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Journal of the Anatomical Society of India

Abstract of papers presented during the 54th National Conference of The Anatomical Society of India, 2006 held at Amrita Medical College, Kochi, Kerala (249 - 277)

Author(s): Editors

Vol. 56, No. 1 (2007-01 - 2007-06)

249. A Histoarchitectural Study Of Meckel’s Diverticulum

Zaidi Tariq M, Khan A.A And Faruqi N.A Azim Khan

J.N Medical College A.M.U Aligarh

Meckel’s diverticulum is considered to be a vestigial remnant of the vitellointestinal duct that may occasionally be present in about 2-3 % of persons. It is thought to arise from residual yolk sac cells. When present it is located 80cms from ileocaecal valve on antimesenteric border and is about 18cms in length. The lining epithelium is unique in having no fixed histoarchitechtural structure. We conducted a study on microstructure of the Meckel’s diverticulum and observed some striking features in its mucosa i.e., presence of villi, and lymphoid follicles and abundance of goblet cells. The crypts of Leiberkuhn are also full of goblet cells instead of paneth cells and simple columnar cells. The most important point about the hybrid histoarchitecture is that its correct functional histoarchitectural name should be Accessory Appendix because it has abundant goblet cells and lymphoid follicles, blind lumen with its own blood supply and clinically also presents as a case of acute appendicitis.

250. Age Related Morphometric Changes In Human Renal Artery

Sudha Chhabra, Rajender Kumar, Suresh Kanta Usha Dhall and Basant Lal Sirohiwal.

P.G.I.M.S., Rohtak.

A study of the age related changes in human renal artery has been carried out in 29 autopsies cases of age ranging from 20-70 years. All cases were classified into the five different age groups. The renal artery was dissected out from origin to its branching in renal hilus. Each artery was divided into three parts a, b and c and separate paraffin blocks were prepared for each part. Four serial sections were cut out of each block. Section I and II were stained were Verhoeff’s stain and section II and IV wth Masson trichrome stain. In conclusion it was observed that relative volume of elastic fibers showed continuous decline in media, collagen fibers deposition increased continuously with age and smooth muscle showed continuous decline. Thickness of media though showed slight variation in each group but is significant range in the thickness of media in different age groups was not noticed. So, we conclude that with age tunica media of renal artery shows continuous elastolysis, degeneration of smooth muscle mass and a continuous increase in the collagen fibers proportion.

251. 3 D Reconstruction Of Hypothalamic Nuclei And It’s Connections

(1)M.Gopalan and N Jeyaseelan

School of Medicine, Amrita Institute of Medical Sciences, Elamakkara PO, Kochi

One of the greatest wonders in this Universe is the 1.5 Kg grey and white matter tissue of gelatinous consistency, well fitted in the cranium to interact with the environment by effective communication for the survival of the body.

0.3 % of this 1.5 Kg tissue is mainly responsible for maintaining the body’s status quo (homeostasis) .It is the central switch board, a sort of co-ordinating system with remarkably fixed set point situated in the base of the brain just in the center of one’s head. Though very small in size, yet is having a richer blood supply (compared to other regions) and highly developed sensing system with extensive direct and indirect connections.

The 3D orientation of the various parts, nuclei, the input and output from this center is quite difficult for Anatomy teachers to dispense with the students. A sincere attempt to rebuild a 3-D hypothalamus, the morphology of various nuclei, it’s orientation, the anatomical relations and connections have been made in Fiber glass. The assembly of the Composite Model is presented here.

252. Anatomy Curriculum In A New Graduate Entry Medical Programme At The University Of Western Australia

BharadwajAV (1), Sandoyer, Sally, and Bharadwaj, SA

The University Of Western Australia. (2)Course Coordinator, Faculty Of Medicine And Dentistry. The University Of Western Australia. (3)South Metropolitan Health Services, Western Australia.

