The carrying angle: racial differences and relevance to inter-epicondylar distance of the humerus

The human carrying angle (CA) is a measure of the lateral deflection of the forearm from the arm. The importance of this angle emerges from its functional and clinical relevance. Previous studies have correlated this angle with different parameters including age, gender, and handedness. However, no reports have focused on race-dependent variations in CA or its relation to various components of the elbow joint. This study aimed to investigate the variations in CA with respect to race and inter-epicondylar distance (IED) of the humerus. The study included 457 Jordanian and 345 Malaysian volunteers with an age range of 18–21 years. All participants were right-hand dominant with no previous medical history in their upper limbs. Both CA and IED were measured by well-trained medical practitioners according to a well-established protocol. Regardless of race, CA was greater on the dominant side and in females. Furthermore, CA was significantly greater in Malaysian males compared to Jordanian males, and significantly smaller in Malaysian females compared to their Jordanian counterparts. Finally, CA significantly decreased with increasing IED in both races. This study supports effects of gender and handedness on the CA independent of race. However, CA also varies with race, and this variation is independent of age, gender, and handedness. The evaluation also revealed an inverse relationship between CA and IED. These findings indicate that multiple factors including race and IED should be considered during the examination and management of elbow fractures and epicondylar diseases.


Characteristics of Sertoli cells in the ectopic and scrotal testes of unilateral cryptorchid West African dwarf goats

Sertoli cell population and histology were studied in testes of unilateral cryptorchid goats. Histomorphological and electron microscopic techniques were employed. The results demonstrated that the number of Sertoli cell per testis was significantly (p < 0.05) higher in the descended scrotal testes of unilateral cryptorchid bucks compared with the right and left testes of the normal bucks, respectively. However there was no significant difference (p > 0.05) on comparing the number of Sertoli cells in the scrotal testes of the unilateral cryptorchid bucks with the paired testes of the normal bucks. Significant differences were not observed in the dimensions of the Sertoli cell nuclei in the retained, scrotal testes of the cryptorchids and the testes of the normal bucks. The Sertoli cells of the descended scrotal testes of the cryptorchid bucks and those of the normal bucks showed histological evidence of normal activity. Degeneration of Sertoli cells was observed in the retained testis of the cryptorchid bucks. The failure of one testis to descend most probably influenced compensatory hyperplasia of Sertoli cells and enhanced function of the cells in the descended testis of the unilateral cryptorchids.

Interstitial cells of Cajal — systematic review

This paper reviews the distribution of interstitial cells of Cajal (ICC) in the human gastro­intestinal (GI) tract, based on ultrastructural and immunohistochemical evidence. The distribution and morphology of ICC at each level of the normal GI tracts is addressed from the perspective of their functional significance. Alterations of ICC reported in as well as in GI stromal tumours are reviewed, with emphasis on the place of ICC in the pathophysiology of disease.

The impact of type 1 diabetes on the development of the craniofacial mineralised tissues (bones and teeth): literature review


Background: There are many reports on the impact of diabetes on periodontium as well as the state of organs in diabetics; however, there is little research on the impact of the disease on morphological and anatomical changes in the mineralised tissues like teeth and craniofacial bones. The aim of this study was to present a review of literature on morphological and anatomical changes of mineralised tissues in the course of type 1 diabetes.

Materials and methods: A review of PubMed database was made using the keywords: morphological changes, anatomical changes, enamel hypoplasia, type 1 diabetes, induced diabetes and the names of individual anatomical and morphological structures of the teeth.

Results: The analysis of experimental studies have shown that in induced type 1 diabetes in rats there is a substantial reduction in the thickness of the enamel and dentin, compared with the control group. The changes in the content of indivi­dual minerals in the tissues of the tooth have been shown — a decrease in the concentration of calcium and fluoride ions and an increase in the concentration of magnesium. In a study conducted on embryos of rats born of diabetic dams, defects were observed in enamel organ, which can cause delayed enamel hypo­plasia. Literature analysis revealed morphological disorders also in some clinical cases of patients with type 1 diabetes.

Conclusions: Type 1 diabetes mellitus as a metabolic disorder may affect changes in the structure of mineralised tissues, thereby increasing their susceptibility to caries development and orthognathic disorders.

