Browsing by Author "Satyapal, Kapil Sewsaran."

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Anatomic study of the morphologic relationship between the proximal left and right coronary arteries.
(2016) Singh, Sadhna.; Satyapal, Kapil Sewsaran.; Lazarus, Lelika.; Ajayi, Nasirudeen Oladipupo.
Arising from the aorta, the right (RCA) and left (LCA) coronary arteries provide the arterial supply to the heart. An extensive literature review revealed that most studies have either evaluated the morphology of the RCA or the LCA independently. This study aimed to document the relationship between the morphology of the RCA and LCA using coronary angiograms and fetal dissections. In addition, variations such as split or double RCA and absence of the LCA was documented. A review of 500 coronary angiograms and a fetal dissection of 41 heart specimens was conducted. The RCA and LCA were classified according to their branching patterns and arterial dominance. The embryologic relationship between the RCA and the LCA was also documented including their lengths and diameters. The angiographic review showed that the most prevalent branching pattern of the LCA was bifurcation in 65.8%, while trifurcation and quadrifurcation occurred in 20.4% and 1.6%, respectively. The splitting of the RCA and absence of the LCA occurred in 4.2% and 11.8%, respectively. A significant correlation was found between the split RCA and absent LCA showing that the split RCA was more prevalent in the absence of the LCA. The dissection of the fetal heart specimens (age range 13.13 - 26.95 weeks) found that the RCA arose from the right aortic sinus and provided arterial dominance in all the specimens. The LCA was classified into types according to their branching pattern. The bifurcation, trifurcation and quadrifurcation of the LCA occurred in 68.3%, 29.3% and 2.4% of hearts, respectively. The mean lengths of the RCA and LCA were 0.98 ± 0.54mm and 1.83 ± 0.77mm, respectively. The mean diameters of the RCA and LCA were 0.38 ± 0.12mm and 0.49 ± 0.17mm, respectively. A significant correlation was found between the RCA and LCA length and the fetal age indicating changes in the development of the coronary vasculature with fetal development. A knowledge of the distribution of the RCA and LCA assists in providing information on the area of the myocardium supplied. With the advent of coronary angiography, a comprehensive understanding of coronary arterial anatomy and their variations is necessary.
Anatomical classification of Tessier craniofacial clefts number 3 and number 4 in a South African population.
(2019) Omodan, Abiola Olugbenga.; Madaree, Anil.; Lazarus, Lelika.; Pillay, Pamela.; Satyapal, Kapil Sewsaran.
The craniofacial clefts are rare defects of the face with an incidence of 1.43 to 4.85 per 100,000 live births. In 2016, WHO reported a death rate of 303,000 new-borns before 4 weeks of age due to congenital anomalies of which craniofacial clefts are one. Surviving the defect is associated with long term disabilities which impacts the individual, families, the healthcare system and society. How much we know about these clefts is seriously hampered by the rarity and the variations of these defects, so much so, that its treatment and communication amongst researchers is affected. The understanding of the skeletal defects occurring in the clefts has long been postulated as a key to any successive reconstruction of the face. This study aimed to reveal the extent of our understanding of these clefts, document the anatomical basis for the craniofacial cleft number 3 and number 4 and generating a sub-classification based on this and also document the clinical presentation as well as associated clefts of these craniofacial clefts in our select South African population. The methods used to achieve these included conducting a scoping review of the literature on patients with Tessier cleft number 3 and number 4 using relevant identified studies from 1976 sourced from PubMed, Medline, EBSCOhost, Google Scholar and the Cochrane libraries. The result of the study was reported using the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA). Likewise, CT scans of patients who had been treated for Tessier clefts number 3 and 4 at Inkosi Albert Luthuli Central Hospital in Durban South Africa between 2003 and 2017 were analysed. Measurements of the expected defects in each cleft were taken and compared with the unaffected side as reference points. Emerging patterns of their analysis were then used to generate a sub-classification for these clefts. Lastly the records of 8 patients who had been treated for either Tessier cleft number 3 or number 4 were reviewed and compared with 9 studies sourced from the literature. In addition to the defects recorded, associated clefts and other congenital malformations were also documented, and findings were compared. The scoping review had 33 studies that met the inclusion criteria. The majority were conducted in middle income countries (54.5%) while none were recorded in low income countries. Only 12.1% of the included studies reported on anthropometry. In understanding the skeletal defects, the presence of an alveolar cleft, the emerging patterns of comparison of the measurements of the maxilla and the orbits of the cleft side and the non-cleft side as well as absence of the bone were used to arrive at a sub-classification system using (a), (b). (c), (M+ O+), (M- O-), and (0). Clinical presentation of the patients who had been treated as cases of Tessier cleft number 3 and number 4 were compared to the reviewed literature and the different parameters were documented. In addition, associated clefts were also recorded, and this study found that the association pattern noted for Tessier cleft number 4 did not conform to its traditional counterpart. In conclusion, this study found that the knowledge of Tessier clefts number 3 and number 4 exist albeit not fully documented. Also, the study proposed a sub-classification for Tessier clefts number 3 and number 4 that will allow physicians to anticipate the extent and form of skeletal defect present before even seeing the patient. Lastly, it was concluded that however variable these clefts appear; they have a similar presentation worldwide and also that associated clefts do not conform to the original Tessier classification system.
An anatomical exploration into the variable patterns of the venous vasculature of the human kidney.
