Indian Journal of Anatomy

 This letter to editor is aimed at re-exploring the structure-function inter-relationship from an evidenceinformed bench-to-bedside perspective for ultrastructural characteristics of peripheral nerves in diabetic peripheral neuropathy (DPN) and its implications for assessment and management of patients. Ultrastructural changes occurred in all parts of the peripheral nerves- axons, cell bodies, dendrites, myelin sheath and endplates.The ultrastructural changes were reported in both sympathetic and parasympathetic fibers, and occurred in both myelinated and unmyelinated nerve fibers. The ultrastructural changes responded to treatment by ponalrestat, an aldose reductase inhibitor. These findings from experimental studies on diabetic rats indicate that the peripheral nerve lesions in human diabetics were mainly due to metabolic impairment of nerve fibers, accompanying dysmetabolism of Schwann cells and diabetic microangiopathy.

Keywords: Ultrastructure; Morphometry; Histochemical Study; Neuroanatomy; Diabetic Neuropathy.

 Introduction: The present study aims to assess different morphometric parameters of condylar and intercondylar surface of tibia and to compile the results, analyze and formulate a baseline data for future studies with relevance to North-East Karnataka population. Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) are frequently done procedures for the treatment of various forms of arthritis and knee injuries. The knee prosthesis, which is used for these procedures, requires adequate sizing specific to the population. Hence the aim of the present study is to measure various parameters of the proximal end of the tibia in North east Karnataka population in Bidar district. Materials and Method: Sixty (32 Right and 28 Left) adult fully ossified tibia bone were taken and various parameters of the proximal end of tibia were measured using a vernier caliper. Statistical analysis of the parameter was done.Comparision between various parameters of right and left side was done using paired‘t’ test. Result: In our study the mean transverse, the antereposterior diameter of total, medial and lateral candyles of tibia are 6.29, 4.16, 2.66, 4.08, 2.80, 3.35 cm. The area of medial, lateral and total tibial condyle is 10.86, 9.50 and 26.30 cm. The mean length between the upper end of tibia and tibia tuberosity and the mean circumference of the upper end of tibia is 2.16 and 19.11cm. Groove for ligamentum patellae is found in 100% of cases. Conclusion: The result of these study will be helpful for anatomist, anthropologist, to Orthopedition in cases of UKA, TKA procedures and meniscal transplantation. This study is also helpful to prepare prosthesis of accurate size related to Bidar district population.

 Introduction: The study on morphology of nutrient foramina of fibula can provide prudent information for various bone grafting orthopedic surgeries.The present study was undertaken to generate morphometric and topographic data of fibula from western India, where there is paucity of such information. Materials and methods: This study included 140 specimens of dry human fibulae devoid of gross pathological deformities, obtained from department of Anatomy of four medical colleges in Mumbai (Topiwala National Medical College, Seth GS Medical College, Lokmanya Tilak Medical College and Government Medical College, Mumbai). All fibulae were observed for number, direction and location of the nutrient foramina. The position of foramina was labeled by using foraminal index (FI) which was calculated by applying the Hughes’ formula. Results: Nutrient foramina were traceable in 125 (89.29%) fibulae. Dominant and secondary nutrient foramina was present in 121 (86.43%) and 10 (7.14%) fibulae respectively. 110 (88.71%) dominant foramina were in lower direction. Most of the foramina were present on the posterior surface. Dominant and secondary nutrient foramina were present on middle of shaft of fibulae in 91.12% and 50% of cases respectively. Conclusion: The present study confirms and compares the morphometric and topographic data on fibula from western part of India.

