Snigdha Mishra

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.

Hot Corrosion Behaviour of Detonation Gun Sprayed Al2O3-40TiO2 Coating on Nickel Based Superalloys at 900°C

Hot corrosion is the major degradation mechanism of failure of boiler and gas turbine components. These failures occur because of the usage of wide range of fuels such as, coal and oil at the elevated temperatures. Nickel based superalloys having excellent mechanical strength and creep resistance at elevated temperature are used under such environment but they lack resistance to hot corrosion at high temperature. To overcome these problems hot corrosion resistant coatings are deposited on these materials. In the current investigation Al2O3-40%TiO2 powder has been deposited on Superni 718 and AE 435 superalloys by Detonation Gun method. The hot corrosion performance of Al2O3-40%TiO2 coated as well as uncoated Superni 718 and AE 435 alloys has been evaluated in aggressive environment Na2SO4-82%Fe2(SO4)3 under cyclic conditions at an elevated temperature of 900°C. The kinetics of the corrosion is approximated by weight change measurements made after each cycle for total duration of 50 cycles. Scanning electron microscopy was used to characterize the hot corrosion products. The coated samples imparted better hot corrosion resistance than the uncoated ones. The AE 435 superalloy performed better than Superni 718 for hot corrosion in a given environment.

Audio–Visual Aid in Teaching “Fatty Liver”

Use of audio visual tools to aid in medical education is ever on a rise. Our study intends to find the efficacy of a video prepared on “fatty liver,” a topic that is often a challenge for pre‐clinical teachers, in enhancing cognitive processing and ultimately learning. We prepared a video presentation of 11:36 min, incorporating various concepts of the topic, while keeping in view Mayers and Ellaway guidelines for multimedia presentation. A pre–post test study on subject knowledge was conducted for 100 students with the video shown as intervention. A retrospective pre study was conducted as a survey which inquired about students understanding of the key concepts of the topic and a feedback on our video was taken. Students performed significantly better in the post test (mean score 8.52 vs. 5.45 in pre‐test), positively responded in the retrospective pre‐test and gave a positive feedback for our video presentation. Well‐designed multimedia tools can aid in cognitive processing and enhance working memory capacity as shown in our study. In times when “smart” device penetration is high, information and communication tools in medical education, which can act as essential aid and not as replacement for traditional curriculums, can be beneficial to the students.

A sciatic nerve with three roots and its perforation by the enlarged ischiadic artery.

Knowledge about the variations of the sciatic nerve (SN) is important for many medical science disciplines. Its compression, entrapment or injury of any kind can result in loss of sensation, pain or motor disabilities in the lower limbs. We observed concurrent neurovascular variations in the gluteal region of an adult female cadaver. The SN had three roots as it emerged out of the greater sciatic foramen. The upper root passed above the piriformis; the middle and lower roots passed below the piriformis. The three roots joined to form the SN in the gluteal region. The inferior gluteal artery (IGA) was large, and it passed below the piriformis, between the middle and lower root of the SN. After a tortuous course, this artery continued down as the sciatic/ischiadic artery. The ischiadic artery (IA) was large in size and pierced the SN in the thigh. After piercing the nerve, it terminated by dividing into muscular branches. The inferior gluteal nerve emerged out from the pelvis through the greater sciatic foramen, above the level of the piriformis. The SN in this case was highly predisposed to compression by the piriformis, IGA or IA, which in turn may lead to altered cutaneous sensation or weakness of the muscles.

Omento-cystic peritoneal fold and rudimentary quadrate lobe: a case report

Introduction: Abnormal peritoneal folds are often found in the abdomen. They may cause serious problems like obstruction of the intestine. This report discusses a case of an omento-cystic peritoneal fold in a male cadaver. Case report: We report an omento-cystic peritoneal fold seen in an adult male cadaver. The fold extended upwards from the right end of the greater omentum to the gallbladder. It enclosed the gallbladder completely. The gallbladder was slightly larger than its normal size. The quadrate lobe was rudimentary and was represented as a small bar of hepatic tissue between the gallbladder and the fissure for ligamentum teres. Conclusion: The knowledge of this variation may be of importance during radiological diagnosis, liver transplant surgery and laparoscopic cholecystectomy.

Unusual Branches of Femoral Artery in the Femoral Triangle –A Case Report

La arteria femoral es la principal arteria del miembro inferior. Se observan algunas variaciones en su patron de ramificacion. Una variante rara, pero clinicamente importante es el origen comun de las arterias circunfleja iliaca profunda y epigastrica inferior no desde la arteria iliaca externa. Presentamos el origen bilateral de las arterias epigastricas inferiores y circunfleja iliaca profunda desde la arteria femoral. Ambas arterias pasaron profundas al ligamento inguinal y tuvieron un curso y distribucion normal despues de cruzar el ligamento inguinal. El conocimiento de estas variaciones son de importancia en la cirugia plastica, en el acceso anterior a la articulacion de la cadera, el drenaje absceso del musculo psoas mayor o para reducir una hernia femoral.

