Attachment of vermiform appendix to the right lobe of liver through a fibrous band - a rare observation.

Vermiform appendix is a highly variable organ, which is an enigma to the surgeon in terms of its position, size and symptoms. Attachment of its tip to the surrounding organs is relatively rare. Here we present a rare variation of vermiform appendix. The appendix was 12cm long and was in retrocecal and retrocolic position. Its tip was attached to the right lobe of the liver through a fibrous band which was 2cm long. This variation might pose difficulties in appendicular resection, renal and hepatic surgeries.

Innervation of the scrotum by the anterior division of the obturator nerve - a rare variation.

The scrotum is supplied by ilioinguinal, genital branch of genitofemoral, perineal branch of the posterior cutaneous nerve of the thigh and the posterior scrotal branches of the pudendal nerve. We report an extremely rare innervation of the anterior part of the scrotum by the anterior division of the right obturator nerve. The genital branch of genitofemoral nerve did not reach the scrotum. The ilioinguinal nerve did not supply the scrotum. The anterior division of the obturator nerve gave a branch which ascended superomedially in the thigh, crossed superficial to the spermatic cord and communicated with the right ilioinguinal nerve. As it crossed the spermatic cord, it gave a scrotal branch which descended over the spermatic cord and ramified to supply the anterior part of the scrotum. Knowledge of this variation could be important to anaesthesiologists, urologists and surgeons in general.

Unusual contribution of the first jejunal vein in the formation of the portal vein.

Jejunum is drained into superior mesenteric vein through a series of jejunal veins. The way in which the first jejunal vein terminates is of great importance in upper abdominal surgery and radiological procedures. Knowledge of its variations is particularly important in surgical procedures like orthotropic hepatic transplantation, hepatic vein reconstruction, pancreatic surgery and surgical procedures of duodenojejunal junction. We saw a first jejunal vein opening directly into the portal vein. Further, the inferior mesenteric vein drained into the first jejunal vein. This case could be useful to gastroenterologists, general surgeons and radiologists.

Accessory slip of flexor digitorum accessorius (Quadratus plantae) muscle surrounding the lateral plantar nerve and vessels.

Flexor digitorum accessorius (quadratus plantae) is a muscle of second layer of the sole of the foot. Though it is not a very important muscle in terms of movements or stability of foot, it could pose problems when it presents variations. We observed a novel, accessory slip of flexor digitorum accessorius. The slip arose from the fascia covering abductor digiti minimi muscle and got inserted into the tendon of the flexor digitorum longus muscle. It was supplied by a branch from lateral plantar nerve. The proximal part of this accessory slip surrounded the lateral plantar nerve and vessels. Compression of lateral plantar nerve by this accessory slip might produce symptoms similar to that of tarsal tunnel syndrome and lead to misdiagnosis. The case could be of importance to foot and ankle surgeons and radiologists.

Variant formation of left common iliac vein by the confluence of four veins.

Common iliac vein variations are relatively rare compared to the variations of external and internal iliac veins. A rare pattern of formation of common iliac vein by the confluence of four veins is being reported here. The left common iliac vein was formed by the union of left external iliac vein, internal iliac vein, iliolumbar vein and a common trunk formed by the obturator and vesical veins. External iliac vein and obturator veins were connected by a communicating vein. Both external and common iliac veins were respectively medial to the external and common iliac arteries. Knowledge of this variant formation of common iliac vein could be useful to radiologists, gynecologists and orthopedic surgeons.

Complete enclosure of gall bladder inside the lesser omentum - a rare anomaly.

Gall bladder is known for many congenital anomalies such as duplication, intrahepatic position, floating position etc. Most of its anomalies can be detected in ultrasound examination and radiography. We report an extremely rare congenital anomaly of gall bladder as observed in a male cadaver during dissection classes. The gall bladder was totally enclosed in the right free margin of the lesser omentum, in front of the usual contents of the right free margin of lesser omentum. The size, shape and blood supply of the gall bladder were normal. Though this anomaly might not cause any functional disturbances, it might result in complications during laparoscopic cholecystectomy.

Accessory fold of skin on the ventral surface of the penis: Is it a redundant prepuce?

Variations in the skin of the prepuce are very rare. We report here a variation of the penile skin as observed in an adult male cadaver aged approximately 65 years. The penis was covered by thin nonhairy skin. The glans was not covered with prepuce. There was no evidence of circumcision. The ventral surface of the penis, adjacent to the glans, had a huge fold of skin. This fold resembled the prepuce and had a hole in it. The glans penis had a normal urethral meatus. There was no evidence of hypospadias as the entire ventral surface of the penis was covered completely by the skin. We discuss the clinical importance of this accessory fold of skin.

Descendens vagohypoglossi: rare variant of the superior root of ansa cervicalis.

Knowledge of variants in the formation and position of the ansa cervicalis is important in head and neck surgery, specifically in reconstructions of the tongue that use the infrahyoid muscles, and in the anastomosis of the ansa cervicalis to the recurrent laryngeal nerve when the laryngeal muscles have been paralysed. We describe a rare variant of the superior root of the ansa cervicalis, which had a contribution from the vagus and hypoglossal nerves. The inferior root was formed by the C2 and C3 ventral rami, but it passed medial to the internal jugular vein before it joined the superior root to form the loop.