The University of Western Australia embarked upon a graduate entry medical programme in 2005, with the first intake of 20 students. The entry requirement is any bachelor’s degree and the selection criteria include a Graduate Medical Admission Test and an Interview. The programme begins with a ‘bridging course’ of 26 weeks covering basic sciences, foundations of clinical practice, population health and behavioural sciences. All the strands of the bridging course are integrated through the Problem Based Learning approach. After the bridging course these students join the regular undergraduate medicine stream in its third year.

During the design of the bridging course major concerns were expressed regarding the high content density, diverse educational backgrounds of the students and their ability to cope with an intensive professional course.

The details of the anatomy component of the bridging course, assessment details and logistical aspects are analysed and discussed in this presentation. This is supplemented by preliminary observation on the second intake of 40 students.

The major conclusions were: 1. The past educational background of the students has no bearing on performance. 2. After an initial period of stress the students adapted well to the course. 3. Some finetuning is required in specific aspects of the curriculum.

253. Determination Of Sex Of Femur By Combination Of Parameters

Mohd. Laeeque, LU Bopshetty, CV Diwan and A GShroff. GMC, Aurangabad (M.S.)

Establishing identity from skeletal remains requires commenting on sex with 100% accuracy. Femur is one of the long bones that can help in the above question. Although individual parameters alone cannot help in all cases, a simple combination of two or more parameters like Vertical diameter of head, midshaft circumference and biepicondylar width of femur are able to sort 80% of femora with certainty.

This can be simple alternative that can be used before going for Regression analysis, which requires worked out formulae and a lot calculations. However former cannot replace the later. Details of the study will be discussed in the Conference.

254. AVariation Of Musculocutaneous Nerve

Susan Joseph And K. Gopinathan

AIMS, Kochi, Kerala.

Variations in the formation and branching pattern of the brachial plexus are common. In one of the upper limbs of cadavers used for teaching medical students in our department, the musculocutaneous nerve was found to have an unusual course and branching. The nerve arose as a branch of lateral cord of brachial plexus and divided into two branches at the upper medial border of the coracobrachialis muscle. These two branches of the nerve pierced coracobrachialis and coursed downwards; one branch running parallel to median nerve and then joining it, and the other running laterally between biceps and brachialis, supplied them with separate branches and continued further beyond the elbow as the lateral cutaneous nerve of forearm. Awareness of these variations may help prevent complications during surgery in this region.

255. An Accessory Muscle In The Supraclavicular Triangle Of Neck

Asha.G And K.K.Krishnamma

AIMS,Kochi, Kerala.

While the undergraduate students were doing the routine dissection of the Head and Neck region, during the years 2002 to 2006,we examined 40 cadavers bilaterally (80 specimens). There was an accessory muscle in the supraclavicular triangle (lower part of posterior triangle of neck) in two of the specimens. Both the accessory muscles were seen in male cadavers but one on the left side (No.1) and the other was on the right side (No.2). The muscle resembles the omohyoid muscle in the shape and in one of its attachments. Detailed attachments, relations, nerve supply and clinical importance of this muscle will be discussed during the conference.

256. Anomalous Insertion Of Deep Head Of Pronator Teres

Salini Binu Syam and K Gopinathan

AIMS, Kochi, Kerala.

Variation in the insertion of deep head of pronator teres is rare. In one of the upper limbs of cadavers used for teaching medical students in our department, the deep head of pronator teres muscle was found to have an unusual insertion. The deep head originated from medial side of coronoid process of ulna and did not join the superficial head. The deep head passed downwards between median nerve and ulnar artery and ended in a tendon, which joined the flexor digitorum profundus in the forearm. As anomalous insertions of pronator teres is rare, this variation is reported.

257.”Pozzi”

Tintu TS And Asha J Mathew

AIMS, Kochi, Kerala.

In a routine dissection, conducted in the Department ofAnatomy, AIMS, Kochi, a well-developed small muscle was seen bilaterally, arising from the dorsal surface of wrist joint capsule overlying the carpus and deep to extensor retinaculum. It extends distally as one small muscle fasciculus between the extensor tendons and metacarpals. The insertion is to extensor expansion of the middle finger. This was identified as the extensor digitorum brevis manus muscle. This has immense clinical significance. The details will be discussed at the time of presentation.

