Evaluating the effectiveness of gluteal intramuscular injection sites: a cadaveric study / 대한해부학회지

The gluteal region is a frequent target for injecting high volumes. However, the safe intramuscular injection sites have been controversy in this region. This study was aimed to compare the subcutaneous fat and muscle thicknesses at the two gluteal injection sites and to determine the influence of sex and body mass index (BMI) on fat and muscle thicknesses.The ultimate purpose of this study is to suggest the most suitable intramuscular injection site among the ventrogluteal and dorsogluteal regions. Eleven fresh cadavers were injected with colored gelatin using syringes at the two gluteal injection sites.Seven variables were measured at both gluteal injection sites and analyzed relative to sex and the BMI. No variables showed statistically significant differences between the two gluteal injection sites according to sex. In a one-way analysis of variance, total length and muscle thickness had significant difference according to the BMI category. In obese cadavers, the injected gelatin core was located in the subcutaneous layer (average 109.0 percentile), and in the muscle layer (average 78.9 percentile) in the dorsogluteal region. These were found that the success rate of injection in the dorsogluteal region was higher than in the ventrogluteal region, especially when classed as obese. Also, it is suggested that nurses should use the traditional intramuscular injection method. It will also be necessary to consider expanding these findings to other ethnic groups in the Asia–Pacific region and then also education in universities and health providers on selecting the intramuscular gluteal injection site.

Topography of human ankle joint: focused on posterior tibial artery and tibial nerve / 대한해부학회지

Most of foot pain occurs by the entrapment of the tibial nerve and its branches. Some studies have reported the location of the tibial nerve; however, textbooks and researches have not described the posterior tibial artery and the relationship between the tibal nerve and the posterior tibial artery in detail. The purpose of this study was to analyze the location of neurovascular structures and bifurcations of the nerve and artery in the ankle region based on the anatomical landmarks. Ninety feet of embalmed human cadavers were examined. All measurements were evaluated based on a reference line. Neurovascular structures were classified based on the relationship between the tibial nerve and the posterior tibial artery. The bifurcation of arteries and nerves were expressed by X- and Y-coordinates. Based on the reference line, 9 measurements were examined. The most common type I (55.6%), was the posterior tibial artery located medial to the tibial nerve. Neurovascular structures were located less than 50% of the distance between M and C from M at the reference line. The bifurcation of the posterior tibial artery was 41% in X-coordinate, -38% in Y-coordinate, and that of the tibial nerve was 48%, and -10%, respectively. Thirteen measurements and classification showed statistically significant differences between both sexes (P<0.05). It is determined the average position of neurovascular structures in the human ankle region and recorded the differences between the sexes and amongst the populations. These results would be helpful for the diagnosis and treatment of foot pain.

Questionnaire Survey Analysis on Necessity of Cadaveric Dissection for Nursing Students: In Scope of Nursing Students and Professors / 체질인류학회지

Nursing students will work to promote the health of patients as a nurse after graduation. Basic nursing science is to improve the quality and efficiency of nursing activity and to form the basis of nursing mandatory major. Anatomy is a curriculum of medical college, for that reason, it does not fit the characteristics of basic nursing science, and it is difficult to study mandatory major. This research was to provide basic data to be improved anatomy curriculum for nursing students using questionnaire about necessity of cadaveric dissection. Questionnaires were distributed to nursing students enrolled in anatomy course and professor taught basic nursing science in nursing college. Eighty-one percentage of nursing student and 95.5% in professor answered to need cadaveric dissection for nursing students. Nursing students answered that it should be helpful to understand about human body and nursing activity. Professors replied to acquire knowledge of human body and be of help to learn. They filled in internal organs and nervous system that have to observe during cadaveric dissection. The result of this research would be used as the basis for the improvement of anatomy curriculum in nursing college.

Sex Determination Using Three-dimensional Image of Skull in Korean: Metric Study by Discriminant Function Analysis / 체질인류학회지

Sex determination is considered the first and most important process in the identification of unknown skeletal remains. The skull is one of bones with high accuracy to discriminate sexes, but there is no dimorphic studies of Korean skull by discriminant function analysis. The aim of this study was to build and provide an easy and accurate discriminant equation to sex determination by using three-dimensional skull images of Korean. Computed tomography images from 102 cadavers were reconstructed three-dimensional images by computer program. We measured 44 variables using the template in computer program and variables were sorted out items with high accuracy and reliability by intraclass correlation coefficient (ICC), Cohen's d value, and receiver operating characteristic (ROC) curve. The equation with the highest accuracy had 82.7% in males, 82.2% in females, it was constituted bizygomatic diameter, cranial base length, biauricular breadth, upper facial breadth, frontal chord, foramen magnum breadth, and right mastoid length. The cross-validated accuracy had 76.5%~86.7% using 3D skull images in Koreans. The value of variables that matches the other population group study, most of variables had a statistically significant difference among population groups. Male skulls in Koreans were smaller than those in European and female skulls were bigger than in Asian. This result should be helpful to determine sex in Koreans.

