Penultimate Draft of programme for 22nd July 2008 20-5-08

BRITISH ASSOCIATION

OF

CLINICAL ANATOMISTS

SUMMER SCIENTIFIC MEETING

2008

The Liverpool Medical Institution,

Mount Pleasant,
 Liverpool

SUMMER SCIENTIFIC MEETING 2008

The Summer Scientific Meeting and Annual General Meeting of the Association
will be held at:-
The Liverpool Medical Institution, Mount Pleasant, Liverpool.

Overnight accommodation on campus in Dale Hall Elmswood Road, Mossley Hill

must be booked when you register for the meeting.
Contact:- Dr. Peter Dangerfield Tel: 0151 795 4366 (secretary) Email:
spine92@liverpool.ac.uk

The Association dinner will be held on the evening of the meeting,

following the meeting in the Carnatic House, adjacent to Dale Hall
(tickets must be purchased in advance) starting at 7.00 pm for drinks
(hopefully outside if weather permits).

COUNCIL MEETING: Monday 21 st July 2007

at 5.30 pm in the Dale Hall, with dinner at
7.30pm
SCIENTIFIC MEETING

(Please note 10 minutes for oral communications with a further 5 minutes for
questions: Posters will be discussed as scheduled during the Tea/coffee/lunch
breaks. At the allotted time for each poster presenters MUST be beside their
poster to discuss it with delegates)
Please support colleagues presenting posters during the breaks between oral
presentations.

8.30 – 8 50: REGISTRATION The Liverpool Medical Institution

8.50 – 9.00: WELCOME & FORMAL OPENING OF MEETING

The Lecture Theatre

9.00 to 10.30 Session 1 Education The Lecture Theatre

Chair:- Dr. S. McDonald

1. DANGERFIELD Peter H. The University of Liverpool, UK The Liverpool Cholera riots

 of 1832 and their association with body snatching.

2. PADWICK, Robert T., Elizabeth M. MCEVOY, Stephen BRYDGES, S. James J. COEY,

Daniel E. FIELDING, Peter J. GOLD, Laura E. A. HARRISON, P. Narasimha MURTHY,
Chia Tsyh TAN, Peter ABRAHAMS, Edward PEILE.  Warwick Medical School,
Coventry, CV4 7AL, UK. ‘Coachpod’ – an innovative method of preparing medical
students for dissection

3. CARTLIDGE, David, Hayley DERRICOTT*, Sarah HAUXWELL, Christina MACANO,

Michael MAHON*, Mark STEPHENS and Peter WILLAN*. University Hospital of North
Staffordshire, and School of Medicine*, Keele University, UK. Anatomical opportunities
within Foundation Year programmes: a new type of "anatomy demonstrator"?

4. DANGERFIELD P H, T VARGA-ATKINS, N BUNYAN, S McKINNELL, D BRIGDEN,

D WILLIAMS, M RALPH. The University of Liverpool, UK Enhancing student
learning through the use of web2.0 technologies.

● TRYFONIDIS Marios, Lawrence O’CONNOR-READ*. University of Oxford, UK. The

Oxford Orthopaedic Anatomy course. Early experience of a new anatomy course.

6. HEYLINGS David J. A. University of East Anglia, Norwich, UK. Anatomy – A SWOT

analysis.

10.30- 11.15 Tea/Coffee Viewing posters 1 to 8

11.15- 1.00pm Session 2 Limbs and upper trunk The Lecture
Theatre
Chair:-
Dr. M.
Tryfoni
dis

● BENHAM, Alex 1, Barbara J INTROWICZ 2, Jackie WATERFIELD. 2, Hayley

DERRICOTT 3 Mike MAHON3. 1Faculty of Health, Leeds Metropolitan University, Leeds,
West Yorkshire, UK LS1 3HE . 2School of Health and Rehabilitation, Keele University,
Staffordshire, UK ST5 5BG. 3School of Medicine, Keele University, Staffordshire, UK An
investigation into intra-individual variations of the bifurcation of the radial nerve

8. KIMBLE, Adam, Andrew O’BRIEN, Diana LAWRENCE-WATT Department of

Anatomy, Brighton and Sussex Medical School. The Long Thoracic Nerve – A
cadaveric study of the injury to the nerve during insertion of intercostal drainage.

9. STEPHENSON, Paul and Bahaa SEEDHOM, School of Medical Education, Cedar

House, Ashton Street, Liverpool, L69 3GE. Modelling the geometry of the human
femur: clinical anatomy leads to an implant design
10. ANSARI, Aneel, Surendra PATNAIK, Avadhoot KANTAK, George TSELENTAKIS.
Trauma and Orthopaedic Surgery, East Surrey Hospital, Canada Avenue, Redhil, Surrey
RH1 5RH, UK. Inferior genicular tributary of the saphenous vein – an interesting
landmark for hamstring tendon harvesting.

11. TIENGO Cesare*, Veronica MACCHI*, Andrea PORZIONATO*, Carla STECCO*,

Enrico VIGATO*, Aldo MORRA *, Francesco BASSETTO*, MAZZOLENI Francesco*,
DE CARO Raffaele. Departments of Human Anatomy and Physiology, University of
Padova, Italy; Plastic Surgery, and Section of Radiology, Euganea Medica Centre, Padova;
Section of Radiology, Euganea Medica Center, Italy; Surgical, Anestetich and Radiologic
sciences, University of Ferrara. Anatomo-radiological study of the vascularisation of
the gluteal region.

12. BURWELL, R Geoffrey1, Peter H DANGERFIELD 2, Alan MOULTON 3, Susan I

ANDERSON4*. 1Centre for Spinal Studies and Surgery, Queen’s Medical Centre,
Nottingham, 2Children’s Hospital, University of Liverpool, 3Department of Orthopaedic
Surgery, King’s Mill Hospital, Mansfield, and 4School of Biomedical Sciences, University
of Nottingham, UK. Pathogenesis of adolescent idiopathic scoliosis in girls: a battle
between two nervous systems, autonomic and somatic, fought out in the spine and
trunk? (Supported by AO)

● BURWELL, R Geoffrey1, Ranjit K AUJLA 1*, Alanah S KIRBY 1*, Peter H

DANGERFIELD2, Alan MOULTON 3, Ashley A COLE 1, Fran J POLAK1*, Roland K
PRATT1*, and John K WEBB1*, Centre for Spinal Studies and Surgery, Queen’s Medical
Centre, Nottingham, Children’s Hospital, University of Liverpool, and Department of
Orthopaedic Surgery, King’s Mill Hospital, Mansfield, UK. Leptin-hypothalamic
dysfunction of energy metabolism (bioenergetics) affecting a normal sympathetic
nervous system mechanism contributing to human trunk size in girls: expressed
asymmetrically and potentially pathogenic for adolescent idiopathic scoliosis
(Supported by AO)

1.00 - 2.00pm LUNCH

1.15 - 1.45 Viewing of posters 9 to 16

2.00 – 2.30pm Annual General Meeting :- The Lecture Theatre
● Apologies for absence
● President’s comments
● Honorary Treasurer’s comments
● Honorary Secretary’s comments
● Editor’s comments
● Future meetings – Oxford - January 2009
● Any Other Business
 2.30 – 4.00 pm Session 3 TRUNK below diaphragm The Lecture
Theatre
Chair
:- Mr. A.
Moulton

14. SETH, Ajai, Jai SETH, Harold ELLIS, Department of Anatomy, School of Biomedical and
Health Sciences, Guys Campus, King’s College London, U.K. Axial Torsion of Meckel’s
Diverticulum – A Case Report and Review of the Previous Publications.

15. MORRISON, Stuart,  Janet REID,  Richard DRAKE,  Departments of Anatomy and
Radiology, Cleveland Clinic, Ohio USA. Obstetric MRI imaging of Foetal Anatomy.

16. NANDAR, Myo, Ravindra B VEMULAPALLI, S. PARVEEN, Department of Obstetrics

and Gynaecology, Nevill Hall Hospital, Abergavenny, NP7 7EG. Sacrospinous ligament
and its clinical significance in genital prolapse surgery in women

17. PAL CHAUDHURI Amit, Mathangi RAJAGOPALAN, Sajitha PARVEEN Department of

Obstetrics and Gynaecology, Nevill Hall Hospital, Abergavenny, UK Urethra and Stress
Incontinence in Women

18. RAJAGOPALAN Mathangi, Amit PAL CHAUDHURI, Sajitha PARVEEN Department of

Obstetrics and Gynaecology, Nevill Hall Hospital, Abergavenny, UK. Course of ureter in
female – Significance in pelvic surgeries

19. PARVATHI S Sindagi, S. PARVEEN, Department of Obstetrics and Gynaecology, Nevill

Hall Hospital, Abergavenny NP7 7EG Clinical significance of perineal body.

4.00 – 4.30pm Tea/Coffee Viewing posters 16 to 23

4.30 - 6.00pm Session 4 HEAD & NECK The Lecture Theatre

Chair
:- Dr. L
Scheuer

20. DENNIS, Helen, Roger SOAMES, Centre for Anatomy and Human Identification, College
of Life Sciences, University of Dundee, Dundee, Scotland. The cervical internal carotid
artery and relation of the common carotid bifurcation to the hypoglossal nerve.

21. DELIEU, John,1 Nigel JOHN,1 Mike MAHON,2 Paul MULLINS,1 Hayley DERRICOTT,2
 Ik Soo LIM,1 Rhys THOMAS1 1Bangor University and 2Keele University, UK. Magnetic
resonance imaging of an embalmed human head.

