Study on the time frame for ossification of the medial clavicular epiphyseal cartilage by x-ray in ghanaian students / Estudio con rayos x sobre el periodo de tiempo para la osificación del cartílago epifisial clavicular medial en estudiantes ghaneses

The objective of this study was to determine the rate of ossification of the medial epiphysis of the clavicle and some of the different factors that may influence the rate of ossification in the Ghanaian population. The study was a retrospective study and was conducted at the University of Cape Coast hospital, Cape Coast, Ghana. Chest x-rays of 1035 first year University of Cape Coast students admitted, for the 2008/2009 academic year were used. Statistically significant differences were produced for some of the stages when sex comparisons were done using the t-test for two independent groups with a 95 percent confidence level. Stages 2 (p=0.001), stage 3 (p<0.001) and stage 4 (p=0-001). The age of onset of ossification of the medial clavicle appeared generally to be earlier in females than in males. The stage of partial ossification of the medial clavicular epiphysis also lasted longer than in other studies indicating a delay in the ossification at this stage. In conclusion conventional x-ray of the medial clavicle can be an effective tool in assessing forensic age of subjects for any purpose; however there is a need to develop reference values that are specific for particular geographical areas.

El objetivo de este estudio fue determinar la tasa de osificación de la extremidad esternal de la clavícula y determinar algunos de los diferentes factores que pueden influir en la tasa de osificación en la población de Ghana. Se efectuó un estudio retrospectivo en el hospital de la Universidad de Cape Coast, Cape Coast, Ghana. Se utilizaron 1035 radiografías de tórax de estudiantes admitidos al primer año de la Universidad de Cape Coast, el año académico 2008/2009. Se observaron diferencias estadísticamente significativas para algunas de las etapas en que se realizan comparaciones de sexo mediante el t-test para dos grupos independientes con un nivel de confianza del 95 por ciento. Etapas 2 (p = 0,001), la etapa 3 (p <0,001) y la etapa 4 (p = 0-001). La edad de inicio de la osificación de la extremidad esternal de la clavícula aparecía generalmente antes en las mujeres que en los hombres. La etapa de osificación parcial de las extremidad esternal de la clavícula también duró más tiempo que lo relatado en otros estudios los cuales indican un retraso en la osificación en esta etapa. En conclusión la radiografía convencional de la extremidad esternal de la clavícula puede ser una herramienta eficaz en la evaluación forense de la edad de los sujetos, sin embargo existe necesidad de definir valores de referencia que sean específicos para determinadas zonas geográficas.

Horner's syndrome revisited: with an update of the central pathway.

A brief summary is presented of the life of Johann Friedrich Horner, the eminent Swiss ophthalmologist, renowned for describing the effects of paralysis of the human cervical sympathetic nerves. His early education, the quality of his professional training, and the influence of his mentors, notably Carl Ludwig and Albrecht von Graefe, contributed to his discovery of the syndrome. The full text of Horner's original work (translated by J. F. Fulton, 1929a, Arch. Surg. 18:2025-2039) is cited. The history of clinical and experimental work carried out on the autonomic nervous system prior to Horner's discovery is reviewed, including the studies of Pourfour du Petit (cited in Fulton, 1929a and Singer and Underwood, 1962, Clarendon); Hare, 1838, Lond. Med. Gaz. 23:16-18; Bernard (cited by Singer and Underwood); Budge (1853, Acad. de Sci., p.377-378); Mitchell et al. (1864, Lippincott). Hare and Mitchell et al. came close to making the discovery but were apparently hindered by their inability to interpret the signs they elicited in their patients. The experiments of Claude Bernard gave succinct accounts of the effects of damage to the cervical sympathetic nerves in animals, although there appears to be no evidence that he made similar observations in humans. Horner was the first to give a detailed, scientifically supported account and accurately interpret the signs of cervical sympathetic nerve damage in a human subject. The anatomy of the pathway is reviewed and the detailed structure of its central part updated. Evidence from computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and single-photon-emission computerized tomography (SPECT) studies have confirmed that reciprocally connected centers in the insular cortex, central nucleus of amygdala, hypothalamus, mesencephalic and pontine tegmentum, nucleus of tractus solitarius, and the ventrolateral medulla form the central pathway. The nucleus of tractus solitarius is probably the main reflex center for the sympathetic system, whereas the ventrolateral medulla serves as the pathway through which the central neurons influence the preganglionic neurons of the thoracolumbar outflow. Emotional and sensory inputs from the frontal and somatosensory cortices provide the inputs needed by the insula to drive the sympathetic nervous system to produce appropriate responses.