258. Variation In The Branching Pattern Of Femoral Artery

M Remya and K Gopinathan

AIMS, Kochi, Kerala.

In the right lower limb of one of the adult male cadavers, used for teaching medical students, an unusual branching pattern of the femoral artery was noticed. Just below the mid inguinal point superficial external circumflex iliac artery was arising from the lateral side of femoral artery. Superficial epigastric and superficial external pudental arteries were seen arising from a common trunk from the medial side of the femoral artery.

About 3.5cms below the midinguinal point two thick branches were seen, one from the medial side and the other from the lateral side of the femoral artery. The latter gave a small branch to the lateral side and then continued medially behind femoral vessels and then between psoas and pectineus muscles to the back of upper thigh like a medial circumflex artery. Its lateral branch divided into three – one ascending, a transverse and a discending resembling a lateral circumflex artery. The discending branch was small and it ended in rectus femoris and upper part of vastus lateralis.

The thick medial branch, of femoral artery resembled a profunda femoris artery. It gave a considerably big branch to the lateral aspect of the thigh and continued downwards deep to adductor longus, on the adductor magnus, giving the usual 3 to 4 perforating arteries and muscular branches to adductor muscles. Its lateral branch ran behind femoral artery and downwards to supply lower part of vastus lateralis and then the knee.

This type of variations in the vascular pattern are of surgical significance.

259. A Spectrum Of Malformations In Gastrochiasis

K.K. Krishnamma and Janaki Krishnan

AIMS, Kochi, Kerala.

Gastrochisis and its associated anomalies were studied in a dead foetus with congenital anomalies brought to the department of anatomy from a neighbouring hospital for making a museum specimen. All available records of maternal and foetal medicine therapy were looked upon. Other parameters reviewed included: -Maternal age, Marital status, Gestational age at delivery, Socio-economic conditions, Nutritional status, Substance abuse, Past obstetric history and Exposure to teratogenic substances. Morphometric and radiological studies were also done to see the various anomalies.

Gastrochisis was associated with a spectrum of other congenital anomalies. The details of these will be discussed during the conference. Prenatal detection of congenital anomalies with ultrasonography is of great value. Gastrochisis will be associated with multiple congenital anomalies.

260. Variation In The Origin Of The Axillary Artery Branches – Case Reports

Swapna Bijuraj, K Gopinathan and KK Krishnamma

AIMS,Kochi, Kerala.

In routine dissection, variations in the branching pattern of axillary artery was seen .In one cadaver, the right axillary artery had superior thoracic artery from its first part and a common stem arising from its second part which gave off subscapular and lateral thoracic arteries. The left axillary artery had independent branches namely thoracoacromial, superior thoracic, lateral thoracic and sub scapular arising from its second part and anterior and posterior circumflex humeral arteries arising from its third part. In another cadaver, the right axillary artery showed superior thoracic and lateral thoracic arteries arising from its first part. The left axillary artery had no variation. In the third case, the posterior circumflex humeral artery arose from the subscapular branch of the left axillary artery. These vascular variations are of surgical importance.

261. Cranial Meningocele With Spina Bifida Occulta – A Case Report

K Saniya and Sandhya Kurup

AIMS and R, Kochi, Kerala.

Neural tube defects result from defective closure of the neural folds during the fourth week of development . These include Spina bifida, anencephaly and encephalocele.Their incidence may be affected due to racial, geographic and seasonal variations . We present a case of cranium bifidum with meningocele and spina bifida occulta. The etiology and embryological aspects will be discussed along with the case presentation.

262. Prenatal Morpho-Histogenesis Of Cerebellum In Human Foetuses

B.N.Rao And M.Pramila Padmini

M.I.M.S, Nellimarla, A.P.

