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1.
S. Afr. j. bioeth. law ; 12(1): 14-18, 2019.
Artigo em Inglês | AIM | ID: biblio-1270205

RESUMO

At the request of the Health Professions Council of South Africa (HPCSA), draft ethical guidelines on palliative care (the draft guidelines) have been produced, to assist healthcare practitioners in their treatment of palliative care patients. These have been submitted to the HPCSA, which has circulated them for comment by the boards and other relevant stakeholders. This article provides a wider audience,including healthcare practitioners and patients involved in palliative care, an opportunity to comment on the draft guidelines.Suggestions should be sent to the corresponding author for onward transmission to the HPCSA


Assuntos
Atenção à Saúde , Cuidados Paliativos , Pacientes , África do Sul
2.
Int. j. morphol ; 36(2): 730-736, jun. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-954178

RESUMO

The dorsalis pedis artery (DPA) is the largest blood vessel distal to the ankle joint. It is the continuation of the anterior tibial artery (ATA) and runs along the dorsum of the foot until the 1st intermetatarsal space. The DPA gives rise to five branches, viz. medial tarsal, lateral tarsal, arcuate, deep plantar and dorsal metatarsal arteries. Given the vast blood supply provided by the DPA, in the current era of microvascular surgery, the anatomy of the DPA is of increasing interest to anatomists, surgeons and angiographers. The aim of this study was to outline the course, origin, branching patterns and possible variations of the DPA. The present study included the dissection of forty (n=40) cadaveric specimens of the lower limb region (Left: 25; Right: 15). The origin, course and branching patterns of the artery were studied. These morphological parameters were further analysed with regard to laterality to determine if a correlation existed. The Pearson Chi-square test was employed and a p value of less than 0.05 was deemed statistically significant. Although the DPA was present in 97.5 % of cases, it followed the standard anatomical description in only 42.5 % of cases. The DPA originated from the peroneal artery in 5 % of cases. In 25 % of cases, DPA deviated laterally. Variation in the branching pattern of the DPA, which was recorded in 50 % of cases, was further classified according Types 1 to 6. The findings of this study correlated closely with most previous studies. However, the incidence of lateral deviation of the DPA was higher in this study as well as the incidence of Type 1 variation in branching pattern. Additionally, this study proposes a novel variation in branching pattern which has been termed Type 6, which displays a recurrent branch of the Type 5 variation. The DPA has an important role in a clinical setting since the DPA flap is employed in reconstructive surgeries and peripheral circulation may be assessed by the palpation of the DPA pulse. Therefore, a thorough understanding of the anatomy of the DPA is of prime importance to podiatrists, surgeons, anatomists and angiographers.


La arteria dorsal del pie (ADP) es el vaso sanguíneo más grande distal a la articulación del tobillo. Es la continuación de la arteria tibial anterior (ATA) y se extiende a lo largo del dorso del pie hasta el primer espacio metatarsiano. La ADP da lugar a cinco ramas: a. tarsalis medialis, a. tarsalis lateralis, a. arcuata, a. plantaris profunda y aa. metatarsales dorsales. Dado el vasto suministro de sangre proporcionado por la ADP, en la era actual de la cirugía microvascular, la anatomía de la ADP es de creciente interés para los anatomistas, cirujanos y expertos en angiografía. El objetivo de este estudio fue delinear el curso, origen, patrones de ramificación y las posibles variaciones de la ADP. El presente estudio incluyó la disección de cuarenta (n = 40) muestras cadavéricas del miembro inferior (izquierda: 25; derecha: 15). Se estudiaron los patrones de origen, curso y ramificación de la arteria. Estos parámetros morfológicos se analizaron adicionalmente con respecto a la lateralidad para determinar si existía una correlación. Se empleó la prueba Chi-cuadrado de Pearson y se consideró estadísticamente significativo un valor de p de menos de 0,05. Aunque la ADP estuvo presente en el 97,5 % de los casos, siguió la descripción anatómica estándar en solo el 42,5 % de los casos. La ADP se originó en la arteria fibular en el 5 % de los casos. En el 25 % de los casos, la ADP se desvió lateralmente. La variación en el patrón de ramificación de la ADP, que se registró en el 50 % de los casos, se clasificó según los tipos 1 a 6. Los hallazgos de este estudio se correlacionaron estrechamente con la mayoría de los estudios previos. Sin embargo, la incidencia de desviación lateral de la ADP fue mayor en este estudio, así como la incidencia de la variación del tipo 1 en el patrón de ramificación. Además, este estudio propone una nueva variación en el patrón de ramificación que se ha denominado Tipo 6, que muestra una rama recurrente de la variación Tipo 5. La ADP tiene un papel importante en la clínica, ya que el colgajo de la ADP se emplea en cirugías reconstructivas y la circulación periférica se puede evaluar mediante la palpación del pulso de la ADP. Por lo tanto, una comprensión profunda de la anatomía de la ADP es de vital importancia para los podólogos, cirujanos, anatomistas y en la angiografía.


Assuntos
Humanos , Artérias/anatomia & histologia , Pé/irrigação sanguínea , Cadáver
3.
Int. j. morphol ; 36(1): 92-96, Mar. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-893193

RESUMO

SUMMARY: The critical shoulder angle and acromion index are conventional radiological tools employed as predictors of shoulder degeneration. As they represent the static components of glenohumeral stability, the scapulo-humeral geometry and underlying subacromial tissue appear as the resultant cause-effect factors. Consequently, the purpose of this study was to investigate the critical shoulder angle and acromion index as interrelated parameters within the South African population. The measurement of both biomechanical parameters was conducted on two-hundred and sixty (n = 260) true AP radiographs. This was a cross-sectional study that also incorporated the demographic representation of the population group which was analysed accordingly. The mean values recorded for both the critical shoulder angle (36.31±5.84º) and acromion index (0.74±0.13) suggested rotator cuff arthropathy. The results confirmed the theories of Nyffeler et al. (2006) and Moor et al. (2012) who alluded to glenoid inclination and the acromial coverage over the humeral head. A significant proportionality correlation, verified by a P value of 0.000, was established between the acromion index and critical shoulder angle which may assist to differentiate between normal asymptomatic shoulders and those with cuff disease. Furthermore, these predictors of shoulder degeneration may present as a preventative tool against tear progression.