22. LO, William, Harold ELLIS, Department of Anatomy and Human Sciences, King’s
College London, Guy’s Campus, London, UK. The Circle Before Willis

23. OWENS, David, Heikki WHITTET Department of ENT, Department of ENT Singleton
Hospital, Swansea. The anterior ethmoid artery in sinus surgery. A discussion of the
anatomical variations found and a surgical approach to its management in epistaxis.

24. HOWARTH, Antony, Heikki WHITTET. Department of ENT, Singleton Hospital,

Abertawe Bro Morgannwg University NHS Trust, Swansea, Wales UK. Endoscopic and
Radiological Anatomy of the Sphenoid Sinuses.

25. PHILLIPS Carla and Abayomi ODEKUNLE Anatomy Unit, Department of Preclinical
Sciences, Faculty of Medical Sciences , University of the West Indies, St. Augustine
Campus, Trinidad and Tobago. Morphological and Craniometrical studies of the
Agouti’s (Dasyprocta Leporina) skull

Close of meeting

ABSTRACTS

EDUCATIONAL

1. DANGERFIELD Peter H. The University of Liverpool, UK The Liverpool Cholera riots

of 1832 and their association with body snatching.
In 1831, a second cholera pandemic reached Britain and spread rapidly
throughout the UK. The first cases in Liverpool were accompanied by a
series of riots. The first riot occurred on in Toxteth Park when a woman
being taken to hospital generated a mob shouting abuse at “medical men”.
Further riots followed over 10 days. While quackery, poor medical practice
and poverty played a part, the major cause of the riots was a perception of
body theft, with cholera victims being removed to be killed by doctors to be
used for anatomical dissection. "Bring out the Burkers" was one cry of the
Liverpool mobs, derived from the practice of Grave Robbers, known as
Resurrectionists, removing recently deceased people for anatomical
dissection. In 1826, 33 bodies were discovered on the Liverpool docks in
casks, ready for shipping to Scotland for dissection. These were traced to
Hope Street but the criminal behind the shipments escaped. However, in
1828, Dr William Gill, a local surgeon, was found guilty of running an
extensive local grave-robbing system to supply corpses for his dissection
rooms. These Liverpool events and others elsewhere in the UK, led to the
 passing of the 1832 Warburton Anatomy Act.

2. PADWICK, Robert T., Elizabeth M. MCEVOY, Stephen BRYDGES, S. James J. COEY,

Daniel E. FIELDING, Peter J. GOLD, Laura E. A. HARRISON, P. Narasimha MURTHY,
Chia Tsyh TAN, Peter ABRAHAMS, Edward PEILE.  Warwick Medical School,
Coventry, CV4 7AL, UK. ‘Coachpod’ – an innovative method of preparing medical
students for dissection
Warwick Medical School currently has no dissection facilities, and thus at
present students and staff have to travel an hour to the nearest facilities in
Leicester. In order to prepare students for each dissection session, we have
produced a series of anatomy teaching videos for use on video MP4 devices
(such as the Ipod) by students during the coach journey to Leicester. Use of
these ‘Coachpods’ has been evaluated amongst the current first year cohort,
using a questionnaire with Likert-scale and free-text answers. 106/200
students responded following session one, of which 105 had viewed the
Coachpod. 51% of students watched the Coachpod on their laptops the night
before their dissection session, with 32% using a device such as an Ipod
during the coach journey. Several students viewed the Coachpod more than
once. Comments on the evaluation forms indicated that the students enjoyed
the Coachpod and found it helpful in preparation for dissection. Suggestions
for improvement were mostly on technical matters, which we have
improved on a week-to-week basis as filming has usually taken place before
the preceding dissection session. Evaluation of data from subsequent weeks
is ongoing. We believe the Coachpod is potentially a valuable preparation
tool for dissection sessions.

3. CARTLIDGE, David, Hayley DERRICOTT*, Sarah HAUXWELL, Christina MACANO,

Michael MAHON*, Mark STEPHENS and Peter WILLAN*. University Hospital of North
Staffordshire, and School of Medicine*, Keele University, UK. Anatomical opportunities
within Foundation Year programmes: a new type of "anatomy demonstrator"?
Since the 1990s the teaching of anatomy at UK medical schools has
undergone many changes and continues to be subject to much debate. More
recently the training of doctors has been transformed by the introduction of
Foundation Year programmes in which junior doctors now enter two years'
training (F1, F2) that aims to provide broad clinical experiences in several
specialties before progression on to Specialist Training programmes. Over a
similar period across the country anatomy demonstrator posts, traditionally
very popular with doctors wishing to enter surgical training, have become
fewer. However, since 2007, trainees at the University Hospital of North
Staffordshire undertaking the F2 rotation with pathology and surgery have
had regular sessions timetabled in the Anatomy Facility at Keele University.
These liaisons, piloted on a trial basis by enthusiastic Pathology and
Anatomy staff, have provided advantages for the F2 rotation as a whole.
The educational opportunities proved positive for medical students who
rated aspects of anatomical tutoring very good / excellent. In addition, the
 F2 doctors gained first-hand experience of tutoring and were able to expand
their anatomical skills and knowledge before applying to Specialty Training
programmes. It is anticipated that these beneficial links may become more
firmly established.

4. DANGERFIELD P H, T VARGA-ATKINS, N BUNYAN, S McKINNELL, D BRIGDEN,

D WILLIAMS, M RALPH. The University of Liverpool, UK Enhancing student
learning through the use of web2.0 technologies.
In Liverpool, medical students study in a case-derived problem-based
learning (PBL) context, covering four themes which are followed throughout
the five year course. This study explored the use of web2.0 technologies, in
particular wikis, to investigate if they enhance students’ learning in anatomy
and the other themes of the course. The wiki was piloted in four PBL groups
in the first year of the medical undergraduate course, employing the wiki
tool installed within the institutional virtual learning environment (VLE),
which is based on Blackboard software..Using a small-scale survey, focus
groups and facilitator interviews, triangulated data was collected. This data
indicated that students demonstrated a range of working patterns in-between
PBL sessions in the way they collaborated with one another, particularly in
their use of both formal (e.g. VLEs) and informal (face-to-face and online
social networking) learning opportunities. Two main purposes of wikis as
utilised by students has demonstrated: firstly, as a formative learning tool
and secondly, as building up a knowledge-base as a resource for meeting
their self-assigned learning objectives. The study has shown how students
view the purpose of the wiki and their own role within in it
(‘professional’/public vs learner/private) and it thus is seen to influence their
interactions within the wiki and their PBL group.

5. TRYFONIDIS Marios, Lawrence O’CONNOR-READ*. University of Oxford, UK. The

Oxford Orthopaedic Anatomy course. Early experience of a new anatomy course.
We present our early experience of a new anatomy course that has started in
Oxford. The Oxford Orthopaedic Anatomy course is run by Orthopaedic
Trainees and takes place in the Medical School at the University of Oxford.
Teaching involves a combination of short presentations as well as
prosection-based demonstrations in the dissecting room. The course is aimed
towards medical students, junior doctors (pre-MRCS exams) as well as
provides an excellent opportunity for Orthopaedic trainees to revise surgical
anatomy in preparation for their exit exams. We present the difficulties in
setting up the course, how it was possible to provide the course free of
charge, as well as the responses, satisfaction rate and commends of the
course students.

6. HEYLINGS David J. A. University of East Anglia, Norwich, UK. Anatomy – A SWOT

 analysis.
Traditional cadaveric Anatomy as an academic discipline is one of the
oldest subjects within the ancient or modern medical curricula. Medics have
always wanted to know how the body is put together normally and how it
gets diseased. It has acted as the trigger for the development of physiology
and pathology in particular. Many however feel it is time for it to be
replaced by something new. There have been numerous papers suggesting
ways forward to address aspects that are real or perceived weaknesses,
many building upon developments with computer aided learning. Through
modern imaging comes three dimensional reconstruction and this has its
advocates as a replacement for traditional anatomy. There are opportunities
for research which in particular develop alternate teaching approaches and
for teaching, through projected changes in the post graduate education
system. The increased moves to ensure Anatomy in the UK talks with a
single voice and has the ability to respond clearly and quickly provides hope
for a clear way forward. However overarching all of the now familiar debate
in the UK there are still many threats created through, the loss of the
clinically experienced teacher, reduced curricular time, cadaver shortage and
a reduction in permitted formaldehyde levels. This paper will explore these
a more fully and open debate to inform future discussions nationally.