Morpho-histogenesis of cerebellum were studied in human foetuses of CR length 7cms (12 wks) to 38 cms(40 wks). Cerebellar plate will be formed by 8th week of gestation. At 7 cms CR length a very inconspicuous vermis and two lateral hemispheres were made out resembling a dumbel. At 11 cms CR length cerebellar foliation was observed. Horizontal fissure appeared at 16 wks with CR length 11 cms along with fissura prima. Folia were well formed at 13 cms CR length.

Cerebellar plate consisting of neuro-epithelial mantle and marginal layer further developed, with differentiation into outer granular layer by 18th week. Cells of this layer retained ability to divide and form a proliferative zone. In the 6th month differentiation and migration of cells from outer granular layer took place. The final placement of different neurons and classical description of 3 layered cortex was found in postnatal life.

263. Imaging Anatomy Of Liver Segments

P.K.Sharma

K.G Medical University, Lucknow

Liver is divided into right and left lobes. Right lobe is further divided into anterior and posterior segments and left lobe into lateral and medial segments. Each of these four segments are further divided into upper and lower segments. Thus there are eight segments in liver, each of which has its own artery, portal vein branch and billiary duct. Hepatic veins are intersegmental.

These segments are separated by different structures and the segments have surgical importance. Hepatic veins are intersegmental and portal veins are intrasegmental.

264. Anencephaly With Associated Congenital Anomalies – A Case Report

Akshara.VR, Minnie Pillay and KK Krishnamma

AIMS, Kochi, Kerala.

A 25 year old primigravida of 21 weeks gestation presented to the Department of Obstetrics, AIMS with history of bleeding per vaginum. Ultrasound examination revealed single intrauterine gestation in a septate uterus. Cranial vault was not visualized with neural tissue protruding out. There was spina bifida involving cervical and thoracic region. The foetus was expelled after emacridil instillation and subsequently received by the Department of Anatomy, AIMS for academic purposes. Detailed examination revealed multiple congenital anomalies including bilateral cleft lip, cleft palate and myeloschisis. The details will be discussed in the paper.

265.”TOWARDS THE DEVELOPMENT OF TISSUE ENGINEERED WHOLE BONE SUBSTITUTE

K.V.Menon,

AIMS, Kochi

The future of tissue engineering is the ultimate synthesis of live, transplantable whole organ. Over the last 10 years the author in collaboration with the Biotechnology wing of SCTIMST, Trivandrum has been researching on the development of live whole bone transplants that are tissue engineered. The evolution of the research took many stages starting with the development of scaffolds that are completely biodegradable and replaceable by the bone, yet have all the mechanical properties of bone. The next stage was the development of the capability to culture osteoblast from mesenchyma stem cells and to multiply them in vitro. The third stage involved the development of growth factors regulating bone formation. A combination of matrix, cell and growth factor has been tried successfully on animals and is in the process of being implanted in human beings. This paper describes our sojourn through the development of bone substitutes and the future possibilities. 266.” ROAD MAP OF LIVER –ASURGICAL JOURNEY” Sudhindran,

AIMS, Kochi

Good knowledge of the anatomy of the liver is a prerequisite for moder~ surgery of the liver said Henry Bismuth, the father of modern anatomy of liver in 1988 This prediction concerning liver anatomy has turned out to be exceptionally noteworthy, given that liver transplantation has become a tremendously successful operation with survival rates over 80 to 90% in 10 years. As the technical aspects of liver transplant are central to its success, the knowledge of the anatomy of liver becomes a fundamental concern to the surgeon. As we all know, there are two types of donors.

Cadaver donor: In this case, the donor liver is obtained from a person who is diagnosed as”brain dead” and whose family volunteers to donate the organ for transplantation. The liver from such donor can either be transplanted as a whole to a needy individual or it can be split into two and transplanted to two different individuals.