Vertebral level and measurements of conus medullaris and dural sac termination with special reference to the apex of the sacral hiatus: anatomical and magnetic resonance imaging radiologic study

Background: Anatomical orientation of the caudal space and termination level of conus medullaris (CMT) and dural sac (DST) has great significance for anaesthetists and neurosurgeons. This study aimed to explore the anatomical landmarks important to perform save spinal anaesthesia, lumber puncture and caudal analgesia through the correlation between the vertebral level of CMT, DST and sacral hiatus apex (SHA) in human cadavers and by using magnetic resonance imaging (MRI).

Materials and methods: Sixty adult cadavers (40 males, 20 females) and 200 (100 males, 100 females) MR lumbosacral images of 16–69-year-old persons were used in this study. Vertebral level of CMT, DST and SHA and their linear distances were determined in cadavers and MRI. Also, anteroposterior diameter at SHA, length and thickness of sacrococcygeal membrane were measured as well, and correlate these levels and their distances with age and sex.

Results: Mean and highest frequent number of MRI vertebral level of CMT was observed at lower third of L1 in men and L1-2 disc in women, that of DST at upper third of S2 in men and middle third of S2 in women, while SHA was seen at middle third of S4 in both men and women with no significant (p > 0.05) age or gender differences. In 5% of cases, CMT, DST and SHA were seen at vertebral level below L2, below S2-3 and above S3, respectively. However, mean vertebral level of CMT, DST, SHA was observed at L1L, S2M and S4U without sex differen­ce in cadaveric specimens, respectively. All linear distances of men MRI revealed significant difference (p < 0.05) compared with those of women except thickness of sacrococcygeal membrane and anterposterior diameter at SHA.

Conclusions: Accurate knowledge of vertebral level of CMT, DST and SHA and the distances in-between might decrease the iatrogenic injury of dural sac, spinal cord and cauda equina.

Selected clinical challenges of a supraclavicular cephalic vein in cardiac implantable electronic device implantation

Background: Supraclavicular variations of the cephalic vein (CV) are detected sporadically. A somewhat more common finding is a CV variation with the typical course of the main vessel but with an additional supraclavicular branch, called the jugulocephalic vein (JCV). The aim of the study was to detect supraclavicular CVs or JCVs via intra-operative venography as well as assess their effects on primary and later revision cardiac implantable electronic device (CIED) procedures in our patients.

Materials and methods: We analysed venographic images obtained during CIED procedures at our centre between 2011 and 2015. Out of the 324 venographies conducted during first-time CIED implantation, we identified 14 showing either a supraclavicular course of the CV itself or a persistent JCV. Among revision procedure venographies, we identified 1 case of pertinent CV variations. These vessels had been morphometrically altered by previous medical interventions.

Results: Based on topography and morphometric parameters, we identified three anatomical variations of supraclavicular vessels: 2 cases of a supraclavicular CV and 12 cases of an infraclavicular CV accompanied by a persistent supraclavicular JCV (with the diameter larger than that of the main CV in 5 cases and smaller in 7 cases). In 2 cases the enlarged diameter of the JCV was probably due to increased collateral venous flow resulting from thrombotic lesions in the subclavian vein.

Conclusions: Supraclavicular CV variations are rare. Nonetheless, they may significantly affect both first-time and later revision CIED procedures. The presence of a supraclavicular vein is an indication for diagnostic venography in the area of the clavipectoral triangle before the CIED procedure.

Lumbosacral plexus in Brazilian Common Opossum

The opossum has been suggested as an animal model for biomedical studies due to its adaptability to captivity and number of births per year. Despite many studies on morphology and experimental neurology using this opossum model, the literature does not offer details of the nerves of the lumbosacral plexus in this species. Ten lumbosacral plexus were dissected to describe the peripheral innervations of the Brazilian Common Opossum (Didelphis aurita) and compare the results with Eutheria clade species. The tensor fasciae latae muscle was absent and there was only one sartorius muscle for each limb. The distribution of the nerves were similar to other mammals, except for the caudal gluteal nerve, sartorius muscle innervations and the position of the pudendal nerve which arose from the major ischiatic foramen together with the ischiatic nerve, the cranial gluteal nerve and the caudal gluteal nerve. No anatomical variation was found. The special position of the pudendal nerve suggested that the Brazilian Common Opossum is a better model than rats or rabbits in surgical procedures with that specific nerve. In addition, the study revealed that the pelvic limb nerves are not an invariable structure of reference for muscle homology and homonym as reported previously. New investigation using other species of opossums are necessary to best comprehend the lumbosacral plexus distribution in the Methatheria clade and to confirm that other opossum species is eligible as a good model for pudendal nerve studies.