Evaluation of vitamin D relationship with type 2 diabetes and systolic blood pressure

Objective: To investigate whether relationships existamong vitamin D, type 2 diabetes mellitus (T2DM), and blood pressure in Trinidadian subjects with T2DM. Research design and methods: This was a case­ controlled study to determine if vitamin D levels were lower in patients with T2DM. After data analysis, an exploratory hypothesis of vitamin D relationship to systolic blood pressure (SBP) was developed. Plasma calcifediol (25(OH)D) concentrations were used as a measurement for vitamin D levels and were determined by ELISA. Cholesterol levels were measured by an automated dry chemistry analyzer and blood pressure was measured using an automatic blood pressure monitor. Results: There was no significant difference ( p=0.139, n=76) in 25(OH)D levels between patients with T2DM and controls. Subjects with SBP above 130 mm Hg were 8 times more likely to have a 25(OH)D plasma concentration above 25 ng/mL (OR 7.9 (2.2 to 28.7)), and were 5 times (OR 4.7 (1.7 to 15.1)) more likely to have a 25(OH)D plasma concentration above 30 ng/mL (OR 7.5 (2.3­24.2)). Vitamin D levels moderately and positively correlated with SBP (rs=0.38, p=0.001). Conclusions: There was no significant difference in the 25(OH)D levels between patients with T2DM and controls ( p=0.139). Patients with SBP under 130 mm Hg were 8 times more likely to have a vitamin D level above 25 ng/mL (OR 7.9 (2.2 to 28.7)). Further investigations are required to examine the relationship between vitamin D and SBP.

Abnormal length and position of the sigmoid colon and its clinical significance.

Sigmoid colon is one of the most variable parts of the large intestine. Here we report a very rare type of variation of the sigmoid colon. This variation was observed during the routine dissections for undergraduate medical students at Melaka Manipal Medical College (Manipal Campus) India in September 2012. In the current case, the sigmoid colon was about 60 cms long and made an inverted U shaped loop in front of the descending colon and the left kidney. It had a sigmoid mesocolon which covered the left kidney. The sigmoid colon had an ascending and a descending limb. This position of sigmoid colon and its mesocolon is dangerous as it can get twisted to form a volvulus. It also might cause confusions in radiologic and sigmoidoscopy techniques.

Age-related effect of aluminium on the catalase activities of the brains of two species of poikilothermic vertebrates.

BACKGROUND: Although aluminium (Al) has been implicated in various neuropathological states with aging due to its involvement in neurotoxicity, the exact role of the metal ion is still unclear. OBJECTIVE: The aim of the present study is to ascertain whether the antioxidant enzymes of the brain protecting from oxidative damages which accumulate with aging are regulated by Al in an age-dependent manner. METHOD: The inhibitory effect of Al on the catalase activity of brain homogenates of two species of poikilothermic vertebrates was studied in vitro using a spectrophotometric method. RESULTS: At a final concentration of 666 microM, the metal ion inhibited the enzyme activity of the brain in both species. In fish brain the degree of inhibition was not age-dependent. On the other hand, the rate of inhibition increased between young and middle-aged lizards followed by a decline in the old counterparts. CONCLUSION: Al inhibits catalase activity but this effect may not be a major contributing factor in the aging of the brain in the two species capable of maintaining their antioxidant capacity until old age.

Effects of age and manganese (II) chloride on peroxidase activity of brain and liver of the teleost, Channa punctatus.

Fish provide enormous spectrum of longevity and thus present the possibility of multiple mechanisms of senescence. Oxidative stress as a causative agent of senescence and the protective role of antioxidant enzymes were tested in the teleost, Channa punctatus taking peroxidase (POD) (EC 1.1 1.1.7) as the representative enzyme. The activity of POD in brain and liver declined during maturation phase (young vs middle-aged). During senescence phase (middle-aged to old) the enzyme activity increased in liver but remained stabilized in brain. The degree of increase in peroxidase activity following in vitro MnCl2 treatment was always higher in liver than in brain. The rate of MnCl2 induced increase in POD activity of both tissues showed an increasing trend with age. However statistical significance was observed only in brain during senescence phase. No significant loss of enzyme activity in both the tissues and greater degree of increase by MnCl2 in brain suggest that antioxidant capacity is not impaired in old murrels.

Age-related changes in catalase activity and its inhibition by manganese (II) chloride in the brain of two species of poikilothermic vertebrates.

Two species of poikilothermic vertebrates, a teleost fish (Channa punctatus) and the garden lizard (Calotes versicolor) were used to study the effect of age on brain catalase (CT) activity and its inhibition by manganese (II) chloride (MnCl(2)). While in fish the CT activity of brain remained unchanged throughout the lifespan, the enzyme activity decreased during maturation and then showed an increase during aging in the garden lizard. MnCl(2) at a concentration of 333 muM in incubating medium significantly inhibited the CT activity of the brain of both fishes and lizards of all the three age groups (young, middle-aged and old), the degree of inhibition showing a trend of increase with advancing age. However, statistical significance was observed when fishes of the young age group were compared either with those of middle-aged or old counterparts, and between young versus old and middle-aged versus old lizards. Increased susceptibility to Mn(2+) during aging suggests changes in regulation of CT.