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   Table of Contents - Current issue
October-December 2020
Volume 69 | Issue 4
Page Nos. 193-255

Online since Tuesday, December 29, 2020

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Implementation of competency based medical education in anatomy with poor teacher-student ratio: The utopia p. 193
Vishram Singh, Ashok Sahai
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A computed tomography angiography study to correlate main renal artery diameter with presence of accessory renal artery in healthy live kidney donors p. 196
Alka Nagar, Navbir Pasricha, Eti Sthapak, Deshraj Gurjar, Hira Lal
Introduction: The chosen technique of surgery during nephrectomy can be influenced by the sudden discovery of an aberrant source of blood supply to the kidney. Thus, a prospective study was undertaken to investigate the relationship between the diameter of the main renal artery and the presence of an accessory renal artery by computed tomography (CT)-angiography. Material and Methods: The study was conducted on 115 healthy kidney donors who presented to the department of nephrology and radiology for voluntary kidney donation. All CT examinations were performed on a 64-slice CT scanner in the arterial phase. The number of the renal arteries supplying each kidney was evaluated and their diameters were measured. Results: Eighty-six of the right side and 88 of the left side of the 115 kidneys donors had a single renal artery whereas 29 had one or more accessory renal artery (aRA) on the right side and 27 had one or more aRA on the left side. The mean diameter of mRA was 5.4 ± 1.0 mm in kidneys without aRA and 4.6 ± 10 mm in kidneys with aRA on the right side and on the left side the mean diameter of mRA was 5.59 ± 1.12 mm in kidneys without aRA and 4.7 ± 1.2 mm in kidneys with aRA. Discussion and Conclusion: The presence of additional renal arteries is very probable when the main renal artery has a diameter of < 4.15 mm. Kidneys presenting a main renal artery > 5.5 mm very probably do not present additional renal arteries. Hence, the renal artery diameter is a factor which should be considered for predicting the presence of additional renal arteries.
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Morphological side differences of the hemipelvis p. 201
Gloria Maria Hohenberger, Angelika Maria Schwarz, Andreas Heinrich Weiglein, Sabine Kuchling, Georg Hauer, Uldis Berzins, Magdalena Holter, Christoph Grechenig, Renate Krassnig, Axel Gänsslen
Introduction: Differences of anatomical characteristics regarding side and gender have been the topic of interest in various recent studies. Studies have reported either significant or insignificant differences of the bony pelvis. The aim of this study was to evaluate possible gender and side differences of the pelvis in a cadaveric model. Material and Methods: Fifty human cadaver pelves, preserved by the use of Thiel's method, underwent measurement during this study. Diverse parameters were measured on both hemipelves by three surgeons. Analysis of the morphology of the acetabular cavity was performed by measuring its longitudinal, horizontal, and maximal diameters. Results: The distance between the anterior superior iliac spine and the posterior superior iliac spine (females: mean of 15.9 cm; males: mean of 16.9 cm) and the horizontal diameter of the acetabular cavity (females: mean of 4.5 cm; males: mean of 4.9 cm) were statistically significantly shorter in females than in males. The subpubic angle was significantly (P < 0.001) larger in females (mean 61.4°; standard deviation [SD] 11.02°; range 37°–82°) when compared to males (mean 45.5°; SD 7.48°; range 35°–60°). The vertical diameter of the obturator foramen was significantly (P = 0.002) smaller for the right (mean 3.1; SD 0.56; range 1.9–4.6) in comparison to the left side (mean 3.4; SD 0.57; range 2.5–5.2). Discussion and Conclusion: Overall, a clear gender difference was observed for typical gender-specific parameters, whereas the anatomy of the hemipelves showed no relevant side differences.
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The morphological variants of dural venous sinuses p. 207
Sercan Ozkacmaz, Yeliz Dadali, Muhammed Alpaslan, Ilyas Uçar
Introduction: In this study, we aimed to analyze the dural venous system variations in Turkey by magnetic resonance imaging examinations. Material and Methods: Images of a total of 200 patients (65 males, 135 females M/F: 0.48) who underwent a magnetic resonance venography examination were retrospectively screened. Results: Variation was detected in 101 patients (53.85% of males [35/65] and 48.89% of females [66/135]). In 16.5% of the patients, only one variation of dural venous system was detected, while the most common variation was left transverse hypoplasia in this group. Twenty-six percent of the patients had two variations of the dural venous system since the most common dual variations were left transverse hypoplasia + left sigmoid hypoplasia in this group. In 8% of the patients, three or more variations of the dural venous system were observed as the most common variations were right transverse hypoplasia + right sigmoid hypoplasia + presence of occipital sinus in this group. Discussion and Conclusion: It is essential to know the anatomical variations of the dural venous system for the discrimination between pathological processes such as thrombosis and physiologic conditions. Furthermore, the association of these variations with each other must be kept in mind for the explanation of the presence of multiple variations in the same individuals.
