Prakashchandra Shetty

Abnormal Branching Pattern of the Axillary Artery and its Clinical Significance

El incremento del uso de diagnosticos invasivos y procedimientos de intervencion en las enfermedades cardiovasculares hace que sea importante que el tipo y la frecuencia de las variaciones vasculares esten bien documentados y entendidos. Un buen conocimiento de las variaciones neurovasculares es importante para los cirujanos que extirpan linfonodos axilares, para anestesiologos y cirujanos ortopedicos, considerando la frecuencia de los procedimientos realizados en esta region. Una inusual variacion en el patron de ramificacion de la arteria axilar se observo en el lado izquierdo de un cadaver de sexo femenino de 60 anos de edad. En el presente caso, el curso y la distribucion de la primera y segunda parte de la arteria axilar fueron normales. Sin embargo, fue encontrado en el lado izquierdo, durante la diseccion de rutina, un caso raro, de origen inusual, de las arterias subescapular cirunflejas humerales anterior y posterior, braquial profunda y arterias colaterales ulnares desde un tronco comun. Este tronco comun se encontro derivado de la tercera parte de la arteria axilar y en su comienzo se comprobo que pasaba entre las dos raices del nervio mediano. Los casos con este tipo de variaciones deben ser examinados u operados cuidadosamente durante prodecimientos quirurgicos o electro fisiologicos.

A rare case of variant morphology of peroneus tertius muscle.

Peroneus tertius (PT) is frequently used as a free muscle flap to treat the soft tissue defects and osteomyelitis, in the lower limb as it is functionally insignificant while balancing the foot during walking. The morphology of the PT is highly variable. In the present case we report a rare case of unusual morphology of the PT in a formalin embalmed male cadaver. At the level of ankle, PT divided into three tendons; two of them were inserted to the base of the distal phalanx of the fifth toe and base of the fifth metatarsal bone respectively. The smaller third tendon was attached to the fascia covering the capsule of the ankle joint. Further, extensor digitorum longus (EDL) gave only three tendinous slips for the second, third and fourth toes.

A lobulated spleen with multiple fissures and hila.

During our dissection classes, we observed a lobulated spleen with multiple hila and fissures. The spleen presented 4 hila and 5 deep fissures. The hila were seen on the visceral surface. The fissures extended into the substance of the spleen from superior border, inferior border and the visceral surface. Because of these fissures, the spleen appeared to be lobulated, having seven distinct lobes/lobules. Knowledge of this variation could be useful to the radiologists and surgeons.

Absence of transverse colon, persistent descending mesocolon, displaced small and large bowels: a rare congenital anomaly with a high risk of volvulus formation.

Congenital anomalies such as positional anomalies of the right half of the colon are more common when compared to its left half. We report a rare case of congenital anomaly where the transverse colon was totally absent. Ascending colon continued as descending colon at the right colic flexure. Ascending and descending colons formed an inverted U shaped loop which was situated in the right half of the abdomen. The sigmoid colon began from the descending colon, on the right side of the midline and coursed to the left iliac fossa. The terminal part of ascending colon and entire descending colon had a persistent mesocolon. The jejunum and ileum were situated in the upper left part of the abdominal cavity. This anomaly can cause volvulus of the colon at any stage of life. Furthermore, the knowledge of this anomaly is very useful for radiologists, gastroenterologists and surgeons.

Bifurcated Bicipital Aponeurosis Giving Origin to Flexor and Extensor Muscles of the Forearm – A Case Report

Bicipital aponeurosis is usually attached to the antebrachial fascia on the medial side of forearm and to posterior border of ulna assisting in the supination of the forearm along with biceps brachii muscle. Variations in the bicipital aponeurosis may lead to neurovascular compression as reported earlier. In the present case, the bicipital aponeurosis had two slips i.e. medial and lateral. Medial slip gave origin to some fibers of pronator teres and flexor carpi radialis and the lateral slip gave origin to some fibers of brachioradialis. Such unusual slips of bicipital aponeurosis may distribute the stress concentration and may work in different directions affecting the supination of forearm by biceps brachii muscle and bicipital aponeurosis.