Oxidation and Hot Corrosion Performance of Al 2 O 3 -40%TiO 2 Coating on Nickel Based Superalloys at 800 °C

The properties of good oxidation and corrosion resistance Nickel based Superalloys are mostly common in used at high temperature. The major degradation mechanism of failure of boiler and gas turbine components are due Oxidation and Hot corrosion. Most of the failures occur just because of the frequent uses of broad range of fuels such as oil and coal at the very higher temperature range. Superalloys as like Nickel based having extraordinary mechanical properties such as creep resistance and mechanical strength at very high temperature is used under such environment but they have small resistance. To avoiding these problems, in present research investigation Al2O3-40%TiO2 powder has been deposited on two materials Superni718 and Superni600 superalloys by using Detonation spray gun method. The coated Al2O3-40%TiO2 as well as uncoated Superni718 and superni600 alloys performance regarding Oxidation and hot corrosion, has been evaluated in air and Na2SO4-82%Fe2(SO4)3 in an aggressive environment, under cyclic conditions at a very high temperature of 800 °C. The kinetics of the oxidation and hot corrosion is approximated by weight change measurements made after each cycle for total duration of 50 cycles. Each cycle consists of keeping the samples for 1 h duration in Kanthol wire tube furnace at 800 °C followed by 20 min cooling in ambient air repeatedly. Thermogravimetric technique was used to approximate the kinetics of oxidation and hot corrosion. Technique like scanning electron microscopy was used to characterize the oxidation and hot corrosion products. The coating was deposited on both Ni based superalloys imparted better oxidation and hot corrosion resistance than the uncoated one. The Superni600 superalloy have shown better resistance to oxidation in comparison to Superni718 and Superni718 superalloy performed better than Superni600 in case of hot corrosion in the given environment.

Surgical and radiological importance of a rare cysto-duodeno-colic peritoneal fold

It is quite common to see abnormal peritoneal folds in the abdominal cavity. Some of them might compress or strangulate the viscera and others might determine the direction of the flow of peritoneal fluid, pus or blood. Many unusual clinically important peritoneal folds such as Ladds band, cysto-gastro-colic fold, omento-cystic fold, and cysto-colic fold have been reported earlier. Knowledge of these folds is important for radiologists, gastroenterologists, and surgeons. We report an unusual cysto-duodeno-colic fold observed during our dissection classes. The fold was seen to compress the duodenum and colon. The fold extended from the descending part of the duodenum and the transverse colon to the gallbladder. It enclosed the entire gallbladder. A case similar to this has not been reported yet. It is important for the gastroenterologists and laparoscopic surgeons to be aware of this fold to avoid misdiagnosis and iatrogenic injuries.

Lateral pouch appendix associated with retroperitoneal terminal part of the ileum: a potential diagnostic and surgical challenge

Knowledge of development and various possible positions of the appendix is important in understanding the pathophysiology of appendicitis. In the present case, we report on a lateral pouch type of appendix in a formalin-embalmed male cadaver. The appendix was found to be situated in a space between the caecum and the lateral abdominal wall. A short band of peritoneum extended from the right iliac fossa to the base of the appendix. The terminal part of the ileum was retroperitoneal and it was vertically situated in the right iliac fossa. Both the ileocaecal junction and the base of the appendix were located at the posterolateral wall of the caecum. The mesoappendix was unusual in position, and it extended from the appendix to the anterolateral wall of the caecum and commencement of the ascending colon. Documentation of rare anatomical variants of the appendix may hold significant clinical importance in diagnosis as well as surgical treatment of appendicitis.

Dangerous course and atypical termination of the splenic vein in relation to pancreas – A case report

CONTEXT Knowledge of variations of the vessels closely related to the pancreas adds greatly to the success of pancreatic surgery. Splenic vein is one of the vessels that are closely related to the pancreas. Its variations might not only change the haemodynamics in the vein but also cause unexpected bleeding during pancreatic surgery. CASE REPORT During our dissection classes, we noted the variations in the course and termination of the splenic vein. After emerging from the spleen, it coursed upward and to the right, embedded in a groove on the anterior surface of body of pancreas. After reaching the upper border, it turned downwards and entered the body of the pancreas. After having a downward course in the body of pancreas, it emerged out and united with the superior mesenteric vein at an angle of about 160 degrees to form the portal vein. CONCLUSION This peculiar course of the vein might predispose it for thrombosis in case of pancreatitis. It can also lead to iatrogenic injuries during pancreatic or splenic surgeries.