Soft tissue thickness values for black and coloured South African children aged 6-13 years

In children, craniofacial changes due to facial growth complicate facial approximations and require specific knowledge of soft tissue thicknesses (STT). The lack of South African juvenile STT standards of particular age groups, sex and ancestry is problematic. According to forensic artists in the South African Police Service the use of African-American values to reconstruct faces of Black South African children yields poor results. In order to perform a facial approximation that presents a true reflection of the child in question, information regarding differences in facial soft tissue at different ages, sexes and ancestry groups is needed. The aims of this study were to provide data on STT of South African Black and Coloured children and to to assess differences in STT with respect to age, sex and ancestry. STT was measured using cephalograms of South African children (n = 388), aged 6 – 13 years. After digitizing the images, STT measurements were taken at ten mid-facial landmarks from each image using the iTEM measuring program. STT comparisons between groups per age, sex and ancestry were statistically analyzed. The results showed that STT differences at lower face landmarks are more pronounced in age groups per ancestry as opposed to differences per age and sex. Generally, an increase in STT was seen between 6 - 10 year old groups and 11 -13 year old groups, regardless of ancestry and sex, at the midphiltrum, labiale inferius, pogonion, and beneath chin landmarks. This research created a reference dataset for STT of South African children of Black and Coloured ancestry per age and sex that will be useful for facial reconstruction / approximation of juvenile remains.http://www.elsevier.com/locate/forsciint2016-07-31hb2016Anatom

The success of various management techniques used in South African children with type 1 diabetes mellitus

Background. Despite the availability of international guidelines for the treatment of type 1 diabetes mellitus (T1DM) in children, important aspects of treatment are not accessible to all young patients in South Africa (SA). Objective. To investigate factors in diabetes management strategies that are associated with poor glycaemic control and decreased quality of life (QoL) in SA children with T1DM. Methods. Eighty children (mean (standard deviation) age 12.9 (2.7) years) with T1DM were asked to answer standardised questionnaires on demographics, management techniques used and perceptions of diabetes. The height and weight of each child was recorded and glycosylated haemoglobin (HbA1c) measured. Informed consent and assent for each participant was obtained before enrolment. Results. A total of 51.4% of the participants had poor metabolic control, with an HbA1c level >10.0% (86 mmol/mol). Factors in clinical practice found to have a significant association with decreased HbA1c and/or QoL were healthcare system (p<0.001), insulin administration (p=0.001), correction dose (p=0.002), carbohydrate counting (p<0.001) and number of severe hyperglycaemic events (p=0.048). Regular exercise did not show any association with HbA1c classification or QoL. Children from single-parent households were prone to unsuccessful diabetes management regardless of treatment techniques used (p=0.002). Conclusions. The use of premixed insulin without access to rapid-acting insulin, absence of correction doses for hyperglycaemia and lack of carbohydrate counting showed significant association with poor diabetes management. Some recommendations regarding the adoption of more effective diabetes management strategies in the public healthcare system are suggested.http://www.samj.org.zaam201

Anatomical variations in the origins of the lateral circumflex femoral arteries in a South African sample : a cadaver study

BACKGROUND : Clinically, the lateral circumflex femoral artery (LCFA) is used in a variety of procedures, these include anterolateral thigh flaps, aortopopliteal bypass, coronary artery bypass grafting and extracranialintracranial bypass surgeries. Variations in the anatomy of the LCFA, profunda femoris artery (PFA) and their branches have been noted in several studies. There are numerous clinical implications related to the inadequate anatomical knowledge of this region. METHODS : The study sample consisted of 55 cadavers of different ages, ancestry groups and varying body mass index. A total of 90 legs were dissected. The anterior thigh compartment was dissected and the common femoral artery (CFA), superficial femoral artery (SFA), PFA and LCFA further exposed. The course and variations were noted and results documented for further analysis. RESULTS : The LCFA was present in all the legs dissected. The origin of the LCFA was found to be the PFA in 75.6% of the left legs and 82.2% of the right legs dissected. In two cases, a male and female limb, the branching of the PFA from the CFA was observed directly from the external iliac artery, deep to the inguinal ligament. A variation was noted in a female cadaver, where the branches of the LCFA on the left limb had different points of origin. Another variation was noted on a male cadaver, the left limb had two different points of branching for the ascending and descending branches of the LCFA, a common trunk was absent. CONCLUSION : This study indicates that the most common site of origin for the LCFA was the PFA. The branching of the PFA from the CFA was found to be variable in 2.2% of the cases, where the PFA was a direct branch of the external iliac artery. The study also noted variations relating to the origin of the transverse branch of the LCFA, this branch was absent in 4.4% of the limbs dissected. Knowledge of the variations related to the origin of the PFA, LCFA and their branches is important in reducing the chances of intra-operative bleeding, during different surgical procedures.National Research Foundation (NRF).https://www.elsevier.com/locate/triadm2022Anatom

