Morphometric evaluation of great vein of Galen and its clinical implications / 대한해부학회지

The Galenic venous system plays a vital role in the drainage of blood from deeper parts of the brain. This venous system is contributed by many major veins. These veins are located closer to the pineal gland making the surgical approach in this region difficult. Any accidental injury or occlusion of the vein of Galen could lead to devasting results. Thus, studying the dimensions of the vein of Galen is more important. Hence, we aimed to evaluate the morphometry and trajectory to the vein of Galen. About 100 computed tomographic venography records were evaluated and the length, diameter of vein of Galen, angle between straight sinus and vein of Galen and distance from internal occipital protuberance and roof of fourth ventricle to vein of Galen were studied. The mean length and diameter of vein of Galen were 9.8±2.7 and 4.08±1.04 respectively. The mean angle between straight sinus and vein of Galen was 64.2°. The mean distance between external occipital protuberance and roof of fourth ventricle to vein of Galen were 52±6.9 and 33.3±4.5 respectively. No significant morphometric differences were observed between the age groups as well as between the sexs. The results obtained from this study may be helpful for the neurosurgeons in better understanding of the anatomy of the Galenic venous system and to adopt a safe surgical approach to improve the efficacy of the surgeries of the pineal gland and also in the region of vein of Galen.

Reappraisal of arterial anatomy of thumb / 대한해부학회지

The nomenclature of arteries supplying the thumb and its sources arteries differs between the studies. This makes difficulty in understanding the irrigation pattern to the thumb. The main purpose of this study was to identify the proper digital arteries supplying the thumb on its radial and ulnar side from both the palmar and dorsal aspect. Also this study aimed to trace its source and classify with proper definition with the review of blood supply to thumb. Dissection was carried out in 55 hands form 28 freshly embalmed adult human cadavers of both genders. The proper digital arteries to the thumb and its source arteries were carefully traced and defined. Thumb receives its dominant blood supply mostly from its palmar side. The ulnar palmar digital artery was seen in all the dissected hand (100.0%) whereas; the radial palmar digital artery was present in 53 hands (96.4%). The radial dorsal digital artery and ulnar dorsal digital artery were observed in only 10.0% and 7.3%. The most common source of both the palmar digital arteries to thumb was from first palmar metacarpal artery (FPMA). In majority of the hands, in addition to the radial or ulnar palmar digital arteries from the FPMA, there were also additional palmar digital arteries arising from the superficial palmar arterial system. The universal naming of the proper digital arteries to the thumb as well as its source arteries is mandatory for the proper understanding of normal as well as variant arterial anatomy of thumb.

Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint.

Introduction The collateral ligaments of the first metacarpophalangeal (MCP) joint provide stability to the thumb. Injury to these collateral ligaments occurs more commonly in sports accidents leading to joint instability, weakness in pinch and grip strength. Normal morphometric measurements of collateral ligaments are essential for primary repair or reconstruction of the injured ligament. Hence, the objective of the study is to give the detailed morphometric profile of the proper collateral ligaments of the MCP joint of the thumb. Materials and Methods A total of 55 adult cadaveric hands were included in the study taken from 18 male (36 hands) and 10 female (19 hands) cadavers. Out of 55 hands, 28 belonged to the left side, while 27 were of the left side. The MCP joints were dissected to expose the collateral ligament complex. The length and width of the proper ligaments were measured. Results Both the proper collateral ligament attachments and the direction of the fibers were defined. Overall length and the width of both the proper collateral ligaments showed no statistically significant difference of mean between the left and the right sides. However, the length of both the proper collateral ligaments is significantly less in females compared with the males. Conclusion The morphometric details of the proper collateral ligaments obtained from this study would be useful for hand surgeons during surgical correction of the injured collateral ligaments either by primary repair or reconstruction with a tendon graft.

Learning Gains of Liver Resection and Transplantation Workshop on Genelyn® Embalmed Human Cadavers: Surgical Gastroenterologists' Perceptions.

