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Table of Contents
Year : 2019  |  Volume : 68  |  Issue : 5  |  Page : 73-105

Poster Presentation

Date of Web Publication21-Oct-2019

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How to cite this article:
. Poster Presentation. J Anat Soc India 2019;68, Suppl S1:73-105

How to cite this URL:
. Poster Presentation. J Anat Soc India [serial online] 2019 [cited 2023 Feb 4];68, Suppl S1:73-105. Available from: https://www.jasi.org.in/text.asp?2019/68/5/73/269579

  Plantaris Muscle: Correlation to Muscular Evolution – (Fetal Studies) Top

C. K. Indira, K. G. Arun Kumar

Government Medical College, Konni, Kerala, India

Muscular evolution in humans is an overview of the muscular adaptations made by humans from early ancestors to modern man. Plantaris is regarded as vestigial by the reason of its slender diameter and its seemingly minor contribution to calf muscles. It is often referred to as' Freshmans nerve' because of its long tendon mistaken by fresh surgeons as nerve. Surgeons use it for repair of damaged tendon. Cruveilheir first proposed the muscle to be vestigial in man and as our evolutionary ancestors assumed erect posture, plantaris lost its original attachment to plantar aponeurosis. In apes and prosimians, plantaris is attached to plantar aponeurosis. In American polar bear, the muscle is as large as gastroncemius.

Aim of the Study: To study prevalence of the so called vestigial muscle plantaris and comparison with evolutionary studies of the muscle to ancestral beings.

Materials and Methods: On the 30 fetuses got from department of O&G, Government medical college Thrissur, plantaris muscle was dissected, length of the belly and tendon of muscle was measured, variation in origin of muscle was recorded.

Observation: Of the 30 fetuses dissected, 30% fetus showed absent plantaris muscle. There was variation in length of muscle in same fetus, and one limb showed two heads of origin.

Conclusion: Plantaris is used by animals in gripping and manipulating objects with feet. Now the muscle is so underdeveloped that it is taken by doctors for tissue reconstruction. Plantaris makes perfect sense that we share common ancestory with monkeys and it lost its function when we stopped swinging from trees.

  Awareness of Overweight and Obesity in 1st Year Dental Students Top

Jyoti Kiran Kohli

Manav Rachna Dental College, Faridabad, Haryana, India

Background: Obesity is a chronic medical condition associated with various health problems like persistant hypertension, coronary artery disease and stroke. Urbanization, unhealthy eating and reduced physical activity are the important reasons. Prevention of obesity is always better than its treatment. The aim of this study was to assess the awareness of dental students towards obesity and its complications.

Materials and Methods: A validated predesigned and pretested questionnaire was used. overweight/obesity was assessed on basis of body mass index (BMI) for age using gender specific center for disease control charts. Settings and design –cross-sectional study conducted in 1st year dental students, mrdc (Manav Rachna Dental College, Faridabad).

Statistical Analysis: ANOVA and unpaired t-tests were used to find out stastically association of mean BMI for age with various correlate.

Results: Out of 108 students, 101 were included in the study 72 (71.2%) females and 29 (28.7%) males. Total 25.7% were overweight students and 17.82% were obese with BMI >30 and grade 1 obesity while 1.9% were of grade 2 obesity. Out of 101 students only 40 students i.e 39.6% only are aware of their body weight while 60 students were not conscious /aware of their body weight (59.4%). 80% females (i.e 32/40) are found to be more aware while males were only 20% aware (i.e 8/40). Out of 101 only 35 students (34.6%) were aware of obesity and related complications of which females were more aware then males, i.e 77.14% of females as compare to 22.8% of males. 66 students were not aware of obesity and overweight and its complications i.e 65.34%, out of which males were 21/66=31.81%, while females were 45/66=68.1% only. Thus lack of awareness of overweight, obesity and its sequelae is found to be correlated with lack of physical activity, consumption of junk food, habbit of not consuming breakfast, consuming food in canteen and mess in dental students and related to obesity and overweight too.

Conclusion: The problem of obesity is on rise and there is a definite need to make dental students aware of good eating habbits, healthy eating, regular physical exercise and consequences of obesity for better control of physical as well as mental health.

  Study of Femoral Neck Anteversion Angle in Central Indian Population: A Guide for Orthopaedic Surgeries Including Hip Arthroplasty Top

D. Dhurandhar, J. Agrawal

Pt. J.N.M Medical College, Raipur, Chhattisgarh, India

Objectives: Femoral neck anteversion angle (FNA) is the angle which measures the anterior rotation of the neck of the femur around the shaft. Its variation in the various population groups is attributed to various factors such as heredity, diet, climatic factors and lifestyle. This angle is clinically significant for orthopedicians while doing hip arthroplasties and osteotomies where it is pertinent to restore the anatomy of proximal femur for stability of the hip joint. Thus, present study acts as a guide for normal values and range of this clinically significant angle.

Methods: 152 dried femora were procured from Department of anatomy consisting of 77 femora of right side and 75 femora of left side. Anteversion angle was recorded using Goniometer. Means were calculated and correlated for laterality using suitable statistical test after p value was obtained.

Results: Mean anteversion angle of right side was found to be 19.03° ± 12.10° (Range from -15 to 43) and that of the left side came out to be 18.62 ± 10.8° (Range from -15 to 46). Among 152 femora taken, 7 retroverted and 7 neutral verted femora were also found in the study. No significant difference in the values of FNA was found between right and left side, p value > 0.05.

Conclusions: So much variation in the angle of anteversion along with the presence of retroversion (4.6%) and neutral version (4.6%) is a challenge for both implant designer companies as well as orthopedicians.

  Variation in the Shapes of Coronoid Process of Dry Human Mandible of Gujarat Region Top

N. N. Chavda, P. D. Elaviya

Medical College Baroda, Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India

Objective: The coronoid process is one of the bony processes of the ramus of the mandible. It is a thin, triangular eminence, which is flattened from side to side. It varies in shape and size. The Knowledge of variation in the shapes of coronoid process is important for maxillofacial surgeons as a graft material as well as for anthropologists for the detection of races.

Aim: To determine the different shape of coronoid process of mandible in both sides.

Materials and Methods: The Present study was conducted on 50 mandibles from the department of Anatomy, Baroda Medical College, Baroda. Variations in the shapes were observed, and photographs were taken.

Results: Triangular shape of coronoid process was most prominent as compare to hook and round shape. Triangular shaped coronoid was seen in 70% shaped (Type: I) followed by Rounded shaped 26%, Hook shaped was least 4% respectively.

Conclusion: This study will be helpful for maxillofacial surgeons, anatomists, forensic researchers, anthropologists.

  The Anthropometric Measurements of Tibia in Central India Top

Gujar Vijay, Pradeep Bokariya, Kachhawa Karuna, M. R. Shende

MGIMS, Sevagram, Wardha, Maharashtra, India

Introduction: Anthropometry provides scientific method and technique for taking various measurements in different geographic regions and races. The Tibia itself is a complex anatomic unit so anthropometric study was devised on the same.

Objectives: To evaluate the morphometry of dried tibia of central Indian population; To use the obtained osteometric data to estimate the bilateral differences between the right and the left bones.

Materials and Methods: In the present study 60 (26 right and 34 left) intact adult tibia were obtained from the bone bank of Anatomy Department of MGIMS, Sevagram. For this purpose a digital vernier caliper, osteometric board and measuring tape were used.

Results: The mean of Cross Sectional index for Right tibias was 102.90± 22.78. Similarly mean of Cross Sectional index for left tibias was 124.31± 25.06. The mean of Cnemicus Index for Right tibias was 66.17 ± 10.68 and for left side these values came out to be 67.31 ± 7.35. The mean of Length-Thickness Index were 24.21 ± 0.96 and 24.43 ± 1.78 for right and left Tibias respectively.

Conclusion: The knowledge of the Morphometricvalues of tibia segments is important in forensic, anatomic and archeological cases. Therefore our study supplies the mean values of the different morphometric measurements from the tibia.

  Thyroid Hemiagenesis: A Case Report Top

P. Sankarganesh, S. D. Nalinakumari, Guru T. Arun

Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India

Introduction: Failure of development of one lobe of thyroid called unilateral thyroid agenesis, a rare developmental anomaly of the thyroid gland first reported in 1866 by Handfields-Jones. This anomaly has been commonly reported three times more in women compared to men. Among the lobes absence of left thyroid has been documented in more than 50% of reported cases. Multitude of pathologies that had been shown to be associated with thyroid hemiagenesis being thyroiditis, autoimmune thyroid diseases, hyper or hypo functional status and malignancy. Yet, the underlying causative factor still remains elusive for this condition that has 300 and odd literature reportings.

Case Report: A 23 year old male was subjected to radiological investigation following a swelling in the neck region that was suspected to be of thyroid origin. On clinical examination the swelling was found to be firm, non fluctuant, non tender, moved with deglutition. On USG examination absence of left lobe of thyroid with a rudimentary isthmus was noted. CT and MRI Neck showed hypertrophied right lobe of thyroid with rudimentary isthmus with total absence of left lobe. Biochemical investigation revealed a hypothyroid status with elevated TSH level and reduced T3, T4.

Conclusion: Non specific etiology coupled with rare occurrence of this condition mainly in women necessitated reporting of this condition that was observed in male gender. The management of this case is directed mainly towards correction of functional status and follow up to check for future malignant transformation.

  Right Renal Ectopia with Left Renal Agenesis: MDCT Angiographic Study Top

C. S. R. Babu, O. P. Gupta

Muzaffarnagar, Uttar Pradesh, India

Unilateral renal agenesis is one of the common congenital renal anomalies, more common in males and has a tendency to occur more on the left side. We incidentally detected a case of unilateral renal agenesis in a female patient who underwent multidetector computed tomography angiography for lower abdominal pain. Her past surgical history was negative for any abdominal surgery. She had an empty left renal fossa suggesting unilateral renal agenesis. The normally functioning right kidney was ectopically located in the right lumbar region with the upper pole opposite to L-3 vertebra and lower pole at L-5 vertebra. The right kidney was also malrotated with the hilum facing anteriorly. The ectopic right kidney was supplied by two renal arteries, one arising from the abdominal aorta passing anterior to inferior vena cava and posterior to the kidney and the second artery arising from anterior aspect of aortic bifurcation. A single right renal vein winds round the lateral aspect to open into inferior vena cava posterior to the kidney. The right ureter was normal. Embryologically failure of development of ureteric bud from the mesonephric duct results in unilateral renal agenesis. The patient also had lumbarization of first sacral vertebra. Clinically the condition may remain asymptomatic or may be associated with vesicoureteral reflux. Urogenital, musculoskeletal and cardiac anomalies may also be associated with this condition.

  Influence of BMI on Quadriceps (Q) Angle among Adult Female in Indian Population Top

Rai A. L. Thirumala

KITS Dental College

Background: The Quadriceps angle (Q-angle) is an important parameter to assess knee function and alignment. It provides an estimate of the vector force between the quadriceps femoris muscle and the patellar tendon. Lower extremity alignment can be disturbed with BMI (Body mass index) and may affect Q angle resulting in, loads on joints of lower limb.

Objective: This study was designed to determine influence of raised BMI on Q-angle values in adult females.

Materials and Methods: Bilateral Q angle of 75 subjects (female) was measuredusing the universal goniometer with subjects standing in an erect, weight-bearing position. Their ages ranged from 18 to 25 years. The subjects were divided into three groups (n=25 each group), Group-I (normal weight/ control), Group-II (over weight), and Group-III (obesity) based on the BMI. Bilateral asymmetry in Q-angle was calculated for significance (p<0.05) by unpaired student t-test at 95% confidence interval. Pearson correlation coefficients were used to examine the relationship of BMI with Q-angle with alpha level set at p=0.05. All statistical analysis was performed using SPSS version 21.0 for windows.

Results: In Group I, Group II and Group III, the mean Q-angles values of 50 limbs were 16.98 ±1.70, 18.54 ±1.78, and 20.82±1.54 respectively. Using one way ANOVA for the mean value of Q-angle in all the three groups a significant increase was seen with BMI (p<0.05). Significant bilateral asymmetry (p<0.05) was seen in Group I and Group III, with Q angle value being more on the right than on the left side in all the groups. A significant positive correlation of Q angle was seen with BMI in GroupII (r=0.8) and GroupIII (r=-0.3).

Conclusion: The present study shows a significant increase in Q angle values with raised BMI in adult females.

  VACTERL Association with Caudal Agenesis: A Case Report Top

N. Hema

ESICMC and PGIMSR, Bengaluru, Karnataka, India

Objectives: VACTERL association refers to mesodermal defects that leads to set of fetal anomalies without any particular causative factor. Genetic and environmental factors may play a role in this condition. It is also known as VATER association. This condition includes Vertebral defects, Anal atresia, Cardiac anomalies, Tracheo - esophageal fistula, Renal or Radial dysplasia with Limb defects. Studies shows the incidence to be less than 1/10,000 to 1/40,000 infants. Many differential diagnosis are made with these associated anomalies. I report a case of VACTERL associated fetus with its embryological significance.

Methods: The present case (dead fetus) of about 16 +or- 1 week was received in department of Anatomy at ESI Medical college, Bangalore. It was preserved in formalin, dissected and photographed.

Results: The anomalies included hydrocephalus with pre-sacral mass and absence of lower limb. It showed omphalocoele and ambiguous genitalia with imperforate anus. Internal features showed liver tissue extending into umbilicus and absence of kidneys. Antenatal scan showed khyphoscoliosis and severe oligohydramnios.

Conclusion: These set of anomalies occurred together in various forms than would be expected by chance, hence the condition was termed as association. Prompt diagnosis with early risk factors and genetic counselling reduces morbidity.

  Meromelia: A Case Report Top

J. D. Leishangthem, D. S. Irungbam, A. Rajkumari

Regional Institute of Medical Sciences, Imphal, Manipur, India

Objective: To report a case of congenital amputation of limb.

Methods: An abnormal male fetus with congenital amputation of limbs was collected from the obstetrics and gynaecology department, RIMS, Imphal after taking permission from the concerned authorities and parents. The fetus was observed externally and was dissected for further observation.

Results: The fetus on examination had absent left hand, the herniated viscera and the visceral contents seen are liver and small intestine and flattened nasal bridge.

Conclusion: Meromelia is the partial absence of a limb so that hands or feet are attached to the body like stumps. Such shrunken and deformed exterimities are caused mainly by amniotic bands. Genetic factors may play a role in the causation of the anomaly and some teratogenic (or environmental) factors have been identified, such as thalidomide. This study will illustrate the congenital partial absence of the left upper limb. The intimate interaction between genetic and environmental factors govern the limb pattern formation in humans and will elucidate the normal and pathological development of the body.

  Developmental Anomaly of Auricular Hillocks: A Case Report Top

A. Phairembam, R. Chongtham, M. Moirangthem

Regional Institute of Medical Sciences, Imphal, Manipur, India

Objectives: To study a case of developmental anomaly of external ear.

Methods: A female fetus of 36 weeks of age with auricular abnormality was collected from the Department of Obstetrics and Gynaecology, RIMS, Imphal, after taking permission from the concerned authorities and parents. The fetus was examined for external findings.

Results: On examination, the external features of the left ear of the fetus were found to be abnormal with no external meatus however, a pit was observed. On the right ear preauricular appendages was observed.

Conclusion: Auricular abnormality is one of the commonest forms of ear abnormality. Auricle is formed by fusion of six hillocks. Fusion is a complicated process giving rise to abnormal auricle. Cosmetic surgery requires a detailed knowledge of regional and developmental anatomy. We present a detail anatomy and developmental analysis of a case of auricular anomalies with review of relevant literatures.

  A Rare Case of Frontal Encephalocele Top

A. Sharma, M. Sharma, R. Singh

Government Medical College, Chandigarh, India

A case of Frontal Encephalocele was reported in 14 wksfetus during autopsy. Mother was 20 year oldprimi gravida. The defect was diagnosed on ultrasound at 13 wks of gestation. Mother was advised MTP. Fetus was sent to Anatomy department for autopsy. Parents did not give any history of neural tube defect in their family. Mother had no past disease suggestive of resulting in defect. She was nonsmoker and did not give any history of drug abuse. She was taking iron folic acid as suggested by her doctor, External examination revealed fetus had a frontal cystic swelling. Nose had not developed. Fetus also had anophthalmia and pinna were small and crumpled. No other CMF was seen on external examination. Autopsy was done after taking photograph and radiograph. Sagittal section of head showed intrafrontal encephalocele with no brain extension into the defect. Eyeballs were formed in orbits but palpebral fissures were not formed. Internally separate nasal cavity and oral cavity were seen in section. Frontal encephalocele are rare type of anterior encephalocele mainly found in South East Asia with incidence ranging from 1/35000 to 1/6000. Hereditary transmission is seen in the families. In liveborn usual presentation is swelling over the nose, hypertelorism, nasal obstruction, leaking encephalocele, meningitis and neurofibromatosis. The defect is usually diagnosed on ultrasound. If diagnosed early mother is advised termination of pregnancy. In live born surgical intervention is required.

  Molecular Profiling of HPV 16 and 18 Its Prevalence and Distribution in Saliva of the Patients with Oral Squamous Cell Carcinoma and Carcinoma of Cervix in Population of Vijayapura District, Karnataka Top

Bheemshetty S. Patil, S. Ritu Kumar, G. S. Kadakol, R. S. Bulagouda, I. B. Bagoji, S. R. Mudanur, P. B. Jaju

Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India

Background: Nowadays world's major population is suffering from different type's cancers and among all cervical cancer is the most common. This is the second most common cancer occurring among women in large areas of the developing countries, where an estimated 80% of new cases arise. Studies in 22 countries, coordinated by the International Agency for Research on Cancer (IARC), and identified HPV DNA in almost all (99.7% of about 1000) cases of cervical cancer. Advanced research and technology have focused on identifying possible risk factors such as oncogenic human papilloma virus.

