M.N.R. Medical College & Hospital, Sangareddy (A.P.)
Variations of Median and Musculocutaneous nerves at the level of Brachial Plexus are common. This interpretation of the nerve anomaly of the arm requires consideration of the Phylogeny or Comparative Anatomy. (Kosugi et.al.1986). The Median Nerve (MN) is unique in the fact that it is formed by two roots from Medial and Lateral cords of the Brachial Plexus. Its relation in the upper arm should be understood before surgery in this respective area. Variation in the formation, course & branching pattern pose a great challenge to the operating surgeons.
Normally Lateral cord terminates into two terminal branches, Lateral root of Median nerve (MN) and Musculocutaneous nerve (MCN). The MN, MCN & Ulnar nerve after their origin from the Brachial plexus pass through the anterior compartment of the arm without receiving any branch from any nerve in the neighbourhood. (Hollinshed 1976, William et.al 1995) Variations in the formation of MN or absence of MCN in the infraclavicular part of Brachial plexus are common. The present report describes two variations in the upper arm nerves in the routine cadaveric dissection - 2002 to 2003.
In the first case a male cadaver the Median nerve was formed by fusion of 3 roots on the right upper limb. One each from Lateral and Median cord. The third root was from MCN after piercing the Coracobrachialis. This abnormal root coming from the MCN coursed obliquely over Brachial artely to join the MN in the lower third of the arm. Brachial artery bifurcation was normal. However MN on the left side was normal.nter communications between the peripheral nerves deserve special attention in the view of their Surgical prospectives and interventions. Communications between MN & MCN was reported in literature (Kaus and Wetowicz 1995, Bergman et.al 1998). In the second case a female cadaver supplying reveals the absence of MCN on the right side, which was not seen on the left upper arm. The right MN Supplying the Coracobrachialis, Biceps Brachii & Brachialis and thereafter gave Lateral cutaneous nerve of the arm close to elbow joint. These branches crossed the Brachial artery to supply the muscles. Absence of MCN was reported by LcMinor 1990, Nakatami et.al 1994, Prasad Rao & Choudhary 2001.
S.K. Pandey and Sushil Kumar, I.M.S., BHU, Varanasi.
The anomalies in the formation of the brachial plexus cords and median nerve were studied during routine dissection of the axillary region in 172 cadavers. The total incidence of anomaly was 12.8%(CI:7.8%-17.8%), which divided into three groups. The first group revealed that all the cords merged to form a common cord in 2.3% cadavers. The second group showed absence of the posterior cord in 3.5% cadavers. The third group had the anomaly in the formation and course of the median nerve in 7% cadavers, The fibers of the lateral and medial cords rearranged in 4 (2.33%) cadavers to form all three cords at the middle part of the artery. In two cadavers fibers form the lateral and medial cords decussated in front of the axillary artery and then divided into two intermediate branches. The lateral and medial roots of the median nerve on the medial side of the axillary artery in 8 (4.65%) cadavers to form the median nerve, which run medial to the artery. The communicating branches joined the two roots of median nerve which were sandwitchted between the axillary artery and one of the branches of the thoracoacromial trunk in most of the anomalous cases. The observed anomalies are of significant clinical importance particularly in surgical procedures of the axillary region.
Mohapatra BB, Chinara PK, Dutta BK, Nayak AK.
V.S.S. Medical College, Burla.
Variations in peripheral nerves are of interest to clinicians especially to surgeons. Routine dissection of the cadavers revealed rare anomalies in the formation and branching pattern of the median nerve in the arm. In the present case the left median nerve, in addition to its normal roots, is joined by an unusual, large contributory root from the lateral cord. This root is as thick as the median nerve. After giving muscular branches to superficial flexors of the forearm it joins with the median nerve in cubital fossa. This appears as double median nerve in the arm. Such type of variation is very rare. Knowledge of such variations are useful for surgical procedure in this area.
Kanak Iyer, R. Uma,
K.J. Somaiya Medical College, Mumbai
It is a general impression that brachial plexus anomalies are quite common. However, real variations with a change in segmental supply of muscles are only in 6.28%. We report one variation involving musculocutaneous and median nerves. Musculocutaneous nerve arose from lateral cord and supplied the muscles in anterior compartment of arm. After this, it joined the median nerve, This plexus had contribution from C4 [prefixed plexus]. Instead of anterior divisions of upper and middle trunks joining to form the lateral cord, the anterior division of middle trunk [C7] formed the lateral root of median nerve and lateral pectoral nerve and a small thin contribution to musculocutaneous nerve. The anterior division of upper trunk along with C4, formed the m.cutaneous nerve which joined the median nerve later lower down in the arm thus contributing C4, 5, & 6 to the lateral root of median nerve. Hence, lateral cord was absent Medial root of median nerve was normal.
Anomalies of brachial plexus are reported to be due to abnormal formation of axillary artery.
Vasudha Saralaya, Narayana K
Kasturba Medical College, Mangalore
The present study was planned to evaluate theposition of the mandibular foramen and inferior alveolar nerve in the mandibular canal in 12 right and 14 left cadaver hemi mandibules. The soft tissue including the muscle attachments of the mandible was cleaned and the inferior neurovascular bundle was dissected up to the MF. The distances from the mandibular foramen to the angle, symphysis menti, 3rd molar, and the lowest point of the mandibular notch were measured. The bone was chiseled from its lingual surface to expose the mandibular canal. The distances from the nerve to the alveolar and inferior borders were measured. The distances from the mandibular foramen to different landmarks did not show any side differences except the one to the symphysis menti (P<0.05; Mann-Whitney 'U' test). Similarly the distances from the nerve to the borders also did not show any significant side differences. The canals were located either at the middle or below near to the base of the mandible, when classified based on the midpoint between the two borders. These data indicate that, the location of the mandibular foramen varies from bone to bone despite its bilateral symmetry. Further, the canal does not maintain a constant position in the mandible.
