Cadaver as a first teacher: A module to learn the ethics and values of cadaveric dissection.

OBJECTIVES: The undergraduate medical students must be made aware of the ethical and humanistic values of cadaveric dissection. This study therefore designed, implemented, and evaluated the impact of the module 'Cadaver as a Teacher' (CrAFT) that examines the ethical values of cadaveric dissection. METHODS: This prospective, multimethod study involved 447 first-year undergraduate medical students who had participated in all three sessions of the CrAFT module. Activities included interactive lectures, individual assignments, and a poster-making competition. Students offered a silent tribute and wrote words of gratitude down on a tribute wall. They also expressed their thoughts in the form of essays, poems, and collages. These reflections were qualitatively analysed to generate themes. At the end of the module, an online quiz was conducted to assess the knowledge gained by the students. Their scores were correspondingly recorded and calculated. RESULTS: The major themes identified were: cadaver as a teacher, acknowledgement and thanksgiving, bonding, and empathy. Out of all the test takers, 316 students (94.32%) scored more than a five out of ten. The students strongly felt that the module effectively sensitised them towards the ethical and humanitarian aspects of handling cadavers. CONCLUSIONS: The implementation of an educational module about cadavers is a novel approach towards sensitising medical students. The students believed that sensitising them early on would have helped them establish a practice grounded in professionalism, human values, and empathy.

Histogenesis and Histomorphometric study of Human Fetal Small Intestine.

BACKGROUND: Intestine plays a major role for the normal growth of the fetus during the prenatal period. The process of the embryonic development is not quantified histologically. Therefore the main aim of the study was to measure the thickness of all part of the wall of the small intestine that are mucosa, submucosa and muscularis externa and to look for the appearance of the Brunner's glands and Peyer's patches in the submucosa of duodenum and ileum. METHODS: The present study was carried out on 30 fetuses of gestational ages ranging from 11-36 weeks. Ten fetuses from each trimester were used in the study. Fetal small intestine were dissected carefully, and were separated as duodenum, jejunum & ileum and fixed in formalin solution. The tissue was processed for histology and then slides were stained with Haematoxylin and Eosin. The microscopic features were noted using light microscope. RESULTS: The thickness of the mucosa, submucosa and the muscularis externa was observed to be increased in first trimester, decreased in the second trimester and again increased in the third trimester, which could be because of the increase cell turnover and the arrangement of the collagen fibers as to support the mucosa and the muscularis externa. CONCLUSION: Thus, the knowledge of the histogenesis and histomorphometry of the human fetal small intestine is crucial for the adult gastroenterologist to appreciate, because of the potential for these early life events to affect the responsiveness of the intestine to physiological or pathological challenges in later life.

A Cadaveric Report on a Giant Ureteric Stone Led Right Hydro Ureter and Severe Hydronephrosis.

BACKGROUND: The ureter shows natural constrictions in its course, and these are the potential site for the impaction of the renal calculus. Giant ureteral stones are associated with insidious growth and late presentation, often leading to renal failure. CASE PRESENTATION: In the present case, we observed a huge ureteric stone obstructing the right ureterovesical junction in a 58 year-old male cadaver. We also found hydroureter distal to the impaction of the calculus, renal damage and severe hydronephrosis on the right side. Histopathological analysis showed conditions of arterio-nephro-sclerosis and eroded ureter secondary to the calculus. Ureteric stones obstruction may result in hydroureter, hydronephrosis and progressive renal damage leading to irreversible renal function. The present case provides valuable information regarding the gross and histopathological alterations in ureteric calculi. CONCLUSION: It further enables clinicians to be armed with the knowledge of preventive approaches to educate patients with previous calculi, or those who may develop in the future.

Persistent fetal superficial middle cerebral vein: an anatomical study.