Accessory levator muscle of the upper eyelid: case report and review of the literature.

The authors describe a supernumerary muscle in each orbit of an elderly male subject. There appear to be no previous reports of this muscle; most reports of anomalies of extraocular muscles describe hypoplasia or aplasia. Thirty-five formalin-fixed cadavers assigned to medical students for dissection were studied. The orbits were dissected by a superior approach which involved removal of the orbital plate of the frontal bone and the superior orbital margin. A supernumerary extraocular muscle was seen in each orbit of one cadaver, located between the superior oblique and levator palpebrae superioris muscles. It originated on the inferior surface of the lesser wing of sphenoid bone and was inserted into the skin of the medial one-third of the upper eyelid. It was innervated by a branch from the superior division of the oculomotor nerve. The insertion of the muscle into the upper eyelid produced a crease running obliquely upwards and medially, from the junction of the medial one-third and lateral two-thirds of the lid margin, towards the medial part of the superior orbital fold. The authors suggest the name levator palpebrae superioris accessorius for this muscle in view of its topography and action as tested in the cadaver. The significance of the findings is discussed and the literature on the development of the muscles supplied by the oculomotor nerve is reviewed.

The superficial ulnar artery: development and surgical significance.

The upper limbs of 72 formalin-fixed human cadavers were examined by dissection for arterial anomalies. In one subject, the ulnar artery was noted to be a branch of the second part of the axillary artery on both right and left sides. It ran a superficial course in the arm, crossed the elbow immediately subjacent to the median cubital vein, and continued its course in the forearm in a subcutaneous position. In the hand it played a dominant role in the formation of the superficial palmar arch. The anomalous ulnar artery was of a smaller caliber than both the radial and common interosseous arteries. Although superficial ulnar arteries have been reported in the literature, the combination of bilateral superficial ulnar arteries originating from the axillary arteries appears to be rare. The developmental and surgical significance of the findings are discussed.

Age-related variations in the horizontal and vertical diameters of the pedicles of the lumbar spine.

The horizontal and vertical diameters of the pedicles of the lumbar vertebrae were measured from plain anteroposterior radiographs of the lumbar spines of male and female subjects aged from 10 to 65 y. The results showed that there were significant differences between the pedicle diameters of males and females. Horizontal diameters ranged from 7.4 to 13.6 mm in females and from 7.5 to 14.2 mm in males. Female vertical diameters ranged from 14.2 to 18.2 mm whilst male vertical diameters ranged from 14.8 to 20.7 mm. Generally, there was a cephalocaudal increase of diameters in both sexes. Significant age-related variations of pedicle diameters were noted at all segmental levels. Within the adolescent group (10-19.9 y), the diameters of the 10-14.9 y group and 15-19.9 y group differed significantly (P < 0.001). When the pedicle diameters of the individual age groups were compared, the pedicles of the 10-19.9, 20-29.9, 30-34.9, 40-49.9, and 50+ y groups were found to be significantly different from each other. The evidence suggests that pedicle diameters undergo continuous change throughout the age range studied. The changes are characterised by increase of diameters in some age groups and decrease in others, but there was an overall increase of both vertical and horizontal diameters as the age groups were followed from the youngest to the oldest. The pattern of variation with age differed for horizontal and vertical diameters. After the 5th decade, female horizontal and vertical diameters showed a tendency to increase while male diameters decreased.