Bhagath Kumar & T. Ramesh Rao
Kasturba Medical College, Manipal
A very rare case of bifurcation and reunion of phrenic nerve was found close to its origin. From its normal origin the phrenic nerve was found running downwards in front of the trunks of the brachial plexus and scalenus anterior muscle. In relation to the scalenus anterior muscle the nerve was dividing into 2 roots, which encircle the origin of thyrocervical trunk and internal thoracic artery. However the remaining course and distribution of the phrenic nerve was found to be normal. No such variation was found on the opposite side. Detail of which will be discussed in the paper.
M Gupta and Harjeet
The internal laryngeal nerve is supposed to be sensory to laryngeal mucosa above the vocal cords. This study was caff ied out in larynges of 5 human adult cadavers to see the distribution of internal laryngeal nerve (ILN). The whole larynx was dissected and preserved in formalin and stained by modified Sihler's technique (Mu et al. 1994) which stain axons and renders other tissue transparent to make the nerve branches to be seen in whole mount preparation. The specimens were dissected to demonstrate the branching of internal laryngeal nerve down to level of its terminal branches. The superior branch of ILN mainly supplied the mucosa of laryngeal surfitce of epiglottis and middle division supplied mucosa of true and false vocal folds and aryepiglotic fold. While inferior division supplies the mucosa of arytenoids region, subglottis and anterior wall of hypopharynx and upper esophageal sphincter. Branches of either nerve were crossing the midline. This nerve also appears to innervate transverse arytenoid- muscle. The branching pattern and some key landmarks for localizing the major branches of the ILN would be helpful during sensory reinnervation of the larynx.
P. D. Athavia, MMC - Mumbai. A. P. Chaphekar, TMC-Mumbai.
The course of the facial nerve is tortuous, at the very least and it is studied after much effort, attempting to visualize its many twists and turns and its relationship to a host of important structures, on its way.
This is an attempt to simplify the study of the course of the facial nerve. We begin by noting that all cranial nerves exit the cranial cavity in a downward and outward direction. The facial nerve would appear to be an exception to this general rule, but it really does exactly what the other cranial nerves do - save for over a short distance in its course, inside the petrous temporal bone.
A M. Natarajan, M.V.L. Kothari, L. A. Mehta
Seth G. S. Medical College & K.E.M. Hospital, Mumbai
At the level of the ankle, the tendo Achilles is significantly distanced from the back of tibia and fibula. A lateral radiograph of the foot shows this pyramidal gap vividly with the top of post articular calcaneum forming the base of the pyramid. The neurovasculomuscular tissue do fill in the gap but far from adequately.
Filling in this gap is a large multisided stadipose body calcella that rests on the calcaneum, is probably continuous with the calcaneum (like patella being continuous with the fatella), is continuous with the plantar fat and gives a distinct slip like an alar fold which is continuous with the talar cartilage which joins talella, the pad of fat in front of the ankle.
There is a striking parallel between the knee and the ankle in the sense that a very large tendon rides over a small bone and the space between the tendon and the long bone is bridged by a large stadipose body. At the knee it is fatella and the patellar tendon and at the ankle it is the calcella and the tendo Achilles. Patella being continuous with fatella comprises patellofatellar complexes. Expectedly calcella is integrally bound to the top of the cacaneum to comprise calcellocalcaneal complex. There is need for postulating a widely dispersed but unitary hydrodynamic mechanism that integrates the tendon strength / pressure, the intra-articular pressure exerted on the cartilage and the dissipation thereof through the folds into the stadipose bodies towards efficient function and protection of the joint. This would be a principle as important as Hilton's law of joint innervation.
KJ Vasaiya, GR Singel
PDU Medical College, Rajkot
Brachial Plexus injury can result into devasting impairment of upper extremity function. Brachial Plexus injuries are caused by severe traction injuries occurring during motorcycle accidents. Essentially all brachial plexus birth palsies, and most traumatic injuries of brachial plexus are due to traction . The technical achievements b-rA in optics, sutures and instruments have made complex nerve reconstruction possible and beneficial'. The aim of this study is to correlate anatomical knowledge of brachial plexus with fate and microneural reconstruction of brachial plexus after injury. For that 20 brachial plexus were dissected and studied fiom root fo cord. Anatomic studies have determined that the supporting tissues anchoring the upper roots to the vertebral foramina are significantly stronger about C-5 & C,6 roots than dish Because of this anatomic arrangements, the more cauded structures of brachial plexus would be predicated to suffer more sigmficant injuries than upper roots (and this is also proven clinically).The T1 & C-8 roots are more likely to be avulsed from spinal cord, where as C-5 and C-6 roots are more likely to stretch or rupture in continuity after exiting than neural foramina. The anatomical classification of injury will decide the fate of brachial. plexus.
Soni.S, Rath G, Arora J
Vardhman Mahavir Medical College, New Delhi.
During routine dissection, variation in the course and branching of lateral cord of brachial plexus was noted on the right side of an adult female cadaver. The lateral cord was found to pierce the coracobrachialis muscle. Before piercing, the cord gave a muscular branch to this muscle from its lateral side. After emerging from the muscle, it divided at the middle of the arm into two branches. The medial branch corresponded to the lateral root of the median nerve, where as, the lateral branch corresponded to the musculocutaneous nerve. The latter coursed giving muscular branches to biceps brachii and brachialis from its lateral side and finally it bifurcated giving two terminal branches. The lateral branch formed the antebrachial cutaneous, while the medial branch coursed downwards for a short distance deep to the brachial artery. Interestingly, this branch joined the median nerve forming communication with it. Such intercommunications between musculocutaneous nerve and median nerve have great clinical importance in the diagnosis of related neurological disorders and surgical procedures in this region.