A cadaver study on the anatomical variation and branching of the anterior cerebral artery

The cortical branches of the distal anterior cerebral artery (ACA) are responsible for the primary blood supply of the corpus callosum. Anatomical variation in these arteries leads to difficulty in defining a standard vascularisation pattern for the distal ACA, which in turn complicates the task of neurovascular surgeons operating on these structures. The particular aim of this study was to investigate the vascularisation of the corpus callosum by studying the anatomical variations and branching of the ACA. The diameter of the ACA at specific landmarks, its course and branches were studied in 34 embalmed brains. The study revealed that the diameter of the distal ACA was the largest (2.46±0.1mm) at the start of the A4-1 segment. At the start of the A4-2 segment, the ACA was significantly smaller (1.61±0.09mm), while being the smallest (1.31±0.1mm) at the start of the A4-3 segment. Therefore, the artery becomes thinner as it proceeds posteriorly over the corpus callosum. In 29.4% of subjects, 4 branches of the A4-2 segment were found to supply the body of the corpus callosum, causing it to be the most vascular portion. The A4-1 segment had 3 branches in 29.4% of subjects, supplying the genu of the corpus callosum. In 38.2% of subjects, 1 supplying branch of the A4-3 segment was found. Although the most supplying branches were expected to be from the A4-1 segment of the distal ACA, the shorter length of this segment, compared to that of the A42 segment, could possibly be the reason for the fewer number of supplying branches. In conclusion, the blood supply of the corpus callosum differs in the various segments of the distal ACA. Knowledge of this vascular anatomy will aid pre-operative planning and avoidance of complications during neurosurgical proceduresPoster presented at the University of Pretoria Health Sciences Faculty Day, August 2009, Pretoria, South Afric

The success of various management techniques used in South African children with type 1 diabetes mellitus

Background. Despite the availability of international guidelines for the treatment of type 1 diabetes mellitus (T1DM) in children, important aspects of treatment are not accessible to all young patients in South Africa (SA). Objective. To investigate factors in diabetes management strategies that are associated with poor glycaemic control and decreased quality of life (QoL) in SA children with T1DM. Methods. Eighty children (mean (standard deviation) age 12.9 (2.7) years) with T1DM were asked to answer standardised questionnaires on demographics, management techniques used and perceptions of diabetes. The height and weight of each child was recorded and glycosylated haemoglobin (HbA1c) measured. Informed consent and assent for each participant was obtained before enrolment. Results. A total of 51.4% of the participants had poor metabolic control, with an HbA1c level >10.0% (86 mmol/mol). Factors in clinical practice found to have a significant association with decreased HbA1c and/or QoL were healthcare system (p<0.001), insulin administration (p=0.001), correction dose (p=0.002), carbohydrate counting (p<0.001) and number of severe hyperglycaemic events (p=0.048). Regular exercise did not show any association with HbA1c classification or QoL. Children from single-parent households were prone to unsuccessful diabetes management regardless of treatment techniques used (p=0.002). Conclusions. The use of premixed insulin without access to rapid-acting insulin, absence of correction doses for hyperglycaemia and lack of carbohydrate counting showed significant association with poor diabetes management. Some recommendations regarding the adoption of more effective diabetes management strategies in the public healthcare system are suggested.http://www.samj.org.zaam201

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 is 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 sample size of 102, consisting of cadavers and living patients, was used. 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; p0.05). We conclude from the statistical evidence that the right transverse sinus demonstrates significantly more potential venographic filling defects and submit that this information may assist in treatment options for patients diagnosed with idiopathic intracranial hypertension, as well as direct future research.Poster presented at the University of Pretoria Health Sciences Faculty Day, August 2008, Pretoria, South Africa