Living donor: Recently, living-donor liver transplants have become more popular in Asian countries such as India, Japan, Korea, Taiwan, and Singapore where for various reasons, cadaveric donors are few in number. A healthy family member, usually a parent, sibling, child or spouse may

J. Anat. Soc. India 56 (1) 55-108 2007 105

volunteer to donate part of their liver for transplantation. Here the living donor’s liver is split during surgery and one part is transplanted to the recipient. Especially for living donor liver transplant, every single detail of the anatomy of hepatic artery, portal vein, hepatic vein and bile ducts is to be accurately identified by the surgeon preoperatively for safe surgery. The aim of this topic”Road map of liver-a surgical journey” is to provide an insight into the recent advances in the knowledge of liver anatomy and the status of modern technology such as multi detector CT scan, MRI scan, and the like in elucidating the infinitesimal anatomical details that are pertinent to liver transplantation.

267.”TEMPORAL BONE ANATOMY -ANEUROSURGEON’S PERSPECTIVE” Dr. Dilip Panikar,

Amrita Institute of Medical Sciences, Cochin.

The temporal bone occupies a position of great importance in the cranial base. Anatomically, it is one of the most complex bones of the skull, which is closely related to important neurovascular structures like the internal carotid artery, sigmoid sinus and internal jugular vein, and the facial and lower cranial nerves. Within it’s substance lie the ear and the labyrinth. A number of pathological processes affect the bone either directly or indirectly, and can affect the structures within and around the bone with serious consequences. These could be infections, neoplasms, trauma, congenital abnormalities, among others. Management of these disease processes requires an intimate understanding of the anatomy of the bone. Modern imaging techniques allows us to see many of these changes that are otherwise hidden, and help the surgeon to understand both normal and abnormal anatomy. For the neurosurgeon, the temporal bone is the key to lateral skull base approaches which are used to treat a number of intracranial and skull base lesions. It also offers a route to access the region of the central skull base. The anatomy of the temporal bone will be presented in relation to the understanding and management of intracranial and skull base pathology.

268. “CONOTRUNCAL ANOMALIES OF THE HEART AND THEIR SURGICAL CORRECTION.”

Suresh G. Rao.

Amrita Institute of Medical Sciences, Kochi

Anomalies of the development of the conotruncal region of the heart are common and manifest as many types of congenital heart defects. Right from the direction the bulbous cordis loops, to the development of the conal area which constitutes the outflows of both ventricles, and the partition of the truncus which determines the anatomy of the great arteries in terms of their position and connection to the ventricles, conotruncal anomalies form a large segment of defects as the only ones, or as an associated anomaly encountered.with others in congenital heart surgery. Common conotuncal lesions range from the ‘physiological’, anatomically corrected malposition of the great arteries to Tetralogy of Fallot, Double outlet Ventricles, Transposition of great Arteries with or with out left ventricular outflow obstructions and Truncus arteriosus to name a few. Other set of malformations with deviation of conal septum into left ventricular outflow, could alter flow dynamics in the developing heart and give rise to secondary set of problems like coarctation and in extreme cases interruption of aortic arches usually associated with ventricular septal defects. Thanks to delineation of the developmental anatomy and mapping of conduction tissues of the heart by Cardiac morphologists, better understanding of the fetal circulation and haemodynamics, advances in imaging techniques so as to non invasively diagnose these lesions, cardiological and surgical interventions either palliative, staged or curative could be offered to a great many of these children today. This has changed their natural history for the better. Technological advancements in perfusion technology, surgical hardware and intensive care have now enabled a vast variety of the conotruncal anomalies to be fixed soon after the birth of the child with a high degree of success. It is currently hoped that correcting these defects at birth will mitigate and prevent the ill – effects on the growth and development of the heart that they are wont to cause, if left untreated. It is anticipated that this will translate into a better quality of life, with increased longevity of the patient.