Buch HA, Patel S A, Suthar A A, and Agnihotri RG
Govt. Dental College & Hospital, Ahmedabad
Inferior alveolar nerve block anesthesia (IANBA) requires sound knowledge of the anatomy of pterygo-mandibular space and related region. It has been said that IANBA does not fail if you can only wait for some more time (!), and it has also been remarked that you realize the importance of having studied geometry when you undertake this block anesthesia. Between these two extremes is the usual opinion that if you know the anatomy involved you not only succeed but also create less complications.
Many medical teachers are teaching dental students and therefore, they need to be well versed in the anatomy of relevance to dentistry including that concerned with IANBA. This presentation is aimed at this target group.
A cadaveric specimen is prepared using band saw and routine dissection instruments to demonstrate the anatomy in question and such a model may be used to train and test the clinical dental student before he undertakes the IANBA on a patient.
Anatomical features like groove and ridge of the mandibular neck, retromolar fossa and triangle; and temporal crest etc are constantly present though ignored by most textbooks. Some visible and/or palpable landmarks in the oral cavity like pterygomandibular fold and coronoid notch must be accurately correlated with the deeper underlying anatomy of pterygomandibular space for successful IANBA. The presentation aims to simplify the complicated anatomy involved.
Jeyaseelan N and Sundarapandian S
Amrita Institute of Medical Sciences, Cochin.
Double right renal vein and its formation by persistence of some embryonic renal veins arranged in ladder-like pattern are described. Additional renal veins were common on the right side (26%) while it was rare (2.6%) on the left side.
In the present case there is double renal vein on the right side that is in line with the previously reported findings. However the rare anomaly is that the right testicular vein opens in the lower right renal vein. The knowledge of these anatomic variations in the retroperitoneal region is of great importance to both surgeons and invasive radiologists.
KD Khushale, MVL Kothari, LA Mehta
Seth G.S. Medical College, Mumbai
Aim: To study the right trigone of the heart and note its measurements.
Material and Methods: The right trigone of the heart was dissected and studied in 30 adult cadaveric hearts. Their morphological features were noted.
Results: This study helped in greater understanding of the three dimensional orientation of the right trigone.
Conclusions: The right trigone of heart and its three dimensional view is helpful for both undergraduate and postgraduate students of Anatomy and Cardiology. It would also help cardiothoracic surgeons during annuloplasty operation.
Hirendra Shah, Bakul Leuva, Vasant Vaniya
B. J. Medical College Parallel dissection on body of a premature infant and of an adult was carried out in Anatomy Department of B. J. Medical College. Position of cecum was compared in both cases. The cecum was found to be in right lumbar region in both cases. In case of the infant it was almost subhepatic. The body of the infant had no demonstrable alteration in duodenum like atresia or stenosis, or in Transverse Colon like evidence of mal rotation of mesentery.
Was it en-route to its normal position in Right Iliac Fossa ? or was it an abnormal finding ?
We suggest that more studies in this direction are required. More numbers of dissections of premature infant bodies with different gestational age should be performed to establish the relationship between stage of development of certain organs and definite gestation period.
The term 'low-set ears' has been commonly used to describe the ears in various malformation syndromes. However, a scientific definition of low-set ears is lacking in relevant literature. The reference point/line or surface landmark taken by various workers to describe/define low-set ears does not seem to be consistent.
An attempt has thus been made to redefine the position of auricles using a fixed bony point as a surface landmark. The normal position of the auricle was determined in 100 neonates. The distance between the upper & lower attachment of the auricle and the distance between the upper & lower poles from the reference point were measured on both the sides & in the two sexes, and statistically analysed. There was a wide variation in the distances measured in normal neonates. This highlights the importance of redefining the term 'low-set ears'
Keshaw Kumar and Bindu Singh
M.L.N. Medical College, Allahabad.
During dissection of the cadavers only in one out of 312 cadavers it was observed that ascending colon and hepatic flexure were absent because transverse colon directly commenced from caecum taking an oblique course starting from right iliac fossa to left hypochondrium along greater curvature of stomach ending into splenic flexure which was related to visceral surface of greatly hypoplastic spleen which was related to upper part of posteroinferior surface of stomach weighing about 30gm. There was no anomaly observed in descending colon and sigmoid colon and greater omentum commencing from greater curvature of stomach covered all the structures completely. The stomach was J-shaped and abnormally elongated and its pyloric end was situated in the right lumbar region where it ended into the first part of duodenum.
K. Shyam Kishore Seth G. S. Medical College & KEM. Hospital, Mumbai.
Introduction : The six great teachers of Rudyard Kipling tell us how little we know about the fundamentals of the human heart.
Aim : To get an insight to solve the queries posed by anyone between nine and ninety :
What is the need for a heart ? i.e. ... why heart ?
Where is it located ? Why ?
Who (i.e. Which organs) are its relations? Why?
When (in evolution) do the chambers septate? Why?
How many degrees of folding does the heart tube show?
Why does it have a trabeculated portion? Why a compact part ?
Why? Why? Why?
Result: A careful study of the comparative anatomy, embryology and physiology of the heart shows that the heart, in its ontogeny, hardly shows any eagerness to recapitulate phylogeny. Instead, its development and modifications depend on the early demand for a functional heart.
Conclusion: Functional necessity is the mother of structural innovation
Kaushal S., Patnaik V.V.G., Agnihotri G
The anterior teeth are aesthetically important as they are readily seen during eating, speech, mastication and facial gesticulation. Among them maxillary central incisors occupy a strategic anatomic position being in front and in the centre of the upper arch. The philtrum of the upper lip is a landmark of individual distinction with an unique configuration. With the loss of maxillary central incisors, the philtrum is known to loose its characteristic shape and gets flattened. A study was designed in the Anatomy Department, Govt. Medical College, Patiala to determine the correlation between the width of maxillary central incisors and width of philtrum. It was envisaged that the determination of this correlation would contribute significantly towards the satisfaction of the exacting aesthetic demands in the restoration of philtral anatomy and selection of the mesiodistal dimension of the maxillary central incisors. Since, morphology is known to be influenced by cultura environmental and racial factors, the present study establishes the morphometric criteria for the width of philtrum and maxillary central incisors in North Indian population. The width of philtrum was measured directly on the face while the width of maxillary central incisors was measured on the study casts. The data so obtained was computed, tabulated and statistically analysed with the purpose of establishing a correlation between the two parameters, especially emphasizing on sexual dimorphism.
