain injury. Its shocking to see neurodegenerative disease in a 25 year old. Photo by Vernon DoucetteFor Ann McKee, every brain tells a story. And sometimes its a tragic one. McKee, a professor of neurology and pathology at the Boston University School of Medicine MED, is the director of neuropathology for the Veterans Affairs New England Healthcare System, and also directs BUs Chronic Traumatic Encephalopathy Center. Chronic traumatic encephalopathy CTE is a degenerative brain disease found in athletes with a history of repetitive brain trauma. McKee first identified its telltale marktiny tangles of a protein called tau, clustered around blood vesselsin the dissected brain of a boxer who had been diagnosed with Alzheimers disease. Although most people associate CTE with professional football players, McKee has found it in the brains of soccer, hockey, rugby, and baseball players as well. Her research has alerted the public to the long term dangers of repetitive hits in sports and raised tough questions about safety. McKee was invited to speak about this growing public health concern at the annual meeting of the American Association for the Advancement of Science AAAS, the worlds largest general scientific society, held in February 2015 in San Jose, CA.

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Kpeds, have your wife read my book The Doctors Guide to Eliminating Debt. She may think differently afterwards. One doctor family had the same discussion and after reading my book they had her student loans paid off in a few hours. She wrote about it here: t is shocking how quickly tuition is rising in both undergraduate and graduate schools. If something is not done soon, I just cant imagine that this can continue in future. Having a $500k+ debt coming right out of medical school will be prohibitive for many, especially as going into residency for an additional 3+ years can make it grow even higher I would have really suffered since I did deferment and forbearance during my residency foolishly so. It can absolutely continue see dental school and law school. There are 30,000 applicants each year who dont get into medical school who would be glad to take on debt to become a doctor, as long as they can be assured a very high probability of a residency position after medical school. I wish the medical schools would seriously consider making mandatory some financial courses. I think we would see reduced debt if the students had some concept of finances. The majority of students I taught had no idea.