(1993) Satyapal, Kapil Sewsaran.; Haffejee, A. A.; Robbs, John Vivian.
In clinical anatomy, the renal venous system is relatively understudied compared to the arterial system. This investigation aims to clarify and update the variable patterns of the renal venous vasculature using cadaveric human (adult and foetal) and Chacma baboon (Papio ursinus) kidneys and to reflect on its clinical application, particularly in surgery and radiology. The study employed gross anatomical dissection and detailed morphometric and statistical analyses on resin cast and plastinated kidneys harvested from 211 adult, 20 foetal and 10 baboon cadavers. Radiological techniques were used to study intrarenal flow, renal veins and collateral pathways and renal vein valves. The gross anatomical description of the renal veins and its relations were confirmed and updated. Additional renal veins were observed much more frequently on the right side (31 %) than previously documented (15.4%). A practical classification system for the renal veins based on the number of primary tributaries, additional renal veins and anomalies is proposed. Detailed morphometric analyses of the various parameters of the renal veins corroborated and augmented previous anatomical studies. Contrary to standard anatomical textbooks, it was noted that the left renal vein is 2.5 times the length of its counterpart and that there are variable levels of entry of the renal veins into the IVC. Justification for the distal segment of the left renal vein to be termed the surgical trunk, and the proximal segment to be the homologue of the right renal vein is presented. Radiological investigations demonstrated a non-segmental and non-lobar intrarenal venous architecture, an absence of renal vein valves and extensive venous collaterals centering on the left renal vein. These collateral channels, present in the foetus, and persisting in the adult, may be operative and of clinical significance in pathological states. No sex differences and no race differences of note were recorded in this study. The Chacma baboon displayed similar intra-renal venous anatomy. The applied clinical anatomy of these findings with particular regard to renal surgery and uro-radiology is emphasised.
An anatomical exploration of the extracranial (V1-V3) and intracranial (V4) components of the vertebral arteries in a select KwaZulu-Natal population.
(2021) Omotoso, Bukola Rukayat.; Lazarus, Lelika.; Satyapal, Kapil Sewsaran.; Harrichandparsad, Rohen.
The risk of injury to the vertebral artery is a significant complication of surgery. The presence of anatomical variation in the course of the vertebral artery increases the likelihood of injury. Due to inadequate understanding of the presence and location of anatomical variations in the morphology and morphometry, the vertebral artery can be injured during surgical intervention. Apart from the vascular injury that can occur during surgical intervention, anatomical variations have implications for some pathologies in the posterior circulation territory. These include aneurysm formation, cerebrovascular disorders, posterior circulatory stroke, and some neurovascular problems. In this retrospective observational study, we investigated the anatomical features of the extracranial (V1-V3) and intracranial (V4) components of the vertebral arteries in a South African population. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and White) who had undergone computed tomography angiography (CTA) at Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa, from January 2009 to September 2019. The vertebral artery exhibited various morphological variations in its course. We report the incidence of variant origin of the left vertebral artery (6.9%). The level of entry into the transverse foramen ranged between C7-C3. We report the incidence of vertebral artery tortuosity at V1, V2: 76.6%, and 32.1%, respectively. We observed fenestration at V3 (0.18%) and V4 (0.4%) segments. We registered the incidence of the persistent first intersegmental artery (1.1%), extradural PICA origin (2.8%), atresia (6.7%), and hypoplastic terminal vertebral artery (13.2%). Average length and diameter at each vertebral artery segment were registered; we also report on hypoplasia of the vertebral artery. Anatomical variations of the vertebral artery are common in the South African population studied in the present study. Imaging of the complete segments of the vertebral artery from the origin to the point of convergence to form the basilar artery may be necessary to decide a treatment strategy for interventions in the vicinity of the vertebral artery. Understanding the patterns of anatomical variations of the vertebral arteries will contribute significantly to the diagnosis of various diseases in the posterior circulatory territory. The average diameter was significantly larger on the left in all the racial groups, but there were no significant gender differences. We registered a left dominance pattern in all the segments (V1-V4). Iqoqa Ingozi yokulimala emithanjeni yomgogodla iyinkinga enzima kakhulu yokuhlinzwa. Ukuba khona kokwehlukahlukana kokwakheka komzimba ekuhambeni komthambo