7. BENHAM, Alex 1, Barbara J INTROWICZ 2, Jackie WATERFIELD. 2, Hayley

DERRICOTT 3 Mike MAHON3. 1Faculty of Health, Leeds Metropolitan University, Leeds,
West Yorkshire, UK LS1 3HE . 2School of Health and Rehabilitation, Keele University,
Staffordshire, UK ST5 5BG. 3School of Medicine, Keele University, Staffordshire, UK An
investigation into intra-individual variations of the bifurcation of the radial nerve
During clinical examination of patients using upper limb neurodynamic
tests, practitioners assume the morphology of the radial nerve is bilaterally
symmetrical. While inter-individual variations of radial nerve bifurcation
have been previously reported, no studies have investigated the
intra-individual differences. Eighteen embalmed human cadavers used for
medical teaching were further dissected to reveal the radial nerve and it’s
major branches. The distances from the lateral humeral epicondyle to the
radial nerve bifurcation (measurement 1) and from the bifurcation to the
radial tunnel (measurement 2) were measured to the nearest mm. The
measurements were compared between left and right arms and analysed
using a Wilcoxon signed ranks test. In all cadavers variations were noted.
The median difference between left and right arms for measurement 1 was
13 mm (interquartile range 0, 31 mm) and for measurement 2 was 5.5 mm
(interquartile range 0, 35 mm). Statistical analysis revealed significant
intra-individual differences in measurement 1 (p=0.013) but not in the
differences between measurement 2 (p=0.084). The results suggest that the
point at which the radial nerve bifurcates is subject to intra-individual
variations. Therefore, an assumption that the radial nerve in the upper limb
is bilaterally symmetrical may not be valid.
8. KIMBLE, Adam, Andrew O’BRIEN, Diana LAWRENCE-WATT Department of
Anatomy, Brighton and Sussex Medical School. The Long Thoracic Nerve – A
cadaveric study of the injury to the nerve during insertion of intercostal drainage.
The Long thoracic nerve is derived from the ventral rami of C5-7 of the
brachial plexus and supplies motor fibres to serratus anterior. The nerve
arises in the apex of the axilla and passes inferiorly onto the lateral chest
wall, terminating at the level of the fifth intercostal space, where it lies
approximately in the mid-axillary line. Placement of an intercostal drain is
usually performed via the fourth or fifth intercostal space at the mid or
anterior axillary line, and therefore, the long thoracic nerve is potentially at
risk during intercostal drainage tube insertion. Using 32 cadaveric axillae,
intercostal drains were inserted in the anterior and mid-axillary line at the
third, fourth and fifth intercostal spaces. The axillae were then dissected and
any injury to the nerve was recorded. The distance of the nerve from the
anterior axillary line along a perpendicular line running from the anterior
axillary line to the mid-axillary line was also recorded. The incidence of
nerve injury in the mid-axillary line was 28.1% at the fourth intercostal
space and 12.5% at the fifth intercostal space. No nerve was present at or
within 2 cm of the anterior axillary line. The anterior axillary line is a safer
site for intercostal drain insertion.

9. STEPHENSON, Paul and Bahaa SEEDHOM, School of Medical Education, Cedar

House, Ashton Street, Liverpool, L69 3GE. Modelling the geometry of the human
femur: clinical anatomy leads to an implant design
The development of a medical implant requires that the anatomy of the host
region is fully understood. A focused anatomical study was undertaken to
help research the development of an implant that would enable direct
skeletal fixation of artificial limbs in transfemoral amputees. The proposed
implant was to be located in the femoral mid-third region; this study
therefore focused on the geometry of the medulla and cortex and the
relationship between them along the femoral diaphysis. The mid-third
portion of the femur has a distinct curvature, which potentially presents
problems when considering implant design. For practical purposes, this
study therefore considered the femoral diaphysis as two straight
(intersecting) sections. On analysis, this straight line model for the femur
was clinically suitable. In addition, the medulla was found to be almost
cylindrical in the studied region. The cortical thickness is smallest on the
anterior side and greatest posteriorly; this implies the medulla does not lie
centrally within the femur but is positioned anteriorly. These findings
enabled the Author to justify a circular cross-sectional shape and straight
axial geometry for the designed implant. The anatomy of the host region
was of crucial importance in finalising implant design.

10. ANSARI, Aneel, Surendra PATNAIK, Avadhoot KANTAK, George TSELENTAKIS.

 Trauma and Orthopaedic Surgery, East Surrey Hospital, Canada Avenue, Redhil, Surrey
RH1 5RH, UK. Inferior genicular tributary of the saphenous vein – an interesting
landmark for hamstring tendon harvesting.
Hamstring tendons have become a popular choice for use as an autograft
during ligament reconstruction surgery. Harvesting of these tendons remains
a surgical challenge with their tibial insertion, the pes anserinus, being
difficult to identify. Although most surgeons rely on the tibial tuberosity as a
reference point, in our practice we have found an inferior genicular tributary
of the long saphenous vein to be a useful indicator. This previously
unreported vessel lies in the subcutaneous tissue superficial to the pes
anserinus but in the same transverse plane. A clinical and radiological study
was undertaken to confirm this anatomical relationship, relying on fifty
patients undergoing hamstring tendon harvesting and by evaluating the
magnetic resonance imaging scans of a further 100 knees. We found the
vessel to be present and to lie in close proximity to the pes anserinus in 94%
of the clinically evaluated patients and 79% of the radiologically evaluated
knees. Our findings confirm that this previously unreported inferior
genicular tributary of the long saphenous vein does lie in close proximity to
the pes anserinus and can reassure surgeons when visualised during
hamstring harvesting.

11. TIENGO Cesare*, Veronica MACCHI*, Andrea PORZIONATO*, Carla STECCO*,

Enrico VIGATO*, Aldo MORRA *, Francesco BASSETTO*, MAZZOLENI Francesco*,
DE CARO Raffaele. Departments of Human Anatomy and Physiology, University of
Padova, Italy; Plastic Surgery, and Section of Radiology, Euganea Medica Centre, Padova;
Section of Radiology, Euganea Medica Center, Italy; Surgical, Anestetich and Radiologic
sciences, University of Ferrara. Anatomo-radiological study of the vascularisation of
the gluteal region.
Perforator flaps of the gluteal region based on superior (SGA) and inferior
gluteal arteries (IGA) have become the preferred surgical reconstructive
option in the care of sacral and ischiatic pressure sores. Their mobilization
allows to recover with appropriate subcutaneous tissues the sacral and
ischiatic regions without the sacrifice of the muscular plane, thus permitting
future reconstructive possibilities. Aim of this study is to investigate the
origin, course, calibre and distal branches of the SGA and IGA through a
comparison between anatomical dissection, radiological TC angiography
and clinical experience. Our results confirm the well known topographical
division of the vascularization of the gluteal region in two distinct territories
supplied by the SGA and IGA, although in 25% of the cases perforator
vessels of SGA are visible below a line drawn from the posterior superior
iliac spine to the greater trochanter. Knowing this vascular variability is
necessary to the reconstructive surgeon in order to plan and raise a safe flap
from the gluteal region without damaging the dominant perforator vessels.

12. BURWELL, R Geoffrey1, Peter H DANGERFIELD 2, Alan MOULTON 3, Susan I

 ANDERSON4*. 1Centre for Spinal Studies and Surgery, Queen’s Medical Centre,
Nottingham, 2Children’s Hospital, University of Liverpool, 3Department of Orthopaedic
Surgery, King’s Mill Hospital, Mansfield, and 4School of Biomedical Sciences, University
of Nottingham, UK. Pathogenesis of adolescent idiopathic scoliosis in girls: a battle
between two nervous systems, autonomic and somatic, fought out in the spine and
trunk? (Supported by AO)
Addressing the pathogenesis of adolescent idiopathic scoliosis (AIS) in girls
in a previous paper we outlined a neuro-osseous timing of maturation
(NOTOM) escalator concept involving the somatic nervous system (SNS).
The autonomic nervous system (ANS), through its hypothalamic
neuroendocrine control of puberty and skeletal growth, contributes
importantly to AIS pathogenesis. Lower body mass index (BMI) and lower
circulating leptin levels for girls with AIS are reported to show a positive
correlation between leptin and BMI. In mice, adipocytes talk to bone
through leptin acting centrally via a hypothalamic pathway mediated by the
sympathetic nervous system to increase longitudinal bone growth and
decrease bone formation. We propose that AIS initiation in girls, given
adequate nutrition and energy stores (metabolic fuel), results from a
dysfunction in hypothalamic sensitivity to leptin causing increased
sympathetic nervous system activity and asymmetry (leptin-sympathetic
nervous system concept) which, with neuroendocrine mechanisms leads to:
1) earlier age at, and increased, peak height velocity, 2) general skeletal
overgrowth, 3) earlier skeletal maturation, 4) skeletal length asymmetries,
including vertebrae, periapical ribs, ilia and humeri, 5) generalized
osteopenia, and 6) lower BMI. In girls, AIS expression may result from a
battle between the SNS and ANS, fought out in the spine and trunk.

13. BURWELL, R Geoffrey1, Ranjit K AUJLA 1*, Alanah S KIRBY 1*, Peter H
DANGERFIELD2, Alan MOULTON 3, Ashley A COLE 1, Fran J POLAK1*, Roland K
PRATT1*, and John K WEBB1*, Centre for Spinal Studies and Surgery, Queen’s Medical
Centre, Nottingham, Children’s Hospital, University of Liverpool, and Department of
Orthopaedic Surgery, King’s Mill Hospital, Mansfield, UK. Leptin-hypothalamic
dysfunction of energy metabolism (bioenergetics) affecting a normal sympathetic
nervous system mechanism contributing to human trunk size in girls: expressed
asymmetrically and potentially pathogenic for adolescent idiopathic scoliosis
(Supported by AO)
Asymmetries in upper arm length (UAL) are evaluated by higher and lower
body mass index (BMI) subsets about means for three groups of girls age
11-18 years: 1) normals (n=274), 2) scoliosis screening referrals (n=137),
and 3) preoperative girls with adolescent idiopathic scoliosis (AIS) (n=110).
In lower BMI subsets: 1) preoperative girls show abnormally increased
asymmetry of UAL, and 2) in thoracic AIS of screened and preoperative
girls, UAL asymmetry is associated significantly with Cobb angle and
apical vertebral rotation. Higher and lower BMI subsets are likely to
separate girls with higher from those with lower circulating leptin levels. In
 the lower BMI subset preoperative girls show abnormal UAL asymmetry
and relatively reduced pelvic and shoulder widths, suggesting all are linked
to lower circulating leptin levels. The UAL asymmetry is not explained by
hormonal mechanisms. Given that leptin signals energy stores (metabolic
fuel) to the hypothalamus, we hypothesize: 1) normal trunk size control is
dual, by hypothalamic neuroendocrine and neural mechanisms, the latter
via the sympathetic nervous system (SNS); and 2) AIS initiation results
from hypothalamic dysfunction of the neural mechanism (possibly
involving abnormality of a G-protein coupled receptor to leptin, or a
G-protein) with the SNS inducing potentially pathogenetic asymmetries in
vertebrae, ribs, ilia, and upper arms.