The anatomy of the anterior approach : a cadaver study

BACKGROUND : This research investigated the anatomy underlying minimally invasive total hip arthroplasty when the anterior approach was used. METHODS : Ninety hips were dissected and in one cadaver, a complete hip replacement was performed. Simulations of the anterior approach surgical incisions were carried by the orthopaedic surgeon in order to see if injury to the lateral femoral cutaneous nerve (LFCN) could be avoided, when the correct anatomical landmarks were palpated. RESULTS : The data analysis revealed significant differences for the mean distances from the pubic tubercle to the straight head of the rectus femoris muscle. Statistical significance was detected for comparisons between males and females, for weight ranges and BMI categories. CONCLUSION : The study findings prove that the concerns relating to the course and distribution pattern of the LFCN and the lateral circumflex femoral artery (LCFA) using the anterior approach, could be overcome when the anatomy of the hip joint and the thigh is understood. However, it is important to note the possible variations in the course of the LFCN and the branching pattern of the LCFA in order to avoid intra-operative bleeding and possible thigh numbness post-surgery.https://www.saoa.org.za/publications/saojam2018Anatom

The size, branching pattern and anatomical relationships of the dorsal pedal aretery on the dorsum of the foot: a cadaver study

Surgical techniques such as ankle arthroscopy and reconstructive flap surgery have made detailed knowledge of the dorsal pedal artery (DPA) and the deep fibular nerve (DFN) on the foot dorsum essential. The aims of this study were to determine the size, branching pattern of the DPA and its relations to the DFN and inferior extensor retinaculum (IER). Forty cadaver ankles were dissected to expose the contents of the anterior tarsal tunnel. The size of the DPA and branches were measured with a Vernier caliper and the branching pattern and relationship of the DPA to the DFN and IER were noted. The size of the DPA were 3.90 mm +/- 0.2 mm (n=40). No significant difference were seen between the sexes (T-test, p>0.05). The branching pattern of the DPA can be described in 3 categories. In 27.5% the DPA had branches above the IER, 62.5% underneath IER and 10% below the IER. No significant difference was noted between the sexes (T-test, p>0.05). The bifurcation of the DPA was mostly underneath IER (57.5%), followed by 37.5% below the IER. In 2.5% the distal branching was above the IER or absent. The bifurcation of DFN is similar as the majority (55.0%) was located underneath the IER, while 27.5% was located above the IER and 17.5% of bifurcations were observed below the IER. A distance of 7.79 +/- 2.9mm was recorded between the bifurcation of DPA and DFN. No significant difference was observed when comparing male and female as well as age groups (T-test, p>0.05). In some cases, the arterial branching lead to the formation of trunks, while 'loops' were observed in the branching pattern of the DFN. The measurements and patterns noted increases the awareness of the possible variations and should assist surgeons during vascular and reconstructive surgeryPoster presented at the University of Pretoria Health Sciences Faculty Day, August 2009, Pretoria, South Afric

The anatomy of the anterior approach: a cadaver study

BACKGROUND : This research investigated the anatomy underlying minimally invasive total hip arthroplasty when the anterior approach was used. METHODS : Ninety hips were dissected and in one cadaver, a complete hip replacement was performed. Simulations of the anterior approach surgical incisions were carried by the orthopaedic surgeon in order to see if injury to the lateral femoral cutaneous nerve (LFCN) could be avoided, when the correct anatomical landmarks were palpated. RESULTS : The data analysis revealed significant differences for the mean distances from the pubic tubercle to the straight head of the rectus femoris muscle. Statistical significance was detected for comparisons between males and females, for weight ranges and BMI categories. CONCLUSION : The study findings prove that the concerns relating to the course and distribution pattern of the LFCN and the lateral circumflex femoral artery (LCFA) using the anterior approach, could be overcome when the anatomy of the hip joint and the thigh is understood. However, it is important to note the possible variations in the course of the LFCN and the branching pattern of the LCFA in order to avoid intra-operative bleeding and possible thigh numbness post-surgery.https://www.saoa.org.za/publications/saojam2018Anatom