RESUMEN: El ángulo crítico del hombro y el índice acromial son herramientas radiológicas convencionales empleadas como indicadores de la degeneración del hombro. Debido a que representan los componentes estáticos de la estabilidad glenohumeral, la geometría escápulo-humeral y el tejido subacromial subyacente aparecen como los factores causa-efecto resultantes. En consecuencia, el propósito de este estudio fue investigar el ángulo crítico del hombro y el índice acromial como parámetros interrelacionados dentro de la población sudafricana. La medición de ambos parámetros biomecánicos se realizó en 260 radiografías antero-posteriores (AP). Se realizó un estudio transversal que también incorporó la representación demográfica del grupo de la población que fue analizada. Los valores medios registrados tanto para el ángulo crítico del hombro (36,31 ± 5,84º) como para el índice del acromión (0,74 ± 0,13) sugirieron una artropatía del manguito rotador. Los resultados confirmaron las teorías de Nyffeler et al. (2006) y Moor et al. (2012) que aludían a la inclinación glenoide y a la cobertura acromial sobre la cabeza humeral. Se estableció una correlación de proporcionalidad significativa, verificada por un valor de P de 0,000, entre el índice acromial y el ángulo crítico del hombro, lo que puede ayudar a diferenciar entre los hombros asintomáticos normales y aquellos con enfermedad del manguito rotador. Además, estos predictores de degeneración del hombro pueden ser útiles como una herramienta preventiva contra la progresión del desgarro.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Acrômio/patologia , Manguito Rotador/patologia , Ombro/patologia , Estudos Transversais , África do Sul
4.
S. Afr. j. surg. (Online) ; 56(2): 36-40, 2018. tab
Artigo em Inglês | AIM | ID: biblio-1271013

RESUMO

Background: Laparoscopic cholecystectomy (LC) is the gold standard for the management of symptomatic cholelithiasis and complications of gallstone disease. Mini laparotomy cholecystectomy (MOC) may be a more appropriate option in the resource constrained rural setting due to its widespread applicability and comparable outcome with LC. The study aimed toprovide an epidemiological analysis of gallstone disease in the rural population and to evaluate the outcome of MOC in a rural hospital.Methods: A retrospective chart analysis of 248 patients undergoing cholecystectomy in a rural regional referral hospital in KwaZulu-Natal from January 2009 to December 2013 was undertaken.Results: Of the 248 patients, the majority were females (n = 211, [85%]). The most frequent indications for cholecystectomy included: biliary colic (n = 115, [46.3%]); acute cholecystitis (n = 80, [32.3%]); gallstone pancreatitis (n = 27, [10.8%]). Forty cases (16.1%) were converted to open cholecystectomy (OC). The median operative time was 40 minutes (range18­57). Twenty-three morbidities (9.3%) occurred including: bile leaks (n = 6, [2.4%]); bleeding from drain site (n = 1, [0.4%]), incisional hernia (n = 8 [3.2%]) and wound sepsis (n = 8 [3.2%]). The median length of hospital stay in patients who underwent MOC was 48 hours (range: 24­72 hours) and the median time to return to work was 10 days (range: 4­14 days). There was one mortality in the entire cohort.Conclusion: MOC is a safe and feasible operation for symptomatic cholelithiasis when cholecystectomy is indicated. The low operative morbidity and mortality in the context of a high risk patient profile and complicated gallstone disease makes this procedure an alternative to LC where LC is inaccessible


Assuntos
Colecistectomia , Colecistectomia Laparoscópica , Pacientes , África do Sul
5.
S. Afr. med. j. (Online) ; 108(1): 61-68, 2018. ilus
Artigo em Inglês | AIM | ID: biblio-1271186

RESUMO

Background. Drowning is defined as the process of experiencing respiratory impairment from submersion/immersion in liquid, and can have one of three outcomes ­ no morbidity, morbidity or mortality. The World Health Organization African region accounts for approximately 20% of global drowning, with a drowning mortality rate of 13.1 per 100 000 population. The strategic implementation of intervention programmes driven by evidence-based decisions is of prime importance in resource-limited settings such as South Africa (SA).Objective. To review the available epidemiological data on fatal drowning in SA in order to identify gaps in the current knowledge base and priority intervention areas. Methods. A systematic review of published literature was conducted to review the available epidemiological data describing fatal drowning in SA. In addition, an internet search for grey literature, including technical reports, describing SA fatal drowning epidemiology was conducted.Results. A total of 13 published research articles and 27 reports obtained through a grey literature search met the inclusion and exclusion criteria. These 40 articles and reports covered data collection periods between 1995 and 2016, and were largely focused on urban settings. The fatal drowning burden in SA is stable at approximately 3.0 per 100 000 population, but is increasing as a proportion of all non-natural deaths. Drowning mortality rates are high in children aged <15 years, particularly in those aged <5. Conclusions. This review suggests that SA drowning prevention initiatives are currently confined to the early stages of an effective injury prevention strategy. The distribution of mortality across age groups and drowning location differs substantially between urban centres and provinces. There is therefore a need for detailed drowning surveillance to monitor national trends and identify risk factors in all SA communities


Assuntos
Prevenção de Acidentes , Afogamento/epidemiologia , Afogamento/mortalidade , Imersão , Insuficiência Respiratória , Literatura de Revisão como Assunto , Fatores de Risco , África do Sul
6.
S. Afr. j. child health (Online) ; 11(3): 146-148, 2017.
Artigo em Inglês | AIM | ID: biblio-1270309