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An evaluation on the morphology of the nasal bone, piriform aperture, and choana on dry skulls p. 213
Anil Didem Aydin Kabakci, Duygu Akin Saygin, Şerife Alpa, Mustafa Buyukmumcu, Mehmet Tugrul Yılmaz
Introduction: Piriform aperture (PA) and nasal bone (NBs) are important structures that contribute to the formation of the nose. Both anatomic structures show differences based on ethnicity, gender, and age. Hence, it is widely used to determine sex in science branches such as anthropology and forensic medicine. Furthermore, morphometry of the PA and choana is an important criterion for physiological nasal respiration of individuals. Recognition of structural differences of PA, NB, and choana along with all this information becomes important during maxillofacial procedures to be performed especially in plastic and reconstructive surgery. The aim of the present study is to determine the individual differences in NBs, PA, and choana. Material and Methods: This study was conducted on 83 Turkish dried skulls and PA, NBs, and choana was examined as morphometrically. PA was classified into seven types and NB was classified into eight subtypes. Results: The most common type of PA was found type 5 (20%–24.1%) and the least most common type of PA was type 7 (4%–4.8%). Type 1 was determined as the most common observed shape of the NB. The mean width of the choana on the right and left sides was found 13.21 ± 1.4 and 13.98 ± 1.81 mm, respectively. Moreover, the mean height of the choana on the right and left sides was found 25.56 ± 3.06 and 26.1 ± 2.5 mm, respectively. Discussion and Conclusion: We believe that obtained data from our study will constitute a morphometric data set and will be useful in a wide range of fields from forensic science to reconstructive surgery.
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Morphological and morphometric study of the acetabulum of dry human hip bone and its clinical implication in hip arthroplasty p. 220
Archana Singh, Rakesh Gupta, Arun Singh
Introduction: The objective was to study the morphology of the acetabular margin and articular surface and to measure the various dimensions of the acetabulum in dry human hip bones. Material and Methods: A cross-sectional morphological and morphometric study was performed on 92 undamaged acetabulum of adult dry human hip bone of unknown age and gender. The shape of anterior margin of the acetabulum and shape of the anterior and posterior ends of the articular surface of the acetabulum were observed. Morphometry was done using a Vernier caliper of accuracy of 0.01 mm. Vertical diameter (VD), transverse diameter (TD), anteroposterior diameter (APD), internotch distance (ND), and depth of the acetabulum were measured. Surface area (SA) and volume (V) of the acetabulum were calculated by mathematical calculation of dome. Statistical analysis was done using SPSS software version 22.0 (IBM, SPSS statistics, UNICOM GLOBAL, California, United States). The Pearson's correlation test was used. Results: In the present study, the anterior acetabular ridge was curved in 45.7% (42), angulated in 26.17% (24), straight in 13% (12), and irregular in 13% (12) bones. The anterior end of the lunate articular surface was angulated, and the posterior end was lunate in shape in 45.7% (42), whereas in 54.3% (50), bone both the ends were lunate in shape. Morphometric values and mean ± standard deviation were as follows: 48.21 mm ± 3.31 mm (VD), 47.81 mm ± 3.37 mm (TD), 48.79 mm ± 4.08 mm (APD), 23.58 mm ± 2.77 mm (ND), 27.45 mm ± 3.02 mm (D), 4162.56 mm2 ± 755.58 (SA), and 36,563.65 mm3 ± 9408.67 (V). Discussion and Conclusion: The knowledge of these acetabular parameters is necessary for the creation of acetabular prosthesis and surgical procedures such as acetabular reconstruction in hip joint surgeries.
