Lumbosacral transitional vertebrae (LSTV) are defined as congenital anatomical variations, observed unilaterally or bilaterally, in which the transverse process of the last lumbar vertebra exhibits signs of dysplasia evident as increased craniocaudal height, with varying degrees of articulation or fusion to the ‘first' sacral vertebra. Such variations give rise to vertebral morphology that may display lumbar or sacral characteristics at the terminal lumbar spine, together with subsequent enumeration variation. The purpose of this study was to establish baseline data on the prevalence rates of LSTV and to describe the morphological characteristics (Type, subtype, frequency of side and spinal enumeration) of LSTV in the South African population. This study was subdivided into two main sections, namely Part 1: medical imaging appraisal and Part 2: osteological morphology appraisal. In Part 1, both retrospective and prospective cohort randomised sampling methods of data collection of medical images were used. The appraisal of the medical images included radiographs, magnetic resonance imagers and computerised tomography scans. Prevalence rates, utilising the Castellvi et al. (1984) classification, were established via radiographs only. Additionally, lumbar spine enumeration, namely lumbarisation and sacralisation, was made through the appraisal of lumbar radiographs. Images were obtained from medical radiology practices located at Groote Schuur Hospital in Cape Town, Western Cape Province and Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, Gauteng Province. The total imaging cohort included 3096 individuals of which 308 individuals (10%) were found to contain LSTV. Prevalence rates were further evaluated by subdivision of the three largest ancestries in South Africa. Ancestries were classified as African (n=1032), Mixed (n=1032) and European (n=1032). The prevalence of LSTV in the three ancestral groups was 10.5%, 9.3% and 9.9% respectively and the sex distribution was greater in females (52.1%) then in males (47.9%). The morphological assessment found the prevalence of LSTV by Type was Type II (67.9%) followed by Types III (27.6%) and IV (4.5%). The most frequent subtype by prevalence was Type IIA (41.9%) followed by Type IIB (26%), Type IIIB (21.8%), and Type IV (5.8%). Additionally, the frequency of side was bilateral (47.7%), left (26.6%), right (21.1%), and other (4.5%). Comparison of ancestry and spinal enumeration analyses established statistical significance for individuals of African-ancestry (67.0%) and Mixed-ancestry (72.9%) both of which demonstrated a greater affinity of prevalence for sacralisation (p=0.008), with a small effect size (V=0.178) over the European-ancestry subgroup (52.4%). Furthermore, a statistical significance with a medium effect size (V=0.256) was found in males (p=0.010) when comparing ancestry and spinal enumeration between sexes. In Part 2, a systematic search of the total cadaveric skeletal collection housed at the University of Witwatersrand (the Dart Collection of skeletons) yielded 1797 human skeletal specimens of between 21 and 65 years of age at time of death. One-hundred and fourteen skeletal remains were identified as containing LSTV. Damage and loss of vertebral elements resulted in a subset of 91 LSTV for study. A sex balanced control group cohort of 30 males and 30 females was selected at random from the Dart Collection for comparative analyses. A number of osteometric measurements were evaluated comparing the LSTV and control group cohorts. Numerous osteometric comparisons were statistically significant highlighting the many changes in lumbar and sacral morphology associated with LSTV. There are several original findings to emerge. Thisis the first study to establish the prevalence of LSTV in a large sample from the South African population, subdivided into the three largest ancestral groups. Novel findings associated with LSTV include iliolumbar articulation, bipartition of the sacral foramen, intra-articular vacuum phenomenon of accessory articulations of LSTV, enlargement of the contralateral TVP associated with Types III and IV LSTV, lumbar ossified bridging syndrome and a novel complex named by the researcher as the transverso-sacro-iliac articulation. Furthermore, the researcher has proposed three modifications to the Castellvi et al. (1984) classification, namely (1) that there should be a sub-classification of the Type IV LSTV into right and left nomenclature, (2) the inclusion of a new subtype of Type II LSTV morphology, a unilateral right or left iliolumbar articulation associated with contralateral Type IIA morphology, and (3) a modified morphological classification of LSTV based on the presence of an extended sacroiliac articulation either directly or via the transverso-sacro-iliac articulation. The latter effectively increases the size of the sacroiliac joint and is thought to increase spinopelvic stability. The transverso-sacroiliac articulation was demonstrated for all clinically significant LSTV Types (II-IV), both unilateral (right or left) and bilateral. Finally, this is the first study to incorporate an in situ and an ex situ study in the same population by examining spinal morphology of LSTV using medical images and skeletal remains for descriptive analyses.