RESUMO

Background.Knowledge of the pH level of soaps and cleansers used by patients with atopic eczema and sensitive skin is crucial, as high-alkalinity products are irritants and impair the normal skin barrier, so interfering with the adequate control of atopic eczema.Objectives. The aim of this study was to assess the pH of various bar soaps and cleansers that are usually recommended and used by patients with atopic diseases and dry, sensitive skin in South Africa.Methods. Forty-nine commercial soap bars and cleansers were randomly selected for pH analysis. The samples were prepared as 8% emulsions in tap water. Nine undiluted liquid facial cleansers were also evaluated. Deionised water was used as a negative control. The pH of each emulsion or liquid cleanser was recorded in duplicate using a Metrohm pH meter model 827 (Metrohm, Herisau, Switzerland).Results. Of the 49 samples analysed, 34 (69.4%) were alkaline with a pH ranging from 9.3 - 10.7. Two samples (4.1%) were within the acceptable range of (5.4 - 5.9), and 2 samples (4.1%) had pH levels of below 5. In total, 5 samples (10.2 %) had a pH of 4 - 6.Conclusion. The majority of soaps and cleansers analysed in this study were alkaline, with only 2 falling in the acceptable pH range of 5.4 - 5.9 and 5 within the pH range of 4 - 6, thus raising concerns regarding the optimal management of atopic eczema patients


Assuntos
Dermatite Atópica , Eczema , Concentração de Íons de Hidrogênio , Pediatria , Sabões , África do Sul
7.
S. Afr. med. j. (Online) ; 107(3): 270-273, 2017. ilus
Artigo em Inglês | AIM | ID: biblio-1271167

RESUMO

Background. Studies of electrophoresis testing (serum protein electrophoresis (SPE), urine protein electrophoresis (UPE), immunofixation electrophoresis (IFE)) in a South African (SA) pathology laboratory setting are limited. Objectives. To evaluate the prevalence, testing pattern and yield of electrophoresis tests performed over a 5-year period in a tertiary academic laboratory and to relate these findings to bone marrow biopsy findings in a few selected cases.Methods. This was a retrospective audit of all SPE, UPE and IFE tests performed on new and follow-up adult patients (aged ≥18 years) from 2010 to 2015, using data from the Tygerberg Academic Hospital (Cape Town, SA) National Health Laboratory Service hospital information system database. A subgroup analysis of all patients with negative serum (SIFE) and/or urine immunofixation (UIFE) tests who had concurrent bone marrow biopsies close to the time of IFE testing was also performed.Results. A total of 5 086 SPE tests were performed (44.3% were follow-up tests, and of these patients 13.8% had SIFE tests); 1 299 UPE tests were performed (23.3% were follow-up tests, and of these patients 33.6% had UIFE tests). The mean ages of patients who had SIFE and UIFE tests were 59 years (standard deviation (SD) 14.2) and 60 years (SD 15), respectively. The female-to-male ratio was 1.1:1 for both SIFE and UIFE. The negative test yields for SIFE and UIFE were 31.3% and 52.1%, respectively. Bone marrow biopsy findings for patients with negative SIFE tests identified 8 out of the 20 biopsies (40.0%) as positive for myeloma.Conclusion. This audit provides baseline data on the prevalence of test requests, their source and the yield of electrophoresis testing in our laboratory. An increasing trend in SIFE and UIFE was evident


Assuntos
Medula Óssea , Auditoria Clínica , Eletroforese , Prevalência , África do Sul , Centros de Atenção Terciária
8.
Int. j. morphol ; 34(3): 975-985, Sept. 2016. ilus
Artigo em Inglês | LILACS | ID: biblio-828973

RESUMO

The musculotendinous hood of the rotator cuff muscle complex is formed by four tendons which thicken and merge with the underlying glenohumeral capsule as they insert onto the respective regions of the humeral head. This insertional anatomy has been reported to exhibit several pathological patterns which serve as the basis for the operative repair of cuff tears. Since previous literature concentrated on macro-evaluations of tears specific to the supraspinatus tendon, the present study aimed to investigate the macro- morphological and morphometric parameters of all four rotator cuff tendons. Observation of the insertion site configurations and computation of the relative tendon morphometry were performed once the glenohumeral region in forty adult cadaveric specimens (n=80) were bilaterally dissected. Statistical analysis also reflected the demographic representation of the sample: (Age: 74.83±12.92 years old; Gender: 24 Males, 16 Females; Race: 38 White, 2 Black). The general mean supero-inferior and medio-lateral distances were recorded specific to the entire rotator cuff and each tendinous insertion site as follows: i) Subscapularis: 22.57±3.13 mm, 20.45±4.79 mm; ii) Supraspinatus: 15.20±4.29 mm, 20.14±5.38 mm; iii) Infraspinatus: 19.49±5.21 mm, 19.07±4.74 mm; iv) Teres minor: 19.02±5.21 mm, 15.33±3.75 mm; v) Entire rotator cuff: 76.28±10.57 mm, 75.18±11.41mm. Although variation in insertion configurations existed, predominant shapes were identified: Subscapularis ­ Oval (72.5 %), Supraspinatus - Rectangular (76.3 %), Infraspinatus - Oval (78.8 %), Teres minor - Round (100 %). In view of the statistically significant P values, it may be postulated that knowledge of the supero-inferior and medio-lateral distances may provide dimensional data required to obtain optimal cuff coverage during reconstruction procedures. Furthermore, the variation in the insertion patterns may indicate the progression of rotator tendon tears.