Non-metric Study of the External Occipital Protuberance for Sex Determination in Koreans: Using Three-dimensional Reconstruction Images / 체질인류학회지

The most essential biological profiles in physical and forensic anthropology are age, sex, and populations to be determined. In case of dealing intact skeletons, experts can often determine sex with high accuracy. The external occipital protuberance (EOP) is one of the site among morphologic traits which is used to determine human sex. This study suggests the possibility to determine the sexual dimorphism using the EOP and surrounding anatomical structures in Koreans. After three-dimensional reconstruction of the skull model from Digital Korean Human Databse, the three parts were evaluated using a classification system based on Broca, Gulekon and Turgut. To determine for scoring, this study was used two in two different ways to observe the skull model; one was a lateral view and the other was turning the skull models. In a lateral view, the shape of the occipital area was classified as 'flat' or 'convex' type. After then the scores of the anatomical structures were converted into 4-digits code. In females, the skull was more convex in shape than males but the EOP and inion were lesser projection. In the lateral and turning views, the most common pattern was Type 2 in both sexes. The most common digit code was 2-2-2-0 in males, 2-2-2-1 in females. The digit code is better than simple scoring system for determining sex. The skull in Koreans were more feminine than in other populations in both sexes.

Physical Anthropological Study of Excavated Bones from Siheung Cultural Remains / 체질인류학회지

GyeongGi Cultural Foundation was requested the identification of eight excavated human skeletons from Neunggok residential development district within Siheung-si. Those were measured for distinguishing sex, stature, and age at death using metric and non-metric methods. The identification of eight human remains was not easy because the excavated bones were destroyed partly and totally. Six skeletons were excavated from the limed-soiled mixture tomb; five remains among 8 were buried in same grave and 2 skeletons were excavated from the earthen tomb. Four remains were determined female skeletons. One skeleton was assumed adolescence, three skeletons were estimated 40's~50's years old and others couldn't be done. Four among eight remain skeletons, the stature of female remains was around 150~157 cm and male's stature was around 165 cm. Most bones were damaged and destroyed, and the remaining teeth on the maxilla and mandible were not enough for identification. We couldn't identify through metric and non-metric methods. If the human skeletal remains were not found with artifact, those couldn't determine the period. So we couldn't know the relationship between the period of burial and condition of bones. For this reason, we will study the identification using the small and damaged bones. Anthropologists and archeaologists need to work together to make database to determine identification and period.

Statistical Analysis of Bone Elements Excavated from the Forensic Context / 체질인류학회지

Forensic anthropology is helpful for correct and fast identification of unknown individuals in mass disaster or from unidentified skeletal remains. It is based on the data of the physical anthropology and applied to the identification in many countries. The purpose of this study is to statistically analyze the 290 forensic records by an office request at NISI during 6 years and to suggest the research model for physical anthropological data that would be helpful to be used at the forensic field. The most common excavated bone was a hard bone as skull and long bones and an unknown place was the most common excavation seat over 50% among the recording place. The probability of excavation with adjacent bone was high and the small sized bones, such as phalanges of hand and foot, were excavated rarely. The incomplete or fragmented bones were found more frequently than of complete. For this reason, we think that will show the priority order of the forensic and physical anthropologic studies in Korea and the necessity of the anatomical education for police officers and inspectors of forensic fields.