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Polymorphic study of ataxin 3 gene in Eastern Uttar Pradesh population p. 226
Barkha Singh, Prasenjit Bose, SN Shamal, Deepika Joshi, Royana Singh
Introduction: Spinocerebellar ataxia type 3 (SCA3), or Machado-Joseph disease (MJD), is a prevalent autosomal dominant-inherited disease that causes progressive problems with movement. Abnormal repetitive expansion of CAG trinucleotide in the ATXN3 gene results in SCA3. This study was done to review the corporation of CAG repeats and polymorphisms in definitive genes with the occurrence of SCA3 in the Indian community, especially in the eastern UP population. Material and Methods: The 40 Ataxia's patient and their parents were listed after obtaining written consent from the participant's attendant/guardians. Out of these, we have identified polymorphism in three patients. Results: In one patient, we have found a single base change, g.31483A>T in Exon 10, which changes the nucleotide from Adenine to Thymine (A31483T), while in the second patient, we have identified an intronic change at g.35690A>G in Exon 10, which changes the nucleotide from Adenine to Guanine (A35690G) and in the third patient DNA sequence analysis identified an intronic change at g.35587A>G Exon 10, which changes the nucleotide from Adenine to Guanine (A35587G). Discussion and Conclusion: Although the partial loss of ATXN3 function may also contribute, the disease mechanism in MJD is believed to be a toxic gain-of-function. Several pathogenic cascades have been reported to be triggered by mutant ATXN3, but the critical molecular events driving MJD pathogenesis stay unresolved. While significant developments in studies have enhanced our knowledge of MJD, there is presently a lack of preventive treatment. Results presented here also expand our knowledge about MJD found in the eastern UP population.
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An anatomical description of the vermian fossa: The reappraisal of an overlooked entity p. 233
Jeshika S Luckrajh, J Naidoo, L Lazarus
Introduction: The vermian fossa (VF) is a shallow depression at the inferior end of the internal occipital crest, which lodges the inferior part of the cerebellar vermis. Published literature describes the VF as having a highly variable incidence and morphology. The present study is aimed to investigate the incidence, morphology, and morphometry of the VF within a select South African population and to conduct a review of the literature regarding this structure. Material and Methods: A total of 100 dry, adult skulls of South African origin were analyzed to determine the morphological and morphometric parameters of the VF. Results: The VF was found to be present in 62% of cases. The shape of the VF was classified as triangular (27%), quadrangular (8%), and atypical (27%). The average length of the VF was 13.78 mm, and the average width was 11.62 mm. The morphometric findings of this study correlate with that of previous studies; however, the incidence of atypical shaped VF (27%) is higher in comparison to previous studies (9.7%). Discussion and Conclusion: The detailed anatomical description of the VF may aid in the study of diseases which cause alterations in the size and morphology of the vermis of the cerebellum as well as in transvermian approaches to tumors within the fourth ventricle. Furthermore, due to the paucity of anatomical descriptions of the VF, a reappraisal of this structure is warranted as it is of prime importance to clinicians operating in or interpreting radiological images of the posterior cranial fossa.
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Considering the surface area and sagittal angle in a pair of lumbosacral facets: Determining the structural relevance of asymmetric facets at the lumbosacral junction p. 237
Uchenna Kenneth Ezemagu, F Chinedu Akpuaka, Emmanuel C Iyidobi, Chike P Anibeze
Introduction: The mechanism of spine dysfunction that was linked to asymmetry in facet joint planes remains poorly understood. We determined the surface area and sagittal angle in a pair of L4, L5, and S1 vertebral facets. We aimed to explain the structural relevance of asymmetric facets at the lumbosacral junction. Material and Methods: Vertebral columns of 45 adult male human cadavers were cut at the L3–L4 intervertebral disc. Each section was macerated and tied together in a sequence to obtain the value of sagittal angle of the superior facets of L4, L5, and S1 vertebrae and area of the inferior facets of L4 and L5 vertebrae, using a modified protractor and graph paper method, respectively. Asymmetry was determined using the formula propound by Plochocki (2002). Results: The mean value of surface area of the left and right inferior facets of L4 and the left and right inferior facets of L5 was 161 ± 24 and 168 ± 23 mm2 and 200 ± 28 and 218 ± 33 mm2, respectively. The mean value of sagittal angle of the left and right superior facets of L4, L5, and S1 was 37.71° ± 4.38°, 36.18° ± 4.8°, 46.96° ± 6.49°, 48.51° ± 6.25°, 52.49° ± 5.1°, and 54.67° ± 5.25°, respectively. The degree of asymmetry in the area of the inferior facets of L4 and L5 ranges from 0% to 30% and 0%–32.26%, respectively, and that for sagittal angle of the superior facets of L4, L5, and S1 was 0%–37.93%, 0%–30.95%, and 0%–26.32%, respectively. Discussion and Conclusion: This study would suggest that despite the statistically significant mean differences in the paired variables, the vertebrae were free of any pathological change but with consequent adaptive features. However, the stress effects would suggest that the left lumbosacral facet joints are predisposed to dysfunction of mechanical origin.