La capa musculotendinosa del complejo muscular del manguito rotador está formada por cuatro tendones, que se espesan y se funden con la cápsula glenohumeral subyacente a medida que se insertan en las respectivas regiones de la epífisis proximal del húmero. Se han informado varios patrones patológicos en la inserción de estos músculos que sirven como base para la reparación quirúrgica de los desgarros del manguito. La literatura previa se concentró en el estudio de macro-evaluaciones de lesiones específicas del tendón del músculo supraespinoso, por lo cual, el objetivo del presente estudio consistió en investigar los parámetros morfológicos y morfométricos macroscópicos de los cuatro tendon es del manguito rotador. Se llevó a cabo la observación de la configuración de los sitios de inserción y el cálculo relativo de la morfometría de los tendones de la región glenohumeral en una muestra de cuarenta cadáveres adultos (n = 80) los que fueron disecados bilateralmente. El análisis estadístico también refleja la representación demográfica de la muestra: Edad: 74,83 ± 12,92 años de edad; Género: 24 hombres, 16 mujeres; Raza: 38 Blancos, 2 Negros. Las distancias medias supero-inferior y medio-lateral se registraron específicamente en todo el manguito rotador y en cada sitio de inserción tendinosa de la siguiente manera: i) M. subescapular: 22.57 ± 3.13 mm, 20.45 ± 4.79 mm; ii) M. supraespinoso: 15.20 ± 4.29 mm, 20,14 ± 5.38 mm; iii) M. infraespinoso: 19.49 ± 5.21 mm, 19,07 ± 4.74 mm; iv) M. redondo menor: 19.02 ± 5.21 mm, 15,33 ± 3,75 mm; v) manguito rotador completo: 76.28 ± 10.57 mm, 75,18 ± 11.41 mm. Aunque existe una variación en la configuración de la inserción, se identificaron las formas predominantes: M. subescapular - ovalado (72,5 %), M. supraespinoso - rectangular (76,3 %), M. infraespinoso ­ ovalado (78,8 %), M. redondo menor - redonda (100 %). En vista de los valores p estadísticamente significativos, puede postularse que el conocimiento de las distancias supero-inferior y medio-laterales puede proporcionar datos dimensionales requeridos para obtener una cobertura óptima del manguito durante los procedimientos de reconstrucción. Además, la variación en los patrones de inserción puede indicar la progresión de desgarros de los tendones del manguito.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Manguito Rotador/anatomia & histologia , Cadáver
9.
Int. j. morphol ; 34(3): 1051-1057, Sept. 2016. ilus
Artigo em Inglês | LILACS | ID: biblio-828984

RESUMO

The arterial integrity of the "critical zone" of the rotator cuff has led to much uncertainty regarding rotator cuff tendinopathy. As the region of the supraspinatus tendon is the most common area affected by impingement, its central aspect is situated approximately 10 mm from the insertion at the greater humeral tubercle. Although many studies have investigated the vascularity of the "critical zone", there still appears to be lack of consensus regarding its extent. Through the employment of gross dissection and standard histology analysis of twenty-five adult bilateral cadaveric scapulo-humeral regions (n = 50), this study aimed to quantify the degree of vascularity, or lack thereof, within the "critical zone" by evaluating its relative morphometric features. The demographic representation of the sample was also considered. Results: i) Mean diameter of arteriole lumen: 91.6±75.2 µm; ii) Mean diameter of entire arteriole: 119.8±87.1 µm; iii) Mean arteriole wall thickness: 15.1±9.5 µm; iv) Mean area occupied by an arteriole: 20644.4±3358.0 µm2; v) Mean number of arterioles within "critical zone": 14.6±8.7. All tissue samples displayed a scarce distribution of arterioles along the musculo-tendinous junction relative to the "critical zone". A directly proportional relationship between the morphometric parameters was indicated by positive strong correlations and accompanying statistically significant P values. As 66 % of the number of arterioles within the "critical zone" were distributed between the minimum value and the upper quartile, it was postulated to be hypovascular, therefore confirming the findings of previous studies.


La integridad arterial de la "zona crítica" del manguito rotador ha dado lugar a una gran incertidumbre con respecto a la tendinitis del mismo. A medida que la región del tendón del músculo supraespinoso sea el área más común afectada por el impacto, su aspecto central estará situado aproximadamente a 10 mm desde la inserción en el tubérculo mayor del húmero. Aunque muchos estudios han investigado la vascularización de la "zona crítica", aún parece existir falta de consenso en cuanto a su extensión. A través de la disección macroscópica y análisis de la histología normal de ambas regiones escápulo-humerales, se realizó en 25 cadáveres adultos (n = 50), este estudio que tuvo como objetivo cuantificar el grado de vascularización, o su ausencia, dentro de la "zona crítica" mediante la evaluación de su características morfométricas. También se consideró la representación demográfica de la muestra. Resultados: i) La media de diámetro de lumen de las arteriolas: 91,6 ± 75.2 µm; ii) El diámetro medio de la totalidad de las arteriolas: 119,8 ± 87.1 µm; iii) la media del espesor de la pared de las arteriolas: 15,1 ± 9.5µm; iv) La media de la zona ocupada por una arteriola: 20.644,4 ± 3358.0 µm2; v) La media de las arteriolas dentro de la "zona crítica": 14,6 ± 8,7. Todas las muestras de tejidos tenían una escasa distribución de las arteriolas a lo largo de la unión músculo-tendinosa con relación a la "zona crítica". Una relación directamente proporcional entre los parámetros morfométricos indica fuertes correlaciones positivas y junto a valores de P estadísticamente significativos. Como el 66 % de las arteriolas dentro de la "zona crítica" se distribuyeron entre el valor de cuartil mínimo y superior, se postuló como hipovascular, por lo tanto confirma los resultados de estudios anteriores.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Arteríolas/anatomia & histologia , Ombro/irrigação sanguínea , Cavidade Glenoide/anatomia & histologia , Úmero/anatomia & histologia
10.
Int. j. morphol ; 33(3): 817-825, Sept. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-762548