The results indicates the existence of a partial positive correlation between the two parameters i.e the width of maxillary central incisors and the width of philtrum . This correlation is found to exist for 'males', 'females', and the 'whole group'.
The various parameters as measured for males and females were compared and they were found to be statistically significant.
The existence of a variation in size and form between right and left maxillary central incisors. In >75% of the cases the width of right and left maxillary central incisors is found to be dissimilar.
The sexual dimorphism in the mesiodistal width of maxillary central incisors(calculated as per formula given by Garn S. M et al, 1967) came out to be 3.84% for the right maxillary central incisor and 4.52% for the left maxillary central incisor.
Ghatak. S and Srinivas, V
Armed Forces Medical College, Pune
The cytotoxic drugs and radiation often have deleterious effects upon the normal physiology of healthy organs in the cancer patient. The testis is one of the organs frequently affected. This study was undertaken to find out the effect of anti-neoplastic chemotherapy and/or radiotherapy on testicular morphology.
Histologic sections were obtained with careful "no-touch" atraumatic technique. After careful fixation, paraffin sections were cut at a thickness of 4 . Staining of the sections was carried out with H&E and with special stains like Masson's Trichrome and PAS. Subsequently ultrathin sections of approximately 70 mm were obtained for EM study.
The study demonstrated significant histologic changes in the gonads of patients treated for malignancy with chemotherapy and/or radiotherapy. Ther were a marked and significant reduction in spermatogenic activity and TFI, increase in interstitial fibrosis and evidence of basement membrane thickening. Ultrastructurally, there was breakdown of intercellular junctional complexes, marked fibrosis and an increase in lipofuscin granules in Sertoli cells indicating subcellular organellar damage. But, despite these pathological changes, there was evidence of residual germ cells in a few cases. Presence of residual germ cells can be taken as an indication of possible existence of potential fertility in such cases.
Satheesha K.S. & Narayana K
Kasturba Medical College, Mangalore
Anatomy of a horseshoe kidney and the other associated abnormalities were studied in a 92- year old male cadaver. The left kidney was smaller than the right. The hila were wider extending on to the anterior surface. The left ureter was bifid and the left arm of which again showed bifurcation. The left ureter crossed the inferior mesenteric artery posteriorly from medial to the lateral side. The right ureter was little tortuous at its upper part and crossed by, the retrocaval right testicular artery. The left testicular artery was a branch from the inferior mesenteric artery. The left suprarenal was separated from the kidney and supplied by 3 arteries; 2 arising from the aorta and 1 from the left renal artery (LRA), and 2 veins draining to left renal vein. The LRA was passing through a hiatus formed by the 2 suprarenal veins. The right renal artery was normal. One artery was arising from the aorta just above the isthmus and the other one behind the isthmus supplying it. Another artery from the aorta arising just below the previous one, gave the median sacral artery and 5th lumbar arteries. The median sacral vein was large and drained into the left common iliac vein. The aorta showed deviation to the right and partially lying on the inferior vena cava. Only 2 veins drained the kidney, but a large vein was draining the isthmus, which drained into left renal vein. This case differs from the earlier reports in that the renal arteries were atypical, the blood vessels of the suprarenal, the relations of the testicular arteries, and the median sacral vessels were altered.
Suseelamma D., Annapoorna M. and Rao. P. A.
Gandhi Medical College, Secunderabad.
Congenital anomalies of the various structures belonging to the Urinary System are not uncommon. But, the anomalies to be multiple in number is quite uncommon. In this case report on a Complex of Multiple Congenital Anomalies of the Urinary structures, we wish to present a discussion of its embryological aspect.
While the dissection was being carried out by the students in the dissection hall of this college, in a cadaver, we encountered multiple anomalies of the renal and ureteric structures as well as aberrant vascularity.
The observations were as mentioned hereunder : Multiple lobulated fused renal masses, giving a single 'J' shaped appearance, located in the midline at the level between the L4 and L5 vertebrae, hilum facing anteriorly Openly visible structures of Multiple Ureteric Buds (which join to form finally two ureters) Aberrant renal arteries arising a) from the abdominal aorta, proximal to its bifurcation, b) from the abdominal aorta, at its bifurcation, c) from common iliac artery, and, d) from external iliac artery. Discussion for embryological significance.
Shree Lekha D. , Jacintha Antony, Jothi S.S.
Katuri Medical College, Guntur.
A 33 weeks antenatal case presenting massive hydramnios came to Obset & Gynec Dept. of KMC and Hospital and M.T.P was done. The foetus had absence of anal orifice and external genitalia was that of female.
On opening the abdomen the following observations were made.
It was a high type of imperforate anus with rectum ending blindly. There was gonadal agenesis. Mesonephric duct system had failed to develop. Paramesonephric duct system failed to develop. Pressure on left ureter led to hydroureter and hydronephrosis.
Key word - Imperforate anus.
D.Ningthoujam D. , Chongthak R. ,S Sinam S.
The study was conducted to see the pelvicaliceal pattern (pcp) in both foetuses and adults.
100 kidneys from 40 foetuses and 10 adults, and 200 IVU films were studied.