womgogodla kwandisa amathuba okulimala. Ngenxa yokuqonda okunganele kokukhona kanye nendawo yokwehlukahlukana kwesakhikwo somzimba ekwakhekeni nokulinganisa umumo, umthambo womgogodla ungalimala ngesikhathi sokuhlinzwa. Ngaphandle kokulimala kwemithambo yegazi okungenzeka ngesikhathi sokuhlinzwa, ukuhlukahlukana kwemithamdo yomgogodla kunomthelela ngezinye izimbangela ngokuthola umsuka wesifo ngokuhamba kwegazi emigudwini. Lokhu kubandakanya ukwakheka kokuvuvukala komthambo, ukuphazamiseka kokuhamba kwegazi engqondweni, ukushaywa yisifo sohlangothi, nezinye izinkinga ngezinzwa nemithambo. Kulolu cwaningo lokubheka ngokuqhathanisa abanesifo nabangenaso, sibheke ukwakheka komzimba kwamathambo ekhanda ngaphandle (V1-V3) kanye nokwakheka kwawo ngaphakathi (V4) nezingxenye zemithambo yomgogodla emphakathini waseNingizimu Afrikha. Ucwaningo lungukuzibonela ngqo, ukuqhathanisa ngokubuyekeza amashadi eziguli zaseNingizimu Afrikha angama-554 ngokulandelana (abaNsundu, amaNdiya, nabaMhlophe) abafakwe emshinini bahlolwa wonke umzimba ngekhompuyutha ukubona okusemithanjeni (isibonathambomzimba) (CTA) esibhedlela i-Lenmed Ethekwini neSikhungo seNhliziyo, eThekwini, eNingizimu Afrikha, kusukela kuMasingana wowezi-2009 kuya kuMandulo wowezi-2019. Umthambo womgogodla ukhombisa ukwehlukahluka kwesakhiwo ekuthubelezeni kwawo. Sibika isehlakalo semvelaphi esehlukile somthambo womgogodla kwesokunxele (6.9%). Izinga lokungena esikhaleni esiphakathi komthambo womgogodla laliphakathi kwe-C7 ne-C3. Sibika isehlakalo esihambisana nokuguga komthambo womgogodla nomfutho wegazi okulinganiselwa phakathi kuka-V1, V2: 76.6% no-32.1%, ngokulandelana. Sibone ukuhlinzwa kwesakhiwo sendlebe ngaphakathi kwezingxenye ezingu-V3 (0.18%) nezingu-V4 (0.4%). Sabhalisa izehlakalo zomthambo wokuqala ngezingxenye ezilokhu zikhona ngo-1.1%, imvelaphi ye-PICA yamathambo ekhanda (2.8%), isicubu esingenayo embotsheni ngokwemvelo (6.7%), nokungakhuli kwesitho ngokuphelele (13.2%). Isilinganiso sobude nobubanzi engxenyeni ngayinye yomthambo womgogodla yabhaliswa; siphinde sibike ngokungasebenzi ngokwejwayelekile komthambo womgogoda. Ukwehlukahlukana kokwakheka komthambo womgogodla kuvamile kubantu baseNingizimu Afrikha ocwaningweni lwamanje. Ukufanekisa kwezingxenye eziphelele zomthambo womgogodla lapho zihlangana khona ukwenza umthambo ophakathi nendawo ekhanda kungadingakala ukunquma ngamasu okwelapha ngokungenelela endaweni eseduze nomthambo womgogodla. Ukuqonda ukuphiceka kwesakhiwo esahlukahlukene semithambo yomgogodla kuzodlala indima ebalulekile ekuhlonzeni izifo ezahlukahlukene ekuhlinzekweni kokuhamba kwegazi. Isilinganiso sobubanzi besisikhulu kakhulu kwesokunxele kuwo wonke amaqembu ezinhlanga, kodwa kwakungekho mehluko obalulekile phakathi kobulili. Sibhalise indlelakwenza ebihamba phambili kuzo zonke izingxenye ebe ngu-V1-V4.
An anatomical investigation of the sympathetic and parasympathetic contributions to the cardiac plexus.
(2011) De Gama, Brenda Zola.; Satyapal, Kapil Sewsaran.; Partab, Pravesh.; Lazarus, Lelika.
The cardiac plexus is “formed by mixed autonomic nerves” that are “described in terms of superficial and deep components, with the superficial located below the aortic arch and anterior to the right pulmonary artery, and the deep located anterior to the tracheal bifurcation (above the division of the pulmonary trunk) and posterior to the aortic arch” (Standring et al., 2008). This investigation aims to review and update the medial cardiac contributions of the cervical and thoracic sympathetic chains to the cardiac plexus and also the contributions from the vagus nerve and its counterpart, the recurrent laryngeal nerve. This study involved the macro and micro-dissection of 100 cadaveric sides of adult and fetal material. The number of ganglia in a cervical sympathetic chain varied from 2 to 5 in this study. This study confirms previous reports on the location of the two components of the cardiac plexus. The origin of the sympathetic contributions to the cardiac plexus in this study were either ganglionic, interganglionic or from both the ganglion and interganglionic chain of the respective ganglia. The superior cervical cardiac nerve had an incidence of 92% while the middle cervical cardiac nerve had an incidence of 65% in the specimens studied. This study also records a vertebral cardiac nerve that arose from the vertebral ganglion in 39% of the cases. The inferior cervical and cervicothoracic cardiac nerves had incidences of 21%, respectively. This investigation records the thoracic caudal limit of the sympathetic contributions to the cardiac plexus as the T₅ ganglion. The findings in this study indicate the importance of understanding the medial sympathetic contributions and their variations to the cardiac plexus as this may assist surgeons during minimal surgical procedures, sympathectomies, pericardiectomies and in the management of diseases like Reynaud’s Phenomenon and angina pectoris (Kalsey et al., 2000; Zhang et al., 2009).
The anatomical study of the osteochondral, vascular and muscular relations of the superficial and deep cervical plexuses.
(2010) Pillay, Pathmavathie.; Satyapal, Kapil Sewsaran.; Partab, Pravesh.