Mentolabial sulcus: a histologic study.

This study deals with the structure of the lower lip in the region of the mentolabial sulcus with particular emphasis on the morphologic factors responsible for producing and maintaining the sulcus. The results of this study provide information about the anatomic framework as it pertains to reconstructive and aesthetic procedures on the lower face deformed by injuries.

Postburn deformity of lip-chin complex: a method to restore the mentolabial sulcus.

An extensive postburn deformity of the lower lip presents a difficult reconstructive problem. Efforts to reconstruct the resultant defect by conventional methods were found unsatisfactory. In a deformed lower lip, restoration of the contour of the lip with a well-defined mentolabial sulcus should be the aim of any reconstructive effort to bring aesthetic balance to the face. We describe a simple and effective method of restoring the function and form of the lip-chin complex.

Anomalous origins of colic arteries.

The topography of the celiac trunk and superior and inferior mesenteric arteries was studied by dissection in 27 embalmed cadavers. Variant vascular patterns were noted in four subjects. These consisted of: (1) an accessory right hepatic artery from the superior mesenteric artery, (2) an anomalous middle colic artery from the proximal segment of the splenic artery, and (3) two instances of an accessory left colic artery originating from the superior mesenteric artery. The precarious course of the middle colic artery (coming from the splenic artery) and its dominance in the formation of the marginal artery were thought to predispose the ascending and transverse colon to an increased risk of vascular damage. These cases also illustrate two variant patterns of formation of the marginal artery. In the case of the anomalous middle colic artery, the only contribution of the superior mesenteric artery to the marginal artery was through the anastomosis of its ileocolic branch with the right branch of the aberrant middle colic artery. In subjects with accessory left colic arteries, the superior mesenteric artery played a dominant role in the formation of the marginal artery by contributing the accessory left colic artery, which supplied the splenic flexure and the proximal part of the descending colon. These arterial variations underscore the importance of doing vascular studies prior to major abdominal surgery.

Changes in the lumbosacral angle, sacral inclination and the curvature of the lumbar spine during aging.

Measurements of the curvature of the lumbar spine are useful in the investigations of low back pain. It is unclear whether the degree of lumbar lordosis, sacral inclination and lumbosacral angulation are the same for all normal adults. Radiographic studies were carried out on the lumbar spines of subjects aged 9-61 years. Mean and 95% tolerance ranges of the values of lumbar lordosis, lumbosacral angle and sacral inclination for adult age groups up to the sixth decade are given. The results showed that all three parameters varied steadily with age. The pattern of changes differed in males and females. Females had greater angles than males. Sacral inclination appeared to be a more important determinant of the degree of lumbar lordosis. All three parameters showed a tendency to decrease after the sixth decade. The significance of the findings is discussed.

Morphometric changes in the heights and anteroposterior diameters of the lumbar intervertebral discs with age.

Changes in the heights and anteroposterior diameters of human lumbar intervertebral discs have been studied by means of measurements from radiographs. The results confirm previous reports that there is overall increase in the various dimensions of the disc with age. Growth of the discs apparently does not follow a linear pattern. There are alternating periods of overgrowth and thinning. After the 5th decade of life there is an appreciable decline of disc height. The significance of the findings is discussed.

Transverse diameter of the lumbar spinal canal in normal adult Saudis.

Pathological changes in the diameters of the lumbar spinal canal may be associated with low back pain. The assessment of the size of the canal is therefore an important diagnostic procedure. Evidence suggests that there are ethnic differences in the dimensions of the canal. A radiogrammetric study was therefore undertaken to establish norms of the transverse diameter for the Saudi population. The results show that the transverse diameter of the canal in Saudis differ from that of other populations, but the shape is similar to those of earlier reports. Intersegmental differences which are useful for the detection of isolated segmental anomalies were also calculated. The significance of the findings is discussed.