Objectives: To identify the proportion of HPV among married women in Vijayapura district (Karnataka.) Identify high risk populations for cervical cancer. The high risk HPV genotypes (HPV 16 and 18) among married women in this region and develop the PCR based markers for high risk HPV types in this region.

Methodology: A total of 50 (30 malignant and 20 benign) tissue samples were obtained from Vijayapura district (Karnataka.) women with cervical cancer, were investigated for the presence of HPV subtypes 16 and 18 by Polymerase Chain Reaction (PCR) at Karnataka Institute of DNA Research (KIDNAR) Dhrawad and Laboratory of Genetics, Dept of anatomy Shri B M patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University) Vijayapura Karnataka.

Results: Of the 50 cervical cancer tissue specimens, HPV subtypes 10 and 12 by Polymerase Chain Reaction (PCR) were identified in 02/50 (6.7%), 2/50 (4%), 2/50 (4%), 2/50 (3.3%) and 3/50 (6.7%), respectively. The frequency of these HPV subtypes among Vijayapura district (Karnataka.) women with cervical cancer was 24%.

Conclusion: HPV subtypes 16 and 18 by Polymerase Chain Reaction (PCR) were prevalent among North Karnataka women with cervical cancer.

  Meroencephaly Top

Abhijeet Yadav

Gandhi Medical College, Bhopal, Madhya Pradesh, India

Anencephaly which is basically a misnomer used in place of meroencephaly. For a long time is one of the most common birth defect that is seen in stillborn fetuses. It has multifactorial relations with environment, genetics as well as nutrition. It can be diagnosed by ultrasound, serum alfafetoprotein (AFP) level. The term anencephaly which is commonly used is a misnomer because a remnant of the brain tissue is present. It's a type of upper neural tube defect that result in failure of the brain to develop. The present study was done of a female aborted fetus of 32 weeks having anencephaly whose specimen was present in our department. There was a history of polyhydraminios and no history of folic acid supplementation. The fetus showed absence of a major portion of scalp and cranial vault and the defect extended upto the cervical vertebrae. The brain tissue and spinal cord in the cervical region were exposed to the outside. The recurrence risk is 1.9% for parents who had one affected child. Folic acid supplementation has been shown to be an effective means of lowering recurrence risks for future pregnancies. It is recommended that she takes 400 micrograms of folic acid daily and then 1000 micrograms per day when she tries to become pregnant. So we planned to present a case report of this very anomaly with its development and genetic causes that lead to this lethal but preventable congenital defect.

  A Case Report on Vascular Malformation Top

M. Raj, N. S. Thounaojam, A. J. Devi

Regional Institute of Medical Sciences, Imphal, Manipur, India

Objective: To report a case of vascular malformation.

Methods: A term female baby weighing 2.94 kg was selected for the study from the Department Obstetrics and Gynaecology, RIMS, Imphal after getting permission from the concerned authorities and parents. Crown rump length of the baby was found to be 36 cm. The baby was examined for external findings.

Results: On examination, a vascular malformation was found over the face and neck over right side. It was extending to right side of nose upper lip, eyes and right ear. Right side of shoulder was also affected. A mongloid spot was also seen over the buttocks.

Conclusion: Port wine stain is a discoloration of human skin caused by vascular anomaly (capillary malformation) in the skin. Due to its location and appearance it can be a port wine stain.

  Oxidative DNA Damage to Paternal Genome – Mother of Childhood Diseases Top

V. Dhawan, M. Kumar, D. Dipika, D. Vatsla, P. Chaurasia, R. Dada

AIIMS, New Delhi, India

Background: Oxidative DNA damage in the male germ line has been shown to be related to poor fertilization rates, derangements in pre-implantation embryonic development, risk of congenital malfornations, miscarriage and increased incidence of childhood diseases like autism, schizophrenia and even childhood carcinomas. The structurally and epigenetically marked paternal genome is highly susceptible to oxidative insult with a collateral induction of lipid peroxidation, DNA damage and propensity of mutations/epimutations in the embryo. The current case control study aims to analyse the oxidative DNA damage in the semen samples of male partners of couples who had previously reported fetal congenital malformations (CMF).

Materials and Methods: Semen samples from 25 male partners of couples with previous conception with CMF and 25 healthy fertile controls. Semen analysis was assessed by WHO (2010) criteria. ROS levels were assessed by chemiluminescence, DFI by sperm chromatin structure assay and 8-OhdG levels by ELISA.

Results: The mean DFI of male partners of couples with CMF was significantly higher (>28) (37.32 ± 6.23) as compared to controls (22.34 ± 5.67) (p<0.0001). The mean ROS level was also seen to be significantly higher (>25) (45.7 ± 9.23) RLU/sec/million sperm. 8-OHdG, the mutagenic base in sperm DNA also showed significantly higher levels in patients (p<0.001).

Conclusion: The resolution of the causes of DNA damage in the male germ line thus becomes pertinent to minimize the generation of genetic/epigenetic damage in the embryos. The adoption of various lifestyle modifications, yoga/meditation may aid as an adjunct in management.

  Cyclopia: A Case Report Top

S. D. Sanjenbam, G. Sharma, N. S. Thounaojam

Regional Institute of Medical Sciences, Imphal, Manipur, India

Objective: Cyclopia is a rare congenital craniofacial abnormality considered the severest form of alobar holoprosencephaly.

Methods: On routine collection of fetuses from the department of Obstetrics and Gynaecology, an abnormal fetus with facial deformity was found. The fetus was examined externally, and further dissection was done to see any internal abnormalities.

Results: A 32 weeks old female fetus. On external examination, the fetus had a deformed face having a single central slit-like orbital groove, with a superiorly attached blind-ending proboscis. Nose was absent. Mouth was well developed. The brain consists of a non-cleaved frontal lobe with absent tracts and bulbs. The pitiutary gland was absent.

Conclusion: Cyclopia is the severest facial expression of the holoprosencephaly syndrome. Its incidence is 1 in 100000 in newborns. It is aetiopathogenically heterogenous and incompatible with life.

  Anencephaly: A Case Report and Lesson for the Future Top

Fariha Sabeen

Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India

Objective: The main objective of this particular case report is to create awareness among the people about the importance of folic acid intake, not only during pregnancy but even before it. As anencephaly could be prevented but not cured, hence a small step such as eating food rich in folic acid, along with folic acid supplementation can prevent many from this dreadful ill-fated disorder and the mothers from the emotional turmoil.

Methods: A pregnant women of G2 P1, aged 28 years presented with 29 weeks of gestation, without any prior antenatal checkups. She complained of watery discharge per vagina in large amount. On examination abdomen was over distended with fundal height of 32 weeks. She delivered a still born anencephalic female baby. On further asking she revealed there was no history of iron and folic acid intake.

Results: The anencephalic baby was female and weighed 1.2 kg. External examination revealed complete absence of the cranium. Cerebrum and cerebellum were reduced, but brain stem was present. The eyeballs were protruded, which gave the appearance of a frog. The remaining of the facial features and body were typical to a developing premature baby.

Conclusion: The case highlights the importance of folic acid even before conception and also during pregnancy. The author recommends fortification of regular food products such as wheat and salt before selling. Antenatal checkups are crucial along with Anatomical USG, so that such birth defects may be diagnosed beforehand and terminated after proper counseling.

  Hydrops Fetalis with Cystic Hygroma: A Case Report with Its Embryological Basis Top

Shilpi Garg, Amit Saxena, Prachi Aneja

SGT Medical College, Gurugram, Haryana, India

Introduction: Cystic hygromas are malformations of the lymphatic system that appears in the anterolateral or occipito cervical area. They are usually the result of juglar lymphatic obstruction in which the normal communication between the juglar veins and the juglar lymphatic sacs fails to develop. Various genetic factors like SHH (sonic hedgehog) and VEGF (vasculo endothelial growth factor) are involved in the specification of arteries, veins and the lymphatic system after angioblast induction.

Materials and Methods: An 18 weeks old male fetus product of spontaneous abortion of 21 yr old primi gravida was examined for swelling in the neck region after obtaining ethical consent from the parents in SGT medical college, Gurgaon. Fetal autopsy has been done by giving Y shaped incision and all the internal organs has been examined.

Observations: There was generalized edema along with a cystic swelling of well-defined margins around 2×1.5 cm in the posterolateral compartment of the neck. Gestational age was determined by taking various parameters like C.R.L =16.2 cm, B.P.D =8.5 cm, F.L=2.8 cm and it was corresponding with the menstrual history. All the facial features including eyes, nose, ear, lips were formed. Umbilical cord was normally present. In Fetal autopsy all the internal organs were normal and no any other congenital abnormalities was seen.

Conclusions: This case report highlighted the association between the cystic hygroma and hydrops fetalis. Due to its poor prognosis termination should be considered before viability. The diagnosis can be made early by routine antenatal USG screening.

  Exstrophy of Bladder: A Case Report Top

Jayanta Biswas

Topiwala National Medical College, Mumbai, Maharashtra, India

Bladder exstrophy is a ventral body wall defect in which the bladder mucosa is exposed, epispadis is a constant feature. The open urinary tract extends from dorsum of penis through the bladder to umbilicus. It may be due to defect of lateral body wall fold which fail to close in the mid line. It is found only in 2 out of 100000 babies born.

We present a neonatal case of exstrophy of bladder that came in the department of pediatrics, with defect in the lower abdominal wall and protrusion of globular soft swelling, also presenting with continuous dribbling of urine from a opening in lower abdomen.

We are giving a note on its teratology along with it.

  Morphometry of Upper Limb in Fetuses Top

Avinash Abhaya, Arun Sharma, Kanchan Kapoor

Government Medical College and Hospital, Chandigarh, India

Objectives: To study the morphometry of upper limb of fetuses of different gestational age group.

Methods: Morphometric observations were done before foetal autopsy in 47 spontaneously aborted Foetuses (Male-30, Female-17) which were without any gross morphological malformations. Fetuses were divided into four groups (I-IV) according to their gestational age from 12-16, 16+-20, 20 +-24 & 24+-28 wks respectively. The following measurements were recorded using tape & spreading calliper.

  1. Shoulder Width (SW)
  2. Arm Circumference (At Upper Arm- UAC & Lower Arm- LAC)
  3. Forearm conference (At Upper Forearm –UFC & Lower Forearm-LFC)
  4. Hand Length (HL).

Results: The average values for each parameter were calculated. The shoulder width (SW) of group I to IV were 37.2, 48.33, 60.31 & 66.8 mm. The arm circumference (UAC & LAC) were 24.2, 37.13, 48.31, 47.6 mm and 20.4, 33.79, 48.08, 46.6 mm respectively in each group. The forearm circumference (UFC & LFC) were 18.8, 30.88, 43.85 & 45.2 mm and 18.2, 27.21, 39, 42.2 mm respectively. The hand length were 16.8, 21.33, 25.92, 28.4 mm respectively in group I to IV. The readings were compared with other bio-metric parameters.

Conclusion: The present observations will be discussed in light of available literature.

  A Huge Lipoma Mimicking Thyroid Swelling Top

Reeta Kushwah, Rajendra Gupta

Gajra Raja Medical College, Gwalior, Madhya Pradesh, India

Study was conducted on 60 years old resident of Gol Pahadiya, Gwalior admitted in female surgery ward, Kamla Raja Hospital, Gwalior with presenting complaint of huge swelling over anterior aspect of neck since last 15 years. On examination swelling was 30×25 cm in size, bilobed, globular in shape present over anterior aspect of neck with smooth surface, with dilated veins present over it, overlying skin is freely mobile not fixed to surrounding structures and swelling moving with deglutition. Laboratory test shown Hb - 9.2 gm%, TLC - 6400 mm3, DLC – P62L37M0E0B0, RBS – 80 mg%, urea – 34 mg%, chest x-ray - bilateral lung field clear, cardiac shadow normal. Soft tissue swelling seen in neck and upper chest, ECG – occasional APC with ST-T changes. Thyroid profile – T3 0.26 ng/ml, T4 7.0 mg/dl, TSH – 3.0 mIU/ml. X-ray soft tissue neck – soft tissue swelling in anterior part of neck compressing trachea and extending over chest. USG neck – Large heterogeneous mass seen anteriorly involving the entire neck with few dilated vessels, displacing the carotid vessels and IJV laterally, most probably originating from thyroid. USG abdomen – spleenomegaly with dilated splenic vein with ascites. FNAC – Only mature adipose tissue seen suggestive of lipoma. IDL- vocal cord movement present. Left side vocal cord thickening present compared to right side. Lipoma present on anterior aspect of neck mimicking a thyroid swelling is rare finding, amazing and largest till date.

  An Independent Muscle Belly Housed within the Posterior Triangle of the Neck: A Case Report Top

A. Guru, N. Kumar

Melaka Manipal Medical College, Manipal, Karnataka, India

Objective: To dissect the unusual muscle located within the posterior triangle to determine the variation.

Methods: The left posterior triangle of an embalmed male cadaver was dissected to trace the unusual muscle located within the space of posterior triangle of the neck. The origin, insertion and nerve supply are traced to determine the variation.

Results: The proximal attachment of the unusual muscle was concealed by the insertion of the sternocleidomastoid muscle. Upon reflection of the insertion part of sternocleidomastoid muscle, the unusual muscle was observed to be attached to the undersurface of the sternocleidomastoid. The muscle then passed downwards and laterally deep to the trapezius. Distally it was attached to the undersurface of the trapezius. The unusual muscle was supplied by a thin branch from the spinal part of accessory nerve prior to piercing the trapezius. The fibers of the unusual muscle were directed downwards and laterally but did not coincide with that of the underlying muscles namely levator scapulae and the scalene muscles.

Conclusion: Owing to the connection between the sternocleidomastoid and trapezius, the unusual muscle may be regarded as a remnant of the occipital myotome that gives rise to the two muscles.

  Multiple Innervation of the Human Brachialis Muscle: A Case Report Top

A. M. Prasad, Anu V. Ranade, B. V. Murlimanju

Manipal, Karnataka, India

We report variation in the innervation of the brachialis muscle, which was observed in the left arm of a formalin fixed cadaver. There was a nerve plexus in between the biceps brachii and brachialis muscles. This nerve plexus was formed by the branches from the musculocutaneous and the median nerves. The brachialis muscle was supplied by two of the branches from this nerve plexus. The brachialis muscle was innervated by a branch from the median nerve as well. There was another branch, which exhibited an oblique course and fused with the musculocutaneous nerve to form the lateral cutaneous nerve of forearm. Radial nerve was also observed to be innervating the brachialis muscle in the present case. This multiple innervation of the brachialis muscle is not reported previously in the literature. The variant course and branching pattern as in the present case have implications in the compression neuralgia, unexplained signs and symptoms. This type of neuroanatomical variation has clinical implications due to their involvement in the entrapment syndromes and injuries during the surgery.

  Bilateral High Division of Sciatic Nerve in a Human Female Cadaver: A Case Study Top

T. S. Solomon, A. K. Nayyar, S. Ghatak

All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Objectives: The sciatic nerve separates into its branches, the tibial and common peroneal nerves at the apex of popliteal fossa. However, rarely it may be separated in lesser pelvis. In such cases, its two branches may leave the pelvis through different routes. These variations may cause nerve compression under other anatomic structures resulting in non discogenic sciatica.

Methods: Bilateral high division of sciatic nerve was observed during routine dissection of a 81 year old formalin fixed female cadaver during undergraduate teaching program in the Department of Anatomy, AIIMS Jodhpur.

Results: On dissection of the gluteal region of the female cadaver, high division of sciatic nerve (within the pelvis) was present bilaterally. On the right side, the common peroneal nerve entered the gluteal region superior to the piriformis while tibial nerve entered inferior to the piriformis. While on the left side both the nerves entered the gluteal region below the piriformis after their division in pelvis.

Conclusion: High division of sciatic nerve is important clinically for knowing the etiology of non discogenic sciatica, accidental nerve injury during deep intramuscular injections in gluteal region, piriformis syndrome and nerve injury during posterior hip dislocations.

  Anterior Appendix: A Boon or a Curse? Top

B. Satheesha Nayak

Manipal, Karnataka, India

Vermiform appendix is a part of large intestine. It is usually attached to the posteromedial wall of the caecum. It is considered as a vestigial organ, and has almost no role to play in the digestion and absorption of the food. It is an enigma to the clinicians due to its variable positions and symptoms caused by its inflammation. In the available literature, there are many reports on variant positions and size of appendix. However, there is no report on an anteriorly located appendicular attachment to the caecum. During dissection classes for medical undergraduates, an appendix with its base attached to the anterior wall of the caecum was noted. The appendix was suspended from the ileum through a mesoappendix and was entirely visible when the anterior abdominal wall was reflected. The anterior position of appendix could be considered as a boon to the clinicians because it could be easy to diagnose its inflammation and to remove it surgically due to a more visible position in the abdomen. At the same time, this could be the most vulnerable position of appendix since it was directly touching the anterior abdominal wall. The spread of infection from this position is easier than other positions. There is a greater chance for its rupture since it is directly exposed to the vibrations of the anterior abdominal wall.

  Double Femoral Veins and Other Variations in the Lower Limbs of a Single Cadaver Top

C. Samanta, S. Majumdar

Sushrutanagar, Darjeeling, West Bengal, India

Introduction: In a single formalin embalmed male cadaver (about 70 years old) multiple variations were found in the lower limbs during routine dissection for undergraduate students in the Department of Anatomy, NRS Medical College, Kolkata, India.

Results: In the left lower limb of the cadaver, there were two femoral veins (lateral and medial) flanking the femoral artery. The long saphenous vein passed deep to the adductor longus muscle to drain into the medial femoral vein. Moreover, the medial and the lateral circumflex femoral arteries arose directly from the femoral artery. In the right lower limb, the sacrotuberous ligament was big enough and was attached with the gluteus maximus, piriformis and hamstring group of muscles. There was also high division of the sciatic nerve into tibial and common peroneal components emerging separately in the gluteal region in the right inferior extremity.