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In vivo cross-sectional topographic anatomy at sternal angle on magnetic resonance imaging p. 243
Rohit Aggarwal, Sreedhar Muthukrishnan Calicut, Raheem Abdul Sheik, Vijaya Sagar Theegala, Indrani Mukhopadhyay
Introduction: The manubriosternal angle, first described by Louis in 1825, is an important landmark in the anatomy of the thorax and has been conventionally described as corresponding to the T4–5 IV disc level based on cadaveric dissections. The objective of this study was to document the level of the angle of Louis and various anatomic structures that also correspond to the same level in living individuals based on multiplanar magnetic resonance (MR) images. Material and Methods: We reviewed MR scans of the cervicodorsal spine of 262 individuals comprising 174 males and 88 females in the age range 14–76 years. For each individual, the vertebral level of the following structures was noted on T1-weighted (T1W)/T2-weighted (T2W) turbo spin echo (TSE) coronal and sagittal images, namely tracheal bifurcation (TB), aortic arch (AA), and sternal angle (SA). Results: The SA was most commonly seen corresponding to the T5 vertebral body level (45.20%) and at T4–5 IV disc level in only 20.45% of the individuals. The convexity of the arch of the aorta was seen in the majority of the individuals corresponding to the T3 vertebral body level (47.96%). TB was seen at T4 level in 34.35% and only in 22.69% at the T4–5 IV disc level. Discussion and Conclusion: The anatomical level of the SA, AA, and TB in living individuals as assessed on MR images is significantly different from the traditionally held belief based on cadaveric dissections.
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Ectopic pelvic kidney and its renal artery from the common iliac artery p. 249
Sevda Lafci Fahrioglu, Musa Muhtaroglu, Selda Onderoglu, Sezgin Ilgi
The pelvic kidney is the most common type of renal ectopia. It is clinically asymptomatic in general but are more prone to the urinary infections. It has also been associated with an increased risk of nephrolithiasis. The 37-year-old man was admitted to the emergency room with complaints of left flank pain, nausea and vomiting. In addition to this flank pain, the patient had an intermittent pain in the lower abdomen and pelvic region for 6 years with no history of fever. The renal ultrasound demonstrating several shadowing echogenic areas consistent with nephrolithiasis in both kidneys. In addition, while the right kidney was in the normal size and location, the left kidney was located on the ectopic site, just above the bladder. Doppler examination revealed double renal arteries originating from the aorta on the right side. Our case indicates the importance of the ectopic pelvic kidney location when planning surgical procedures in patients with renal and pelvic pathology, kidney transplantation and nephrectomy.
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Turner syndrome associated with cerebellar abnormalities p. 252
Tanya T Kitova, Ekaterina H Uchikova, Kristina P Kilova, Veselin T Belovejdov
We present an autopsied fetus with Turner syndrome (TS), obtained after a therapeutic abortion at the Clinic of Obstetrics and Gynecology at the University Hospital, Plovdiv, Bulgaria. It was a female fetus weighing 75 g. The chorionic villus sampling followed by karyotyping established monosomy XO. The fetal autopsy confirmed agenesis of the cerebellar vermis and cerebellar hypoplasia. The immunohistochemical study of the brain with S100 protein (S100), glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), and cluster of differentiation 68 was taken into consideration. The presence of extensive gliosis reaction is proved in the cerebellar structures of TS by the positivity of glial markers: (GFAP) and S100 protein. The quantity of neurons proved by NSE marker is probably associated with the deficiency of differentiation and cell migration caused by inhibition in the development of young cells. The presented case of TS found a new phenotype with cerebellar abnormalities described for the first time.
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