Single bony landmark may not help in locating SH because of anatomical variations. Depth of hiatus less than 3 mm may be one of the causes for failure of needle insertion. Surrounding bony irregularities, different shapes of hiatus and defects in dorsal wall of sacral canal should be taken into consideration before undertaking caudal epidural block so as to avoid its failure.

The knowledge of sacral hiatus anatomy is imperative in clinical situations requiring caudal epidural block for various diagnostic and therapeutic procedures of the lumbosacral spine to avoid failure and dural injury. In this study, a detailed anatomic study of the sacral region was carried out on 49 male adult Indian cadavers. Dorsal surface of sacral region was dissected to study sacral cornua, sacral hiatus, and the dimensions of triangle formed by the right and left posterosuperior iliac spines with apex of the hiatus. Midsagittal sections were subjected for various anatomical measurements. The angle of needle insertion and the depth of caudal space were noted. Cornu was not palpable bilaterally in 7 (14.3%) and palpable unilaterally in 12 (24.5%) specimens. Mean (standard deviation) distance between apex of hiatus and coccyx tip was 57.5 (8.7) mm and length of sacrococcygeal ligament was 34.2 (7.4) mm. The dimensions of the triangle were found to be interchangeable in 25 cadavers. Once the needle is introduced into the canal after penetrating the sacrococcygeal ligament, it should not be advanced >5 mm to prevent dural puncture. The level of maximum curvature of sacrum was S3 in 34 (69.4%) of cases. The dural sac was found to terminate at S2 in 41 (83.6%). The mean (SD) angle of depression of the needle was 65.7 (5.5) (range 58-78). The measurements described for the identification of the sacral hiatus, optimal angle of depression, and depth of the needle may improve the safety and reliability of a caudal epidural block.

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Background: Pituitary growth hormone (GH) is a key hormone in the maintenance of glucose homeostasis. Results: GH acts on the macrophage to blunt the deleterious effects of diet-induced obesity (DIO) on insulin sensitivity. Conclusion:The effect of GH on glucose homeostasis is tissue-specific. Significance: Administration of GH could have salutary effects on DIO-associated chronic inflammation and insulin resistance in humans.

The objective of this work was to study the morphometry and morphology of the round window (RW) and its relationships with the internal carotid artery, jugular bulb (JB), facial nerve and oval window (OW). Fifty cadaveric temporal bones were microdissected to expose the medial wall of the middle ear. The areas around the RW were cleared and its shape, height and width were noted. Its distances from the carotid canal (CC), jugular fossa (JF), facial canal (FC), and OW were measured. Oval, round, triangular, comma, quadrangular, and pear shapes of RW were observed. The average height and width of the RW were 1.62 ± 0.77 mm and 1.15 ± 0.39 mm, respectively. There was a statistically significant correlation (r = 0.4, P < 0.01) between the height and width. The distances between the RW and the CC, JF, FC, and OW were in the ranges 4.39-11.05 mm, 0.38-8.65 mm, 2.99-6.3 mm, and 1.39-3.57 mm, respectively. In 8% of cases, the distance between the RW and the JF was <1 mm. There were no statistically significant differences with regard to age group, gender, or side. Electrode insertion can be challenging in cases where the height and width of the RW are <1 mm. The thin bone separating the roof of the JF from the RW (<1 mm in 8%) highlights a potential risk of injury to the JB during cochleostomy placement. This information could be useful for selecting cochlear implant electrodes in order to avoid potential risks to vital neurovascular structures during implant surgery.