The superficial middle cerebral vein (SMCV) drains the venous blood from most of the superolateral surface of the brain and drains typically into the cavernous sinus as mentioned in standard textbooks. But the drainage of the SMCV is variable as indicated by various radiological studies. Although variations in the drainage of the SMCV exist, there is a shortage in the literature providing cadaveric evidence for the same. The present study was designed to identify the variations in the drainage pattern of the SMCV in fetal cadavers. During the dissection of formalin-fixed full-term fetuses, deviation in the drainage of the SMCV was observed in five out of 30 cases. In three out of 30 specimens (10%), SMCV was observed draining into superior petrosal sinus; and in two specimens (6.6%) into the transverse sinus. In the remaining specimens, the SMCV drained directly into the cavernous sinus. Knowledge of the variations noted in the present study is essential, not only for diagnosing several diseases involving the cavernous sinus or paracavernous sinuses but also in surgeries of paracavernous sinus lesions and endovascular treatment of arteriovenous fistulas. The SMCV and superior petrosal sinus can be a venous refluxing route in patients with arteriovenous fistulas.

Influence of traditional medicines on the activity of keratinocytes in wound healing: an in-vitro study.

Natural medicinal systems such as Ayurveda and folk medicine has remedies for wound management. However, the exact cellular and extracellular mechanisms involved in the healing process and its influence on keratinocytes is less discussed. Therefore, the present study was designed to evaluate the effect of certain natural wound healing medicines on the biology of the keratinocytes/HaCaT cells. Test materials such as honey (H), ghee (G), aqueous extracts of roots of Glycyrrhiza glabra (GG) and leaves of Nerium indicum (NI) were considered. The HaCaT cells were treated with the test materials singly and in combinations (H+G, all combined [Tot]) for a specific period (24, 48, and 72 hours). The cells were then subjected to cytotoxicity/proliferation and migration/scratch assays. All the test materials, except NI, were non-cytotoxic and showed increased cell proliferation at variable concentrations. Significant observations were made in the groups treated with honey (100 µg/ml at 48 hours, P<0.05; 1,000 µg/ml at 72 hours, P<0.05), GG (all concentrations at 48 hours, P<0.05; 750 µg/ml at 72 hours, P<0.05), H+G (250 µg/ml at 24 hours, P<0.001; 500 µg/ml at 48 and 72 hours, P<0.05), and Tot (50 µg/ml at 24, 48 and 72 hours, P<0.01). In the in-vitro wound healing assay, all the treated groups showed significant migration and narrowing of the scratch area by 24 and 48 hours (P<0.001) compared to control. The results obtained from the present study signifies the positive influence of these natural wound healing compounds on keratinocytes/HaCaT cells.

Effect of Diabetes on the Male Reproductive System­A Histomorphological Study

Introduction Type 1 diabetes is an autoimmune disorder characterized by lack of insulin production by the ß cells of the pancreas. This lack of insulin causes a variety of systemic effects on the metabolism of the body, one of which is reproductive dysfunction. The present study investigates the effects of diabetes on the male reproductive system of streptozotocin (STZ)-induced diabetic rats. Material and Methods A total of 18 adult male Wistar rats weighing between 250 and 300 g were included in the present study. The animals were divided into normal and diabetic groups. The diabetic group was further subdivided into 2 subgroups with durations of 24 and 48 days. A single dose of STZ (40 mg/kg body weight) was administrated intraperitoneally to the animals of the diabetic group. After the planned duration, the testes and epididymides were dissected, and their gross weight was measured. The tissues were then processed for histological study. Results The gross weight of the testes and epididymides in diabetic rats at 24 and 48 days showed a decrease in comparison to the control. (p < 0.01 for testes and epididymides). Diabetic animals presented a significant decrease in the diameter of the seminiferous tubules compared with the control group (p < 0.01). The epididymides in the diabetic groups showed a considerable reduction in the tubular surface area compared with the control group (p < 0.01). There was also a reduction in the mean diameter, which was measured using the maximum and minimum diameter of the tubules (p < 0.01). Conclusion The present study is an insight into the adverse effects that diabetes can have on the tissue structure of the testes, of the epididymides, and ultimately on the process of spermatogenesis.

Additional Muscle Slip of Bicipital Aponeurosis and its Anomalous Relationship with the Median Cubital Vein.

