Ashwini P Aithal

A peculiar liver with surgically and radiologically important variations: a case report

A peculiar liver was found in an adult male cadaver during a dissection class for undergraduate medical students. The quadrate lobe and fissure for the ligamentum teres were totally absent. Thus, the cystic notch on the inferior border was very broad and deep, and the fundus and body of the gall bladder popped out through this notch. The cystic duct terminated into the right hepatic duct at the porta hepatis instead of terminating into the common hepatic duct. Awareness of variations of the lobes and fissures may minimize a misdiagnosis of liver problems. The aim of the current study was to alert radiologists and surgeons about possible variations in the external appearance and anomalies of the lobes and fissures of the liver.

Bilateral vascular variations at the renal hilum: a case report.

Imaging technology with its advancement in the field of urology is the boon for the patients who require minimally invasive approaches for various kidney disorders. These approaches require a precise knowledge of the normal and variant anatomy of vascular structures at the hilum of the kidney in terms of their pattern of arrangement and division. The present paper describes a bilateral anomalous arrangement of the structures at the renal hilum as well as their peculiar branching pattern which is of clinical and surgical relevance. Multiple branching of the renal vessels was observed in both kidneys due to which the hila were congested. The right renal artery immediately after its origin divided into 2 branches. The upper branch represented an aberrant artery whereas the lower branch gave 5 divisions. The left renal artery also divided into 2 branches much before the hilum as anterior and posterior divisions. The anterior branch took an arched course and gave 6 branches. The posterior branch gave 3 terminal branches before entering the renal substance. In addition to anomalous hilar structures, normal architecture of both kidneys was altered and the hilum of the left kidney was found on its anterior surface.

Unusual jejunal tributaries of the splenic vein and their surgical importance: a case report

Introduction: Knowledge of variations regarding the formation, termination and tributaries of the portal vein, superior mesenteric vein and splenic vein are very useful and of utmost importance for surgeons performing surgeries of the pancreas and duodenum. Normally, the jejunal veins are the tributaries of the superior mesenteric vein. We report here, a very unusual case where two proximal jejunal veins drained into the splenic vein instead of the superior mesenteric vein. Case Report: During the dissection classes for undergraduate medical students, we noted variations in the termination of the upper jejunal veins in an adult male cadaver who was approximately 65 years old. We found that the union of three veins formed the portal vein: the splenic vein, jejunal veins and the superior mesenteric vein. Conclusion: Familiarity with such anatomical variation provides useful information for surgeons performing abdominal surgical procedures.

The venous chiasma between the basilic vein and the brachial vein: a case report.

Variations in the venous pattern of the arm are common. In this case report, we are presenting the variations of the brachial vein and the basilic vein.During the routine dissections which were done by medical undergraduate students, we observed some variations in the veins of the upper limb. In the current case, there was only one brachial vein which accompanied the brachial artery. The basilic vein originated from the medial side of the dorsal venous network, ascended along the medial side of the forearm and joined the brachial vein to form the axillary vein at the distal border of the teres major muscle. The basilic vein and the brachial vein joined with one another in the middle of the arm to form a unique venous chiasma.A large number of invasive procedures are carried out by using the veins of the upper limb, particularly in and distal to the axillary region. This type of a venous chiasma may lead to complications in these procedures.

A South Indian Cadaveric Study About the Relationship of Hepatic Segment of Inferior Vena Cava with the Liver

INTRODUCTION Inferior Vena Cava (IVC) is the largest vein of the body. It runs vertically upwards in the abdomen, behind the liver. Its course is very constant in relation to liver. However, the amount of liver parenchyma related to it can vary from person to person. The data regarding its course and relations may be very useful to radiologists and surgeons during surgical treatment procedures for Budd-Chiari syndrome, liver carcinoma, liver transplant, venous cannulations and many other clinical procedures. AIM Aim of this study was to document the incidence of straight and curved course of IVC in relation to liver and also to note the pattern in which the liver tissue was related to the IVC. MATERIALS AND METHODS In the current study, 95 adult cadaveric livers were observed; specifically to study the course/direction of the hepatic segment of IVC in relation to the liver. The extent of liver tissue related to various aspects of IVC was also studied. The course of the IVC was classified as straight and curved; and the relationship of liver parenchyma to the IVC was classified into 6 categories. The data was expressed as percentage incidence. RESULTS In 78.94% cases, the IVC had a straight course in relation to the liver; whereas in 21.06% cases, it had a left sided curve (concavity of the curve towards the caudate lobe) in its course. In 6.31% cases, IVC travelled in a tunnel, being encircled by the liver parenchyma all around; in 36.84% cases, it was covered by liver parenchyma on front and sides so that only posterior surface of IVC was visible; in 3.15% cases it was covered by liver tissue on front, sides and also partly on posterior aspect; in 50.52% of cases, its anterior surface, sides and left edge of the posterior surface was covered by liver tissue; and in 3.15% cases it was covered only from the front by the liver tissue. CONCLUSION The data being reported here might be useful for surgeons while planning and executing various hepatic surgeries and also to the radiologists in planning and performing venous cannulation and therapeutic procedures. Since in many livers, the curvature of IVC was associated with enlarged caudate lobe, the curved IVC could hint about the increase in the volume of caudate lobe or liver itself.