269. Study Of Palmar Dermatoglyphics In Thalassemia

Lata Mahato, Mrs. K. Venkataratnam And Mrs. S.S. Naidu

G.S.L.Medical College Rajamundry, A.P

Thalassemia is genetic defect having at least 91 point mutations and several deletional mutations on chromosome 11,p,15.5, around the beta globin chain gene, resulting defects in activation, initiation, transcription due to which dermatoglyphic variations are to be expected in this disease. Thus a study was conducted to know dermatoglyphic pattern in thalassemia.

To find variations in dermatoglyphic patterns in thalassemic patients of vidarbha region in Maharashtra, to Study, compare and correlate with other similar studies. Compare with normal population. Establish sexual and digital differences of dermatoglyphic pattern of thalassemic patients. 100 patients and 100 controls were selected at random and palmar prints were obtained by ink method and then ridge counting and pattern study was done. Thalassemics have fewer arches, increased TFRC, increased loops in hypothenar, thenar and third inter-digital areas, distal displacement of axial tri-radii, increase in total number of plamar tri-radii, increased ‘atd’ angle and increase in ‘a-b’ ridge count and the other aspects were also studied and correlated in detail. There is significant statistical difference in dermatoglyphic pattern of thalassemic patients and controls in accoradance with digital patterns, race and sex.

270. E-Learning In Anatomy

V Balasubramanyam,

Medical e-Iearning, MEdRC Edutech, Rajbhavan Road, Hyderabad

Of the many applications of computers in medicine, it is uniquely adaptable for anatomy teaching. Structure based topics like anatomy and pathology can be depicted in 2d and 3d and also dynamically represented in animations – both structural and concept based, The author shares his experience by demonstrating state of the art multimedia graphics with specific reference to anatomy and describes how it brings about a meaningful communication. Multimedia elements can be synchronized with one another and presented through a learning management system. This offers the student the benefit of multiple viewing, anytime utility and teaching customized to his learning levels. Topics like embryology and neuroanatomy are likely to benefit the most by adapting this technology.

271. Germinal Activity And Layering Of Seminiferous Tubules In Undescended Testis – A Light Microscopic Study

Jain Anjali(1), Kaushai S and Patnaik VVG

Christian Medical College, Ludhiana(1),

Govt. Medical College, Patiala.

Sterility and malignancy are two main problems resulting from undescended testis. Present study is aimed at noting the changes in the state of germinal activity and layering of seminiferous tubules in cases of undescended testis. These parameters are good predictors of degree of spermatogenesis and hence of fertility. Biopsy specimens were taken from 30 patients admitted to Rajindra Hospital, Patiala having diagnosed to be of undescended testis. Cases belonged to prepuberal (0-1- years), puberal (11-15 years) and post puberal (16 and above) age groups 3 controls belonging to same age groups were studied. For control, healthy tissues were taken from biopsy specimen received by the Department of Pathology, GMC, Patiala. Biopsies were fixed in 10% buffered formalin solution and then processed for paraffin section. Slides were studied under light microscope to note changes in state of germinal activity and layering of seminiferous tubules. Present study revealed that during prepuberal age the tubules were single to double layered having spermatogonia in most of the cases but many cases revealed immature cells with atrophied tubules. In puberal age group, tubules had single to double layers lined by spermatogonia only showing maturation arrest and improper spermatogenesis. In post puberal age group the tubules were atrophied and there was retardation seen In development of germ layers. It was concluded that spermatogenesis was impaired in cases of undescended testis leading to infertility.

272. Omohyoid Muscle Variation – Clinical Aspects

Sreenivasulu Reddy M and Mamata S

KMCIC And KMC Manipai.

Routine dissection on a male cadaver of 50 years revealed a variation in the right omohyoid muscle. In place of the muscular part of superior belly of omohyoid was a tendon extending from the hyoid bone. It continued deep to the sternocleiodmastoid muscle with the inferior muscular belly. The inferior belly was attached to the scapular notch. The muscle was normal on the left side; no other anomaly was noticed in the cadaver. The clinical implications with a review of literature will be discussed .

