Sudarshan Surendran

Double gallbladder completely enclosed in a cystogastric fold of peritoneum.

Double gallbladder is one of the rare congenital anomalies of the gallbladder. Failure to detect an accessory gallbladder hampers diagnosis and treatment of cholecystitis, which might result in recurrent attacks of cholecystitis. In addition, presence of peritoneal folds extending from the stomach and duodenum to the gallbladder is very rare. Here we report the presence of a double gallbladder enclosed in a cystogastric fold of the peritoneum. During cadaveric dissection, we observed a cystogastric peritoneal fold that extended from the lesser curvature of the stomach and the first part of the duodenum to the gallbladder. The left end of the peritoneal fold merged with the lesser omentum. It enclosed two gallbladders: the main gallbladder and a small accessory gallbladder. The accessory gallbladder was a small pouch with its fundus attached to the main gallbladder by fibrous tissue, and its duct opened into the main cystic duct.

Collagen and Elastic Fiber Content Correlation Analysis between Horizontal and Vertical Orientations of Skin Samples of Human Body

Background. Unequal distribution of dermal collagen and elastic fibers in different orientations of skin is reported to be one of the multifocal causes of scar related complications. Present study is to understand the correlation pattern between collagen in horizontal (CH) and in vertical (CV) directions as well as that of elastic in horizontal (EH) and vertical (EV) directions. Materials and Method. A total of 320 skin samples were collected in two orientations from suprascapular, anterior chest, lateral chest, anterior abdominal wall, and inguinal regions of 32 human cadavers. Spearman correlation coefficient (r) was calculated between the variables (CH, CV, EH, and EV). Results. Significant positive correlation between CH and CV, and between EH and EV observed in all 5 areas tested. A negative correlation between CV and EV at suprascapular, lateral chest, and inguinal regions and negative correlation between CH and EH at anterior chest and anterior abdominal wall have been identified. Conclusion. Knowledge of asymmetric content of dermal collagen and elastic fibers together with the varied strength and degree of association in the given area provides guidelines to the dermatologists and aesthetic surgeons in placing elective incisions in the direction maximally utilizing the anatomical facts for aesthetically pleasing result.

Tendinous flexor carpi radialis: a case report

Introduction:Flexor carpi radialis is a muscle of the superficial group of muscles, in the anterior compartment of the forearm. Normally, it takes origin from the medial epicondyle of humerus and is inserted into the palmar aspect of the base of second metacarpal bone and gives off a slip to the third metacarpal in the same aspect. Case report:Here we present a case with most of FCR (except for few muscle fibres close to the origin) being replaced with tendinous portion. Discussion:The action of FCR is in combination with the other muscles acting at the wrist joint. Some of the actions include flexion, abduction and circumduction that involve FCR. Any change in the normal anatomy of the muscle would affect the normal actions at the wrist. The knowledge regarding the variations in this muscle would prove beneficial to physiotherapists and also clinicians. Other main clinical implications of FCR is in grafts. The clinical and applied aspects have been discussed in the report.

Correlation between Ischemia modified albumin with pH in acidosis and alkalosis: A possible link

Ischemia modified albumin (IMA), a recently developed marker for myocardial ischemia is measured by using albumin cobalt binding (ACB) assay. The correlation between the formation of IMA and alterations in the pH levels are of considerable importance and the same was not clear in the available literature. Based on our literature search, the study was designed to check and compare the levels of IMA and the pH in acidosis and alkalosis patients with those in normal patients. The mean of IMA in patient with acidosis (0.832±0.16) was higher when compared with the normal pH patients (mean 0.71±0.21). The IMA levels in patients of alkalosis were also found higher (mean 0.804±0.19) compared to that of the normal control. It was also observed that the mean of IMA was lower in the patients with alkalosis than the patients with acidosis. When the IMA levels and the pH levels in acidosis and alkalosis patients were correlated, there was a weak negative correlation between pH levels in acidosis and IMA levels. In alkalosis, the correlation was positive but there was no significance in these changes. In conditions of acidosis and alkalosis, where the pH levels are altered which could be one of the factors responsible for increase in the IMA levels. However, the correlation was weak and an increase in the sample size could provide us with a better relation between the levels of pH and IMA.

Inhabitation of an accessory renal artery in a cratered hilum of a malrotated kidney

Structural variations of the kidney and its abnormal vascular architecture make the kidney unsuitable for transplantation. We report here a case of malrotated left kidney with cratered hilum and presence of an accessory renal artery. A lumbar vein was seen to loop under the accessory renal artery on the way of its termination into the left renal vein. The kidney appeared to have failed to rotate from its fetal position. Thus, the hilum was placed ventrally. The hilum was crater-like in shape, wide, and allowed passage of the hilar structures. The shape of the kidney itself had undergone slight modification as it appeared more ovoid than its typical bean shape. The poles, but not the surface or borders were distinguishable. The variations described in the current observation are of a unique pattern of congenital malformation having surgical, urological, and radiological implications.

Three lateral roots of median nerve: A case report

Introduction:The median nerve is formed by the union of a lateral and a medial root from the lateral and medial cords of brachial plexus. Reports on the existence of variations in the formation, branching and communication of median nerve are seen in the literature. However, there are very few reports on the involvement of two additional lateral roots in the formation of the median nerve. Such variations are of considerable importance for surgeons, physiotherapists and other clinicians. The details regarding the formation of the median nerve, developmental considerations and its importance have been discussed here. Case report:Apart from the normal roots, two additional lateral roots were given off from the lateral cord at the level of the second part of the axillary artery. These roots then coursed superficial to the axillary artery from the lateral to medial side to join the medial root, on the medial side of the axillary artery. The medial root then crossed on to the lateral side of the axillary artery to join the lateral root to form the median nerve. The rest of the course of the median nerve was found to be normal. Conclusion: Surgeons during surgeries of the axilla and physiotherapists during rehabilitation would require knowledge of such variations in the axilla, along with use for other clinicians too.