Aorta is the largest artery in the human body. Its starting point is the aortic orifice of the aortic valve and it terminates at the level of the fourth lumbar vertebra. The main function of the aorta is to transport oxygenated blood to supply all the organs and cells. With advancing age, the structure and hence the function show progressive changes. Various changes in the aortic morphology include the luminal diameter of aorta, whole length of the aorta, thickness, the microstructural components also change, and these include collagen, elastin and smooth muscle cells. In addition, the dimensions of all segments of the aorta increase with age in both sexes. Since age is a major risk factor for degenerative change and diseases affecting the aorta, understanding the detailed anatomy of the aorta may provide essential information concerning the age-associated process of the aorta. Knowledge of the morphological changes in the aorta is also important for future clinical therapies pertaining to aortic disease. Additionally, the information regarding the structural changes with age may be applied for age determination. This review describes the overview of the anatomy of the aorta, age related changes in the morphology of the aorta and aortic diseases.
Cardiac valves are highly complex structures optimizing their function during the cardiac cycle. They open and close directed by blood flow under different pressure conditions in the dynamic environment in the heart. It is acknowledged that the aging process affects the structure and functions of the heart valves. With regard to morphometry, age-related changes of the heart valve can be found in valve circumference, thickness of the leaflet, luminal area at the sinotubular junction, valve diameter, orifice area, and leaflet size in circumferential and radial direction. In addition, there are differences between male and female hearts in some features. Moreover, there are studies the qualitative and quantitative assessment of histological compositions, echocardiography study to investigate the annular circumference and diameter in the human heart valves related with age. Studies into the detailed anatomy of the changes in heart valves with age are important and the correlation between valve morphology and age may be used as an age indicator. This study reviews the basic anatomical structure of the heart valves, age-related changes of valve morphometry, heart valve diseases, and general treatment of valvular diseases in humans. Detailed knowledge of the anatomical features of the morphology of the human heart valve is useful for any treatments of valve pathology.
Anomalies of the peritoneum and the colon are quite common. Some of these anomalies can disturb the normal digestive and absorptive functions of the intestine and the others might result in formation of volvulus or impede the blood supply of the intestine. We report a rare, combined variation of peritoneum and ascending colon. In a 70-year-old male cadaver, the greater omentum was very small and extended only for about an inch below the transverse colon. From its lower end, a fibrous band extended to the right wall of the upper part of ascending colon. There was a deep constriction on the right wall of the ascending colon at the site of attachment of the fibrous band. The ascending colon was grossly dilated. Further, the ascending colon was mobile and presented a small ascending mesocolon along its left edge. We discuss the possible embryological basis and clinical and surgical relevance of the case.
Ischemic stroke caused by occlusion of cerebral artery is responsible for the majority of stroke that increases the morbidity and mortality worldwide. Diabetes mellitus (DM) is a crucial risk factor for ischemic stroke. Prolonged DM causes various microvascular and macrovascular changes, and blood-brain barrier (BBB) permeability that facilitates inflammatory response following stroke. In the acute phase following stroke, BBB disruption has been considered the initial step that induces neurological deficit and functional disabilities. Stroke outcomes are significantly worse among DM. In this article, we review stroke with diabetes-induce BBB damage, as well as underlying mechanism and possible therapeutic targets for stroke with diabetes.
Geometric morphometrics is a new approach for shape identification in diagnosis of malocclusion. Lateral cephalogram is an X-ray that taken for diagnosing malocclusion in dental setting. The aim of this study was to determine the differences of craniofacial shape in malocclusion by application of two-dimensional geometric morphometrics and to compile the database of malocclusion in adult Malaysian population. Lateral cephalogram radiographs of 381 adults Malaysia (age 18-45) were retrieved retrospectively and assigned to three groups according to their occlusion: class I, class II, and class III. The geometric morphometric shape study incorporated nine landmarks and was analyzed in details using tpsUtil p software. Geometric morphometric analysis such was done using MorphoJ software. The results of the principal component's analysis (PCA) yielded 14 main components responsible for 100% of the variation exhibited by the malocclusion with three highly significant PCA. The highest Mahalanobis distances were exhibited by the malocclusion class II and III population. The Procrustes ANOVA showed that the shape effect was highly significant (P<0.01). The discriminant function analysis showed the high percentage of 80% discriminate among the malocclusions after cross-validation. There are significant differences for ANB angle (A point-Nasion-B point) in all malocclusion groups. Class II has the widest ANB angle while class III has the most acute ANB angle. Skeletal shape was clearly associated with dental malocclusion and showed considerable variation. Geometric morphometrics is an alternative research tool and can be used for diagnosing individual classification of malocclusion.