 Papillary muscles are the part of the myocardium and plays an important role in valve function by drawing atrioventricular valve annulus towards apex thus preventing ventricular overextension. The aim of the present study is to find out the variations in the number of papillary muscles of right ventricle and its statistical difference between males and females. The material for the present study comprised of 50 formalin fixed adult human hearts (35 males and 15 females) without macroscopic pathological changes, obtained from different medical colleges in Maharashtra. The number of the papillary muscles varies from two to six. Anterior and posterior papillary muscles were constantly present in all hearts but septal papillary muscle was absent in 24% samples. No statistical significance was observed between males and females. The left atrioventricular valve had been largely studied. The number of papillary muscles of right ventricle varies considerably. Damage to papillary muscles may occur after trauma and further even lead to death. Knowledge regarding variability of papillary muscles will help cardiac surgeons during their corrective procedures.

Kidneys are supplied by a pair of renal arteries which arise from abdominal aorta and branches laterally below the superior mesenteric artery. A single renal artery arising from aorta supplying the corresponding kidney is actually seen in less than 25% of cases. Kidneys are drained by pair renal veins into inferior vena cava. Variations in the number and branching pattern of renal vessels are common. Persistence of lateral splanchnic arteries is the main reason for variation in the number of renal arteries. The different fate of right and left subcardinal and supracardinal anastomosis is responsible for the presence of supernumerary renal veins. Aims and objectives: To study the anomalous pattern of renal vessels and its clinical implications. Materials and methods: We studied 100 cadavers over a period of 3 years for the presence of anomalies of renal vessels. Results: We found 3 cases of double renal arteries all on left side; 2 cases of double renal veins on right side; 1 case of pre-hilar division of renal artery. We also found 2 unusual variations: in the 1st case, inferior phrenic artery arose from right renal artery; in the 2nd case testicular artery arose from left renal artery. Conclusion: Variations in renal vessels can go unnoticed many times and can give rise to a number of clinical manifestations. A thorough knowledge of renal vessels is thus important for radiologic, diagnostic, operative and endovascular procedures.

The importance of size and shape of the sella turcica in connection with the occurrence of symptoms of npituitary diseases has long been recognized. Present study was aimed to study normal shape of Sella turcica by radiographs. In the present study, lateral radiographs of skulls of four hundred and forty seven subjects of known age (between 13 to 55 years) and sex (two hundred and thirty seven males; two hundred and ten females) were studied. The Sella Turcica is classified into three basic shapes Oval, Round & Flat. Oval shape is most commonly found and flat least commonly found in Maharashtrian population.

Identification of sex from remains of skeleton is an important demographic assessment in medico legal investigations and anatomists are frequently consulted by law enforcement authorities for it. Present study is conducted on 50 human humeri (all are dry, and undamaged. 25 are male and 25 are female) Five parameters are studied. The mean values of all parameters are significantly higher in males than in females (P<0.001) with univariate analysis. Not a single parameter gives us an idea of sex of humerus with 100% accuracy. The single best parameter is CA (Circumference of anatomical neck of humerus) with an accuracy of 64 % in males and 68 % in females.

Flexor carpi radialis [ FCR] is a superficial flexor muscle of forearm and show variations in pattern of origin, abnormal fusion with other muscles, as well as insertion pattern. The objective of the study was to enumerate variations of FCR muscle and to establish a clinico-anatomical correlation. The present study was conducted on bilateral upper limbs of thirty cadavers, irrespective of sex, over a period of four years. The study revealed two abnormal pattern of origin of FCR in two cadavers. In one cadaver, FCR has additional B/L head of origin from Biceps tendon insertion. In another cadaver, U/L fused origin of FCR with Pronator teres was found. This study has relevant implication related to clinical and radiological diagnosis of neurovascular compression involving forearm, and also various reconstructive surgeries involving forearm structures.