The pcp. was found to be dissimilar in the two kidneys of the same individual. Foetal kidneys in early age group revealed different types of surface lobulation.12-18 minor caliceal segments coalesce to form upper, middle and lower calices. The anterior and posterior minor calices were most evident in the middle calyx while the upper and lower had apical and basal minor calices as well. Upper and lower major calices showed 3 to 5 minor calices draining from different aspects. The commonest pattern was Triangular or tricaliceal (40% in foetus and 51% in adults), Yshaped or bicaliceal (20% in foetus and 22% in adults); and Radiate or multicaliceal (30% in foetus and 15% in adults). There were many variant forms of each subgroup due to variable lengths of the calices and the direction of the major and minor calices.
The knowledge of such wide ranging pattern of pelvicaliceal system in particular the presence of anterior and posterior minor calices, the angles they make with the pelvis, direction of the minor calices and cross drainage would help the surgeons and interventional radiologists in planning and executing their procedures more accurately.
D. Sree lekha, Sri Devi Thammana, B.T.Narayana Rao & S.S. Jyothi
Katuri Medical College & Hospitai, Guntur.
During routine dissection of midline of the neck, we came across a cadaver which presented left lobe of the thyroid lobe and apart of isthmus ending blindly. There were singns of inflammation, adhesion and enlargement of deep cervical lymph nodes on the right side of the neck. After releasing the adhesions and while exploring the contents of carotid sheath, right lobe of the thyroid gland made its appearance and it was confirmed as right thyroid lobe as we could trace the superior and inferior thyroid arteries to it. This rare presentation may be of use to the surgeons.
Kaushal S, Patnaik VVG, Wealthy HS, Jain A
Testicular descent into the low temperature environment of the scrotum in mammals is a complex multistage process. Upto the time of sexual differentiation in human fetus at 7-8 weeks gestation, the fetal testis and ovary occupy similar position. The gonadal position then diverges; the testis remains close to the future inguinal canal held by the cranial suspensory ligament (upper pole) and the gubernaculum (lower pole). The causative factors for non-descent of testis are multifactorial. Most of the undescended testes are located outside the inguinal canal but a few are intrabdominal. The chances of torsion in a cryptorchid testis were reported to be high in previous surgical textbooks but due to awareness, early diagnosis and earlier surgical correction there has been a decrease in the serious complications of torsion in an undescended testis.
The present case is a rare case of torsion of undescended testis in a 3 months old infant who was surgically intervened by doing orchidectomy. Biopsy was taken and histological changes were observed like haemorrhages etc.
Das Srijit, Paul Shipra
Maulana Azad Medical College, New Delhi
During routine dissection of thorax, an abnormal fusion of the right lung and the right dome of the diaphragm was noticed in a 65 year old male cadaver. The muscle fibres from the superior surface of the right dome of the diaphragm were seen to extend to the mediastinal surface of the right lung in the lower part of the hilum. On further dissection, the muscle fibres were seen to reach the anterior and posterior parts of the pulmonary ligament. This can be explained embryologically by the fact that septum transversum which lies between the pleural and pericardial cavity cranially and peritoneal cavity caudally may also have contributed to formation of these muscle fibres which were extending to the mediastinal surface of the lung. The presence of such phrenico pulmonary fusion might cause restrictions in respiratory movements and other respiratory problems without showing any changes in the X-ray findings of the lung. The finding may be of great help to the cardiothoracic surgeons.
V. Bhagyam, Ram Kumar, Salini Dharmadas J.M. Medical College & Research Institute,Thrissur.
Routine examination of the fetuses collected for museum specimens for the anatomy department of Jubilee Mission Medical College, Trichur showed a cervical malformation in one of the aborted female fetus of 18 weeks size. Congenital cervical cysts are frequently encountered in pediatric population. This stimulated the study of cervical cysts. Detailed dissection of the specimen proved it to be a case of giant cystic hygroma of neck. This anomaly will be presented with illustration.
Sherke AR, Parchand MP, Kamble RA, Shende MR,
Indira Gandhi Medical College, Nagpur.
Aim: To find out 'atd' angle in patients of cataract associated with Diabetes Melilitus.
Material & Method: The study consists of 400 subjects (300 Patients and 100 Normal Controls).
Palmar prints were taken by the 'INK METHOD'. Prints were analysed and results were tested for statistical significance.
Result: 'atd' angle was found to be significant in diseased cases.
Conclusion: Result of the study may be useful to diagnose the disease at an earlier age.
Panda M, Chinara PK, Nayak AK,
V.S.S. Medical College, Burla
Diabetes Mellitus (DM) being one of the curses of the human civilization is said to be genetically linked. But the association of DM with dermatoglyphics has been used as a scientific tool for early prediction and thus prevention of the development of DM, in particular type II. In the present study attempt has been made to detect the persons more prone for DM by parameters which can be determined easily.
Thus finger and palmar prints were studied in established cases of DM i.e. 50 cases of type I (IDDM) - 25 Females & 25 Males and 50 cases of type 11 (NIDDM) - 25 Females & 25 Males and compared with 100 normal controls. 50 Females & 50 Males with a similar racial distribution.
After statistical evaluation of some of the parameters there was increase in - total finger ridge count, absolute finger ridge count, radial and ulnar loops and arches and decrease in whorls.
On analysing the axial triradii (t, t', t") all the DM patients irrespective of sex have t' or t" while most of the normal controls have t.
Though the above qualitative & quantitative parameters of the finger ridges has been reported by other workers the present study emphasises on the presence of t'or t" as a better parameter helpful in scientific screening of the persons more prone for Diabetes Mellitus.
Kshirsagar S V, Diwan C V
S. R. T. R. Medical College, Ambajogai
The inheritance of dermatoglyphic features is polygenic, with individual gene contributing a small additive effect. The genetic basis of inheritance of blood groups is well established. The distribution of dermatoglyphic patterns and blood group in various races, medical conditions is extensively but separately studied. The present study is carried out to study the correlation between the fingertip patterns and the Rh. blood group.
The dermatoglyphic patterns of 328 individuals (181 males and 147 females) of known blood groups were studies. The distribution of fingertip patterns triradial count, main line index, angle 'atd' total finger ridge count and three indices in Rh+ve and Rh-ve blood groups was studied.