Variation of the Infrahyoid Muscle: Duplicated Omohyoid and Appearance of the Levator Glandulae Thyroideae Muscles

The embryologic origin of the omohyoid muscle is different from that of the other neck muscles. A number of variations such as the absence of muscle, variable sites of origin and insertion, and multiple bellies have been reported. However, variations in the inferior belly of the omohyoid muscle are rare. There have been no reports of the combined occurrence of the omohyoid muscle variation with the appearance of the levator glandulase thyroideae muscle. Routine dissection of a 51-year-old female cadaver revealed a duplicated omohyoid muscle and the appearance of the levator glandulae thyroideae muscle. In this case, the two inferior bellies of the omohyoid muscle were found to originate inferiorly from the superior border of the scapula. One of the inferior bellies generally continued to the superior belly with the tendinous intersection. The other inferior belly continued into the sternohyoid muscle without the tendinous intersection. In this case, the levator glandulae thyroideae muscle appeared on the left side, which attached from the upper border of the thyroid gland to the inferior border of the thyroid cartilage. These variations are significant for clinicians during endoscopic diagnosis and surgery because of the arterial and nervous damage due to iatrogenic injuries. The embryologic origins of the omohyoid and levator glandulae thyroideae muscles may be similar based on the descriptions in the relevant literature.

Determination of Sex in Koreans using Atlas / 체질인류학회지

When forensic anthropologists tried to reconstruct the biological profile, they would rely on the statistical data of documented human osteological/anatomical specimens. However, the metric data of Korean ancestry which is suitable for determining sex has not been established because documented human skeletal specimens are lack in Korean. The aim of this study is to discuss the possibility of determination of sex by metric data of atlas in Koreans. We measured 43 (male 25 and female 18) atlas from the department of anatomy, College of Medicine, Soonchunhyang University and the department of anatomy, Yonsei University College of Medicine. We measured 21 measurements of atlas using digimatic caliper and performed statistic analysis using SPSS to establish the discriminant functions. Among 21 measurements of atlas, the measurement values of the width of atlas exhibited the strongest relation with sexes. The accuracy of arbitrary discriminant functions derived from 6 measurements exhibited 93.9% and that of stepwise discriminant functions derived from 3 measurements exhibited 97.0%. In conclusion, this study could indicate that metric data of atlas is helpful to determine the sex in Koreans, but a further investigation should be followed.

Evaluation of the Rib Seriation Using Analysis of Quantitative Methods in Koreans / 체질인류학회지

Rib seriation has not been used to identify individual human skeletal remains in Koreans. Accurate rib seriation is important for determining rib number and for establishing an individual's age at death. The aim of this study was to use a previously published quantitative method to correctly predict rib sequencing in Koreans. We used complete rib sets of 54 individuals and measured three variables: AFTAL (articular facet of the tubercle-toangle length), HAFL (head-to-articular facet length), and SCTCH (superior costo-transverse crest height). AFTAL and SCTCH were more useful than HAFL for predicting rib seriation, and AFTAL produced the simplest equation for determining sex. In the ranking, the cumulative percentage of AFTAL was 79% with an error of 0, and the range of seriation error was +/-4. Compared to other studies using European measures, AFTAL showed greater accuracy of rib seriation in this study of Korean ribs. In fact, both AFTAL and AFTAL with SCTCH accurately predicted rib 4 in 94% of cases. AFTAL was the most accurate, and use of both SCTCH and AFTAL yielded better results than either alone. Thus, the high accuracy and predictive ability showed that this method is useful for measuring rib seriation in Koreans.

Statistical Analysis for Organ Weights in Korean Adult Autopsies / 대한해부학회지

The organ weight is one important indicator to discern normal condition from abnormal in forensic pathology as well as in clinical medicine. This study includes organ weights of Korean population, which can be fundamental sources to be analyzed comparatively with other ethnic groups. Seven organs (heart, lung, liver, kidney, spleen, thyroid gland, and brain), which were harvested from 526 Korean adults (369 males and 157 females) during ordinary postmortem examination, were weighed. All of the organs in males were heavier than those in females. With variables controlled, the organ weights of hearts, spleens, and thyroid glands in males were not different from those in females, and the rest of organs were heavier in males than females. Mean weight of left kidneys was higher than that of right ones (P<0.05). All of the organs but heart became lighter in weight, as one got older. The liver and kidney weights of the middle-aged adults were heavier than those of any other age groups (P<0.05). The weights of all organs except for lungs and cerebrums were more related to body weight than height. These results are considered for useful anatomical data to understand the disease properties in Koreans.