 Introduction: Higher education like medical education aims not only to prepare students to learn existing knowledge but to generate new knowledge and apply that knowledge to solve complex problems.Research suggests that complex problems can be solved with the help of knowledge integration. The use of conceptmaps as teaching toolfacilitates knowledge integration.Present study was undertaken to sensitize students to use concept maps and to compare learning with concept maps versus with traditional lecture and demonstration methods. Methods: A randomized cross sectional prospective study was conducted on 120 medical students of 1st year. Students were divided into 3 groups A, B and C. Group A studied “Gross anatomy of knee joint” by developing concept maps in number of small subgroups. Group C learnt through lecture and demonstration methods. Group B studied with concept maps developed individually by each student. Pre and posttest were conducted for all groups with pre validated questionnaire. Feedback was obtained from both students and faculty through a 5 point Likert scale. Students T test was applied for statistical analysis. Result: There was significant improvement in knowledge in group A and B students in comparison to group C students. This improvement was more marked in regards to high cognitive type MCQs. 90% students found that development of concept maps helped them to understand topic better. Discussion and Conclusion: Concept mapping is a better teaching learning tool than lecture and demonstration methods. Teaching-learning with development of concept maps individually or collaboratively facilitates higher cognitive learning.

 Introduction: The cervical vertebrae are cranially placed, moveable vertebrae in the human body. The characteristic feature of these vertebrae are the presence of a Foramen Transversarium (FT) in each lateral mass. A plexus of sympathetic nerves surrounding the Vertebral Artery (VA) and Vertebral Veins (VV) passes through the FT. The variable number and size of FT may lead to clinically significant conditions. It may be due to variable course of the VA which implicates an embryological basis. Aims: The objective of the present study is to find out the incidence of accessory FT in the cervical vertebrae and its morphological and clinical significance. Material and Methods: There were 117 dried cervical vertebrae available in the Department of Anatomy, AII India Institute of Medical Sciences, Patna, Bihar. They were macroscopically studied to find variations in the number of FT. Results: Out of 117 cervical vertebrae accessory FT were found in 25 vertebrae (21.3%). The accessory FT were unilateral in 15 vertebrae (12.8%) and bilateral in 10 vertebrae (8.7%). The unilateral foramina were more common than the bilateral one. The accessory FT were smaller and posteriorly placed compared to the regular FT. Conclusions: The accessory FT are of importance to radiologists and surgeons operating on the cervical spine.

 Introduction: The measurement of angle of anteversion is important in orthopedic surgery for hip replacement and to gain the normal activities of that joint. It is also important factor to increase the longevity of joint. Methods: Adult femora available in the anatomy department of different Medical College in costal Andhra Pradesh including G S L Medical College was used as study sample to get exact idea of femoral anteversion, any significant difference between right and left sided femora in South Indian population and to compare them with previous study. Goniometer and Vernier calliper were used to measure all the parameters. Values were analyzed by using statistical software (SPSS programmed, version- 17). Results: The anteversion of present study was about 18.780 . Significant differences between left sided and right sided anteversion was observed. Anteversion on right side is 19.45+/-5.64 and on left side 18.45+/-4.30. The p value is 0.048 which is <0.05. Conclusion: The present study is an attempt to evaluate the angle of anteversion among the South Indian Population to determine the bilateral asymmetry and to compare it with the anteversion of other races like Caucasian, Negroes etc as stated in different literatures that might be helpful for orthopedic surgeon in hip replacement therapy.

 Background: Anencephaly and spina bifida are the commonest type of Neural tube defect. Exencephaly is the severe form of anencephaly in whichthere is not only deficiency of scalp and cranial vault but also uncovered immature braintissue protrudes out of the cranium. There isloss of fetal brain tissue to variable degrees and it is considered a precursor to anencephaly . Most cases are stillborn. Present study was carried outtostudy exencephaly and the associated morphological abnormalities. This study also compares the findings with other studies and defines a clinical entity that is incompatible with human life. Method: The study was carried out on a collection of 20 aborted fetuses in department of anatomy out of which 11 showed presence of exencephaly. Result: These exencephalic fetuses presented with facial abnormalities, cvs abnormalities, skeletal deformities and abdominal abnormalities.This study describes in detail the severe form of NTD called exencephaly and the associated abnormalities. We have described a lesser defined condition that is exencephaly, the anatomical knowledge of such may be important for academic, clinical as well as radiological procedures .With  the detailed knowledge of the condition the diagnosis ofexencephaly, can be established sonographically even in the first trimester and necessary measures can be taken. 