Prostate cancer is the most common cancer type in men and is the second cause of death, due to cancer, in patients over 50, after lung cancer. Prostate specific antigen (PSA) is a widely used tumor marker for prostate cancer. Recently, PSA is discovered in non-prostatic cancer tissues in men and women raising doubts about its specificity for prostatic tissues. PSA exists in low serum level in healthy men and in higher levels in many prostate disorders, including prostatitis and prostate cancer. Thus, a supplementary tumor marker is needed to accurately diagnose the cancer and to observe the patient after treatment. Recently, soluble human leukocyte antigen-G (sHLA-G) has been introduced as a new tumor marker for different cancer types, including colorectal, breast, lung, and ovary. The present descriptive-experimental study was carried out including patients with malignant prostate tumor, patients with benign prostate tumor, and a group of health men as the control group, as judged by an oncologist as well as a pathologist. After sterile blood sampling, sHLA-G was measured by enzyme-linked immunosorbent assay in each group. The data was then analyzed using one-way ANOVA. P≤0.05 was considered as statistically significant. The results showed that the mean of sHLA-G level was high in patients. Also, it was found that there was a significant difference in sHLA serum level between the three groups. The data revealed that sHLA-G can be a novel supplementary tumor marker in addition to PSA to diagnose prostate cancer.
Osteochondromas develop as cartilaginous nodules in the periosteum of bones. They are the commonest benign tumors of the skeleton, generally observed in the long bones. Rarely, they are also found in the axial skeleton, flat bones of skull and facial bones. During a regular dissection, we came across a solitary osteochondroma in posterior surface of the body of the right pubic bone. Histopathology of the bony projection confirmed the typical features of the osteochondroma. The symptomatic osteochondromas are usually evaluated during radiographic examination. Though, the observed osteochondroma is relatively smaller its unusual location is remarkable and knowledge of occurrence of such nodules is clinically important during the diagnosis and planning of treatment.
Superficial temporal artery (STA) based pedicled fascial flap plays a pivotal role in ear reconstruction for microtia patients. There is paucity of literature on the anatomy of the STA in microtia patients. The present study aimed to describe any possible anatomical variations seen in the STA of patients afflicted with microtia. Pre-operative carotid computer tomographic angiography images of patients under the microtia database of Plastic and Reconstructive Surgery Unit at a tertiary medical centre were selected and 3-dimensionally reconstructed. Measurements were made on the 3D reconstructed computed tomographic angiography images of the STA on both the sides of the microtic ear and the non-microtic ear to assess its various anatomical parameters. We managed to obtain a total of 39 computed tomographic angiography images of STAs for analysis. There was a significant difference in the number of main branches of STA between the two groups (P=0.006). The proportion of ears with 2 main branches was higher in the non-microtia group (89.5%) compared to the microtia group (45.0%). A significant difference was found in the STA diameter between the two groups (P=0.012). The mean diameter of STA in the non-microtia group was larger by 0.4 mm. Furthermore, the median angle of STA was larger on the side of the non-microtic ears compared to that of microtic ears by 24.5°, with a P-value of 0.011. The results of the study may be of clinical importance while planning and performing ear reconstructive surgeries using STA based pedicled fascial flaps.