Conclusion: This case report will augment our knowledge in gross and surgical anatomy, physical medicine and nerve block (regional anaesthesia) in relation to inferior extremity.

  Sacralization of Lumbar Vertebra: A Case Report Top

S. Gupta, V. D. S. Jamwal, S. Kumar

AFMC, Pune, Maharashtra, India

Lumbosacral transitional vertebrae (LSTV) are congenital spinal anomalies, in which an elongated transverse process of the last lumbar vertebra fuses with varying degree to the “first” sacral segment. LSTV, as a morphological variation, spans a spectrum from partial/complete L5 sacralization to partial/complete S1 lumbarization. When the L5 vertebra fuses completely to the sacrum, 4 lumbar vertebrae exist, whereas when S1 separates entirely from the sacrum, 6 lumbar vertebrae exist and the sagittal contour of the spine becomes more lordotic. Many intermediate incomplete transitions have also been recognized and classified as LSTV.

Methods: The variation was observed during one routine osteology tutorial. The same is presented.

Observation: Sacralization of 5th lumbar vertebra is observed.

Conclusion: Sacralization of L5 vertebra is a congenital anomaly, in which L5, mainly its transverse process, gets fused or semi-fused with the sacrum or the ilium or to both. This fusion can occur in one or both sides of the body. Sacralization has several forms, classified according to whether the fusion seen on an X-ray is partial or total, and whether the fusion is on only one side (unilateral) or both (bilateral). The commonly used Castellvi classification is:

  • Type 1: a fusion at least 19 mm in width on one (1a) or both sides (1b)
  • Type 2: incomplete fusion with a pseudo joint created on one side (2a) or both sides (2b)
  • Type 3: complete fusion of the L5 to the sacrum on one side (3a) or the other (3b)
  • Type 4: combination of Type 2 and Type 3.

Due to it, L5 appears and works more like sacral components so known as sacralized vertebra. Only four lumbar vertebra presents, hence this condition also known as 'one less vertebra'. It occurs during embryonic development, when the vertebrae begin to ossify, in about the eighth week. There may be a genetic predisposition involved. Estimates of the incidence of sacralization in the general population vary widely, from 4 to 36 percent.

  A Novel Way to Macerate Bones Top

A. Soni, A. Kumar, A. Sharma, H. Vohra

Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Objective: Learning osteology is an essential part of anatomy curriculum. However, recently, there has been scarcity in availability of bones for teaching in India. A solution must be found to meet the demand as the supply dwindles. Traditional methods of getting bones being very tedious and time consuming are not able to meet the requirement of bones. Therefore, the present study was conducted to procure bones by a new method which will be less time consuming and more simpler.

Methods: The study was carried on the dissected upper limb made available from the department of Anatomy, Dayanand Medical College and Hospital, Ludhiana. The upper limb was defleshed. The bones were freed from the joint. A paste was made using baking soda and 20% hydrogen peroxide and applied and kept for twenty four hours. The bones were washed and dried. After that any remaining soft tissue was removed manually.

Results and Conclusions: The new method was very efficient as the time taken to macerate was very less. It was easy to perform. The bones were procured completely.

  Relationship between Tracheal Bifurcations and Pulmonary Trunk Bifurcations Top

S. Maurya, A. Tuli, S. Raheja

Lady Hardinge Medical College, New Delhi, India

Introduction: The bifurcation of the pulmonary trunk and trachea were followed on 30 cases being appreciated on the dissection. Ventral side of the pulmonary trunk bifurcation corresponds to tracheal bifurcation. The pulmonary trunk is slightly more caudal then tracheal bifurcation and is related to it.

Objective: The recognition of relation of tracheal bifurcation and pulmonary trunk bifurcation to prevent to avoid the devascularization of a lobe or segment left in place during pulmonary excision.

Methods: Trachea with right and left principle bronchus and heart with pulmonary trunk obtained from 30 cadavers of age group 18-75 yrs on whom medicolegal postmortem had been conducted in the department of Anatomy and Forensic, LHMC & SSKH.

Results: The tracheal bifurcation formed an angle of 76o, the bifurcation of trachea and pulmonary trunk makes a triangular, rectangular, quadrangular and asymetricinterbifurcalspace. When this interbifurcal area was triangular, when the base was formed by pulmonarytrunk and right pulmonary artery and apex by tracheal bifurcation. The pulmonary artery trunk is located about 3 cm caudal to the trachealbifurcation. When the left pulmonary artery also took part in the formation of space, then it formed a quadrangular interbifurcal space.

Conclusions: The recognition of the pulmonary artery branches variations leading to geometrical spaces formation is of importance in pulmonary excision of a lobe or a segment to avoid thedevascularization of a lobe or segment left in place.

  Unusual Branching Pattern and Termination of Facial Artery and Its Clinical Implication for Facial Surgeries Top

P. Ashwini Aithal, Naveen Kumar

Manipal, Karnataka, India

Facial artery is the main artery of the face. It is known to show some variations in its origin, course, and branching pattern. We found multiple variations of the facial artery on the face. The left facial artery gave a large posterior (premasseteric) branch, which ran upwards behind the main trunk of facial artery. This artery had a straight course along the anterior border of masseter and terminated by supplying the adjacent tissues below the parotid duct. The facial artery was thick, tortuous, and terminated as the superior labial artery. Knowledge of this variation is of great academic and clinical significance in general practice. It is important for maxillofacial surgeons and plastic surgeons as it forms the anatomical basis for the facial artery musculo-mucosal flap.

  Horseshoe Kidney: A Case Report Top

Vyas Lekhni, Ojha Parveen

Udaipur, Rajasthan, India

Objective: Horseshoe kidney is a rare congenital malformation of kidney. This anomaly occurs in 0.25% of the general population and it is more common in male than female in a 2:1 ratio.

Methods: Horseshoe kidney was observed in 62 years old male cadaver during routine dissection for undergraduate teaching in the department of Anatomy, R.N.T. Medical College, Udaipur, Rajasthan.

Results: In present case the lower poles of both right and left kidneys were fused by an isthmus to form horseshoe kidney which laid anterior to both abdominal aorta and inferior vena cava. Horseshoe kidney extended from lower border of L3 to upper border of L5 vertebra with renal hila directed anteriorly. Both the ureters and inferior mesenteric artery were anterior to the isthmus. No other congenital anomaly was observed.

Conclusion: The incidence of horseshoe kidney is known with patients of Turner's syndrome, Edward syndrome. It is more frequently associated with calculi formation, urinary tract infections, pelviureteric junction obstruction, hydronephrosis.

  Absence of Profunda Brachii Artery: A Cadaveric Study Top

Sushant Vanawat, Ghanshyam Gupta

R.N.T. Medical College, Udaipur, Rajasthan, India

Objective: Profunda brachii (deep brachial artery) is a large branch from posteriomedial aspect of the brachial artery distal to teres major. It follows the radial nerve and gives muscular branches, nutrient artery to the humerus and terminal branches are radial and middle collateral arteries which take part in the anastomosis around elbow joint.

Methods: During routine dissection of upper limb of an adult male cadaver in the department of Anatomy, R.N.T. Medical College, Udaipur, absence of profunda brachii artery was noticed bilaterally.

Results: During the dissection of axilla and anterior compartment of arm profunda brachii artery was observed to be absent and a branch of posterior circumflex humeral artery followed course of profunda brachii artery in posterior compartment of arm and its terminal branches took part in anastomosis around elbow joint.

Conclusion: Knowledge of such variations is important for all clinicians and specially for vascular and orthopaedic surgeons to avoid complications like haemorrhage, ischemia and necrosis. The absence of profunda brachii artery is a rare pattern anomaly reported in literature and awareness of such variations is clinically important for clinicians, surgeons and radiologist for diagnostic evaluation and surgical procedure to avoid complications.

  Bilateral Accessory Head of Abductor Digiti Minimi and Its Clinical Aspects Top

Vaibhav Bhatnagar, Seema Prakash

R.N.T. Medical College, Udaipur, Rajasthan, India

Objective: Accessory head of abductor digitiminimi was first reported in 1868 by Wood. It is one of the commonest anomaly among all the accessory hypothenar muscles. Abductor digitiminimi arises from the pisiform bone, the tendon of flexor carpi ulnaris and pisohamate ligament. It inserts as a flat tendon which divides into two slips: one is attached to the ulnar side of the base of proximal phalanx of the little finger and the other to ulnar border of the dorsal digital expansion of extensor digitiminimi.

Methods: An abnormal presence of accessory head of abductor digitiminimi was observed bilaterally in middle aged male cadaver during routine cadaveric dissection of hand in department of Anatomy, R.N.T. Medical College, Udaipur.

Results: This accessory head of abductor digitiminimi after arising from deep fascia of forearm passed superficial to ulnar nerve and artery in Guyon's canal and joined radial side of abductor digitiminimi.

Conclusion: Accessory head of abductor digitiminimi can cause ulnar nerve and artery compressionleading to neurological symptoms, vasculopathy and ischemic changes. Knowledge of such variations is helpful for orthopaedic surgeons and radiologists.

  Variation in Higher Division of Sciatic Nerve in Relation to Piriformis and Its Clinical Importance Top

P. D. Elaviya, N. N. Chavda

Medical College Baroda, Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India

Introduction: The sciatic nerve (SN) divides into two branches, tibial and common peroneal nerves outside the pelvis. Sometimes it may separate within the pelvis. In such cases, tibial and common peroneal nerve may leave the pelvis through different routes. These variations may lead to nerve compression under other anatomical structures, resulting in sciatica. The aim of this study is to define sciatic nerve exit and its division.

Materials and Methods: 50 gluteal regions were examined during routine cadaveric dissection in department of anatomy, Medical College Baroda.

Results: In 97% of cases, the SN exited the pelvis as a whole nerve without any division, whereas in 3% a higher division was observed.

Conclusions: The higher division of SN inside the pelvis through is great of academic and clinical significance in neurology, general surgery, orthopedics and anesthesiology, sports medicine and physiotherapy. The knowledge of these variations is important for paramedics who frequently give intramuscular injection into the gluteal region.

  Gall Stone Ileus: A Case Report Top

Soumya Khanna, Ajay Kumar Khanna, Katyani Dubey, Puneet Gupta, Satyendra Tiwari

Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Introduction: Gallstone ileus (GI) is an impaction of a gallstone within the gastrointestinal tract causing mechanical bowel obstruction. Patients with gallstone ileus may present with radiographic findings of Rigler's triad of pneumobilia, small-bowel obstruction and an ectopic gallstone. It results from a bilary-enteric fistula, and is a relatively rare presentation accounting for only 0.1% of mechanical bowel obstruction.

Case Report: We present a 70 year female presented with features of Intestinal obstruction for 1 week. Ultrasound of abdomen revealed distended bowel loops and contracted gall bladder. Computerized tomography scan suggested contracted gall bladder with hyperdense contents with air foci in gall bladder and common bile duct with hypodense lesion in jejunal loop with air foci and calcifications causing luminal occlusion with dilated proximal bowel loop. After resuscitation, laparotomy was done which revealed a 3 cm stone impacted in jejunum 2 feet distal to DJ flexure with proximal dilatation of the jejunum. Enterotomy was done and stone was removed and bowel was decompressed. Primary closure of jejunum was done. The patient has been on follow up without any complaints for last 6 months.

Conclusion: Gallstone ileus is perhaps the most diificult diagnosis as a cause of mechanical intestinal obstruction. It is often misdiagnosed and carries a significant rate of mortality and morbidity. Its danger reflects the advanced age of patients and the high incidence of severe concomitant diseases. Surgical treatment mandates removal of the stone via enterotomy. Whether to perform a cholecystectomy at the time of laparotomy remains controversial.

  Santorinicele Associated with Divisum of Pancreas: A Case Report Top

M. Rajeshkumar, S. D. Nalinakumari, Guru T. Arun

Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India

Introduction: Cystic dilatation of dorsal pancreatic duct associated with pancreatic divisum has been reported to be cause of repeated acute pancreatitis due to obstruction of minor duodenal papilla. This condition has prevalence of 5-14%. Often this condition had been found to be associated with duodenal diverticulum and calculus cholecystitis.

Case Report: A 63 year old male reported to the OP with right hypochondral and epigastric pain. Previous history of repeated such attacks was present. Positive history of belching, vomiting and loss of appetite was elicited. On radiological examination, Echogenic foci within lumen of gall bladder and cystic duct noted in USG. CECT abdomen showed medial duodenal wall out pouching and a residual liver abscess. MRCP showed anomalous course of pancreatic duct with focal dilatation at minor papilla with non-visualization of ventral pancreatic duct. Common bile duct was observed to drain into the duodenal out pouching.

Conclusion: Cases with repeated episodes of pancreatitis need to be evaluated for pancreatic divisum and dilatation of duct system. Noninvasive modalities help to delineate and conclude such cases.

  Study of Variation in Morphology of Xiphoid Process of Sternum Top

Maitreyee Kulkarni, S. K. Nagar, V. H. Vaniya, J. S. Soni, B. Shital Hathila, Ukti Desai

Medical College, Baroda, Vadodara, Gujarat, India

Objective: Xiphoid process is the most variable part of sternum. It can be put into multiple categories depending on its shape, size and presence or absence of xiphoidal foramina. The aim of this study was to record the variant morphology of xiphoidal process.

Methods: 40 cadaveric sternums with intact xiphoid process from six different medical and dental colleges in Gujarat were observed and photographed. They were statistically analyzed in terms of their frequency and percentage.

Results: The present study shows xiphoid process can be elongated (2.5%), ventrally curved (15%), dorsally curved (5%), straight (22.5%), deviated (12.5%), pointed (15%), broad (27.5%), hook shaped (5%), bifid (25%) and with xiphoid foramina (5%).

Conclusion: These variable morphologies are important during radiological imaging and physical examination, as they can lead to misdiagnosis as fractures or hard lumps resembling epigastric masses. They can also prove helpful in the diagnosis of xiphodynia. Moreover, their familiarity would help in assessing injuries during autopsy and post mortem examination.

  A Case Report on Elongated Unilateral Styloid Process in Human Adult Dry Skull Top

J. Tunglut, S. Wahengbam, T. S. Gurumayum

Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India

Objectives: To report a case of unilateral left sided elongated styloid process in a dry human adult skull.

Materials and Methods: During routine osteology class in the department of Anatomy, JNIMS, Manipur, an elongated styloid process on the left side was observed in a dry human adult skull. The length of the elongated styloid process was measured using digital caliper and the significance of its presence was researched and studied.

Results: The length of the styloid process measured 4.20 cm, the tip of the Styloid process tapered and on palpation it was found to be roughened.

Conclusion: The knowledge of presence of elongated styloid process will help to rationalize in the treatment approach for craniofacial or cervical pain by the clinicians.

  Procurement of Cadavers for Teaching and Research: Ethical and Legal Requirements in South Africa Top

P. Pillay, D. Mcquoid Mason, K. S. Satyapal

University of KwaZulu-Natal, Westville, Durban, KwaZulu-Natal, South Africa

Legislation providing for the altruistic act of body donation exist in several countries such as the United Kingdom and New Zealand. In Romanian law, use of unclaimed bodies is seen as a violation of the principle of self-determination while the fundamental principle of autonomy is respected with body donation. Literature on changes regarding international legal requirements for acquisition of cadavers are well documented over centuries. However, in the African context, countries such as Nigeria lack of such legislation. While legislation in South Africa exists, its interpretation within provinces varies making the acquisition of cadavers for teaching and research problematic. This study aimed to document in chronological order the relevant legislation related to cadaver acquisition, and evaluate their impact and effect teaching and research in South African Higher Education Institutions. A comprehensive literature review of scientific and legal aspects using primary data such as Parliamentary debates, Law reports, case studies, and National and International Archives of official documents. The method of inquiry for this qualitative analysis was based upon historical and documentary research. Emerging from colonisation, South African Common Law was formed by Roman-Dutch and English Law, as well as Indigenous laws referred to as customary law. This study documents pertinent changes to South African legislation related to cadaver acquisition over a political transition period from colonialism to democracy. Knowledge of these changes is important for academic institutions. Scientists need to keep abreast with current legislation since it is continuously challenged, debated and directly impacts on access to cadaveric material.

  Variant Formation of Median Nerve and Its Embryological Basis Top

P. Rani, S. Yadav

Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Objectives: Median nerve is one of the terminal branches of brachial plexus formed by C 5-8, T1. Median nerve variations in the upper limb are not uncommon and have been reported earlier. It is formed anterior to the axillary artery by lateral and medial roots which are the branches of lateral and the medial cord of brachial plexus respectively.

Methods: During routine dissection of the first year MBBS students, at the University College of Medical Sciences, Delhi, India, we encountered a rare formation of median nerve in the left axilla of a 65 year old cadaver.

Results: In the above mentioned left axilla, the median nerve was formed from three roots instead of two. The medial root of median nerve arose from the medial cord of brachial plexus to join the lateral root, which traversed anterior to the axillary artery after arising from the lateral cord of brachial plexus. Both the roots joined each other to form the median nerve. A third root of median nerve was also seen to join the median nerve which arose from the lateral cord after the latter gave the musculocutaneous nerve.

Conclusions: The knowledge of formation of median nerve along with its variations becomes important in surgical, clinical, radiological and interventional approach as there are increasing trends of vascular and reconstructive surgeries these days.

