Variations of Cystic Duct and Its Clinical Significance

Background: Cystic duct drains the bile from the gallbladder into the common bile duct. Gallstone disease is one of the most common problems affecting the digestive tract and may lead to many complications. To avoid the complications in these patients the gallbladder is removed surgically (Cholecystectomy). Ligation of cystic duct and cystic artery is a prerequisite procedure when cholecystectomy is done. Understanding about the normal anatomy & the possible variations in biliary ductal system is important for the surgeons for doing cholecystectomy surgery successfully. Errors during gallbladder surgery commonly result from failure to appreciate the common variations in the anatomy of the biliary system. Aim of the study: To find out the incidence of variations in the length, course, and termination of cystic duct in cadavers. Materials and Methods: Present study was done in 50 adult cadavers in the Department of Anatomy, Government Tiruvannamalai medical college, Tamilnadu. Meticulous dissection was done in the hepatobiliary system of these cadavers. Observations: During the study variations in the length of cystic duct, course and different modes of insertion of cystic duct were observed. Conclusion: Knowledge of variations in the length of cystic duct and knowing about different modes of course & insertion of cystic duct is necessary for surgeons while conducting cholecystectomy. The risk of iatrogenic injury is especially high in cases where the biliary anatomy is misidentified prior to surgery. KEY WORDS: Cystic duct, Gallbladder, Cholecystectomy.

Study on Morphometric Features of Coronal Suture Along with it Absence and Craniosynostosis

Background: Cranial sutures are syndesmosis between the cranial bones. The coronal suture is oblique in direction and extends between the frontal and the parietal bones. Craniosynostosis is a rare birth defect that occurs when the coronal suture in the skull fuses prematurely, but the brain continues to grow and develop. This leads to a misshapen head. There are a number of forms of this defect, such as coronal, sagittal, lambdoid, and metopic. Materials and Methods: Total 500 skulls were used for study, coronal suture length measured by thread method, distance between Nasion to bregma and midsupraorbital rim to coronal suture were measured. For finding skull with absence of coronal, sagittal, lambdoid, and metopic suture, we examined many skulls during routine osteology classes of Medical, Dental and other medical sciences students. Around 500 skull observed and we find only one skull with absence of left coronal suture completely. Results: The length of coronal suture was 24.8+1.4cm length, the distance between nasion to bregma was 126.7 +10.25 mm and Midsupraorbital rim to cranial suture was 102.76+8.64mm We have found only one skull with absence of coronal suture. Some of the skulls shows partly fusion of sagittal, coronal sutures. The skull with complete absence of coronal suture showing the features of other sutures clearly and right side of coronal suture is showing the complete suture. The skull was not damaged and it is in perfect condition which was using by students for their osteology study. Conclusion: We found the skull with absence of left coronal suture, which may resulted due to craniosynostosis. It may be due to hot climate in India also might be resulted for absence of suture. KEY WORDS: Birth defect, Skull, Coronal suture, Craniosynostosis.

Variations in Course and Branching of Sciatic Nerve and it’s Relation to Pyriformis Syndrome

Background: Sciatic nerve is a branch of sacral plexus. It passes below the pyriformis and divides in the popliteal fossa. Higher division and relation of sciatic nerve to pyriformis have been documented. Beaton and Anson have classified relation of sciatic nerve to pyriformis. The aim of this study is to find incidence of variant anatomy of sciatic nerve as per Beaton and Anson classification. Materials and methods: 48 formalin embalmed lower limbs used for regular anatomy teaching were used. Branching and course of sciatic nerve was observed in gluteal region,thigh and popliteal fossa. Observations: As per Beaton and Anson classification, we found 81.2% showed type A or normal arrangement. Type B variation was seen in 14.6% while 4.2% showed type D variation. Conclusion: Variations in branching of sciatic nerve and it’s relation to pyriformis muscle are important from point of view of Surgeons and Anaesthetists. Knowledge of these variations will help reducing block failures in cases of sciatica, pyriformis syndrome and hip replacement surgeries. KEY WORDS: Sciatic nerve, Sacral plexus, Pyriformis Syndrome, Hip replacement.

An Osteological Study of Anatomical Variations of Foramen Transversarium of Cervical Vertebrae and its Clinical Implications