A detailed study of multiple vascular variations in the upper part of abdomen

Introduction: Knowledge of vascular variations near the kidney is of importance to many clinical disciplines such as nephrologists, radiologists, gastroenterologists, and general surgeons. Variant branches of the abdominal aorta and renal arteries are the victims of iatrogenic bleeding during surgery. We found multiple vascular variations in the upper part of the abdomen during our dissection classes. Methods: During the dissection classes of the abdomen for undergraduate medical students, we observed multiple vascular variations in the abdomen of an adult male cadaver. The vessels and surrounding viscera were cleaned using dissection instruments. Variations observed were photographed. Results: The right kidney had its hilum directed posteriorly. There were two right renal veins and a partially doubled left renal vein (LRV). The left suprarenal and gonadal veins drained into the upper LRV. There were two right renal arteries. Upper right renal artery gave origin to the right inferior phrenic and middle suprarenal arteries. There were two renal arteries on the left side also. The left upper renal artery gave a polar branch to the left kidney and divided into two branches before entering the kidney. The left inferior phrenic artery (IPA) gave two gastric branches to the fundus of the stomach. Conclusions: The variations noted by us are of tremendous surgical application. The variant vessels might get damaged during surgical procedures if the surgeons are not aware of these variations. The most important among the variations reported here is the gastric branch of the IPA, which has not been reported yet.

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.

An extensive study and review of literature about multiple variations of the lumbar plexus

Introduction: Lumbar plexus involves the L1 – L5 spinal segments for the formation of the nerves which supply parts of the abdominal wall, pelvis and the upper part of the thigh (both sensory and motor). Our aim in this study was to compile all the rare variations found in a single cadaver, which is of the rarest possible kind. Methods: During the dissection of the abdomen and pelvis in approximately 70 year old cadaver, there were multiple variations observed in the anatomy of the lumbar plexus. The entire region was cleaned for visibility of the variations and all those were clearly documented for compiling purpose. Results: The following variations in the formation of the lumbar and sacral nerves were observed. 1. The genitofemoral nerve bifurcated at a higher level; genital branch of genitofemoral nerve gave branches to the anterior abdominal wall muscles, 2. A communicating branch was given from the lateral cutaneous nerve of thigh to the medial cutaneous nerve of thigh, 3. A muscular branch was given from femoral nerve to psoas major, 4. There was absence of contribution of L4 spinal nerve in the formation of the lumbosacral trunk, and 5. Lumbosacral trunk gave communicating branches to the femoral and obturator nerves. Most of the variations found were rare and finding all the above said variations in a single cadaver is even rare. Conclusion: Knowledge of the normal anatomy and any possible variations would help the clinicians and surgeons dealing with this region and avoid possible complications beforehand.

Erratum to “Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis” [Br J Oral Maxillofac Surg 55 (2017) 834–5]

Please cite this article in press as: Nayak SB, et al. Erratum to “Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis” [Br J Oral Maxillofac Surg 55 (2017) 834–5]. Br J Oral Maxillofac Surg (2017), https://doi.org/10.1016/j.bjoms.2017.10.007 he publisher regrets that S. B. Nayak’s initial appeared incorrectly in the original article. It appears correctly above. The publisher would like to apologise for any inconvenience caused.

An Unusual Course and Termination of Small Saphenous Vein: A Case Report.

The superficial veins of the lower limb can vary in their course and termination. We report a relatively rare type of variation in the course and termination of small saphenous vein. The small saphenous vein had normal origin and course in the leg. However, instead of terminating into the popliteal vein, it continued up in the posterior compartment of the thigh and terminated into the femoral vein after piercing the fleshy part of the adductor magnus muscle. This course might lead to varicosity of the small saphenous vein due to the compression by the fleshy fibres of adductor magus near its termination. The case may be of interest to general and plastic surgeons and even cardiothoracic surgeons.