The cubital region of the arm is a common site for recording blood pressure, taking blood for analysis and administering intravenous therapy and blood transfusions. During the routine dissection of a 70-year-old male cadaver at the Kasturba Medical College, Manipal, Karnataka, India, in 2015, it was observed that the aponeurotic insertion of the biceps brachii muscle divided into two slips. The medial slip fused normally with the deep fascia of the forearm, while flexor carpi radialis muscle fibres originated from the lateral slip. There was also a single vein in the forearm, the cephalic vein, which bifurcated to form the median cubital vein and the cephalic vein proper. The median cubital vein, further reinforced by the radial vein, passed deep to the two slips of the bicipital aponeurosis and then continued as the basilic vein. During venepuncture, medical practitioners should be aware of potential cubital fossa variations which could lead to nerve entrapment syndromes.

A cadaveric study of the testicular artery and its clinical significance / Um estudo da artéria testicular em cadáveres e sua relevância clínica

Abstract Background Knowledge of testicular artery variations is vital to ensure that they are not neglected during a variety of different operative techniques, since damage can cause testicular atrophy. Objectives The present study was therefore intended to identify variants in the origin and course of the testicular arteries. An attempt was made to classify the arteries based on their various origins. Methods This study examined 42 formalin-fixed cadavers of 40 to 70-year-old adult males. Variant origins of the testicular artery were identified and classified. Variations in the origin and course of the artery were colored, photographed, and documented. The distances between the origins of the testicular arteries and the mid-points of the origins of the renal arteries were measured. Results Testicular arteries were classified into four categories on the basis of origin. This variability was defined in relation to the renal and inferior mesenteric arteries. The mean distance between the origin of the testicular artery and the mid-point of the origin of the renal artery were 3.08 and 3.47 cm, on the right and left sides respectively. Variations were almost exclusively found on the left side. The variations observed included multiple arterial twigs forming the testicular artery, suprarenal arteries arising from the testicular artery, and testicular artery duplication. Conclusion This study provides an insight into variations in the testicular artery and proposes a classification which could help surgeons during a variety of procedures on the male abdomen and pelvis.

Resumo Contexto O conhecimento de variações da artéria testicular é vital para assegurar que essas artérias não serão negligenciadas durante a realização de diferentes técnicas operatórias, já que qualquer dano poderia causar atrofia testicular. Objetivos Este estudo teve como objetivo identificar variações na origem e no trajeto das artérias testiculares. Foi feita uma tentativa de classificar as artérias com base em suas diferentes origens. Métodos Este estudo examinou 42 cadáveres de adultos do sexo masculino com idade entre 40 e 70 anos preservados em formol. As diferentes origens da artéria testicular foram identificadas e classificadas. Variações na origem e no trajeto da artérias foram coloridas, fotografadas e documentadas. Foram medidas as distâncias entre a origem das artérias testiculares e o ponto médio da origem das artérias renais. Resultados As artérias testiculares foram classificadas em quatro categorias com base em sua origem. Essa variabilidade foi definida com relação às artérias renal e mesentérica inferior. A distância média entre a origem da artéria testicular e o ponto médio da origem da artéria renal foi de 3,08 e 3,47 cm nos lados direito e esquerdo, respectivamente. As variações foram encontradas quase exclusivamente no lado esquerdo. As variações observadas incluíram múltiplos ramúsculos formando a artéria testicular, artérias suprarrenais surgindo a partir da artéria testicular, e duplicação da artéria testicular. Conclusão Este estudo traz informações sobre variações da artéria testicular e propõe uma classificação que poderia ajudar os cirurgiões durante diferentes procedimentos realizados no abdome e na pelve de pacientes do sexo masculino.

Effects of Lead in Various Preparatory Stages of Nagabhasma on Function and Histopathology of Cornu Ammonis of Hippocampus.