Background: In cervical vertebrae, the costal and transverse elements are connected to each other around the foramen transversarium of the transverse process. The adult cervical vertebrae are characterized by the presence of Foramen Transversarium (FT) in transverse process. These transverse foramina are found to have variations in size, shape and numbers and may be absent, incomplete or duplicate, which may lead to various symptoms. Aim: To study the anatomical variations of cervical vertebrae. Materials and methods: The present observational study was performed on 182 dry human cervical vertebrae of unknown sex and age. Intact cervical vertebrae without any degenerative or traumatic disorders were included in this study. Deformed and damaged vertebrae were excluded from the study Results: Out of these 364 foramen transversarium, 98 (27%) foramen transversarium were of type-I. Type -I was the most common presentation in the present study. Type -II foramen transversarium were seen in 33 (09%) foramen transversarium. Out of 364 foramen transversarium 88 (24%) foramen transversarium were of type-III. Type-IV foramen transversarium were seen in 62 (17%) foramen transversarium. Type-V foramen transversarium were seen on 83 (23%) foramen transversarium. Out of 182 vertebrae 40 (22%) showed complete double foramen transversarium. Incomplete double foramen transversarium were seen in 24 (13%) of vertebrae. One side complete & other side incomplete foramen transversarium were seen in 04 (02%) vertebrae. Conclusion: Knowledge of such variations is important for Physicians, Neurologists Otorhinolaryngologists, radiologists and Orthopedicians. Presence of accessory foramen transversarium especially of incomplete variety, the second part of vertebral artery may be dislodged and prone to get damaged easily during posterior cervical injuries. It helps in radiological imaging, neurological diagnosis and complex surgical procedures in the cervical area. KEY WORDS: Cervical Vertebrae, Foramen transversarium, Accessory Foramen Transversarium.

An Erratic Origin of Quadratus Plantae: An Embryological Error

Background: Quadratus plantae (Flexor digitorum accessorius) is one of the plantar muscles of foot . It is present in the second layer of sole. It takes origin from calcaneus and gets inserted into the tendon of flexor digitorum longus. The main function of it is to flex the lateral four toes in any position of the ankle joint by pulling on tendons of the flexor digitorum longus. Its variations like high origin have been implicated in the causation of tarsal tunnel syndrome. Methodology and Results: In routine dissection done on 22 cadavers, we observed a bilateral variant muscle flexor digitorum accessorius longus on both right and left sides in a male cadaver. The modality of choice in diagnosing the accessory muscle is magnetic resonance imaging. Conclusion: The knowledge of this variation would be essential to anatomists, radiologists and also to the foot surgeons while performing posterior ankle endoscopy. KEY WORDS: Flexor digitorum Accessorius longus, Tarsal tunnel syndrome, Posterior ankle endoscopy.

3D Digital Imagery a Solution for the Teaching of Osteology: Example of the Thoracic cage

Osteology is a fundamental discipline, its classical teaching becomes difficult because of plethora of students and shortage of bony parts. It’s in this context that we have made, from 3D volume imaging, a modeling of the rib cage as a test using a software for post-treatment of CT images in order to propose a pedagogical tool for studying thorax’s skeletal and adding descriptions with the help of classical works. This was a prospective study involving 27 patients aged between 35 and 45 years. The scanners used were HITACHI ECLOS 16 cuts. Once the CT scan was selected, the DICOM data was transmitted to the post-processing console. The images were processed on the console "Aquarius Intuition Edition Version 4. 4. 7. 855113", for one patient we used Veiwer Osirix 10.6.8 Mac. All bones have been dynamically described thanks to the volume rendering. We thus obtained volumetric reconstructions of three-dimensional CT images of the different bone structures superimposed on those taught in classical anatomy practical work. We obtained a scenario of practical work in the form of a slide show that the teacher can use for works with or without model and even remotely. The virtual reality obtained with the 3D reconstructions of CT scans of the rib cage is a tool for self-learning of osteology for students but also a way for teachers to do practical work without having to use models, and even at a distance. KEY WORDS: 3D imaging, Teaching, Tomodensitometry, Osteology.

A Study of Dermatoglyphic Patterns of Fingers in Patients with Myocardial Infarction

Background: The myocardial infarction (MI), the most common manifestation of coronary artery disease remains as a major cause of mortality in both developed and developing countries. The people without known major risk factors can be screened for MI with a simple and cost-effective tool which will be helpful in developing countries to reduce the mortality. Dermatoglyphic patterns in clinical conditions have been studied so far and their relationship is established in the literature. Dermatoglyphics has been considered as a diagnostic tool in many diseases with genetic bases. Hence this study is conducted to analyse the correlation between dermatoglyphic features and MI, so that dermatoglyphics may be used as screening tool for MI. Materials and Methods: We conducted a cross-sectional study of 150 MI patients diagnosed with ECG or coronary angiography who were admitted in the Institute of cardiology, Madras Medical College, Chennai after obtaining clearance from Institutional ethics committee. 150 healthy consented volunteers were included as controls. The finger prints from both groups were taken by ink method and type of fingerprint patterns and total finger ridge count (TFRC) and absolute finger ridge count (AFRC) were studied. The correlation of the findings between cases and controls were analysed with t-test and Chi-square test using SPSS 13.0. Results: The frequency of loop, arch and whorls is 54.9%, 8.3% and 36.8% respectively in MI as compared to 59.4%, 13.2% and 27.4% respectively in controls. The frequency of whorls is increased in thumb, middle finger and little finger of both hands of the MI patients when compared with controls with statistically significant difference (p<0.005). The mean value of TFRC and AFRC is increased in cases than controls and statistically significant difference was observed for AFRC. Conclusion: Thus, our study has indicated the specific fingerprint patterns in MI and we hope this knowledge can be used for screening the people without known risk factors for MI. KEY WORDS: Fingerprint, Dermatoglyphics, Myocardial infarction, early diagnosis.