Morphology of muscle spindles in the human popliteus muscle. Evidence of a possible monitoring role of the popliteus muscle in the locked knee joint?

The mechanical events leading to locking of the human knee joint are well described in the literature, but there appears to be little information on the source of afferent feedback needed to monitor the locked joint. Human fetal popliteus muscles were studied by histological and graphic reconstruction techniques. The results showed that the muscle contained many muscle spindles. The arrangement of these receptors into complex and tandem forms seems to support the view that the popliteus muscle is capable of subserving kinaesthesia.

Ligaments associated with lumbar intervertebral foramina. 2. The fifth lumbar level.

The lumbosacral spines of two fetal and twelve adult cadavers have been studied by dissection. Evidence shows that the fifth lumbar intervertebral foramen is crossed on its external aspect by a strong, cord-like corporotransverse ligament passing obliquely downwards, forwards and medially from the inferior aspect of the accessory process of the fifth lumbar vertebra to the lateral surface of the intervertebral disc and the adjacent parts of the bodies of the fifth and first sacral vertebrae. Superficially, the ligament is related to another flat band--the lumbosacral hood. Together these ligaments separate and provide openings for the sympathetic ramus, the ventral ramus and blood vessels related to the intervertebral foramen. On the dorsal aspect, a tripartite ligament, the mamillo-transverso-accessory ligament, bears important relationships to the subdivisions of the dorsal ramus and also the zygapophyseal joint. The significance of these findings is discussed.

Ligaments associated with lumbar intervertebral foramina. 1. L1 to L4.

Lumbar intervertebral foramina have been studied by dissection of fetal and adult cadaveric spines. The results show that these foramina are crossed by ligaments which subdivide the opening into smaller compartments for the structures traversing it. At L1-L4, there appears to be a basic pattern of arrangement of the ligaments. The bands are tougher in the upper lumbar region and become steadily thinner caudally. Evidence from the study suggests that these ligaments are probably normal components of the intervertebral foramen. The significance of these findings is discussed.

The sagittal diameter of the lumbar vertebral canal in normal adult Nigerians.

An osteometric study of the anteroposterior diameter of the lumbar vertebral canal and intervertebral foramina of normal adult Nigerians is reported. The results show that the midsagittal diameter of the canal is subject to racial variations, and is determined primarily by the thickness and orientation of the lamina and to a lesser extent by the height of the pedicle. The significance of the findings is discussed.

The density of muscle spindles in the medial, intermediate and lateral columns of human intrinsic postvertebral muscles.

The area occupied by the intrinsic postvertebral muscles varies in the different region of the back. This is associated with variations in the densities of muscle spindles in successive segments of the three columns of muscle. In the thoracic region, the lateral column has the highest density of spindles, whilst the intermediate and medial columns have steadily less. The attachment of iliocostalis and longissimus thoracis muscles to the ribs is such that contraction of these muscles can produce changes in the costotransverse joints. Conversely, movement in these joints might stimulate stretch receptors in the postvertebral muscles. There is collateral innervation of the costotransverse joints and the postvertebral muscles of the thoracic region by the posterior ramus. The finding of high densities of spindles in the thoracic region would therefore seem to support the hypothesis that these muscles probably monitor postural activity of the back as well as the rib cage.

The number and distribution of muscle spindles in human intrinsic postvertebral muscles.

Serial transverse sections of intrinsic postvertebral muscles of a 21 weeks old human fetus were studied after staining with haematoxylin and eosin, Van Gieson's stain with Weigert's haematoxylin, and Glees' silver impregnation technique. Muscle spindles have been demonstrated throughout the entire length of the intrinsic postvertebral muscles. The total numbers of spindles on the right and left sides were determined. Using a special technique of graphic reconstruction, the locations of spindles within these muscles were plotted. Regional differences in the numbers and distribution of spindles were noted. The significance of these findings has been discussed.