- ItemHistochemical properties of the iliocapsularis muscle: implications for hip function.(Stellenbosch : Stellenbosch University, 2023-03) Mac Dermott, Kerryn-Anne; Keet, Kerri; Kohn, Tertius Abraham; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences. Anatomy and Histology. Division of Clinical Anatomy.ENGLISH ABSTRACT: The iliocapsularis (IC) is a deep skeletal muscle that overlies and attaches to the anteromedial hip joint capsule and is an important anatomical landmark in anterior approaches to hip replacement surgery. Researchers have proposed the IC functions to stabilise the anterior hip joint and limit impingement of the hip capsule, between the femoral head and acetabulum, in hip flexion. However, a conclusive description of the function of the IC is not yet known. This study, therefore, aims to determine the skeletal muscle properties of the IC muscle and to compare these to that of the iliacus (IL) and vastus lateralis (VL). A cross-sectional observational study was conducted on 11 recently deceased unembalmed bodies with a mean age of 83 ± 9 years (range 69 - 95 years). Muscle samples, harvested from the IC, IL, and VL, were analysed for muscle fibre type distribution and fibre cross-sectional area (CSA) using fluorescent immunohistochemistry, while relative mitochondrial density was visualised histochemically using the NADH stain. IC had predominantly type I fibres (63 ± 12%), followed by type IIA (32 ± 13%) and IIX (5 ± 3%) fibres. IL comprised of a similar high distribution of type I fibres (61 ± 8%), compared to type IIA (31 ± 7%) and IIX (8 ± 8%) fibres. Conversely, VL had equal amounts of type I (47 ± 12%) and IIA (40 ± 11%) fibres, with lower proportions of type IIX (13 ± 10%) fibres. No difference in fibre type distributions were found between the IC and IL, whereas VL had less type I fibres compared to the IC and IL. The latter two muscles observed higher relative mitochondrial density (darker fibres) and, therefore, oxidative capacity, compared to the VL with a more equal proportion of light and dark stained fibres. The IC had larger (p < 0.0001) type I fibres (3607 ± 1422 μm2) compared to its type IIA (1849 ± 1306 μm2) and IIX (1379 ± 900 μm2) fibres. Similarly, the IL and VL had larger (p < 0.0001) type I fibres (3320 ± 1182 μm2 and 4235 ± 882 μm2, respectively) compared to type IIA (1790 ± 987 μm2 and 2738 ± 1650 μm2, respectively) and IIX (1428 ± 769 μm2 and 2170 ± 1355 μm2, respectively) fibres. No difference in the CSA of fibre types were found when the IC was compared with the IL and VL. However, the VL reported larger CSA compared to IL for type I and IIA fibres. Mean fibre CSA of the IC and IL were similar in size, while the VL had larger fibres. Fibre type distribution and fibre CSA showed no association with age. Therefore, the predominant oxidative type I fibre distribution of the IC may supports its proposed function to stabilise the hip joint and limit impingement of the hip capsule in hip flexion. Therefore, conclusive knowledge of the function of the IC will allow for more informed decisions regarding patient care and rehabilitation following anterior approaches for hip-replacement surgery.
- ItemThe iliac and femoral vessels: dimensions and tortuosity in a South African sample.(Stellenbosch : Stellenbosch University, 2023-02-22) Lunn-Collier, Robyn; Keet, Kerri; Baatjes, Karin; Witbooi, Lee-roy; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences. Anatomy and Histology. Division of Clinical Anatomy.ENGLISH ABSTRACT: Arterial morphology varies between individuals and undergoes changes with increasing age. The safety and success of endovascular procedures, performed by accessing and traversing vessel pathways, are influenced by this variable morphology. Research exploring the iliofemoral arterial pathway is limited in South Africa, which may implicate the efficacy of endovascular procedures performed in this country. Therefore, the present study aimed to determine the mean length, luminal diameter, and tortuosity severity of the common iliac, external iliac, and common femoral arteries of adult males and females in a South African sample, and to determine the influence of increasing age on this arterial morphology. A retrospective, cross-sectional study was conducted using a sample of 224 computed tomography angiograms, accessed from Tygerberg Hospital, Cape Town, South Africa. The sample included 117 adult males and 107 adult females (aged 18-79). The arterial length and lumen diameter of the common iliac, external iliac, and common femoral arteries were measured. Tortuosity severity was assessed by a visual estimation and allocation into a phenotypic category. Furthermore, tortuosity was quantitatively assessed using the tortuosity index and inflection count metric. Regression analysis was used to adjust for estimated body height. The common iliac artery was the widest artery of the iliofemoral pathway, while the external iliac artery was the longest. The morphology of the external iliac artery varied bilaterally and with sex, with males presenting with increased tortuosity, particularly on the right side. The diameter of all arterial segments was larger in males, while the length of these arteries did not differ between the sexes, with the exception of the right external iliac artery being longer in females. The inflection count metric reported the external iliac arteries of males to be more tortuous. Regression analysis revealed a strong positive relationship between arterial tortuosity and increasing age. A tortuosity phenotype was most frequently observed in the external iliac artery. However, a c-shaped curving phenotype of tortuosity was observed in all arteries of interest. The tortuosity severity of the external iliac artery doubled throughout the adult lifetime, with increases in arterial tortuosity and changes in morphology commencing between 40-49 years of age. Severe tortuosity was typically reported in individuals aged 60 years and older. Arterial morphology of the iliofemoral pathway is variable both bilaterally and between the sexes. Furthermore, changes in arterial morphology become significant from 40-49 years of age and are most severe after 60 years of age. Thus, the vasculature of patients within this age range may present with challenging anatomy for endovascular procedures. Comparing the arterial dimensions and tortuosity of this South African sample to international measurements is challenging due to the varying methodologies employed in existing literature. Therefore, the demographic-specific measurements generated in this study serve to contribute to a reference database of expected arterial anatomy in a South African context.