14. SETH, Ajai, Jai SETH, Harold ELLIS, Department of Anatomy, School of Biomedical and
Health Sciences, Guys Campus, King’s College London, U.K. Axial Torsion of Meckel’s
Diverticulum – A Case Report and Review of the Previous Publications.
Johann Friedrich Meckel, in 1809, described the anatomy and embryology
of this small bowel diverticulum, which bears his name. Meckel’s
diverticulum (MD) is the most common congenital abnormality of the
gastrointestinal tract, with a prevalence ranging from 1 to 4% of the
population. The large majority are clinically silent, and are incidentally
identified at surgery or at autopsy. Lifetime risk of complications is
estimated at 4%, most of these presenting in adults. It is these cases that can
cause problems to the clinician, as the diagnosis can be elusive, and
consequences extremely serious. We present a case of axial torsion of the
MD around it’s base; one of the rarest complications. Factors predisposing
to axial torsion of MD include the presence of mesodiverticular bands, a
narrow base, an excessive length, and associated neoplastic growth or
inflammation of the diverticulum. Once identified, prompt surgical excision
generally leads to an uncomplicated recovery. A retrospective review of all
cases, published in the English language, of axial torsion of Meckel’s
diverticulum was performed. This identified 24 cases, with the earliest case
published in 1952. The demographic details, clinical features,
investigations, operative diagnosis, surgical procedure and histopathology
are noted and discussed.

15. MORRISON, Stuart,  Janet REID,  Richard DRAKE,  Departments of Anatomy and
Radiology, Cleveland Clinic, Ohio USA. Obstetric MRI imaging of Foetal Anatomy.
Ultrasound remains the initial and in most pregnancies the only needed
method for imaging of the foetal and maternal anatomy. MRI however
offers several advantages over ultrasound which together with improved
technical factors have increased the value of MRI imaging during
pregnancy. These advantages include a large field of view and exquisite
imaging of the brain that is not degraded by the skull bones. Normal brain
maturation following the chronological appearance of the sulci and gyri can
be dated from an atlas.  Exquisite soft tissue contrast allows excellent
 imaging of the entire foetal anatomy. For example the foetal liver can be
easily separated from the foetal lung in cases of congenital diaphragmatic
hernia.  MRI is not operator dependant or degraded by maternal obesity or
oligohydramnios. All scans were obtained after 20 weeks gestation on a 1.5
Tesla magnet.  The majority were performed to better image the central
nervous system for presumed brain and spine anomalies. Diaphragmatic
hernia identified by ultrasound can be confirmed by MRI and volumes of
the lung obtained to aid in the prognosis prior to delivery. The placenta and
maternal anatomy can also be imaged. Examples of normal foetal anatomy
and embryological errors will be presented.

16. NANDAR, Myo, Ravindra B VEMULAPALLI, S. PARVEEN, Department of Obstetrics

and Gynaecology, Nevill Hall Hospital, Abergavenny, NP7 7EG. Sacrospinous ligament
and its clinical significance in genital prolapse surgery in women
Sacrospinous ligament (Bilateral structure) arises from the ischial spine and
fans out to an insertion on the sides of the sacrum. The role of this ligament
in pelvic surgery of women cannot be underestimated despite its small size.
With increasing prevalence of post hysterectomy vaginal vault prolapse,
many reports have proved that transvaginal sacrospinous ligament fixation
is an effective and safe procedure with high long-term success rates even in
aged women. The use of sacrospinous colpopexy in young women has been
suggested as a primary treatment of uterovaginal prolapse who want to
preserve their fertility. In recurrent vaginal vault prolapse, repeated
sacrospinous ligament fixation with mesh interposition and reinforcement
has been proved to be effective in some studies. Recent advances in
minimally invasive sacrospinous ligament fixation procedures like the Raz
Anchoring System and laparoscopic extraperitoneal scarospinous
suspension allows alternative to traditional procedures. Vaginal
sacrospinous fixation is also feasible for neovaginal prolapse prevention
with high preservation of sexual function in male transsexuals. Clinicians
should be aware of its close proximity to the pudendal vessels and nerves at
the ischial spines. Knowledge of the relationship between sacrospinous
ligament and pudendal nerve allows clinicians for successful analgesia in
pudendal block for instrumental delivery.

17. PAL CHAUDHURI Amit, Mathangi RAJAGOPALAN, Sajitha PARVEEN Department of

Obstetrics and Gynaecology, Nevill Hall Hospital, Abergavenny, UK Urethra and Stress
Incontinence in Women
The internal urethral sphincter has an intrinsic tone contributed by the
smooth muscle layer which directs the submucosal expansile pressure
inward towards the mucosa and maintains urinary continence. Among the
extrinsic factors maintaining continence the endopelvic fascia condenses to
form three distinct ligaments which attach to the urethral and pelvic walls to
form a ‘hammock’ behind the urethra. When the intra-abdominal pressure
rises the urethra is forced closed against this posterior ‘hammock’. Stress
 incontinence of urine is involuntary loss of urine when the intravesical
pressure, as a result of increased intra-abdominal pressure, exceeds the
resistance produced by the urethral closure mechanisms in the absence of
bladder activity. It is a major problem particularly in elderly women where it
presents as leakage of urine on straining such as coughing or sneezing.
Majority of cases are due to urethral hypermobility as a result of loss of the
normal pelvic support mechanism following trauma and stretching of
vaginal delivery, hysterectomy, menopause or pelvic denervation. As the
bladder neck support is weakened, the increase in intra-abdominal pressure
is no longer transmitted equally to the bladder outlet and leakage occurs.
Treatment involves surgical repositioning of the bladder neck and urethra to
a high retropubic position or use of mid-urethral slings. Few cases are due to
intrinsic sphincter dysfunction resulting from previous operations, trauma,
radiation, neurogenic disorders or menopause. Periurethral injections with
collagen may be beneficial.

18. RAJAGOPALAN Mathangi, Amit PAL CHAUDHURI, Sajitha PARVEEN Department of

Obstetrics and Gynaecology, Nevill Hall Hospital, Abergavenny, UK. Course of ureter in
female – Significance in pelvic surgeries
Ureters are a pair of muscular tubes lined by transitional epithelium that
carry urine form kidneys to urinary bladder. The anatomical relationships of
ureter in abdomen and pelvis vary from male to female. In female the pelvic
portion of ureter is closely associated with genital tract which has great
clinical significance. At the pelvic brim, the ureter forms the posterior
boundary of ovarian fossa. It then runs medially and forward on lateral
aspect of cervix (1-2 cm from the cervix) and vagina. Here it is crossed by
uterine artery. Ureteric injuries are increasing with the advancement in
pelvic surgeries. The three common sites of ureteric injury in
gynaecological operations are at the pelvic brim during ligation of ovarian
vascular pedicle, crossing by uterine artery and in the ureteric canal in the
cardinal ligament. Commonly ureteric injuries occur during hysterectomies,
operations for vaginal prolapse and laparoscopic surgery for endometriosis.
Good anatomical knowledge of ureter is essential for all health care
professionals performing open and laparoscopic abdominal and pelvic
surgery. Advances in ureteric stenting might help to reduce these injuries. A
high index of suspicion is essential for early identification of these injuries
to improve the outcome.

19. PARVATHI S Sindagi, S. PARVEEN, Department of Obstetrics and Gynaecology, Nevill

Hall Hospital, Abergavenny NP7 7EG Clinical significance of perineal body.
Maternal birth injuries contribute significantly towards maternal morbidity.
Perineal body a pyramidal fibromuscular structure in the midline of the
perineum at the junction between the urogenital triagle and the anal triangle,
supports the lower part of vagina and is frequently torn during childbirth.
The perineal body superficially contains insertion of transverse perineal
 muscles and fibres of external anal sphincter and on a deeper plane levator
ani muscle which assist the perineal body in supporting the posterior vaginal
wall. It is subjected to continuous intra-abdominal pressure variations and
damage during childbirth can be followed by permanent weakness of pelvic
floor leading to a relaxed vaginal outlet. This can be minimised by taking
measures to avoid birth injuries or repair them appropriately at the time of
delivery. Relaxed vaginal outlet is defined as weakening of the distal
recto-vaginal septum and perineal body. It results in prolapse of posterior
vaginal wall leading to rectocoele and enterocoele. Common symptoms of
which are difficulty with defecation and sexual dysfunction. Proper
reconstruction of the perineal body is a critical element of successful vaginal
prolapse repair, so a clear understanding of its anatomy is essential. Recent
advances in vaginal reconstructive surgery aim at reinforcing the the post
vaginal wall along with reconstruction of the perineal body.