  Direct Origin of Anterior Interventricular and Left Marginal Arteries from the Left Posterior Aortic Sinus – A Case Report Top

Prakashchandra Shetty, S. B. Nayak

Manipal Academy of Higher Education, Manipal, Karnataka, India

Coronary arteries are the branches of ascending aorta and they supply the myocardium of the heart. Some of the variations like, absence of one of the coronary arteries, origin from pulmonary trunk and origin of both coronary arteries from the same aortic sinus have been reported in the literature. We present a unique, unreported variation of the left coronary artery. During dissection classes for first year medical students, we observed the absence of left coronary artery in an adult male cadaver aged approximately 75 years. The left posterior aortic sinus was dilated and it gave origin to anterior interventricular and left marginal arteries independently. Left marginal artery was large and the circumflex artery arose from it. No variations were found in the walls and chambers of the heart.

Knowledge of variations of coronary arteries is important during coronary stent placing and bypass surgeries. The current variation if observed and found in more cases, it might cause difficulties in catheterization of anterior interventricular and circumflex arteries.

  Awareness of Carpal Tunnel Syndrome in Women of Udupi District Top

Melanie Dsouza, Anil Bhat, Shovan Saha

Melaka Manipal Medical College, MAHE, Manipal, Karnataka, India

Introduction: Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies. It affects mainly middle-aged women. In the majority of patients, the exact cause and pathogenesis of CTS is unclear. Although CTS is common and causes considerable disability people are unaware of its debilitating effects. To prevent this condition and to promote health, there is a need for educating women about preventive measures of carpal tunnel syndrome.

Objectives: This study attempts to assess the level of pre-test knowledge scores of women of Udupi district on knowledge and preventive measures of carpal tunnel syndrome. This study also attempts to identify the risk factors leading to CTS among housewives.

Methods: The study was conducted after approval of human ethical committee. A pre-experimental research design was used for the study. Self-prepared knowledge questionnaire was validated and then administered to 40 housewives. Participants were then interviewed on an evaluative research survey and symptom questionnaire to identify the risk factors of CTS.

Results: In the pre-test, it was observed that 90% of the housewives had inadequate knowledge, and 3% had moderate knowledge about carpal tunnel syndrome. The evaluative and symptom questionnaire revealed that 10% of the study population presented symptoms pertaining to carpal tunnel syndrome.

Conclusion: From the study it is observed that majority of the population have very low knowledge regarding Carpal Tunnel Syndrome. Many factors contribute to the development of carpal tunnel syndrome. There is no single approach to prevent the onset. Treatment of an underlying cause is of primary importance. The above results show that an awareness needs to be created among women from various occupational backgrounds.

  A Case Report of a Variant of Lumbo-Sacral Transition Vertebrae: Castellvi Type IIA Sacralisation Top

Monalisa, Col. Subhendu Pandit, Col. Sushil Kumar

LHMC, Delhi, India

Lumbosacral transitional vertebrae (LSTV) are congenital anomalies of the vertebrae where the fifth lumbar vertebra (L5) may articulate with the sacrum producing sacralisation or the highest sacral vertebra may show a transition to a lumbar type causing lumbarisation. A sacrum of Indian origin of an unknown age was retrieved from the departmental burial ground. On examination, the L5 transverse process of the right side presented an articulation with the ala of the sacrum. The sacrum presented here is of Type IIA as per Castellvi's classification on sacralisation. The sacralisation has been studied for almost a century for its association with low back pain as “Bertolotti Syndrome”, but there are studies for and against its association. Castellvi in 1984 had propounded a radio graphical classification identifying sacralisation in four sub types. Out of this, the Type IIA, is the least prevalent wherein there is a unilateral articulation of the L5 transverse process with the sacral ala.

  A Rare Case of Ileal Membrane with Sub-Hepatic Caecum Top

J. Kaur, M. Sharma, A. Wadhwa

Objective: To describe an unusual case of ileal membrane with sub-hepatic caecum.

Methods: During routine dissection of a 60 yr old male cadaver in the department of Anatomy, Punjab Institute of Medical Sciences, Jalandhar, an ileal membrane with sub-hepatic caecum was noted. The length of membrane was taken along the antimesenteric border with a thread which was then measured with a metric scale.

Results: The ileal membrane extended from the right iliac fossa to the antimesenteric border of terminal ileum. It was 3.4 inches in length. In addition to this, the position of caecum was just below the inferior border of right lobe of liver. Ascending colon was absent. Blood supply of caecum was normal. Appendix was retrocaecal.

Conclusion: This case demonstrates that an anomalous ileal membrane can be included in the differential diagnosis of intestinal obstruction, though, they may pass unnoticed. Moreover, the varied positions of the caecum can influence the clinical presentation of appendicitis leading to delayed diagnosis and increased incidence of complications.

  Unique Variation of Testicular Artery Passing Through a Vascular Hiatus of Renal Vein Top

Naveen Kumar, P. Ashwini Aithal

Manipal Academy of Higher Education, Manipal, Karnataka, India

During routine dissection for medical undergraduate students of Melaka Manipal Medical College, Manipal, we observed an unusual course of left testicular artery in a male cadaver aged about 60 years. The left testicular artery had a slightly higher origin from the anterior aspect of the abdominal aorta at the level of origin of left renal artery. In its further course, the left testicular artery passed forward through an opening present in the left renal vein. This vascular hiatus was located distal to the opening of left suprarenal vein and was very prominent. After passing through the hiatus, the testicular artery coursed downwards and forwards towards the deep inguinal ring accompanying the corresponding vein on its right side contrary to normal position. This variation is unique and has not been previously reported in the scientific literature. This unusual course of the testicular artery through the vascular hiatus is vulnerable to its entrapment. Surgeons should have a thorough knowledge regarding such morphological variations of the testicular arteries as any injury to this artery during surgery might cause testicular atrophy.

  Anomalous Drainage Pattern of Left Testicular Vein: A Rare Developmental Anomaly Top

R. Deepthinath, Satheesha Nayak, S. Sudharshan, Prakash Shetty

Manipal Academy of Higher Education, Manipal, Karnataka, India

The pampiniform plexus of veins form the testicular veins after the former join to form four veins at the superficial inguinal ring, which again join to form two veins at the deep inguinal ring and finally one vein, which could be at varying levels. The termination of the right testicular vein is directly into the IVC, whereas the left testicular vein drains into the left renal vein. Here we present a case of duplication of the left testicular vein, which we named as medial and lateral divisions of left testicular veins. The medial one drains into the IVC and the lateral one to the left renal vein. About half way through their ascent, the two veins were communicated with each other through a communication channel. Close to the medial division, there was another communication, which was seen to connect between the IVC and the testicular vein. Knowledge of the variations in the gonadal veins which generally tend to be silent and show no signs clinically, as in the case presented here, could prove beneficial during renal transplantations, surgeries involving renal and gonadal vessels. Recent increase in the use of minimal invasive procedures in surgeries could probably become less complicated, if such variations are taken care and kept into consideration during the procedures.

  Congenital Fusion of C2-C3 Vertebrae: A Case Report Top

Nitin Gupta, V. D. S. Jamwal, S. Kumar

AFMC, Pune, Maharashtra, India

Objective: To study the congenital fusion of Cervical Vertebrae and differentiate it from other pathological causes such as Tuberculosis, Juvenile Rheumatoid Arthritis and trauma.

Methods: The variation was observed during routine osteology tutorials for I MBBS students; same will be presented.

Results: Congenital fusion of C2-C3 vertebrae was observed which is the commonest of all of the cervical vertebrae fusion.

Conclusion: Vertebral column starts developing during 3rd week with segmentation of paraxial mesoderm forming somites. Failure of normal segmentation of embryological spines may lead to fused vertebrae or block vertebrae. Commonest site of fusion of cervical vertebrae is at C2-C3 with an incidence of 0.4% to 0.7% with no sex predilection. Kleippel Feil syndrome may be associated with it. Cervical fusion of vertebrae may be observed incidentally during routine Xrays. In advanced age it causes degenerative changes in non segmented cervical regions. Signs and symptoms such as shortening of cervical spine, webbed appearance of neck, limited neck mobility and signs of peripheral nerve irritation or nerve compression such as pain, hypoaesthesiaetc may be seen. Diagnosis can be made by clinical examination, X-rays, CT scan or MRI. Knowledge of such anomalies is important for Anaesthesiologists, Orthopaedicians, Surgeons and Neurosurgeons.

  Rare Course of Maxillary Artery in Infratemporal Fossa: A Case Report Top

V. Sharma, C. S. R. Babu

Department of Anatomy, Muzaffarnagar Medical College, Muzaffarnagar, Bahadarpur, Uttar Pradesh, India

Maxillary artery, the large terminal branch of external carotid, enters infratemporal fossa passing medial to neck of mandible and then courses superficial or lateral to lateral pterygoid in majority of the cases to enter pterygopalatine fossa. In few cases the artery passes deep or medial to lateral pterygoid. The maxillary artery while passing medial to lateral pterygoid exhibits variable relationship with lingual and inferior alveolar nerves. During routine dissection we have observed a very rare variation of maxillary artery on the left side in a male cadaver. The second part of maxillary artery was passing deep to lateral pterygoid and both lingual and inferior alveolar nerves to enter pterygopalatine fossa. The middle meningeal artery was passing deep to auriculotemporal nerve to enter foramen spinosum. Such rare variation of the artery passing deep to the main branches of mandibular nerve is reported to occur in 1% - 3% cases in the literature. The variant course of maxillary artery has clinical implications during infratemporal fossa surgeries, T-M joint surgeries and anaesthetic procedures.

  Cervical Rib in a 30-Year-Old Male Individual in JNIMS, Manipur: A Case Report Top

E. Remei, A. K. Pfoze, A. Keisam, T. S. Gurumayum

Jawaharlal Nehru Institute of Medical Sciences, Manipur, Karnataka, India

Objective: To study the radiological features of bilateral cervical ribs.

Methods: The case is encountered on routine OPD digital examination of the cervical spine in AP view in an asymptomatic 30 year-old male individual in the Radiology Department of JNIMS. The information of the particular case has been corresponded to the Department of Anatomy, JNIMS for academic purpose. The gross radiological feature of the cervical rib is studied and length of the cervical rib also recorded by using measuring scale on 9/19/2016.

Results: A bony extension (cervical rib) of about 3.2 cm on the right side and 3.7 cm on the left side in length is observed extending laterally, downwards and forwards reaching upto approximately one-fourth of posterior part of length of the first rib on both sides. A definite gap is seen below the lower border of the cervical rib and upper surface of the first rib. The minimum measurable gap between tip of the cervical rib and first rib was 0.5 cm on the right side and 0.1 cm on the left side.

Conclusion: Cervical rib is a congenital bony anomaly in which an extra rib is present above the first rib and attached to the C7 vertebra. Although cervical ribs are usually asymptomatic, they can cause thoracic outlet syndrome (TOS) by compression of the brachial plexus or the subclavian vessels leading to muscle wasting, stroke and limb ischaemia. Therefore a careful musculoskeletal, neurological and peripheral vascular examination is required for these patients.

  A Case Report of Variation in Muscle Pattern Due to Defect in Myogenesis in the Sole Top

K. Sesham, Asmita, A. Sachan, Annapurna, N. Rani, S. Kaler, S. Singh

All India Institute of Medical Sciences, New Delhi, India

Introduction: Muscular system acting upon the skeletal system is the one responsible for mobility and locomotion, whose variations are very common. Variants include their absence or presence in supernumerary numbers or possess an anomalous origin or insertion. In the present case, variation in muscle pattern in sole is documented unilaterally.

Materials and Methods: During our routine dissection curriculum for undergraduates at AIIMS, New Delhi, we had observed an accessory muscle belly of flexor digitorum accessorius (FDA) along with distinctly separated muscle belly for flexor digitorum brevis (FDB) in left leg and foot of about 60 year old female cadaver.

Observations: The accessory muscle belly of FDA was originating from deep fascia over flexor hallucis longus of posterior compartment of leg (high origin), passing under the flexor retinaculum and is inserted into main muscle which had been observed in previous literatures, while distinctly separated muscle belly for FDB was originating from medial side of calcaneum, passing on lateral aspect of main belly of FDB and getting inserted into the plantar surface of base of proximal phalanx of little toe.

Conclusion: Such variations are usually asymptomatic and incidentally found. Embryological basis for the existence of such accessory and distinctly separated bellies could be due to the failure of the development of muscle primordia in normal pattern at certain places. These aberrantly developed accessory bellies may compress adjacent neurovascular structures. They could be potential sources of clinical symptoms and knowledge of these variations is important for the clinicians.

  Ulnar Artery: A Case Report of High Origin and Superficial Course Top

M. S. Chougule, S. K. Deshpande, R. Kumar

SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India

Introduction: Variations in the arteries of the upper limb are common and these variations can be of considerable interest to orthopaedic surgeons, plastic surgeons, radiologists and anatomists.

Materials and Methods: Cadavers utilised for the routine dissection classes for the medical students, were also used for the study of any variations in the structures.

Objective: We want to study variations in the branching pattern, neurovascular & other relations of ulnar artery, which will be important for the surgeons, radiologists and anatomist.

Results: In a routine dissection for undergraduate students of the right upper limb in a adult male cadaver, a high origin of ulnar artery from brachial artery was noticed. The brachial artery ended in the cubital fossa by dividing into radial and ulnar or interosseous arteries. The radial artery took normal courseand branches. The other divisions, the common interosseous artery, anterior and posterior ulnar recurrent arteries showed normal course.

Conclusion: Orthopaedic surgeons, plastic surgeons, radiologists and anatomists should consider this unusual course of ulnar artery while doing any procedure to avoid complication. The unusual high origin of ulnar artery from the brachial artery was noticed which was taking origin from medial side of the brachial artery higher than the radial artery, descended on the superficial muscles and passing below the Palmaris longus tendon and crossing the tendon from lateral to medial. It then descended superficial to the muscles taking origin from medial epicondyle of the humerus and was covered by the deep fascia of the forearm, then it crossed the flexor retinaculum, and formed the superficial palmar arch. During its course, artery did not give any branch.

  Evaluation of Ossified Tissue in Quadriceps Femoris: A Case Report Top

N. Kamal, A. Bahl, C. Kumari, T. Gupta, A. Aggarwal, D. Sahni

Department of Anatomy, PGIMER, Chandigarh, India

Objective: To analyze an incidental finding of presence of bony tissue in the left quadriceps, found during the routine cadaveric dissection in the Department of Anatomy, PGIMER, Chandigarh. The right side was apparently normal.

Methods: The thigh & the knee joint were exposed after reflecting the overlying skin. The knee joint capsule was incised circumferentially around the patella. The condition of bones and articulating surfaces, surrounding muscles and vessels were observed. The dimensions (length, width & thickness) of the ossified structure within the quadriceps were measured with the help of digital verniercaliper and its relation to surrounding landmarks was noted. To determine the tissue structure a sample was processed for histological studies.

Results: We discovered an extension of patella going upwards up to almost centre of the thigh. The structure was 10 cm in length including the patella and extended 16 cm from the tibial tuberosity. This bony mass was superficially covered by the skin, fascia & the quadriceps muscle. On the deeper aspect, this mass was related to the femoral bone in the lower part and quadriceps muscle in the upper part.

Conclusion: Knowledge of occasional occurrence of this type of space occupying ossification is clinically relevant as it may compress the surrounding structures specially the adductor canal and also can restrict the movement of the knee joint.

  Anterior Longitudinal Ligament in Cadaver: Ossification or Calcification? Top

Anjankar Vaibhav Prakash, G. N. Trivedi

Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands

Background: The anterior longitudinal ligament is a strong band extending along the anterior surfaces of the vertebral bodies. It is broader caudally, and thicker and narrower in thoracic than in cervical and lumbar regions. It extends from the basilar part of the occipital bone to the anterior tubercle of C1 and the front of the body of C2, and then continues caudally to the front of the upper sacrum. Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis (DISH), is an idiopathic rheumatological abnormality in which exuberant ossification occurs along ligaments throughout the body, but most notably the anterior longitudinal ligament of the spine. It affects older men predominantly.

Methods: We found two sets of fused vertebrae (five thoracic and four lumbar vertebrae fused with each other) in a 62 year old male cadaver which was dissected out for undergraduate teaching and then put for maceration.

Results: Five thoracic vertebrae (T8-T12) and four lumbar vertebrae (L2-5) were fused to each other along anterior longitudinal ligament. No other obvious deformity noted.

Conclusion: Ossified ligament may produce dysphagia due to oesophageal compression and and radiculomyelopathy due to associated stenosis of the cervical spine. The vertebral mobility is diminished or reduced at site of ossification or calcification, which is typical of rhiomelic spondylosis.

  Unilateral Absence of Palmaris Longus: A Case Report Top

Prashant Kumar

Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

Introduction: Palmaris longus is one of the flexor muscle of the forearm. Phylogenitically classified as retrogressive muscle because it has got a short belly and long tendon. The Palmaris longus is considered as the most variable muscle of the human body. The most common variation is its absence.

Case Report: During routine dissection of upper limb in the Department of anatomy, Rajendra institute of medical sciences, Ranchi, Jharkhand, we came across with absent Palmaris longus on left forearm of an adult male cadaver whereas this muscle was present on right forearm. The other muscle of the forearm were normally located.

Discussion: Palmaris longus is often absent in 10% of individuals. The Palmaris longus is a sex linked dominant trait, more absent in female. The muscle is most popular for use in tendon graft without producing any functional deformities.

Conclusion: Precise knowledge of variation in the Palmaris longus is essential for plastic surgeon, orthopaedicians, anatomist and interventional radiologist.

[TAG:2]Abnormally Kinked and Curved Cervical Segment of Internal Carotid Artery: Case Report [/TAG:2]

S. Yadav, P. Rani

Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Objectives: The internal carotid artery is the larger terminal branch of common carotid artery. It ascends vertically in the neck after originating at upper border of thyroid lamina and enters the carotid canal at the base of the skull. Normally, it has a straight course in neck. In the current case, the right internal carotid artery showed a characteristic loop. Kink in its course in the neck may result in hindrance in the blood flow to the brain and can cause serious problems.

