Assessment of the variability in the dimensions of the intact pelvic canal in South Africans: A pilot study.

Cephalopelvic disproportion is common among Africans and is a major cause of maternal and perinatal mortality and morbidity. As the dimensions of the pelvis may vary between populations and according to stature and age, they need to be considered during childbirth and also in the planning and performance of pelvic and perineal procedures. The aim of this study was to assess the possible variations in the dimensions of the intact pelvic canal in South Africans and their implications. Eighty intact cadaver pelves, belonging to 40 white South Africans (20 males and 20 females) and 40 black South Africans (20 males and 20 females) were used for both metric and geometric morphometric analyses. Pelvic inlet shapes did not differ significantly between groups but pelvic inlet and midpelvic dimensions were the greatest in white South Africans and females. The pubic symphyseal length was the greatest in white males and the smallest in black females, resulting in a smaller pelvic cavity anteriorly than for white females. Pelvic outlet shapes varied significantly between sexes in white South Africans and between white and black males. Females presented with the greatest dimensions. Black South African females presented with an elongated anteroposterior outlet diameter. Certain transverse pelvic diameters correlated positively with age in white males and with height in females. In planning childbirth options, the smaller pelvic inlet of black females and stature-dependent diameters should be considered. Pelvic and perineal surgery may be technically more challenging because of smaller pelvic dimensions in black South Africans, especially in males.

The value of Tuffier's line for neonatal neuraxial procedures.

The spine of L4 usually lies on a line drawn between the highest points of the iliac crests (Tuffier's line) in adults. Although its accuracy has been questioned, it is still commonly used to identify the spinous process of the 4th lumbar vertebra before performing lumbar neuraxial procedures. In children, this line is said to cross the midline at the level of L5. A literature search revealed that the description this surface anatomical line is vague in neonates. The aims of this study were to determine the vertebral level of Tuffier's line, as well as its distance from the apex of the sacrococcygeal membrane (ASM), in 39 neonatal cadavers in both a prone and flexed position. It was found that when flexed, Tuffier's line shifted from the level of L4/L5 (prone position) to the upper third of L5. The mean distance from the ASM to Tuffier's line was 23.64mm when prone and 25.47 mm when flexed, constituting a statistically significant increase in the distance (P=0.0061). Therefore, in the absence of advanced imaging modalities, Tuffier's line provides practitioners with a simple method of determining a level caudal to the termination of the spinal cord, at approximately the L4/L5 in a prone neonate and the upper margins of L5 when flexed.

Degenerative trends of the palmaris longus muscle in a South African population.

The literature reports that the palmaris longus muscle (PL) is only found in mammals in which the forelimbs are weight-bearing extremities. It is suggested that the function of this muscle has been taken over by the other flexors in the forearm. Terms used in the literature to describe the diminishing of this muscle include retrogressive or phylogenetic degenerative trends. The aims of this study were to determine the prevalence of PL in a South African population and whether a phylogenetic degenerative trend for the PL exists. To determine the prevalence of the PL, five groups, representing different age intervals (Years 0-20, 21-40, 41-60, 61-80, and 81-99) were used. A sample of 706 participants of various ages was randomly selected. Statistical analysis included comparisons of the prevalence of the muscle between males and females and left and right sides, using a student t-test. A Chi-squared test was used to determine a possible phylogenetic degenerative trend of PL within the five groups. The sample yielded a bilateral absence of the PL in 11.9% of the cases. The muscle was unilaterally absent on the left side in 7.65% and 6.94% on the right side. The Chi-squared tests revealed a P-value of 0.27 for the left arm and 0.39 for the right arm. No obvious trend could be established for the phylogenetic degeneration of the PL in this study. It would appear that the PL muscle should not be considered as a phylogenetically degenerating muscle in a South African population.

Preliminary results on a study to locate the pterygopalatine fossa using mathematical formulae.

