Ganesh Kumar Chettiar

Morphological and topographical anatomy of nutrient foramina in the lower limb long bones and its clinical importance

BACKGROUND Knowledge regarding nutrient foramina of bones is useful in surgical procedures such as microvascular bone transfer in order to preserve the circulation. The objective of the present study was to study the morphology and topography of nutrient foramina and to determine the foraminal index of the lower limb long bones to provide detailed data on such features. METHOD The study comprised examination of 206 lower limb long bones which included femora, tibiae and fibulae. The nutrient foramina were identified analysed macroscopically and the foramen index calculated. Each bone was divided into five parts and topographical analysis was performed on each section. RESULTS Femora had single nutrient foramen in 47.7% of the cases, double foramen in 44.2% of the cases, triple in 3.5% of the cases and an absence of foramen in 4.6%. In the case of tibiae, 98.6% showed single foramen and in 1.4% of the cases, the foramen was absent. With respect to fibulae, 90.2% had single foramen and foramen was absent in 9.8%. The mean foraminal index was 38.9 for the femora, 32.5 for tibiae and 49.2 for fibulae. The majority (51.3%) of the foramina in the femora were located at the 2/5(th) part, 98.3% of the tibiae foramina at the 2/5(th) part and 60% of the fibulae at the 3/5(th) part. CONCLUSION The study provides information on the morphology and topography of nutrient foramina in lower limb long bones. The double foramina were more common in femur and rare in the tibia and fibula. The foramina of the femur and tibia were commonly observed at their upper part, whereas in the fibula they were present on the lower part. This knowledge of the nutrient foramina has to be kept in mind during surgical procedures.

Origin of the sinoatrial and atrioventricular nodal arteries in South Indians: an angiographic study

FUNDAMENTO: Estudiar el suministro arterial del sistema conductor y su correlacion con la dominancia de las arterias coronarias en poblacion del Sur de la India. OBJETIVO: Determinar angiograficamente los origenes de la arteria del nodulo sinusal (AnSA) y la arteria del nodulo atrioventricular (AnAV) en indios. METODOS: El estudio incluyo 300 pacientes consecutivos (114 del sexo femenino y 186 del sexo masculino; edad promedio, 55 anos), habitantes de la region costera al Sur de la India, sometidos a cineangiocoronariografia debido a sintomas como dolor en el pecho, angina pectoris o test ergometrico positivo. Las angiografias incluyeron ambas arterias coronarias (derecha e izquierda) en posicion oblicua anterior derecha e izquierda. El origen de la AnSA y AnAV a partir de las arterias coronarias se observo y se correlaciono con la dominancia arterial. RESULTADOS: El nodulo SA (sinusal) recibio suministro por la arteria coronaria derecha (ACD) en el 53% de los casos, por la rama circunfleja (Cx) de la arteria coronaria izquierda (ACI) en el 42,66% de los casos, y en el 4,33% de los casos este nodulo fue irrigado por ambas arterias coronarias. El nodulo AV (atrioventricular) tambien recibio suministro sanguineo con mas frecuencia de la ACD (72,33% de los casos) que la rama Cx de la ACI (27,66%). Sorprendentemente, en ningun caso este nodulo recibio suministro de ambas arterias coronarias. CONCLUSION: Los resultados del presente estudio pueden auxiliar a los cirujanos cardiacos, sobre todo en cirugias relacionadas a valvulopatias, debido a la franca proximidad entre las ramas nodales y el complejo valvular.BACKGROUND To study the arterial supply of the conducting system and its correlation with the dominance of the coronary arteries in the South Indian population. OBJECTIVE To determine angiographically the origins of the sinoatrial nodal artery (SAna) and atrioventricular nodal artery (AVna) in Indians. METHODS The study included 300 consecutive patients (114 females, 186 males; mean age, 55 years) living in the southern coastal region of India, who underwent coronary angiography either for the symptoms of chest pain, angina pectoris or positive Treadmill Test. The angiograms contained both coronary arteries (right and left) in the right and left anterior oblique position. The origin of SAna and AVna from the coronary arteries was observed and correlated with the arterial dominance. RESULTS The SA (sinoatrial) node was supplied by the right coronary artery (RCA) in 53% of the cases, by the circumflex (Cx) branch of left coronary artery (LCA) in 42.66%, and by both coronary arteries in 4.33% of cases. The AV (atrioventricular) node was also more often supplied by the RCA (72.33% of cases) than by the Cx branch of the LCA (27.66%), and surprisingly in none of the cases was this node supplied by both coronary arteries. CONCLUSION The results of the present study may help cardiac surgeons, particularly in surgeries related to certain valvular disorders, due to the proximity of the nodal branches to the valve complex.