A Cadaveric Study on Morphometric Features of Spleen and Splenomegaly with Accessory Spleen in Hilum

Background: Anatomical knowledge regarding the external morphology of the spleen is essential for surgical intervention and radiological diagnosis. Splenomegaly is defined as pathologic enlargement of the spleen measured by size or weight. A normal spleen has a craniocaudal length of no more than 12 cm and weighs less than 200 g. It is surrounded by a thin capsule. The spleen is usually not palpable unless it is enlarged; therefore, a palpable spleen is almost always abnormal. At times the spleen may be difficult to palpate, but dullness to percussion during inspiration in the area of the lower left intercostal space in the left anterior axillary line suggests splenic enlargement. Massive splenomegaly, weight >1000 g usually occurs in lymphoma, myeloproliferative disorders, visceral leishmaniasis, and malaria. Materials and Methods: This study was conducted in different medical institutions, to find morphometric features, spenomegaly in cadaver during routine anatomy dissection as part of curriculum, 100 cadavers were observed to find out splenomegaly. Results: Out of 100 spleens studied, 81 cases wedge shaped spleen was the most common, followed by 12 tetrahedral shaped spleens and 7 oval shaped spleens. Average weight of the spleen was 175g. Average length of the spleen was 11.64cm, Average breadth of the spleen was 7.3cm and average thickness of spleen was 3.6cm. Out of 100 cadavers observed only one cadaver observed with massive splenomegaly with one accessory spleen in hilum. The spleen weight was 875gm, length was 18.15 cm, width was 8.65cm, thickness was 5.75cm and extended upto 7 rib and it is easily palpable below the rib cage from lumbar aspect. The cadaver was male and age around 55 years. Conclusion: The morphometric knowledge of spleen will helpful for surgeons and for understanding deceases related spleen. The knowledge of splenomegaly is important in finding splenic disorders and accessory spleen information helpful in understanding embryonic development of spleen. KEY WORDS: Splenomegaly, Spleen, Hilum of Spleen, Accessory spleen.

An Isolated Dextrogastria Simulating Diaphragmatic Rupture in a Post-Traumatic Context

We report a case of isolated dextrogastria discovered in imaging a 34-years-old woman who was in the emergency department for vomiting and fluctuating right chest pain following a road accident. It was a collusion between 2 motorcycles, the patient being a rear passenger, performing a whiplash mechanism with a brief initial loss of consciousness. The day after the accident, she complained of left cervical swelling, painful with dysphagia to solids. Physical examination revealed bilateral palpebral oedema. There was a decrease in right vesicular murmurs with symmetrical tympanism towards the base of the lung. The rest of the examination was normal. The chest x-ray showed digestive loops above the liver that appeared to be located in the right intra-thoracic, suggesting in this context a diaphragmatic rupture. The OGDT and the thoraco-abdominal CT made possible to correct the diagnosis of type II dextrogastria by showing the stomach and part of the colon located on the right, above the liver, under the diaphragmatic dome which is disembowelled, pushing back the lung homolateral up. There was also a deviation of the ipsilateral thoracic esophagus in continuity with the stomach. The liver, in the right quasi-lateral position, is forced downward, extending to the lower edge of the ipsilateral flank. The other viscera kept their usual topographies. KEY WORDS: Dextrogastria, Isolated dextrogastria, Chest pain, Dysphagia.

Mental foramen of Human Mandible: Morphometric Study

Aim: The aim of our study was to perform a morphometric analysis of the mental foramen in senegalese context. Material and method: The study was performed on thirty-nine dry mandibles of adult humans. On these mandibles, the number of mental foramen present and their shape were noted on inspection. The situation of the foramen in relation to the lower teeth was studied according to a methodology already described. The following measurements were made: the distance between the foramen and the other landmarks of the mandible (symphysis, basilar border, posterior border), vertical and horizontal diameters. Results: The number of mental foramina were 39 on the right and 40 on the left: one mandible presented a double foramen on the left. The oval shape was predominant. The most frequent situation was below the second premolar on both sides. The mean distance between the foramen and the mandibular symphysis was 25mm on both sides. The distance between the foramen and the basilar border of the mandible was on average 13mm on the right and 14mm on the left. The distance between the foramen and the posterior border of the mandible was on average 72mm on the right and 73mm on the left. The average vertical diameter was 33mm on the right and 32mm on the left, and the average horizontal diameter was 4mm on both sides. Conclusion: Mental foramen is a constant anatomical structure, found on all the mandibles studied. The results can be superimposed on those described in the majority of studies carried out on the mental foramen. Key words: Mental Foramen, Mandible Anatomy, Morphometry.