Surekha D Shetty

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.

A Study on the Variations in the Formation of the Trunks of Brachial Plexus

EL plexo braquial muestra algunas variaciones en su formacion y patron de ramificacion. Las variaciones en la formacion de los troncos son muy raras. Se disecaron 44 especimenes para observar las eventuales variaciones en la formacion de los troncos del plexo braquial. Cinco cadaveres (11,3%) mostraron variaciones en la formacion de los troncos. Todas las variaciones fueron unilaterales. En un cadaver (2,27%), el tronco medio se formo por la union de las raices C7 y C8 y, parte inferior del tronco, estaba formado por la raiz de T1. En un caso (2,27%) los troncos superior y medio se fusionaron entre si. En 3 muestras (6,81%), la raiz de C5 cruzo el musculo escaleno anterior antes de unirse a C6 para formar la parte superior del tronco. El conocimiento de estas variaciones es importante para los cirujanos ortopedicos, los neurologos y anestesiologos.

A Mini Accessory Liver Lobe in the Fissure for Ligamentum Teres and Its Clinical Significance: A Case Report

The liver can present a number of congenital anomalies. More common among them are the irregularities of the shape and the number of lobules. The less common variations include the presence of accessory lobes or accessory livers. The accessory lobes may be attached to the liver through a mesentery or a bridge of the hepatic tissue and they are usually asymptomatic. An accessory liver lobe is a very rare occurrence and when it exists, it becomes clinically important because of its rarity. We are reporting here the presence of a very small accessory liver lobe and have discussed its clinical relevance. We observed a mini liver lobe which was situated in the posterior part of the fissure for ligamentum teres. It was triangular in shape and about one inch in width. It was attached to the left anatomical lobe of the liver through a vascular pedicle which contained the branches of hepatic artery and portal vein and hepatic duct. Histological sectioning revealed the normal liver architecture in the accessory lobe. The knowledge of this accessory lobe could be of use to surgeons and radiologists.

Hypoplastic Anterior Tibial Artery Associated with Continuation of Fibular (Peroneal) Artery as Dorsalis Pedis Artery: A Case Report

continuationof fibular (peroneal) artery as dorsalis pedis artery. A case report. Int. J. Morphol., 31(1):136-139, 2013.SUMMARY: Arterial variations of distal parts of lower limb are well documented. However, continuation of fibular artery asdorsalis pedis artery is a rare finding. Unusual course and distribution of the anterior tibial artery and fibular artery were observed duringroutine anatomical dissection of the right lower limb of an approximately 40-year-old male cadaver. The arteries of the crural regionarose from the popliteal artery, as usual. However the anterior tibial artery was hypoplastic. The fibular artery was larger th an usual andcrossed the lowest portion of the interosseous membrane and continued as dorsalis pedis artery. Posterior tibial artery had a normalcourse and distally divided into medial and lateral plantar arteries. The awareness of these variations is important to vascular surgeonswhile performing arterial reconstructions in femorodistal bypass graft procedures, and also to orthopaedic surgeons during surgicalclubfoot release.KEY WORDS: Anatomical variaton; Anterior tibial artery; Peroneal artery; Fibular artery; Dorsalis pedis artery.

A rare anatomical variation of the Berrettini anastomosis and third common palmar digital branch of the median nerve

Variations in the origin and distribution of Berrettini anastomosis between the digital branches of the ulnar and median nerves exist and are well described in the literature. During regular dissections by medical students, we encountered a rare variation in the left hand of an approximately 50-year-old male cadaver. Berrettini anastomosis connecting the third common palmar digital branch of the median nerve with the fourth common palmar and proper palmar digital branches of the ulnar nerve presented a plexiform nature. This communicating branch and the third common palmar digital branch of the median nerve were perforated by the superficial palmar arch. Further, the superficial palmar arch was incomplete, and it was solely formed by the superficial branch of the ulnar artery. The unusual relationship of Berrettini anastomosis with the superficial palmar arch is very rare, and knowledge about such a variation is important when performing carpal tunnel release, flexor tendon surgery, and Dupuytren’s fasciectomy and when dealing with arterial repairs and vascular graft applications in the hand.

Multiple vascular variations at the vicinity of the left kidney

Although isolated variations of the renal artery, renal vein and testicular artery are commonly described in the literature, the concurrent presence of variations in all three of these vessels has seldom been reported. Here, we report concurrent vascular variations in the vicinity of the left kidney. The left renal vein was found to have a retropelvic tributary, and a communicating vein connecting the inferior vena cava and retropelvic tributary was also noted. In addition, the left renal artery separated into anterior and posterior divisions just before reaching the hilum. The anterior division further divided into two segmental branches which had a peculiar ‘ram horn’ shape. The posterior division of the renal artery entered the substance of the kidney without forming any further branches. The left testicular artery arose from the aorta above the level of the renal artery and then passed in front of left renal vessels following a tortuous course. The anatomical knowledge of this unusual vascular pattern may be useful during renal vascular reconstruction, treatment of renal artery stenosis, endoscopic surgeries and clinical evaluation of renovascular hypertension.

Hepatosplenic trunk associated with tortuous course of right hepatic artery forming caterpillar hump.

Celiac trunk usually trifurcates and supplies the organs in the supracolic compartment. The vascular variations are common in this region. There are reports on the variant course of right hepatic artery (RHA). The tortuous RHA forming a caterpillar hump is a rare finding and also its providing origin to gastroduodenal artery (GDA) is an important observation. During routine dissection of abdomen of approximately 60-year-old male cadaver, concurrent arterial variations were observed. The celiac trunk bifurcated into splenic and common hepatic arteries. The left gastric artery arose from the abdominal aorta. The common hepatic artery was tortuous and divided into right and left hepatic arteries in front of portal vein. The RHA gave origin to GDA and then made a characteristic loop around the bile duct with the convexity to the right side. Knowledge of arterial variations of celiac trunk and its branches is useful in planning and executing the radiological interventions and surgeries in the supracolic abdominal compartment.

Effect of sorafenib on sperm count and sperm motility in male Swiss albino mice

The issue of male germ line mutagenesis and the effects on developmental defects in the next generation has become increasingly high profile over recent years. Mutagenic substance affects germinal cells in the testis. Since the cells are undergoing different phases of cell division and maturation, it is an ideal system to study the effect of chemotherapeutic agents. There are lacunae in the literature on the effect of sorafenib on gonadal function. With background, a study was planned to evaluate the effects of sorafenib on sperm count and sperm motility in male Swiss albino mice. Male Swiss albino mice were used for the study. The animals were segregated into control, positive control (PC) and three treatment groups. PC received oral imatinib (100 mg/kg body weight) and treatment groups received 25, 50, and 100 mg/kg body weight of sorafenib orally for 7 consecutive days at intervals of 24 h between two administrations. The control group remained in the home cage for an equal duration of time to match their corresponding treatment groups. The animals were sacrificed at the end of 1 st , 2 nd , 4 th , 5 th , 7 th , and 10 th weeks after the last exposure to drug, respectively. Sperm suspensions were prepared and introduced into a counting chamber. Total sperm count and motility were recorded. There was a significant decrease in sperm count and sperm motility by sorafenib which was comparable with the effect of PC imatinib. Sorafenib adversely affects sperm count and sperm motility which are reversible after discontinuation of treatment.

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.

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.