Blocking the contents of the pterygopalatine fossa (PPF) has been shown to be effective in treating most orofacial pain including that associated with trigeminal neuralgia. However, the technique is not widely used, and we propose it to be due to the vague descriptions of the techniques in the literature. The aim of this study was therefore to achieve an alternative method of locating the PPF. One hundred and sixty skulls from the department of Anatomy, University of Pretoria, were used. Distinct landmarks (both anthropometric and clinical) accompanied by existing and new anthropometric measurements were used to define the location of the PPF. Regression analysis was used to measure the reliability of predicting the location of the PPF. From the results, two mathematical formulae were devised (one for each side). These formulae were tested on 47 cadavers by inserting a needle at the calculated points after which the areas where dissected to determine whether or not the needle had entered the PPF. Our results showed an accuracy of 65.2% on the right and 54.4% on the left. In conclusion, improvement in the accuracy of the technique could aid in the management of various pain disorders as well as pain management during surgery.

The anatomical basis of venographic filling defects of the transverse sinus.

Obstruction of the intracranial dural venous sinuses would result in an increase in intracranial dural venous pressure. This intracranial hypertension is not only the result of poor cerebral venous drainage but also life threatening. The aim of this study was to identify the structures, which may show signs of potential venographic filling defect qualities, including trabeculae/septa (also described as "fibrous bands") and arachnoid granulations, which ultimately can lead to increased intracranial dural sinus venous pressure. A total of 102 cadavers and living patients were used for the study. Fifty-three percent of the subjects presented with structures in their transverse sinuses that could be potential venous filling defects. Thirty percent of the subjects presented with arachnoid granulations in the right transverse sinus, which were found to be significantly dominant (Chi-square; p < 0.05). The study also revealed the presence of 1 to 5 septa in 29.4% of the subjects. The septa were found to be more dominant in the central (30%) and lateral (22%) thirds of the right transverse sinuses, while the central third of the left transverse sinus proved to be the least dominant occurring site (8%). In general, the right transverse sinus is highly more significantly dominant in septal occurrence (Chi-square; p < 0.01) than the left transverse sinus. We conclude from the statistical evidence that the right transverse sinus demonstrates significantly more potential venographic filling defects than the left sinus and submit that this information may assist in management options for patients diagnosed with idiopathic intracranial hypertension as well as direct future research.

Tuberculosis epidemiology in six provinces of Vietnam after the introduction of the DOTS strategy.

SETTING: Six provinces in Vietnam where the DOTS strategy was introduced in 1989. OBJECTIVE: To assess the impact of improved tuberculosis (TB) control on TB epidemiology in Vietnam. METHODS: Data from the surveillance system in the period 1990-2003 were analysed to assess trends of notification rates and the mean ages of notified cases. Data from repeated tuberculin surveys in the period 1986-2002 were estimated to assess the prevalence of TB infection, the annual risk of infection and its trend using various cut-off points in those with and without bacille Calmette-Guérin (BCG) scar. RESULTS: Age-standardised notification rates in the period 1996-2003 declined significantly, by 2.6% to 5.9% per year, in five provinces. However, in four provinces notification rates in the age group 15-24 years increased significantly, by 4.5% to 13.6% per year, during this period. The mean age of newly diagnosed patients with smear-positive TB increased up to 1995 but decreased thereafter. The annual risk of TB infection showed a significant annual decrease (4.9% per year) in one province in surveys performed between 1986 and 1997, and in two provinces (6.6% and 4.7%) in surveys conducted between 1993 and 2002. CONCLUSION: These data suggest limited impact to date of the DOTS strategy in Vietnam.

Health sector reform and tuberculosis control: the case of Zambia.

SETTING: Zambia, 1995-1997. OBJECTIVE: To describe the process leading to the collapse of Zambia's National Tuberculosis Programme NTP). DESIGN: A descriptive analysis of health sector reform in Zambia and its effects on the NTP during the period 1995-1997. RESULTS: By the end of 1997 the NTP had stopped functioning. The main reason was that external support had ended, while the National Strategic Health Plan 1995-1999 had no budget for special programmes according to the policy to integrate these into the general health services. As a consequence, technical support for tuberculosis control to districts ended as staff was reduced to one officer responsible for the national coordination of AIDS/HIV, sexually transmitted diseases (STD), tuberculosis and leprosy. The most serious effect of the transition was the interruption of supplies of anti-tuberculosis drugs in 1998. CONCLUSIONS: The experience in Zambia demonstrates the urgent need for constructive dialogue between 'health reformers' and 'disease controllers'. The aim of this dialogue would be to develop a model that ensures that tuberculosis patients are properly diagnosed and cured in countries that are embarking on a reform of their health services.