It was observed that, though the distribution was statistically insignificant, Rh-ve blood group showed high frequency of arch and ulnar loop patterns, high value of main line index, and total finger ridge count and also higher percentage of interdigital patterns in I2 area while, Rh+ve blood group showed higher percentage of interdigital patterns in I3,I4 and hypothenar area.
Kaur N, Sharma P K, Tiwari SC, Tiwari N
Dermatoglyphics is used as a diagnostic aid in a number of diseases that have a strong hereditary basis. The genetic profile revealed by studies on schizophrenia is still contradictory and confusing. However, studies in twins and adoption provide biological evidence for the existence of inherited factors in schizophrenia.
Some investigators found a poor prognosis correlated with an increased number of relatives with a diagnosis of schizophrenia.
The present study was designed to assess the effect of a positive family history of schizophrenia on fingerprint patterns. This study included 53 schizophrenic patients (31 males and 22 females). These patients were compared with 50 healthy controls (20 males and 30 females) having the same demographic profile. The fingerprints were obtained by the ink and pad method and analyzed to detect variations in dermatoglyphic features among schizophrenics with and without a positive family history with controls. A significant increase in whorls and a decrease in loops was observed in the male schizophrenics. Arches were significantly increased in the schizophrenic population with a positive family history of the disease.
Ingole I V, Shah M M
JNMC, Sawangi, Wardha
Dermal ridge differentiation occurs early in fetal development. Resulting ridge configurations are genetically determined. The association of abnormal ridge patterns with chromosomal aberrations has been amply demonstrated. Though these ridge patterns have hereditary basis, they are known to be influenced by the environmental factors acting at the time of their development. Abnormal dermatoglyphics have been reported in children with embryopathy and even in apparently normal children whose mothers were exposed to rubella virus early during gestation. This suggests that dermatoglyphics may be a sensitive indicator of even subtle intrauterine damage. With this view the present study was taken up.
43 Children of a school for deaf and dumb, in the age group of 7 to 16 years were selected with a definite history of being deaf and mute right from birth.
30 normal children in the same age group were taken as control.
The prints of both the hands of each child from both the groups were taken by commonly used printers ink method.
The prints in both the groups were studied and compared for following features.
1. atd angle in right and left hand. 2. percent of hypothenar pattern types 3. percent of thenar pattern types 4. percent of radial loops on individual fingertips 5. frequency of patterns in the interdigital areas It was observed that there is an asymmetry of atd angle of a greater degree in affected group as compared to control group. In relation to other features there was a difference in the percentage of palms showing a particular type of pattern in the same area in two groups.
S. B. Sukre,A. A. Mahajan,
A. G. Shroff Government Medical College, Aurangabad.
Aim: This paper is co-relative study to analyse relation between breast cancer patients and control of dermatoglyphics pattern. This study is also to add in the list of diagnostic parameters of breast cancer.
Material and Methods: Fifty controls selected from employees of Government Medical College and Hospital, Aurangabad age ranging from 25 to 60 years. Fifty diagnosed patients of breast cancer were selected for dermatoglyphic prints from Radiotherapy Department of Government Medical College and Hospital, Aurangabad. The prints were taken on white glossy paper with the help of special ball made-up of cotton, soaked in coarse duplicating ink.
Observation and Results: Significant rise of arches was found in breast cancer than control in left hand as well as right and left hand combined. Radial and ulnar loop shows decrease incidence in cancer patients. Whorls showed statistically significant rise in breast cancer. Similarly atd angle is more in breast cancer than control. ab-ridge count, tri-radial count and total finger radial count did not show any statistical variation in both the groups.
Shabana Borate, PR Kulkarni, BH BahetI.
Aim: To find out specific dermatoglyphic pattern in congenital deaf. Materials and methods : The study consists of 200 subjects (100 patients and 100 normal controis). Palmar prints were taken by the ink method. Prints were analysed and results were tested for statistical significance.
Results : Congenital deaf showed significant decrease in the frequency of ulnar loops and arches and increase in the whorl patterns, TFRC and AFRC is increased significantly, increase in frequency of high axial triradii, increase in 'atd' angle, increase in 'a-b' ridge count, larger main line index in congenital deaf males and low main line index in congenital deaf females and increase in frequency distribution of simian creases in congenital deaf.
Conclusion: Results of this study are promsing and may be useful as a predictive anatomic tool to diagnose the disease at an earlier age.
Shabana Borate, LS Khanzode, R A Kambale. IGMC, Nagpur
Aim: To find out specific dermatoglyphics pattern in cleft lip and cleft palate patient.
Materials and methods: The study consists of 120 patients of cleft lip and cleft palate and control group of I00 from general population. Palmar prints were taken by ink method. Prints were analysed and results were tested for statistical significance.
Results: There is significant increase in total number of palmar axial triiradii, wider 'atd' angle, increase 'a-b' ridge count, increase of patterns in hypothenar and thenar-interdigital-I area, presence of simian creases and sydeny lines, when compared with controls.
Conclusion: Results of the study showed statistically significant difference between dematoglyphic patterns of congenital cleft lip and cleft palate patients
Minnie Pillay,* Vasudevan DM, CP Rao, Vidya
M. Amrita Institute Of Medical Sciences, Cochin.
Epidemiological studies conducted in several countries have provided strong evidence that among the various known risk factors, the main factors implicated in the aetiology of oral cancer are tobacco, betel quid and alcohol. Mutations of the tumour suppressor gene p53 and overexpression of the p53 protein have been correlated with carcinogen exposure. In this study, oral cancers (a total of 110 cases of oral squamous cell carcinoma) were analyzed in a section of South Indian population known to have a high consumption of betel and tobacco, for the presence of alterations in the p53 gene by immunohistochemistry using anti p53 monoclonal antibody Pab 240. An attempt has also been made to find out the association between p53 expression and various oral habits of the patients such as tobacco smoking, quid chewing (classified as tobacco quid, areca quid, or a combination of both), and alcohol consumption by statistical analysis using Chi Square test with Yates correction for continuity. Out of all oral habits, only chewing of tobacco either in isolation or in combination with smoking and alcohol consumption was found to have a significant association with p53 expression. p53 may be one of the possible sites of genetic damage induced by tobacco alone, or in combination with alcohol.