In standard anatomical textbooks, the formation of the cervical plexus is well defined; however the accurate differentiation into superficial and deep plexuses, their emerging patterns, and gross anatomical relations are not documented as expansively. In order to obtain detailed anatomical knowledge of the superficial and deep cervical plexuses, the investigation aimed to clarify the anatomy and variations of these plexuses, define possible anatomical landmarks, and record the relationship of the external jugular vein and muscles of the posterior triangle of neck to the branches of the superficial cervical plexus, and the relationship of the common carotid artery, internal jugular vein, sympathetic chain, cervical verterbrae, and vertebral artery to the deep cervical plexus. The studies utilized the gross anatomical dissection, morphological and statistical analyses of forty fetal and fifteen adult cadaveric, formalinized specimens. The branches of the superficial cervical plexus emerged from the posterior border of the sternocleidomastoid muscle at the great auricular point (situated in the middle third of the muscle) and was described as ascending (lesser occipital, great auricular, transverse cervical nerves) and descending (supraclavicular nerves). Further, these branches were recorded according to their branching patterns, relations to the external jugular vein and variations. The branching patterns are described as single, duplicate and triplicate. The external jugular vein was constantly located inferior to the great auricular nerve, superior to the transverse cervical nerve and intertwined with the branches of the supraclavicular nerves. Variations of the branches of the superficial cervical plexus were observed only in fetuses and classified according to their course, branching patterns and communications. The emerging point of the branches of the superficial cervical plexus on the sternocleidomastoid muscle, were determined according to the seven types of “emerging pattern” classification by Kim et al., (2002). In order to record the deep cervical plexus, the sternocleidomastoid muscle was reflected with the following observation: the ventral rami of the second and third cervical nerves emerged between the scalenus anterior and scalenus medius muscles, and the third and fourth cervical nerves was located at the lateral edge of scalenus medius muscle. The deep cervical plexus was described as communicating, muscular, ansa cervicalis, and phrenic nerves. The superior cervical ganglion constantly communicated with the ventral rami of the cervical nerves; and the hypoglossal communicated with the superior root of the ansa cervicalis. The muscular branches were observed to the scalenus anterior and scalenus medius muscles with an anomalous branch to the sternocleidomastoid muscle. The ansa cervicalis demonstrated a degree of variation with regard to its origin, course and formation of the loops. The phrenic nerve arose from the ventral rami of the third, fourth and fifth cervical nerves and descended on the lateral border of the scalenus anterior muscle. The precise understanding of the anatomy of the superficial and deep cervical plexuses together with variations may assist anesthetists and surgeons to accurately identify the vascular, neural and muscular structures and reduce the risks of complications when performing neural blocks in regional anesthesia, facial rejuvenation surgery and parotidectomies.
An anthropometric evaluation of the glenohumeral joint in a South African population.
(2018) Khan, Raeesa.; Satyapal, Kapil Sewsaran.; Lazarus, Lelika.; Naidoo, N.
The glenohumeral joint (GHJ), the most mobile yet unstable joint in the body, is comprised of a large humeral head which fits into the relatively smaller socket formed by the glenoid fossa. While this articulation allows for a wide range of motion, it predisposes the shoulder to injury. There is a paucity of literature on the biomechanics of the GHJ in the South African population. The aim of the study was to evaluate the anthropometric parameters of the GHJ, with emphasis on the coracoid process, glenoid fossa, bicipital groove (BG), long head of the biceps brachii tendon (LHBBT) and the transverse humeral ligament (THL). This study comprised of two subsets (n = 404), viz. (i) anthropometric evaluation of the scapula and proximal humerus [n=324: Scapula – Right (R): 80, Left (L): 84; Male (M): 68, Female (F): 96; Humerii – (R): 80, (L): 80; (M): 68, (F): 96] and (ii) cadaveric dissection of the LHBBT and THL [n=80: (R): 40, (L): 40; (M): 44, (F): 36], both of which focused on morphological and morphometric parameters. Results (i) (a) Shape of glenoid fossa = Type 1 (inverted comma): (R): 16.47%, (L): 10.98%; (M): 20.12%, (F): 7.32%; Type 2 (pear): (R): 14.02%, (L): 15.24%; (M): 18.29%, (F): 10.98%; Type 3 (oval) : (R): 18.29%, (L): 25.00%; (M): 27.44%, (F): 15.85%. (b) Notch type of glenoid fossa: Type 1 (without a notch): (R): 1.83%, (L): 7.32%; (M): 6.71%, (F): 2.44%; Type 2 (with one notch): (R): 46.95%, (L): 43.90%; (M): 59.15%, (F): 31.70%. (c) Mean parameters of coracoid process (mm): Length (CL): (R): 41.74±4.74, (L): 41.50±4.87; (M): 42.07±4.73, (F): 40.74±4.84; Width (CW): (R): 13.27±1.89, (L): 14.18±11.90; (M): 13.05±1.90, (F): 15.07±14.49. (d) Mean parameters of glenoid fossa (mm): Horizontal diameter 1 (HD1): (R): 18.40±3.27, (L): 17.51±2.87; (M): 18.23±3.29, (F): 17.38±2.60; Horizontal diameter 2 (HD2): (R): 24.45±2.88, (L): 23.64±2.63; (M): 24.22±2.74, (F): 23.68±2.83; Vertical diameter (VD): (R): 35.23±3.10, (L): 34.88±3.03; (M): 35.26±3.18, (F): 34.64±2.79. (e) Mean coracoglenoid distance (CGD) (mm): (R): 27.40±8.34, (L): 28.15±3.53; (M): 28.19±7.41, (F): 27.00±3.38 .