INTRODUCTION: Heavy metals are frequently used in the preparations of traditional/folk medicines. One such preparation in Ayurveda is Nagabhasma, in which lead is the main ingredient. Lead is non-essential element to the human body and is known toxic substance to many organ systems. However, it is claimed that, the highly toxic metallic lead will be converted into health beneficial organo-metallic compound when raw lead is subjected to various traditional methods of purification during preparation as mentioned in the ancient medicinal system. AIM: The present study is designed to evaluate the effect of such detoxification of lead in various stages of authentically prepared Nagabhasma on the learning and memory. MATERIALS AND METHODS: Using half of the human equivalent doses of traditionally prepared Nagabhasma, at intermittent stages of its preparation were fed orally to healthy Wistar rats for 30 days. After treatment, the immediate effect and residual effect after 2 months was evaluated by subjecting them to passive avoidance test. Then rats were sacrificed and hippocampus was collected for histopathological evaluation. RESULTS: Pure lead treated animals showed deficit in learning and memory which is indicated by spending more time in the dark compartment in passive avoidance test. However, animals treated with stage 1 to 4 Nagabhasma showed gradual increase in the memory and learning. This observation is substantiated by the findings of the histopathology of the Cornu Ammonis (CA) region of hippocampus. CONCLUSION: The results of the present study indicate that, the metallic toxicity of the lead used in the preparation of bhasma was gradually decreased from stage 1 to stage 4 of preparation. Therefore, the traditional way of preparing the metallic bhasma is very critical in eliminating the possible health hazardous metallic lead toxicity.

Histological and biochemical study of the superficial abdominal fascia and its implication in obesity.

The advancement of liposculpturing and fascial flaps in reconstructive surgery has renewed interest in the superficial fascia of abdomen. Its histological and biochemical composition may play a vital role in maintaining strength and elasticity of the fascia. Hence, study of abdominal fascia for the elastic, collagen, and hydroxyproline contents is desirable to understand asymmetrical bulges and skin folds and in improving surgical treatment of obesity. Samples of superficial fascia were collected from of upper and lower abdomen from 21 fresh cadavers (15 males and 6 females). Samples were stained using Verhoeff-Van Gieson stain. Digital images of superficial fascia were analyzed using TissueQuant software. The samples were also subjected to hydroxyproline estimation. The superficial fascia was formed by loosely packed collagen fibers mixed with abundant elastic fibers and adipose tissue. Elastic contents and collagen contents of superficial fascia were significantly more in the upper abdomen than that in the lower abdomen in males. Hydroxyproline content of superficial fascia of upper abdomen was significantly more than that of lower abdomen in both males and females. The elastic, collagen and hydroxyproline contents of superficial fascia of upper abdomen were higher compared to the lower abdomen. This may be a reason for asymmetric bulging over abdomen and more sagging fold of skin in the lower abdomen than in the upper abdomen. This study may therefore be helpful in finding new ways to manage obesity and other body contour deformities.

A cadaveric study of the testicular artery and its clinical significance.

BACKGROUND: Knowledge of testicular artery variations is vital to ensure that they are not neglected during a variety of different operative techniques, since damage can cause testicular atrophy. OBJECTIVES: The present study was therefore intended to identify variants in the origin and course of the testicular arteries. An attempt was made to classify the arteries based on their various origins. METHODS: This study examined 42 formalin-fixed cadavers of 40 to 70-year-old adult males. Variant origins of the testicular artery were identified and classified. Variations in the origin and course of the artery were colored, photographed, and documented. The distances between the origins of the testicular arteries and the mid-points of the origins of the renal arteries were measured. RESULTS: Testicular arteries were classified into four categories on the basis of origin. This variability was defined in relation to the renal and inferior mesenteric arteries. The mean distance between the origin of the testicular artery and the mid-point of the origin of the renal artery were 3.08 and 3.47 cm, on the right and left sides respectively. Variations were almost exclusively found on the left side. The variations observed included multiple arterial twigs forming the testicular artery, suprarenal arteries arising from the testicular artery, and testicular artery duplication. CONCLUSION: This study provides an insight into variations in the testicular artery and proposes a classification which could help surgeons during a variety of procedures on the male abdomen and pelvis.