Variations of the dural folds and the dural venous sinuses are infrequently reported in the existing medical literature. Such variations in the posterior cranial fossa may pose difficulties in various analytical and surgical procedures of this region. We present a rare concurrent variation of the falx cerebelli and tentorium cerebelli that was detected during routine dissection of an adult male cadaver. While removing the brain, a partial duplication of tentorium cerebelli was observed below the left half of the tentorium cerebelli and above the left cerebellar hemisphere. This fold did not have any dural venous sinus in it. Further, a complete duplication of falx cerebelli with a single occipital venous sinus within its attached border was also observed. We present the review of literature and discuss the comparative anatomy of this case.
We present a unique, unreported variation of the left coronary artery. During dissection classes for first-year medical students, we observed the absence of left coronary artery in an adult male cadaver aged approximately 78 years. The left aortic sinus was dilated and it gave origin to anterior interventricular and left marginal arteries independently. Left marginal artery was large and the circumflex artery arose from it. There were two independent opening for anterior interventricular and left marginal arteries in the left posterior aortic sinus. No variations were found in the origin and branching pattern of right coronary artery and the walls and chambers of the heart.
Nerve to mylohyoid is a branch of inferior alveolar nerve. It arises in the infratemporal fossa and runs in the mylohyoid groove of mandible to reach the submandibular region, where it supplies the anterior belly of digastric and mylohyoid muscles. Though sensory distribution of this nerve have been described, it is predominantly a motor nerve. Here, a rare intra-mandibular origin of nerve to mylohyoid has been presented. This nerve arose from the inferior alveolar nerve inside the mandible and came out to the submandibular region by passing through a small foramen present on the medial surface of the body of the mandible. It ended by supplying the anterior belly of digastric and mylohyoid muscles. The knowledge of this variation could be of importance to maxillofacial surgeons and radiologists.
Research in forensic anthropology is recent in Malaysia due to limited access to documented skeletal collections. However, advanced imaging techniques provide virtual bone samples for use in morphometric studies to establish population-specific standards by virtual anthropology. This study examined sexual dimorphism in the subpubic angle using a three-dimensional computed tomography model of the pelvis, in a contemporary Malaysian population. The sample comprised multidetector computed tomography (MDCT) scans of 50 male and 50 female adults. Segmentation of the MDCT scans was performed using 3D Slicer, and four landmarks were acquired using Stratovan Checkpoint for the subpubic angle measurement. The technical error of measurement (TEM), relative TEM, and coefficient of reliability (R) exhibited high reliability in measurements. Results showed that the subpubic angle in males was 68.6°±7.6° and in females 87.4°±6.5°. The subpubic angle in females was significantly larger than in males (P<0.001). Inverse correlation was found between the subpubic angle and age, in both males (r=-0.449, P<0.01) and females (r=-0.385, P<0.01). The overall accuracy of sex estimation using the subpubic angle was 94% (P<0.001). The subpubic angle, with a demarcating point of 78.6°, showed a sensitivity and specificity of 94% in the classification of female individuals. In conclusion, sex estimation using the subpu bic angle is highly accurate, with a high degree of expected sensitivity and specificity in the Malaysian population.
Sex determination is one of the main steps in the identification of human skeletal remains. It constitutes an initial step in personal identification from the skeletal remains. The aim of the present study was to provide the population-specific sex discriminating osteometric standards to aid human identification. The present study was conducted on 87 (174 sides) slices of crania using postmortem computed tomography in 45 males and 42 females, aged between 18 and 75 years. About 22 parameters of crania were measured using Osirix software 3-D Volume Rendering. Results showed that all parameters were significantly higher in males than in females except for orbital height of the left eye by independent t test (P<0.01). By discriminant analysis, the classification accuracy was 85.1%, and by regression, the classification accuracy ranged from 78.2% to 86.2%. In conclusion, cranium can be used to distinguish between males and females in the Malaysian population. The results of the present study can be used as a forensic tool for identification of unknown crania.