(f) Mean dimensions of BG (mm): Length: (R): 66.64±9.06, (L): 68.31±11.52; (M): 67.44±9.12, (F): 67.53±12.25; Width: (R): 8.98±1.49, (L): 9.27±1.30; (M): 9.18±1.45, (F): 9.05±1.31; Depth: (R): 7.73±1.31, (L): 7.20±1.18; (M): 7.43±1.29, (F): 7.53±1.24. (ii) (a) Mean parameters of the LHBBT (mm): Length: (R): 81.99±21.28, (L): 79.73±17.27; (M): 79.82±19.66, (F): 82.14±19.03; Width: (R): 4.28±1.31, (L): 4.67±1.43; (M): 4.35±1.17, (F): 4.63±1.60. (b) Mean parameters of the THL (mm): Length: (R): 20.91±5.24, (L): 21.19±6.36; (M): 21.52±5.71, (F): 20.48±5.92; Width: (R): 16.65±6.92, (L): 16.63±7.49; (M): 16.83±6.65, (F): 16.40±7.84. In this study, Type 3 (oval) was observed to be most prevalent shape of the glenoid fossa, which corroborated the findings of previous studies. Type 2 (with one notch) was found to be the predominant notch type, differing from the literature reviewed. The mean VD, HD1, HD2, CL and CGD were larger in male individuals, while female individuals presented with larger means of CW. Both BG length and depth were increased on the right side; with the latter yielding a statistically significant difference thus suggesting that an increased depth is a common finding in the right side of individuals. Although the BG length and depth were noted to be greater in female individuals, male individuals presented with larger widths. The mean length and width of the THL were markedly smaller than those reported in previous studies. Any variation from the normal musculoskeletal composition of the GHJ is fundamental to understand rotator cuff disease, tendinitis and shoulder dislocation. This study may provide clinicians and biomechanical engineers with reliable anthropometric reference parameters of the GHJ for the design of prosthesis and may also act as diagnostic tools of degenerative pathology.
Aortic valve replacement : anatomical considerations in a narrow aortic root.
(2015) Mushiwokufa, Willard.; Satyapal, Kapil Sewsaran.
Coronary artery ostial stenosis is a life threatening complication of aortic valve replacement (AVR) surgery. It occurs in 3-5% of all AVR operations. Most cases occur 1 to 6 months following AVR. However, some cases have been recorded during and immediately after operation and these have been attributed to embolization of calcium debris, coronary artery spasm, occlusion by the prosthetic valve and distortion of the anatomy of the aortic root. AVR is a standard procedure routinely performed to alleviate the symptoms of aortic valve stenosis and regurgitation. The standard procedure involves removing the diseased, poorly functioning valve cusps and implanting a mechanical or biological prosthesis whose size allows it to perform almost like a normal aortic valve. The size of the prosthesis may be determined through pre-operative echocardiographic assessment of the aortic root correlated to the body surface area of the patient. Intra-operative “sizing” of the aortic annulus is also performed using graduated obturators. The required size may not fit well in patients who have narrow aortic roots forcing the implantation of a smaller size prosthesis, a situation that is termed patient-prosthesis mismatch. To prevent patient-prosthesis mismatch surgeons have developed techniques to enlarge the aortic annulus and place larger prostheses. However, the operating surgeon may elect not to surgically enlarge the aortic annulus but forcibly implant or “shoe-horn” a larger prosthesis. The aim of this study was to investigate and document anatomical changes on the aortic root when a large size valve is implanted in a simulated AVR operation where the aortic root is considered to be narrow. The study also aimed to report the size of the aortic root and the influence of sex, race, body height and age. Additionally, the study demonstrates the difference between the pliability of the aortic annulus and sino-tubular junction. The study was conducted at Gale Street State Mortuary in Durban, KwaZulu-Natal, South Africa. A total number of 60 unfixed cadaveric heart specimens were selected for the investigations. For investigation of morphometry of the aortic root, 30 heart samples were selected for this study. The other 30 specimens were selected for the experimental study to investigate the effect of placing a large size valve. Ethics approval for the study was obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee (Ethics number 307/15). Of the 30 normal hearts, the mean aortic annulus diameter was 20.2mm and the mean sinotubular junction diameter was 21.8mm. There was a significant correlation between aortic root diameters and age but no association with sex, race or body height. The mean diameter of the left coronary ostium (LCO) was 6.1mm. The most common shapes of the LCO were circular (96.7%) and ellipsoidal (3.3%). The mean distance of LCO from the aortic annulus was 12.6mm. The LCO was located below, on and above the sino-tubular junction in 73.3%, 23.3% and 3.3%, respectively. The study showed clearly that when an oversized prosthesis is implanted into a normal aortic root, the LCO is distorted and displaced caudally towards the aortic annulus. A transverse ridge of aortic tissue, in the form of a tight bar was created above the LCO extending from the adjacent commissures. The sino-tubular junction was more pliable than the aortic annulus by a factor of 1.5.
A clinically applied anatomical study of the coronary arteries in the South African population.
(2003) Lachman, Nirusha.; Satyapal, Kapil Sewsaran.; Acland, Robert D.