273. Bilateral Variation In Median Nerve

A.A.Siddiqui, G A.Shroff and CV Diwan

Govt. Medical College,Aurangabad

Median nerve is a branch of brachial plexus. It arises by two roots from the lateral and medial cords, which unite anterior or lateral to third part of axillary artery.

In the present study, a variation was found in the formatiol of median nerve during routine dissection of cadavers for 1 MBBS students. The .median nerve was formed by two roots anterior to axillary artery, and it was joined by a large branch from musculocutaneous nerve distally. Oneof the small branches from the same nerve joined it later also. This variation was found in bothright and left sides. The photographs of the dissected part were taken, without and with using routine colours.

Variations in the brachial plexus are, common and frequently reported; similarly this variation had also been reported in literature. The further detailsls of this study will be discussed in the conference.

274. Unilateral Duplication Of Ureter – A Case Report

Ansari M Mujahid. S Nerpagar. S.S Rao and CV Diwan

Govt. Medical College, Aurangabad.

During routine dissection of male cadavers (adult) for 1 M.B.B.S. duplication of Ureter was observed on left side both the ureters were arising separately from the renal pelvis of left kidney one below the other. Their course was found to be usual. They were having their separate opening in the urinary bladder without any associated abnormality. On the right side single ureter was found with a normal course and opening in the urinary bladder.

Duplication of ureters may be partial with two ureters proximally separately and distally joint to form one ureter before entering urinary bladder. Complete duplication are less common where two ureter remains separate through out with separate opening in the urinary bladder. Such type of cases has been reported in literature. Russel et al (2000) stated that an average 3% excretory urogram shows ureteral duplication on routine examination.

The possibility of duplication of ureter should always be borne in mind in children ‘presenting with urinary track infection at a high degree of suspicion should be present during Xray investigation. Further details of the case, relevant Anatomy and development will be discussed in the conference.

275. A Rare Case Of Combined Neurovascular And Muscular Variations In The Arm

Seetharama Rao KP, Vijay Paul Samuel., Anoop Jalan., Hugh K Duckworth

Saba University School of Medicine, Saba, Netherlands-Antilles

Variations in the brachial plexus are common. Isolated vascular and muscular anomalies in the arm are also frequently observed. However, concurrent occurrence of multiple variations is a very rare event. One such case is reported here.

During routine dissection of the left arm of a female cadaver the following variations were noted. The musculocutaneous nerve neither pierced, nor supplied the coracobrachialis. Instead, it perforated the superficial surface of the biceps brachii muscle to continue its further course down the arm and forearm. The coracobrachialis received nerve supply directly from the lateral cord of the brachial plexus. The median nerve showed three roots. Medial root originated from the medial cord. Lateral cord contributed two roots. The long head of the biceps appeared very narrow and there was an additional head of origin of the biceps from the fibrous capsule of the shoulder joint. The posterior circumflex humeral artery was given off from the subscapular artery. The brachial artery gave profunda brachii and superior ulnar collateral branch and divided into radial and ulnar arteries in the upper S! of the arm. The radial artery crossed superficial to the median nerve from medial to lateral side and continued a wavy course to the elbow, superficial to the biceps. The ulnar artery followed the medial side of the median nerve to the elbow deep to the bicipital aponeurosis. Inferior ulnar collateral artery was given off from the ulnar artery.

Musculocutaneous nerve perforating the biceps is very rare and is of clinical significance since contraction of biceps can cause compression symptoms which may interfere with normal functioning of the arm. The high division of the brachial artery and the abnormal course of the radial artery are of interest to clinicians; in particular vascular and plastic surgeons and radiologists.

276. “Teaching inside the dissection hall”

Dr.Jacob Abraham

M.O.S.C. Medical College,Kerala

277. Variations of venous drainage of rectum

S.K. Siraj Ahmed, Dept. of Anatomy, Mamatha Medical College, Khammam, A.P.

278. Anatomical parameters of hip joint – a human cadaveric study

C. Lavanya, Dept. of Anatomy, RajaRajeswary Medical College, Banglore.

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