CONTEXTO: O conhecimento de variações da artéria testicular é vital para assegurar que essas artérias não serão negligenciadas durante a realização de diferentes técnicas operatórias, já que qualquer dano poderia causar atrofia testicular. OBJETIVOS: Este estudo teve como objetivo identificar variações na origem e no trajeto das artérias testiculares. Foi feita uma tentativa de classificar as artérias com base em suas diferentes origens. MÉTODOS: Este estudo examinou 42 cadáveres de adultos do sexo masculino com idade entre 40 e 70 anos preservados em formol. As diferentes origens da artéria testicular foram identificadas e classificadas. Variações na origem e no trajeto da artérias foram coloridas, fotografadas e documentadas. Foram medidas as distâncias entre a origem das artérias testiculares e o ponto médio da origem das artérias renais. RESULTADOS: As artérias testiculares foram classificadas em quatro categorias com base em sua origem. Essa variabilidade foi definida com relação às artérias renal e mesentérica inferior. A distância média entre a origem da artéria testicular e o ponto médio da origem da artéria renal foi de 3,08 e 3,47 cm nos lados direito e esquerdo, respectivamente. As variações foram encontradas quase exclusivamente no lado esquerdo. As variações observadas incluíram múltiplos ramúsculos formando a artéria testicular, artérias suprarrenais surgindo a partir da artéria testicular, e duplicação da artéria testicular. CONCLUSÃO: Este estudo traz informações sobre variações da artéria testicular e propõe uma classificação que poderia ajudar os cirurgiões durante diferentes procedimentos realizados no abdome e na pelve de pacientes do sexo masculino.

Multiple variations in the branches of the coeliac trunk.

Here we present a unique case of variation in the branching pattern of the coeliac trunk. In the present case, the coeliac trunk was replaced by two separate arterial trunks. The first arterial trunk bifurcated into the left gastric and the left hepatic arteries. The second arterial trunk bifurcated into a splenic artery and a hepato-gastroduodenal trunk. The hepato-gastroduodenal trunk presented an unusual course and termination. The right hepatic artery arising from the hepato-gastroduodenal trunk also showed a variant course. Such rare variations are important for gastroenterological surgeons and interventional radiologists due to increase in number of transplantation surgeries and live donor liver transplantations.

An unorthodox innervation of the gluteus maximus muscle and other associated variations: A case report.

Knowledge of peripheral nerve morphology, location, and variation is important for facilitating appropriate diagnosis and intervention. We present a unique case of absence of the inferior gluteal nerve and high division of the sciatic nerve. In this instance, the common peroneal nerve was found piercing the piriformis muscle and emerging distally in the form of two trunks: thin medial and thick lateral. The medial trunk presented an interesting course, supplying the gluteus maximus muscle before joining the lateral trunk to form the common peroneal nerve. Additionally, the arteria nervi ischiadisci was also observed accompanying and supplying the tibial nerve passing inferior to the piriformis. These variations are important for clinicians and surgeons for some radiological diagnoses and surgical procedures in the lower limb.

An unusual right popliteal vein aneurysm in an adult cadaver: A case report.

The incidence of venous aneurysm is less than arterial aneurysms. Most are incidental findings with no major clinical significance. However, popliteal vein aneurysms (PVA) may be potentially life threatening, as they can be a source of pulmonary embolism and potentially even death. We report a case of right PVA in a 67-year-old male cadaver. Information from this case study may contribute to an improved understanding of these phenomena, including early detection of these or similar thromboembolic events.

Bifurcated plantaris with rare relations to the neurovascular bundle in the popliteal fossa.

The plantaris muscle (PM) is a vestigial muscle in human. The PM arises as a small muscular belly from the lateral condyle of the femur and then its long tendon inserts into the calcaneum or blends with the tendocalcaneus. There are many reports to describe the variations in the origin, nature of muscle, course of the tendon, and insertion of PM. However, here we report a case of a rare and unreported variation of PM with one common origin and two muscle bellies with peculiar relations with the neurovascular bundle in the popliteal fossa. Although its anatomical functions are insignificant, its tendon is useful as a graft in various reconstructive surgeries and variation in this muscle and its relation to nearby neurovascular bundle may be of clinical interest. Therefore, the present variation is worth considering in predicting uncommon neurovascular entrapment in the leg and may also be useful in various surgical procedures in the region of the knee joint.