20. DENNIS, Helen, Roger SOAMES, Centre for Anatomy and Human Identification, College
of Life Sciences, University of Dundee, Dundee, Scotland. The cervical internal carotid
artery and relation of the common carotid bifurcation to the hypoglossal nerve.
Carotid endarterectomy is the main preventative procedure for patients at
risk of ischaemic stroke. However, the reported rates of complications, such
as cranial nerve palsies, are high. The aim of the present study is to
determine the relationship of the common carotid bifurcation (CCB) and
course of the cervical part of the internal carotid artery (ICA) to bony and
soft tissue structures. Forty five carotid regions (12 males, 12 females) were
dissected, the course of the ICA described and distances from the CCB to
specific anatomical landmarks measured. Twenty nine (64%) specimens had
a straight ICA, 12 (27%) a curved ICA, 3 (7%) pronounced kinking of the
ICA and 1 (2%) a coiled ICA: in addition the ICA was medial to the
external carotid artery in 4 (9%) specimens. Based on the distance between
the CCB and sternoclavicular joint (SCJ) a ‘safe zone’ for the hypoglossal
nerve can be established. At the mean CCB-SCJ distance (100mm) the
hypoglossal was observed to lie within 15.5mm superior to the CCB in 5%
of specimens: the larger the distance the smaller the safe zone. This can be
extrapolated for use on patients undergoing carotid endarterectomy to
reduce the incidence of injuries to the hypoglossal nerve.

21. DELIEU, John,1 Nigel JOHN,1 Mike MAHON,2 Paul MULLINS,1 Hayley DERRICOTT,2
Ik Soo LIM,1 Rhys THOMAS1 1Bangor University and 2Keele University, UK. Magnetic
resonance imaging of an embalmed human head.
Embalmed human cadavers provide a rich source of teaching and research
material for health related, pathological and anatomical studies. However it
would be valuable to both utilise such specimens in conjunction with
imaging and volume rendered simulations as well as providing stand-alone
computerised images in situations where cadaveric material is inappropriate.
Previous CT and MR studies of embalmed material are scant and suggest
 poor tissue differentiation. In this study a partially prosected formaldehyde
fixed head embalmed three years previously was scanned in the sagittal
plane at 0.5 mm3 resolution using a Philips Achieva 3 Tesla MRI scanner,
giving a high resolution DICOM data set. Preliminary observation showed
that tissue types and specific structures were clearly identifiable throughout
the head including differentiation of grey and white matter areas of the
brain. Observations were made easily manageable using public domain
software. In conclusion, we affirm that high resolution MRI may be utilised
with traditionally embalmed material to generate multi-planar data sets for
visualisation, segmentation, and volume rendering. A Virtual Environment
or Augmented Reality (AR) application is being developed as a potential
novel approach to supplement anatomy teaching, whereby external and
internal anatomy can be explored in three dimensions from any view point.

22. LO, William, Harold ELLIS, Department of Anatomy and Human Sciences, King’s
College London, Guy’s Campus, London, UK. The Circle Before Willis
Thomas Willis (1621-1675) is famous for the eponymous anastomotic
arterial supply to the human brain. However, was he the first person to
describe this important anatomical structure? We trace the history of
discovery of the intracranial arterial ramification in human from 4th century
BC, when Herophilus discribed the rete mirabile (“wonderful net”) in sheep,
which was later incorporated into Galen’s physiological scheme, illustrated
in Vesalius’s Tabulae Anatomicae Sex (1538) but eventually denied in De
Humani Corporis Fabrica (1543). Since then, Fallopius, Casserio and
Vesling made important contributions to the understanding of the blood
supply to the brain and Wepfer (1658) provided an accurate description of
the ‘circle’. However, it was not until 1664 that Willis provided the first
undisputably complete illustration of the structure in Cerebri Anatome with
the aid of illustrations by Christopher Wren, who later designed the St
Paul’s Cathedral. Despite not being the first person to describe the ‘circle’,
we suggest that Willis still deserves to be the bearer of this eponymous
structure.

23. OWENS, David, Heikki WHITTET Department of ENT, Department of ENT Singleton
Hospital, Swansea. The anterior ethmoid artery in sinus surgery. A discussion of the
anatomical variations found and a surgical approach to its management in epistaxis.
The Anterior ethmoid artery is one of the confluence of vessels that form
kiesselbachs plexus of the anterior nasal septum. During surgery to the
paranasal sinuses the artery is at risk of surgical trauma due to its position
within the ethmoid cells. Division of the artery at this site may result in
significant bleeding and because of the vessel intra-orbital course a serious
risk intra-orbital haemorrhage and potentially blindness. This presentation
will discuss the anatomy of the vessel and the variations in its intranasal
course which expose it to a risk of iatrogenic injury. We will also describe
the anatomical principles of surgical cessation of haemorrhage from the
 anterior ethmoid artery via an external approach.

24. HOWARTH, Antony, Heikki WHITTET. Department of ENT, Singleton Hospital,

Abertawe Bro Morgannwg University NHS Trust, Swansea, Wales UK. Endoscopic and
Radiological Anatomy of the Sphenoid Sinuses.
The sphenoid sinuses are both clinically and anatomically important
structures. Clinically, they may be involved in inflammatory, infective or
neoplastic sinus disease; anatomically they are closely related to the internal
carotid arteries, optic nerves, cranial fossae and skull base. While the
sphenoid sinuses may need to be accessed for surgical procedures on the
sinuses, they are also accessed for surgery to the brain, most notably the
pituitary fossa. The proximity of vital structures to the sphenoid sinuses
means that accurate localisation of the sinuses and surrounding regions is
crucial for safe surgery to the area. Ongoing improvements in radiological
imaging of the paranasal sinuses allow characterisation of both the nature of
disease processes and relevant anatomy. There has been a progressive shift
towards endoscopic surgical techniques in sinus and pituitary surgery, and
correlation of the radiological with endoscopic findings is essential. We aim
to aid this correlation by describing the relationship of the sphenoid sinuses
to endoscopic landmarks within the nose with reference to measurements
taken from radiological imaging of the paranasal sinuses.

25. PHILLIPS Carla and Abayomi ODEKUNLE Anatomy Unit, Department of Preclinical
Sciences, Faculty of Medical Sciences , University of the West Indies, St. Augustine
Campus, Trinidad and Tobago. Morphological and Craniometrical studies of the
Agouti’s (Dasyprocta Leporina) skull
In a bid to sustain the efforts aimed at updating the data available to the field
of experimental animal studies on the Agouti, we carried out a pilot study
on the skull of this new arrival to the field of experimental animal studies. A
total number of ten agoutis were utilized for this study. These were obtained
from local animal farmers and hunters. Following deep anaesthesia with
xylazine and ketamine, animals were decapitated and the heads immersed in
water for hot water maceration. The heads were then heated to a temperature
of 80°C for 30 minutes and subsequently placed under cold running tap
water. The eyes were enucleated and the skin and muscle carefully peeled
off the skull, avoiding damage to the bone. The skulls were air-dried
preparatory to cranial and mandibular measurements. Parameters
corresponding to those used in previous studies such as skull length,
interorbital distance, bicondylar width, and cranial capacity were measured
with the aid of a vernier caliper, string and beads. The data were analyzed
using standard statistics, correlation coefficients and regression equations.
Variation was relatively high for some measurements. Basal length was
highly correlated with cranial capacity. Clinical significance of study will be
discussed.
 POSTERS

1. SCOTT, Elizabeth, Roger SOAMES, Centre for Anatomy and Human Identification,
College of Life Sciences, University of Dundee, Dundee, Scotland. Variations in the
morphology of the abdominal aorta and lumbar arteries.
The morphology of the abdominal aorta and lumbar arteries was
investigated in 32 cadavers (14 male, 18 female). The level of aortic
bifurcation and origin of the median sacral artery; the level of origin of each
lumbar artery and aortic diameter at each level; and angle of origin and
diameter of each lumbar artery were determined. Mean aortic length (lower
border of T12 to the bifurcation) was 145.0mm, with the mean level of
bifurcation being at the lower border of L4: a median sacral was observed in
24 cadavers. Tapering of the aorta from T12 to L3 followed by an increase
until bifurcation was observed in both sexes. Only 11 specimens had four
pairs of lumbar arteries arising from the aorta, a further 11 had five pairs: in
10 specimens the lumbar arteries arose as a common trunk. The majority of
lumbar arteries arose at the level of the corresponding vertebral body or the
body above. The angle of origin of right and left lumbar arteries was
consistent, being posterolateral: common trunks arose perpendicular to the
posterior aorta. Lumbar artery diameters increased from first to fifth lumbar
artery. These results demonstrate a greater variation in lumbar artery
morphology than previously reported.

