Unduly extensive uncinate process of pancreas in conjunction with pancreatico-duodenal fold / 대한해부학회지

Anatomical variations of pancreatic head and uncinate process are rarely encountered in clinical practice. These variations are primarily attributed to the complex development of the pancreas. An unduly enlarged uncinate process of the pancreas overlapping the third part of duodenum was discovered during dissection. This malformation of the pancreatic uncinate process was considered to be due to excessive fusion between the ventral and dorsal buds during embryonic development. On further dissection, an avascular pancreatico-duodenal fold guarding the pancreatico-duodenal recess was observed. The enlarged uncinate process can cause compression of neurovascular structures and also cause compression of adjoining viscera. The pancreatico-duodenal recess becomes a potential site for internal herniation. This case is of particular interest to the gastroenterologists and surgeons performing surgical resections. Precise knowledge of embryogenesis of such pancreatic anomalies is necessary for understanding and thus treating many diseases of the pancreas.

Multiple unilateral variations in medial and lateral cords of brachial plexus and their branches / 대한해부학회지

During routine dissection of the upper extremity of an adult male cadaver, multiple variations in branches of medial and lateral cords of brachial plexus were encountered. Three unique findings were observed. First, intercordal neural communications between the lateral and medial cords were observed. Second, two lateral pectoral nerves and one medial pectoral nerve were seen to arise from the lateral and medial cord respectively. The musculocutaneous nerve did not pierce the coracobrachialis. Finally, the ulnar nerve arose by two roots from the medial cord. Knowledge of such variations is of interest to anatomists, radiologists, neurologists, anesthesiologists, and surgeons. The aim of our study is to provide additional information about abnormal brachial plexus and its clinical implications.

Anomalous composition of musculature of the first dorsal fibro-osseous compartment of the wrist

The anomalous orientation of musculature of the first dorsal fibro-osseous compartment of the wrist is clinically relevant to De Quervian's stenosing tenosynovitis and reconstructive surgeries. Split insertion of the abductor pollicis longus (APL) is commonly found in chimpanzees, gorillas and gibbons. A comparable identical pattern of anomalous slips in humans is of anthropological and phylogenetic importance and could be a result of atavism. This case report describes an unusual fused muscle belly of the APL and extensor pollicis brevis (EPB), which split into three slips--medial, intermediate and lateral. Further, the medial slip was seen to divide into two tendons, inserting on the base of the first metacarpal along with the intermediate slip. The lateral slip divided into three tendons, inserting into the base of the proximal phalanx, base of the first metacarpal and abductor pollicis brevis muscle. The fusion and unusual insertion pattern of the APL and EPB merits documentation for reconstructive procedures such as tendon transfer and interposition arthroplasty.

Bipartite clavicular attachment of the sternocleidomastoid muscle: a case report / 대한해부학회지

Morphological variations of the sternocleidomastoid (SCM) muscle assume relevance during attempted surgical interventions in the cervical region. The present study reports bipartite clavicular attachment of the SCM in the neck of an adult male cadaver during performance of a routine anatomy demonstration. The anomaly was unilaterally observed on the left side of the neck. The clavicular head of the muscle exhibited two bellies, one medial and one lateral. While the medial belly was fused with the sternal head, the lateral belly appeared to blend with the medial. Cranially, the SCM attached to the mastoid process and superior nuchal line. We have attempted to elucidate the embryological basis of the above muscular variant. Additionally, we discuss its clinical relevance, highlighting the utility of the SCM in various reconstructive procedures. We assert that detailed anatomical knowledge of such SCM variants is of utility not only to the gross anatomist, but also for neck and orthopaedic surgeons and anaesthetists. Moreover, radiologists require familiarity with such aberrations to decipher magnetic resonance imaging scans of the cervical region.

Quadrifurcation of the hepatic artery proper in conjunction with double right gastric arteries

Descriptions of the variant hepatic arterial pattern are common and frequently reported in anatomy archives. We describe a noteworthy deviation from the usual branching pattern in a single cadaver. There was a unique division of the hepatic artery proper into two right gastric arteries (RGAs), apart from the usual branches. Furthermore, an arterial loop was formed by these two RGAs, giving off another RGA, which we termed 'right gastric proper'. This report attempts to evaluate the embryological basis of the anomaly. The significance of this anomalous hepatic arterial pattern is appreciated while performing liver transplantations, hepatic artery infusion of chemotherapeutic drugs and Doppler angiographic procedures. We advocate meticulous familiarisation with the anatomy of the coeliac trunk and its topographic relationship to vital viscera for the operating hepatobiliary surgeon and radiologist.

Unilateral duplication of palmar arterial arches--a case report.

Recent progress in hand surgery has engendered a need for precise knowledge of anatomical variations of blood supply of hand. The present paper describes an unusual organization of palmar arterial arches and attempts to discuss its clinical implications. Double superficial palmar arch of the mediano-ulnar variant was observed with a double deep palmar arch of equal caliber, formed by splitting of deep branches of radial artery and ulnar artery. The superficial palmar branch of radial artery was absent.

Ulceroproliferative growth on the heel: epithelioma cuniculatum.

Verrucous papules and plaques on the plantar surfaces should not be assumed to be mere warts, especially if the history is unusual. We present a patient with an ulceroproliferative growth on the heel which was found to represent the epithelioma cuniculatum form of squamous cell carcinoma.

Generalized acanthosis nigricans in childhood.

Acanthosis nigricans in children is usually associated with obesity. Generalized acanthosis nigricans in childhood is rare. We report a 13-year-old boy with an 8-year history of generalized hyperpigmentation and velvety thickening of the skin. Despite an extensive physical and laboratory examination no evidence of underlying endocrinological or neoplastic disease was found.

Ichthyosis follicularis with alopecia and photophobia (IFAP) syndrome.

A 12-year-old boy born of a nonconsanguineous marriage presented with dry rough skin and photophobia since birth. His growth and developmental milestones were normal and there was no history of any neurological problem, hearing deficit or scarring around the hair follicles. Cutaneous examination revealed diffuse thinning of scalp hair with loss of eyebrows and eyelashes and a sandpapery texture of the skin all over the body, suggestive of ichthyosis follicularis with alopecia and photophobia syndrome.

Guillain-Barré syndrome-like presentation in borderline leprosy with type-2 reaction.

A 46-year-old man with borderline lepromatous leprosy with type-2 reaction being treated with multi-bacilliary-multiple drug therapy and steroids presented with an acute onset of flaccid quadriparesis. A nerve conduction study and CSF analysis were similar to that seen in Guillain Barre syndrome. Muscle weakness improved considerably with an increased dose of corticosteroid; after 6 months the patient recovered completely.

Necrotic erythema nodosum leprosum.

A 32-year-old fisherman suffering from lepromatous leprosy presented with fever, joint pains, bullous lesions, and multiple well-defined ulcers on the extremities and back of 10-days duration. The bullae ruptured to form ulcers of varying sizes with well-defined margins and necrotic bases. A few of the ulcers had black crusts resembling eschars. An immunofluorescence study ruled out autoimmune bullous disease. Histopathology of a lesion showed features of erythema nodosum leprosum.

Subacute cutaneous lupus erythematosus (SCLE) presenting in childhood.

A 13-year-old boy presented with erythematous scaly plaques on the face and extremities with history of photosensitivity of 7-years duration. There was no history of oral ulcers or joint pains. Although the histopathological findings were inconclusive, a positive lupus band test confirmed the diagnosis of subacute cutaneous lupus erythematosus.