Lakshmi Ramanathan

Incidence of Extensor Digitorum Brevis Manus Muscle

The extensor digitorum brevis manus, a supernumerary muscle in the fourth extensor compartment of the dorsum of the wrist, is a relatively rare anomalous muscle. Extensor digitorum brevis should be included in the differential diagnosis of soft tissue masses on the dorsal aspect of the hand as it may mimic cystic, neoplastic, inflammatory, and infectious masses arising in the dorsum of the wrist. Seventy-two upper limbs of male and female cadavers were dissected and examined to study the pattern of extensor tendons of the index finger. In the present study, we observed three cases (4.2%) of the extensor digitorum brevis manus on the left side. In one cadaver (0.72%), there was an additional tendon arising from the extensor indices which was inserted to the radial side of the dorsal digital expansion of the index finger. The extensor digitorum brevis manus muscle (EDBM), an anatomic variant of the extensor muscle of the dorsum of the hand, is found in approximately 2% to 3% of the population. This variation is, therefore, clinically and surgically relevant because the EDBM may be the only muscle responsible for the independent extension of the second digit. The aim of the present study is to report the incidences of this muscle thereby creating awareness of its existence and of its characteristic appearance to surgeons.

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.

Incidence of accessory phrenic nerve and its clinical significance: a cadaveric study.

UNLABELLED The description of accessory phrenic nerve (APN) in the standard textbooks and available literature is vague and sometimes limited to few lines. The incidence of APN varies a great deal from 17.6 % to 80.9 % in the available literature. The aim of the present study was to calculate the incidence and variation of APN in Indian population. MATERIAL AND METHODS Forty five adult formalin-fixed cadavers (35 male, 10 female; 90 sides) used for gross anatomy dissection for undergraduates; during the 2 year period 2006-2007 were considered. Findings were recorded at different stages of the dissection. RESULTS Out of 90 body sides studied, the APN was present in 48 sides (53.3 %). In 17 of the above sides the APN was confined to the cervical region (Cervical type) and in 31 sides the APN entered the thorax (Thoracic type), all anterior to the subclavian vein (SV). In eleven specimens the APN was found bilaterally. CONCLUSION The incidence of APN, with its course and relation to the various structures in cervical and thoracic region will help the surgeons while performing internal thoracic artery (ITA) grafting and other radical neck surgery.

Co-existence of superficial brachio-ulno-radial arterial pattern and persistent median artery

The arteries of the upper limbs are situated in a deep plane and are the favourable sites for intra-arterial cannulation. During routine dissection of the left upper limb of a 52-year-old female cadaver, we observed a superficial arterial pattern which was of superficial brachio-ulno-radial type. The right upper limb of the same individual did not show any abnormal arterial pattern. This superficial arterial system was also associated with a palmar type of median artery. The clinical significance of the anomalous arterial system of the upper limb is discussed.

The median-radial type of superficial palmar arch: a case report and review of the literature

The recent use of the RA as a coronary artery bypassgraft in myocardial revascularization makes the MRT of SPA clinically more significant. The SPA is a direct continuation of the ulnar artery. Upon entering the palm, the ulnar artery curves laterally behind the palmar aponeurosis and in front of the long flexor tendons. The arch is completed on the lateral side by one of the branches of the RA, the superficial palmar branch, the arteria radialis indicis (ARI) or the princeps pollicis.

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.

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.