M. V. L. Kothari, L. A. Mehta, M. Natarajan.
Seth G. S. Medical College, Mumbai
The ability of Gray's anatomy to leave the average reader bewildered is traceable to anatomists' penchant for dividing to decipher. An integral body derived from a single zygote becomes parts and regions with confusion worst confounded. The three categories of sensory receptors, neurons and muscle cells fail to convey their gestalt integrality.
The SNM complex comprises post-mitotic perennial cells precisely connected point to point as if on a computer circuit. The SNM versatility is exemplified by the cardiac cells that assume functions of sensory receptors, neurons, nerve tracts and of course contraction.
Leblond and Moorhead pioneered classification of cells into two broad groups (a) expanding / renewing cell population that are capable of cell division and (b) the perennial or immortal cell population that never divide in postnatal life. The former group comprises the supporting tissue complex and the latter the SNM complex. The structural and functional inseparability of SNM cells allows them to be viewed as the GAIM system comprising Gestalt Afferentation Integration Motorisation. The supporting tissue complex is the GAIM cage.
The GAIM approach offers a consistent coherent thinking wherein there is no separation into receptors, neurons or muscle cells. The three evolve and function simultaneously and synthetically. The appellations central / peripheral for the nervous system become redundant.
Movement disorders and special clinics thereof have become order of the day. Choreaic hypermovements and Parkinsonian stiffness are best expressed through the pioneer Sydenhamic term paralysis agitans. This strange combination of paralysis and agitation must involve a wide network of afferentocytes, integrocytes and motorocytes.
Such a holistic approach is likely to render the understanding of movement disorders a shade better.
Joshi SD, Joshi SS & Athavale SA
Rural Medical College, Loni.
Joints are primarily meant for movements to enable an organism to carry out its normal functions of existence and growth. Simultaneously the joints also perform the mechanical function of transmission of various types of stresses which include weight transmission, torques, impaction, etc.
On a cursory glance it looks as if the nature has patterned them with a specific. not only surfa ce area but critical thickness. Here, an attempt has been made to understand the basic principles underlying the relative thickness of articular cortices and their relation to the articular surfaces.
The articular surfaces of various bones have been sectioned primarily along the longitudinal and transverse axes and the thickness/ thinness of the articular cortices observed. The various factors that may have an interplay in deciding the thickness of articular cortex could possibly be: a) range and freedom of movements b) type of forces transmitted c) types of articulating surfaces etc.
We have found that majority of concave articular areas have thicker
BN Rao, KRSP Rao, V Janaki, Devi , Asha Latha
Identification of INCA bone in 150 adult crania of North coastal Andhra Pradesh constituted the present study. Wormian or sutural bones are known to be fragments of isolated pieces of developing strands of ossification. Keith (1948) is of the opinion that membranous part of occipital bone was part of parietals in Marsupials ruminants and ungulates. Keith further stated that it was rare to find memberanous part of supraoccipital bone as a separate bone. In this background the identification of INCA by its sight, size and shape in crania of North coastal Andhra Pradesh is quite interesting and the details of percentage and its other available reports will be discussed during the conference.
Pawar SE*, Sawant VG* *
*Grant Medical College, Mumbai & **Terna Medical College, Navi Mumbai.
AIMS and objectives:
1) To find out the average maximum dimensions [Anteroposterior (A-P) Transerverse (Trans.), vertical (Vert.)] of Maxillary air sinus by using C.T. scan
2) To find out the average maximum dimensions (A-P, Trans., Vert.) of Maxillary air sinus by using M.R.I.
Materials and Methods: C. T. scan study :In this, C. T. scans of PNS of 50 adult patients, having normal air sinuses were included. All others having pathology, congenital defects were excluded from study. All these patients were referred to radiology dept. of J. J. hospital, Mumbai
(Grant medical college). All C. T. scans were done on SIEMENS, SOMATOM plus-4. machine in both axial and coronal planes. After obtaining C. T.plates, they were observed on large view box and then sections having largest dimensions were selected for measurements.
M.R.I. study: This study includes M.R.I. of brain of 100adult patients having normal paranasal air sinuses, which were referred for neurological complaints at Breach Candy Hospital, Mumbai. All patients under went M.R.I. on Philips Gryroscans Acs-Nt, 1.5 Testa machine. After performing M.R.I., the images having largest dimensions were selected for measurements of maxillary air sinus.
1)The measurements by C. T. scan were recorded for adult patients in tabulated form.
2)Also the measurements by M.R.I. were recorded for adult patients in tabulated form.
SUMMARY AND CONCLUSION :
I) Data from C. T. scan study provide the average dimensions for adult maxillary air sinus as A-P-37.2mm, Trans.-26.2mm and Vert.33.5mm)
2) Data from M.R.I. study provide the average dimensions for adult maxillary air sinus as A-P-36.5mm, Trans.-22.5mm,Vert.31 mm
KV Patil, SD Deshmukh.
Dept. of Anatomy & Otolaryngology, GMC, Aurangabad.
The involvement of maxillary bone by cementifying fibroma may produce nasal cavity and sinus distortion or obstruction, exopthalmos and facial deformity.
Usually these lesions are localized in areas of tooth apex. Histologically, they are characterized By spheroidal calcifications,and hence, they are interpreted as cementum or psammomatous bodies. Jaffe considered the deposits to be part of fibrous dysplasia of jaws.
Here we are reporting a case of 15 year old girl, presented to us with H/O left sided nasal Obstruction and occasional bleeding from nose and facial deformity since last 6 months.
