Rajiv Gandhi University of Health Sciences s157
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE KARNATAKA
ANNEXURE II
PrOforma For Registration Of Subjects For Dissertation
1 / Name of the candidate and Address(Block letters) / : / Dr. PRIYANKA JAINAPURPOST GRADUATE
DEPARTMENT OF ANATOMY
M.R. MEDICAL COLLEGE,
GULBARGA – 585 105.
FAX- 08472 225085
Permanent Address / : / Dr. PRIYANKA JAINAPUR
D/O:B.K.JAINAPUR,
H.NO:462,
S.R.COLONY,
BIJAPUR, PIN-586101
2 / Name of the institution / : / M.R.MEDICAL COLLEGE,
GULBARGA, 585105.
3 / Course of study and subject. / : / M.D.(Anatomy)
4 / Date of Admission / : / 31st MAY 2012
5 / Title of Topic / : / "HUMAN CADAVERIC STUDY ON ANATOMICAL PARAMETERS OF TRACHEA IN NORTH KARNATAKA POPULATION"
6 / Brief resume of work
6.1 / Need for the study:
The trachea is a centrally located, membrano-cartilaginous unpaired hollow organ. It is extending downwards as a continuation of the larynx. It extends from the lower border of the cricoid cartilage opposite C6 vertebra up to the upper border of T5 vertebra1. It splits into right and left main stem bronchi which enter the respective lungs and progressively branch off throughout the entire organ, the tracheo bronchial tree4. The trachea is flexible and can rapidly alter in length. It is flattened posteriorly so that in transverse section it is shaped, with some individual variation, like a letter D. It is 10 -11 cm in length and 12 mm in breadth in adults. Its external transverse diameter is 2 cm in adult males, and 1.5 cm in adult females. The lumen in live adults is 1.2 cm in transverse diameter. In children the trachea is smaller, more deeply placed and more mobile2,3.
The tracheo bronchial tree is the essential part of respiratory tract. It serves as a tubular system for conducting air in and out of the alveoli of lung. It also participates in humidification, temperature adjustment and elimination of air borne pollutants of inspired air4.
The knowledge of anatomy particularly with respect to the shape (width-depth ratio) of the conducting and respiratory tube has drawn attention of both, anatomists and clinicians. Pulmonologists are particularly concerned with the relationship between the lumen of the conducting part of the respiratory tract and its significant role in production of allergic states, fibrosis of lungs and pulmonary tuberculosis1.
The study of the morphometric variations of the trachea is of profound clinical importance as it helpful for anesthetists to conduct certain maneuvers like endotracheal intubation and bronchoscopic procedures (diagnostic, therapeutic and combined) with skill and perfection1,4.It helps the clinicians to understand the etiology of several pulmonary diseases. It is helpful for the surgeons who deal with resection and reconstruction of the tracheobronchial tree1.
6.2 / Review of Literature
1. R Chunder et al studied on human trachea and principal bronchi in the Department of Anatomy, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India, 87 specimens were procured from 51 male and 36 female relatively disease free fresh cadavers. The specimens were grouped into five age groups for both sexes. The length of the trachea, principal bronchi and subcarinal angle were measured in each specimen. The external transverse diameter (width), internal transverse diameter and anteroposterior diameter (depth) were recorded at two different levels of trachea (junction of upper third and middle third; middle third and lower third) and middle of principal bronchi. Then the width-depth ratio was calculated and analysed. Their study revealed a wide variation in different dimensions viz. length, transverse and anteroposterior diameters and width-depth ratio of upper and lower trachea and right and left principal bronchi and the subcarinal angle, in the same age group as well as in different age groups in both sexes1.
2. Tahmina Begum et al studied in the Department of Anatomy, Sir Salimullah Medical College, Dhaka. The study was done on 47 trachea of Bangladeshi adult male, which were subdivided into four age groups, ranged from 20 to 58 years and comparative studies were done between different age groups. They concluded that the length of the trachea increased with the increasing age4.
3. Munguia-Canales DA et al did a cadaveric study on tracheal dimensions in the Mexican population. The aim of the study was to determine the length and tracheal diameter of adults and its correlation with external measurements. They dissected 44 cadavers, of which 19 (43%) were female and 25 (57%) were male. In females the average age was 39.2 ± 13.9 years (range: 19-61 years), average height 161.9 ± 7.4 cm (range: 154-179 cm), tracheal length (TL) 8.6 ± 0.5 cm(range: 7.8-9.5 cm) and transverse tracheal diameter (TD) 1.7 ± 0.3 cm (range: 1.3-2.0 cm). Average age of males was 36.4 ± 14.4 years (range: 19-65 years), average height 169.8 ± 6.7 cm (range: 156-184 cm), TL 9.1 ± 0.9 cm (range:8.0-10.7) and TD 1.9 ± 0.2 cm (range: 1.6-2.3 cm).They concluded that there was no significant correlation between TL and height in both sexes5.
4. Michal Szpinda et al studied on tracheal dimensions in human fetuses. The study was performed to compile normative data for external dimensions of the trachea at varying gestational age. Using anatomical dissection, digital image analysis and statistical analysis, a range of measurements (prebifurcation and bifurcation lengths, proximal and distal external transverse diameters, proximal external cross sectional area and external volume) for the trachea in 73 spontaneously aborted fetuses (39 male, 34 female) aged 14–25 weeks was examined. They conclude that the tracheal parameters do not show sexual differences. The developmental dynamics of prebifurcation and bifurcation lengths and proximal and distal external transverse diameters of the trachea follow linear functions dependent on the natural logarithm of fetal age, its external cross-sectional area-according to a linear function, and its external volume-according to a quadratic function6.