Evaluation of numerical and positional variations of the hepatic veins: A cadaveric study

Introduction: Hepatic veins are the major linking vessels between systemic and portal circulation. Numerical and positional variation of the hepatic veins can play a significant role during surgical interventions on the liver. Materials and Methods: Gross anatomical study regarding the number and arrangement pattern of hepatic veins was undertaken on 88 adult livers which were stored in 10% formalin after the regular dissection classes. Result: Six livers (7%) were found to be drained only by major hepatic veins, whereas 82 out of 88 livers (93%) had accessory (minor) hepatic veins. The total number of persistent hepatic veins ranged from 2 to 10 with the highest prevalence of four hepatic veins (35.2%) followed by 5 (19.3%) and 6 (17%). The presence of three major veins was seen in 45 (51%) livers while 41 (47%) livers had two major hepatic veins. Remaining two livers (2%) showed the presence of four major hepatic veins. In 95% specimens, the minor hepatic veins entered the inferior vena cava below the level of entry of major veins. In 2.5% cases, their entry point was above the major veins and in 2.5% cases, the entry point was below major veins. Conclusion: The data resulting from this study provides a clear idea about the number and drainage pattern of the hepatic veins into the liver. Knowledge of numerical and positional variations of hepatic veins could be useful in normal Doppler ultrasound hepatic vein flow velocities and their variation with respiration in healthy adults as comparable with the similar approach of superior vena cava.

Presence of communication between radial and ulnar nerve at high humeral level and its distribution to triceps brachii muscle

Unusual communications between the branches of brachial plexus is not uncommon phenomenon. But among these, aberrant interconnection between radial and ulnar nerve is seldom reported. We present a case of persistence of well established abnormal communication between radial and ulnar nerves and its distribution to medial head of the triceps brachii muscle. Due to this, the triceps brachii which is normally innervated by radial nerve received additional innervations from the twigs of ulnar nerve through this communication. Aberrant communicating nervous channels when persist are vulnerable to iatrogenic injuries during surgical procedures as well as might results in entrapment neuropathic syndromes.

A rare case of atypical thoracodorsal artery: a challenge for flap reconstruction

The thoracodorsal artery mainly supplies the latissimus dorsi muscle. Anatomical details pertaining to the origin and distribution of thoracodorsal artery are important because the latissimus dorsi myocutaneous flap is one of the most reliable and versatile flaps used in reconstructive surgery. Atypical origin and course of the thoracodorsal artery is, therefore, a challenge for flap reconstruction surgeries. In the present case, we report multiple variations in the branching pattern of axillary artery. The thoracodorsal artery had an unusual origin from the second part of axillary artery. The trunk of thoracoacromial artery was absent. The thoracodorsal artery after its origin, descended downwards over the lateral pectoral region lying deep to pectoralis minor but superficial to teres major muscles. It terminated by supplying the latissimus dorsi muscle. Due to the presence of atypical thoracodorsal branch, the subscapular artery continued as the circumflex scapular artery.

Haemostatic potential of human bone marrow-derived mesenchymal stromal cells in Wistar rats with carbon tetrachloride induced liver cirrhosis

Background To evaluate the haemostatic potential of human bone marrow-derived mesenchymal stromal cells (BM-MSCs) in carbon tetrachloride (CCl4) induced liver cirrhosis in Wistar rats. Methods This was an experimental study. Liver cirrhosis was induced in adult female Wistar rats using CCl4. Rats were randomly divided into 6 groups with ten rats in each group: group 1 (normal control group), group 2 (received only CCl4), group 3 (CCl4 + low dose BM-MSCs), group 4 (CCl4 + high dose BM-MSCs), group 5 (CCl4 + silymarin), group 6 (CCl4 + high dose BM-MSCs + silymarin). Thirty days after the treatment, blood samples were collected for liver enzyme level analysis, prothrombin time test and plasma fibrinogen estimations. The rats were then sacrificed, livers were excised and used for histopathological and scanning electron microscopy (SEM) study. Results BM-MSCs and the combination treatment of high dose BM-MSCs and silymarin effectively decreased the prothrombin time and increased plasma fibrinogen concentration in rats with CCl4 induced liver cirrhosis. BM-MSCs treatment produces significant anti-fibrotic effect which was supported by the liver enzyme level analysis, histopathology and SEM study. Conclusions Results indicate that treatment of BM-MSCs in combination with silymarin had a better haemostatic effect when compared to the administration of BM-MSCs alone.

A comparative study on digit ratio and hand patterns of three ethnic races of Malaysia

BackgroundTo distinguish the characteristic hand pattern of each of the three different ethnicities in Malaysia and to study the hand pattern correlation between race and gender.MethodIndividual lengths of the fingers were then measured and tabulated to serve as the basis for analyzing the 2D (second digit):4D (fourth digit) hand ratio. Based on this ration, the hand patterns were classified as A, B, and C types.ResultsHand pattern A (2D<4D) appears to be the most characteristic trait in Malays. The highest scoring hand pattern in Chinese is A as well with scores of 52% in their right hands and 60% in their left hands. In Indians, hand pattern C (2D>4D) shows dominance in their right hands with a score of 46% while hand pattern A dominates their left hands. Among the males, all three races show dominance in hand pattern A except in Chinese whereby the C hand pattern was dominant in their right hands (44%). Among the females, the most common trait in Malays and Chinese are the hand pattern A in both their hands. Indian females, however, showed dominance in hand pattern C in their right hands (60%), and hand pattern B (2D = 4D) dominated in their left hands (44%). Results of the statistical analysis revealed that there was a highly significant difference in the hand patterns of both the hands when compared to gender.ConclusionThe study suggests that ratio below or equal to 0.90 is suggestive of female sex for both hands, while a ratio of more than 0.91 is suggestive of male sex for both hands. The pattern A (2D<4D) is seen to be the most common trait among the three ethnicities of Malaysia with an exception seen in the right hands of Indians.