Methods: During routine dissection for the first year BDS students at Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, we encountered an abnormally kinked internal carotid artery in a 60 years old male cadaver.

Results: During the dissection, we observed a loop formed by the internal carotid artery near the base of skull in relation to lateral wall of middle part of pharynx. The artery on the left side of the neck was normal. Careful dissection on right side of neck revealed the loop of the artery as it was covered by muscles and ligaments forming styloid apparatus.

Conclusion: Knowledge of variations of internal carotid artery is important to surgeons doing head and neck surgery as well as to radiologists doing imaging and invasive techniques as the kinking and curving may result in confusion during these procedures.

  Unusual Structural Variation of Femoral Nerve Top

Gunjan Rai, C. Mohanty

IMS, BHU, Varanasi, Uttar Pradesh, India

Introduction: Femoral nerve is the nerve of anterior compartment of thigh and it is the largest nerve of lumbar plexus and formed by dorsal division of ventral rami of L2, L3, L4 and innervates the anterior thigh muscles, hip and knee joints and skin of anteromedial surface of thigh.

Case Report: During routine dissection for undergraduate students in department of anatomy, a variations in the branching pattern of femoral nerve and the course of branches was noted. In this case, femoral nerve branch saphenous nerve passes between the aponeurotic tendon of adductor magnus along with the descending genicular artery, a branch of femoral artery.

Conclusion: Since the saphenous nerve is the largest cutaneous nerve of body and supply the skin of medial side of leg and medial border of foot upto the ball of great toe and such type of variation can result in a nerve compression. Knowledge of such type of variation as well as location of compression is useful in determining the appropriate treatment for compressive neuropathies and avoid complication during surgeries.

  Duplicated Ureter, Calcified Cysts and Early Division of Renal Artery of Right Kidney: A Case Report Top

Soni Sachin

Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Papum Pare, Arunachal Pradesh, India

Objectives: To study the anomalous ureters, arterial supply and calcified round structures present on the surface of right kidney found during routine dissection of cadaver for preparation of wet mount specimen.

Methods: During routine dissection for preparation of wet mount specimen of right kidney, we encountered two ureters associated with it. For detailed study, fine dissection was carried out. The calcified round eruptions which were noted on the surface of it were further dissected and studied. The vascular supply was also further explored in relation to the abnormalities visualized. The morphometry of the anomalous structures was performed with the help of verniercalipers.

Results: Two ureters were attached to the hilum of right kidney. The ureters were well developed with first one draining upper one third region of kidney whereas the other one was draining the remaining part of it. 22 Round, smooth and solid eruptions were noticed on the surface of kidney of varying diameters. Renal artery was divided in to 5 different branches about 32 mm ahead of entering in to the kidney.

Conclusion: The duplication of ureter and early division of renal artery suggests the abnormal development of right kidney. The multiple calcified cystic growth over its surface hints towards its clinical implications in the functioning of the organ.

  Complete Agenesis of Dorsal Wall of Sacral Canal: A Case Report Top

Babita Kujur, R. Gaikwad

AIIMS, Bhubaneswar, Odisha, India

Background: The sacral canal is the continuation of vertebral canal in sacrum. It consists of an anterior wall formed by the fusion of the posterior aspects of sacral vertebral bodies and the dorsal wall is formed by the fused laminae, spines and ossified ligamentum flavum. Sacral canal has been used for the caudal epidural block (CEB). The CEB has been widely used for the diagnosis and treatment of lumbar spinal disorders. The reliability of CEB is 70%-80% in the literatures. The cause of failure of CEB may depend on anatomical variation of sacral canal especially in relation to sacral hiatus.

Observation: During routine osteology demonstration classes for undergraduate students we observed a dry human sacrum with complete dorsal wall agenesis of sacral canal. The laminae of sacral vertebrae were present but showed incomplete fusion. Other features of the sacrum were normal.

Conclusion: Among the various anatomical variation of sacral canal, complete agenesis of posterior wall of sacral canal is one of the rare variations. Knowledge of these variations is important to diagnose lower back pain, sciatica, caudal regression syndrome and to avoid complications related to caudal epidural block and other spinal surgeries.

  Duplicated Ureter, Calcified Cysts and Early Division of Renal Artery of Right Kidney: A Case Report Top

Soni Sachin

Tomo Riba Institute of Health and Medical Sciences, Naharlagun, Papum Pare, Arunachal Pradesh, India

Objectives: To study the anomalous ureters, arterial supply and calcified round structures present on the surface of right kidney found during routine dissection of cadaver for preparation of wet mount specimen.

Methods: During routine dissection for preparation of wet mount specimen of right kidney, we encountered two ureters associated with it. For detailed study, fine dissection was carried out. The calcified round eruptions which were noted on the surface of it were further dissected and studied. The vascular supply was also further explored in relation to the abnormalities visualized. The morphometry of the anomalous structures was performed with the help of verniercalipers.

Results: Two ureters were attached to the hilum of right kidney. The ureters were well developed with first one draining upper one third region of kidney whereas the other one was draining the remaining part of it. 22 Round, smooth and solid eruptions were noticed on the surface of kidney of varying diameters. Renal artery was divided in to 5 different branches about 32 mm ahead of entering in to the kidney.

Conclusion: The duplication of ureter and early division of renal artery suggests the abnormal development of right kidney. The multiple calcified cystic growth over its surface hints towards its clinical implications in the functioning of the organ.

[TAG:2]An Unconventional Origin of the Appendicular Artery: A Clinical Insight [/TAG:2]

V. Tiwari, S. Wadhwa, N. Mangla, S. Mishra

Maulana Azad Medical College, New Delhi, India

Objective: A precise knowledge on vascular anatomy of vermiform appendix is a must while doing surgical procedures like appendicectomy and reconstructive microsurgeries involving appendix.

Methods: During routine undergraduate cadaveric dissection teaching sessions of abdominal region of a 58 year old formalin embalmed adult male cadaver of Indian origin in the Department of Anatomy, Maulana Azad Medical College, New Delhi, a rare variation related to the origin of appendicular artery (AA) was noticed. Remaining branches of superior mesenteric artery and their distribution were found to be normal. The variation was photographed and recorded.

Results: The current report is unique as it highlights unusual origin of appendicular artery from the right colic artery.

Conclusion: Knowledge of this type of anatomical variation is important in planning and conducting surgical and radiological procedures. An attempt has been made to comprehend clinical and embryological basis of the above variation.

  Variation in the Origin of Medial and Lateral Circumflex Femoral Arteries, Its Clinical Significance Top

Anil Kumar Dwivedi

Veer Chandra Singh Garhwali Government Institute of Medical Science and Research, Srinagar, Pauri Garhwal, Uttarakhand, India

Objective: The Profunda femoris artery is a large branch of femoral artery arises from the lateral side about 3.5 cm below the inguinal ligament. It is the main supply of adductor, extensor and flexor compartments of thigh. It gives lateral and medial circumflex femoral arteries in upper part of thigh. Knowledge of anatomical variations in the origin of medial and lateral circumflex femoral arteries is important for vascular surgeons and interventional radiologists during surgeries, catheterization procedures and in raising myocutaneous grafts with pedicle.

Methods: During routine educational dissection of an adult male cadaver, anomalous origins of medial and lateral circumflex femoral arteries were found.

Results: The medial and lateral circumflex femoral arteries were seen to be arising directly from femoral artery proximal to the origin of profunda femoris artery.

Conclusion: Knowledge of anomalous branching pattern of femoral artery is important while performing clinical procedures in femoral region such as catheterization, angiography, colour doppler, repair of femoral hernia, raising myocutaneous flaps, and vascular reconstructive surgeries.

  An Analysis of Upper Eyelid Crease in Manipuri Population Top

R. D. Huidrom, K. Pfoze, T. Dangmei

JNIMS, Imphal, Manipur, India

Objective: Large number of Orientals are known to lack a pretarsal crease giving rise the classical Asian eye. Asians tend to possess a greater number of eyelid fat pads and a larger amount of subcutaneous and suborbicularis fat than members of other ethnic groups, and the periorbital fat is lower. These qualities of the periorbital fat compartment in the upper eyelids contribute to the puffiness of the single eyelid, further obscure the supratarsal crease. Normally the levator aponeurosis is connected by some fibres to the dermis of the pretarsal upper eyelids, absence of this connection leads to the characteristic single eyelids.

Methods: 100 Manipuri boys and girls with age ranging from 18-25 were subjected to analysis of eyelid crease by visual appearance and by measurement by a caliper. The height of the lid crease is measured at the mid pupillary line and the canthal margins of both sides. The results were analysed.

Results: Only 17% of the boys and girls in the study group were found to totally lack a pretarsal crease instead of near 50% in reported literature. Near 80% had lid crease which were not prominent and ranged from 2-5 mm in the midpupillary line. More than the absence of the crease the puffiness of the lids due to more amount of Preseptal fat was responsible for the tired looking eyes.

Conclusion: Only 17% of the analysis group lacked the pretarsal crease completely, most had crease at level 2-4 mm from lid margin at the mid pupillary line.

  Accessory Right Hepatic Artery and Its Significance for Hepatobiliary Surgery Top

I. B. Bagoji, G. A. Hadimani, B. S. Patil, B. G. Patil, B. M. Bannur, R. S. Bulgouda

Shri B.M. Patil Medical College and Research Centre, BLDE University, Vijayapur, Karnataka, India

Introduction: The right hepatic artery usually branches from the common hepatic artery. The abnormal entry of hepatic arteries into the liver found during routine dissection in an approximately 61-year-old male cadaver.

Case Report: The accessory hepatic artery (AHA) took its origin from the right side of the celiac trunk, opposite to the splenic artery, passed behind the head of the pancreas, first part of duodenum and reached the porta hepatis through the lesser omentum. In the lesser omentum the artery was posterior to the portal vein. Interestingly (AHA) close to the porta hepatis formed loop (5 cm) and finally fuse with its main accessory trunk. Another interesting finding was the cystic artery arose directly from the common hepatic artery.

Conclusion: The knowledge of this kind of vascular variation may be useful for surgeons doing liver transplants, pancreatic mobilizations and gastro-jejunostomies. The knowledge about this artery passing through the lesser omentum behind the bile duct and the portal vein may be important for radiologists and surgeons removing gall stones from the bile duct.

  Ossified Coraco Acromial Ligament: A Rare Anomaly with Clinical Significance Top

Susmita Saha, Neelam Vasudeva

Maulana Azad Medical College, New Delhi, India

Objective: The Coracoacromial Ligament (CAL) is a strong triangular band, extending from the coracoid process to the acromion process, is one of the major component of Coraco acromial arch. Impingement of the tendinous cuff beneath this arch is an established cause of chronic shoulder disability mainly in rotator cuff impingement pathology.

Methods: In the present study, we report a completely ossified CAL in a single dry bony specimen in the osteology museum. The anomalous bony specimen was studied in great detail.

Results: The left sided adult scapula showed complete ossification of the ccoracoacroial ligament extending from the tip of the coracoid process to the undersurface of the acromial process. The length of the ligament was 37 mm, average thickness was 3 mm & extending from the undersurface of acromion to the tip of the coracoid process. Though an extension of the ligament was also projecting away from the coracoids process but the root of the coracoid process was rounded. It has been noticed that along with this ossified coracoacromial ligament, there was a complete ossification of the superior transverse scapular ligament which was converting the suprascapular notch into suprascapular foramen.

Conclusions: The presence of such variant on plain radiograph or in the MRI scan has been emphasized as an important indicator of rotator cuff impingement syndrome. The clinician needs to be well versed with the appearance of such variant in the dry bones, so that they can interpret the data in the radiograph.

  Anatomical Presentation of Craniofacial Cleft Tessier Numbers 3 and 4 in a Select South African Population Top

A. O. Omodan, P. Pillay, L. Lazarus, A. Madaree, K. S. Satyapal

University of Kwazulu-Natal, Durban, Kwazulu-Natal, South Africa

Tessier numbers 3 and 4 are two of the oblique clefts in the classification with presentation ranging from alveolar cleft between the canine and lateral incisor to colobomas of the nasal ala and lower eyelids to affectation of the frontal part of maxillary bone. Due to the rarity of the disease, facial cleft publications are sparse, however, understanding the skeletal deformity is basic to any reconstructive surgery of the face. We aimed to document a detailed anatomical basis for the craniofacial clefts numbers 3 and 4 in our population.

CT scans of patients who had been treated for Tessier 3 and 4 clefts between 2003 and 2017 were reviewed and measurements of the expected defects in each cleft were taken with the unaffected side of the face being the reference.

Ten cases of Tessier 3 and 4 were record while 6 were included in the study. 66.7% were Blacks and 33.3% were Indians. 66.7% were male and 33.3% female. FC3 were 33.3% and FC4 were 66.7%. Average size of the alveolar cleft was 1.46 cm with the distance from the midline to the medial edge of the cleft being 0.85 cm averagely. 83.3% had no absent medial maxillary wall while 16.7% presented with such.

This study documents the anatomical presentation of Tessier cleft numbers 3 and 4 in KwaZulu- Natal province of South Africa. These findings will assist surgeons in coming to a consensus on standardized landmarks, reference measurements and formulate a principle of repair for this disorder.

  Left Dominance of Heart: A Case Report Top

A. Kumar, N. N. Srivastava, A. Jain, J. Verma, A. Asghar, M. Srivastava, M. Rani, N. K. Gupta, A. Ateeq, S. Dhingra, M. A. Ansari

UPUMS, Etawah, Uttar Pradesh, India

Introduction: The circumflex artery is the branch of left coronary artey that curves left in the atrioventricular groove, continuing round the left cardiac border into the posterior part of the atrioventricular groove and ending left of the crux in most hearts, but sometimes continuing as a posterior interventricular artery in 10% individual called as left dominance.

Objective: To study coronary circulation of heart.

Case Study: The anomaly was found in a 40-years-old male cadaver during the routine undergraduate dissection in Department of Anatomy, Uttar Pradesh University of Medical Sciences, Saifai, Etawah. Visceral pericardium and subepicardial fat was removed. The coronary arteries and their branches were carefully dissected out and followed till their termination. The arteries were painted with red fabric colour to enhance contrast.

Results: Circumflex coronary artery, after reaching to crux, turned into the posterior interventricular sulcus, seen as a continuation of that artery and penetrating deep to myocardium midway between the crux and apex of the heart. Right coronary artery was found to terminate at crux, and it did not entered into posterior interventricular sulcus. Left anterior descending artey reached upto the apex, wrapping around the apex and terminated by giving smaller branches.

Conclusion: It was observed that the left anterior descending artey, wrapped around the apex of the heart, supplying major portion of heart. Lesion in left anterior descending artey have more profound clinical importance in a left dominant heart than in a right dominant one.

  Can the Biceps Brachii Muscle have More Than Two Heads of Origin? A Case Report Top

J. P. Jayaram, R. Sehgal, D. Kasapuram, A. Ganapathy

All India Institute of Medical Sciences, New Delhi, India

Objective: The biceps brachii muscle on the flexor aspect of arm is proximally attached to the scapula by a long head and a short head in an overwhelming majority of cases. A comprehensive survey of existing literature revealed scarce reference to more than two heads for the biceps brachii, a few papers reporting three heads of origin. This study reports a rare variation in the proximal attachment of the biceps brachii muscle.

Methods: An unusual tetra-headed biceps brachii muscle was noticed during routine dissection of an adult male cadaver at the Department of Anatomy, AIIMS, New Delhi.

Results: The muscle was found to have proximal attachment at four distinct anatomical sites. The normal expected tendinous attachments at the supra-glenoid tubercle (long head) and coracoids tip (short head) were present. Two new aberrant attachments were noted on the anterior aspect of the upper half of humerus, through substantial fleshy muscle fibres.

Conclusion: This paper discusses the presentation, probable embryological cause and clinical implications of this novel finding.

  Persistent Left Superior Vena Cava with Atrial Septal Defect and Anomalous Coronary Venous Pattern in a Cadaveric Heart: Embryology and Clinical Relevance Top

Vandana Dave, Kishore Sesham, Simmi Mehra, M. S. Ahuja, T. S. Roy

AIIMS, New Delhi, India

Introduction: A persistent left superior vena cava (LSVC) is a congenital anomaly of heart. Failure of regression of left anterior cardiac vein leads to formation of persistent LSVC. It is the most common anomaly of congenital heart disease and associated with other cardiac anomalies. Anterior cardiac veins drain the sternocostal surface of heart and are highly variable in pattern of their distribution and termination. The atrial septal pouch is a kangaroo pouch like structure that occurs because of partial fusion of septum primum and septum secundum during closure of patent foramen ovale. The right septal pouch is formed when the fusion is limited to the cranial portion of the zone of overlap.

Case Report: The persistent LSVC was observed. The persistent LSVC was draining into right atrium via coronary sinus. The right superior vena cava was normal. Along with the persistent LSVC, variation in normal anatomy of anterior cardiac vein and interatrial septum were also observed. An anterior cardiac vein joined with the right marginal vein to form a common vein. The common vein opened into the right atrium. A right septal pouch (RSP) was noted. The RSP was attached to the limbus fossa ovalis inferiorly.

Discussion: The prevalence of persistent LSVC is 0.3 – 0.5% in the general population with a normal heart and 4.5% in patients with congenital heart disease, reported by Zhong et al. Tyrak et al reported a persistent LSVC draining into dilated coronary sinus, as observed in the present case. The anterior cardiac vein join the right marginal vein to form a common channel was earlier reported by Pina. The present case describes a RSP which is an uncommon finding reported so far in 5 to 11% of cases in different studies by Holda, Krishnan and Piotrowska.

Conclusion: A persistent LSVC, RSP and anomalous anterior cardiac vein are noteworthy for the surgeon. The insertion of central venous catheter via left internal jugular vein is difficult in presence of persistent LSVC. A septal pouch is potential site predispose to thrombus formation.