Interest in the anatomy of the coronary arteries dates as far back as the early 1500's, at a time when anatomical inquiry was being cautiously aroused. Whilst the later 1700's encouraged academic domination of anatomical study, significant documentation of the coronary arteries was only been established by the late 1800's to early 1900's. There is no doubt that this topic continues to remain dynamic, favoured for its value in applied clinical research. Indeed, technological advancement in the 21 st century has transformed modem day anatomy into more than just a simple descriptive exercise. Whether to update standard literature, create ethnically specific banks of anatomical data, abate technical difficulties associated with coronary artery surgery or provide exciting interventional possibilities for clinicians, revisiting the anatomy of the coronary arteries is clearly warranted. The objective of this investigation was to review the anatomy of the coronary arteries using a clinical approach in order to investigate the morphologic presentation of these vessels within the South African population. On a more clinically universal level, this study aimed to elucidate two focal areas of anatomical interest: extra-cardiac collaterals and myocardial bridges. The investigation was conducted by means of micro-dissection, angiography, histology and scientific evaluation. A total of 323 sets of coronary arterial patterns consisting of patient angiograms (n=212) and cadaveric dissections (n=95) were studied. Specimens were harvested at post-mortem and angiograms and surgical reports were obtained from clinical centers within KwaZulu-Natal. Results of this study confIrmed the standard anatomical description of the coronary arteries as documented. Within the South African population, the ramus marginalis artery was found to be present in 13.3% (Females: 10.7%; Males: 5.6% and Blacks: 18.0%; Indians: 6.6%; Whites: 1.4%). The LAD and LCX arteries arose from independent aortic ostia in 14.5%, (Females: 7.5%; Males: 15% and Blacks: 6.5%; Indians 50%; Whites: 35%). Right dominance was observed most frequently in 85.9% (Blacks: 82.3%; Whites: 83.6% and Indians: 86.4% and Males: 82.6%; Females: 89.2%). A bifId LAD artery was noted in 52%, (Females: 6.2%; Males: 8.7% and Blacks: 17.6%; Indians: 6.3 %; Whites: 4.5 %). In 27.7%, (Females: 24.0%; Males: 28.8% and Blacks: 29.5%; Indians: ·50%; Whites: 20%) the LCX artery failed to continue along the atrioventricular groove. The conus artery arose from a high position off the RCA in 19.2%, (Females: 16%; Males: 21% and Blacks: 19.7%; Indians: 100%; Whites: 10%); and from an independent ostium in 3.61%, (Females: 4.0%; Males: 3.8% and Blacks: 4.9% only). The LCA measured 0.82cm (0.27-2.4cm), (Females: 0.84cm, Males: 0.96cm and Blacks: 0.88cm; Indians: 0.53 cm; Whites: 0.78cm). Myocardial bridges were recorded on the RCA in 2.5% and on the LAD in 50.6%. The bridge pattern depicted myocardial loops to complete arterial investment and ranged in length from 3.0 to 20.02 mm. Scientiftc evaluation of the intramural LAD indicated positive correlation between a straight appearance ofthe LAD on angiogram and a deep myocardial position upon surgical observation (mean "tortuosity index" = 1.147 [1.373-1.045] where 1= baseline for straightness). Results were confIrmed in the correlated cadaveric investigation. Extra-coronary collaterals were observed in 100% (n=9). The arterial pattern consisted of 1 to 2 main stems with secondary anastomotic branches. The average external diameter was measured to be 0.6mm (OA-0.7mm), length 52.5mm (1883mm) with at least 5 secondary branches (3-9) of external diameter O.3mm (0.20.5mm). Results of the histopathological investigation (n=20) indicated the presence of atherosclerotic disease within the intramural LAD artery segment (15%). A 60% incidence was recorded in the pre-mural segment and 25% incidence in the post-mural arterial segments. When analysed in terms of severity, the intramural segment reflected only mild signs of intimal alteration. Although not statistically significant, mean values for coronary artery size differed between sexes. The findings were similar when evaluated in terms of the coronary artery anomalies studied. There were signifIcant differences between ethnic groups in terms of the length of the LCA. Mean values showed that Indians had the shortest LCA's when compared with Blacks and Whites. The highest incidence of the ramus marginalis branch was recorded amongst Blacks. Separate origin of the LCX and LAD was highest amongst Indians and high in comparison to reports documented in other countries. A high origin ofthe conus artery was found to be dominant amongst Blacks. A low incidence of separate origin of the conus from the aorta was recorded in the South African population. These findings are significantly lower than that reported in the literature. A right dominant system has the highest occurrence within this population. Statistical evaluation confirmed that neither sex, ethnicity, age nor height influenced dominance in a coronary arterial pattern. The presence and description of the bifid LAD has been recorded. Its occurrence is highest amongst Blacks. The anomalous path of the LCX has been documented and described. The significantly high occurrence of this disposition of the LCX within the South African population appears to be the highest reported fmd in the literature. In terms of the presence and patterns of myocardial bridges, there are no observable differences between ethnic groups or sex. Results ofthis study confirm a relationship between the straight appearance of the LAD on angiogram and its anatomical presence. Extra coronary collaterals have been successfully investigated and observed. Measurements of vessel dimensions and patterns have been recorded. Results of the histopathological investigation illustrate that the intra-mural LAD artery is relatively protected from vascular disease. It does not however support the theory that in such a sub-myocardial position, the LAD artery is never prone to the damaging effects of atherosclerosis. The "cardio-protective" effect of a muscular bridge, whilst prevalent, is dependant on the thickness and extent ofthe bridge itself The anatomy ofthe coronary arteries has been successfully documented and a bank of data, specific for a South African population has been presented. Significant aspects of coronary arterial patterns have been discussed and interpreted in terms of its clinical relevance. This study presents an original method for the investigation of EeC's using technologically advanced materials and equipment. In addition, a scientific method for confirmation of a "straight" appearance of the LAD artery has been developed in this study. Findings contribute to the bank of diagnostic indicators that may be used to predict myocardial bridges pre-operatively. Through the dissection experience of more than 150 hearts and observation of more than 200 angiograms, this study has been able to contribute to the anatomical description o fthe coronary arteries. In some ways new perspectives were afforded and on the same note, already existing concepts have been verified. The value of this study IS enhanced by the potential clinical impact that such data is envisaged to create.