Background: Ventricular enlargement to be a more sensitive indicator ofcortical atrophy due to increasing age anddementias [1].The two major changes that may occur in elderly individual without neurologic deficits is enlargement of ventricles and cortical atrophy. Aim of the study was to statistically analyse the length of anterior horn of lateral ventricle in humans and to correlate the changes in relation to age, gender and side. Method: The CT images of 150 adult individuals (age group 20-80yrs) was studied in both males and females. Length of anterior horn of lateral ventricle was measured using dicomworks software. Result: Mean value of length of the anterior horn increases on both sides as the age increases. Values are larger in 61-80 years.Length of anterior horn ismore in males as compared to females. In relation to the side , the length ofanterior horn is greater on the left side as compared to the right side

Introduction: The term goniometry refers to the measurement of angles created at human joints, it may be used to determine both a particular joint position and total amount of motion available at a joint. Aim & Objectives: The purpose of the study was to determine the effect of age and gender on movements of temporomandibular joint in 100 normal subjects through the Universal Goniometer. Material & Methods: Study was carried out on 100 healthy subjects aged between 20-30 years. All the subjects having normal temporomandibular joint skeleton were chosen and those who were not having any history of joint surgery, trauma or any other type of abnormalities were included for determining the validity and reliability of the goniometric measurements. Results: Male subjects showed higher range of motion for depression of mandible, anterior protrusion and lateral deviation than females. Conclusion: ROM in all active temporomandibular joint motions except retrusion decreases with increasing age. The males also had a greater mean ROM in right lateral deviation, but the difference between genders was small.

Objective: Understanding the anatomical basis of craniovertebral anomalies is important when carrying out surgery in the region. A lateral approach during craniovertebral surgery requires resection of the occipital condyles.The present work is aimed to study the morphology of the occipital condyles and their facets is important clinically. Materials and Methods: The study was performed on 200 occipital condyles of 100 adult human dry skulls of unknown age and sex. The measurements like Distance between basion and anterior and posterior tip of occipital condyle, Distance between opisthion and anterior and posterior tip of occipital condylewere measured. Results: Distance between anterior and posterior tip of occipital condyleand basionwere found to be 10.51 and 26.91 mm on the right and 11.43 and 27.85 mm on the left respectively. Distance between anterior and posterior tip of occipital condyle and opisthion were found to be 38.97 and 27.81mm on the right and 39.05, and 26.98 mm on the left respectively. Conclusion: The above said parameters of the occipital condyles and its variations should be taken into consideration during posterior and lateral approaches to the craniovertebral junction by neurosurgeons and orthopaedicians.The larger the distance, the free the space for the postero- lateral approach.

Anatomy is a highly dynamic science. It is based on factual knowledge and functional correlation and thinking. For centuries it has been regarded as one of the recognized basic biomedical science. In the traditional method of medical curriculum, anatomy is taught in the first year of the course and involves little interdisciplinary interaction. Anatomy is an important basic science that if deficient in, the student may feel inadequately prepared for clinical courses thus, pinpointing the best teaching method warrants investigation. In recent years many researchers worked on Problem Based learning and found that PBL inculcates better understanding, self-directed learning and analytical skills in students [1]. Also it develops problem solving attitude and analytical skills in students. If PBL is included in the curriculum of basic sciences like Physiology, it can help students to apply knowledge of anatomy in clinical practice [2]. However, recently, most of the medical colleges of other countries have adopted a student-centered, problem-based, integrated, community-based, elective-oriented, systematic (SPICES) medical curriculum [3]. So an attempt was made to combine didactic lecture with problem based learning & observe it’s effect as a teaching module in anatomy.