- ItemSex as a spectrum : inclusive anatomical education and the translation thereof into clinical practice(2022-11) Lochner, Ruan Dawid.; Bergsteedt, Bryan Jason.; Camminga, B.; Sexual minorities; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences. Anatomy and Histology. Division of Clinical Anatomy.ENGLISH ABSTRACT: Introduction: Transgender and non-binary individuals repeatedly experience erasure of their identity in healthcare, ultimately leading to avoidance of healthcare environments, and unsupervised, self administered healthcare practices. The erasure of transgender and non-binary identities in healthcare starts at medical school level. Cisnormative teachings and binary views of sex exclude transgender and non-binary identities from the training healthcare workers in South Africa receive. Methods: Data was collected in three parts. a Mix method, cross-sectional survey was sent to students and lecturers at Tygerberg Medical Campus who are involved in the learning and teaching of anatomical sciences at Stellenbosch University (N=154). Simultaneously, individual interviews were conducted with transgender and non-binary adults who have previously used the South African healthcare system before (N=13). After recommendations, knowledge levels and lived experiences were collected from the cross-sectional survey and individual interviews, data was used to triangulate and explore selected themes in a focus group session with community members who participated in the individual interviews (N=6). Results: Students self-reported a lack of resources on transgender and non-binary content in the medical curriculum at Stellenbosch University and expressed willingness to incorporate of this content in the future. Transgender and non-binary adults who have accessed healthcare in South Africa shared how the binary nature of medical teachings have impacted their experience of healthcare in the Country. Discussion: Transgender and Non-binary individuals in South Africa report experiencing complete erasure of their identities in healthcare. Ultimately leading to avoiding healthcare facilities in South Africa; as well as discrimination from undereducated healthcare workers. Majority of Students, lecturers and gender diverse community members reported a lack of transgender and non-binary resources in healthcare. Students and gender diverse community members believe that incorporation of fact-based knowledge and representation of transgender and non-binary individuals throughout the curriculum of transgender and non-binary bodies in healthcare could improve healthcare worker attitudes towards transgender and non-binary individuals, creating a safer and more inclusive environment in healthcare facilities for the individuals of South Africa. Conclusion: Tygerberg Medical Campus is contributing to the passive erasure of transgender and non binary identities in South African healthcare, by not offering any resources to students or lecturer on transgender care or language. An intervention is required to include transgender and non-binary visibility in the training of future healthcare professionals at Stellenbosch University. The present study believes that teaching sex as a spectrum in anatomical sciences and including a primer lecture (discussing gender, sex and medicine beyond the binary) could be a small, yet effective intervention to introduce healthcare students to bodies that are not only cisgender, working towards less of a binary approach to healthcare practices that are life threatening to transgender and non-binary patients.