Patients radiological investigations showed a characteristic 'ground glass' appearance and C. T. scan showed extension into frontal sinus and ethmoidal sinus.
We had done complete enucleation of this extensive tumor by modified Weber Fergussions Incision by doing partial maxillectomy. The patient recovered well without any cosmetic deformity and recurrence.
The basic aim of presenting this case was its extension into surrounding sinuses which are the anatomical and physiological extensions.
M. Natarajan, M.V. L. Kothari, L. A. Mehta Seth G. S. Medical College & K. E. M. Hospital, Mumbai
Two glaring misconceptions about patella need deliberations. Does it really belong to or is embedded in patellar tendon ? Does it deserve the apellation knee cap ?
A look at the lateral radiograph of the knee-joint dispels the myth of patella as capping the knee joint. If at all, patella caps the femoral intercondylar fossa. Metaphorically patella is the finger pointing to the moon called, and denigrated as, the infrapatellar pad of fat. Even the impeccable Gray is eloquent on patella and depressingly silent on the infrapatellar pad of fat christened by us as fatella.
Fatella is the soul and the sole of the knee joint creating a wide articular surface, gasketing the large incongruity staring at you in a radiograph and providing to the lover or the priest a comfortable pad to rest upon in single or double genuflexion.
Since fatella like the quadriceps extensively walls the knee joint and imperceptibly merges with its capsule it is reason enough to call it capsular or as part of the capsule. It is within this that patella is fashioned. The intrafatellar nature of patella is particularly noticeable because of the presence of fatellar fat at the top and sides of the patella and the fibrovascular continuity of the inferior surface of the patella with the top of the fatella.
Summarising, the front of femur and tibia articulate with the patellofatellar complex.
Anatomist of the live and dead humans would do well to pay heed to the raison d'etre of fat and fluids that play a vital role without demanding anatomical radiological / clinical attention.
A Rani, N Kumar, P Manik and A Sahai.
CSM. Medical University (Upgraded K.G.M.C) Lucknow.
The ribs are essential components of the osseous thorax. Normal rib variants include either numerical defects in the form of cervical, lumbar or pelvic ribs or structural defects such as short ribs, forked or bifid ribs, fused or bridged ribs etc. These anomalous ribs should not be neglected as many times they may lead to symptoms (Baumgarter et. al., 1989; Iida et. al., 1997; Donelley and Bisset, 1998). In addition to this almost 20 syndromes are described which involve rib anomalies as one of their constant feature (Winter and Baraister, 1991).
The present anomalous rib was collected from the osteology lab of Anatomy Department of CSM Medical University, Lucknow. This rib was unique among the 1000 ribs collected in the past 10 years (incidence 0.1%). This rib had two heads, so called bicipital rib or bifid rib. A careful examination revealed that it was a synostosis between anterior parts of shafts of first and second ribs. A rare phenomenon in humans but common in whales (Arey et. al., 1942). Morphometry of the anomalous rib interestingly showed a significant decrease in antero-posterior diameter. Various measurements of this rib were compared with the normal first (n=50) and second (n=50) ribs. The clinical consequences and treatment of such a rib will be discussed.
SQ Desai, BD Trivedi, RK Shah, HS Chavda
The role of the scapula has been studied from different viewpoints and its shape, size and movements have been correlated with the various movements of shoulder girdle and shoulder joint in many earlier studies.
In the present study fifty dry, adult human scapulae of unknown sex were taken from the Dept. of Anatomy, Smt. N.H.L.
Municipal Medical College, Ahmedabad. Different angles of scapula were measured and observatations were made on the role of the angulations of scapula in various movements of the bone.
PP Pradhan*, Atindranath Datta**, S Deb***
R. G. Kar Medical Collge*, N. R. S. Medical College** and N. B. Medical College***, West Bengal.
The position of the mandibular foramen (MF) is important anatomically as well as clinically (eg. successful Inferior Alveolar nerve anaesthesia, different types of mandibular osteotomy etc.). The unerupted 3rd Molar tooth is very frequent on one or both sides in adult lower jaw. Some adult dentulous dry mandible (both male and female), available in the departments of Anatomy as well as from 1st year students of different Medical Colleges of West Bengal were used in this study. The distance of the mandibular foramen from the posterior aspect of the last tooth (either from 3rd molar or from 2 nd molar, if 3rd was unerupted) was measured on either side of each mandible. The data was analysed statistically. The measurement of the distance of the mandibular foramen from the last molar tooth provided by the present study are important not only anatomically but also help in the clinical management of the patients in West Bengal.
Deshmukh AG*, Devershi HDB., Shroff AG.
Numerous studies have clearly demonstrated that skeletal Characteristics vary by population. The purpose of this study is to establish population specific standards for sex determination from the cranium.
21 parameters have studied on 74 adult cranium of known sex (male 40 & female 34) in department of Anatomy, G.M.C. Aurangabad, Maharshtra. Aim was to study sexual dimorphism in adult human cranium by using various parameters & comparing the result of multivariate analysis with that of univariate analysis.
By using univariate analysis 5.41% of crania were sexed correctly & maxium cranial circumference was found to be most reliable.
By using multivariate analysis 90% of male crania & 85.29% of female crania were sexed correctly. The overall percentage was 87.84%.
When we compare the result of usual statistical methods & multivariate analysis, it is but obvious that multivariate analysis surpasses former both in reliability & accuracy.
Finally it was concluded that multivariate analysis is by far the best method for determination of sex of cranium with the available resources.
Chotaliya HP, Saggu SK, Singel TC
Shri M. P. Shah Medical College, Jamnagar
Univariate statistical and metric analysis is performed on 180 non-pathological humeri (males=100, females=80), belonging to Saurashtra region, Gujarat, collected from the Department of Human Anatomy, Shri M. P. Shah Medical College, Jamnagar, using concept of