RESUMO

The acromion is classically described as one of the three scapular processes. Its antero-inferior aspect has been identified as the prime region of rotator cuff pathology. The purpose of this study was to determine the morphologic state of the acromion and the relative subacromial architecture within a South African population. The sample series comprised the morphological observation of one hundred and eighty-two scapulae specimens (n= 182). The classification scheme as stated by Bigliani et al. (1986) was employed. The morphometric architecture of the subacromial space was also investigated (n= 120). (a) Acromial Type: (i) Type I (flat inferior surface) 34.6%; (ii) Type II (curved inferior surface) 51.1%; (iii) Type III (hooked inferior surface) 14%. (b) Shape of the subacromial space: (i) rhomboid 60.8% (ii) triangular 10%, (iii) trapezoid 29.2%. Since this study investigated the acromial morphology and its association with the relevant demographic factors specific to the South African population, it may prove beneficial to the South African population as a whole. In addition, statistically significant differences were obtained for the correlation of several morphometric and morphological parameters of the subacromial architecture with age, sex, acromial type and shape of subacromial space. A unique trapezoidal subacromial space was also observed. As the variable acromial types and subacromial morphology have been reported to lead to the narrowed subacromial space and subsequent subacromial syndromes, the association between the respective morphometric and morphological parameters may provide predictive values to assist in the diagnosis and assessment of the cause of rotator cuff disease.


El acromion se describe clásicamente como uno de los tres procesos escapulares. Su aspecto antero-inferior ha sido identificado como la región principal de la patología del manguito rotador. El propósito de este estudio fue determinar el estado morfológico del acromion y la arquitectura subacromial relativa dentro de una población de Sudáfrica. La muestra incluyó la observación morfológica de ciento ochenta y dos escápulas (n= 182). Fue empleado el esquema de clasificación según lo reportado por Bigliani et al. (1986). La arquitectura morfométrica del espacio subacromial también fue investigada (n= 120). (a) tipo acromial: (i) tipo I (superficie inferior plana) 34,6%; (ii) tipo II (superficie inferior curva) 51.1% y (iii) Tipo III (superficie inferior enganchada) 14%. Forma del espacio subacromial: (i) romboide 60,8%; (ii) triangular 10%, y (iii) trapezoide 29,2%. Debido a que este estudio investigó la morfología acromial y su asociación con los factores demográficos pertinentes específicos de la población sudafricana, puede resultar beneficioso para la población de Sudáfrica. Además, se obtuvieron diferencias estadísticamente significativas para la correlación de varios parámetros morfológicos de la arquitectura subacromial con la edad, sexo, tipo acromial y la forma del espacio subacromial y morfométrico. También se observó un único espacio subacromial trapezoidal. Como se ha informado de la variable acromial tipos y morfología subacromial para dirigir al espacio subacromial estrechado y síndromes subacromial posteriores, la asociación entre los respectivos parámetros morfológicos morfométricos puede proporcionar valores predictivos para ayudar en el diagnóstico y evaluación de la causa de la enfermedad del manguito rotador.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Acrômio/anatomia & histologia , Fatores Etários , Fatores Sexuais , África do Sul
11.
Int. j. morphol ; 33(3): 1071-1077, Sept. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-762588

RESUMO

Recent studies have regarded the fibula flap as the benchmark for the reconstruction and treatment of compound wounds and lesions. Owing to its postero-lateral location within the leg, the application of the fibula flap is deemed aesthetically advantageous as the donor scar can be easily hidden. Since the fibula is anatomically characterized by a shaft and two extremities, this study aimed to investigate the nutrient foramen morphology and the relative fibular osteometry. Osteometric and morphological evaluation of 104 dry human fibulae, representing male and female individuals of the Black and Caucasian population groups that are native to South Africa, were conducted (Age range: 15 ­ 81 years old). The presence of single, double and six nutrient foramina were noted. A total of fifteen different locations of the nutrient foramen relative to the fibular surfaces, margins and component parts were identified. In addition to several other osteometric parameters, the mean fibular length (mm) and diameter of the nutrient foramina (mm) were [(male: 374.85±2.01; female: 345.49±1.86) (Black: 363.60±2.38; Caucasian: 380.42±3.01)] and [(male: 1.00±0.34; female: 0.96±0.42) (Black: 0.98±0.37; Caucasian: 1.11±0.27)], respectively. In light of the lack of osteometric data regarding destabilization and subsequent reconstruction of the talocrural joint, the relative sides and angles of the irregular triangular talar facet were quantified. Due to the correlation of the respective fibular parameters with age, sex and races, the focus of this study was extensive in comparison to previous studies. The recorded statistically significant differences for age, sex and race may suggest a South African standardization of those demographic factors with the relevant fibular parameters. Furthermore, the location of nutrient foramina within the fibular shaft may assist with the mapping and development of simple classification schemes for the harvesting of fibular grafts.


A partir de estudios recientes se ha considerado al colgajo de fíbula como punto de referencia para la reconstrucción y el tratamiento de lesiones y heridas compuestas. Debido a su ubicación postero-lateral en la pierna, la aplicación del colgajo de fíbula se considera estéticamente ventajoso ya que la cicatriz del sector donante puede ser disimulada fácilmente. Anatómicamente, en la fíbula se puede reconocer una diáfisis y dos extremos. Este estudio tuvo como objetivo investigar la morfología del foramen nutricio y la osteometría relativa de la fíbula. Se realizó una evaluación osteométrica y morfológica de 104 fíbulas humanas secas, pertenecientes a hombres y mujeres de grupos de población de raza negra y caucásica, nativos de Sudáfrica (rango de edad: 15-81 años). Se observó la presencia de forámenes nutricios individuales, dobles y en número de seis. Se identificaron un total de 15 sitios diferentes de ubicación del foramen nutricio en relación con las superficies, márgenes y demás componentes de la fíbula. Otros parámetros osteométricos como longitud media de la fíbula (mm) fueron: 374,85±2,01 en hombres y 345,49±1,86 en mujeres, 363,60±2,38 en Negros y 380,42±3,01 en Caucásicos, y el diámetro de los forámenes nuticios (mm) fueron 1,00±0,34 en hombres y 0,96±0,42 en mujeres, 0,98±0,37 en Negros y 1,11±0,27 en Caucásico, respectivamente. Debido a la falta de datos osteométricos respecto a la desestabilización y la posterior reconstrucción de la articulación talocrural, se cuantificaron los lados relativos y los ángulos de la faceta triangular irregular del talus. Debido a la correlación de los respectivos parámetros de la fíbula con la edad, sexo y razas, el foco de este estudio fue extenso en comparación con los estudios anteriores. Las diferencias estadísticamente significativas para la edad, el sexo y la raza pueden sugerir una estandarización en Sudáfrica de esos factores demográficos con los parámetros pertenecientes a la fíbula. Por otra parte, la ubicación de los forámenes nutricios dentro del eje de la fíbula puede ayudar con la el desarrollo de sistemas de clasificación simples para la recolección de los injertos de fíbula.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Antropometria/métodos , Fíbula/anatomia & histologia , África do Sul
12.
Int. j. morphol ; 33(2): 452-458, jun. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-755494