- ItemDefining a method to predict mouth morphology in edentulous skulls(Stellenbosch : Stellenbosch University, 2022-04) Daniels, Luke-John; Alblas, Amanda; Smith, Kathryn; Roberts, Tina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences: Anatomy and Histology.ENGLISH ABSTRACT: Forensic facial depiction (FFD) is the process whereby a face is modelled to depict a face from an unknown deceased individual’s skull to assist with human identification. The field of FFD that has not been researched extensively, is the edentulous mouth, where edentulism refers to the condition of not having teeth. Therefore, this study attempted to establish whether a method could be produced to predict edentulous mouth morphology for FFD practice. To achieve this, Pearson’s correlation analysis was used and the relationship between the individual’s soft tissue measurements (somatometry) and skull measurements (osteometry) were analysed. Dentate patients, those with teeth, were also included in the study to understand the morphometric difference between the mouths of dentate and edentulous patients. Cone Beam Computer Tomography (CBCT) scans of n=63 patients were retrieved. This included 40 dentate patients (n=24 males and n=16 females) and 23 edentulous patients (n=7 males and n=16 females). The patients’ CBCT scans were retrieved from the Oral Health Centre of the University of the Western Cape’s Picture Archiving and Communication System. The morphometrics software, Stratovan CheckpointTM, was used to perform osteometry and somatometry on these scans. The somatometry of all patients included measuring soft tissue thicknesses (STTs) of the upper mouth as well as the patients’ lip height (LH) and philtrum length (PL). For the edentulous patients, the STTs included the mid-philtrum (H), and mid- upper lip margin (I). For the dentate patients, the STTs measured were the H, I, the upper incisor (II) and lateral supra-labiale (F). For osteometry, all patients’ skulls were measured to retrieve the following skull lengths: the bizygomatic breadth, basion-prosthion length, basion- gnathion length, maxillo-alveolar breadth, maxillo-alveolar length, nasion-prosthion, and the cranial base length. These lengths were then used to calculate the maxilla-alveolar (MAI), upper facial, subnasal gnathic (SGI), and gnathic indices. A Shapiro-Wilk test was performed, and it was found that all osteometry and somatometry were normally distributed. Therefore, the correlation analysis could be applied. For the edentulous patients, the correlation analysis was only applied to the female patients since the male group was below the suggested sample size for correlation analysis (n<10). The results found that no significant correlations exist between female edentulous mouth somatometry and osteometry. For the dentate males, significant correlations were identified in: the MAI, and II- right and II-left; GI and H; and SGI and LH. For the dentate females: SGI, and II-left, F-left, and LH. Based on this study, it cannot be concluded that osteometry is a good predictor of edentulous mouth morphology. Other factors may play a role in the results of this research such as the sample size and certain edentulous anomalies, for example, residual ridge resorption (RRR). In the dentate group, significant correlations were found since RRR did not affect these patients. Therefore, for future studies, it is suggested that a larger sample is retrieved that is strictly controlled for edentulous anomalies.
- ItemPelvimetry of Males from the Western Cape with Rectal Cancer: Anatomical and Clinical Implication(Stellenbosch : Stellenbosch University, 2020-12) Lathe, Stephanie; Baatjes, Karin J.; Forgan, T. R.; Alblas, Amanda; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences: Anatomy and Histology.ENGLISH ABSTRACT: Colorectal cancer represents an increasing healthcare burden that affects South African males more commonly than females. Surgical intervention, and specifically total mesorectal excision (TME), remains a key modality in the management of rectal cancer. This procedure occurs in the spatially restricted pelvic canal. Observations of increased difficulty during TME on South African males at the Tygerberg Academic Hospital (TH) led to the impression that they display an especially narrow pelvis. Multiple evolutionary factors, such as childbirth, thermoregulation, and bipedal locomotion, have moulded the size of the modern human pelvis, with males naturally displayinga narrower pelvis than female. Climate is geographically structured and is believed to play a pivotal role in pelvic dimensions. Population groups from lower latitudes tend to exhibit a narroweranddeeperpelves compared to those from higher latitudes.The primary aim of the study was to measure the dimensions of the bony pelvis in males from the Western Cape who have undergone potentially curative colorectal cancer surgery at TH, and to compare these results with other ecogeographical regions. Secondarily, it aimed to determine if an association exists between pelvic dimensions and morbidity documented in rectal cancers patients who have undergone a TME at TH.Pelvic size was investigated by conducting nineteen pelvimetric measurements on 3D bony pelvic reconstructions of male patients (n=158) using computed tomography data. Thereafter measurements were compared with other ecogeographical regions to investigate our relative pelvic size and relationships between latitude and pelvic dimensions using forest plots. Lastly, aone-way ANOVA with a post hoc Bonferroni test was performed to determine if significant differences occur in pelvic measurements among different groups of surgical complications. This population was found to display a relatively narrow transverse pelviccanal when compared to populations from higher latitudes, which was accompanied by an increase in anteroposterior dimensions of the canal. Some measurements were found to follow expected ecogeographical patterns. Significant differences inthe inlet anteroposterior measurement were found among patients in some surgical complication groups. However, no relationship between pelvic dimensions and patient morbidity was found.