Appearance of the Cleidohyoideus Muscle Combined with the Multiple Variations of the Infrahyoid Muscle / 대한해부학회지

Multiple variations of the infrahyoid muscle combined with appearance of cleidohyoideus muscle were found in a Korean male cadaver (age : 82) in a routine dissection. In this case, the hyoid bone descended to the level of the upper half of the thyroid cartilage. Then, the mylohyoid, stylohyoid and geniohyoid muscles, which attach to the hyoid bone, descended to the same level. An unusual cleidohyoideus muscle attached from the superior border of the medial third of the clavicle to the hyoid bone was observed bilaterally at the superficial layer. At deeper layer, the sternohyoid muscle, which was additionally attached to the first rib as well as sternum and clavicular head, appeared bilaterally. In the same layer, the left omohyoid muscle was partially merged to the muscle mass of sternohyoid and attached to the hyoid bone. In the deepest layer, the sternothyroid muscle was attached to the medial half of the first rib. The nerves that innervated this infrahyoid muscle originated from the cervical plexus, devoid of the ansa cervicalis.

Study of the Inferior Epigastric Artery Using Anatomical and Radiologic Method for Flap Surgery / 대한해부학회지

The knowledge of arterial patterns of donor and recipient sites is very important for performing a flap surgery. In order to perform a flap surgery using the rectus abdominis muscle knowledge of the distributions, tributaries, and anastomoses of the inferior epigastric artery is necessary. The aim of this study was to establish the clinical and anatomical characteristics of the inferior epigastric artery for flap surgery in Koreans. Sixteen fresh cadavers were injected bilaterally with a radiopaque dye solution through the brachial and popliteal arteries, radiographic images were obtained after the anterior abdominal wall was removed surgically. Subsequently, the anterior abdominal walls of the cadavers were dissected and measured by using metric and non-metric methods. In a majority of the cadavers (83.9%), the inferior epigastric artery had only one main stem. Between the umbilicus and the xiphoid process, the most common type of the anastomosis was multiple anastomoses (Type IV, in 32.1% of the cases), followed by no anastomosis (Type I) and single anastomosis (Type II) in 25% of the cases, respectively. The intramuscular branch of the inferior epigastric artery originated from below the umbilicus in 60.7% of the cases and above it in 39.3% of the cases. The peritoneal branch was further divided into 3 types: lateral, medial, and umbilical. One of them coexisted with other branch of specimen. The peritoneal branch commonly originated from the intramuscu-lar branch. The perforating branch, with an external diameter of greater than 0.5 mm, was clinically significant, was dis-tributed around the umbilicus. The number of arterial branches directly perforating the rectus abdominis muscle was greater than that of those traveling anteriorly. The results of this study may enhance the anatomical knowledge of clinicians with respect to flap surgery or surgical treatments involving the anterior abdominal wall.

Arterial Variation in Upper Limb: Case Report / 체질인류학회지

The arterial variations of the upper limb are frequently encountered in the human body. However, the appearance of multiple variations in one limb is uncommon. The present arterial variations were found in the right upper limb of 86 years-old female cadaver during a routine dissection. The variations of the arterial patterns are as follows: 1. Two thyrocervical trunks from subclavian artery and the internal thoracic artery is rising from lateral branch of thyrocervical trunks. 2. Thoracoacromial artery was divided two branches and the lateral thoracic artery arises from the small of two branches. 3. The distance of bifurcation of the brachial artery is 14.9 mm from the inferior border of teres major muscle. Medial branch of the brachial artery passes along the median nerve and becomes radial artery. Lateral branch of the brachial artery passes along the median nerve and becomes ulnar artery. 4. Bifurcation of radial artery is occurred at the distance of 46.9 mm from styloid process of radius. Deep palmar branch of radial artery is bifurcated on dorsum of hand. Branches for supplying first and second fingers arise from superficial palmar arch. The arterial variations of the upper limb could be caused a several bleeding in intravenous injection or surgeries and a wrong diagnosis. The knowledge of the arterial variation of the upper limb should be decreased to raise clinical problems.

Anatomical Study for Vascular Distribution of the Perforator of Deep Inferior Epigastric Artery in Koreans