RESUMO

The foramen spinosum (FS) and foramen venosum (of Vesalius) (FV) are alisphenoid apertures situated within the hub of the middle cranial fossa in close proximity to foramen ovale (FO). The FS and FV provide a passage to important neurovascular structures. An accurate knowledge of the morphometric details of the FS and FV including their shape, incidence, relation to other foramina and/or presence of any anomalies may represent a reliable anatomical landmark during surgical explorative maneuvers. Therefore, the aim of this study was to investigate the morphologic and morphometric features of the FS and FV. The study was conducted on 100 dry human skulls (n= 200) obtained from the osteological bank at the University of KwaZulu-Natal, to produce a database which may serve as a useful guideline to surgeons and anesthetists. Although single (95%), duplicate (2.5%) and triplicate (0.5%) FS were identified; only single (5%) and duplicate (0.5%) FV were found. Oval (FS: 43.5%; FV: 4.5%) and round (FS: 58%; FV: 0.5%) foramina were observed. In addition, the relationship of the FS and FV to FO was recorded: postero-lateral (FS: 93%; FV: 0%); posterior (FS: 1.9%; FV: 0%); postero-medial (FS: 0.5%; FV: 0%); anterior (FS: 0%; FV: 0.5%); antero-medial (FS: 0%; FV: 4.5%). The mean morphometric parameters of the FS and FV included the internal diameter (FS: 2.53±0.76 mm; FV: 1.93±0.46 mm), external diameter (FS: 2.50±0.74 mm; FV: 2.81±1.53 mm) and distance to the FO (FS: 3.45± 1.29 mm; FV: 2.63±1.24 mm). In light of the morphometric and morphological variations of skull-based foramina, the evaluation of the FS and FV in our study may provide a reliable osteometric reference in clinical practice which may be beneficial during interpretation of imaging and surgical intervention.


El foramen espinoso (FE) y foramen venoso (FV) son aberturas situadas en el centro de la fosa craneal media en las proximidades de un foramen oval permeable (FO). El FE y FV proporcionan el acceso a importantes estructuras neurovasculares. Un conocimiento preciso de los datos morfométricos del FE y FV, incluyendo su forma, incidencia, relación con otros forámenes o presencia de cualquier anomalía puede representar un punto de referencia anatómica fiable durante las maniobras exploratorias quirúrgicas. El objetivo de este estudio fue investigar las características morfológicas y morfométricas del FE y FV. El estudio se realizó sobre 100 cráneos humanos secos (n= 200) obtenidos del banco osteológico de la Universidad de KwaZulu-Natal, para producir una base de datos que pueda servir como guía útil para los cirujanos y anestesistas. Se identificaron FE únicos (95%), dobles (2,5%) y triples (0,5%); junto a FV únicos (5%) y dobles (0,5%). Según forma, se encontraron forámenes de tipo oval (FE: 43,5%; FV: 4,5%) y circular (FE: 58%; FV: 0,5%). Además, se registró la relación entre FE, FV y FO: postero-lateral (FE: 93%; FV: 0%); posterior (FE: 1,9%; FV: 0%); postero-medial (FE: 0,5%; FV: 0%); anterior (FE: 0%; FV: 0,5%) y antero-medial (FE: 0%; FV: 4,5%). Los parámetros morfométricos medios de los FE y FV incluyeron el diámetro interno (FE: 2, 53±0,76 mm; FV: 1,93±0,46 mm), diámetro externo (FS: 2,50±0,74 mm; FV: 2,81±1,53 mm) y distancia al FO (FS: 3,45±1,29 mm; FV: 2,63±1,24 mm). Considerando la morfometría y las variaciones morfológicas de los forámenes en la base del cráneo, la evaluación del FE y FV puede proporcionar una referencia osteométrica fiable en la práctica clínica, que puede ser beneficiosa durante la interpretación imagenológica y la intervención quirúrgica.


Assuntos
Humanos , Cefalometria , Osso Esfenoide/anatomia & histologia
13.
Int. j. morphol ; 33(2): 600-606, jun. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-755516

RESUMO

The tibia is the medial long bone of the leg and is characterized by a shaft and two expanded extremities. Despite the recent advent of tibial bone graft harvesting, the tibia has also been confirmed to be of great forensic significance. As this appears to be the only tibial dry bone study done in Southern Africa, this study aimed to investigate morphological and morphometric parameters that are of clinical and anthropometric importance. Morphological and morphometric examination of 302 adult tibial bone specimens of Black South Africans obtained from the osteological bank of the Discipline of Clinical Anatomy at the University of KwaZulu-Natal was performed. The sample consisted of 168 males and 134 females with an age range of 15 to 87 years old. The number of nutrient foramina were: (a) One (male: 98.2%; female: 99.3%); (b) Double (male: 1.8%; female: 0.7%); Relationship of nutrient foramen to the soleal line: (a) infero-medial (male: 0.6%; female: 1.5%); (b) inferior but directly opposite the middle of the bone (male: 8.2%; female: 2.2%); (c) infero-lateral (male: 81.8%; female: 88.9%); (d) infero-lateral, along interrosseous crest (male: 4.1%; female: 3.0%); (e) supero-medial (male: 4.7%; female: 3.7%); (f) supero-medial, along interrosseous crest (male: 0.6%; female: 0%); (g) supero-lateral (male: 0%; female: 0.7%). Statistically significant differences were recorded in tibial morphometric parameters between males and females. The relationship between the number of nutrient foramina and the soleal line was of statistical significance (p= 0.002). The greater prevalence of a single foramen observed in this study compared favorably with that reported in previous literature. The recognition of the regional distribution of the nutrient foramina may prevent injury during tibial bone graft procedures. A thorough understanding of the tibial anatomy may also assist with the provision of demographic data required in forensic investigation.