BACKGROUND: In the light of increased requirement for liver transplantation procedures, it is pertinent to develop bankable human expertise in the areas of liver resection and anastomoses. The alternative simulator sources available for learning surgical skills might not always provide the realistic learning gains as provided by human cadavers, especially in terms of haptic and tactile fidelity. For the first time, we have used Genelyn® embalmed cadavers (GEC) for training the surgical gastroenterologists in liver resection and transplantation procedures and we wish to document our experience of using them to facilitate the learning of liver resection procedures. MATERIALS AND METHODS: A cross-sectional satisfaction survey fitting to the first level of the Kirkpatrick model for training evaluation was performed among participating surgical gastroenterologists of liver resection and transplantation training workshop using GEC. Visual, haptic and tactile characteristics of the liver and related structures were assessed along with overall satisfaction of the workshop. RESULTS: Eleven surgical gastroenterologists had participated in the workshop conducted using three GEC. Nine participants agreed that the transection of liver parenchyma was similar to reality. However, two opined that the liver parenchyma was a bit harder to resect. Identification of portal pedicle, dissection of the peri-portal area and securing vascular anastomoses also had an acceptable level of similarity to real life. The two parameters that received a unanimous degree of the agreement are mobilization of liver and cannulation of key vessels for perfusion. CONCLUSION: Participants of the cadaveric surgical skills training workshop opined that the soft-embalmed cadaver using Genelyn® is an excellent realistic model for practicing liver resection and transplantation surgery.

Morphometry of the Uncinate Process, Vertebral Body, and Lamina of the C3-7 Vertebrae Relevant to Cervical Spine Surgery.

OBJECTIVE: The cervical spine consists of 4 typical and 3 atypical vertebrae. The uncinate process is one of the unique features of the cervical vertebrae. Uncinectomy and uncoforaminotomy are widely used to decompress the nerve in the intervertebral foramen and to remove osteophytes from the uncinate process. Morphometric analyses of the uncinate process help spine surgeons obtain a 3-dimensional orientation for approaching the cervical spine with minimal risk to the surrounding vascular and neural structures. This study aims to analyze the morphometry of uncinate process of cervical vertebrae with relevant to cervical spine surgery. METHODS: Eighty dry adult cervical vertebrae were studied, and 11 parameters were measured. Seven parameters were paired and 4 were unpaired. RESULTS: The height of the uncinate process progressively increased from C3 to C6 and decreased at C7. The length of the uncinate process increased from C3 to C6-7. The width was greatest at C6 and smallest at C3. The vertebral body width and anteroposterior diameter gradually increased from C3 to C7. The parameters of the lamina also increased from C3 to C7. CONCLUSION: Precise knowledge about the cervical vertebrae is useful for diagnosing both common and uncommon causes of symptoms and for choosing an appropriate approach. Thus, it helps to increase the success rate of cervical surgery.

Three-dimensional magnetic resonance-based morphometry of pituitary stalk.

PURPOSE: The pituitary or infundibular stalk is an anatomically important structure identified routinely in radiologic imaging for the evaluation of pituitary and suprasellar lesions. The morphometry of the pituitary stalk with 1.5 T MR images was useful in diagnosing the infundibular lesion and to assess the efficacy of treatment given by chemotherapy for many pathological conditions. The normative data for the length, the thickness of the stalk, and the infundibular recess are inadequate in the literature. There are no data regarding the morphometry of the pituitary stalk in the adult population. METHODS: One hundred and fifty normal brain MR images (75 males and 75 females) were analyzed for the evaluation of stalk and other parameters. Mean and the standard deviation were calculated. The unpaired t test was used to assess any significant difference between age-groups and gender. The intraclass coefficient correlation was used to analyze the inter-observer variability. RESULTS: The mean length of the stalk was 0.55 ± 0.16 mm. There was a significant difference (p < 0.05) in the length between the genders. The mean diameter of the stalk at the level of optic chiasma was 0.24 ± 0.06 mm, and the infundibular depth was 0.52 ± 0.12 mm. There was no significant difference between the genders in the thickness of the stalk and the depth of the recess. CONCLUSION: The normative data from the present study can be used as a screening tool for diagnosis as well as to assess the effect of treatment in pituitary infundibular lesions. These normative data shall be of help in the evaluation of stalk in various neurosurgical and endocrinological pathologies and lead the radiologist and endocrinologist in the early diagnosis and management of hypothalamo-pituitary axis diseases.