  The Morphological State of the Lower-Limb Lumbricals in Adult Human Cadavers: Exploration of Degenerative Changes Top

H. Krishna, R. Tandon, T. G. Jacob

All India Institute of Medical Sciences, New Delhi, India

Objective: In the foot, the lumbricals are four small muscles, which proximally attach to the medial aspect of tendons of flexor digitorum longus (FDL) and distally attach to dorsal digital expansions of the lateral four toes. They flex the metatarsophalangeal and extend the interphalangeal joints. They help in maintaining the medial longitudinal arch. Here, we studied the morphological state of lower-limb lumbricals in cadavers.

Materials and Methods: We explored lumbricals in 20 male and 8 female cadavers that were 60-80 years of age at the time of death, preserved in 10% formalin solution. We exposed the tendons of the FDL and the lumbricals. We noted their attachments, course and morphological appearance. Thereafter, we took tissue from the apparently degenerated lumbrical muscles and these were processed for paraffin-embedding, sectioning and staining by hematoxylin and eosin and Masson's trichrome methods.

Results: Of the 224 lumbricals studied, we found four apparently degenerated lumbricals in two male cadavers. In the first, the 2nd and 4th lumbricals in the left foot and 2nd in the right foot. In the second cadaver, right fourth lumbrical was degenerated. Microscopically, the degenerated tissue was made of bundles of collagen that were aligned with skeletal muscle fibres and on MT-staining these fibrous bundles appeared green, hence, confirming the fibrous replacement of muscle tissue.

Conclusion: Degeneration can affect the function of lumbricals, especially in maintenance of the longitudinal arches. This would affect the gait of the individual. This may be due to compression of the lateral plantar nerve.

  Anomalous Bifurcation of Sciatic Nerve and its Clinical Implications Top

Niyati Airan

Veer Chandra Singh Garhwali Government Institute of Medical Science and Research, Srinagar, Pauri Garhwal, Uttarakhand, India

Objectives: Sciatic nerve, the thickest nerve of the body arises from the lumbosacral plexus. Its two divisions - Tibial nerve (anterior division of L4, L5, S1, S2, S3) and Common Peroneal nerve (posterior division of L4, L5, S1, S2) are enveloped in a common epineural sheath from its beginning. It then leaves the pelvis through greater Sciatic foramen below Piriformis, enters the gluteal region and then passes along the back of thigh where it gets crossed by Biceps femoris. The nerve then bifurcates into its two terminal divisions- Tibial nerve and Common Peroneal nerve at the superior angle of popliteal fossa.

Methods: During routine educational dissection, Sciatic nerve anomalies were found in both lower limbs in an adult female cadaver.

Results: In the left lower limb, Sciatic nerve bifurcated into its two terminal divisions inside the pelvis. The Tibial nerve left the pelvis below Piriformis and Common Peroneal nerve below Superior gemellus. The Sural nerve was seen to be arising from Common Peroneal nerve at mid-thigh level. Whereas on the right side, the undivided Sciatic nerve left the pelvis below the Piriformis and bifurcated into its two terminal divisions at mid-thigh level. The Sural nerve was seen to be arising from Common Peroneal nerve superior angle of popliteal fossa.

Conclusion: High division of Sciatic nerve with variations in the level of its exit from pelvis can lead to its compression, resulting in piriformis syndrome, sciatica, nerve injury during deep intramuscular injections and surgeries of gluteal region. It can also result in incomplete Sciatic nerve block during popliteal block anesthesia.

  Accessory Origin of Lumbricals in the Hand Top

A. Dandapath, A. Bhar

Malda Medical College, Malda, West Bengal, India

Lumbrical muscles of the hand act on the interphalangeal joints of the fingers, and may have a proprioceptive function. They are essential for fine skilled movements of the fingers, as in writing, or playing a musical instrument.

Objective: To study the gross anatomy of the lumbrical muscles of the hand.

Methods: During routine dissection of a male cadaver of unknown age for M.B.B.S. students, superficial and deep dissection of the palm was performed, following the method described in Grant's Dissector, 15th edition.

Results: In the left hand, the 1st and 2nd lumbrical muscles, both unipennate, were observed to be arising radially from the superficial surface of the flexor digitorum profundus tendon and deep surface of the flexor digitorum superficialis tendons to the index and middle fingers. Insertions were on the radial side of the extensor expansions as usual. Nerve supply was from branches of the median nerve. The 3rd and 4th lumbricals of the left hand, as well as all 4 lumbricals of the right hand, had the usual attachments and nerve supply.

Conclusion: Accessoryorigins of lumbrical muscles from flexor digitorum superficialis tendons may affect their functioning in fine skilled movements of the fingers. This anatomical variation may also be borne in mind during surgical exposure of the palm.

  Anatomical Variation in Number of Pulmonary Veins Draining into the Left Atrium: A Case Report Top

G. T. N. Sangma, S. Sonali

Regional Institute of Medical Sciences, Imphal, Manipur, India

Introduction: During the fifth week after conception the embryonic period begins. The mesoderm will give rise to the primitive circulatory system. The pulmonary veins takes place around 24 days. The smooth surface of the wall of the atrium is formed by the incorporation of the primodial pulmonary vein, which develops as an outgrowth of the dorsal atrial wall, just lateral of the septum primum in the sinoatrial region. As the left atrium expands, the primordial pulmonary vein and its main branches are incorporated into the wall and as a result, four pulmonary veins are formed.

Materials and Methods: During routine dissection of 1st year MBBS students in Department of Anatomy, RIMS, Imphal, an anomaly was noted while removing the pulmonary veins from the lungs. Usually four pulmonary vein, two superior and two inferior pulmonary veins from each lungs open into the posterolateral surface of left atrium. They carry oxygenated blood from the lungs to the left atrium of the heart. In this case, two pulmonary veins draining on the left side and three pulmonary veins on the right side draining into the left atrium were seen.

Results: The variability discovered on dissection was a two pulmonary vein on the left side with pulmonary ostium leading to left atrium. On the right side, a middle pulmonary vein was noted. Therefore three in total, superior, inferior and middle, with a three patent ostia opening into left atrium.

Conclusion: Clinically several issues can arise with this type of pulmonary vein anomaly. Presence of middle pulmonary vain has been found to produce an increased frequency of cardiac arrhythmias, atrial fibrillation being the most common. This arrhythmia is a cause of significant morbidity and mortality, with highest risk being sudden cardiac death through heart failure.

Therefore knowledge of the variations in pulmonary vein drainage is clinically important during cardio thoracic surgeries on left atrium.

  Variation in Branching Pattern of Sciatic Nerve and Renal Artery: A Cadaveric Case Report Top

Renuka Saini, Anjana Mathur, Yamini Singh

Jawahar Lal Nehru Medical College, Ajmer, Rajasthan, India

Objective: The aim of study is to describe and analyze the variations in sciatic nerve and renal artery. The higher division of nerve within the lesser pelvis which may cause nerve compressions under other anatomic structures, resulting in non-discogenic sciatica. The variation in pattern of renal artery as aberrant and accessory renal arteries; bring awareness to clinicians about the renal vascular region and this report may also be useful to clinicians performing invasive techniques and to surgeons performing nephrectomy and renal transplantation.

Methods: The observational descriptive study was performed during routine dissection. For sciatic nerve study first the gluteus maximus was elevated to explore the piriformis, the superior gemellus, the obturator internus, the inferior gemellus and the quadratus femoris. While for renal dissection, the kidney and its arteries were explore and variations in morphological patterns of renal arteries were noted. The variation was detected unilaterally in right kidney.

Results: Variations in Sciatic nerve division was found bilaterally. The tibial and common peroneal nerve were seen to leave the pelvis below the undivided piriformis separately with high division of sciatic nerve. Accessory or aberrant renal arteries were found at right side at level of L2 about 4.6 cm long.

Conclusion: Variations in the division of sciatic nerve and renal artery are useful for clinicians and surgeons.

  A Variant Supernumery Bone in the Knee Joint Top

C. Kumari, A. Aggarwal, Tulika Gupta, D. Sahni, P. Kumari, N. Saini, Deepak Rao

PGIMER, Chandigarh, India

Objective: Any extra bone present apart from the normal anatomical locations is considered to be a supernumery or the accessory bone. It may be misdiagnosed as fracture or osteophyte. So knowledge of its presence in different locations is of importance to anyone studying or dealing with the skeletal system. During dissection, a similar type of bone was encountered and it was evaluated for further details.

Methods: Routine dissection was done in a 59 year old cadaver for teaching of the graduate students in the Dept of Anatomy, PGIMER, Chandigarh. Knee joint was exposed after incising the capsule circumferencially. In the region of the popliteal fossa the posterior part of the knee joint revealed a circumscribed bone deep to the medial tendon of gastrocnemius. The dimensions of the bone were noted and ground as well as histological sections done for microscopic evaluation.

Results: The bone was within the capsule of the knee joint. It had an articular surface with the medial condyle of the femur. In haematoxylin and eosin staining as well as the ground sections, haversian systems were noted ruling out sesamoid type of bone. It had a separate entity as it was not an extension from any one of the adjacent bone.

Conclusion: Presence of a sesamoid bone in the lateral head of gastrocnemius is a known fact. Our findings shows a separate articulating bone in relation to the medial condyle of the femur. Such bones may be misdiagnosed as an intracapsular fracture. Its presence may also change the dynamics of knee movement.

  Fibre Dissection Technique of Brain to Create 3D Specimens: Cadaveric Study Top

M. P. Wakchaure, K. Shyamkishore, Shraddha Bhadarge

Topiwala National Medical College, Mumbai, Maharashtra, India

Objective: Fibre dissection technique involves peeling away the white matter tracts of the brain to display its three dimensional anatomic organization. The complexities of the preparation of the brain and the execution of fibre dissection have led to the neglect of this method. The objectives were to dissect

  1. 3D architecture of corpus callosum & its regional neuroanatomy in relation to lateral ventricle
  2. Insula, corona radiata & internal capsule
  3. Limbic system
  4. Visual pathway.

Methods: 15 formalin fixed adult human cadaveric brains of unknown sexes which were in routine dissection for undergraduate dissection and teaching were included. Any injured, dried or unfixed brains were excluded from the study. Cerebral hemispheres were dissected by lateral to medial & vice versa approach. A combination of both approaches was utilized for limbic system dissection. Each stage of dissection is described. The dissection tools were metal spatulas, small forceps, and scalpel.

Results: Though time consuming & complex, with fibre dissection technique we created excellent three dimensional neuroanatomy models for comprehensive understanding of deep structure of brain. This is possible even in routinely formalin fixed brains and without using dissecting microscope.

Conclusion: The complex structures of the brain can be more clearly defined and understood with re-establishment of fibre dissection. Specimensprepared are more relatable with texts than conventional cross sectional models for undergraduates and postgraduates. The technique per se can be practiced by neurosurgeons and applied to surgical strategies.

  Rare Case of Accessory Humeral Head of Pronator Teres with Vascular Manifestation Affecting Radial Artery Top

Tuhin Ghulyani

The pronator teres is a forearm muscle with two heads: humeral and ulnar heads. During routine cadaveric dissection for undergraduate students we came across an accessory humeral head of pronator teres muscle on the left side. This musculotendinous head had high proximal attachment to lower medial side of shaft of humerus and then it was seen running between biceps tendon and brachial artery. The course was slightly oblique from medial to lateral side and joined the pronator teres at its middle making an acute angle. Brachial artery and median nerve were noted to have a course between the two humeral heads. In relation to this it was noticed that this accessory head had passed upon the origin of radial artery and the caliber of radial artery was greatly reduced whereas the ulnar artery was almost of the same caliber as brachial artery. Hence it was inferred that this abnormal musculotendinous slip had greatly compressed upon the origin of radial artery thereby affecting its diameter; and ulnar artery in the need to supply the distal limb had even increased diameter. Although the pronator teres is notorious to cause entrapment of median nerve but here it was noted to have normal course and no thenar wasting was present. Rather in this case abnormal variation has caused visible vascular manifestation affecting radial artery. No other abnormality was noted in the limb. Presence of such abnormal accessory musculotendinous slips can lead to compression of neurovascular structures. Awareness of such variations is important to clinicians and surgeons.

  Cadaveric Study on the Course of Inferior Gluteal Nerve in the Gluteal Region Top

R. Rai, P. Dass

Kasturba Medical College Mangalore, MAHE, Mangalore, Karnataka, India

Inferior gluteal nerve (IGN) is a branch of sacral plexus that originates in the pelvis to exit into the gluteal region through greater sciatic foramen (GSF), below the piriformis. Inferior Gluteal Nerve may get traumatized during gluteal augmentation procedures or any other operative procedures in the buttock region. It supplies the gluteus maximus muscle by ramifying on its deeper surface. Objective of the present study is to trace the course of IGN in the gluteal region and to study its relation with the neighbouring nerves & vessels. This study was conducted on thirty-four embalmed cadavers in which gluteal region was already dissected for undergraduate teaching purpose. In these selected cadavers, structures deep to the divided gluteus maximus was cleaned carefully to examine the course and relation of IGN. It was observed that in majority of the specimens (70%) IGN exited the GSF below the piriformis and in some it was either a branch from the sciatic nerve or a branch from one of its components (Tibial or common peroneal). In three specimens out of 34 IGN and posterior femoral cutaneous nerve were communicated with each other. This study is an attempt to explain the vulnerability of IGN to injury during flap surgeries or other operative procedures in the gluteal region.

  Anatomical Study on Persistent Sciatic Artery Emphasizing Its Development Top

P. Dass, R. Rai

Kasturba Medical College, MAHE, Mangalore, Karnataka, India

In early embryonic life, the lower limb bud gets its blood supply from the sciatic artery (SA) which grows out from the dorsal root of the umbilical artery. With development of the femoral arteries, the SA usually involutes. Usually persistent sciatic artery (PSA) arises from the Inferior Gluteal artery if it is present. The incidence of PSA has been reported by many authors and is associated with higher incidence of aneurysm formation. Literature survey suggests that PSA is associated with clinical symptoms ranging from resting pain, claudication, necrosis, mass formation and neurological problems. Arterial insufficiency as a result of thrombosis or distal embolization of the mural thrombus from the aneurysm is a common clinical presentation and it is associated with a high incidence of limb loss. The present study is carried on thirty four cadaveric lower limbs, which were available in the Anatomy department of our Institution. In these cadavers PSA was observed in three limbs (8.8%) out of 34. Both were independent branches from the internal iliac artery. Its development and surgical relevance will be discussed further.

  Intermuscular Connections in Anterior Brachium: It's Implication in Radial Nerve Compression Top

M. Tonse, M. M. Pai, L. V. Prabhu, B. V. Murli Manju

Kasturba Medical College Mangalore, MAHE, Mangalore, Karnataka, India

The radial nerve arises from the posterior cord of the brachial plexus. It supplies the extensors of the forearm, wrist, and fingers and provides sensory function mainly to the posterior aspect of forearm. Radial nerve entrapment or compression may occur anywhere along the course of the nerve. Muscular and tendinous variations have been implicated in various nerve entrapment/compression syndromes along with other causes. The objective of this study is to determine the connection between brachialis and brachioradialis muscle, forming a bridge across the radial nerve at the elbow. This muscular/tendinous communication may be responsible in compression of the radial nerve, especially during movements of the elbow and radio-ulnar joints. The study was done on 84 formalin fixed human cadaveric upper limbs. Meticulous dissection in and around the cubital region revealed such a bridge in 24 of the specimens. In 17 specimens the brachialis muscle split into two, the larger medial part going for its usual insertion and the smaller lateral part joining the brachioradialis. In 6 specimens muscle fibres arose from the lateral aspect of brachialis and merged with brachioradialis. In 1 limb the connection was tendo-aponeurotic. Knowledge about this anatomical entity will be helpful in further understanding the etiology of radial nerve compression and its treatment.

  An Anatomic Study of the Ulnar Collateral Nerve and the Initial Branching Pattern of Radial Nerve Top

P. J. Jiji, Teresa Joy, Mangala M. Pai

Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka, India

The present study involving the initial segment and branching pattern of the radial nerve focusses more on the ulnar collateral nerve (UCN), a well-defined but rarely studied entity in human anatomy. The ulnar collateral nerve, a branch of radial nerve that accompanies the ulnar nerve in the arm, supplies the medial head of triceps brachii muscle. Our study was aimed at delineating and quantifying the UCN by cadaveric dissection of 68 upper limbs. The distinction of the ulnar collateral nerve as a robust branch even to the distal part of the medial head of triceps is found in 84% cases studied. Our study confirms the popular notion about the role of this nerve in the innervation of medial head of triceps brachii muscle. It was noted that the first muscular branch given from the radial nerve trunk was the nerve to long head of triceps brachii in 96%. Trifurcating radial nerve branching pattern was observed in one-third of cases in our study and in another third of cases additional branches to medial head of triceps were seen other than the UCN and the branch given at the entry point of spiral groove. The information gathered will be helpful in planning muscle or nerve transpositions.

  An Anthropometric Evaluation of the Gleno-Humeral Joint with Emphasis on the Coracoid Process and Glenoid Cavity Top

R. Khan, L. Lazarus, N. Naidoo, K. S. Satyapal

University of KwaZulu-Natal, Durban, Kwazulu-Natal, South Africa

The shoulder joint, also known as the gleno-humeral joint, is formed by the articulation between the spheroidal humeral head and the glenoid fossa of the scapula. The exact dimensions of the scapula, including the coracoid process and glenoid cavity, are considered to be fundamental in the patho-mechanics of the gleno-humeral joint. The aim of the study was to evaluate the anthropometric parameters of the gleno-humeral joint, with emphasis on the coracoid process and glenoid fossa. A total of one hundred and sixty-four (n = 164) dry bone scapulae (80 right; 84 left) were obtained from the Discipline of Clinical Anatomy, University of KwaZulu-Natal. All relevant parameters were measured with a digital caliper and the following were observed: (i) Incidence of shape of glenoid fossa; (ii) Incidence of notch type; (iii) Vertical diameter of glenoid fossa (VD); (iv) Horizontal diameter 1 of glenoid fossa (HD1); (v) Horizontal diameter 2 of glenoid fossa (HD2); (vi) Length of coracoid process (CL); (vii) Width of coracoid process (CW); (viii) Coraco-glenoidal distance (CGD). The CL, VD, HD1 and HD2 were observed to be larger on the right side, while the CW and CGD were larger on the left side. The VD, HD1, HD2, CL and CGD were found to be larger in male individuals, while the CW was found to be larger in female individuals. The observed findings in this study provide knowledge regarding the etiology of subcoracoid impingement and its management and for glenoid prosthesis designs in shoulder arthroplasty for the South African population.