The purpose of this study was to explore the perceived value of supplementing the traditional cadaver dissection course at the University of Cape Town's Faculty of Health Sciences (UCT FHS) with alternatives in order to aid students in their learning of anatomy. The study aimed to collect information which could be used to provide insight into facilitating a deeper educational experience for students and teachers alike in the future with the aim of better retention of knowledge over time. The intention of the study was to obtain results which could potentially provide insight into the feasibility of adopting a contemporary view on anatomy education at UCT FHS and thus inform the anatomy course in the future by acquiring feedback directly from the students and staff of the university. Data was collected by way of a 22 question survey delivered to second to sixth year MBChB students as well as the staff and postgraduate students at UCT FHS. The survey was entirely voluntary. A total of 190 complete responses were collected. The results of the study indicate that both staff and students feel that the cadaver dissection course is an irreplaceable part of the curriculum, and if the faculty chose to use any technological alternatives to teach anatomy, that they should supplement and not replace traditional dissection. Furthermore, the study showed that the staff and students are comfortable with technology in general, and are open to the use of various technologies such as online material, virtual software, media sites, applications and the like in order to bolster their learning. These results may provide insight into the viability of adopting a contemporary view on anatomy education at UCT FHS and may thus inform changes to the anatomy curriculum in the future.

Includes bibliographical references / The anatomical structure of circulus arteriosus cerebri was first described by Thomas Willis in 1664. Many variations in the circulus arteriosus cerebri have since been reported. The extent to which anatomical variations within the circle influence aneurysm formation in a South African sample has not yet been established. The results of such a study would be of value to clinicians treating patients with vascular diseases. The aim of the study was to determine if there is a correlation between arterial variations in the circulus arteriosus cerebri and cerebral aneurysm formation. The brains of 39 cadavers at the Faculty of Health Sciences were removed and the circulus arteriosus dissected. In addition, 113 patients who underwent a MRI or MRA of the circulus arteriosus cerebri at the Department of Radiology at the Groote Schuur Hospital, Cape Town were included. For both of these samples the anatomical variations and any aneurysms present were documented. The external diameters of the arteries forming the circulus arteriosus cerebri were also measured. No aneurysms were found in the cadaver sample, thus the correlation could not be tested. In the sample of images from the 113 patients, 111 images showed one or more anatomical variation of the circulus arteriosus cerebri. Of these, 59 had one or more cerebral aneurysm and 52 had no aneurysms. Statistical analysis showed no significant correlation between cerebral aneurysms and anatomical variations in the circulus arteriosus cerebri for a South Africans ample. This is contradictory to what is seen in the literature. Further investigation is required to establish the reason why the results from this South African sample differ from the results reported in the international literature.

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. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Westville, 2010.

The safe and successful performance of office procedures, surgical procedures, and emergency procedures as well as radiological imaging procedures demand a working and yet specific knowledge of anatomy. This study focuses on the competency to perform clinical procedures, especially the underlying anatomical knowledge base necessary to perform a safe and successful procedure. No study reports on the assessment of clinical anatomy as part of the competency of family physicians to perform clinical procedures. The aim of this study was to determine a) which clinical procedures are performed in hospital practices in South Africa; b) the frequency of performance; c) the importance rating of clinical procedures; d) the comfort of performance; e) difficulties and anatomically related complications encountered; f) the role of clinical anatomy competency in reducing difficulties and complications; g) the role of clinical anatomy in improving confidence of performance; h) a selection of 15 problem procedures; i) the relevant clinical anatomy necessary to perform these procedures and j) to develop a clinical anatomy training program for these procedures. A list of 57 procedures relevant to family practice in South Africa was compiled and a questionnaire completed by doctors at various hospitals, which were randomly selected in three provinces in South Africa. A total of 102 questionnaires were obtained and analyzed. The following procedures were selected which were performed often (>50%), ranked important, encountered most difficulties and complications, where more doctors were uncomfortable than comfortable and where the influence of clinical anatomy knowledge on the safe and successful performance of the procedure, was ranked highest: Central venous catheterization, cricothyroidotomy, pericardiocentesis, great saphenous vein cutdown, oro/naso tracheal intubation, lumbar puncture, appendectomy, cesarean section, reduction of uncomplicated forearm fractures, ectopic pregnancy surgery, epistaxis and nasal packing, rectal examination, proctoscopy and sigmoidoscopy, knee joint aspiration, wrist and digital nerve block and obstetric ultrasound. A referenced knowledge base was developed by an extensive literature search of the selected procedures under the following headings: Indications, contraindications/ precautions, step by step procedure, anatomical pitfalls and anatomically relevant complications. This was expanded to develop a Virtual Procedures Clinic, an interactive multimedia package. / Thesis (PhD)--University of Pretoria, 2009. / Anatomy / unrestricted