Morphological study of the hoof in yak

The fore- and hindlimb of yak have been studied by the gross anatomical methods and standard histological techniques. The artery of ungula was also determined by X-ray and acrylonitrile-butadiene-styrene casting. Anatomical features of the forelimb of yak resemble those of hindlimb, including hoof periphery, hoof coronal, hoof wall, hoof sole, and hoof sphere. The forelimb and hindlimb are almost the same in histological structure. The epidermis comprised all 5 strata: stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum and stratum basale. The papillary layers and dermal lamellae contained a variable amount of capillary as well as collagen and elastic fibres. Many venules and arteriovenous anastomosis were distributed among the reticular layer. Subcutaneous tissue was composed of rich adipose and connective tissue in hoof periphery, hoof coronal, and, especially, hoof sphere. Major arteria in forelimb of yak include arteria digitalis palmaris communis III and arteriae digitales palmares propriae III and IV axialis. Those in hindlimb include arteria digitalis plantaris communis III and arteria digitalis plantaris propria III and IV axialis. Our findings highlight the main morphological features of yak and provide a morphological basis useful to researchers using yak hoof.

The sciatic nerve in human cadavers — high division or low formation?

Variations of the sciatic nerve have been extensively studied in the past including its relationship with the piriformis muscle and associated clinical conditions like piriformis syndrome and sciatica. In the present study we noticed some interesting variations of the sciatic nerve, which were slightly different from the cases described earlier. In the previous studies most of the authors described the higher division of sciatic nerve and none of them discussed its formation. In this study we tried to look its formation from the sacral plexus and its divisions in the thigh.

We noticed that in one cadaver the two components of the sciatic nerve originated directly from the sacral plexus and coursed down without merging in the thigh. Should this be called a higher division or non formation of the sciatic nerve? On the other hand in two other cadavers, the two divisions after emerging separately from the sacral plexus, united in the gluteal region and in the thigh respectively. Should we call this as higher division or low formation of the sciatic nerve? In two other cadavers the sciatic nerve emerged from the greater sciatic foramen below the piriformis and divided in the gluteal region itself. Ideally this should be called as higher division of sciatic nerve.

The beneficial roles of insulin and parathyroid hormones in the treatment of experimentally induced diabetic osteoporosis in female rats: bone mineral density, morphometric and histological studies

Background: Diabetes mellitus (DM) and osteoporosis are two frequent medical conditions with an increasing prevalence in elderly people and are responsible for large number of incurable fractures. This study is designed experimentally in female rats in order to determine whether combined treatment of insulin and parathyroid hormone (PTH) enhances the reversibility of the osteoporotic changes that occurred in streptozotocin (STZ)-induced DM.

Materials and methods: In this study, 30 adult female rats aged 3 months were used, they were randomly divided into: control group (6 rats) and diabetes group (24 rats), in which experimental DM was induced by i.p. injection of a single dose of STZ (60 mg/kg/body weight). Diabetic group was further divided into four subgroups (6 rats each): non-treated diabetic, insulin-treated (8–12 units s.c./day of Humalin U-40), PTH-treated (6.0 μg s.c./kg/day) and combined insulin and PTH-treated subgroups. All tested groups were assessed for body weight, food and water consumptions.

Results: At the end of the experimental period, the bone mineral density (BMD) was measured for all rats of different groups; then the rats were sacrificed and blood samples were collected for measuring glucose, alkaline phosphatase and osteocalcin levels. Right femora were dissected out and subjected to measurement of diameter of neck and shaft, length of shaft, and weight. Then the femora specimens were processed and stained with haematoxylin and eosin for histological study. The results showed that there was a statistically significant, decrease in BMD, increase in the level of alkaline phosphate, and decrease in the level of osteocalcin in rats in diabetic group compared with other groups; these parameters improved in other groups, especially in diabetes/insulin/PTH group. The rats in diabetic group showed statistically significant decrease in neck and shaft diameters and weight of femur bone compared with other groups, while rats in diabetes/insulin/PTH group showed a significant improvement of these parameters. In diabetic group, there were different histopathological changes in cortical bone and Haversian canals, which improved in other groups, especially in rats in diabetes/insulin/PTH group.

Conclusions: The untreated DM resulted in dramatic reduction in BMD and morphometric parameters. Treatment with insulin ameliorated these effects to some extent, while PTH co­-treatment had a more positive effect. The combination of PTH and insulin resulted in stronger improvement of all parameters to approximately like those of control rats.