  Block Lumbosacral Transitional Vertebra: A Case Report Top

Vandana A. Sharma, Deepak Sharma

Gandhi Medical College, Bhopal, Madhya Pradesh, India

Introduction: Skeletal variation in lumbo-sacral region may result in sacralization, lumbarization or transitional vertebra. Developmental defects occurring at lumbosacral border results in transitional vertebra with mixture of lumbar and sacral characteristics. The morphology of affected vertebra is intermediary or transitional with a combination of lumbar and sacral anatomical structures resulting into variety of anatomical configurations collectively called as Lumbosacral transitional vertebra (LSTV). Sacralization refers to condition where the last lumbar vertebra acquires sacral characteristics and articulates with sacrum. Lumbarization refers to a condition where the first sacral segment acquires characteristics of the lumbar vertebra. Inclusion of coccyx refers to fusion of coccyx vertebra with last sacral vertebra.

Case Report: During study of lumbosacral transitional vertebra, fusion of L-3 to L-5 and sacrum with scoliosis was observed at Gandhi Medical College, Bhopal. In this case L-3 to L-5 and sacrum were completely fused with incomplete lumbarization of S-1. The vertebral body width of L-4, L-5 & S-1 is 37, 42 & 40 mm respectively. Vertebral foramen width and depth is 22 mm & 12 mm respectively. Such condition of block lumbosacral vertebra has embryological importance and clinical implications.

Discussion: Embryological Basis -Vertebra is bi-segmental in development and receives contribution from caudal half of one sclerotome and from the cranial half of succeeding sclerotome. Thus lumbosacral transitional vertebra is caused by the border shifts, cranial shift resulting in the sacralization of the last lumbar vertebra and a caudal shift resulting in the lumbarization of the first sacral segment. Improper formation, migration, differentiation and union of somites results into segmental vertebral abnormalities. The cranial shifts often occurs at only one or two transitional border areas but caudal shifts involves three or four borders and the shifts are often in the same direction. The cranial shifts are dominant over the caudal shifts, so the sacralization is more common than lumbarization. Motion Segment - Lumbosacral transitional vertebra are common but usually involves L-5 and S-1, the higher level block lumbosacral vertebra involving L-3 are rare and have major morphological and clinical implications. Such block vertebra morphologically and functionally acts as a unit, resulting in upward shift of the motion segment. This fusion of vertebra may be congenital, acquired or pathological. Such anamolies of lumbosacral region are important from morphological and clinical prespective to anatomists, orthopedics, neurologists, anesthetics and neurosurgeons.

Clinical Implications: Identification of such cases are important as they may result in a varity of symptoms extending from lower back pain, disc degeneration, lumbar canal stenosis and disc prolapse resulting into limitation of movements, myelopathy, muscular atropy and neurological sensory loss. Such lumbosacral skeletal variations are detected by orthopedics and neurologists during management and radiological investigation of lower back pain. If remain asymptomatic, these are incidental oesteological findings during cadaveric dissections.

  Incidence of Thoracic Vertebral Synostosis and Its Clinical Importance Top

Padamjeet Panchal

All India Institute of Medical Sciences, Patna, Bihar, India

Introduction: Thoracic vertebral synostosis is of interest not only to the anatomist but also to surgeons, neurologist, orthopedician, radiologist, anaesthetics and for forensic medicine also. These anomalies may be associated with pain, muscular weakness of limbs and sensory deficits. The fusion of two or more vertebra is called as vertebral synostosis or block vertebrae which may occur in the cervical, thoracic & lumbar region.

Objectives: To determine the incidence of the thoracic vertebrae synostosis and to know the commonly involved level of synostosis in thoracic vertebrae.

Methods: The present study was conducted on 408 dry adult human vertebrae of unknown age & sex obtained from the Department of Anatomy, All India Institute of Medical Sciences, Phulwari-Sharif, Patna. The vertebrae were macroscopically observed to find if there exists any abnormal fusion between adjacent vertebral bodies, pedicles, laminae, spines or transverse processes. The features were measured by digital calliper (DVCA 150) 150 mm having accuracy of ± 0.03 mm.

Results: According to our study, we found presence of one set of fused 4th and 5th thoracic vertebrae (2.94%), one set of 5th to 8th thoracic vertebrae (2.94%). Out of 34 sets of vertebral columns we got 2 sets of fused thoracic vertebrae 5.88%. 2 sets of fused thoracic vertebrae present ossification of the anterior longitudinal ligament.

Conclusions: Knowledge about fusion of vertebral column at thoracic region is important to surgeons, neurologist, orthopedician, radiologist and anaesthetics.

  Human Sacrum with Negligible Curvature and 5th Lumbar Sacralization: A Case Report Top

Adil Asghar, Binita Chaudhary

AIIMS, Patna, Bihar, India

Introduction: Achieving the erect posture in human has necessitated many skeletal modification but these are more apparent in lumbosacral region. One the modification is sacral curvature. Sacral curvature is main feature which differentiate the human sacrum from that of animal.

Case Report: We are reporting the adult human sacrum with negligible curvature which is accidently found during routine teaching. This sacrum has sacralization of 5th Lumbar vertebra along with negligible curvature. The sacral index is 100.57 and might be belongs to male. 5th Lumbar vertebra is completely fused with first sacral vertebra and makes its length longer than breadth and reduced the sacral index to 84. But Sacralization of 5th Lumbar vertebra is identifiable by existence of mammillary process in superior articular facet, groove between transverse process and ala, and overriding of spinous process and lamina over spine of first sacral vertebra. Above finding challenge its human origin. But gross morphology, actual sacral index and comparison with ape gave sufficient evidence of human origin.

Conclusion: Human origin of sacrum is questionable if sacral curvature is absent. But sacralization and comparative morphology help to determine the origin. No such case reported earlier so, we presenting this interesting report.

  Tarsal Bones Coalition: An Anatomical Case Report Top

R. Kumar, C. Sahni, C. J. Das, S. Kaler

AIIMS, New Delhi, India

Objective: Coalition of naviculo-cuboid bones is extremely rare tarsal coalition. In the present case report a naviculo-cuboid fusion was observed. The purpose of this report is to highlight this rare variation among clinicians and orthopedic surgeons, which will be helpful in further diagnosis and treatment in the patients with this variation.

Methods: In the present case, naviculo-cuboid coalition was seen in a specimen of skeleton of foot (Left foot), during routine bone demonstration to undergraduate medical students. We observed this variant foot under x-rays also at different angles and compared with normal foot.

Results: It was found that in the skeleton of foot (left foot), a bony fusion was present between navicular and cuboid bone. We found that in x-ray there was no joint space between bones.

Conclusion: Tarsal coalitions represent an abnormal fusion between tarsal bones. It can be osseous, cartilaginous, or fibrous. It develops secondary to failure of differentiation and segmentation of the primitive mesenchyme during development. The patients with tarsal coalition clinically present with progressive pain and stiffness in the foot. The knowledge of this rare variation is important for clinician for diagnosis and treatment of patient with such rare condition.

  Omega Sign: Indicator of Motor Hand Area Top

S. N. Gosavi, R. S. Garud

Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India

Objective: Detailed knowledge of the structure and form of the cerebral sulci and gyri continues to be mandatory for neuroimaging as well as intraoperative guidance. Precise localization of precentral gyrus is important for neurosurgeons and neurobiologists. The omega sign is the knob on the precentral gyrus, which represents the motor hand area. During direct cortical observation, it is difficult to understand the cortical anatomy of the sulci and gyri because of the arachnoid matter. Further, anatomical variation often occurs in this region. Therefore, it is important to the neurosurgical team to have many methods, including morphological and morphometric methods, to recognize the sulcal and gyral anatomy of this region.

Methods: Fifty five Cerebral hemisphere fixed in 10% formalin, were studied in department of Anatomy of Bharati Vidyapeeth (Deemed to be University) Medical college, Pune. Arachnoid mater, blood vessel with pia mater were removed carefully. On the superolateral surface, presence of Omega sign was observed. If present the height of the omega, width at the base, its distance from superior and Inferior Rolandic point was noted.

Results: Presence of Omega sign was observed in 27 hemispheres (49.1%). The average height of Omega was 9.31 ± 2.94 mm, the width at the base was 16.03 ± 3.34 mm. Its distance from the superior Rolandic point was 27.53 ± 7.05 mm while from Inferior Rolandic point was 52.55 ± 7.8 mm.

Conclusion: Although technology offers modern intraoperative localization tools such as MRI and neuronavigation, anatomical knowledge is important for the surgical planning.

  Short Cystic Artery Arising from Aberrant Hepatic Artery: A Case Report Top

P. Kaushal, R. Kumar, N. Rani, P. Dhar

All India Institute of Medical Sciences, New Delhi, India

Objective: In depth knowledge with context to structural variations in the region of Calot's triangle is imperative for surgeons dealing with laproscopic cholecystectomy. Owing to the dense arrangement of various structures in this region, any deviation from the normal anatomy could lead to catastrophic bleeding and/or inadvertent ligation of biliary ducts or vessels during various surgical procedures. Though variations of cystic arteries have been widely reported in literature, yet the reports of short cystic arteries arising from aberrant hepatic artery (AHA) are barely come across.

Methods and Results: During undergraduate dissection, variation in hepatic vasculature was noted. A short cystic artery (SCA) (<1 cm) was seen arising from AHA, which in turn was a branch of superior mesenteric artery. AHA ran posterior to the duodenum, superior mesenteric vein and the cystic duct to reach the Calot's triangle, where SCA was given and AHA continued to supply the right lobe of the liver. SCA divided into smaller branches. Common hepatic artery from the celiac axis divided into gastroduodenal and hepatic artery, and later bifurcated immediately into right and left hepatic arteries.

Conclusion: Embryologically such variations can be attributed to persistence of omphalomesenteric arteries and variable expression of proteins such as Sonic hedgehog and vascular endothelial growth factor, which play a crucial role in vascular patterning during development. Aberrant vessels do pose a grave challenge for the operating surgeons as their avulsion due to excessive traction applied to structures in the vicinity, could present as catastrophic bleeding. Hence, adequate knowledge pertaining to varied vasculature in this area is imperative to avoid iatrogenic injuries.

  Study of Anatomic Variations of Intrahepatic Bile Ducts in South Indian Population Top

S. Rout, H. R. Singh, R. A. John, M. Rymbai, A. Eapen, S. Rabi

Christian Medical College and Hospital, Vellore, Tamil Nadu, India

Background: Preoperative knowledge of variations in intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery.

Objective: To describe the anatomical variants of the IHDs branching pattern using Magnetic Resonance CholangioPancreatography (MRCP) and luminal casting method in South Indian population.

Materials and Methods: Fifteen livers procured from cadavers used for teaching in anatomy department, with no gross deformity were injected with Glass sealant (silicone) using a silicone gun. Soft tissue was corroded using diluted HCl. Further dissection was completed with finger fracture technique by tracing the biliary ducts and branching patterns were noted. Branching pattern were also studied in fifty MRCP films obtained from radiology department.

Results: Out of 15 gross specimens, 12 specimens (80%) showed normal pattern in which the right posterior segmental duct (RPSD) joined with right anterior segmental duct (RASD) forming right hepatic duct (RHD). Two specimens (13.34%), showed trifurcation while in 6.67%, the RPSD drained into left hepatic duct (LHD). Radiologically, 72% showed typical pattern while RPSD drained into LHD in 14% of cases. The trifurcation and low posterior inserting ducts were found in 6% and 8% of cases respectively. Variations in branching pattern of LHD or presence of accessory hepatic duct was not observed.

Conclusions: The typical branching pattern of intrahepatic ducts was found to be commonly present in 80% in cadavers and 72% of radiological images, while atypical presentation was found in 20% and 28% for the same.

  Multiple Vascular Variations in the Left Half of the Abdomen Top

Surekha D. Shetty, B. Satheesha Nayak, S. N. Somayaji, K. G. Mohandas Rao

Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India

Variations in the abdomen are common. Knowledge of variations of the renal and gonadal vessels is of importance in abdominal surgeries. We report the vascular variations associated with the left kidney and left testis, which were observed during routine dissections for medical undergraduates in a cadaver aged approximately 70 years. Left kidney was supplied by the left renal artery from the abdominal aorta and was drained by left renal vein into the inferior vena cava. Apart from this, left kidney was also supplied by an aberrant renal artery arising from the abdominal aorta, one inch below the origin of inferior mesenteric artery. This artery entered the kidney through its inferior pole. This artery was accompanied by an aberrant renal vein, which drained into the left common iliac vein. There were two testicular veins on the left side. About 1 cm below the left renal vein, these two veins united with first and second lumbar veins to form a 'common gonado-lumbar vein.' The common gonad-lumbar vein drained into the left renal vein. Further, the left testicular artery arose from the abdominal aorta and hooked around the junction of union of first lumbar vein with the common gonado-lumbar vein. The knowledge of above mentioned variations could be useful during renal transplant surgeries, therapeutic embolization of testicular veins and also in radiological procedures of abdomen. Presence of a common gonado-lumbar vein might further increase the chance of varicocele, which is common on the left side.

  An Additional Muscle Belly from Palmaris Longus Tendon to the Thumb: A Muscle which Deserves to be Called as Palmaris Pollicis Brevis Top

L. S. Ashwini, S. N. Somayaji, K. G. Mohadas Rao, Sapna Marpalli

Manipal Academy of Higher Education, Manipal, Karnataka, India

Anatomical variations of the tendons of the forearm and wrist encountered during cadaver dissection, radiological examination and surgical interventions are very important clinically and for the biomechanics of movements of digits. During routine cadaveric dissection for first year medical students at Melaka Manipal Medical College, Manipal, we observed an additional muscle belly in the thenar eminence of left palm in a 65-year-old male cadaver. This muscle belly was originating from the palmar aponeurosis and lateral aspect of lower end of the tendon of palmaris longus. This additional muscle was extending downwards and laterally, superficial to other thenar muscles. The fleshy fibers of this muscle were converging to form a tendon which were inserting into the lateral side of base of proximal phalanx of thumb. The muscle was supplied by a twig from the recurrent branch of median nerve. We also observed that the muscle belly was crossed by unusually large superficial branch of radial artery which was joining the superficial palmar arch. Normally, palmaris longus ends as palmar aponeurosis which gives slips to all the digits except the thumb. However, the muscle observed in the present case was arising from the aponeurosis and the palmaris longus and was inserting into the bones of the thumb as an additional thenar muscle. Such a variation was not reported in the literature as per our knowledge. Based on its location and attachments, the muscle can be called as palmaris pollicis brevis.

  A Case of Third Head of Biceps Brachii along with an Additional Slip of Insertion Top

Sapna Marpalli, K. G. Mohandas Rao, S. N. Somayaji, L. S. Ashwini

Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Muscular variations in the upper extremity are uncommon. Biceps brachii (BB) is a muscle of anterior compartment of the arm, with two heads of origin and it inserts into the radial tuberosity and antebrachial fascia through a tendon and aponeurosis respectively. During routine dissection for undergraduate medical students, we encountered an unusual case of third head and additional slip of insertion of BB in the upper limb of an approximately 60-year-old male cadaver. The third head of the BB was arising from the lower 1/3rd of the anterolateral surface of the humerus along with the fibers of brachialis. The median nerve was passing through this third head as it entered into the cubital fossa. The fibres of the third head formed a separate tendon which distally expanded to form bicipital aponeurosis and blended with antebrachial fascia. Some of the lateral fibers of the long head of BB got split from the main belly in the middle 1/3rd of the arm and was inserted to the shaft of the humerus. The median nerve may get compressed as it passes through the third head of BB and can cause weakness of flexor muscles of forearm and hand. Thus, it is crucial that clinicians must know about such variations to treat the compression neuropathies in the arm and forearm. Similarly, slip of muscle fibers of BB which are ending in the arm instead of forearm may restrict the movements of the shoulder joint for a limited extent.

  Anatomic Variations of the Sural Nerve in Leg and Foot with Clinical Relevance: A Study of 50 Cadavers Top

P. R. Krishna Prasad, S. N. Somayaji, K. G. Mohandas Rao, Sapna Marpalli, L. S. Ashwini

MAHE, Manipal, Karnataka, India

The sural nerve is a cutaneous afferent nerve which originates in the leg, courses along the back of the leg, lateral side of the foot and the little toe, supplying the skin over the back of the leg and lateral aspect of ankle and foot including little toe. The purpose of this study is to categorize the sural nerve variations in the leg and foot of cadaveric specimens, which will be useful for surgeons while encountering sural nerve for various operative indications around this region. Fifty lower limb cadaveric specimens were studied and variations (if any) of the sural nerve course, branching and distribution in the leg and the foot were documented. Based on our findings on the pattern of origin, course and termination, we divided the sural nerve in the leg into 6 types and in the foot into 2 types. In the leg, 39 specimens showed type 1, one specimen showed type 2, three specimens showed type 3, two specimens showed type 4, four specimens showed type 5 and one specimen showed type 6 category of sural nerve variations. In the foot, two specimens showed type 1 and two specimens showed type 2 category of sural nerve variations. The knowledge of anatomical variations in the sural nerve becomes utmost important when the posterolateral aspect of leg and lateral aspect of foot is approached for various operative indications.