La tibia es el hueso largo y medial de la pierna, con un eje y dos extremos expandidos. Además de ser considerado como posible donante de injerto, se ha confirmado su importancia en el ámbito forense. Este estudio tuvo como objetivo investigar los parámetros morfológicos, morfométricos y antropométricos de la tibia que son de importancia clínica. Se llevó a cabo un examen morfológico y morfométrico de 302 muestras de tibias perteneciente a negros sudafricanos adultos, obtenidas desde el banco osteológico del Departamento de Anatomía Clínica de la Universidad de KwaZulu-Natal. La muestra estuvo constituída por 168 hombres y 134 mujeres, con un rango etario entre 15 y 87 años. El número de forámenes nutricios fueron los siguientes: (a) Únicos (hombres: 98,2%; mujeres 99,3%); (b) Doble (hombres: 1,8%; mujeres: 0,7%). La relación del foramen nutricio con la línea del sóleo fue: (a) infero-medial (hombres: 0,6%; mujeres: 1,5%); (b) inferior y anterior a la mitad inferior del hueso (hombres: 8,2%; mujeres: 2,2%); (c) infero-lateral (hombres= 81,8%; mujeres= 88,9%); (d) infero-lateral, a lo largo del margen interóseo (hombres: 4,1%; mujeres: 3,0%); (e) supero-medial (hombres: 4,7%; mujeres: 3,7%); (f) supero-medial, a lo largo del margen interóseo (hombres: 0,6%; mujeres: 0%); (g) supero-lateral (hombres: 0%; mujeres: 0,7%). Estadísticamente, se registraron diferencias significativas en los parámetros morfométricos tibiales entre hombres y mujeres. La relación entre el número de forámenes nutricios y la línea del sóleo tuvo significación estadística (p= 0,002). La mayor prevalencia de un solo foramen nutricio observada en este estudio, se compara favorablemente con los casos reportados en la literatura analizada. El reconocimiento de la distribución regional de los forámenes nutricios puede evitar lesiones durante los procedimientos de injerto de hueso tibial. Un conocimiento profundo de la anatomía de la tibia también puede aportar datos demográficos necesarios para la investigación forense.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , População Negra , Tíbia/anatomia & histologia , Antropometria , África do Sul
14.
Int. j. morphol ; 33(1): 251-254, Mar. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-743793

RESUMO

The jugular foramina (JF) are bilateral openings situated between the lateral part of the occipital bone and the petrous part of the temporal bones in the human skull. It is a bony canal transmitting neurovascular structures from the posterior cranial fossa through the base of the skull to the carotid space. Since the JF depicts variations in shape, size, height and volume between different racial and gender groups, along with distinctive differences in laterality from its intracranial to extracranial openings, knowledge of the JF may be necessary to understand intracranial pathologies. Therefore, the purpose of this study was to evaluate the morphometric measurements of the jugular foramen. Various morphometric parameters of the JF and its relation to surrounding structures were measured and assessed in 73 dry skull specimens (n=146). Each of the morphometric parameters measured were statistically analyse using SPSS to determine the existence of a possible relationship between the parameters and sex, race, age and laterality. The comparisons of sex and age with the distance between the JF and lateral pterygoid plate and distance between the JF and foramen magnum yielded statistically significant p values of 0.0049 and 0.036, respectively. The results of this study correlated with that of previous studies indicating that measurements regarding the JF are greater on the right side. The provision of morphometric data pertaining to the JF and surrounding structures may assist surgeons and clinicians during operative procedures.


Los forámenes yugulares (FY) son aberturas bilaterales situadas entre la parte lateral del hueso occipital y la porción petrosa del hueso temporal del cráneo humano. Se trata de un canal óseo que da paso a estructuras neurovasculares de la fosa craneal posterior a través de la base del cráneo hasta el espacio carotídeo. Ya que el FY representa variaciones en la forma, tamaño, altura y volumen entre diferentes grupos raciales y sexo, además de las diferencias distintivas en la lateralidad desde sus aperturas intracraneales a las aperturas extracraneales, se hace necesario su conocimiento con el objetivo de comprender las patologías intracraneales. El propósito de este estudio fue evaluar las mediciones morfométricas del FY. Se midieron y evaluaron muestras de 73 cráneos secos, bilateralmente (n=146). Se estudiaron varios parámetros morfométricos del FY y su relación con las estructuras circundantes. Cada uno de los parámetros morfométricos medidos fue analizado estadísticamente con el programa SPSS para determinar la existencia de una posible relación entre los parámetros y sexo, raza, edad y lateralidad. Las comparaciones de sexo y edad con la distancia entre la placa pterigoidea lateral y el FY, y la distancia entre el FY y el foramen magno, arrojaron valores de p significativos de 0,0049 y 0,036, respectivamente. Los resultados de este estudio se correlacionaron con estudios previos que indican que las mediciones relativas al FY son mayores en el lado derecho. El suministro de datos morfométricos relativos al FY y las estructuras circundantes puede ayudar a los cirujanos y clínicos durante los procedimientos quirúrgicos.