Mastoid emissary foramina: an anatomical morphological study with discussion on their evolutionary and clinical implications

The identification of mastoidal emissary veins is of importance in the neurosurgical practice to diagnose abnormal and normal structures. In the present study, the objectives were to estimate the prevalence rate of mastoidal emissary foramina in the temporal bones of the adult skull and to study their number and morphology. The present study included 48 adult human skulls which were obtained from the gross anatomy laboratory of our institution. The mastoid parts of 96 temporal bones were macroscopically observed for the prevalence, number and morphology of the emissary foramina. It is observed that, the mastoidal emissary foramen was present in 88 temporal bones (91.7%) of our specimens. The foramen was observed single in 60 temporal bones (62.5%), double in 22 bones (22.9%), and triple in 6 temporal bones (6.2%). The mastoidal emissary foramen was absent in 8 (8.3%) temporal bones. The foramen was bilaterally absent in 3 (3.1%) skulls. It was unilaterally absent in 2 (2.1%) skulls and both were on the left side. The mastoidal emissary vein is prevalent in a large number (91.7%) of cases. It was observed that the accessory mastoidal emissary foramina were present in 29.1% of cases. Recognition of the mastoid emissary veins and accessory mastoid emissary veins during the otologic surgery is critical to avoid the significant bleeding. In the neurosurgical practice, the knowledge is important due to variability in the number of mastoidal emissary veins and their connection to the venous sinuses.

The dimensions of the corpus callosum of the cerebrum-an anatomical study

Aims To determine the dimensions of the human corpus callosum and its parts. The objective was also to know its location in the cerebral hemisphere of South Indians. Methods Twenty mid-sagittal sections from formalin fixed human cadaveric brain specimens were used for this study and the parameters recorded were: distances from frontal pole to occipital pole (AB), inferior surface to the superior surface of the brain (CD), frontal pole of brain to genu (AG), occipital pole of cerebrum to corpus callosum splenium (BS), from splenium of corpus callosum to superior colliculus (Ls-SC) and inferior colliculus (Ls-IC), genu to fornix (GF), outer curvature O (G-S) and inner curvature I (G-S) from genu to splenium, the entire outer curvature (OUTCR) and inner curvature (INCUR) from beginning of corpus callosum rostrum to the splenium end. We did also measure the thicknesses of its splenium (S), isthmus (I), body (T), genu (G) and rostrum (R). Results Statistical analysis using correlation study showed significance between A-B and B-S, O (G-S) and INCUR, O (G-S) and OUTCR, A-G and R, T and I. Highly significant correlations were found between C-D and Ls-IC, O (G-S) and I (G-S), I (G-S) and G-F, G-F, and G. Very highly significant correlations were seen between I (G-S) and INCUR, Ls-SC, and Ls-IC, T and S. Conclusion This morphometric study on the corpus callosum provides data that could be valuable in the diagnosis of lesions of the corpus callosum. The data are of particular relevance to neurologists and radiologists.

Origem das artérias dos nós sinoatrial e atrioventricular em população do sul da Índia: um estudo angiográfico

FUNDAMENTO: Estudiar el suministro arterial del sistema conductor y su correlacion con la dominancia de las arterias coronarias en poblacion del Sur de la India. OBJETIVO: Determinar angiograficamente los origenes de la arteria del nodulo sinusal (AnSA) y la arteria del nodulo atrioventricular (AnAV) en indios. METODOS: El estudio incluyo 300 pacientes consecutivos (114 del sexo femenino y 186 del sexo masculino; edad promedio, 55 anos), habitantes de la region costera al Sur de la India, sometidos a cineangiocoronariografia debido a sintomas como dolor en el pecho, angina pectoris o test ergometrico positivo. Las angiografias incluyeron ambas arterias coronarias (derecha e izquierda) en posicion oblicua anterior derecha e izquierda. El origen de la AnSA y AnAV a partir de las arterias coronarias se observo y se correlaciono con la dominancia arterial. RESULTADOS: El nodulo SA (sinusal) recibio suministro por la arteria coronaria derecha (ACD) en el 53% de los casos, por la rama circunfleja (Cx) de la arteria coronaria izquierda (ACI) en el 42,66% de los casos, y en el 4,33% de los casos este nodulo fue irrigado por ambas arterias coronarias. El nodulo AV (atrioventricular) tambien recibio suministro sanguineo con mas frecuencia de la ACD (72,33% de los casos) que la rama Cx de la ACI (27,66%). Sorprendentemente, en ningun caso este nodulo recibio suministro de ambas arterias coronarias. CONCLUSION: Los resultados del presente estudio pueden auxiliar a los cirujanos cardiacos, sobre todo en cirugias relacionadas a valvulopatias, debido a la franca proximidad entre las ramas nodales y el complejo valvular.BACKGROUND To study the arterial supply of the conducting system and its correlation with the dominance of the coronary arteries in the South Indian population. OBJECTIVE To determine angiographically the origins of the sinoatrial nodal artery (SAna) and atrioventricular nodal artery (AVna) in Indians. METHODS The study included 300 consecutive patients (114 females, 186 males; mean age, 55 years) living in the southern coastal region of India, who underwent coronary angiography either for the symptoms of chest pain, angina pectoris or positive Treadmill Test. The angiograms contained both coronary arteries (right and left) in the right and left anterior oblique position. The origin of SAna and AVna from the coronary arteries was observed and correlated with the arterial dominance. RESULTS The SA (sinoatrial) node was supplied by the right coronary artery (RCA) in 53% of the cases, by the circumflex (Cx) branch of left coronary artery (LCA) in 42.66%, and by both coronary arteries in 4.33% of cases. The AV (atrioventricular) node was also more often supplied by the RCA (72.33% of cases) than by the Cx branch of the LCA (27.66%), and surprisingly in none of the cases was this node supplied by both coronary arteries. CONCLUSION The results of the present study may help cardiac surgeons, particularly in surgeries related to certain valvular disorders, due to the proximity of the nodal branches to the valve complex.