Sex estimation is one of the crucial procedures in the biological profile identification of human skeletal remains. Knowing sex of unknown case can lead to accurate and appropriate methods for predicting age, stature, ancestry, or even personal identification. Skull is one of the most reliable one among other skeletons and it is usually retained for both archaeological and forensic contexts. Although many morphological features and metric measurements of skull have been studied for sexing, but to the best of our knowledge is no study on maxillary suture length for sex estimation. Therefore, this study aims to develop a new sex estimation method for a Thai population by determining three maxillary suture lengths: anterior, transverse, and posterior maxillary suture, by computerizing amount of pixel obtained from photographs of these sutures. The present study was conducted on 190 Thai bone samples of which 96 were males and 94 were females. Independent t test revealed statistically significant difference (P<0.01) between males and females in all maxillary suture measurements. Equations derived from prediction model, which required three maxillary suture lengths gave 76.8421% accuracy from the leave-one-out cross validation in estimating sex percentage accuracies in predicting sex from these equations, which were relatively moderate. This study provides a novel and objective sex estimation method for Thais. It suggests that maxillary suture length can be applied for sex estimation. The new computerized technique will contribute basis knowledge and method for sex estimation, especially when only base of skull is available in forensic circumstance.
This study aimed to investigate the general mandibular symphysis (MS) shape variation among Class III skeletal base, using geometric morphometric analysis. Pre-treatment lateral cephalometric radiographs of 254 patients aged 11-40 years old, with Class III skeletal base (ANB <1°) and lower incisor angle (<99°) were included. Nine-landmarks with x and y coordinates were identified on MS using TPSDig2 software, then exported into Morpho J for shape and statistical analysis. Principal component analysis showed that three main shape dimensions with a total variance of 74.6% represented the majority variation of samples. Procrustes Anova showed the shape of MS in Class III skeletal base to be mainly influenced by gonial angle, incisor inclination and sex (P<0.0001). Canonical variate analysis showed that high gonial angle groups had significantly narrower and elongated MS whereas low gonial angle groups had wider, bulbous and rounded MS (P<0.0001). The ratio of alveolar part to basal part was 1:5 in low gonial angle and 2:3 in high gonial angle. Males had significantly taller MS with narrower B point area compared to females (P<0.0001). Retroclined incisors exhibited taller and retroclined alveolar parts (P<0.0001). The shape of MS in Class III skeletal base varied at the alveolar part, basal part or both and it is influenced by gonial angle, incisor inclination and sex. Hence, understanding the shape variation of MS is important to aid orthodontic treatment planning.
Knowledge of variations of renal vessels is of utmost importance in retroperitoneal surgeries and kidney transplant surgeries. We report concurrent variations of the right renal vessels, observed in an adult male cadaver during dissection classes. The right kidney was supplied by three renal arteries, out of which two entered the kidney through the hilum and the other one entered through the lower pole of the kidney. There were five renal veins, emerging independently from the hilum and opening separately through five openings into the inferior vena cava. Among the veins, only one emerged anterior to the renal pelvis and the other four emerged behind it. Four of them terminated into the posterolateral aspect of the inferior vena cava, whereas one terminated into its anterior aspect. Fourth vein from above, received the right testicular vein. The renal hilum was clogged with the presence of seven vessels and renal pelvis.
Entrapment neuropathies of the peripheral nervous system are frequently encountered due to anatomical variations. Median nerve is the most vulnerable nerve to undergo entrapment neuropathies. The clinical complications are mostly manifested by median nerve impingement in forearm and wrist areas. Median nerve entrapment could also occur at the arm, due to the presence of ligament of Struthers. Here we report a rare case of proximal entrapment of median nerve and brachial artery in the arm by an abnormally formed musculo-fascial tunnel. The tunnel was formed by the muscle fibers of brachialis and medial intermuscular septum in the lower part of arm. Due to this, the median nerve coursed deep, below the tunnel and continued distally into the forearm, underneath the pronator teres muscle and hence did not appear as a content of cubital fossa. The present entrapment of neurovascular structures in the tunnel might lead to pronator syndromes or other neurovascular compression syndromes.