PURPOSE: The pedicle of transverse rectus abdominis myocutaneous(TRAM) flap and deep inferior epigastric arterial perforator flap is deep inferior epigastic artery (DIEA) and accurate anatomic knowledge about perforator of DIEA is very important for the elevation of these flap. The authors investigated a detailed vascular network of perforator of DIEA in Koreans. METHODS: 24 fresh cadavers were studied. Among them, 15 were examined based on the plain X-ray examination for the distribution and location of perforator of DIEA. And 9 fresh cadavers were examined based on the 3-dimensional computed tomography(CT) study for the distance between ending point of perforator of DIEA and mother artery, the distance between most medial mother artery and midline, the distance between most lateral mother artery and midline, and the running type of perforators of DIEA. RESULTS: Based on the plain X-ray examination, suitable(external diameter> or =0.5mm) perforators of DIEA are located between the level of umbilicus and 8cm below it. Based on the 3D-CT study, average distance between the ending point of perforator of DIEA and the mother artery is 30.26mm on the left, 28.62mm on the right, respectively. The average distance between most medial mother artery and midline is 17.13mm on the left, 15.76mm on the right, respectively. The average distance between most lateral mother artery and midline is 56.31mm on the left, 50.90mm on the right, respectively. The main running course of suitable perforators of DIEA is type a, which is a direct musculocutaneous perforator vessel from main vascular axis passing outward to join the subdermal plexus, directly. CONCLUSION:3-dimensional computed tomography study as well as plain X-ray examination provided more accurate and detail informations about perforators of DIEA in Koreans. These informations will help us understand the detailed vascular anatomy and operation with ease and safe in the lower abdomen of Koreans.

Estimation of Maximum Femoral Length from Fragmentary Femur / 체질인류학회지

Positive identification of human body remains is one of the most important tasks in mass disaster management. In general, anthropometric studies of long bones help to take informations such as race, gender, age, and stature of an individual. The previous reports estimated the stature from the femur length or from its fragments. One hundred ninety five (male 120, female 75) human bodies were examined. We measured 11 items which related breadth and length of femur. The highest correlation coefficients showed in the distance from most proximal point of intercondylar fossa to midpoint of lesser trochanter (IFLM) and distance from most proximal point of intercondylar fossa to most proximal point of greater trochanter (IFGP). The regression formulae were obtained from the various measurement of the fragmentary femur. With known values, the expected maximum femoral length was as follows. When using IFLM, maximum femoral length (male) = 21.788+/-1.278*IFLM+/-9.714 maximum femoral length (female) = 33.892+/-1.224*IFLM+/-11.311 maximum femoral length (combined) = 10.201+/-1.310*IFLM+/-6.746 When using IFGP, maximum femoral length (male) = 1.162*IFGP-8.770+/-8.882 maximum femoral length (female) = 1.117*IFGP+/-7.265+/-13.604 maximum femoral length (combined) = 1.149*IFGP-3.860+/-5.827 Consequently, these formulae are useful to persume the maximal length of femur for the unidentified fragments of femur in Korean.

Morphologic Study of the Rectus Abdominis Muscle for Flap Surgery / 체질인류학회지

Forty-nine cadaver dissections (male 30, female 19) were performed to identify the shape and size of rectus abdominis muscle and the distribution of vessels in Korean for flap surgery. The total length between xiphoid process and pubic symphysis of male is 375.9+/-41.8 mm and female is 339.4+/-39.1 mm. But the length between umbilicus and pubic symphysis of male and female did not show significant difference. The three tendinous intersections are 61.2%, the 4 intersections are 35.7%, and 2 intersections are 3.1%. The most of first, second and third intersections had the most complete intersection. The most of fourth intersection had the most fragmentary intersection. The external diameter of superior epigastric artery is 1.4+/-0.3 mm, and inferior epigastric artery is 2.6+/-0.6 mm. The percentage of superior epigastric artery that goes into the medial 1/3 region of rectus abdominis muscle is 52%, middle 1/3 region is 38%, lateral 1/3 region is 2% and 2 stem goes into the muscle is 8%. The length between the origin of inferior epigastric artery and the point of semilunar line met inferior epigastric artery is 41.1 mm in male and 38.8 mm in female.

Morphometric Analysis of the Korean Thyroid Cartilage for Identification of Sex : Metric Study / 체질인류학회지

The thyroid cartilage is located just below the hyoid bone and is the biggest cartilage in laryngeal cartilage. The purpose of this study is to identify the sex based on the morphological analysis of the thyroid cartilage of Koreans. This study was carried out on the thyroid cartilage of 109 specimens of adult subjects (age over twenty years old) including 69 males and 40 females. We measured 27 measurements, followed by the statistic procedures. The results were as followed ; 1. Male subjects exhibited larger values of width, height and length of the thyroid cartilage and height of lamina than female subjects (p < 0.01). 2. Female subjects exhibited larger values of angle of lamina, angle of inferior horn and angle of upper margin of lamina than male subjects (p < 0.01). 3. Discriminant functions were obtained with the measurement values of length of the thyroid cartilage and height of lamina. In conclusion, the thyroid cartilage in Korean is different depending on sexes. Therefore we can identify the sex for over twenty years old Koreans by the morphometric analysis of the thyroid cartilage.