Morphometric study of pulleys of the thumb / 대한해부학회지

Pulleys are thickened regions in flexor tendons sheaths of the digits. They are essential and act as fulcrum for the flexion and extension of the digits. The arrangement and number of pulley system differs greatly between the thumb and other digits. There is paucity of literature regarding the pulley system of thumb. We aimed to study the morphometry of the pulley system of the thumb in Indian cadavers. Dissection was carried out in 55 adult human cadaveric thumbs. The most common morphologic pattern of pulley observed in the thumb is type III (30 thumbs). The least observed is type I (4 thumbs). The mean width and standard deviation of A1, Av, oblique, and A2 pulleys are 5.06±0.87, 5.38±1.22, 4.68±1.13, and 6.04±1.41 mm, respectively. The gap distances between the pulleys were also measured. The results obtained from the present study may be helpful in surgical treatment of trigger thumb with less complication and also in reconstruction of the closed rupture of the pulley of the thumb.

Morphometric study of tensor of vastus intermedius in South Indian population / 대한해부학회지

Tensor of vastus intermedius is a newly discovered muscle located between vastus lateralis and vastus intermedius. The purpose of this study was to investigate the detailed morphology of tensor of vastus intermedius, specifically to provide data pertaining to the attachments, innervations, variation in the types and its morphometry in South Indian population. The tensor of vastus intermedius was studied in thirty six cadaveric lower limbs using macrodissection techniques. The origin of the muscle was from upper part of intertrochanteric line and anterior part of greater trochanter of femur inserted to medial aspect of upper border of patella. The muscle was classified into four types based on the origin and also the aponeurosis course with independent type (type 1) being common. The mean and standard deviation of the length of tensor of vastus intermedius and aponeurosis were 145.40±37.55 mm and 193.55±42.32 mm, respectively. The results of the study suggest that tensor of vastus intermedius is variable and the information provided regarding the attachments, types and quantitative data will contribute to the existing knowledge of the muscle.

Perception of MBBS students to "flipped class room" approach in neuroanatomy module / 대한해부학회지

A flipped classroom is a learner centered approach in which the learner is responsible to attend the class with basic understanding of the subject to fully participate and engage in discussions. The aim of this study was to evaluate students' perception of flipped classroom approach for neuroanatomy module and assess the impact on their performance and attitudes. The subject chosen to evaluate the flipped classroom model for first year medical students was clinical neuroanatomy. One hundred and thirty first year medical students participated in the study module. Students were divided into five groups and five case scenarios pertaining to various clinically relevant regions of the neuraxis, with varying anatomical complexity were generated. The pre- and post-tests were designed to specifically test the declared learning objectives of the session. The perception of the students regarding this model of teaching and learning was also evaluated. Eighty-six percent of students felt that the flipped classroom approach was better at fulfilling the stated learning objectives than the conventional didactic teaching, 92% felt that the work-sheet with questions provided prior to the class enabled a better understanding of the subject and 87% were of the opinion that the web sources with references kindled a greater interest to read as compared with didactic lectures. The paired t test showed highly significant differences between the pre and post-test scores. Student response to the flipped classroom structure was largely positive, indicating it to be an approach worth pursuing in future years.

The Quadriceps angle (Q angle) in Indianmen and women

The quadriceps angle (Q angle) is a clinical measure of the alignment of the quadriceps femoris musculature relative to the underlying skeletal structures of the pelvis, femur and tibia. The aims of this study were to calculate the Q angle in a young, healthy adult Indian population in order to document any significant differences in the Q angle between males and females and to analyze these differences. Two hundred limbs (100 from males and 100 from females) from healthy adult Indian volunteers were studied. The Q angle was measured using a goniometric method with the subjects supine, the quadriceps relaxed and the lower limbs in neutral rotation. Lateral placement of the tibial tuberosity with respect to the centre of the patella was measured. Inter-observer variations in the above mentioned parameters were studied in twenty limbs. The average Q angle value of all 200 limbs was 12.73° ±2.58. The mean value in females was 14.48° ±2.02 and 10.98° ±1.75 in males. The lateral placement of the tibial tuberosity was 0.9 ±0.59 cm and 1.8 ±0.65 cm in males and females respectively. Both the Q angle and the lateral placement of the tibial tuberosity were significantly greater in females. The intra-class correlation coefficient was 0.66 for the Q angle and 0.8 for the lateral placement of the tibial tuberosity. Females had a significantly greater Q angle as compared to males as a result of a more laterally placed tibial tuberosity (AU)

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