An investigation of the medial branches of the cervical and thoracic sympathetic chain.
(2001) Pather, Nalini.; Satyapal, Kapil Sewsaran.; Partab, Pravesh.
The number of peripheral segmental branches of the cervical and thoracic sympathetic chains are more variable and larger than assumed by textbooks and literature (Groen et al., 1987). This investigation aims to clarify and update the variable patterns of the cervical sympathetic chain, the incidence of fused thoracic ganglia and the contributions of the cervical and thoracic sympathetic chain to the cardiac plexus. The study involved the macro and micro-dissection of 89 cadaveric sides (foetal, 60 and adult, 29). The gross anatomy of the cervical sympathetic chain and variations is documented. This study confirms previous reports that the number of ganglia in the cervical region ranged from 2 (absent MCG) to four (double MCG) ganglia. A double MCG was found in 25.9%. This study reports the higher incidence of the normal/typical MCG (as per textbook definition) i.e. Type II MCG (46.6%) than the Type I MCG (27.6%) and Type III (32.8%). The number of thoracic ganglia in this study is 8-11. Fusion of ganglia was found to be more common in the lower thoracic chain than in the upper thoracic chain. This study reports the origin of cardiac rami from the thoracic sympathetic chain up to the interganglionic segment between T5 and T6 ganglia. The incidence if TCR5 was 60.4%. In 15/58 sides (25.9 %) TCR5 arose from the interganglionic segment of the chain, either above or below the ganglion. An accurate knowledge of the anatomy of the sympathetic nervous system and the adjacent structures is, inescapably a definite asset to the procedures used in interrupting the neural mechanism (Jamieson et al.) 1952). Successful sympathetic denervation of the heart, a field often beset with failure, is dependant on adequate morphological knowledge. It is hoped that this study using human foetuses as well as adult cadaveric specimens will draw the attention to important variations that are relevant to the surgeon. The intricate anatomical relations presented in this study attest the complex anatomy of the sympathetic nervous system.
The morphology and morphometry of the digastric muscle in a predomantly fetal South African population.
(2019) Guambe, Khayelihle.; Satyapal, Kapil Sewsaran.; De Gama, Brenda Zola.; Pillay, Pamela.
Introduction: The digastric muscle is a suprahyoid muscle made up of two muscle bellies namely, the anterior and posterior bellies. These bellies originate from the digastric fossa of the mandible and the mastoid notch of the temporal bone respectively and insert via a common intermediate tendon (IT) onto the hyoid bone. This study aimed to investigate and document the morphology and morphometry of the digastric muscle in cadaveric specimens in the South African population. Materials and methods: Macro-and micro-dissection was conducted on 40 fetuses (26 males, 14 females) between a gestational age range of 22-31 weeks old and 10 adults (8 males, 2 females) between the age range of 33-84 years old. Results: In fetuses, the anterior belly inserted via a narrow and broad belly onto the body, lesser – and greater horns of the hyoid bone. The posterior belly originated from the mastoid notch of the temporal bone as well as the lateral surface and tip of the mastoid process. Trifurcation of the posterior belly was reported in 2.5% of the cases. The IT location varied as it travelled on the superior and inferior border of the stylohyoid muscle in 5% and 2.5% of the specimens, respectively. In adults, the anterior accessory bellies were documented as they occurred unilaterally (20%) and bilaterally (30%). Conclusion: The fetal morphology reflected anatomical variations in the digastric muscle that have not been previously documented compared that of the adults. Comprehensive understanding of these anatomical variations may be of surgical relevance during corrective surgery and radiological imaging of the head and neck.
The praxis and research of human anatomy through autoethnography.
(2016) Lazarus, Lelika.; Satyapal, Kapil Sewsaran.; Sookrajh, Reshma.