Morphology and topography of the parietal emissary foramina in South Indians: an anatomical study

The objectives of the present study were to study the prevalence of the parietal emissary vein in adult South Indian population and to study the distance of foramen from the sagittal suture. There were 58 adult human skulls in the present study which were available at the anatomy department of our institution. The study included 116 parietal bones which have been observed macroscopically for the number, prevalence and topography of the emissary foramen. The emissary foramen was present in 83 parietal bones (71.5%) of the present study. It was present at the junction between the middle 1/3 and posterior 1/3 region of the parietal bone. The foramen was observed solitary in 73 parietal bones (62.9%), double in 8 bones (6.9%), and triple in 2 parietal bones (1.7%). The foramen was not observed in 33 parietal bones (28.4%). The bilateral absence of parietal emissary foramen was seen in 7 skulls (12.1%). It was absent unilaterally in 19 skulls (32.7%). The accessory foramina were seen in only 8 skulls (13.8%). The mean distance of the foramen from the sagittal suture was 6.7±2.9 mm and 6.8±2.8 mm on the right and left sides respectively. The prevalence of parietal emissary vein in the present study was 71.5%. The present study has observed important data about the morphology and morphometry of the parietal emissary vein in South Indian population. The identification of parietal emissary veins and accessory veins is important in the operation room to prevent the blood loss.

Origen de las arterias de los nódulos sinusal y atrioventricular en población del Sur de la India: un estudio angiográfico

FUNDAMENTO: Estudiar el suministro arterial del sistema conductor y su correlacion con la dominancia de las arterias coronarias en poblacion del Sur de la India. OBJETIVO: Determinar angiograficamente los origenes de la arteria del nodulo sinusal (AnSA) y la arteria del nodulo atrioventricular (AnAV) en indios. METODOS: El estudio incluyo 300 pacientes consecutivos (114 del sexo femenino y 186 del sexo masculino; edad promedio, 55 anos), habitantes de la region costera al Sur de la India, sometidos a cineangiocoronariografia debido a sintomas como dolor en el pecho, angina pectoris o test ergometrico positivo. Las angiografias incluyeron ambas arterias coronarias (derecha e izquierda) en posicion oblicua anterior derecha e izquierda. El origen de la AnSA y AnAV a partir de las arterias coronarias se observo y se correlaciono con la dominancia arterial. RESULTADOS: El nodulo SA (sinusal) recibio suministro por la arteria coronaria derecha (ACD) en el 53% de los casos, por la rama circunfleja (Cx) de la arteria coronaria izquierda (ACI) en el 42,66% de los casos, y en el 4,33% de los casos este nodulo fue irrigado por ambas arterias coronarias. El nodulo AV (atrioventricular) tambien recibio suministro sanguineo con mas frecuencia de la ACD (72,33% de los casos) que la rama Cx de la ACI (27,66%). Sorprendentemente, en ningun caso este nodulo recibio suministro de ambas arterias coronarias. CONCLUSION: Los resultados del presente estudio pueden auxiliar a los cirujanos cardiacos, sobre todo en cirugias relacionadas a valvulopatias, debido a la franca proximidad entre las ramas nodales y el complejo valvular.BACKGROUND To study the arterial supply of the conducting system and its correlation with the dominance of the coronary arteries in the South Indian population. OBJECTIVE To determine angiographically the origins of the sinoatrial nodal artery (SAna) and atrioventricular nodal artery (AVna) in Indians. METHODS The study included 300 consecutive patients (114 females, 186 males; mean age, 55 years) living in the southern coastal region of India, who underwent coronary angiography either for the symptoms of chest pain, angina pectoris or positive Treadmill Test. The angiograms contained both coronary arteries (right and left) in the right and left anterior oblique position. The origin of SAna and AVna from the coronary arteries was observed and correlated with the arterial dominance. RESULTS The SA (sinoatrial) node was supplied by the right coronary artery (RCA) in 53% of the cases, by the circumflex (Cx) branch of left coronary artery (LCA) in 42.66%, and by both coronary arteries in 4.33% of cases. The AV (atrioventricular) node was also more often supplied by the RCA (72.33% of cases) than by the Cx branch of the LCA (27.66%), and surprisingly in none of the cases was this node supplied by both coronary arteries. CONCLUSION The results of the present study may help cardiac surgeons, particularly in surgeries related to certain valvular disorders, due to the proximity of the nodal branches to the valve complex.