5. Eamann Breatnach et al did a radiological study on normal tracheal dimensions. In their study the coronal and sagittal diameters of the tracheal air column were measured on posteroanterior and lateral chest radiographs of 808 patients of which 430 were male and 378 were female with no clinical or radiographic evidence of respiratory disease. The aim of the study was to determine whether correlation exists between tracheal width and body weight or body height. Assuming a normative range that encompasses three standard deviations from the mean or 99.7% of the normal population, the upper limits of normal for coronal and sagittal diameters, respectively, in men aged 20-79, are 25 mm and 27mm; in women, they are 21 mm and 23 mm, respectively. The lower limit of normal for both dimensions is 13 mm in men and 10 mm in women. Deviation from these figures reflects pathologic widening or narrowing of the tracheal air column. Their study showed that there is no statistical significant correlation between trachea width and body weight7.
6. Nina Zahedi Nejad et al did a radiological study on normal dimensions of trachea and two main bronchi. The purpose of the study was to determine the normal diameters of larger airways in the Persian population. The sagittal and coronal diameters of trachea of two hundred subjects, including 132 men and 68 women aged 20–85 years, were studied. Coronal and sagittal diameters of the trachea in the upper part were as follows: 1.8±0.24 and 2.06±0.27cm for men, and 1.48±0.20 and 1.49±0.24 for women, respectively. For the lower part the values were 1.8±0.23, 1.86±0.27, 1.51±0.18, and 1.46±0.23, respectively. For the right and left main-stem bronchi the values were as follows: 1.16±0.17 and 1.02±0.22 for men and 0.93±0.13 and 0.81±0.13 for women, respectively. They concluded that the values determined by them had a narrower range of normality than the ones found in the previous reports8.
6.3 / Objectives of the study
1. To record the following parameters in cadavers including males and females
· Length of the trachea.
· Internal transverse and anterioposterior diameter of the trachea.
· External transverse and anterioposterior diameter of the trachea.
2. To compare the parameters between males and females.
7. / Materials and Methods
7.1 / Source of Data
Minimum of 50 human cadaveric trachea will be dissected to study and measure the anatomical parameters.
Trachea obtained from the Department of Anatomy from M.R. Medical College, Gulbarga; Homeopathy Medical College, Gulbarga; KBN Medical College Gulbarga
Following features of the trachea will be studied and measurements will be taken with BY USING A VERNIER CALIPERS AND MEASURING TAPE:
· Length of the trachea.
· Internal transverse and anterioposterior diameter of the trachea.
· External transverse and anterioposterior diameter of the trachea.
7.2 / Methods of collection of data
1. Place of study : Department of Anatomy, M.R.Medical College,
Gulbarga.
2. Duration of study : December 2012 to September 2014.
3. Sample size : Minimum 50 human cadaveric trachea.
4. Inclusion criteria : Not applicable.
5. Exclusion criteria : Not applicable
7.3 / Does the study require any investigation or intervention to be conducted on patients or other humans or animals’ if so describe briefly?
The study of anatomical parameters of trachea is done by dissection Method on human cadavers. So the study doesn’t require any investigation, No other interventions to be conducted on animals or other humans.
7.4 / Has Ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance has been taken from our institution for this study.
8 / List of References
1. R Chunder, S Nandi, R Guha and N Satyanarayana. A morphometric study of human trachea and principal bronchi in different age groups in both sexes and its clinical implications. Nepal Med Coll J 2012;12(4):207-214.
2. Susan Standring. Grays anatomy.40th ed. Edinburgh London : Churchill Livingstone 2008;1000-1005.
3. Datta.A.K. Essentials of human anatomy head and neck, 5th edition:160.
4. Tahmina Begum, Humaira Naushba, Jahangir Alam, Uttam Kumar Paul et al. Cadeveric length of trachea in Bangladeshi adult male. Bangladesh Journal of Anatomy. January 2009;7(1): 42-44.
5. Munguia-Canales DA, Ruiz-Flores J, Vargas-Mendoza GK, Morales-Gomez J, Mndez-Ramirez I, Murata C. Tracheal dimension in the Mexican population. Cir Cir 2011;79:465-510.
6. Michal Szpinda, Marcin Darozewski, Alina Wozniak, Anna Szpinda, Celestyna Mila-Kierzenkowska. Tracheal dimensions in human fetuses:an anatomical, digital and statistical study. Surg Radio Anat 2012;34:317-323.
7. Eamann Breatnach, Gypsy C Abbott, Robert G Fraser. Dimensions of the normal human trachea. American Journal of radiology 1984;141:903-906.
8. Nina Zahedi-Nejad, Mehrdad Bakhshayesh-Karam, Shahram Kahkoei, Azizola Abbasi-Dezfoully, Mohammad Reza Masjedi. Normal dimensions of trachea and two main bronchi in the Irani population. Polish Journal Radiology. Oct-Dec2011;76(4):28-31.
9 / Signature of candidate
10 / Remarks of Guide / It is worth to continue the dissertation.
11 / 11.1 Name and Designation of Guide. [In block letters]. / Dr. S.B. MALIPATIL
M.S.,F.I.A.S
PROFESSOR & H.O.D.,
DEPT OF ANATOMY,
M.R. MEDICAL COLLEGE, GULBARGA.
11.2 Signature of Guide
11.3 Co-Guide / -
11.4 Signature of Co-Guide / -
11.5 Head of the Department / Dr. S.B. MALIPATIL
M.S.,F.I.A.S
PROFESSOR & H.O.D.,
DEPT OF ANATOMY,
M.R. MEDICAL COLLEGE,
GULBARGA.
11.6 Signature
12 / 12.1 Remarks of the Chairman and Principal.
12.2 Signature