2. MAHER Ben1, Tahseen CHAUDHRY2, John BRIDGER.3. 1 General Surgery, Withenshaw

Hospital Manchester, 2Univeristy Hospitals Birmingham, , 3 University of Cambridge. The
Surgical Anatomy Of The Radial Nerve And The Triceps Aponeurosis
The course of the radial nerve has been extensively documented. Previous
studies have assessed the location of the radial nerve in relation to osseous
landmarks. We found no cadaver based studies looking at the relationship of
the radial nerve to the triceps aponeurosis. In this study we attempted to
determine whether the position of the radial nerve in relation to the
aponeurosis was consistent enough to allow early recognition and protection
of the nerve. 55 formalin preserved cadaver upper limbs were dissected. The
superficial muscle layers were exposed and the triceps aponeurosis and
midpoint of the lateral epicondyle were identified. The radial nerve was
exposed and a number of measurements were made to determine the course
of the nerve relative to the lateral epicondyle and the aponeurosis. The
results of our study suggest that in the region of the triceps aponeurosis, the
radial nerve follows a consistent course adjacent to the lateral border of the
aponeurosis. It tends to run along a line that is 2.19-2.65cm lateral to this
line and is reliably greater than 1.3 cm away from it. The consistency of our
results suggest that the aponeurosis may provide a useful surgical guide.
3. SARGON, Mustafa F.*, H. Hamdi CELİK*, Selcuk SURUCU* and Tugrul
CABIOGLU**, *: Department of Anatomy, Faculty of Medicine, Hacettepe University
and **: Department of Physiology, Faculty of Medicine, Baskent University, Ankara,
TURKEY. Electron microscopic study of acupuncture points
Acupuncture is a traditional Chinese medical technique for unblocking chi
(by inserting needles at particular points on the body to balance the
opposing forces of yin and yang. It is well known that the LI 4 (He Gu)
point is the most famous point in acupuncture and found on the dorsum of
the hand; to the side of the midpoint of the second metacarpal bone and in
the belly of the first dorsal interosseous muscle. Like the other acupoints,
the LI 4 also shows a low electrical resistance when compared with the
surrounding tissues. In this study, we aimed to examine the ultrastructure of
LI 4 acupoint and compared the ultrastructural appearance of this point with
a biopsy specimen obtained near to this point. To our knowledge, this is the
first study examining the ultrastructural appearance of acupoint LI 4 and
nearby skin biopsy samples. The ultrastructure of LI 4 point was examined
in two patients. The very small skin biopsies were obtained by punch biopsy
and examined under a transmission electron microscope. In conclusion, no
prominent ultrastructural difference was observed in between the acupoint
LI 4 and the biopsy specimen obtained from the nearby skin area.

4. TATAR Ilkan1, Necdet KOCABIYIK2, Ozcan GAYRETLI2 and Hasan OZAN2.

1
Department of Anatomy, Hacettepe University Medical School, Ankara, Turkey
2
Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey.
Relationship between deep branch of radial nerve and supinator muscle in fetus and
adults.
Radial nerve is one of the important terminal branches of posterior fascicle.
It splits its two main branches, superficial and deep, close to the cubital
fossa. We aimed to present the course of deep branch of the radial nerve
through the supinator muscle in this study. We investigated 80 upper limbs
of 20 formalin fixed fetuses (between 20 and 37 week gestational age) and
20 formalin fixed adult cadavers (mean 65 years old). Deep branch passes
under the supinator muscle through Frosse arch. Before it enters this arch, it
gives a motor branch to the extensor carpi radialis brevis muscle. In the arch
two thin branch, lateral and medial, accompanies with the radial nerve and
than they continue at under supinator muscle. Deep branch of radial nerve
gives its terminal branches at three different levels: superior and inferior
border of supinator muscle and between them. It was seen in 2, 33 and 5
fetus forearms respectively. On the other hand it was seen also in 3, 30 and 7
adult forearms. The knowledge about the course of deep branch of radial
nerve through the supinator muscle may be helpful to clinicians and
researchers interested in radius head dislocations and proximal end
fractures.
5. DENK Cem C., Department of Anatomy, Faculty of Medicine, Hacettepe University,
Ankara, Turkey. Leonardo Da Vinci And Anatomy
The aim of the study is to gather information on Da Vinci's life and his
studies about anatomy. One of the most important influences on the
development of anatomy is Da Vinci. He did enlightening studies on the
heart, respiratory, procreational, digestive and nervous systems. Da Vinci
discovered that the human body had observable proportions and studied the
human body with mathematical proportions. Leonardo Da Vinci could use
both his hands to write and draw, and this enabled him to keep notes with
his left hand while creating his work of art. The notes that he wrote with his
left hand can only be read with the assistance of a mirror. Da Vinci is also
the first person to define the heart valves' functional and structural anatomic
features and heart disorders due to the dissection works he had done. In
addition, Da Vinci is the founder of functional anatomy. Most of his
drawings are made in the dissection room, while working on cadavers, and
they include functional and physiological explanations. Leonardo Da Vinci
studied human anatomic structure by comparing it to different animal
anatomic structures. He was the first one to discover many things related to
anatomy such as, eyes, fetus and heart anatomy.

6. STECCO CarlaA, Veronica MACCHIA, Andrea PORZIONATO A, Luca LANCEROTTOA,

E.L. CARNIELB, P.G. PAVANB, Arturo NATALI B, Raffaele De CAROA
A) Department of Human Anatomy and Physiology, University of Padova,
Italy B) Centre of Mechanics of Biological Materials, University of Padova,
Padova Italy
Mechanical behaviour of crural fascia: from anatomical and
histological observation to constitutive modelling.
The aim of this study is to clarify the structural conformation, the
mechanical behaviour and to propose a constitutive model of the crural
fascia. It is a lamina of connective tissue with a mean thickness of 924 µm,
formed by two or three layers of parallel collagen fibre bundles. Each layer
is separated from the adjacent one by loose connective tissue that permits to
the different layers to slide one on the other. Adjacent layers show different
orientations of the collagen fibres. The elastic fibres are few. The
mathematical formulation is based on experimental evidence about the
structural conformation of the tissue and is capable to describe the main
mechanical characteristics of the tissue, such as the strong anisotropy, a
non-linear elastic behaviour and the possibility to have visco-elastic
behaviour or damage phenomena. These characteristics are given by the
specific orientation of the collagen fibres, their initial ‘crimp’ conformation
when unloaded and the progressive creep or failure when the tissue is
stretched over specified limits of strain. The possibility to describe and
numerically simulate inelastic phenomena is important for the investigation
of the crural fascia in the case of trauma, disease and compartimental
syndrome.
 Electronic poster
7. THOMSON, Richard M., David BRIGDEN, Peter DANGERFIELD. School of Medical
Education, University of Liverpool, Cedar House, Ashton Street Liverpool The Merits of
an Intercalated Degree in Anatomy for Medical Students
As part of the MBChB programme at Liverpool medical students are given
the opportunity to intercalate and study for a further degree. Many choose a
degree in Anatomy seeing this as being particularly relevant to the ongoing
study of medicine. Currently few medical schools provide an opportunity to
do dissection. A degree in Anatomy may be the best chance to gain this
experience. This, the authors believe, enables students to enhance their
understanding of the structure and function of the human body more than
would be gained during the medical degree. The practical laboratory skills
and opportunities for research provide new skills in critical appraisal,
essential for life long learning in medicine. The opportunity of working in
research groups enhances team working skills, vital during clinical practice.
Postgraduate medical training is extremely competitive, having a degree in
Anatomy and acquisition of new skills gives future clinicians the
competitive edge when applying for their first and future promoted posts.

Electronic poster
8. BURWELL, R Geoffrey1, Ranjit K AUJLA 1*, Alanah S KIRBY 1*, Peter H
DANGERFIELD2, Alan MOULTON 3, Ashley A COLE 1, Fran J POLAK1*, Roland K
PRATT1*, and John K WEBB1*, Centre for Spinal Studies and Surgery, Queen’s Medical
Centre, Nottingham, Children’s Hospital, University of Liverpool, and Department of
Orthopaedic Surgery, King’s Mill Hospital, Mansfield, UK. The timing of chest growth
in screened and preoperative girls with adolescent idiopathic scoliosis revealed by
body mass index: relation to puberty, thoracic visceral growth and the evolutionary
acquirement of bipedal gait (Supported by AO)
Biacromial width for age in adolescent girls was relatively larger in higher,
than in lower, body mass index (BMI) subsets in each of three groups of
girls. Here we evaluate chest sizes for age anthropometrically as lateral and
anteroposterior (AP) diameters by higher and lower BMI subsets about the
means in two groups of girls age 11-18 years: 1) scoliosis screening referrals
(n=147), and 2) preoperative girls with adolescent idiopathic scoliosis
(n=122). Higher BMI subsets reveal: 1) chest lateral and AP size for age
relatively greater than in lower BMI subsets of both groups (chest lateral:
screened p=0.001, preoperative p<0.001; chest AP, screened p=0.015,
preoperative p<0.001)(analysis of variance with corrections for age); and 2)
relatively earlier menarche. The findings for chest lateral diameter by BMI
subset are similar to those for biacromial and biiliac widths in these groups
of subjects. An earlier puberty with estrogen secretion explains the
relatively larger chest diameters in the higher BMI subset. By analogy with
early skull growth, the driving force to increasing chest diameters may be
thoracic visceral growth. The relatively wide human ribcage was acquired in
 human evolution with decoupling of head and trunk movements required for
efficient bipedal gait.

9. NISBET, Lee, Roger, SOAMES, Centre for Anatomy and Human Identification, College
of Life Sciences, University of Dundee, Dundee, Scotland. Innervation of the patella.
Anterior knee (patellofemoral) pain can result from overuse of the joint,
trauma or damage during surgery. An understanding of the origin and course
of nerves innervating the knee is paramount to reduce the risk of surgical
injury. Ten knees (5 left, 5 right) from nine cadavers (5 males and 4 females:
mean age 71 years) were examined. The infrapatellar branch of the
saphenous nerve (IPBSN) was identified and traced to the medial and
anterior aspects of the knee and proximal leg: in the midline of the patella it
divides into 2/3 branches which continue to the lateral aspect of the knee. In
5 knees a branch from the nerve to vastus medialis was observed running
with the descending genicular artery to the medial margin of the patella
within vastus medialis: no similar fibres were observed in either vastus
intermedius or lateralis. Whether fibres from the IPBSN or those within
vastus medialis are responsible for innervating the patella and relaying pain
could not be determined. Further detailed study of a larger number of knees
is required before the likelihood of these nerves being involved in the
transmission of pain can be determined.

