Clinical morphometry of male’s diaphragm in the sagittal plane.

Dudenko V.G., Vdovichenko V.I., Korobka I.M. Clinical morphometry of male’s diaphragm in the sagittal plane. ABSTRACT. Background. Individual spatial topography of the diaphragm is of great importance for understanding the organization of the body in a particular clinical case. For diagnostic and particularly therapeutic manipulation knowledge of the individual characteristics of each patient is required. This knowledge allows you to avoid damage to the internal organs of the abdominal and thoracic cavities when they puncture (catheterization) and more accurately determine the localization of the pathological process, choose the method further surgical or conservative treatment. Objectve. The purpose of our research was determination of the individual characteristics of the spatial topography of the human diaphragm in two vertical planes — sagittal and frontal based on SCT-research depending on gender, age and somatotype. Methods. According to the results of the measurements reveal the presence (or absence) of the relationship between individual characteristics and spatial topography of gender, age and the type of body structure. Results. The resulting data were also used to make individual 3D modeling programs for human diaphragm. Material the data of 75 patients surveyed in the last 2 years about various diseases of the abdominal and thoracic cavities. Any diaphragm with pathology was excluded. Analysis and image processing were performed on a workstation "HP-Z820" c using the specialized program "Vitrea 2". Gender-based cases were: male – 61 and female – 14 cases. Age interval from 26 to 82 years old, according to the type of the structure revealed the following relationships — male hypersthenics — 35%, normosthenics — 60%, asthenics — 15%; for female following ratio was 30%, 50% and 20% resp. Type of body structure was determined by the index of Pinue. Due to the limited amount of messages we do not give all the findings are limited to the minimum and maximum values. The height of the cupola of a diaphragm and angles of its attachment in the sagittal plane have been calculated. The study of angles of attachment of the human diaphragm in the sagittal plane was made along next lines: vertebral (vl), paravertebral (pvl), scapular (sl) and posterior axillary (pal) lines for left side and the same lines except vertebral line for right side of body. Statistical analysis of the measurements revealed little correlation between the age and height of diaphragmatic cupolas in male. Other parameters were not correlated with the studied values (sex and type of body structure). Conclusion. Individual spatial topography of the diaphragm is highly variable and is practically independent of sex, age and type of body structure. In some cases (10%) in both sexes the height of the cupola of the diaphragm more on the left side than the right. Obtained data should be taken into account in the interpretation of X-ray research data and performing thoracentesis left.


Introduction
Individual spatial topography of the diaphragm is of great importance for understanding the organization of the body in a particular clinical case [5]. For diagnostic and particularly therapeutic manipulation knowledge of the individual characteristics of each patient is required. This knowledge allows you to avoid damage to the internal organs of the abdominal and thoracic cavities when they puncture (catheterization) and more accurately determine the localization of the pathological process, choose the method further surgical or conservative treatment [6,7].
Objective The purpose of our research was determination of the individual characteristics of the spatial topography of the human diaphragm in two vertical planes sagittal and frontal based on SCT-research depending on gender, age and somatotype [1,2].
According to the results of the measurements reveal the presence (or absence) of the relationship between individual characteristics and spatial topography of gender, age and the type of body structure. The resulting data were also used to make individual __________________________________________________________________________________ MORPHOLOGIA • 2018 • Том 12 • № 3 75 3D modeling programs for human diaphragm [3,4].

Material and methods
Material the data of 75 patients surveyed in the last 2 years about various diseases of the abdominal and thoracic cavities. Any diaphragm with pathology was excluded. Analysis and image processing were performed on a workstation "HP-Z820" c using the specialized program "Vitrea 2".
Gender-based cases were: male -61 and female -14 cases. Age interval from 26 to 82 years old, according to the type of the structure revealed the following relationshipsmale hypersthenics -35%, normosthenics -60%, asthenics -15%; for female following ratio was 30%, 50% and 20% resp. Type of body structure was determined by the index of Pinue. Due to the limited amount of messages we do not give all the findings are limited to the minimum and maximum values.
The height of the cupola of a diaphragm and angles of its attachment in the sagittal plane have been calculated.
The study of angles of attachment of the human diaphragm in the sagittal plane was made along next lines: vertebral (vl), paravertebral (pvl), scapular (sl) and posterior axillary (pal) lines for left side and the same lines except vertebral line for right side of body.
Presentation data show values of 2 angles of attachment of the human diaphragm in the sagittal plane in male on indicated lines: for the anterior (as) and posterior (ps) surfaces ( Fig. 1).

Results and discussion
The data of the minimum and maximum values of the angle of attachment of the diaphragm in males are given in table 1.
The greatest number of values is noted in the range from 70° to 80°. Such cases were 17 (28.3%). In the range from 50° to 60°, 14 (23.3%) cases were detected.
Some cases were found in the interval from 60° to 70° -11 cases (18.3%). In the interval from 70° to 90° there were 16 cases (26.6%). Thus, 44.9% of observations were in the range from 60° to 90°. A total were made 42 measurements in male.
The second values for male along the left paravertebral line are the next: several values were repeated. This is 40.0° -2 cases (72 years old, hypersthenic and 63 years old, asthenic) and 75.0° -2 cases (50 years old, asthenic and 64 years old, normosthenic).
Angles of attaching the diaphragm along the left scapular line.
The values in the interval from 50° to 60° were encountered more often. There were 15 observations (25%). In the range from 60° to 80° 41.6% of all observations were encountered. Thus, in the range from 50° to 80° 66.6% of all observations were contained.
Values in the range from 30° to 40° were encountered the most often -21 observations, which accounted for 35% of all observations. Thus, 58.3% is detected in the range from 30° to 50°. The next line studied in the sagittal plane to the left is the posterior axillary line.
Angles of attaching the diaphragm on the right side along the same lines.
Values in the range from 40° to 50° were encountered more often. There were 22 observations (36.66%). Thus, in these intervals 51.66% of all cases were detected.
Values in the range from 50° to 60° were encountered more often. There were 17 observations (28.33%). Thus, in the range from 30° to 70° over 75% of all observations was occurred.
The values in the range from 30° to 40° were more common. Thus, in the interval from 30° to 50° -66.6% of all observations were detected.
Angles of attaching the diaphragm along the right posterior axillary line.
The values in the interval from 30° to 40° were more common. There were 23 cases (38.33%). Thus, in the range from 20° to 40° 64.99% of all observations were contained.
More often values were found in the range of 30° to 40° and 40° to 50°. Thus, in the interval from 30° to 50° 2 65% of all observations were detected. Conclusions 1. Individual spatial topography of the diaphragm is highly variable and is practically independent of sex, age and type of body structure.
2. In some cases (10%) in both sexes the height of the cupola of the diaphragm more on the left side than the right.
3. Obtained data should be taken into account in the interpretation of X-ray research data and performing thoracentesis left.

Prospects for further research
For increase knowledge about the spatial topography of the human diaphragm further studies in other planes and projections relatively with sex, age and type of body structure are needed.