This thesis is in manuscript format, as per the guidelines of the College of Health Sciences of the University of KwaZulu Natal. It comprises five manuscripts that have been submitted to accredited journals for publication (one manuscript is currently in press and the others are awaiting final status after revisions were completed). The use of autoethnography as an approach is an emerging transformative field of study within the Health Sciences at Higher Education institutions and is a move away from the key traditional positivist models of research in the domain of anatomical education. This study with praxis and research at the nucleus, aimed to investigate the following: (i) challenges experienced in the teaching and learning of human anatomy; (ii) the views and perceptions of fellow colleagues regarding research in the domain of clinically applied anatomy and how this has impacted on their teaching practices; (iii) the opinions of senior anatomy instructors regarding the state of anatomical knowledge at their respective institutions; (iv) student attitudes and experiences regarding human cadaveric dissection through an analysis of their journal-reflective writings; and (v) the use of mobile devices by learners at a selected medical school. Each of these aims stated above were achieved through the articles which comprised the manuscript of this study. In the first manuscript, Bits, bytes and bones: An Autoethnographic Account of Challenges in Anatomy Education: Perceptions Emanating from a Selected South African University I describe the methodological approach of autoethnography, specifically as it applies to reflection and memory work, and describe how this style enabled me to interrogate the current challenges and dilemmas underpinning the research, teaching and learning practices within this discipline. This was done through the use of an exclusive autoethnographic approach which is a qualitative method of research that seeks to describe and examine personal experience to comprehend cultural practice. The autoethnographic study highlighted challenges experienced, and these included the shortage of cadaveric material for teaching and research, the subsequent implementation of medical software applications, deficiencies in the curriculum and the teaching of anatomy by scientist anatomists. The second manuscript was entitled Communities of Practice: a new methodology in anatomical research and teaching. In this the notion of collaborative autoethnography as a research method is introduced. In this approach, researchers worked in tandem with me to gather autobiographical material to analyse and understand their data collectively with each contributing to an understanding of the sociocultural phenomena. This type of research allowed for in-depth learning about the self and others and fostered collaboration among researchers in this field of applied anatomy. The use of semi-structured interviews with coauthors (n=10) on co-written papers formed the essential method used in generating this article. The collaborative autoethnographic study revealed four important themes namely: the value of research collaboration; the impact of human anatomical variations; the association with medical and non-medical collaborators; and teaching practice emanating from collaborative research. In manuscript 3, Views of South African Academic Instructors regarding the Scholarship of Teaching and Learning in Anatomy Education, a reflective design is presented and it is understood that reflecting on teaching is commonly referred to as an essential practice for personal and professional development. Open-ended questionnaires were distributed to senior anatomy faculty based at the eight national medical schools in South Africa. The emerging argument in this paper is that educational research into the scholarship of teaching and learning anatomy includes engaging in discipline-specific literature on teaching, reflecting on individual pedagogical methods and communicating these findings to peers. In medical education, reflection has been considered to be a core skill in professional ability. Faculty teaching anatomy highlighted several challenges such as time constraints within the medical curriculum, the lack of cadavers to reinforce knowledge and lack of appropriately qualified staff in the delivery of the subject. The anatomy laboratory is an ideal setting for faculty/student interaction and provides important occasions to investigate active learning and reflection on anatomical knowledge. This forms the basis of the Manuscript 4, Reflective Journals: Unmasking student perceptions of anatomical education, in which seventy-five journals from medical and allied Health Science students were collected and analysed. Through the use of journal-reflective writing as a technique, student attitudes and experiences of human cadaveric dissection of anatomy were analysed. Student reflective journals highlighted the following themes which included (a) Dissecting room stressors, (b) Educational value of dissection , (c) Appreciation, Gratitude, Respect & Curiosity for the cadaver , (d) Positive and negative sentiments expressed in the dissecting room , (e) Benefit of alternate teaching modalities, (f) Spirituality/Religious Beliefs, (g) Shared humanity and emotional bonds, (h) Acknowledgement of human anatomical variations, (i) Beauty and complexity of the human body, and (j) Psychological detachment . For the final manuscript which forms this compilation, Anytime, Anywhere’: Tablet technology in Medical education, a questionnaire comprising both open and closed- ended questions was analysed from 179 (60 male; 119 female) second year medical students registered for the Anatomy course to establish the use of mobile devices by learners at a selected medical school. The themes that emerged from m-learning included students’ ideas on mobile device engagement, and propositions related to the advantages and challenges affecting use of mobile devices. The use of autoethnography as a research approach can be considered dissident, and an ‘anatomical turn’ in the praxis and research in the domain of anatomical education. This study highlights relevant contributions to the research, praxis (teaching and learning) of human anatomy through views of all significant role players – students, researchers and educators. The conceptual framework which was abstracted from the articles and the thesis in its entirety, offers significant understandings regarding the praxis and research of human anatomy within the context of educational theory.
Prevalence of impacted third molar teeth in the greater Durban Metropolitan population.
(2014) Ishwarkumar, Sundika.; Haffajee, Mohamed Rashid.; Pillay, Pamela.; Satyapal, Kapil Sewsaran.
Tooth impaction is a pathological condition in which a tooth is completely or partially unerupted and positioned against another tooth, bone or soft tissue, thus preventing further eruption. Many theories have been proposed to explain the prevalence of impacted third molars. These theories discuss relationship of jaw size to tooth size which is suggested to result from difference in genetics and dietary habits, as the latter differs from one region to another. The aim of this study is to investigate the prevalence of an impacted third molar tooth on a mixed population in the Greater Durban Metropolitan area. The third molar was classified using Winter’s and Pell and Gregory’s classification schemes. Various morphometric parameters of the mandible were measured and assessed in 320 digital panoramic radiographs (n=640). Each parameter recorded was statistically analyzed, using SPSS, to determine if a relationship existed between the aforementioned parameters and sex and age of each individual. 77.9% of cases presented with at least one impacted third molar, with the most prevalent type of impaction being mesio-angulation in the mandible and vertical angulation in the maxilla. In respect to the level of impaction, class IIB and class A was most frequent in the mandible and maxilla, respectively. For correlation with sex, only the length of the mandibular ramus was statistically significant (p-value=0.000). No statistically significant relationship was found between each morphometric parameter and age. However, these results correlated with previous studies indicating that impacted third molars are most prevalent in individuals between 20-25 years. In addition, all morphometric parameters in this study differed from that recorded in previous studies conducted in the Northern Hemisphere. The findings of this study may assist maxillofacial surgeons, dentists, anatomists, anthropologist and forensic investigators.