10. ANANTHARACHAGAN Ariharan and Harold ELLIS, Department of Anatomy and

Human Sciences, School of Biomedical & Health Sciences, King’s College London, Guy’s
Campus, London Bridge, London, SE1 1UL. The incidence of pelvic phleboliths on
abdominal X-rays.
Phleboliths are small areas of calcification in a vein. When occurring in the
pelvis, they may be difficult to differentiate from small kidney stones. All
the abdominal X-rays taken at Guy’s Hospital and St Thomas’s Hospital for
duration of six months from October 2007 till April 2008 were looked at.
Patient’s aged 16 and above were included in the study. Phleboliths were
diagnosed based on central lucency. Information pertaining to age, sex and
site of phleboliths were recorded.

11. DENK Cem C., Department of Anatomy, Faculty of Medicine, Hacettepe University,
Ankara, Turkey. Cadavers From The Scope Of Religion And Law
The aim is to inform about the preparation of the cadavers, and the legal and
religious aspects of cadavers. The internet database was scanned. Related
official documents were studied. The experts of the subject were
interviewed. After researching the legal aspects of cadavers, related laws,
protocols and regulations were found. Laws no. 2238 and 2594 regulate
scientific studies on human corpses in Turkey. These laws regulate the
processes related to the corpses which are donated and bodies who are
unclaimed for, to be used in scientific university researches. These laws also
regulate the processes on the transportation, preservation, burial license of
 the cadavers. According to the related laws and protocols, the bodies of
voluntary donators and bodies which are unclaimed for at least 6 months
can be used as cadavers. The bodies are buried according to appropriate
religious procedures after being used in scientific researches. When the
usage of human corpses for scientific research is analyzed from a religious
aspect, it can be observed that according to Christianity, Islam and the
Jewish religion it is acceptable to use cadavers. The only point to be taken to
account is that the body is treated with respect during the burial procedures.

12. DENK Cem C., Department of Anatomy, Faculty of Medicine, Hacettepe University,
Ankara, Turkey. Organ Donation From A Religious Point Of View
The study examines the religious aspect of organ donation. Data bases,
scientific articles and experts on the subject were scanned and interviewed.
In general, major religions point of view, in special, all world religions point
of view on the subject was analyzed. In general, it was observed that the
most authorized institutions of all religions supported organ donation.
However, since religion is a sociologically variant phenomenon and every
religion has many sects, it is impossible to reach an absolute result on the
subject. Religions in Turkey were used in the project. The declarations
about organ donation of the authorized institutions of Islam, Christianity and
Jewish religion in Turkey were examined. The results are, major sects of
Christianity (Orthodox, Protestant, Catholic) and Islam support organ
donation, while the Jewish religion supports organ donation in vital
situations but forbids it in any other case. These religions argue that the
human body has no individual state of belonging and that the body parts
gives life to others after death cannot be banned because it is a 'necessity'.
There has been negative and radical statements on the subject but these
statements do not represent the general approach of religious authorities on
organ donation.

13. TATAR Ilkan, Peter Cheng-te CHOU and Mehmet BİLGEN. Department of Radiology,
Medical University of South Carolina, Charleston,SC,USA. Imaging corticospinal tract
connectivity in injured rodent spinal cords using manganese-enhanced magnetic
resonance imaging.
In rodents, the CST lies between the dorsal horns next to the central canal.
Anatomical magnetic resonance imaging (MRI) do not produce CST
specific image contrast, but manganese-enhanced (MEI) offers a novel
neuroimaging tool to anterogradely trace the CST in rodents. The goal of
this presentation is to expand the current MEI capability further and test its
utility to image the axonal fiber connectivity in an injured SC. Contusion
type spinal cord injury (SCI) was produced on rats at T4 level and at
postinjury day 14, MnCl2 solution was delivered into the rat’s motor cortex
bilaterally. The injection site was subjected to electrical stimulation. Next
day, the animal was imaged using anatomical, MEI and diffusion tensor
imaging (DTI) modalities. In sections rostral to the injury, MEI depicted
 signal enhancement confined spatially to the ventral-most part of the dorsal
funiculus between the dorsal horns of the gray matter. This enhanced region
overlapped exactly with the anatomical location of the CST in rodents. The
results demonstrate the feasibility of imaging fiber connectivity in
experimentally injured SC using MEI. This imaging approach may play
important role in future investigations aimed at understanding the
neuroplasticity in experimental SCI research.

14. CELIK Hakan Hamdi, Ilkan TATAR, Selcuk TUNALI and Muhammed Mustafa ALDUR.
Department of Anatomy, Hacettepe University Medical School 06100 Ankara,Turkey.
Creating Digital Anaglyph Images From Different Regions of Formalin Fixed
Cadavers and Their Usage on Anatomy Teaching and Examinations.
Cadavers are common materials of teaching for all departments as they
accelerate both graduate and postgraduate education. But the impossibilities
of body donation like tissue and organ donations in our country, we have to
go on with the present number of cadavers in the best efficient way for the
longest time. Just here we see the anaglyph technique in which the objects
are photographed from different viewpoints as stereopairs and then
perceived three dimensionally by using special filtered glasses.
Because of the organs in the body have close relationship each other and
they have a lot of different plane from superficial to deep, it must be imaged
and studied with carefully. The images taken from formalin-fixed cadavers
from two different viewpoints by anaglyph camera simultaneously, will be
processed in special software. Then they would be suitable for viewing with
anaglyph glasses. The images which will be held by this technique, would
be used as teaching and examination materials both in graduate and
postgraduate education activities. By this mean, more people would benefit
from limited number of cadavers and also it would be possible to have
cadaver based education outside the anatomy laboratory.

Electronic poster
15. BURWELL, R Geoffrey1, Ranjit K AUJLA 1*, Alanah S KIRBY 1*, Peter H
DANGERFIELD2, Alan MOULTON 3, Ashley A COLE 1, Fran J POLAK1*, Roland K
PRATT1*, and John K WEBB1*, Centre for Spinal Studies and Surgery, Queen’s Medical
Centre, Nottingham, Children’s Hospital, University of Liverpool, and Department of
Orthopaedic Surgery, King’s Mill Hospital, Mansfield, UK. Leptin-hypothalamic
mechanisms in the puberty of normal subjects: allocation of relatively less energy
stores (metabolic fuel) to skeletal growth in girls compared with boys (Supported by
AO)
There is a link between body fat and the timing of puberty with leptin
playing a permissive role. The coupling of skeletal growth to energy balance
involves leptin and Y2-receptors on neuropeptide Y hypothalamic neurons.
Here we evaluate skeletal sizes for age by higher and lower body mass
index (BMI) subsets about the means for normal boys (n=281) and girls
(n=274) age 11-18 years. Skeletal size for age by these higher and lower
 BMI subsets for boys and girls shows respectively (p values, ANOVA with
correction for age): biacromial width <0.001, 0.036; biiliac width <0.001,
0.014; corrected standing height 0.046, 0.612; corrected sitting height 0.002,
0.058; lengths of upper arm 0.140, 0.832; forearm-with-hand 0.029, 0.769;
and tibia 0.265, 0.879. In higher than lower BMI subsets significantly
greater (very highly or highly) are 1) relative trunk widths of boys
(italicized above); and 2) the sex effect favoring boys for each of biacromial
width, biiliac width, corrected standing height, subischial height, and
lengths of upper arm, forearm-with-hand and tibia (ANOVA with correction
for age and sex). The hypothesis is suggested that in puberty
leptin-hypothalamic mechanisms allocate less energy stores (metabolic fuel)
to the growing skeleton in girls than boys, because of preparing for
pregnancy and lactation.

Electronic poster
16. DANGERFIELD P H. Mason C Jones L. An anomalous muscle in the forearm. The
University of Liverpool, UK
In the course of routine dissection of the upper limbs of a donated cadaver
in the Department of Human Anatomy and Cell Biology at Liverpool, an
unusual muscle arrangement was found in the flexor compartment of both
forearms. This was established as an anomaly of Palmaris longus. While
this variant is reported to be common, it is the first instance noted in the
Liverpool dissecting rooms by the staff. One of the first reports of a similar
variant was recorded by John Morrison in 1916 in a paper in the journal of
Anatomy and Physiology. Historically, this is interesting as Dr Roberts was
the pathologist at the Royal Southern Hospital in Liverpool where
orthopaedics was established by Robert Jones and the first radiologist Dr
Thurston Holland also practiced.

17. OWENS Dave, Jiannis HAJIIOANNOU, Heiki B. WHITTET. Department of ENT

Singleton Hospital, Swansea. Pneumatization of Crista Galli. Anatomical variants with
potential clinical implications
Variations of ethmoid sinus and nasal anatomy are common and of clinical
relevance to endoscopic surgical management in this area. Pneumatization of
middle turbinates, abnormal pneumatization of anterior ethmoid (Haler cells)
and frontal ethmoid cells has been troublesome during endoscopic
procedures. The authors have encountered a number of cases in which
pneumatization of Crista Galli was notable. A case of Crista Galli mucocele
with connections to a congenital dermoid in the nasal bridge prompted an
investigation of the incidence of this feature. A series of CT scans (n=103) of
scull base and sinuses were reviewed and a classification system derived to
describe this finding. Crista Galli variations were classified according to the
relative position of it to the scull base and to the degree of pneumatization.
Three variation types of CG position were defined and pneumatization was
noticed in 13.6 % of the patients. The results will be presented and illustrated
 and the clinical implications will be discussed.