Assuntos
Humanos , Cefalometria , Osso Occipital/anatomia & histologia , Osso Temporal/anatomia & histologia
15.
Ghana Med. J. (Online) ; 48(4): 178-184, 2015.
Artigo em Inglês | AIM | ID: biblio-1262279

RESUMO

Background: Later years of life are accompanied by many physical; emotional and environmental changes which may impact on the well-being of the individual. Many factors are known to influence the subjective well-being of older adults; but most; if not all of this information was the result of studies in the Western world. This study aimed at obtaining and documenting the predictors of subjective well-being (SWB) among older Ghanaians. Methods: Data for the study was obtained from the WHO SAGE study. The single item measure of life satisfaction was used to determine subjective wellbeing. Descriptive statistics as well as logistic regression analysis were carried out to determine the predictors of SWB. Results: A total of 4724 individuals aged 50 years and above responded to the questionnaires. Of these 50.4 were males. Following multivariate logistic regression analysis; age; sex; educational level; income and ethnic background were found to significantly affect the SWB of older Ghanaians. Being male was associated with higher level of SWB (OR=1.68; CI: 1.39 - 2.03). For those 50 years and above; being younger (50-59 years) was also associated with a high level of SWB (OR=17.72; CI: 10.13-30.98). Earning a low income and having low educational level were both associated with low levels of SWB (OR=0.304; CI: 0.22-0.42; and OR=0.47; CI: 0.37-0.60 respectively). Ewes (p=0.027); Grumas (p=0.002) and Mole-Dagbons (p=0.04) had significantly higher SWB compared to the other ethnic groups. Conclusion: Among older Ghanaians; factors that positively influence SWB are younger age; male sex; high educational level and high income


Assuntos
Saúde , Qualidade de Vida
16.
Int. j. morphol ; 32(4): 1436-1443, Dec. 2014. ilus
Artigo em Inglês | LILACS | ID: lil-734695

RESUMO

The subclavian-axillary arterial tree is responsible for the arterial supply to the rotator cuff muscles as well as other shoulder muscles. This study comprised the bilateral dissection of the shoulder and upper arm region in thirty-one adult and nineteen fetal cadaveric specimens. The variable origins and branching patterns of the axillary, subscapular, circumflex scapular, thoracodorsal, posterior circumflex humeral and suprascapular arteries identified in this study corroborated the findings of previous studies. In addition, unique variations that are unreported in the literature were also observed. The precise anatomy of the arterial distribution to the rotator cuff muscles is important to the surgeon and radiologist. It will aid proper interpretation of radiographic images and avoid injury to this area during surgical procedures.


El árbol arterial subclavio-axilar, es responsable del suministro arterial de los músculos correspondientes al manguito de los músculos rotadores, así como de otros músculos del hombro. Este estudio comprende la disección bilateral del hombro y la región superior del brazo en 31 cadáveres adultos y 19 fetos. Las variables y patrones del origen, ramificación de las arterias axilar, subescapular, circunfleja escapular, toracodorsal, circunfleja humeral posterior y supraescapular, identificados en este estudio, corroboran los hallazgos de estudios anteriores. Además, se observaron variaciones únicas no comunicadas previamente en la literatura. La anatomía precisa de la distribución arterial de los músculos del manguito de los músculos rotadores es importante para el cirujano y el radiólogo. Esta información constituirá una ayuda para la adecuada interpretación de imágenes radiológicas y para evitar lesiones en esta área durante los procedimientos quirúrgicos.


Assuntos
Humanos , Adulto , Artéria Subclávia/anatomia & histologia , Artéria Axilar/anatomia & histologia , Manguito Rotador/irrigação sanguínea , Músculo Esquelético/irrigação sanguínea , Cadáver , Feto , Variação Anatômica
17.
Int. j. morphol ; 32(1): 136-140, Mar. 2014. ilus, tab
Artigo em Inglês | LILACS | ID: lil-708736

RESUMO

The arterial supply to the rotator cuff muscles is generally provided by the subscapular, circumflex scapular, posterior circumflex humeral and suprascapular arteries. This study involved the bilateral dissection of the scapulohumeral region of 31 adult and 19 fetal cadaveric specimens. The subscapularis muscle was supplied by the subscapular, suprascapular and circumflex scapular arteries. The supraspinatus and infraspinatus muscles were supplied by the suprascapular artery. The infraspinatus and teres minor muscles were found to be supplied by the circumflex scapular artery. In addition to the branches of these parent arteries, the rotator cuff muscles were found to be supplied by the dorsal scapular, lateral thoracic, thoracodorsal and posterior circumflex humeral arteries. The variations in the arterial supply to the rotator cuff muscles recorded in this study are unique and were not described in the literature reviewed. Due to the increased frequency of operative procedures in the scapulohumeral region, the knowledge of variations in the arterial supply to the rotator cuff muscles may be of practical importance to surgeons and radiologists.


El suministro arterial a los músculos del manguito rotador generalmente es proporcionado por las arterias subescapular, circunfleja escapular, circunfleja humeral posterior y supraescapular. Se realizó la disección bilateral de la región escapulo humeral de 31 especímenes cadavéricos adultos y 19 fetos. El músculo subescapular estaba irrigado por las arterias subescapular, supraescapular y circunfleja escapular. Por otra parte, la arteria supraescapular irrigaba a los músculos supra e infraespinoso. Observamos que los músculos infraespinoso y redondo menor fueron irrigados por la arteria circunfleja escapular. Además de las arterias de origen y sus ramas, observamos que los músculos del manguito rotador son irrigados por la arteria escapular dorsal y las arterias torácica lateral, toracodorsal y circunfleja humeral posterior. Las variaciones en la irrigación de los músculos del manguito rotador registrados en este estudio son únicos y no existe una descripción referente a ellos en la literatura revisada. Debido a la mayor frecuencia de los procedimientos quirúrgicos en la región escápulohumeral, el conocimiento de las variaciones de la irrigación de los músculos del manguito rotador puede ser de importancia práctica para cirujanos y radiólogos.


Assuntos
Humanos , Adulto , Artérias/anatomia & histologia , Manguito Rotador/irrigação sanguínea , Músculo Esquelético/irrigação sanguínea , Cadáver , Variação Anatômica
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