National tuberculin survey of Kenya, 1986-1990.

SETTING: The first tuberculin survey conducted in Kenya by the World Health Organisation in 1958-1959 found an annual risk of tuberculosis infection (ARTI) of 2.5%. OBJECTIVE: To estimate the ARTI and its trend in recent years and to compare the estimated incidence rates with the notification rates. DESIGN: A tuberculin survey was held in 12 randomly selected districts in the period 1986-1990. Tuberculin testing with 2TU PPD RT 23 + Tween 80 was performed in 40,365 primary schoolchildren aged 6-13. RESULTS: Of 14,984 non BCG-vaccinated children, 1,380 (9.2%) had indurations of > or = 10 mm. Double testing with PPD RT 23 and PPD-scrofulaceum in 980 non BCG-vaccinated children revealed a high level of infections due to mycobacteria other than tuberculosis (MOTT). Therefore, the prevalence of tuberculous infection was based on the sum of 50% of the indurations of 17 mm and all indurations of 18 mm or more multiplied by two. The prevalence of tuberculous infection in schoolchildren aged on average 8.4 years, 'weighted' for the population size according to the provisional results of the 1989 census, was calculated at 5.5%. The corresponding ARTI is 0.6%. CONCLUSION: The ARTI has declined by an average 4.6% per year. The tuberculosis problem differs from one area to the next, with the highest prevalences of infection on the coast and in Eastern Kenya, and the lowest in Western Kenya. Although the average ratio of observed and estimated incidences indicate that 70% of incident cases are notified, considerable inter-district variations are observed.

Histogenesis of the chequered pattern of ivory of the African elephant (Loxodonta africana).

This study aimed to propose a hypothesis on the events which lead to the development of the characteristic chequered pattern of elephant ivory. Twenty fragments of ivory and six elephant tusks were obtained through the National Parks Board of South Africa. Polished surfaces were prepared in sagittal and longitudinal planes and the characteristics of the distinctive chequered pattern described. Light- and electron-microscopical techniques and image analyses were employed to determine the morphological basis of the pattern and to describe the spatial distribution, density and morphology of the dentinal tubules. These investigations showed that the distinctive pattern was the result of the sinusoidal, centripetal course followed by dentinal tubules. The apical, slanted part of the sinusoidal curve is the result of the centripetally moving odontoblast, which, during formation of ivory, progresses towards the centre of the tusk on a decreasing circumference. It is suggested that this leads to cell crowding, increased pressure between odontoblasts and subsequent apical movement of their cell bodies, cell degeneration and fusion. Odontoblastic degeneration and fusion probably relieve the pressure between the crowded odontoblasts by reducing their numbers and the remaining odontoblasts now orientate their centripetal course towards the tip of the tusk, thereby forming the anterior-directed part of the sinusoidal path of the tubule. As odontoblasts progress centripetally the diameter of the pulpal cavity decreases further and the processes of apical movement, fusion and degeneration of odontoblasts are repeated. This occurs until the pulpal cavity is obliterated.

The ultrastructure of the 'peripheral resistance' and the precapillary sphincters.

The vascularization of the primary somaesthetic cortex of the albino rat was studied by snap-fixing of the vessels with a constant infusion of glutaraldehyde through the left ventricle of the heart, followed by injection of a resin under a constant pressure and flow rate directly into the aorta. The vibrissae on one side were stimulated both before and during the fixing procedure. Specimens of the appropriate area of the cortex were taken and treated for viewing by scanning electron microscopy. The apparent morphological changes are described and illustrated by micrographs.