18. TATAR Ilkan, Peter Cheng-te CHOU and Mehmet BİLGEN. Department of Radiology,
Medical University of South Carolina, Charleston,SC,USA. Imaging corticospinal tract
connectivity in injured rodent spinal cords using manganese-enhanced magnetic
resonance imaging.
In rodents, the CST lies between the dorsal horns next to the central canal.
Anatomical magnetic resonance imaging (MRI) do not produce CST
specific image contrast, but manganese-enhanced (MEI) offers a novel
neuroimaging tool to anterogradely trace the CST in rodents. The goal of
this presentation is to expand the current MEI capability further and test its
utility to image the axonal fiber connectivity in an injured SC. Contusion
type spinal cord injury (SCI) was produced on rats at T4 level and at
postinjury day 14, MnCl2 solution was delivered into the rat’s motor cortex
bilaterally. The injection site was subjected to electrical stimulation. Next
day, the animal was imaged using anatomical, MEI and diffusion tensor
imaging (DTI) modalities. In sections rostral to the injury, MEI depicted
signal enhancement confined spatially to the ventral-most part of the dorsal
funiculus between the dorsal horns of the gray matter. This enhanced region
overlapped exactly with the anatomical location of the CST in rodents. The
results demonstrate the feasibility of imaging fiber connectivity in
experimentally injured SC using MEI. This imaging approach may play
important role in future investigations aimed at understanding the
neuroplasticity in experimental SCI research.

19. PORZIONATO Andrea, Veronica MACCHI, Carla STECCO, Cesare TIENGO, Enrico
VIGATO, Aldo MORRA, Anna PARENTI, Raffaele SCAPINELLI, Raffaele DE CARO
Department of Human Anatomy and Physiology, University of Padova, Italy Integrated
study of the vascularization of the infrapatellar fat pad
The present study focused on the vascularization of the infrapatellar fat pad,
which plays a pivotal mechanical role in the knee function. Twenty knees
from 20 cadavers (age range: 2 days – 77 years) were perfused with barium
sulphate suspension and resected. They were fixed, frozen, sectioned in
sagittal and coronal planes, and radiographed. Sections were also cleared by
the Spalteholz technique. Twenty-two other knees were studied in vivo
through CT angiographies to evaluate origin, number and calibre of arteries
irrorating the infrapatellar fat pad. Anatomical variations of the arteries of
the knee were quite frequently found. In 25% of cases, two middle genicular
arteries were present, the inferior one usually showing narrower calbre; in
30%, the middle genicular artery originated as a collateral of the lateral
superior geniculate artery. In newborns, the infrapatellar fat pad was
vascularized by the terminal branches of the middle geniculate artery,
medial inferior geniculate artery, lateral inferior geniculate artery and
anterior tibial recurrent artery which anastomose with each other. In adults,
vascularization of the fat pad by the anterior terminal branches of the middle
 geniculate artery was reduced, due to involution of the infrapatellar septum.

20. H. Hamdi ÇELİK, BROHI R. A., TATAR I, ŞEN F., DENK C. C. Department of Anatomy,
Faculty of Medicine, Hacettepe University, Ankara, Turkey. A Mylohoid Anomaly
together with Bilaterally Duplication of Digastric Anterior Belly
An anomaly of the mylohyoid muscle during dissection of the submental
region was revealed together with a bilateral duplication of the anterior
bellies of the digastric muscles. The mylohyoid muscle had distinguishable
muscle fibers originating from mylohyoid raphe and coursing inferior to the
anterior bellies of the digastric muscles to the mylohyoid line. The anterior
bellies of the digastric muscle (ABDM) were duplicated bilaterally. Such a
complex variation of the mylohyoid and digastrics together has not been
previously reported in the literature. Moreover, such an organization of the
fiber groups of the mylohyoid has never been reported.

21. OZISIK P.A.1, M. TORU2, C.C DENK2, Ö. TASKIRAN4 1,2,4

TDV 29 Mayis Hospital,
Departments of Neurosurgery, Radiology and Physiotherapy and Rehabilitation,
respectively. Ankara, Turkey. 3Hacettepe University, Faculty of Medicine, Department of
Anatomy, Ankara Turkey. Piriformis Syndrome With Excesssive Bilateral Leg Cramps
Piriformis syndrome is a rare neuromuscular disorder that occurs when the
piriformis muscle compresses or irritates the sciatic nerve, causing pain in
the buttocks and referring pain along the course of the sciatic nerve. The
authors presented 65 year old male patient, admitted to our hospital as an
outpatient with leg cramps for 1.5 years. He has fallen down from 3.5
meter-high on his buttocks. Since then he experience bilateral leg cramps
with some certain leg movements. When he performs squat down such as
going to alaturca toilet and/or working in his garden, he has got cramps in
his toes and calf muscles with severe pain and numbness in these areas. He
had bilateral L4, L5 and S1 hypesthesia. Cramps in the calf and cramp-like
flexion of the foot fingers were observed during PACE manoeuvre in both
legs. The patient underwent bilateral piriformis muscle injection with CT
guidance. All symptoms and findings were resolved in three days following
steroid and local anaesthetic drug infusion. In this poster the
pathophysiology of the syndrome will be discussed, as the piriformis
injection causes 8-10 ml. extra volume in the muscle and increases the
possibility of pressure on the nerve, on the basis of anatomical structures
and drug effect.

22. TRYFONIDIS Marios, Naffis ANJARWALLA*. Heatherwood and Whexham Park

Hospital NHS Trust, Slough, UK. An unusual case of acute onset non-traumatic
paraplegia and why knowledge of the relevant anatomy may make a difference in
patient management.
We present an unusual case of a 65 year-old man presenting with acute
onset non-traumatic paraplegia. The patient bent forwards and felt pain in
the back before collapsing on the floor with complete loss of sensory and
 motor function of both lower limbs. We present the clinical findings,
investigation process and outcome of the patient. We discuss the differential
diagnoses, review the relevant anatomy as clearly demonstrated in the
radiological investigations as well as previous relevant literature. This case
demonstrates the importance of good knowledge of basic anatomy of the
spine, spinal cord and its vascular supply by all clinicians dealing with
patients in the Emergency Department.

Electronic poster
23. BURWELL, R Geoffrey1, Ranjit K AUJLA 1*, Alanah S KIRBY 1*, Peter H
DANGERFIELD2, Alan MOULTON 3, Ashley A COLE 1, Fran J POLAK1*, Roland K
PRATT1*, and John K WEBB1*, Centre for Spinal Studies and Surgery, Queen’s Medical
Centre, Nottingham, Children’s Hospital, University of Liverpool, and Department of
Orthopaedic Surgery, King’s Mill Hospital, Mansfield, UK. The timing of trunk
widening in adolescent girls with scoliosis and in normals revealed by body mass
index: leptin-hypothalamic mechanisms allocate energy stores (metabolic fuel) to
puberty and the growing skeleton topographically mainly in the trunk (Supported by
AO)
Leptin, secreted by adipocytes, is a signal of energy sufficiency. It is master
hormone with many regulatory functions mediated through the
hypothalamus including appetite repression, initiation of puberty, control of
growth and reproduction, bone growth and formation both centrally through
the SNS and peripherally. Here we evaluate skeletal sizes for age by higher
and lower body mass index (BMI) subsets about the means for each of three
groups of girls age 11-18 years: 1) normals (n=274), 2) scoliosis screening
referrals (n=137), and 3) preoperative girls (n=110). Higher and lower BMI
subsets are likely to separate girls with higher from those with lower
circulating leptin levels. The higher BMI subsets reveal 1) biacromial and
biiliac sizes for age relatively larger than in the lower BMI subsets of all
three groups, and 2) relatively earlier menarche. In the higher BMI subsets
an earlier puberty with estrogen secretion explains the relatively larger trunk
width at shoulders and pelvis especially evident at the younger ages. These
findings for girls are consistent with 1) leptin-hypothalamic mechanisms
allocating energy stores (metabolic fuel) to the process of puberty and the
growing skeleton topographically mainly in the trunk, and 2) shoulder girdle
widening being driven mainly by lateral growth of the underlying ribcage.

Electronic poster
24. Veronica MACCHI, PORZIONATO Andrea, CLEMENTE Alberto*, MORRA Aldo**,
VIGATO Enrico, STECCO Carla, MACCHI Carlo, DE CARO Raffaele Dep. Human
Anatomy and Physiology, University of Padova; *Surgical, Anestetich and Radiologic
sciences, University of Ferrara; **Section od Radiology, Euganea Medica Center, Italy.
From the Virtuos Anatomy of Leonardo Da Vinci to the Virtual Anatomy of the
Radiological Bioimages
The aim of this study is to compare the anatomical drawings of Leonardo
Da Vinci and the radiological bioimages of 3D reconstruction of CT and
MR. 35 anatomical drawings of Leonardo have been selected from the
‘Codici di Anatomia’, Windsor Collection. 3D reconstruction of 30 CT and
10 MR have been performed, using a similar range of colour of Leonardo. A
good correspondence between the drawings of Leonardo and the
radiological bioimages has been obtained, also between some cross
sectional images of Leonardo and the corresponding radiological
reconstructions. Nowadays for the didactic purposes the 3D reconstrcution
obtained from CT and MR images can be used beside the anatomical
drawings and dissecting images, giving an optimal representation of the
morphology of the organs and a more intuitive visualisation of the deepness,
spatial orientation and topography of the structures.