  Rare Variation of Axillary Artery and It's Clinical Significance Top

C. Sahni, S. Singh, N. Rani, R. Dada

All India Institute of Medical Sciences, New Delhi, India

Objective: Knowledge regarding the axillary vasculature is important for the planning of axillary nerve block, axillary lymph node resection and radical mastectomy. The presence of variation in the axillary vasculature may result in the postoperative complications such as bleeding. In the present study, a rare vascular variation reported and is of foremost importance for clinicians, anesthetist, surgeons, radiologist and anatomists.

Methods: During routine dissection, an uncommon variation of the branching pattern of axillary artery was observed in one female cadaver aged 60 years. The axillary region was dissected very carefully after reflecting the pectoralis major and minor.

Results: In the present study, alar thoracic artery arose from the 3rd part of axillary artery in the cadaver which was supplying axillary fat and a lymph node. Along with this alar thoracic artery, a common arterial stump in 3rd part of axillary artery was giving one posterior circumflex humeral and three subscapular branches. No other neurovascular variations were observed in the in axillary region.

Conclusion: The knowledge of the vascular variation regarding the branches of axillary artery is important for surgeons and anesthetist during axillary nerve block or any axillary surgeries, and it can also help to decrease the postoperative morbidity of the patients.

  The Peroneus Quartus Muscle – Revisited: Case Report Top

Lt Col Rahul Jha, S. M. Rustagi, M. S. Ahuja

Army College of Medical Sciences, New Delhi, India

Introduction: The Peroneus Quartus, a supernumerary muscle of the ankle is located in the lateral compartment of leg. It plays a role in eversion of the foot, pronation of the foot against the walking surface, and lateral stabilization of the ankle.

Case Report: We observed an unusual variant of the muscle arising from the lateral surface of fibula between the two peroneal muscles. The muscle was found to be inserted onto the peroneal trochlea.

Discussion: Peroneus Quartus muscle is a variant muscle of the lateral compartment of the leg. The accessory muscles of the peroneal compartment have been given various names- Peroneus Quartus by Otto, Peroneus Calcaneum externum by Hecker. Zammit and Singh found the most common site as the retrotrochlear eminence- 50% of dissections and 83% of MRI examinations. Sobel and co-workers reported the insertion at the peroneal tubercle of the calcaneus in 63% of cases studied.

Conclusion: The Peroneus quartus muscle is usually asymptomatic. Apart from the anatomical interest, orthopedicians and radiologists need to know of its existence and involvement in pathological conditions.

  Yoga's Potential for Improving Disease Activity and Inflammatory Markers among Patients with Rheumatoid Arthritis Top

S. Gautam, U. Kumar, U. Kanga, A. Goswami, P. Chaurasia, R. Dada

All India Institute of Medical Sciences, New Delhi, India

Objective: Apart from usual medical therapy, recovery of patients with Rheumatoid Arthritis (RA) in which quality of life (QoL) is greatly compromised is dependent on several physical and psychological factors. This study aimed to assess impact of 4 weeks Yoga-based lifestyle intervention (YBLI) on QoL, stress markers and immune parameters of active RA group compared with usual-care control group.

Methods: After randomization, 156 subjects were assigned two groups: Yoga Intervention Group and Control Intervention Group. They were assessed for pre and post intervention levels of reactive oxygen species (ROS) and panel of pro-inflammatory (IL-6, IL-17A, TNF-α) and anti-inflammatory cytokines (TGF-β, sHLA-G). Parameters of disease activity, QoL, disability index and pain acuity were assessed by various scales.

Results: YBLI participants showed significant improvements in disease activity, pain acuity, disability index, QoL over control group (p<0.05***). Mean levels of pro and anti-inflammatory cytokines showed significant reversal after YBLI (p<0.05**), but ROS did not change significantly (p>0.05).

Conclusion: Short term YBLI has significantly improved pain perception, disability quotient and disease activity. Thus this simple lifestyle intervention can reduce disease severity and dose of disease modifying anti-rheumatic drugs used in the treatment of RA. YBLI emphasizes stress reduction, QoL improvement and immune-modulation may be beneficial for individuals with RA as an adjunctive therapy.

[TAG:2]Tyrosine Kinase A Receptor Expression in Breast Cancer [/TAG:2]

A. Dubey, R. Sehgal, T. C. Nag, A. Srivastava, T. G. Jacob, A. Kumar

All India Institute of Medical Sciences, New Delhi, India

Introduction: Breast cancer is one of the major causes of cancer related deaths in women. Nerve growth factor (NGF), the prototype member of the neurotrophin family and its two receptors Tyrosine kinase A (TrkA) and Neurotrophin receptor p75 (p75NTR) are implicated in several cancers including carcinoma (CA) breast. Resistance to chemotherapy is a major obstacle in the effective treatment of many types of cancers. Although many anticancer therapies can alter tumor growth, the effect is not long-lasting in most cases. With an overall goal towards exploring new therapeutic strategies for the future, the present study was designed to record and compare TrkA receptor expression in normal and CA breast tissues.

Materials and Methods: Surgically removed fresh tissue specimens from malignant breast tumors (test) as well as normal tumor margins/mammoplasty tissue (control) were collected from 21 patients reporting to the Surgery OPD. The study was conducted on one control and two test groups (CA breast with and without chemotherapy prior to surgery), with tissue collected from 7 patients included in each of the three groups. TrkA receptor expression was recorded for tissue specimens in each group using Immunohistochemistry (IHC) and Sandwich ELISA.

Results: Maximal TrkA receptor expression was observed in CA breast tissue collected from untreated cases (test group without chemotherapy) and in a subgroup of treated cases (with chemotherapy) that showed poor response to the treatment. The expression was found to be the least in normal breast tissue.

Conclusion: This evidence of a significant central role for the TrkA receptor in breast cancer is suggestive of a possible novel therapeutic approach targeting this receptor in the near future.

  Faculty Perception on Vertical Integration as a Teaching Learning Method in Undergraduate Medical Education Top

Madhusmita Panda, Mohua Biswas, Srikant Panda

S.C.B. Medical College, Cuttack, Odisha, India

Objectives: To determine and compare the perception of preclinical, paraclinical and clinical faculty on vertical integration as a teaching learning tool in undergraduate education and so also to determine the difficulties of execution of vertical integration in undergraduate curriculum.

Materials and Methods: The study was approved by Institutional Ethics Committee. Informed consent forms were administered to the faculty members of the preclinical, paraclinical and the clinical departments. By random sampling 20 members from the nonclinical faculty, 36 members from the paraclinical departments and 65 faculty members of the clinical departments were taken for our study. Self administered questionnaire forms were distributed to all the above faculty members.3 faculty of the clinical departments did not turn up with the filled up forms. From the rest of the faculty their perception of the new approach was collected using the prevalidated questionnaire consisting of close ended and open ended questions. Their responses were evaluated and were analysed.

Observation: It was observed that 77.42% of the clinical faculty, 55.55% of paraclinical faculty and 55% of the preclinical faculty gave a positive response for the implementation of integrated teaching. Maximum number of clinical faculty also agreed that there was unnecessary repetition of the subject matters with a disjointed approach towards teaching medical science and thus creating confusion in the students' mind due to differences in opinions. 86.11% of the paraclinical faculty felt that understanding of the subjects would be much better with integrated teaching and the students would have tremendous improvement in cognitive and psychomotor domains.

Conclusion: Vertical integration was a preference factor for maximum number of faculty of almost all the departments but with suggestions that it would be a herculine task for the stake holders who has to develop and modify the curriculum accordingly.

  The Use of Drawings as a Creative Tool to Express Student Perception of Cadaveric Dissection: The UKZN Experience Top

L. Lazarus, J. S. Luckrajh, C. Sookoo

University of KwaZulu-Natal, Durban, Kwazulu-Natal, South Africa

Cadaveric dissection is a key practical component of the anatomy curriculum which enables students to form a link between theory and practice. However, engaging in cadaveric dissection evokes an array of emotions in students which may act as stressors and affect them psychologically. The artistic practice of drawing either from direct observation or memory offers many features of wellness interventions such as relaxation, reflection, self-expression, and creativity, whilst potentially having a direct benefit to students' medical education. In some centres, arts training has also been used as a supplement to anatomical teaching and, in particular, has been used as a method for improving clinical observation skills. This study aimed to identify the students' perceptions of cadaveric dissections through drawings. First year occupational therapy and physiotherapy students were asked to draw a picture to express their feelings regarding cadaveric dissection. A total of 66 drawings were solicited from these students. The drawings were analysed and interpreted. The emotions depicted in the drawings were categorised as Positive (15/66; 22.72%), Negative (34/66; 51.51%) and Ambivalent (17/66; 25.75%). As depicted from the results of this pilot study, drawings can be viewed as an opportunity for students to step away from texts or the dissecting table and it is interesting to note that many evoked negative attitudes toward the dissecting room experience. Drawing helps to avoid the 'trap of the textbook' – that tendency for students to think of the body as discrete chapters in a book rather than a unified whole.

  Introduction of Jigsaw Puzzle to Teach Anatomy to 1st Year MBBS Students Top

S. Gupta

Department of Anatomy, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Objective: Aim is to take students from the traditional view of anatomy as a subject that requires surface learning (rote learning, memorization) to one that can lead to deep learning through understanding. A range of innovative, pro-active, simple, hands on approach instead of didactic lecture can achieve maximum student engagement and help them learn. Working on puzzles makes the students alert, increase their concentration, expands creativity and help in improving cognitive and analytical skills. The principle goal for the study was to support and assist first-year students to develop their knowledge and learning in Anatomy by interactive activity.

Methodology: Two sessions of Jigsaw puzzle were conducted on first year MBBS students (n=100). The students were divided into small groups. Each group was given an incomplete jigsaw puzzle and a set of questions. The answer to these questions helped them to get the missing pieces of jigsaw puzzle and complete the puzzle. Students were requested to fill a questionnaire regarding their perceptions about the interactive activity.

Results and Conclusion: 57.13% students felt that it helped in understanding the topic and for 48% it was a challenging experience. For over 40% students, the problem-solving experience enhanced their learning through experience and they wanted to participate in similar activity in future.

  Communities of Practice: A New Methodology in Anatomical Research and Teaching Top

L. Lazarus, R. Sookrajh, K. S. Satyapal

School of Education, University of KwaZulu-Natal, Durban, Kwazulu-Natal, South Africa

Communities of practice are formed by people who engage in a process of collective learning in a shared domain of human endeavour. To become an official community member, an individual must work in the relevant domain and express buy-in or commitment. Members of the community value their joint competence and learn from each other. In this study the 'community of practice' refers to the interdisciplinary collaboration with co-authors well as national and international faculty-based at other higher education institutions in South Africa. The aim of this paper was to examine the views and perceptions of fellow colleagues regarding research in the domain of clinically applied anatomy and how this has impacted on their teaching practices using our collaborative work. Participants were identified as those individuals who were involved as co-authors (n=10) on co-written papers. Semi-structured one-on-one interviews were conducted with research team members. Interviews were audiotaped and transcribed verbatim. This methodology allowed the first author (LL) to critically reflect on her role as a basic scientist in this research team. Themes that emerged from the data were (i) Value of research collaboration, (ii) Impact of human anatomical variations, (iii) Association with medical and non-medical collaborators and (iv) Teaching practice emanating from collaborative research. We see collaboration to advance anatomy research as a good strategy to overcome some of the globally felt challenges to anatomy education. The community of practice involving co-authors provides an opportunity for institutions and health centres involved to benefit from sharing of experiences and resources, capitalising on each other's strengths.

  Voluntary Body Donation: A Survey of Awareness in Gwalior Top

Rahul Sharma, Rajendra Gupta, Manish Chaturvedi

Gajra Raja Medical College, Gwalior, Madhya Pradesh, India

Introduction: Voluntary body donation is a generous gift of knowledge. This gift will help in medial training and research, and in turn will benefit your children, grand children and people for many generations. The concept of awareness of VBD is large scale utmost necessity of the hour.

Objective: To know the awareness about voluntary body donation among medical and non medical community and promote the voluntary body donation.

Methods: A questionnaire based cross sectional study among medical and non medical persons and statistical analysis. Questionnaire designed to assess regarding VBD was provided to the study population of which 50 belong to the general public and 50 belong to the medical professionals.

Results: The medical members' results showed that 74% are ready to donate their bodies. Among the non medical professionals 26% want to donate and 40% did not know about the body donation. Only 50% of polled to donate their bodies for medical education, 30% are not ready and 20% are unaware of it. These results show that non medical professionals are very much unaware about VBD and they need awareness programme and knowledge about VBD.

Conclusion: From this study it is clear that medical persons are well known the voluntary body donation and know to proceed for this rather than non medical persons.

  Prenatal Amisulpride Induced Behavioral Alterations in Swiss Albino Mice Top

S. Shrestha, C. B. Jha, N. Pandey, A. Pandey

B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Background and Objectives: Amisulprideis an atypical antipshychotic drug used to treat psychosis in schizophrenia and episodes of mania in bipolar disorder. There is no adequate and well controlled study in pregnant women or animal studies have shown an adverse effect in offspring induced by this drug. The present study has been undertaken with the aim to sought the amisulpride induced neurobehavioral alterations in mice offspring when the amisulpride were administered throughout organogenesis period.

Methods: In the present study, amisulpride were administered orally to swiss albino pregnant mice in the doses of 50 mg and 100 mg/kg body weight throughout organogenesis period of mice (6-15 days). The animals were divided into three groups. Group I was control, group II treated with amisulpride at the dose of 50 mg/kg bw and group III treated with amisulpride at the dose of 100 mg/kg bw. The animals from all the groups treated as well vehicle control were allowed to deliver on Gestation day 19. The offsprings were subjected to behavioral test at the age of 8 weeks.

Results: The amisulpride treated at the doses of 100 mg/kg body weight mice offsprings showed significant decreased locomotor activity, increased anxiety and depression and loss of memory on the open field, elevated plus maze test and water morris maze test respectively in comparison to control group.

Conclusion: These findings suggest that the prenatal exposure of amisulpride during critical period of brain development in offspring alter the behavioral function.

  Effects of Monosodium Glutamate on Liver Tissue of Wistar Albino Rats: A Histological and Biochemical Study Top

S. Shrestha, C. B. Jha, B. K. Lal Das1, P. Yadav

Departments of Human Anatomy and 1Clinical Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Background and Objectives: Monosodium glutamate (MSG), chemically known as AJI-NO-MOTO (at the origin of flavor) is the sodium salt of glutamic acid, one of the most abundant naturally occurring non-essential amino acids. MSG entering our bodies with absolutely no limits in hundreds of food items daily. The reports have indicated that MSG is toxic to human and experimental animals. Therefore, MSG has become a controversial food additive and the scientific reality still remains obscure. The objective of this study was to assess the histological and biochemical effects of monosodium glutamate on Liver Tissue of Wistar Albino Rats.

Methods: In the present study, 24 rats were divided into four groups. Each group contained 6 rats. Group I was control and received standard diet with 2 ml distilled water orally by gavage, group II were received 0.6 mg/gm body weight MSG dissolved in 2 ml distilled water orally by gavage, Group III will received 1.6 mg/gm body weight MSG dissolved in 2 ml distilled water orally by gavage. Group IV will received CG waiwai noodles mixed with standard rodent diet and 2 ml distilled water orally by gavage. All groups were treated over a period of 28 consecutive days. On 30 day all rats were sacrificed by cervical dislocation and liver was taken for histology, while blood was collected for biochemical study.

Results: In MSG treated rats, the examined sections showed altered liver architecture, congestion in central vein, dilated sinusoids, decreased size of hepatocyte nuclei diameter. Examination of liver histology of rats from group IV showed normal histological features with hepatic lobules, however mild disturbance of liver architecture was seen. The liver enzyme ALT, AST and GGT significantly increased in the serum, on MSG administration group compared to control.

Conclusion: The results showed that MSG treated rats affected the histology of liver and affected the liver function.

  Effectiveness of Curcumin in Amending Arsenic Trioxide Induced Adverse Effects in Mouse Basal Forebrain Top

B. Kaur, K. Mehta, K. K. Pandey, P. Dhar

All India Institute of Medical Sciences, New Delhi, India

Objective: Arsenic trioxide (As2O3) is reported to induce neurodegenerative changes when administered for longer duration presumably due to generation of reactive oxygen species (ROS). Curcumin (CU) is a phenolic compound with antioxidant and anti-inflammatory properties. The present work was carried out to determine the effects of CU on behavioral, morphological & immunohistochemical parameters pertaining to the basal forebrain (BF) of mice exposed to As2O3.

Methods: Adult male mice were divided into control, As2O3 (4 mg/kg) alone, CU alone (100 mg/kg) and As2O3 and CU-cotreated groups. The test substances were administered orally for 45 days. The behavioral tests - elevated plus maze (EPM) and Morris Water Maze (MWM) - were performed from day 36 to 45 during experimental period. Following perfusion fixation of these animals on day 46, brain tissue was processed for observation of various morphological changes in CV stained paraffin sections. Immunohistochemical expression of ChAT was studied following conventional protocols.

Results: In EPM, the As2O3 alone treated mice showed more number of entries and spent more time in closed arms as compared to control and CU-cotreated animals. In MWM, As2O3 alone treated mice travelled longer distance and took more time to reach the platform. The CV stained sections of BF region revealed altered structural integrity of neurons in As2O3 alone exposed mice. The immunoexpression of ChAT was less intense in AOI in As2O3 treated mice as compared to CU-cotreated mice.

Conclusion: CU supplementation showed positive influence on behavioral, morphological and immunohistochemical features of BF of mice subjected to As2O3 exposure.


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